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Billing guidelines for independent medical examinations

An independent medical examination is an objective medical examination of an injured worker
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An independent medical examination (IME) is an objective medical examination of an injured worker performed by a physician who has not previously treated the injured worker to evaluate prior, current, or proposed treatment or current condition. The Colorado Division of Workers’ Compensation (DOWC) sets the guidelines for IMEs to avoid delays in the treatment of injured workers or payment disputes.

Z0756 – Respondent-requested IME with patient exam
  • Fee schedule is $93.50 per unit.
  • Units are billed in 15-minute increments.
  • Prepayment of two hours is allowed.
  • IME reports are to be received by all parties within 20 days of the IME appointment.
Z0766 – IME audio recording
  • Fee schedule is $35.00 per exam.
  • IMEs are to be recorded in their entirety.
  • The examining physician must retain the recording for 12 months and make it available by request to any party of the case.
Z0767 – IME audio copying fee
  • Fee schedule is $24.00 per copy.
Z0762 – Cancellation 14 days or more prior to the appointment
  • Fee schedule is $93.50.
  • Units are billed in 15-minute increments.
  • Payment is for all reasonable preparation time, less any deposit paid by the requesting party.
Z0763 – Cancellation less than 14 days prior to the appointment
  • Fee schedule is $93.50.
  • Units are billed in 15-minute increments.
  • Payment is for all reasonable time, such as the preparation and scheduled appointment time.

The IME itemized invoice should include, but is not limited to, the following information:

  • The injured worker’s name, claim number, and dates of service.
  • Treating provider’s name and NPI.
  • Treating provider’s tax ID number and address.
  • Total billed amount.
  • DOWC codes with descriptions for each:
  • ~Medical records review: Time is required to be documented. The names of providers and the dates of service records that are reviewed should be documented, as well as a brief summary of each reviewed record.
  • ~Conferences with Pinnacol claims representatives and medical case managers, treating providers, or attorneys: Paid in 15-minute increments per DOWC fee schedule.
  • ~Evidence-based research.
  • ~The review of surveillance.
  • ~The written IME report.
  • Additional diagnostics or services shall be itemized by CPT code and paid per the DOWC fee schedule.

Additional IME billing tips:

  • Providers can estimate the time it will take to perform the IME for prepayment, but payment will be based on the actual time documented on the IME report.
  • Time is required to be documented in the IME report as well as an attestation that the billed charges comply with Colorado Revised Statue § 8-42-101(3)(a)(I) and Rule 16-8.
  • Prepayment up to two hours is allowed. Should the actual time end up less than two hours, the difference should be refunded to Pinnacol.
  • Record review is included in the IME total time. Do not bill record review with Z0755.
  • Although the preparation and exam may span several days, the date of the IME report should match the IME invoice.
  • Pinnacol cannot change any information on the invoice unless we speak with the provider directly or receive an email request from the provider.
  • The physician may refer a psychological component of the IME to a psychologist and incorporate that evaluation into the IME report.
  • Invoices should be submitted on a CMS1500 form.
  • Submit your invoice to fax number 303-361-5820. Invoices may also be mailed to: Pinnacol Assurance, PO Box 469013, Denver, CO 80246

If you have any questions or need additional information, please contact the Medical Payments and Quality Assurance team at medops_qa@pinnacol.com or 303-361-4940. 

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