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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.

A “0.00” amount means OWCP has not yet established a rate or RVU for the service or procedure. If the code is covered under the program being billed, reimbursement may still be made; however, the billed amount may be individually reviewed for medical necessity and cost reasonableness.

Review the “Read Me First” document for important information on the *NEW* fee schedules.

  • 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.
     
  • Medical Physician Fee Schedule
    Medical Physician Fee Schedule establishes payment rates for services provided by physicians and other qualified health care professionals, including evaluation and management visits, surgical procedures, diagnostic services, and other covered medical care. Rates are determined using a formula based on Relative Value Units (RVUs), the Geographic Practice Cost Index (GPCI), and a national Conversion Factor (CF).
     
  • *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.
     
  • 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.
     
  • *NEW* Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
    Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule includes DME items, prosthetic limbs, orthotic devices, and medical supplies such as crutches, wheelchairs, back braces, splints, and wound care materials.
     
  • *NEW* Home Health Care (HHC)
    The Home Health Care Fee Schedule covers skilled nursing, therapy, certified aides, case management, and other services provided to claimants in their homes.
     
  • *NEW* Dental Fee Schedule
    Dental Fee Schedule covers professional dental services, including preventive care, restorative procedures, oral surgery, prosthodontics, and other medically necessary dental treatments.
     

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