Division of Coal Mine Workers' Compensation (DCMWC)
IMPORTANT NOTICE CONCERNING COVERAGE OF LUNG TRANSPLANTS BY THE FEDERAL BLACK LUNG PROGRAM
The Federal Black Lung Program requires pre-approval of lung transplants for Black Lung beneficiaries (20 CFR 725.706).
Information about an individual’s general eligibility for medical benefits may be obtained by calling the District Office where the patient’s claim file is located, or by calling the Black Lung toll-free number at 800-638-7072. Eligibility for medical benefits is not the same as approval of a lung transplant.
Before seeking approval for a lung transplant, a medical center must be approved as a lung transplant center by the Center for Medicare and Medicaid Services (CMS) or a transplant request will automatically be denied. The list of approved transplant centers is available from CMS, and may be seen online at http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/downloads/ApprovedTransplantPrograms.pdf.
Approved centers must determine if the patient’s medical benefits are the responsibility of a coal mine operator or insurer or the Black Lung Disability Trust Fund. The patient should have this information. If the patient is covered by an insurer or coal mine operator, you must obtain that company’s approval prior to a transplant. The documentation that insurers require to determine whether or not they will approve coverage may vary.
If the patient is covered by the Black Lung Disability Trust Fund, only a District Director or the Chief, Branch of Standards, Regulations, and Procedures (BSRP) of the Division of Coal Mine Workers’ Compensation have the authority to grant approval of a transplant. You must initiate the approval process by contacting the District Office by letter or telephone, or by calling BSRP at 202-693-0978. You will be asked to submit copies of medical records and a comprehensive written justification of the need for a transplant. The District Office will consult with BSRP before a decision on coverage is made.
After an evaluation of the information you provide, you will be notified of a decision on coverage. Until you are notified of approval by the District Office or by BSRP, coverage of transplant procedures by the Federal Black Lung Program will be denied.
If you have any questions about transplants, you may call the Division of Coal Mine Workers’ Compensation, BSRP, at 202-693-0978.