CPT® Code 99455 is used to report a work-related or medical disability examination performed by the treating physician. This service involves a comprehensive evaluation to assess a patient’s degree of impairment or disability, often in the context of workers’ compensation, disability claims, or functional capacity determination.
The examination focuses on reviewing medical records, performing a detailed physical assessment, and completing required disability reports or forms that support impairment ratings or work capacity determinations.
CPT 99455 represents the examination and reporting service. It does not include treatment services performed separately.
Key Facts About CPT® 99455
- Service type: Disability and impairment evaluation
- Provider type: Treating physicians
- Medical services included:
- Comprehensive disability-related examination
- Review of medical records and prior treatment
- Completion of required reports or impairment documentation
- Patient context: Work-related injury or medical disability
- Common clinical indications:
- Workers’ compensation disability evaluations
- Determination of permanent or temporary impairment
- Functional capacity or work restriction assessment
- Documentation for disability or legal claims
When to Use CPT® 99455
CPT 99455 is appropriate when:
- The treating physician performs a disability-related examination
- The evaluation is specifically requested for work-related or medical disability determination
- A comprehensive assessment and formal reporting are required
- The service is not part of routine E/M care
Examples:
- Evaluating impairment following a work-related musculoskeletal injury
- Determining work restrictions or return-to-work capacity
- Completing disability documentation for workers’ compensation claims
- Assessing permanent impairment after completion of treatment
Documentation Requirements
To properly support CPT 99455 billing, documentation should include:
- Patient identifiers and date of examination
- Statement confirming the physician is the treating provider
- Relevant medical history and review of records
- Detailed physical examination findings
- Impairment or disability assessment methodology
- Completed reports, forms, or impairment ratings
- Conclusions regarding work capacity or functional limitations
Clear documentation is essential for compliance, legal defensibility, and accurate reimbursement.
Reimbursement and Coding Considerations
- CPT 99455 is commonly reimbursed under workers’ compensation or disability programs
- Coverage and payment policies vary significantly by payer and jurisdiction
- This service is not billed to Medicare
- Treatment services and routine E/M visits are billed separately when applicable
- Proper authorization or documentation may be required before performing the exam
Always verify payer-specific rules for disability and impairment evaluations.
How OptiMantra Supports Disability and Work-Related Exams
OptiMantra’s integrated EMR and practice management platform supports complex documentation and reporting needs associated with CPT 99455 services.
With OptiMantra, providers can:
- Document disability examinations using structured, customizable templates
- Store and organize supporting medical records in one centralized chart
- Track work-related injuries, restrictions, and functional outcomes over time
- Generate clean, audit-ready documentation and billing
- Integrate disability findings into ongoing care plans when treatment continues
By streamlining documentation, reporting, and billing workflows, OptiMantra helps treating physicians manage disability evaluations efficiently while maintaining compliance.
Try OptiMantra for free here!
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