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-   -   CPT code for Independent Medical Examination? (http://www.aapc.com/memberarea/forums/showthread.php?t=8851)

LLinville 10-08-2008 12:54 PM

CPT code for Independent Medical Examination?
:confused: Help! I was just informed that our Ortho doctor is going to be doing IME's or Independent Medical Examinations. The code they have told me to use is 99456, Work related or medical disability examination. But to use it as a hourly rate. I can't find anything that says to use it as hourly. It is my understanding that this is one flat fee. The examination is a very thorough review of a entire chart and then a 5-10 page report.
Does anyone of any other information on this exam? CPT codes? Billing?
Your help would be greatly appreciated. Thanks!!:confused:

BCrandall 10-08-2008 01:04 PM

99455 & 99456 are the codes to use. When I billed these I would bill the Comp rate for Comp claims, (those are set by WC) and bill others for whatever the Dr. wanted to charge since each case was different. If your Dr. wants, you can come up with an hourly rate and multiply it by the time spent doing the service.

RebeccaWoodward* 10-08-2008 01:11 PM

I agree with Bruce. I also reside in NC and these are the codes we use. I'm sure you're in another state but here are the guidelines for our WC carrier.

The Commission, in review of the Committee’s recommendation, and upon further discussion, has decided to adopt the following codes, to be used for all independent medical evaluations, effective March 1, 1996, and to set the following fees based upon time expended for review of medical records. If a physical examination is performed, additional CPT codes may be used.

Code Time Fee
IME 01 1 hour $100.00
IME 02 2 hours $200.00
IME 03 3 hours or more $400.00


janiceccs 04-14-2014 09:32 AM

Maryland, Wash. DC, Virginia
Does anyone out there know what the rules and regulations are for Maryland, DC and Virginia? (Standards for fees and how one charges for record review)

So, are you saying that you would use the 99455 for record review and the consult or new patient e/m codes for the exam????

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