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99455
Quick jump to procedure code: Printer Friendly Version
99460

CPT® 99456: WORK RELATED OR MEDICAL DISABILITY EXAMINATION BY OTHER THAN THE TREATING PHYSICIAN THAT INCLUDES: COMPLETION OF A MEDICAL HISTORY COMMENSURATE WITH THE PATIENT'S CONDITION; PERFORMANCE OF AN EXAMINATION COMMENSURATE WITH THE PATIENT'S CONDITION; FORMULATION OF A DIAGNOSIS, ASSESSMENT OF CAPABILITIES AND STABILITY, AND CALCULATION OF IMPAIRMENT; DEVELOPMENT OF FUTURE MEDICAL TREATMENT PLAN; AND COMPLETION OF NECESSARY DOCUMENTATION/CERTIFICATES AND REPORT.

Short Description: Disability examination

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State


2016 OPPS Status Indicator: B

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Limited claims data available for this procedure.
PercentageICD-9ICD-10 Conversions
40.0% V70.5    Health examination of defined subpopulations Z02.1   Encounter for pre-employment examination
OR:
Z02.3   Encounter for examination for recruitment to armed forces
OR:
Z02.89   Encounter for other administrative examinations
20.0% V72.85    Other specified examination Z01.89   Encounter for other specified special examinations
20.0% 998.9    Unspecified complication of procedure, not elsewhere classified T81.9XXA   Unspecified complication of procedure, initial encounter
20.0% 294.8    Other persistent mental disorders due to conditions classified elsewhere F06.0   Psychotic disorder with hallucinations due to known physiological condition
OR:
F06.8   Other specified mental disorders due to known physiological condition

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

99456 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.

