20 Cfr 10.801 Feca

FECA: 20 C.F.R. § 10.801 How are medical bills to be submitted?
(a) All charges for medical and surgical treatment, appliances or supplies furnished to
injured employees, except for treatment and supplies provided by nursing homes, shall be
supported by medical evidence as provided in § 10.800. The physician or provider shall itemize
the charges on the standard Health Insurance Claim Form, HCFA 1500 or OWCP 1500, (for
professional charges), the UB-92 (for hospitals), the Universal Claim Form (for pharmacies), or
other form as warranted, and submit the form promptly to OWCP.
(b) The provider shall identify each service performed using the Physician's Current
Procedural Terminology (CPT) code, the Health Care Financing Administration Common
Procedure Coding System (HCPCS) code, the National Drug Code (NDC), or the Revenue
Center Code (RCC), with a brief narrative description. Where no code is applicable, a detailed
description of services performed should be provided.
(c) The provider shall also state each diagnosed condition and furnish the corresponding
diagnostic code using the "International Classification of Disease, 9th Edition, Clinical
Modification" (ICD-9-CM), or as revised. A separate bill shall be submitted when the employee
is discharged from treatment or monthly, if treatment for the work-related condition is necessary
for more than 30 days.
(1)(i) Hospitals shall submit charges for medical and surgical treatment or supplies
promptly to OWCP on the Uniform Bill (UB-92). The provider shall identify each outpatient
radiology service, outpatient pathology service and physical therapy service performed, using
HCPCS/CPT codes with a brief narrative description. The charge for each individual service, or
the total charge for all identical services, should also appear in the UB-92.
(ii) Other outpatient hospital services for which HCPCS/CPT codes exist shall also be
coded individually using the coding scheme noted in this paragraph. Services for which there are
no HCPCS/CPT codes available can be presented using the RCCs described in the "National
Uniform Billing Data Elements Specifications", current edition. The provider shall also furnish
the diagnostic code using the ICD-9-CM. If the outpatient hospital services include surgical
and/or invasive procedures, the provider shall code each procedure using the proper
CPT/HCPCS codes and furnishing the corresponding diagnostic codes using the ICD-9-CM.
(2) Pharmacies shall itemize charges for prescription medications, appliances, or
supplies on the Universal Claim Form and submit them promptly to OWCP. Bills for
prescription medications must include the NDC assigned to the product, the generic or trade
name of the drug provided, the prescription number, the quantity provided, and the date the
prescription was filled.
(3) Nursing homes shall itemize charges for appliances, supplies or services on the
provider's billhead stationery and submit them promptly to OWCP.
(d) By submitting a bill and/or accepting payment, the provider signifies that the service
for which reimbursement is sought was performed as described and was necessary. In addition,
the provider thereby agrees to comply with all regulations set forth in this subpart concerning the
rendering of treatment and/or the process for seeking reimbursement for medical services,
including the limitation imposed on the amount to be paid for such services.

(e) In summary, bills submitted by providers must: be itemized on the Health Insurance
Claim Form (for physicians), the UB-92 (for hospitals), or the Universal Claim Form (for
pharmacies); contain the signature or signature stamp of the provider; and identify the
procedures using HCPCS/CPT codes, RCCs, or NDCs. Otherwise, OWCP may return the bill to
the provider for correction and resubmission.
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