Getting Clear on CPT Codes 99080 and WC007

If you’re doing your practice’s medical billing, you know that your bottom line depends on all your coding and paperwork being just right. Your job is complicated by the fact that many Current Procedural Terminology (CPT) codes are eliminated or revised each year.

At MBC Systems, our dedicated legal team has years of expertise and experience with workers’ compensation cases and keeps up to date on the frequent changes in workers’ comp legislation. As you know, requests for authorization and the many timelines now associated with the medical billing and collection process require constant education to ensure optimized collections. If you’re overwhelmed, we can help!

Here’s an especially sticky example: every year the Division of Workers’ Compensation sets new reimbursement amounts for its California-specific CPT codes. This year, a notoriously confusing code, WC007, is reimbursed at $40.45 for the first page and $24.88 for each additional page. Without prior authorization, a maximum of six pages can be billed at $164.85. Last year it was $39.89 for the first page of the report, and $24.54 for each additional page. Next year it will most likely change again.

In addition to making sure you’re billing the correct amount, you need to make sure you’re using the code correctly. It is assumed that WC007 can be used to bill for consultation reports as a substitute for the now no-longer-payable CPT code 99080. But they are not interchangeable. Consultation reports are now typically bundled with Evaluation and Management (E/M) codes.

Actually there are only two procedures where WC007 can be used, according to the Physician Fee Schedule Regulations:

  • Consultation Reports Requested by the Workers’ Compensation Appeals Board or the Administrative Director (Use modifier -32)
  • Consultation Reports requested by the QME or AME in the context of a medical-legal evaluation (Section 9789.14(b)(5)). (Use modifier -30)

We hope that helps! If keeping all this straight, in compliance, and reimbursed is getting to be too much for your office, please give us a call at (949) 863-0022 or use our contact form to reach us. We would love to talk to you about how our expert teams, one for each segment of the billing and collections process, will increase your income and reduce time to payment.