CCI Edits for 99456
Denied Codes (1)
Effective
Modifier
Accepted (2)
0394T Hdr elctrnc skn surf brchytx
01/01/2016 No
0395T Hdr elctr ntrst/ntrcv brchtx
01/01/2016 No
77261 Radiation therapy planning
01/01/2006 No
77262 Radiation therapy planning
01/01/2006 No
77263 Radiation therapy planning
01/01/2006 No
77280 Set radiation therapy field
01/01/2006 No
77285 Set radiation therapy field
01/01/2006 No
77290 Set radiation therapy field
01/01/2006 No
77293 Respirator motion mgmt simul
01/01/2014 No
77295 3-d radiotherapy plan
01/01/2006 No
77300 Radiation therapy dose plan
01/01/2006 No
77301 Radiotherapy dose plan imrt
01/01/2006 No
77306 Telethx isodose plan simple
01/01/2015 No
77307 Telethx isodose plan cplx
01/01/2015 No
77316 Brachytx isodose plan simple
01/01/2015 No
77317 Brachytx isodose intermed
01/01/2015 No
77318 Brachytx isodose complex
01/01/2015 No
77321 Special teletx port plan
01/01/2006 No
77331 Special radiation dosimetry
01/01/2006 No
77332 Radiation treatment aid(s)
01/01/2006 No
77333 Radiation treatment aid(s)
01/01/2006 No
77334 Radiation treatment aid(s)
01/01/2006 No
77336 Radiation physics consult
01/01/2006 No
77338 Design mlc device for imrt
01/01/2010 No
77370 Radiation physics consult
01/01/2006 No
77371 Srs multisource
10/01/2010 No
77372 Srs linear based
10/01/2010 No
77373 Sbrt delivery
10/01/2010 No
77401 Radiation treatment delivery
10/01/2006 No
77402 Radiation treatment delivery
10/01/2006 No
77407 Radiation treatment delivery
10/01/2006 No
77412 Radiation treatment delivery
10/01/2006 No
77417 Radiology port images(s)
01/01/2006 No
77422 Neutron beam tx simple
01/01/2006 No
77423 Neutron beam tx complex
01/01/2006 No
77424 Io rad tx delivery by x-ray
01/01/2012 No
77425 Io rad tx deliver by elctrns
01/01/2012 No
77427 Radiation tx management x5
10/01/2006 No
77431 Radiation therapy management
10/01/2006 No
77432 Stereotactic radiation trmt
10/01/2006 No
77435 Sbrt management
10/01/2010 No
77469 Io radiation tx management
01/01/2016 No
77470 Special radiation treatment
10/01/2006 No
77520 Proton trmt simple w/o comp
10/01/2006 No
77522 Proton trmt simple w/comp
10/01/2006 No
77523 Proton trmt intermediate
10/01/2006 No
77525 Proton treatment complex
10/01/2006 No
77600 Hyperthermia treatment
10/01/2006 No
77605 Hyperthermia treatment
10/01/2006 No
77610 Hyperthermia treatment
10/01/2006 No
77615 Hyperthermia treatment
10/01/2006 No
77620 Hyperthermia treatment
10/01/2006 No
77750 Infuse radioactive materials
10/01/2005 No
77761 Apply intrcav radiat simple
10/01/2005 No
77762 Apply intrcav radiat interm
10/01/2005 No
77763 Apply intrcav radiat compl
10/01/2005 No
77767 Hdr rdncl skn surf brachytx
01/01/2016 No
77768 Hdr rdncl skn surf brachytx
01/01/2016 No
77778 Apply interstit radiat compl
10/01/2005 No
77789 Apply surf ldr radionuclide
10/01/2005 No
77790 Radiation handling
10/01/2005 No
90791 Psych diagnostic evaluation
01/01/2014 No
90792 Psych diag eval w/med srvcs
01/01/2014 No
90832 Psytx pt&/family 30 minutes
01/01/2013 No
90833 Psytx pt&/fam w/e&m 30 min
01/01/2013 No
90834 Psytx pt&/family 45 minutes
01/01/2013 No
90836 Psytx pt&/fam w/e&m 45 min
01/01/2013 No
90837 Psytx pt&/family 60 minutes
01/01/2013 No
90838 Psytx pt&/fam w/e&m 60 min
01/01/2013 No
90869 Tcran magn stim redetemine
01/01/2012 Yes
90935 Hemodialysis one evaluation
01/01/2004 No
90937 Hemodialysis repeated eval
01/01/2004 No
90945 Dialysis one evaluation
01/01/2004 No
90947 Dialysis repeated eval
