2017 Workers' Compensation Fee Schedule

Table A: Prospective Payment System

NPI or Provider #
Provider #
Indirect Medical Education Add-On
Direct Medical Education Add-On
Disproportionate Share Add-On
Paramedical Education Add-On
Aggregate RCC
DRG Rate
Capital Rate
Hold Harmless Rate
Implied Decimal 6
(in percentages)
Implied Decimal 4
(in percentages)
Implied Decimal 6
(in percentages)
Implied Decimal 2 (in dollars)
1528039039 390127 0 0 0 0 633294 826888 92372 0
1184620486 390130 0 0 0 0 3156950 678618 47341 0
1164400131 390133 96119 30636 0 2145 517000 771433 70274 0
1255585303 390137 23063 14230 635 0 455845 679854 66672 0
1821091059 390138 0 0 0 0 791148 677161 48888 0
1508971441 390139 70978 34408 0 4335 408291 826888 80342 0
1902805245 390142 369904 212140 1506 4035 365688 826888 195654 0
1689691214 390145 0 0 360 1235 427067 755642 81308 0
1659360220 390146 0 0 0 0 896975 677161 66995 0
1912905548 390147 0 0 0 0 549750 755642 81360 0
1225417421 390150 0 0 0 0 591382 677161 65752 0
1972982882 390150 0 0 0 0 591382 677161 65752 0
1902804552 390151 0 0 0 0 640294 677161 45480 0
1215042114 390153 0 0 0 0 894406 826888 109294 0
1730173550 390156 159051 111309 1547 0 352862 826888 92893 0
1861486698 390156 159051 111309 1547 0 352862 826888 92893 0
1073598439 390157 0 0 0 35511 621777 755642 77331 0
1962401497 390160 0 0 0 0 846365 755642 77331 0
1740252964 390162 75610 51350 0 0 625314 771433 67474 0
1457408973 390163 0 0 374 0 909003 688058 59997 0
1568577724 390163 0 0 374 0 909003 688058 59997 0
1144384082 390164 429609 170349 862 7967 363586 755642 30093 230464
1821007881 390164 429609 170349 862 7967 363586 755642 30093 230464
1447317896 390168 0 0 732 0 515034 755642 14975 83013
1356334510 390173 0 0 0 0 537053 723515 20540 67045
1134297393 390174 52652 34199 731 45941 383273 826888 12724 165754
1215916002 390174 463742 229874 1399 15681 377172 826888 19845 230250
1225048838 390178 28914 1845 826 0 674040 695284 65489 0
1952465890 390178 28914 1845 826 0 674040 695284 65489 0
1356333579 390179 0 0 260 41582 430116 826888 48963 71945
1457715146 390180 112319 70954 923 9057 384000 826888 88891 0
1437182847 390183 0 0 0 0 569778 677161 68463 0
1144215039 390184 0 0 0 0 815338 755642 48172 0
1548322720 390185 18769 18809 0 15960 461393 679854 59672 0
1528061314 390189 0 0 0 0 1217656 733139 67931 0
1518256726 390192 0 0 0 0 635752 679854 57212 0
1356354567 390194 0 0 0 0 565986 759217 78220 0
1245335629 390195 146350 43945 0 21370 404312 826888 67877 0
1952399933 390197 65092 34620 353 4497 455759 771433 78882 0
1548263973 390198 157011 55037 1444 0 386206 697117 39102 0
1265449870 390199 0 0 840 0 649447 677161 60051 0
1568459436 390201 0 0 0 0 473822 942652 68463 0
1225091697 390203 0 0 0 2762 460513 826888 127835 0
1124023015 390204 0 0 0 6730 410795 826888 109587 0
1184672214 390211 0 0 359 42894 516785 695284 70829 0
1144255159 390217 0 0 803 0 613350 755642 59716 0
