Revised Procedures for In-Facility Pulmonary Rehabilitation

The Division of Coal Mine Workers’ Compensation (DCMWC) has revised the procedures for providing pulmonary rehabilitation services at a health care facility to eligible coal miners whose benefits are paid by the Black Lung Disability Trust Fund. Based on the expertise of the physicians, hospitals, and clinics that treat coal miners who have black lung disease, DCMWC is eliminating the pre-certification requirement for pulmonary rehabilitation services, as well as updating and streamlining our procedures related to pulmonary rehabilitation services provided at a health care facility. Please note that DCMWC will not pay for at-home pulmonary rehabilitation services.

For miners and providers, the new procedures mean:

  1. A medical facility no longer has to be pre-certified as a PR facility to provide pulmonary rehabilitation services;
  2. A miner no longer needs a Certificate of Medical Necessity (CMN) from a physician to receive pulmonary rehabilitation services;
  3. Physicians may refer patients directly to a pulmonary rehabilitation provider without pre-approval by DCMWC.

Pulmonary rehabilitation providers must be enrolled in the DCMWC Provider Network in order to treat miners and receive payment for services. To enroll as a DCMWC provider, please access: https://owcpmed.dol.gov/portal/main.do for enrollment instructions.

All bills for pulmonary rehabilitation services must be submitted on the OWCP-1500 claim form. A downloadable OWCP-1500 form is available at: http://www.dol.gov/owcp/dfec/regs/compliance/OWCP-1500.pdf. Providers must use Healthcare Common Procedure Coding System (HCPCS) code G0424 when billing for pulmonary rehabilitation services. A bill for pulmonary rehabilitation services must include at least one of the following mandatory components:

  1. Physician-prescribed exercise;
  2. Education or training;
  3. Psychosocial assessment;
  4. Outcomes assessment; or
  5. An individualized treatment plan.

DCMWC will pay for up to a maximum of 60 one-hour treatment sessions during any 90 day period; or a maximum of 90 one-hour sessions during any 12 month period. Lifetime maximums may also apply.

In accordance with 20 CFR 725.707(b), DCMWC may require reports of treatment from time to time, including an individualized treatment plan for each patient.

There is no change in the procedures for billing for other medical services that may be related to pulmonary rehabilitation services. For example, bills for established patient office visits and pulmonary function tests still do not require a CMN and can be billed separately as they are now. There is also no change in the procedures for prescriptions for durable medical equipment (DME) or home nursing care, which will continue to require CMNs.

All medical bills should be sent to:

DCMWC/Federal Black Lung Program
P.O. Box 8302
London, KY 40742-8302