2018 Workers' Compensation Part B Fee Schedule

01829-11643

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CPT/HCPC Code
Modifier
Medicare Location
Global Surgery Indicator
Multiple Surgery Indicator
Prevailing Charge Amount
Fee Schedule Amount
Site of Service Amount
01829   1 XXX 9 59.44 0 0
01829   2 XXX 9 59.05 0 0
01829   3 XXX 9 56.83 0 0
01829   4 XXX 9 52.95 0 0
01830   1 XXX 9 59.44 0 0
01830   2 XXX 9 59.05 0 0
01830   3 XXX 9 56.83 0 0
01830   4 XXX 9 52.95 0 0
01832   1 XXX 9 59.44 0 0
01832   2 XXX 9 59.05 0 0
01832   3 XXX 9 56.83 0 0
01832   4 XXX 9 52.95 0 0
01840   1 XXX 9 59.44 0 0
01840   2 XXX 9 59.05 0 0
01840   3 XXX 9 56.83 0 0
01840   4 XXX 9 52.95 0 0
01842   1 XXX 9 59.44 0 0
01842   2 XXX 9 59.05 0 0
01842   3 XXX 9 56.83 0 0
01842   4 XXX 9 52.95 0 0
01844   1 XXX 9 59.44 0 0
01844   2 XXX 9 59.05 0 0
01844   3 XXX 9 56.83 0 0
01844   4 XXX 9 52.95 0 0
01850   1 XXX 9 59.44 0 0
01850   2 XXX 9 59.05 0 0
01850   3 XXX 9 56.83 0 0
01850   4 XXX 9 52.95 0 0
01852   1 XXX 9 59.44 0 0
01852   2 XXX 9 59.05 0 0
01852   3 XXX 9 56.83 0 0
01852   4 XXX 9 52.95 0 0
01860   1 XXX 9 59.44 0 0
01860   2 XXX 9 59.05 0 0
01860   3 XXX 9 56.83 0 0
01860   4 XXX 9 52.95 0 0
01916   1 XXX 9 59.44 0 0
01916   2 XXX 9 59.05 0 0
01916   3 XXX 9 56.83 0 0
01916   4 XXX 9 52.95 0 0
01920   1 XXX 9 59.44 0 0
01920   2 XXX 9 59.05 0 0
01920   3 XXX 9 56.83 0 0
01920   4 XXX 9 52.95 0 0
01922   1 XXX 9 59.44 0 0
01922   2 XXX 9 59.05 0 0
01922   3 XXX 9 56.83 0 0
01922   4 XXX 9 52.95 0 0
01924   1 XXX 9 59.44 0 0
01924   2 XXX 9 59.05 0 0
01924   3 XXX 9 56.83 0 0
01924   4 XXX 9 52.95 0 0
01925   1 XXX 9 59.44 0 0
01925   2 XXX 9 59.05 0 0
01925   3 XXX 9 56.83 0 0
01925   4 XXX 9 52.95 0 0
01926   1 XXX 9 59.44 0 0
01926   2 XXX 9 59.05 0 0
01926   3 XXX 9 56.83 0 0
01926   4 XXX 9 52.95 0 0
01930   1 XXX 9 59.44 0 0
01930   2 XXX 9 59.05 0 0
01930   3 XXX 9 56.83 0 0
01930   4 XXX 9 52.95 0 0
01931   1 XXX 9 59.44 0 0
01931   2 XXX 9 59.05 0 0
01931   3 XXX 9 56.83 0 0
01931   4 XXX 9 52.95 0 0
01932   1 XXX 9 59.44 0 0
01932   2 XXX 9 59.05 0 0
01932   3 XXX 9 56.83 0 0
01932   4 XXX 9 52.95 0 0
01933   1 XXX 9 59.44 0 0
01933   2 XXX 9 59.05 0 0
01933   3 XXX 9 56.83 0 0
01933   4 XXX 9 52.95 0 0
01935   1 XXX 9 59.44 0 0
01935   2 XXX 9 59.05 0 0
01935   3 XXX 9 56.83 0 0
01935   4 XXX 9 52.95 0 0
01936   1 XXX 9 59.44 0 0
01936   2 XXX 9 59.05 0 0
01936   3 XXX 9 56.83 0 0
01936   4 XXX 9 52.95 0 0
01951   1 XXX 9 59.44 0 0
