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Federal Black Lung (BL) Program

Providers should question Medicare beneficiaries upon admission to determine if services are related to BL. Where it appears that a beneficiary is entitled to medical benefits under the Federal BL Program, and the services being provided are related to BL, the provider must bill the Department of Labor (DOL) before billing Medicare. (See Process F on the Medicare Secondary Payer Billing and AdjustmentsPDF quick resource tool.)

If the services being provided to the beneficiary are not related to BL, and the claim does not include any BL-related ICD-9 diagnoses (500-508) or ICD-10 codes, the provider may bill Medicare as primary.

Note: BL-related ICD-10 diagnoses codes will be issued by the Centers for Medicare & Medicaid Services when available.

The following provides three important points about Medicare and BL.

Services Related to Black Lung Record / Claim Includes Black Lung Diagnoses

Claims for services that are related to BL, or that include BL-related diagnoses, must be submitted to the DOL before billing Medicare.

  • If DOL denies some, or all of the services on the claim, the provider may bill Medicare conditionally. A paper claim must be submitted to Medicare along with a copy of the DOL denial notice.
  • For detailed instructions on the data elements required to submit a BL-related claim to Medicare, refer to "Process F"on the Medicare Secondary Payer Billing and Adjustments PDF quick resource tool.
  • If a claim containing BL-related diagnoses is submitted and a BL record exists on the beneficiary's eligibility file, it will be rejected (R B9997).

Services Unrelated to Black Lung Record / Claim Does Not Include Black Lung Diagnoses

Claims for services that are unrelated to a BL record, and does not include BL-related diagnoses may be submitted to Medicare showing Medicare as the primary payer. These claims will process through, and pay. NOTE: Medicare claims that are unrelated to the beneficiary's BL record should not contain any BL-related diagnosis codes.

If the beneficiary has an open BL record, and a claim is submitted to Medicare as the primary payer with BL-related diagnoses code, the claim may be rejected.

Additional Resources

Posted: 02.05.19

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