CM-933 Radiologic Interpretation (Black Lung X-Ray)

The physician reading a coal miner's chest image for a black lung claim records the interpretation here, using classification boxes for small and large opacities, pleural plaques, costophrenic angle obliteration and diffuse pleural thickening. DCMWC uses the reading to help determine eligibility for benefits. Each form covers a single image and goes back promptly to the office that requested the interpretation.

Who completes it

The interpreting physician completes all five sections and signs section 5C, stating whether they are a board-certified or board-eligible radiologist and a B reader, with the B-reader certification expiration date. Section 5A identifies the facility and the radiographer who took the image.

Submitting and payment

How to submit it
Return the completed reading to the office that requested it, through DCMWC's C.O.A.L. Mine Portal or by mail to DCMWC.
Who pays
DOL pays for the DOL-sponsored reading under its fee schedule, but only for images of acceptable quality (grades 1, 2 and 3); unreadable images must be retaken at no cost to DOL.

Good to know

  • If item 1D marks the image completely negative, go straight to section 5. Otherwise work through parenchymal (2), pleural (3) and other abnormalities (4) in order.
  • Other symbols in section 4B are obligatory when other abnormalities are present, and the form asks whether the worker should see a personal physician because of the comments.
  • Interpret per Form CM-954a instructions and 20 CFR 718.102 and Appendix A. Revised April 2020; DOL's forms index lists it as Roentgenographic Interpretation.
  • A second quality reading of the same image is recorded on the companion Form CM-933b, Radiologic Quality Rereading.

Get the official form

Download the current version from the source each time; forms change without notice.

Radiologic Interpretation

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Who can complete a CM-933 interpretation?

The interpreting physician, who records in section 5B whether they are a board-certified radiologist, a board-eligible radiologist or a B reader, and when their B-reader certification expires. The physician certifies that the reading follows Form CM-954a instructions and 20 CFR 718.102 and Appendix A.

What happens if the chest image quality is poor?

Mark quality grade U/R and give the reason; any grade other than 1 needs a reason in item 1C. DOL pays only for images of acceptable quality, grades 1 to 3, and images of inferior quality must be retaken without cost to the Department.

What is the difference between CM-933 and CM-933b?

CM-933 records the full interpretation of a miner's chest image, including small and large opacities and pleural abnormalities. CM-933b, the Radiologic Quality Rereading, records a second reader's quality grade, other abnormalities and comments for the same image. Both are filed with DCMWC.