* Modifier -WC: This modifier generally indicates that the services were rendered for a workers' compensation case. This is arguably the *most* important modifier for this scenario.
* Modifier -GP: This modifier (sometimes used with -WC) might be applied if the physician is providing an independent medical examination (IME) or an opinion separate from the treating physician.
* Modifier -KX: This modifier might be used if the physician has already performed a comprehensive examination in the past year and is providing follow-up care for a related condition. The specific requirements for using -KX vary by payer.
Important Considerations:
* Payer Specific Requirements: The most critical aspect is to check the specific requirements and preferred modifiers of the *workers' compensation insurance carrier* involved. Their instructions will override any general guidelines. They often have very detailed billing manuals or online resources.
* State Regulations: Workers' compensation regulations vary by state. Your state's workers' compensation board or agency will have specific requirements for billing and coding.
* Billing Codes: The correct CPT or HCPCS codes must accompany the appropriate modifiers. A complete physical examination will use a different code than a follow-up or problem-focused visit.
In short: While -WC is the most likely primary modifier, you absolutely *must* consult the specific payer's guidelines and your state's regulations to determine the correct modifiers to use for accurate and timely reimbursement. Using the wrong modifier can lead to claim denials.