01951   2 XXX 9 59.05 0 0
01951   3 XXX 9 56.83 0 0
01951   4 XXX 9 52.95 0 0
01952   1 XXX 9 59.44 0 0
01952   2 XXX 9 59.05 0 0
01952   3 XXX 9 56.83 0 0
01952   4 XXX 9 52.95 0 0
01953   1 XXX 9 59.44 0 0
01953   2 XXX 9 59.05 0 0
01953   3 XXX 9 56.83 0 0
01953   4 XXX 9 52.95 0 0
01958   1 XXX 9 59.44 0 0
01958   2 XXX 9 59.05 0 0
01958   3 XXX 9 56.83 0 0
01958   4 XXX 9 52.95 0 0
01960   1 XXX 9 59.44 0 0
01960   2 XXX 9 59.05 0 0
01960   3 XXX 9 56.83 0 0
01960   4 XXX 9 52.95 0 0
01961   1 XXX 9 59.44 0 0
01961   2 XXX 9 59.05 0 0
01961   3 XXX 9 56.83 0 0
01961   4 XXX 9 52.95 0 0
01961   1 XXX 9 59.44 0 0
01962   2 XXX 9 59.05 0 0
01962   3 XXX 9 56.83 0 0
01962   4 XXX 9 52.95 0 0
01963   1 XXX 9 59.44 0 0
01963   2 XXX 9 59.05 0 0
01963   3 XXX 9 56.83 0 0
01963   4 XXX 9 52.95 0 0
01965   1 XXX 9 59.44 0 0
01965   2 XXX 9 59.05 0 0
01965   3 XXX 9 56.84 0 0
01965   4 XXX 9 52.95 0 0
01966   1 XXX 9 59.44 0 0
01966   2 XXX 9 59.05 0 0
01966   3 XXX 9 56.84 0 0
01966   4 XXX 9 52.95 0 0
01967   1 XXX 9 59.44 0 0
01967   2 XXX 9 59.05 0 0
01967   3 XXX 9 56.83 0 0
01967   4 XXX 9 52.95 0 0
01968   1 XXX 9 59.44 0 0
01968   2 XXX 9 59.05 0 0
01968   3 XXX 9 56.83 0 0
01968   4 XXX 9 52.95 0 0
01969   1 XXX 9 59.44 0 0
01969   2 XXX 9 59.05 0 0
01969   3 XXX 9 56.83 0 0
01969   4 XXX 9 52.95 0 0
01990   1 XXX 9 59.44 0 0
01990   2 XXX 9 59.05 0 0
01990   3 XXX 9 56.83 0 0
01990   4 XXX 9 52.95 0 0
01991   1 XXX 9 59.44 0 0
01991   2 XXX 9 59.05 0 0
01991   3 XXX 9 56.83 0 0
01991   4 XXX 9 52.95 0 0
01992   1 XXX 9 59.44 0 0
01992   2 XXX 9 59.05 0 0
01992   3 XXX 9 56.83 0 0
01992   4 XXX 9 52.95 0 0
01996   1 XXX 9 59.44 0 0
01996   2 XXX 9 59.05 0 0
01996   3 XXX 9 56.83 0 0
01996   4 XXX 9 52.95 0 0
01999   1 XXX 9 59.44 0 0
01999   2 XXX 9 59.05 0 0
01999   3 XXX 9 56.83 0 0
01999   4 XXX 9 52.95 0 0
10021   1 XXX 0 0 161.84 0
10021 26 1 XXX 0 0 126.65 0
10021 TC 1 XXX 0 0 35.21 0
10021   2 XXX 0 0 144.55 0
10021 26 2 XXX 0 0 115.38 0
10021 TC 2 XXX 0 0 29.13 0
10021   3 XXX 0 0 144.55 0
10021 26 3 XXX 0 0 115.38 0
10021 TC 3 XXX 0 0 29.13 0
10021   4 XXX 0 0 144.55 0
10021 26 4 XXX 0 0 115.38 0
10021 TC 4 XXX 0 0 29.13 0
10022   1 XXX 0 0 166.27 0
10022 26 1 XXX 0 0 120.01 0
10022 TC 1 XXX 0 0 46.29 0
10022   2 XXX 0 0 148.88 0
10022 26 2 XXX 0 0 110.29 0
10022 TC 2 XXX 0 0 38.57 0
10022   3 XXX 0 0 148.88 0
10022 26 3 XXX 0 0 110.29 0
10022 TC 3 XXX 0 0 38.57 0
10022   4 XXX 0 0 148.88 0
10022 26 4 XXX 0 0 110.29 0
10022 TC 4 XXX 0 0 38.57 0
