Sep 19th, 2013 - rfiore 1
in Illinois, should we be using 99455 for exam by treating physician in workers comp cases?
IL Worker's Comp
Yes. CPT® code 99455 is an evaluation performed by the primary treating physician. Report 99456 is an evaluation by other than the treating physician. This is an exam by another physician that is not the primary physician. Most important is the documentation. The report MUST include a completion of a medical history commensurate with the patient's condition; performance of an examination commensurate with the patient's condition; formulation of a diagnosis, assessment of capabilities and stability, AND calculation of IMPAIRMENT; development of future medical treatment plan. You can not charge separately for the actual report, it's included in the evaluation.
IL01-$349.36, IL02-$280.09, IL03-$108.76, & IL04-$147.79
IL01-$561.90, IL02-$567.67, IL03-POC53.2, & IL04-$541.01
These worker's comp evaluations must be requested and pre-authorized by the adjustor/case manager.