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Health Care Services Review
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Medical Fee Review
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Fee Schedule
>
Fee Schedule 26567-27178
Begin Main Content Area
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Content Editor
2024 Workers' Compensation Part B Fee Schedule
26567-27178
View the PDF
CPT/HCPC Code
Modifier
Medicare Location
Global Surgery Indicator
Multiple Surgery Indicator
Prevailing Charge Amount
Fee Schedule Amount
Site of Service Amount
26567
003
90
2
X
1,200.80
X
26567
002
90
2
X
1,276.49
X
26567
004
90
2
X
1,187.09
X
26567
001
90
2
X
1,294.85
X
26568
004
90
2
X
1,870.00
X
26568
001
90
2
X
2,048.55
X
26568
002
90
2
X
1,908.74
X
26568
003
90
2
X
1,892.97
X
26580
002
90
2
X
3,939.27
X
26580
003
90
2
X
3,679.23
X
26580
004
90
2
X
3,628.59
X
26580
001
90
2
X
4,062.40
X
26587
003
90
2
X
1,503.11
X
26587
002
90
2
X
1,606.73
X
26587
004
90
2
X
1,485.89
X
26587
001
90
2
X
1,631.87
X
26590
002
90
2
X
1,173.58
X
26590
003
90
2
X
1,099.54
X
26590
004
90
2
X
1,086.45
X
26590
001
90
2
X
1,191.52
X
26591
002
90
2
X
622.73
X
26591
003
90
2
X
582.41
X
26591
004
90
2
X
575.66
X
26591
001
90
2
X
632.46
X
26593
001
90
2
X
1,103.00
X
26593
003
90
2
X
1,013.59
X
26593
002
90
2
X
1,085.53
X
26593
004
90
2
X
1,001.74
X
26596
003
90
2
X
1,900.26
X
26596
002
90
2
X
2,038.23
X
26596
001
90
2
X
2,071.67
X
26596
004
90
2
X
1,877.65
X
26600
004
90
2
X
368.09
290.77
26600
003
90
2
X
378.53
298.68
26600
002
90
2
X
397.18
313.85
26600
001
90
2
X
403.10
318.76
26605
004
90
2
X
548.64
X
26605
002
90
2
X
591.21
X
26605
003
90
2
X
552.02
X
26605
001
90
2
X
559.97
X
26607
001
90
2
X
1,044.67
X
26607
003
90
2
X
966.64
X
26607
002
90
2
X
1,029.43
X
26607
004
90
2
X
955.57
X
26608
002
90
2
X
1,029.43
X
26608
003
90
2
X
966.64
X
26608
004
90
2
X
955.57
X
26608
001
90
2
X
1,044.67
X
26615
001
90
2
X
1,233.12
X
26615
004
90
2
X
1,117.80
X
26615
003
90
2
X
1,131.27
X
26615
002
90
2
X
1,213.22
X
26641
002
90
2
X
430.41
X
26641
003
90
2
X
524.40
X
26641
001
90
2
X
553.20
X
26641
004
90
2
X
408.67
X
26645
001
90
2
X
757.72
X
26645
004
90
2
X
699.91
X
26645
003
90
2
X
707.83
X
26645
002
90
2
X
691.61
X
26650
001
90
2
X
1,178.01
X
26650
004
90
2
X
1,115.09
X
26650
003
90
2
X
1,059.21
X
26650
002
90
2
X
1,182.01
X
26665
001
90
2
X
1,661.90
X
26665
002
90
2
X
1,782.31
X
26665
003
90
2
X
1,736.03
X
26665
004
90
2
X
1,689.00
X
26670
001
90
2
X
508.73
X
26670
004
90
2
X
420.34
X
26670
003
90
2
X
484.07
X
26670
002
90
2
X
477.74
X
26675
001
90
2
X
1,061.53
X
26675
004
90
2
X
966.20
X
26675
003
90
2
X
978.02
X
26675
002
90
2
X
821.04
X
26676
004
90
2
X
1,114.56
X
26676
002
90
2
X
1,204.12
X
26676
003
90
2
X
1,128.04
X
26676
001
90
2
X
1,222.45
X
26685
002
90
2
X
1,473.62
X
26685
003
90
2
X
1,377.30
X
26685
004
90
2
X
1,361.04
X
26685
001
90
2
X
1,496.86
X
26686
001
90
2
X
1,681.71
X
26686
004
90
2
X
1,529.00
X
26686
002
90
2
X
1,655.48
X
26686
003
90
2
X
1,547.16
X
26700
004
90
2
X
343.67
X
26700
001
90
2
X
360.28
X
26700
003
90
2
X
367.53
X
26700
002
90
2
X
426.00
X
26705
001
90
2
X
649.75
X
26705
002
90
2
X
640.17
X
26705
003
90
2
X
625.40
X
26705
004
90
2
X
625.99
X
26706
004
90
2
X
1,065.64
X
26706
002
90
2
X
1,156.24
X
26706
001
90
2
X
1,175.14
X
26706
003
90
2
X
1,078.48
X
26715
001
90
2
X
1,162.37
X
26715
004
90
2
X
1,060.99
X
26715
003
90
2
X
1,073.35
X
26715
