Qme Form 105 Request For Qualified Medical Evaluator Panel (Unrepresented Employee) Page 3
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3For Use with the QME Panel Request Form 105
MD/DO SPECIALTY CODES
MAA Anesthesiology
MHH Orthopedic Surgery - Hand
MAI
Allergy & Immunology
MTO Otolaryngology
MHA Pathology
MPA Pain Medicine
MDE Dermatology
MPR Physical Medicine & Rehabilitation
MPA Physical Medicine & Rehabilitation – Pain Medicine
MAI
Dermatology – Allergy & Immunology
MEM Emergency Medicine
MPS
Plastic Surgery (other than Hand)
MHH Plastic Surgery – Hand
MTT Emergency Medicine – Toxicology
MFP Family Practice
MPD
Psychiatry (other than Pain Medicine)
MPA
Psychiatry – Pain Medicine
MPM General Preventive Medicine
MTT General Preventive Medicine – Toxicology
MSY Surgery (other than Spine or Hand)
MHH Surgery - Hand
MMM Internal Medicine
MSG
Surgery- General Vascular
MAI
Internal Medicine- Allergy & Immunology
MMV Internal Medicine – Cardiolvascular Disease
MTS
Thoracic Surgery
MUU Urology
MME Internal Medicine - Endocrinology Diabetes & Metabolism
MMG Internal Medicine – Gastroenterology
NON-MD/DO SPECIALTIES CODES
MMH Internal Medicine – Hematology
ACA
Acupuncture
MMI Internal Medicine – Infectious Disease
DCH
Chiropractic
MMO Internal Medicine – Medical Oncology
DEN
Dentistry
MMN Internal Medicine – Nephrology
OPT
Optometry
MMP Internal Medicine – Pulmonary Disease
POD
Podiatry
MMR Internal Medicine – Rheumatology
PSY
Psychology
MPN Neurology
MPA Neurology – Pain Medicine
MNS Neurological Surgery (other than Spine)
MNB Neurological Surgery – Spine
MOG Obstetrics & Gynecology
MOQ Medicine Otherwise Qualified
MPO Occupational Medicine
MTT Occupational Medicine – Toxicology
MOP Ophthalmology
MOS Orthopedic Surgery (other than Spine or Hand)
MNB Orthopedic Surgery - Spine
Do not file this page with your form!
QME Form 105 (rev. 09/15)
Page 3
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