1821015462 390219 51991 28021 360 3160 445265 755642 61185 0
1336110287 390220 0 0 0 0 469486 826888 35628 91348
1407856099 390222 0 0 0 0 402183 826888 60361 0
1245207521 390223 232106 71719 1750 19353 450145 826888 148057 0
1083615587 390225 0 0 0 0 676859 717871 69187 0
1548423684 390225 0 0 0 0 676859 717871 69187 0
1063489342 390226 0 79589 0 4412 431688 826888 6532 228981
1073587119 390228 0 0 0 0 490321 755642 80047 0
1811992084 390231 129440 54408 0 21332 366297 826888 98232 0
1730158981 390233 0 0 0 0 731036 699479 62291 0
1164421335 390236 0 0 0 0 645768 677161 69998 0
1336314384 390236 0 0 0 0 645768 677161 69998 0
1881983039 390237 15748 15537 0 1102 537339 679854 68739 0
1568435477 390256 543218 185283 516 1423 868053 733139 62619 0
1780686931 390258 0 0 0 0 941264 826888 50586 104694
1598743585 390263 13629 2497 0 0 624901 759217 60702 0
1578560504 390265 0 0 0 0 506455 755642 77331 0
1023000296 390266 0 0 0 0 889640 695284 70300 0
1679592380 390267 51991 29760 0 0 527563 755642 77331 0
1104991801 390268 0 0 0 4552 868457 747871 72088 0
1730173154 390268 0 0 0 4552 868457 747871 72088 0
1780750620 390268 0 0 0 4552 868457 747871 72088 0
1093001653 390270 0 0 0 0 415541 679854 21806 96561
1174822068 390270 0 0 0 0 415541 679854 21806 96561
1205197894 390270 0 0 0 0 415541 679854 21806 96561
1235424672 390270 0 0 0 0 415541 679854 21806 96561
1265728810 390270 0 0 0 0 415541 679854 21806 96561
1275620585 390270 0 0 0 0 415541 679854 21806 96561
1447538640 390270 0 0 0 0 415541 679854 21806 96561
1649305129 390270 0 0 0 0 415541 679854 21806 96561
1649568403 390270 0 0 0 0 415541 679854 21806 96561
1669768214 390270 0 0 0 0 415541 679854 21806 96561
1760777106 390270 0 0 0 0 415541 679854 21806 96561
1770953994 390270 0 0 0 0 415541 679854 21806 96561
1861791865 390270 0 0 0 0 415541 679854 21806 96561
1881980803 390270 0 0 0 0 415541 679854 21806 96561
1528026671 390272 0 0 500 0 0 826888 31007 0
1467510560 390278 0 0 9140 0 0 826888 116812 0
1023033792 390290 402638 145927 1513 4863 330477 826888 134623 0
1043240351 390302 0 0 0 0 412000 826888 84215 0
1821020421 390304 0 0 294 52838 496395 826888 140096 0
1659392595 390307 0 0 0 0 403000 695284 70300 0
1780919043 390307 0 0 0 0 403000 695284 70300 0
1427097864 390314 0 0 0 0 300000 759217 76583 0
1124193511 390316 0 0 0 0 300000 707815 71549 0
1043456957 390321 0 0 0 0 284000 771433 76607 0
1336378132 390322 0 0 0 0 284000 826888 84215 0
1528398534 390323 0 0 0 0 278000 755642 77329 0
1265664544 390324 0 0 0 0 271000 826888 84215 0
1578881652 390325 0 0 0 0 271000 699479 70715 0
1962758375 390325 0 0 0 0 271000 699479 70715 0
1497050470 390326 0 0 0 0 271000 771433 76607 0
1760787576 390327 0 0 0 0 407000 699479 70715 0
1225323983 390328 0 0 0 0 268000 755642 77331 0
1104192590 390329 0 0 0 0 268000 826888 84215 0
1396194197 390330 0 0 0 0 389000 679854 68739 0
999993 999993 75972 37367 433 8021 431343 733139 74041 0