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Thread: workers comp cpt codes

  1. #1

    Default workers comp cpt codes

    AAPC: Back to School
    Does anyone know where I can find a list of CPT codes that are billable to Workers Compensation. I keep getting EOB's and workers comp has crosswalked all of my codes to unlisted procedures or other CPT codes and such. I can't seem to pull up anything in search.

    Thanks for your help!!

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    Workers Comp is different in every state, they are not a HIPAA covered entity so they are not required to follow standard guidelines and such. Work Comp is allowed to state which year of the CPT book they use for their fee schedule and that is the year codes you need to use for the work comp claims. usually this can be found by going into your state work comp website and looking at the physician fee schedule, most will then tell you what year version this is based on. You usually have to look very close as sometimes it is written as a tiny footnote.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    ok it looks like california is using CPT '96 and I had no problem finding their fee schedule at their website, but I still can't find a drug fee schedule.

  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    Yes they do use 96, I have billed a lot of California work comp. I cannot remember how we billed the drugs though, I cannot remember doing anything special but we did use the NDC numbers and not the HCPC II codes. Also you want to read through all the rules for Calif work comp... I recall a portion that says you must bill the amount from the fee schedule, I know there were a few payers that if we billed off the regular fee schedule we would get a denial for fee exceeding the fee schedule. If you follow the rules exactly you will have no problems.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5


    hi there i need to find out what book to purchase to get the billing codes for workers comp medical billins cpt codes. Which book do i need to purchase that will have the codes from the care providers in it.

  6. #6

    Default Workmans Comp 2013 cpt code list

    Does anyone know where to find a list of California Workmans Comp codes for mental health billing for 2013?

  7. #7
    Join Date
    Apr 2007
    Hartford, CT


    For the last two questions, your best bet is to contact your state workers comp department and ASK them. In the state of CT we have to buy the annual fee schedule, but some states have if free. Some of them list the fees and codes on their websites and some have printed material they will send you.

    I've worked with the work comp commissioners office in CT and the work comp board in NC. I've found them both to be helpful when I've had questions.
    Doreen Clark, CPC, CPMA
    Medical Auditing Specialist
    Integrated Physicians Management Services
    East Harftord. Ct

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