10030   1 XXX 2 0 1,051.05 209.62
10030   2 XXX 2 0 916.80 194.56
10030   3 XXX 2 0 916.80 194.56
10030   4 XXX 2 0 916.80 194.56
10035   1 0 2 0 695.83 111.69
10035   2 0 2 0 603.20 103.97
10035   3 0 2 0 603.20 103.97
10035   4 0 2 0 603.20 103.97
10036   1 ZZZ 2 0 606.40 56.34
10036   2 ZZZ 2 0 522.49 52.39
10036   3 ZZZ 2 0 522.49 52.39
10036   4 ZZZ 2 0 522.49 52.39
10040     10 2 0 * 0
10060   1 10 2 0 130.53 113.04
10060   2 10 2 0 127.96 110.73
10060   3 10 2 0 125.24 108.52
10060   4 10 2 0 122.97 106.89
10061   1 10 2 0 272.08 244.88
10061   2 10 2 0 267.95 241.63
10061   3 10 2 0 228.81 206.52
10061   4 10 2 0 194.97 175.87
10080   1 10 2 0 155.80 138.09
10080   2 10 2 0 162.51 143.86
10080   3 10 2 0 154.09 136.80
10080   4 10 2 0 138.91 123.45
10081   1 10 2 0 317.53 0
10081   2 10 2 0 313.58 0
10081   3 10 2 0 308.08 0
10081   4 10 2 0 306.66 0
10120   1 10 2 0 146.12 126.48
10120   2 10 2 0 144.60 125.19
10120   3 10 2 0 134.84 116.68
10120   4 10 2 0 136.66 118.64
10121   1 10 2 0 323.30 281.06
10121   2 10 2 0 319.76 278.05
10121   3 10 2 0 305.31 265.94
10121   4 10 2 0 302.01 263.27
10140   1 10 2 0 153.66 135.13
10140   2 10 2 0 152.34 133.81
10140   3 10 2 0 142.30 125.01
10140   4 10 2 0 135.97 119.58
10160   1 10 2 0 125.03 110.24
10160   2 10 2 0 134.31 118.79
10160   3 10 2 0 127.90 113.05
10160   4 10 2 0 122.16 108.04
10180   1 10 2 0 358.96 0
10180   2 10 2 0 358.80 0
10180   3 10 2 0 346.92 0
10180   4 10 2 0 347.36 0
11000   1 0 2 0 115.56 98.85
11000   2 0 2 0 114.33 97.82
11000   3 0 2 0 109.15 93.59
11000   4 0 2 0 107.92 92.61
11001   1 ZZZ 0 0 62.80 51.90
11001   2 ZZZ 0 0 62.11 51.37
11001   3 ZZZ 0 0 59.26 49.10
11001   4 ZZZ 0 0 58.57 48.66
11004   1 0 2 0 964.17 0
11004   2 0 2 0 884.17 0
11004   3 0 2 0 884.17 0
11004   4 0 2 0 884.17 0
11005   1 0 0 0 1,315.69 0
11005   2 0 0 0 1,202.62 0
11005   3 0 0 0 1,202.62 0
11005   4 0 0 0 1,202.62 0
11006   1 0 2 0 1,223.74 0
11006   2 0 2 0 1,108.70 0
11006   3 0 2 0 1,108.70 0
11006   4 0 2 0 1,108.70 0
11008   1 ZZZ 0 0 500.46 0
11008   2 ZZZ 0 0 450.10 0
11008   3 ZZZ 0 0 450.10 0
11008   4 ZZZ 0 0 450.10 0
11010   1 10 2 0 782.13 0
11010   2 10 2 0 699.61 0
11010   3 10 2 0 680.81 0
11010   4 10 2 0 680.81 0
11011   1 0 2 0 931.99 0
11011   2 0 2 0 833.87 0
11011   3 0 2 0 811.44 0
11011   4 0 2 0 811.44 0
11012   1 0 2 0 1,295.29 0
11012   2 0 2 0 1,158.94 0
11012   3 0 2 0 1,127.81 0
11012   4 0 2 0 1,127.81 0
11042   1 0 2 0 216.28 0
11042   2 0 2 0 190.96 0
