CPT Code 99455: Work-Related or Medical Disability Evaluation by Treating Physician

CPT code 99455, which covers work-related or medical disability examinations performed by the treating physician, has a fee schedule that varies by payer and location. Providers should always verify the applicable rate with the specific payer or state agency, as reimbursement can differ depending on contracts and geographic region.

Yes, CPT codes 99213 (established patient office visit) and 99455 (disability examination) can be billed together for the same encounter if both services are medically necessary and separately documented; however, payer policies may vary, and some may require the use of a modifier (such as modifier 59) to indicate distinct services.

CPT 99455 may require a modifier in certain situations, particularly for workers’ compensation or state-specific programs. Additionally, modifier 59 may be necessary when billing 99455 with other evaluation and management codes to show that the services are distinct. Always consult the relevant payer or state guidelines to determine if a modifier is required for your claim.