Worker's Comp IME Reimbursement

jhartung

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Adirondack Chapter of Professional Coders, Glens F
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I work for a specialist that is interested in doing IMEs for worker's comp patients but is wondering what the reimbursement is like. We have searched high and low and all we could find is that the reimbursement is based on the documentation and amount of work the provider does. Is there anyone out there that bills worker's comp for IMEs that could give me a ballpark figure of what the reimbursement is? We are looking to bill procedure code 99456 for this.....any info anyone has is greatly appreciated! :)
Also, we are located in the state of New York.
 

RebeccaWoodward*

True Blue
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North Carolina
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I work for a specialist that is interested in doing IMEs for worker's comp patients but is wondering what the reimbursement is like. We have searched high and low and all we could find is that the reimbursement is based on the documentation and amount of work the provider does. Is there anyone out there that bills worker's comp for IMEs that could give me a ballpark figure of what the reimbursement is? We are looking to bill procedure code 99456 for this.....any info anyone has is greatly appreciated! :)
Also, we are located in the state of New York.
NC

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

http://www.ic.nc.gov/ncic/pages/feesec03.htm
 

halebill

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Capital Coders, Columbia, SC
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My Ortho docs get a flat fee of $1000.00 for IME's. We also require these to be paid in advance by the insurance co. or atorney's office. For reporting purposes, we use code 99456.


Bill Hale, CPC
 
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I have seen 1000-1500 and would definately have them paid in advance. We often require additional payment for records reviewed if they are voluminous.
 
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