11042   3 0 2 0 170.97 0
11042   4 0 2 0 161.74 0
11043   1 10 2 0 383.80 0
11043   2 10 2 0 385.48 0
11043   3 10 2 0 396.49 0
11043   4 10 2 0 346.40 0
11044   1 10 2 0 495.79 0
11044   2 10 2 0 486.96 0
11044   3 10 2 0 450.46 0
11044   4 10 2 0 445.02 0
11045   1 ZZZ 0 0 45.92 27.02
11045   2 ZZZ 0 0 41.07 24.38
11045   3 ZZZ 0 0 41.07 24.38
11045   4 ZZZ 0 0 41.07 24.38
11046   1 ZZZ 0 0 79.26 56.40
11046   2 ZZZ 0 0 71.53 51.34
11046   3 ZZZ 0 0 71.53 51.34
11046   4 ZZZ 0 0 71.53 51.34
11047   1 ZZZ 0 0 130.81 98.53
11047   2 ZZZ 0 0 117.96 89.41
11047   3 ZZZ 0 0 117.96 89.41
11047   4 ZZZ 0 0 117.96 89.41
11055   1 0 2 0 41.66 30.91
11055   2 0 2 0 37.40 28.22
11055   3 0 2 0 37.40 28.22
11055   4 0 2 0 37.40 28.22
11056   1 0 2 0 58.62 44.15
11056   2 0 2 0 52.46 40.18
11056   3 0 2 0 52.46 40.18
11056   4 0 2 0 52.46 40.18
11057   1 0 2 0 60.64 49.08
11057   2 0 2 0 55.09 45.27
11057   3 0 2 0 55.09 45.27
11057   4 0 2 0 55.09 45.27
11100   1 0 2 0 139.61 111.09
11100   2 0 2 0 138.89 110.65
11100   3 0 2 0 137.83 109.89
11100   4 0 2 0 131.35 104.95
11101   1 ZZZ 0 0 61.12 49.01
11101   2 ZZZ 0 0 60.45 48.45
11101   3 ZZZ 0 0 57.53 46.21
11101   4 ZZZ 0 0 56.84 45.70
11200   1 10 2 0 117.29 96.10
11200   2 10 2 0 109.24 89.61
11200   3 10 2 0 103.70 84.91
11200   4 10 2 0 109.81 90.32
11201   1 ZZZ 0 0 38.52 31.43
11201   2 ZZZ 0 0 38.03 31.02
11201   3 ZZZ 0 0 36.03 29.34
11201   4 ZZZ 0 0 35.60 29.07
11300   1 0 2 0 121.14 96.60
11300   2 0 2 0 119.61 95.37
11300   3 0 2 0 119.39 95.47
11300   4 0 2 0 107.33 85.62
11301   1 0 2 0 136.56 108.12
11301   2 0 2 0 134.84 106.75
11301   3 0 2 0 147.29 120.19
11301   4 0 2 0 126.20 100.10
11302   1 0 2 0 175.53 137.88
11302   2 0 2 0 173.18 136.04
11302   3 0 2 0 188.39 152.64
11302   4 0 2 0 161.59 127.08
11303   1 0 2 0 308.79 0
11303   2 0 2 0 303.78 0
11303   3 0 2 0 311.79 0
11303   4 0 2 0 293.43 0
11305   1 0 2 0 107.66 85.46
11305   2 0 2 0 106.29 84.40
11305   3 0 2 0 122.71 100.66
11305   4 0 2 0 118.84 97.42
11306   1 0 2 0 152.88 122.73
11306   2 0 2 0 150.95 121.24
11306   3 0 2 0 143.03 114.97
11306   4 0 2 0 141.38 113.73
11307   1 0 2 0 202.14 164.11
11307   2 0 2 0 185.98 146.76
11307   3 0 2 0 219.51 179.56
11307   4 0 2 0 173.51 137.05
11308   1 0 2 0 260.26 0
11308   2 0 2 0 318.02 0
11308   3 0 2 0 325.19 0
11308   4 0 2 0 325.28 0
11310   1 0 2 0 162.28 129.59
11310   2 0 2 0 158.50 126.69
11310   3 0 2 0 161.25 129.18
11310   4 0 2 0 146.60 117.29
