Feca 20 Cfr10.802

FECA: 20 CFR § 10.802 - How should an employee prepare and submit requests for reimbursement for
medical expenses, transportation costs, loss of wages, and incidental expenses?
(a) If an employee has paid bills for medical, surgical or dental services, supplies or appliances due to an
injury sustained in the performance of duty, he or she may submit an itemized bill on the Health
Insurance Claim Form, HCFA 1500 or OWCP 1500, together with a medical report as provided in §
10.800, to OWCP for consideration.
(1) The provider of such service shall state each diagnosed condition and furnish the applicable ICD-9CM code and identify each service performed using the applicable HCPCS/CPT code, with a brief
narrative description of the service performed, or, where no code is applicable, a detailed description of
that service.
(2) The bill must be accompanied by evidence that the provider received payment for the service from
the employee and a statement of the amount paid. Acceptable evidence that payment was received
includes, but is not limited to, a signed statement by the provider, a mechanical stamp or other device
showing receipt of payment, a copy of the employee's canceled check (both front and back) or a copy of
the employee's credit card receipt.
(b) If services were provided by a hospital, pharmacy or nursing home, the employee should submit the
bill in accordance with the provisions of § 10.801(a). Any request for reimbursement must be
accompanied by evidence, as described in paragraph (a) of this section that the provider received
payment for the service from the employee and a statement of the amount paid.
(c) OWCP may waive the requirements of paragraphs (a) and (b) of this section if extensive delays in the
filing or the adjudication of a claim make it unusually difficult for the employee to obtain the required
information.
(d) OWCP will not accept copies of bills for reimbursement unless they bear the original signature of the
provider, with evidence of payment. Payment for medical and surgical treatment, appliances or supplies
shall in general be no greater than the maximum allowable charge for such service determined by the
Director, as set forth in § 10.805.
(e) An employee will be only partially reimbursed for a medical expense if the amount he or she paid to
a provider for the service exceeds the maximum allowable charge set by the Director's schedule. If this
happens, OWCP shall advise the employee of the maximum allowable charge for the service in question
and of his or her responsibility to ask the provider to refund to the employee, or credit to the
employee's account, the amount he or she paid which exceeds the maximum allowable charge. The
provider may request reconsideration of the fee determination as set forth in § 10.812.
(f) If the provider fails to make appropriate refund to the employee, or to credit the employee's account,
within 60 days after the employee requests a refund of any excess amount, or the date of a subsequent

reconsideration decision which continues to disallow all or a portion of the appealed amount, OWCP
shall initiate exclusion procedures as provided by § 10.815.
(g) If the provider does not refund to the employee or credit to his or her account the amount of money
paid in excess of the charge which OWCP allows, the employee should submit documentation of the
attempt to obtain such refund or credit to OWCP. OWCP may make reasonable reimbursement to the
employee after reviewing the facts and circumstances of the case.