20 Cfr 30.701 Eeoicpa

EEOICPA: 20 C.F.R. § 30.701 How are medical bills to be submitted?
(a) All charges for medical and surgical treatment, appliances or supplies
furnished to employees, except for treatment and supplies provided by nursing homes,
shall be supported by medical evidence as provided in § 30.700. The physician or
provider shall itemize the charges on Form OWCP-1500 or CMS-1500 (for professional
charges), Form OWCP-92 or UB-92 (for hospitals), Form 79-1A (for pharmacies), or
other form as warranted, and submit the form promptly for processing.
(b) The provider shall identify each service performed using the Physician’s
Current Procedural Terminology (CPT) code, the Centers for Medicare and Medicaid
Services Common Procedure Coding System (CCPCS) 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 occupational illness is necessary for more than 30 days.
(1)(i) Hospitals shall submit charges for medical and surgical treatment or
supplies promptly on Form OWCP-92 or UB-92. The provider shall identify each
outpatient radiology service, outpatient pathology service and physical therapy service
performed, using CCPCS/CPT codes with a brief narrative description. The charge for
each individual service, or the total charge for all identical services, should also appear on
the form.
(ii) Other outpatient hospital services for which CCPCS/CPT codes exist shall
also be coded individually using the coding scheme noted in this section. Services for
which there are no CCPCS/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 CCPCS/CPT codes and furnishing the
corresponding diagnostic codes using the ICD-9-CM.
(2) Pharmacies shall itemize charges for prescription medications, appliances, or
supplies on Form 79-1A and submit them promptly for processing. 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 for processing.
(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 Form OWCP1500 or CMS-1500 (for physicians), Form OWCP-92 or UB-92 (for hospitals), or Form
79-1A (for pharmacies); contain the signature or signature stamp of the provider; and
identify the procedures using CCPCS/CPT codes, RCCs, or NDCs. Otherwise, the bill
may be returned to the provider for correction and resubmission.
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