11311   1 0 2 0 212.20 172.72
11311   2 0 2 0 207.53 168.89
11311   3 0 2 0 213.96 174.60
11311   4 0 2 0 186.29 152.14
11312   1 0 2 0 252.97 203.09
11312   2 0 2 0 256.08 204.95
11312   3 0 2 0 253.44 203.74
11312   4 0 2 0 192.94 149.58
11313   1 0 2 0 341.83 0
11313   2 0 2 0 330.55 0
11313   3 0 2 0 368.51 0
11313   4 0 2 0 343.32 0
11400   1 10 2 0 135.62 111.08
11400   2 10 2 0 134.09 109.79
11400   3 10 2 0 133.43 109.54
11400   4 10 2 0 121.22 99.50
11401   1 10 2 0 171.71 143.24
11401   2 10 2 0 169.73 141.68
11401   3 10 2 0 164.32 137.23
11401   4 10 2 0 160.00 133.92
11402   1 10 2 0 218.99 181.35
11402   2 10 2 0 216.41 179.27
11402   3 10 2 0 209.39 173.67
11402   4 10 2 0 203.45 168.95
11403   1 10 2 0 284.38 233.00
11403   2 10 2 0 287.63 235.80
11403   3 10 2 0 294.61 242.10
11403   4 10 2 0 273.88 224.69
11404   1 10 2 0 331.44 0
11404   2 10 2 0 316.31 0
11404   3 10 2 0 353.48 0
11404   4 10 2 0 337.12 0
11406   1 10 2 0 517.96 0
11406   2 10 2 0 497.70 0
11406   3 10 2 0 478.30 0
11406   4 10 2 0 462.69 0
11420   1 10 2 0 136.11 113.91
11420   2 10 2 0 134.57 112.64
11420   3 10 2 0 136.36 114.33
11420   4 10 2 0 132.42 110.96
11421   1 10 2 0 194.70 164.61
11421   2 10 2 0 192.58 162.80
11421   3 10 2 0 183.62 155.61
11421   4 10 2 0 181.56 153.99
11422   1 10 2 0 226.15 188.11
11422   2 10 2 0 234.21 195.00
11422   3 10 2 0 242.83 202.87
11422   4 10 2 0 220.12 183.72
11423   1 10 2 0 308.72 253.50
11423   2 10 2 0 335.48 274.99
11423   3 10 2 0 347.94 285.39
11423   4 10 2 0 331.44 272.74
11424   1 10 2 0 356.03 0
11424   2 10 2 0 338.09 0
11424   3 10 2 0 342.99 0
11424   4 10 2 0 395.77 0
11426   1 10 2 0 507.39 0
11426   2 10 2 0 500.88 0
11426   3 10 2 0 488.54 0
11426   4 10 2 0 468.71 0
11440   1 10 2 0 177.59 144.93
11440   2 10 2 0 173.71 141.96
11440   3 10 2 0 176.12 144.05
11440   4 10 2 0 161.40 131.96
11441   1 10 2 0 233.85 194.37
11441   2 10 2 0 229.08 190.44
11441   3 10 2 0 235.00 195.61
11441   4 10 2 0 207.06 172.96
11442   1 10 2 0 279.08 229.19
11442   2 10 2 0 282.02 230.88
11442   3 10 2 0 278.73 229.07
11442   4 10 2 0 243.61 200.29
11443   1 10 2 0 362.12 297.61
11443   2 10 2 0 367.93 302.90
11443   3 10 2 0 379.27 313.08
11443   4 10 2 0 358.42 296.14
11444   1 10 2 0 364.04 0
11444   2 10 2 0 326.65 0
11444   3 10 2 0 446.27 0
11444   4 10 2 0 386.04 0
11446   1 10 2 0 650.06 0
11446   2 10 2 0 574.03 0
11446   3 10 2 0 618.01 0
11446   4 10 2 0 626.82 0
11450   1 90 2 0 733.70 0
11450   2 90 2 0 752.97 0
