Occupational Medicine Billing Services
Occupational medicine has more than one customer. A single visit may involve the patient, the employer, a workers' compensation insurer and sometimes a health plan. Each one expects different paperwork, and each pays under different rules.
Billing for occupational health is also split between injury care and employer services. Treating a work injury follows state workers' compensation fee schedules. Pre-employment exams, drug screens and DOT physicals are often paid by the employer. Westmont Revenue Partners connects occupational medicine practices with vetted billing experts who know how to separate these payer streams and keep each claim tied to the right party.
Who this is for
- Occupational medicine physicians and clinics
- Urgent care centers with an employer services line
- Hospital-based occupational health programs
- Practices that provide DOT and commercial driver exams
- Clinics that serve self-insured employers
What gets billed
- Work injury evaluation and treatment
- Follow-up visits for workers' compensation cases
- Pre-employment and return-to-work exams
- DOT and commercial driver physicals
- Drug and alcohol testing
- Hearing screening
- Breathing tests
- Vaccines and titer testing for employees
- Work status and special reports
- Impairment and disability examinations
- Employer-contracted wellness services
Commonly billed codes
| Code | Type | What it covers |
|---|---|---|
| 99203 | CPT | New patient office visit, low level |
| 99213 | CPT | Established patient visit, low level |
| 99214 | CPT | Established patient visit, moderate level |
| 99455 | CPT | Work-related or medical disability exam by the treating provider |
| 99456 | CPT | Work-related or medical disability exam by someone other than the treating provider |
| 99080 | CPT | Special reports, such as forms beyond the usual medical records |
| 94010 | CPT | Breathing test measuring air flow and lung volume |
| 92551 | CPT | Hearing screening, air only |
| 80305 | CPT | Presumptive drug screen read by direct observation |
| 29125 | CPT | Short arm splint, static |
| Z02.1 | ICD-10-CM | Encounter for pre-employment exam |
| Z02.4 | ICD-10-CM | Encounter for driving license exam |
Note
Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.
Billing challenges in occupational medicine
State fee schedules. Workers' compensation pays under state schedules that differ from Medicare and commercial rates. Billers keep state rules current and check each claim against the schedule.
Claim and employer details. Claims need the date of injury, employer, claim number and adjuster. Missing details cause rejections. Billers build intake checklists and verify them at registration.
Authorization for treatment. Many workers' comp payers require approval for care beyond the first visit. Billers track authorizations and request extensions in time.
Special report codes. Some payers pay for work status forms and some bundle them. Billers know which payers accept them and what documentation is needed.
Employer-paid services. Pre-employment, DOT and drug testing are often billed directly to the employer under contract. Billers keep these separate from insurance claims and invoice correctly.
Compensability disputes. A payer may deny a claim if it questions whether the injury is work-related. Billers support appeals with documentation and follow state dispute timelines.
Mixed billing for one visit. A visit may combine a work injury and an unrelated health concern. Billers split services so each goes to the proper payer.
How Westmont can help
- Matching you with vetted billing experts experienced in workers' comp and employer services
- End-to-end revenue cycle support, including employer invoicing
- Denial management and appeals for compensability and authorization issues
- Credentialing and workers' comp network enrollment support
- Reporting that separates payer types and flags aging balances
Frequently asked questions
How is occupational medicine billing different from regular billing?
Many claims go to workers' compensation insurers or employers, not health plans. These payers use state fee schedules, require claim numbers and often need approval for care. Employer services are billed under contracts. A biller with occupational experience can manage each payer type correctly.
Who pays for a work injury visit?
In most cases the employer's workers' compensation insurer is responsible, not the patient's health plan. The details depend on state law and on whether the claim is accepted. Billers confirm the carrier and claim number at registration and track the claim status.
Can I bill a work status form?
Some payers pay for special reports or work status forms, and others consider them part of the visit. Rules vary by state and carrier. Check the fee schedule and carrier policy, and keep records of what was submitted and when.
Do DOT physicals go through insurance?
Generally no. Employers or drivers typically pay for DOT physicals directly, since health plans usually do not cover them as medical care. Practices usually invoice the employer or collect payment at the visit. Confirm the arrangement before the exam, including who receives the invoice and what the fee covers. Written agreements with employers reduce disputes later.
What should I look for in an occupational medicine billing company?
Look for experience with workers' compensation in your states, employer invoicing and appeals. Ask how they handle authorizations and claim tracking. Westmont can connect you with vetted billing experts so you can compare options and choose a fit. Ask for references from similar clinics and for sample reports.
Related billing services
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