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99455 Florida

David Posted Sat 13th of June, 2015 07:20:39 AM

Can you bill 99455 in Florida? Does this code exist in Florida? If yes, what is the reimbursement for Workers Compensation, Car Accident Cases, Medicare, and Private Insurance?

SuperCoder Answered Mon 15th of June, 2015 03:12:06 AM

Code 99455, Work related or medical disability examination by the treating physician, and code 99456, Work related or medical disability examination by other than the treating physician, are used to report evaluations performed to establish baseline information prior to the issuance of life or disability insurance certificates. This service is performed in the office or other setting, and applies to both new and established patients. When using these codes, no active management of the problem(s) is undertaken during the encounter. These codes are not intended to be used for active E/M services due to work-related injuries. If other E/M services and/or procedures are performed on the same date, the appropriate E/M or procedure code(s) should be reported in addition to codes 99455 and 99456. Modifier 25 may be appended to the E/M service code. Codes 99455 and 99456 would not be used if the complete services as identified for disability evaluation are not performed. Instead, the appropriate code from the 99201-99215 code series may be used to identify the services rendered.

For Q2, 2015, Medicare payment rate (non-facility) for 97755 in Florida --> $0.00 (in all 3 locations in FL).

The below document includes the code 99455 under the text:
"The State did not make payment as of July 1, 2009 for the following codes and will not make payment for those codes under this SPA (specify codes)."

http://ahca.myflorida.com/medicaid/stateplanpdf/florida_medicaid_state_plan_part_II.pdf

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The 2015 WC draft document shows the payment amount proposed at $90.00:
http://www.myfloridacfo.com/Division/WC/pdf/Draft-FL-Health-Care-Provider-Reimbursement-Manual-2015.pdf

David Posted Wed 17th of June, 2015 06:21:46 AM

What is the reimbursement in Florida for Workers Comp. and car accident cases?

David Posted Wed 17th of June, 2015 06:34:16 AM

$90?

SuperCoder Answered Thu 18th of June, 2015 04:01:13 AM

The amount $90 is mentioned in the 2015 draft document. We cannot guarantee or confirm the exact payment amount. And SuperCoder does not deal with car accident reimbursement cases.

Kindly inquire with your payer(s) to get the latest fee schedule and reimbursement policies.

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