11450   3 90 2 0 772.69 0
11450   4 90 2 0 697.28 0
11451   1 90 2 0 1,301.49 0
11451   2 90 2 0 1,297.59 0
11451   3 90 2 0 578.47 0
11451   4 90 2 0 571.74 0
11462   1 90 2 0 695.85 0
11462   2 90 2 0 869.52 0
11462   3 90 2 0 857.16 0
11462   4 90 2 0 408.62 0
11463   1 90 2 0 533.83 0
11463   2 90 2 0 526.64 0
11463   3 90 2 0 497.01 0
11463   4 90 2 0 956.10 0
11470   1 90 2 0 907.59 0
11470   2 90 2 0 893.55 0
11470   3 90 2 0 816.09 0
11470   4 90 2 0 886.21 0
11471   1 90 2 0 1,304.38 0
11471   2 90 2 0 1,300.48 0
11471   3 90 2 0 584.02 0
11471   4 90 2 0 577.55 0
11600   1 10 2 0 254.13 197.37
11600   2 10 2 0 252.61 195.67
11600   3 10 2 0 247.27 191.97
11600   4 10 2 0 247.52 192.16
11601   1 10 2 0 305.75 244.18
11601   2 10 2 0 306.34 244.86
11601   3 10 2 0 296.31 237.21
11601   4 10 2 0 295.16 235.79
11602   1 10 2 0 367.08 285.12
11602   2 10 2 0 360.63 280.15
11602   3 10 2 0 356.70 278.16
11602   4 10 2 0 325.85 254.62
11603   1 10 2 0 423.87 326.23
11603   2 10 2 0 435.68 334.69
11603   3 10 2 0 433.51 333.99
11603   4 10 2 0 393.08 303.19
11604   1 10 2 0 538.57 0
11604   2 10 2 0 553.77 0
11604   3 10 2 0 527.94 0
11604   4 10 2 0 539.05 0
11606   1 10 2 0 785.83 0
11606   2 10 2 0 779.66 0
11606   3 10 2 0 689.91 0
11606   4 10 2 0 780.06 0
11620   1 10 2 0 289.63 220.96
11620   2 10 2 0 283.83 216.15
11620   3 10 2 0 272.54 207.40
11620   4 10 2 0 274.54 209.36
11621   1 10 2 0 382.04 296.83
11621   2 10 2 0 374.15 290.38
11621   3 10 2 0 367.37 285.67
11621   4 10 2 0 319.51 248.41
11622   1 10 2 0 411.68 316.80
11622   2 10 2 0 405.54 312.69
11622   3 10 2 0 399.72 307.50
11622   4 10 2 0 372.30 287.17
11623   1 10 2 0 493.85 384.68
11623   2 10 2 0 487.33 379.57
11623   3 10 2 0 463.62 359.36
11623   4 10 2 0 454.55 354.48
11624   1 10 2 0 599.07 0
11624   2 10 2 0 590.92 0
11624   3 10 2 0 577.28 0
11624   4 10 2 0 559.06 0
11626   1 10 2 0 710.88 0
11626   2 10 2 0 700.24 0
11626   3 10 2 0 656.43 0
11626   4 10 2 0 687.11 0
11640   1 10 2 0 336.59 254.01
11640   2 10 2 0 330.86 249.44
11640   3 10 2 0 307.00 231.81
11640   4 10 2 0 312.00 235.29
11641   1 10 2 0 412.41 319.94
11641   2 10 2 0 413.28 320.40
11641   3 10 2 0 400.88 311.83
11641   4 10 2 0 372.85 289.85
11642   1 10 2 0 493.98 382.41
11642   2 10 2 0 486.86 377.30
11642   3 10 2 0 489.41 379.27
11642   4 10 2 0 452.18 352.50
11643   1 10 2 0 582.21 455.03
11643   2 10 2 0 574.62 449.15
11643   3 10 2 0 561.68 438.74
11643   4 10 2 0 536.63 420.10