01/01/2004 No
90951 Esrd serv 4 visits p mo <2yr
01/01/2013 Yes
90952 Esrd serv 2-3 vsts p mo <2yr
01/01/2013 Yes
90953 Esrd serv 1 visit p mo <2yrs
01/01/2013 Yes
90954 Esrd serv 4 vsts p mo 2-11
01/01/2013 Yes
90955 Esrd srv 2-3 vsts p mo 2-11
01/01/2013 Yes
90956 Esrd srv 1 visit p mo 2-11
01/01/2013 Yes
90957 Esrd srv 4 vsts p mo 12-19
01/01/2013 Yes
90958 Esrd srv 2-3 vsts p mo 12-19
01/01/2013 Yes
90959 Esrd serv 1 vst p mo 12-19
01/01/2013 Yes
90960 Esrd srv 4 visits p mo 20+
01/01/2013 Yes
90961 Esrd srv 2-3 vsts p mo 20+
01/01/2013 Yes
90962 Esrd serv 1 visit p mo 20+
01/01/2013 Yes
90963 Esrd home pt serv p mo <2yrs
01/01/2013 Yes
90964 Esrd home pt serv p mo 2-11
01/01/2013 Yes
90965 Esrd home pt serv p mo 12-19
01/01/2013 Yes
90966 Esrd home pt serv p mo 20+
01/01/2013 Yes
90967 Esrd home pt serv p day <2
01/01/2013 Yes
90968 Esrd home pt srv p day 2-11
01/01/2013 Yes
90969 Esrd home pt srv p day 12-19
01/01/2013 Yes
90970 Esrd home pt serv p day 20+
01/01/2013 Yes
93015 Cardiovascular stress test
01/01/2011 Yes
93016 Cardiovascular stress test
01/01/2011 Yes
93017 Cardiovascular stress test
01/01/2011 Yes
93018 Cardiovascular stress test
01/01/2011 Yes
95004 Percut allergy skin tests
01/01/2008 Yes
95012 Exhaled nitric oxide meas
01/01/2008 Yes
95017 Perq & icut allg test venoms
01/01/2013 Yes
95018 Perq&ic allg test drugs/biol
01/01/2013 Yes
95024 Icut allergy test drug/bug
01/01/2008 Yes
95027 Icut allergy titrate-airborn
01/01/2008 Yes
95028 Icut allergy test-delayed
01/01/2008 Yes
95044 Allergy patch tests
01/01/2008 Yes
95052 Photo patch test
01/01/2008 Yes
95056 Photosensitivity tests
01/01/2008 Yes
95060 Eye allergy tests
01/01/2008 Yes
95065 Nose allergy test
01/01/2008 Yes
95070 Bronchial allergy tests
01/01/2008 Yes
95071 Bronchial allergy tests
01/01/2008 Yes
95076 Ingest challenge ini 120 min
01/01/2013 Yes
95079 Ingest challenge addl 60 min
01/01/2013 Yes
95115 Immunotherapy one injection
04/01/2014 Yes
95117 Immunotherapy injections
04/01/2014 Yes
95120 Immunotherapy one injection
04/01/2014 Yes
95125 Immunotherapy 2/> injections
04/01/2014 Yes
95130 Immntx 1 sting insect
04/01/2014 Yes
95131 Immntx 2 sting insects
04/01/2014 Yes
95132 Immntx 3 sting insects
04/01/2014 Yes
95133 Immntx 4 sting insects
04/01/2014 Yes
95134 Immntx 5 sting insects
04/01/2014 Yes
95144 Antigen therapy services
04/01/2014 Yes
95145 Antigen therapy services
04/01/2014 Yes
95146 Antigen therapy services
04/01/2014 Yes
95147 Antigen therapy services
04/01/2014 Yes
95148 Antigen therapy services
04/01/2014 Yes
95149 Antigen therapy services
04/01/2014 Yes
95165 Antigen therapy services
04/01/2014 Yes
95170 Antigen therapy services
04/01/2014 Yes
95180 Rapid desensitization
04/01/2014 Yes
96360 Hydration iv infusion init
01/01/2009 Yes
96365 Ther/proph/diag iv inf init
01/01/2009 Yes
96369 Sc ther infusion up to 1 hr
01/01/2009 Yes
96372 Ther/proph/diag inj sc/im
01/01/2009 Yes
96373 Ther/proph/diag inj ia
01/01/2009 Yes
96374 Ther/proph/diag inj iv push
01/01/2009 Yes
96401 Chemo anti-neopl sq/im
01/01/2006 Yes
96402 Chemo hormon antineopl sq/im
01/01/2006 Yes
96405 Chemo intralesional up to 7
01/01/2006 Yes
96406 Chemo intralesional over 7
01/01/2006 Yes
96409 Chemo iv push sngl drug
01/01/2006 Yes
96413 Chemo iv infusion 1 hr
01/01/2006 Yes
96416 Chemo prolong infuse w/pump
01/01/2006 Yes
96420 Chemo ia push tecnique
01/01/2006 Yes
96422 Chemo ia infusion up to 1 hr
01/01/2006 Yes
