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.
OWCP Fee Schedule: Frequently Asked Questions
- 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.
- Ambulatory Surgery Center Allowed Procedures
A complete list of surgical and ancillary procedures eligible for OWCP reimbursement at an Ambulatory Surgical Center.
- Anesthesia Fee Schedule
This document details procedure code base units, conversion factors by ZIP code, and applicable modifiers for anesthesia claims.
- Clinical Laboratory Fee Schedule
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.
- Cost to Charge Ratio for Inpatient 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.
- Dental Fee Schedule
Dental Fee Schedule covers professional dental services, including preventive care, restorative procedures, oral surgery, prosthodontics, and other medically necessary dental treatments.
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
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.
- Home Health Care (HHC) Fee Schedule
The Home Health Care Fee Schedule covers skilled nursing, therapy, certified aides, case management, and other services provided to claimants in their homes.
- 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).
- 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.
- 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.
- 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.
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