99455 Work related disability exam

What 99455 is

CMS fee schedule short descriptor: Work related disability exam.

Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.

Medicare payment for 99455 (CY2026)

This code has no Physician Fee Schedule rate: Restricted coverage - payable only in specific circumstances. It may be paid under a different fee schedule (clinical laboratory, DMEPOS, anesthesia) or not paid at all - check the relevant CMS schedule.

Medically Unlikely Edit (MUE)

Medicare caps 99455 at 1 unit per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Nature of Service/Procedure. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with 99455? These codes are bundled into it

99455 is a Column 1 code in 122 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

Showing 30 of 122 column 2 codes. Use the pair checker for any specific combination.

99455 is bundled into these codes

99455 appears as a Column 2 code in 197 active edits. Reported with one of these Column 1 codes on the same date of service, 99455 is the code that denies.

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.