96425 Chemotherapy infusion method
01/01/2006 Yes
96440 Chemotherapy intracavitary
01/01/2006 Yes
96446 Chemotx admn prtl cavity
01/01/2011 Yes
96450 Chemotherapy into cns
01/01/2006 Yes
96521 Refill/maint portable pump
01/01/2006 Yes
96522 Refill/maint pump/resvr syst
01/01/2006 Yes
96542 Chemotherapy injection
01/01/2006 Yes
97001 Pt evaluation
04/01/1998 Yes
97002 Pt re-evaluation
04/01/1998 Yes
97003 Ot evaluation
07/01/2001 Yes
97004 Ot re-evaluation
07/01/2001 Yes
97810 Acupunct w/o stimul 15 min
01/01/2013 Yes
97811 Acupunct w/o stimul addl 15m
01/01/2013 Yes
97813 Acupunct w/stimul 15 min
01/01/2013 Yes
97814 Acupunct w/stimul addl 15m
01/01/2013 Yes
98925 Osteopath manj 1-2 regions
01/01/2005 Yes
98926 Osteopath manj 3-4 regions
01/01/2005 Yes
98927 Osteopath manj 5-6 regions
01/01/2005 Yes
98928 Osteopath manj 7-8 regions
01/01/2005 Yes
98929 Osteopath manj 9-10 regions
01/01/2005 Yes
98940 Chiropract manj 1-2 regions
01/01/2006 Yes
98941 Chiropract manj 3-4 regions
01/01/2006 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
98942 Chiropractic manj 5 regions
01/01/2006 Yes
98943 Chiropract manj xtrspinl 1/>
01/01/2006 Yes
99183 Hyperbaric oxygen therapy
10/01/2015 Yes
99304 Nursing facility care init
07/01/2006 No
99305 Nursing facility care init
07/01/2006 No
99306 Nursing facility care init
07/01/2006 No
99455 Work related disability exam
04/01/2007 No
0359T Behavioral id assessment
10/01/2014 Yes
0360T Observ behav assessment
10/01/2014 Yes
0361T Observ behav assess addl
10/01/2014 Yes
0362T Expose behav assessment
10/01/2014 Yes
0363T Expose behav assess addl
10/01/2014 Yes
0364T Adaptive behavior treatment
10/01/2014 Yes
0365T Adaptive behavior tx addl
10/01/2014 Yes
0366T Group behavior treatment
10/01/2014 Yes
0367T Group behav treatment addl
10/01/2014 Yes
0368T Behavior treatment modified
10/01/2014 Yes
0369T Behav treatment modify addl
10/01/2014 Yes
0370T Fam behav treatment guidance
10/01/2014 Yes
0371T Mult fam behav treat guide
10/01/2014 Yes
0372T Social skills training group
10/01/2014 Yes
0373T Exposure behavior treatment
10/01/2014 Yes
0374T Expose behav treatment addl
10/01/2014 Yes
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
92531 Spontaneous nystagmus study
01/01/2009 No
92532 Positional nystagmus test
01/01/2009 No
93561 Cardiac output measurement
04/01/2008 Yes
93562 Card output measure subsq
04/01/2008 Yes
94002 Vent mgmt inpat init day
01/01/2007 No
94003 Vent mgmt inpat subq day
01/01/2007 No
94004 Vent mgmt nf per day
01/01/2007 No
94660 Pos airway pressure cpap
01/01/2016 No
94662 Neg press ventilation cnp
01/01/2016 No
96020 Functional brain mapping
01/01/2007 Yes
96101 Psycho testing by psych/phys
10/01/2010 Yes
96102 Psycho testing by technician
10/01/2010 Yes
96103 Psycho testing admin by comp
10/01/2010 Yes
96105 Assessment of aphasia
10/01/2010 Yes
96116 Neurobehavioral status exam
01/01/2006 Yes
96118 Neuropsych tst by psych/phys
10/01/2010 Yes
96119 Neuropsych testing by tec
10/01/2010 Yes
96120 Neuropsych tst admin w/comp
10/01/2010 Yes
96125 Cognitive test by hc pro
10/01/2010 Yes
96127 Brief emotional/behav assmt
01/01/2015 No
96150 Assess hlth/behave init
01/01/2002 No
96151 Assess hlth/behave subseq
01/01/2002 No
96152 Intervene hlth/behave indiv
01/01/2002 No
96153 Intervene hlth/behave group
01/01/2002 No
96154 Interv hlth/behav fam w/pt
01/01/2002 No
96523 Irrig drug delivery device
01/01/2006 No
97532 Cognitive skills development
