CPT 99455: Work-Related or Medical Evaluation

CPT code 99455 describes a provider-performed evaluation of a patient for work-related or other medical reasons, applicable to both new and established patients; service type: clinical evaluation/consultation; typical site of service: any outpatient or inpatient location, as the code applies irrespective of place of service.

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CPT 99455: Work-Related or Medical Evaluation

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Get alerted when payer policies referencing 99455 are released or updated.

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Clinical & Coding Specifications

Clinical Context

A 45-year-old construction worker presents for a work-related functional capacity evaluation requested by his employer and occupational health coordinator. The provider performs a focused assessment to determine work fitness, disability status, and any medical restrictions related to a shoulder strain sustained on the job two weeks prior. The visit includes review of medical records, a directed history, targeted physical examination of the musculoskeletal and neurologic systems, and documentation of work-related limitations and recommended restrictions. The provider completes required paperwork for return-to-work clearance and communicates findings to the employer and case manager. Services are furnished for either a newly referred worker or an established patient and may occur in an outpatient clinic, occupational medicine office, employer site visit, or inpatient setting when medically necessary.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99456`	Work-related or medical disability examination by other than the treating physician; more than 45 minutes	Used for more extensive work-related evaluations when time and complexity exceed `99455` parameters.
`99204`	Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity	May be used when a comprehensive new patient E/M is required in addition to work-related documentation.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	May be used for established patients when a standard E/M visit is performed alongside work-related evaluation documentation.
`99454`	Work-related or medical disability examination by the treating physician; 21-40 minutes (hypothetical sequencing)	Related shorter-duration work evaluations; applies when payer-specific time increments are defined.
`99456`	Work-related or medical disability examination by other than the treating physician; extended documentation	Performed when specialist or non-treating physician conducts extensive disability assessment and report generation.

Related Modifiers

5 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RH0000X	Hematology (Internal Medicine) Physician	An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
207RG0300X	Geriatric Medicine (Internal Medicine) Physician	An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects o…
207LP2900X	Pain Medicine (Anesthesiology) Physician	An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chr…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
374K00000X	Religious Nonmedical Practitioner	A religious nonmedical practitioner offers spiritually-based care. Services may be rendered in an office, home, or care facility or by phone, email, …
3336I0012X	Institutional Pharmacy	A pharmacy in a hospital (inpatient) or institution used by pharmacists for the compounding and delivery of medicinal preparations to be administered …
261QC1500X	Community Health Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
207RA0401X	Addiction Medicine (Internal Medicine) Physician	An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified b…

CPT 99456: Work-Related or Medical Disability Examination

CPT-99457-REMOTE-PHYSIOLOGIC-MONITORING-MANAGEMENT

CPT 99457: Remote Physiologic Monitoring Management with Interactive Communication

CPT-99458-REMOTE-PHYSIOLOGIC-MONITORING-ADDITIONAL-20-MIN-STAFF-TIME

CPT 99458: Remote Physiologic Monitoring, Additional 20 Minutes

CPT-99459-PELVIC-EXAMINATION-WITH-EVALUATION-MANAGEMENT

CPT 99459: Pelvic Exam with Evaluation and Management

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99456`	Work-related or medical disability examination by other than the treating physician; more than 45 minutes	Used for more extensive work-related evaluations when time and complexity exceed `99455` parameters.
`99204`	Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity	May be used when a comprehensive new patient E/M is required in addition to work-related documentation.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	May be used for established patients when a standard E/M visit is performed alongside work-related evaluation documentation.
`99454`	Work-related or medical disability examination by the treating physician; 21-40 minutes (hypothetical sequencing)	Related shorter-duration work evaluations; applies when payer-specific time increments are defined.
`99456`	Work-related or medical disability examination by other than the treating physician; extended documentation	Performed when specialist or non-treating physician conducts extensive disability assessment and report generation.

Related Modifiers

5 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RH0000X	Hematology (Internal Medicine) Physician	An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
207RG0300X	Geriatric Medicine (Internal Medicine) Physician	An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects o…
207LP2900X	Pain Medicine (Anesthesiology) Physician	An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chr…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
374K00000X	Religious Nonmedical Practitioner	A religious nonmedical practitioner offers spiritually-based care. Services may be rendered in an office, home, or care facility or by phone, email, …
3336I0012X	Institutional Pharmacy	A pharmacy in a hospital (inpatient) or institution used by pharmacists for the compounding and delivery of medicinal preparations to be administered …
261QC1500X	Community Health Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
207RA0401X	Addiction Medicine (Internal Medicine) Physician	An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified b…

CPT 99456: Work-Related or Medical Disability Examination

CPT-99457-REMOTE-PHYSIOLOGIC-MONITORING-MANAGEMENT

CPT 99457: Remote Physiologic Monitoring Management with Interactive Communication

CPT-99458-REMOTE-PHYSIOLOGIC-MONITORING-ADDITIONAL-20-MIN-STAFF-TIME

CPT 99458: Remote Physiologic Monitoring, Additional 20 Minutes

CPT-99459-PELVIC-EXAMINATION-WITH-EVALUATION-MANAGEMENT

CPT 99459: Pelvic Exam with Evaluation and Management

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 99455: Work-Related or Medical Evaluation

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CPT 99455: Work-Related or Medical Evaluation

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

CPT 99455: Work-Related or Medical Evaluation

Sign up for cpt 99455 policy alerts

CPT 99455: Work-Related or Medical Evaluation

Sign up for cpt 99455 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What clinical situations does CPT 99455 cover?

Where can services billed with CPT 99455 be furnished?

How does CPT 99455 relate to other work-related evaluation codes like 99456?

Can CPT 99455 be billed alongside standard E/M codes such as 99214 or 99204?

Which payers are noted as covering or relevant to this code in the summary metadata?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What clinical situations does CPT 99455 cover?

Where can services billed with CPT 99455 be furnished?

How does CPT 99455 relate to other work-related evaluation codes like 99456?

Can CPT 99455 be billed alongside standard E/M codes such as 99214 or 99204?

Which payers are noted as covering or relevant to this code in the summary metadata?

References