2025 CPT code 99080
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Miscellaneous Medicine Services - Special Services, Procedures and Reports Medicine Services and Procedures Feed
Reports exceeding standard medical communication, such as detailed insurance forms or accident reports.
Modifiers may be applicable depending on the circumstances of service. Consult appropriate coding guidelines and payer specific instructions.
The medical necessity for the special report must be clearly documented in the patient's chart, demonstrating the additional information provided justifies the increased time and effort beyond standard medical communications.The report should directly relate to the patient's medical care and not be solely for administrative purposes.
The physician or qualified healthcare professional is responsible for completing detailed reports that extend beyond the standard medical records.This includes gathering necessary information, composing the report, and ensuring its accuracy and completeness.
In simple words: This code is used when a doctor or healthcare provider spends extra time creating detailed reports, beyond the usual notes, like completing complex insurance forms or writing a lengthy report about an accident.It's added to the bill along with the main service code, but many insurance companies don't pay for it separately.
CPT code 99080 signifies the provision of special reports that go beyond the scope of typical medical documentation.These reports may include detailed documentation for insurance claims, accident reports, or other similar situations requiring more extensive reporting than usual medical communications or standard forms.This code is reported in addition to the primary service code and is not a standalone code.It is crucial to note that many payers consider this service bundled into the payment for other services and may not reimburse it separately.Therefore, careful consideration of payer policies and potential for non-reimbursement is essential before using this code.Do not use this code for routine forms such as discharge summaries or in conjunction with codes 99455 and 99456 for workers' compensation forms.
Example 1: A physician spends significant time completing a detailed report for an insurance company following a complex motor vehicle accident involving one of their patients. This report includes extensive documentation of the patient's injuries, the physician's treatment plan, and a prognosis. Code 99080 is used in addition to the codes for the evaluation and treatment provided., A healthcare provider creates an extensive report for a patient's disability claim, detailing the patient's medical history, functional limitations, and prognosis, far exceeding the information contained in typical progress notes.This is reported alongside the codes for the evaluations and treatments performed., A physician compiles a comprehensive report for a worker's compensation claim after a work-related injury.This report is beyond the usual documentation and necessitates detailed explanation of the injury mechanism, diagnosis, treatment plan, and predicted disability. Note that this cannot be used with codes 99455 and 99456.
Detailed medical records supporting the need for the special report, including patient history, examination findings, diagnostic test results, treatment plans, and prognosis. The report itself should be well-documented and clearly justify the additional time and effort expended beyond standard documentation.
** Many payers do not reimburse for this code separately, due to its often bundled nature.Always verify payer policies before billing this code.This code is intended for exceptional circumstances where the documentation greatly exceeds the usual level of detail for standard medical communications.
- Revenue Code: Y1 (OTHER - MEDICARE FEE SCHEDULE)
- RVU: Information not available in provided sources.RVUs vary based on geographic location and payer contracts.
- Global Days: Not applicable. This is not a surgical procedure.
- Payment Status: Active, but often not reimbursed separately by many payers.
- Modifier TC rule: Not applicable. This is not a procedure with a technical component.
- Fee Schedule: Information not available in provided sources.Fee schedules vary by payer and location.
- Specialties:Many specialties may use this code, depending on the nature of the report.
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, other locations as appropriate.