04/01/2002 Yes
97533 Sensory integration
04/01/2002 Yes
97535 Self care mngment training
04/01/1997 Yes
97537 Community/work reintegration
04/01/1997 Yes
97750 Physical performance test
04/01/1997 No
97762 C/o for orthotic/prosth use
01/01/2006 No
97802 Medical nutrition indiv in
01/01/2002 No
97803 Med nutrition indiv subseq
01/01/2002 No
97804 Medical nutrition group
01/01/2002 No
99172 Ocular function screen
04/01/2014 No
99201 Office/outpatient visit new
01/01/1997 No
99202 Office/outpatient visit new
01/01/1997 No
99203 Office/outpatient visit new
01/01/1997 No
99204 Office/outpatient visit new
01/01/1997 No
99205 Office/outpatient visit new
01/01/1997 No
99211 Office/outpatient visit est
01/01/1997 No
99212 Office/outpatient visit est
01/01/1997 No
99213 Office/outpatient visit est
01/01/1997 No
99214 Office/outpatient visit est
01/01/1997 No
99215 Office/outpatient visit est
01/01/1997 No
99217 Observation care discharge
01/01/1997 No
99218 Initial observation care
01/01/1997 No
99219 Initial observation care
01/01/1997 No
99220 Initial observation care
01/01/1997 No
99221 Initial hospital care
01/01/1997 No
99222 Initial hospital care
01/01/1997 No
99223 Initial hospital care
01/01/1997 No
99224 Subsequent observation care
01/01/2011 No
99225 Subsequent observation care
01/01/2011 No
99226 Subsequent observation care
01/01/2011 No
99231 Subsequent hospital care
01/01/1997 No
99232 Subsequent hospital care
01/01/1997 No
99233 Subsequent hospital care
01/01/1997 No
99238 Hospital discharge day
01/01/1997 No
99239 Hospital discharge day
01/01/1997 No
99281 Emergency dept visit
01/01/1997 No
99282 Emergency dept visit
01/01/1997 No
99283 Emergency dept visit
01/01/1997 No
99284 Emergency dept visit
01/01/1997 No
99285 Emergency dept visit
01/01/1997 No
99291 Critical care first hour
01/01/1997 No
99292 Critical care addl 30 min
01/01/1997 No
99307 Nursing fac care subseq
01/01/2006 No
99308 Nursing fac care subseq
01/01/2006 No
99309 Nursing fac care subseq
01/01/2006 No
99310 Nursing fac care subseq
01/01/2006 No
99318 Annual nursing fac assessmnt
01/01/2006 No
99324 Domicil/r-home visit new pat
01/01/2006 No
99325 Domicil/r-home visit new pat
01/01/2006 No
99326 Domicil/r-home visit new pat
01/01/2006 No
99327 Domicil/r-home visit new pat
01/01/2006 No
99328 Domicil/r-home visit new pat
01/01/2006 No
99334 Domicil/r-home visit est pat
01/01/2006 No
99335 Domicil/r-home visit est pat
01/01/2006 No
99336 Domicil/r-home visit est pat
01/01/2006 No
99337 Domicil/r-home visit est pat
01/01/2006 No
99341 Home visit new patient
01/01/1997 No
99342 Home visit new patient
01/01/1997 No
99343 Home visit new patient
01/01/1997 No
99347 Home visit est patient
04/01/1998 No
99348 Home visit est patient
04/01/1998 No
99349 Home visit est patient
04/01/1998 No
99408 Audit/dast 15-30 min
04/01/2011 No
99409 Audit/dast over 30 min
04/01/2011 No
99446 Interprof phone/online 5-10
01/01/2014 No
99447 Interprof phone/online 11-20
01/01/2014 No
99448 Interprof phone/online 21-30
01/01/2014 No
99449 Interprof phone/online 31/>
01/01/2014 No
99497 Advncd care plan 30 min
01/01/2016 No
99605 Mtms by pharm np 15 min
01/01/2008 Yes
99606 Mtms by pharm est 15 min
01/01/2008 Yes
G0102 Prostate ca screening; dre
06/05/2000 No
G0245 Initial foot exam pt lops
07/01/2002 No
G0246 Followup eval of foot pt lop
07/01/2002 No
G0270 Mnt subs tx for change dx
07/01/2003 No
G0271 Group mnt 2 or more 30 mins
07/01/2003 No
