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The Department of Labor (DOL) regularly revises the OWCP Fee Schedule to reflect economic adjustments, including increases and decreases, as deemed necessary for fees associated with certain Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) codes. These adjustments are made in response to shifts in medical inflation rates, industry trends, and other pertinent factors.
*NEW* - OWCP has published two new fee schedules: the Clinical and Laboratory Fee Schedule and the Physician-Administered Drugs and Biologicals Fee Schedule. Please see the links below for access. Additional information is available in the latest "Read Me First" document.
- Read Me First
A comprehensive guide to OWCP’s fee schedule policies, offering an overview of claims processing, fee schedule reimbursement calculations, rate inputs, and specific billing rules for FECA, Black Lung, and Energy programs.
- Anesthesia Procedure Codes with Base Units, Zip Code Conversion Factors and Anesthesia Modifiers
This document details procedure code base units, conversion factors by ZIP code, and applicable modifiers for anesthesia claims.
- List of Surgical Procedures Allowed For Facility Fee Payment to Ambulatory Surgery Center
A complete list of surgical and ancillary procedures eligible for OWCP reimbursement at an Ambulatory Surgical Center.
- Cost To Charge Ratio Tables For Inpatient Non-PPS Hospital Services
For inpatient claims, these ratios help estimate the actual cost of inpatient services by adjusting hospital charges and are used in reimbursement calculations, particularly for cost-based payment methodologies.
- RCC Codes Requiring CPT/HCPCS/OWCP Codes For Outpatient Hospital Services
This document provides a crosswalk between service codes and Revenue Center Codes (RCCs), which are three-digit codes used on institutional claims to identify the department or cost center within a healthcare facility where services were provided.
- Table of RVU and Conversion Factor Values by Service Code
Provides reimbursement rates for physicians and other healthcare professionals. This document includes the Work Relative Value Unit (RVU), Non-Facility Practice Expense (PE) RVU, Facility PE RVU, Malpractice (MP) RVU, and conversion factor for service codes, which are used to calculate payment rates.
- *NEW* Clinical Laboratory
The Clinical Laboratory Fee Schedule includes pricing for a wide range of clinical diagnostic laboratory tests, such as blood tests, urinalysis, and pathology services. It sets standardized payment rates for each test based on specific procedure codes.
- *NEW* Physician-Administered Drugs and Biologicals
Lists the pricing for drugs and biologicals that are typically administered in a clinical setting, such as injections and infusions. Payment rates are based on the Average Sales Price (ASP) reported by manufacturers and are tied to specific drug codes.
- Geographic Practice Cost Indices by Zip Code
Lists cost index values by ZIP code, which are used to adjust payment rates based on regional variations in practice expenses. This document includes Geographic Practice Cost Indices (GPCI) values for Work, PE, and MP, ensuring that reimbursement rates reflect the relative costs of providing medical services in different geographic areas.
- Modifier Level Table For Quick Reference
Provides a reference for modifier-level adjustments applied to reimbursement rates. This document displays fee schedule modifier tables, helping users understand how specific modifiers impact payment calculations.