U.S. DOL OWCP - Developing Benchmarks for Listed Procedure Codes

OWCP seeks to obtain services for the delivery of benchmark data for CPT, HCPCS, and dental codes (see Attachment  “Service Code List - Attachment A. xlsx”); data distribution for all states and nationwide, identification of derived versus actual rates, and support of modifiers, multipliers, and conversion factors; and periodic updates and customer support for data interpretation.

The anticipated requirements for Benchmark Data services are:

1. Obtain benchmark pricing data (charge and allowed amounts) for Current Procedural Terminology (CPT), Healthcare Comon Procedure Coding System (HCPCS), Current Dental Terminology (CDT), and any other applicable codes provided in the attachment.
2. Ensure benchmarks are statistically valid, transparent, and regularly updated within the supporting period.
3. Provide ongoing support for interpreting and updating underlying fee schedule data, benchmarks, and analyses.
4. Provide benchmarks for each service code based on national rates, state-based rates, ZIP codes, and rural or non-rural classifications. Benchmark rates should include industry, federal government, state government, and other credible sources.
5. Ensure that the rates provided represent one unit of service unless they are clearly identified as a different unit of measurement (such as per diem or daily rate, 1 ML, 1 MG, 1 Dose, or fees that include additional bundled services) not reflected in the service code description.

TASKS

The anticipated tasks are:

1)    Provide Charge and Allowed Benchmarks (all states and nationwide) for each code
    a)    Using standard benchmark percentiles
        i)    50th, 60th, 70th, 75th, 80th, 85th, 90th and 95th, or increments of 5 from the 5th to the 95th
        ii)    Mean, median, mode, maximum, and minimum values
    b)    For codes with less than 25 frequencies (9 for dental) provide derived benchmarks
    c)    Indicate for each service code
        i)    the number of underlying data points, if available 
        ii)    whether the benchmarks are based on actuals or derived 

2)    Provide Ongoing customer support for data questions, including but not limited to
    a)    the reason behind changes
    b)    how a value is calculated
    c)    why benchmarks may vary from one geographical area to another
    d)    graphical illustrations (histograms) that show the relationship between a benchmark value and the underlying data that support it

3)    Update data twice yearly on a rolling monthly basis, to include new codes

DEFINITIONS

Actuals: based on data reported for the specific code in the geographic area

Allowed: amount the program will pay for a specific code

Charge: amount the provider may bill for a specific code

Derived: based on data from related codes in the geographic area

PART II

RFI QUESTIONNAIRE

Provide a company description, discussion of company capabilities, and general summary of approach to accomplishing the requirements addressed within the draft SOW. Descriptions of services should include the length of time (from date-to-date) in which exact or similar services were provided and to whom (names of public or private entities and the city/state in which performance occurred).

Optional Enhancements or Innovations

Vendors may propose additional features such as expanded percentile ranges, advanced analytics, or visualization tools that enhance OWCP’s ability to interpret and apply benchmark data.

Following questions must be answered thoroughly to allow for adequate consideration.

1)     Company Profile: name, size, contacts, NAICS, relevant GSA Schedule or other Government-Wide Acquisition Contract (GWAC) number, Unique Entity Identifier (UEI number).

2)     Does your company deliver benchmark data for the codes listed in the attachment?

3)     What is the methodology for calculating benchmarks, handling low-volume codes, and identifying derived rates?

4)     Does your company utilize standard percentiles and is there an ability to customize?

5)     Does your company provide ongoing data analysis, data interpretation support and potential training?

6)     Is there anything in the anticipated requirements that is not commercially available or would otherwise limit vendor interest?

7)     Provide commercial pricing for your relevant products and/or services available to meet anticipated requirements.

WHO MAY RESPOND:

Interested vendors, registered in SAM.gov under the North American Industry Classification System (NAICS) code for this requirement is 524298 All Other Insurance Related Activities - Medical cost evaluation services may respond.

QUESTIONS:

Questions regarding this RFI shall be submitted in writing by e-mail to Emily Pyatigorsky at [email protected] AND Emily Bear at [email protected] no later than 12:00pm ET on March 23, 2026. Questions over the telephone will NOT be addressed.

SUBMISSION INSTRUCTIONS:

Responses should clearly address all requested information, not exceed 5 pages, and reference the attached service code list (see Attachment  “Service Code List - Attachment A. xlsx”). General marketing materials should not be included.  Submit electronically in Microsoft Word format.

All interested parties are required to submit a Capabilities Statement in Times New Roman 11- point or 12-point font with 1-inch margins minimum all around, not to exceed 30 pages double- sided in PDF format.

The Capabilities Statement package must include the following information:

1. RFI Number & Project Title for historical record.
2. Company name and point of contact (POC) to include individual’s name, title, work and/or mobile telephone number(s), and email address.
3. Date submitted for historical record.
4. Business Size
5. Unique Entity ID Number and CAGE code for business type verification
6. Response to RFI Questionnaire
7. Any general feedback and/or applicable information your firm would like to provide.

EMAIL THE CAPABILITIES STATEMENT AND YOUR SSN/RFI RESPONSES TO Emily Pyatigorsky at [email protected] AND Emily Bear at [email protected].

The subject line of the email must read as: “Response to SSN/RFI Developing Benchmarks for Listed Procedure Codes (Your Company’s Name which may be abbreviated)”. Example: Response to SSN/RFI Developing Benchmarks for Listed Procedure Codes (XYC Inc.). E-mails that do not contain the specified subject line may run the risk of being overlooked.

CAPABILITIES STATEMENTS DUE: By 12:00 PM ET on Tuesday‎, ‎April‎ ‎7‎, ‎2026.