G0380 Lev 1 hosp type b ed visit
10/01/2008 Yes
G0381 Lev 2 hosp type b ed visit
10/01/2008 Yes
G0382 Lev 3 hosp type b ed visit
10/01/2008 Yes
G0383 Lev 4 hosp type b ed visit
10/01/2008 Yes
G0384 Lev 5 hosp type b ed visit
10/01/2008 Yes
G0396 Alcohol/subs interv 15-30mn
04/01/2011 Yes
G0397 Alcohol/subs interv >30 min
04/01/2011 Yes
G0406 Inpt/tele follow up 15
07/01/2010 No
G0407 Inpt/tele follow up 25
07/01/2010 No
G0408 Inpt/tele follow up 35
07/01/2010 No
G0425 Inpt/ed teleconsult30
07/01/2010 No
G0426 Inpt/ed teleconsult50
07/01/2010 No
G0427 Inpt/ed teleconsult70
07/01/2010 No
G0442 Annual alcohol screen 15 min
07/01/2012 Yes
G0443 Brief alcohol misuse counsel
07/01/2012 Yes
G0463 Hospital outpt clinic visit
07/01/2014 No
G0101 Ca screen;pelvic/breast exam
04/01/1998 Yes
G0104 Ca screen;flexi sigmoidscope
04/01/1998 Yes
G0105 Colorectal scrn; hi risk ind
04/01/1998 Yes
G0106 Colon ca screen;barium enema
04/01/1998 Yes
G0120 Colon ca scrn; barium enema
04/01/1998 Yes
G0121 Colon ca scrn not hi rsk ind
04/01/2002 Yes
G0339 Robot lin-radsurg com, first
10/01/2006 No
G0340 Robt lin-radsurg fractx 2-5
10/01/2006 No
G6002 Stereoscopic x-ray guidance
01/01/2015 No
G6003 Radiation treatment delivery
01/01/2015 No
G6004 Radiation treatment delivery
01/01/2015 No
G6005 Radiation treatment delivery
01/01/2015 No
G6006 Radiation treatment delivery
01/01/2015 No
G6007 Radiation treatment delivery
01/01/2015 No
G6008 Radiation treatment delivery
01/01/2015 No
G6009 Radiation treatment delivery
01/01/2015 No
G6010 Radiation treatment delivery
01/01/2015 No
G6011 Radiation treatment delivery
01/01/2015 No
G6012 Radiation treatment delivery
01/01/2015 No
G6013 Radiation treatment delivery
01/01/2015 No
G6014 Radiation treatment delivery
01/01/2015 No
G6015 Radiation tx delivery imrt
01/01/2015 No
G6017 Intrafraction track motion
01/01/2015 Yes
P3000 Screen pap by tech w md supv
04/01/1998 Yes
P3001 Screening pap smear by phys
04/01/1999 Yes
Q0091 Obtaining screen pap smear
04/01/1998 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 99456.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 99456


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Nature of Service/Procedure Nature of Service/Procedure Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   Medicare Part B Utilization Data for 99456*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 91
Total Services Denied 2014: 91 (100.0%)
National Charges Submitted 2014: $ 26,564.00
National Charges Allowed 2014: $ 0.00
National Average (No Modifier) Fee Submitted 2014: $272.35
National Average (No Modifier) Fee Allowed 2014: $ 0.00


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Family practice 20 22.0% $126.10 20 100.0%
Internal medicine 19 20.9% $151.57 19 100.0%
Orthopedic surgery 14 15.4% $632.79 14 100.0%
Pulmonary disease 6 6.6% $754.50 6 100.0%
Nurse practitioner 5 5.5% $231.73 5 100.0%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 85 93.4% $282.15 85 100.0%
Outpatient hospital 6 6.6% $430.61 6 100.0%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 83 91.2% $272.37 83 100.0%
25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Day of a Procedure 3 3.3% $883.33 3 100.0%
32 - Mandated Services 2 2.2% $ 50.00 2 100.0%
GC 1 1.1% $827.00 1 100.0%
AQ 1 1.1% $382.00 1 100.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.



   CMS Transmittals: Hide this section.

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