Summary & Overview
CPT 99075: Medical Record Review and Sworn Medical Opinion
CPT code 99075 documents a provider’s review of medical records and the rendering of a sworn medical opinion based on the facts made available. This code captures medico-legal or administrative activities rather than direct patient care and is relevant nationally where clinicians participate in legal proceedings, disability determinations, or independent medical evaluations. Coverage and payment for this type of service vary across major payers and carry implications for provider administrative workload and documentation standards.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national-level overview of what CPT code 99075 represents, typical service context, and the practical implications for billing and record-keeping. The publication outlines common payment considerations, typical sites of service, and operational points that facilities and clinicians should track when providing sworn medical opinions. Benchmarks, policy updates, and clinical context related to administrative medico-legal services are summarized to help billing leaders and compliance staff align coding practices with payer expectations.
Data not available in the input where payer-specific rates, associated taxonomies, ICD-10 pairings, or related codes would normally appear.
Billing Code Overview
CPT code 99075 describes a provider review of medical records followed by rendering a sworn medical opinion based on the facts made available. The service type is legal or administrative medico-legal testimony/opinion derived from review of clinical documents. The typical site of service is non-clinical or administrative settings, such as a provider office or a legal proceeding location where the sworn opinion is delivered.
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Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a physician who is asked to review a decedent's or claimant's medical records and provide a sworn medical opinion for legal or administrative proceedings. The provider receives a request from counsel, an insurance company, or a government agency to examine the available medical documentation, synthesize clinical findings, and prepare a written, sworn statement or affidavit. The workflow generally includes receipt of medical records, focused review of relevant notes, imaging and lab results, formulation of an expert opinion, preparation of the sworn statement, and delivery under oath either in writing or during deposition. Typical site of service is an office, administrative setting, or court proceeding where the provider performs record review and renders testimony; no direct patient encounter is required. Common scenarios include medico-legal reviews for malpractice claims, workers' compensation disputes, disability determinations, or defense/claimant expert testimony regarding cause, timing, or appropriateness of care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (unused placeholder) | Use when no specific modifier applies to the service. |
22 | Increased procedural services |