CMS Pub. 100-05, ch. 3, § 30.2.3

Black Lung (BL) Program

(Rev. 11874, Issued: 02-23-23, Effective: 03-24-23; Implementation: 03-24-23)

Providers are to identify beneficiaries who may be entitled under the Federal Black Lung (BL)

Program. Where it appears that a beneficiary may be entitled to receive medical benefits under

the Federal BL Program administered by DOL, the provider bills DOL in the following

situations:

• Diagnosis Is BL Related (which includes a diagnosis that is related to BL within

the family of ICD diagnosis codes) - The provider bills all services to DOL, and

includes its DOL assigned provider number on the billing form.

• Diagnosis Is Not BL Related - The bill is for an inpatient stay during which some

BL covered procedures were furnished. The provider bills all services to DOL.

• The bill is for outpatient services that include one or more BL related procedures.

The provider bills DOL only for those procedures that are reimbursable under the

BL program.

• DOL Does Not Pay for All of the Services - If a provider bills DOL, but DOL

doesn't pay for the services in full, the provider bills Medicare as provided in Pub.

100-04, Chapter 25, "Completing and Processing the Form CMS 1450 Data Set,"

attaching a copy of DOL's denial notice which gives the specific reason for

nonpayment. If a claim is denied because of the provider's failure to obtain

a DOL provider number or to furnish documentation needed by DOL,

payment may not be made under Medicare.