002
90
2
X
1,145.00
X
26720
004
90
2
X
290.12
235.09
26720
002
90
2
X
311.47
252.23
26720
003
90
2
X
293.52
237.59
26720
001
90
2
X
315.83
255.81
26725
003
90
2
X
473.39
X
26725
002
90
2
X
505.01
X
26725
004
90
2
X
477.81
X
26725
001
90
2
X
503.70
X
26727
001
90
2
X
1,071.48
X
26727
003
90
2
X
811.70
X
26727
002
90
2
X
1,066.76
X
26727
004
90
2
X
941.50
X
26735
001
90
2
X
1,169.85
X
26735
003
90
2
X
1,052.01
X
26735
002
90
2
X
1,119.33
X
26735
004
90
2
X
1,084.68
X
26740
004
90
2
X
258.77
X
26740
003
90
2
X
326.87
X
26740
002
90
2
X
273.31
X
26740
001
90
2
X
275.58
X
26742
002
90
2
X
602.94
X
26742
003
90
2
X
551.66
X
26742
004
90
2
X
574.85
X
26742
001
90
2
X
609.72
X
26746
004
90
2
X
1,201.11
X
26746
002
90
2
X
1,275.89
X
26746
003
90
2
X
1,185.82
X
26746
001
90
2
X
1,260.20
X
26750
004
90
2
X
262.27
X
26750
001
90
2
X
282.67
X
26750
002
90
2
X
279.28
X
26750
003
90
2
X
265.28
X
26755
001
90
2
X
458.57
X
26755
003
90
2
X
396.18
X
26755
002
90
2
X
413.06
X
26755
004
90
2
X
398.90
X
26756
003
90
2
X
673.39
X
26756
002
90
2
X
711.64
X
26756
004
90
2
X
665.96
X
26756
001
90
2
X
721.00
X
26765
004
90
2
X
857.23
X
26765
002
90
2
X
952.59
X
26765
003
90
2
X
746.79
X
26765
001
90
2
X
1,008.49
X
26770
001
90
2
X
373.69
X
26770
003
90
2
X
350.96
X
26770
002
90
2
X
389.79
X
26770
004
90
2
X
338.05
X
26775
003
90
2
X
414.09
X
26775
002
90
2
X
515.01
X
26775
004
90
2
X
500.12
X
26775
001
90
2
X
431.28
X
26776
002
90
2
X
753.04
X
26776
003
90
2
X
736.59
X
26776
001
90
2
X
788.11
X
26776
004
90
2
X
728.55
X
26785
001
90
2
X
852.35
X
26785
004
90
2
X
778.37
X
26785
003
90
2
X
787.46
X
26785
002
90
2
X
839.78
X
26820
002
90
2
X
1,733.13
X
26820
003
90
2
X
1,621.36
X
26820
001
90
2
X
1,760.20
X
26820
004
90
2
X
1,602.24
X
26841
001
90
2
X
1,585.33
X
26841
004
90
2
X
1,487.49
X
26841
002
90
2
X
1,560.21
X
26841
003
90
2
X
1,494.72
X
26842
004
90
2
X
1,821.88
X
26842
002
90
2
X
1,983.45
X
26842
003
90
2
X
1,844.20
X
26842
001
90
2
X
2,017.10
X
26843
001
90
2
X
1,668.93
X
26843
004
90
2
X
1,513.20
X
26843
003
90
2
X
1,531.22
X
26843
002
90
2
X
1,642.02
X
26844
002
90
2
X
1,873.48
X
26844
003
90
2
X
1,749.65
X
26844
001
90
2
X
1,903.44
X
26844
004
90
2
X
1,728.97
X
26850
004
90
2
X
1,235.38
X
26850
002
90
2
X
1,390.11
X
26850
003
90
2
X
1,309.68
X
26850
001
90
2
X
1,403.93
X
26852
003
90
2
X
1,535.02
X
26852
002
90
2
X
1,596.72
X
26852
004
90
2
X
1,517.36
X
26852
001
90
2
X
1,664.32
X
26860
004
90
2
X
1,063.91
X
26860
002
90
2
X
1,058.67
X
26860
003
90
2
X
1,060.18
X
26860
001
90
2
X
1,128.78
X
26861
002
ZZZ
0
X
766.18
X
26861
003
ZZZ
0
X
749.14
X
26861
004
ZZZ
0
X
472.14
X
26861
001
ZZZ
0
X
527.68
X
26862
004
90
2
X
1,350.41
X
26862
001
90
2
X
1,931.57
X
26862
003
90
2
X
1,574.28
X
26862
002
90
2
X
1,457.33
X
26863
001
ZZZ
0
X
891.13
X
26863
003
ZZZ
0
X
818.31
X
26863
002
ZZZ
0
X
876.93
X
26863
004
ZZZ
0
X
808.77
X
26910
004
90
2
X
1,476.74
X
26910
003
90
2
X
1,475.49
X
26910
002
90
2
X
1,523.37
X
26910
001
90
2
X
1,533.14
X
26951
001
90
2
X
896.27
X
26951
004
90
2
X
803.85
X
26951
003
90
2
X
813.13
X
26951
002
90
2
X
866.05
X
26952
001
90
2
X
1,464.91
X
26952
003
90
2
X
1,426.54
X
26952
002
90
2
X
1,457.36
X
26952
004
90
2
X
1,421.16
X
26989
YYY
2
X
#
X
26990
004
90
2
X
866.88
X
26990
001
90
2
X
950.44
X
26990
002
90
2
X
945.22
X
26990
003
90
2
X
911.83
X
26991
002
90
2
X
638.40
X
26991
003
90
2
X
615.07
X
26991
004
90
2
X
848.39
X
26991
001
90
2
X
551.82
X
26992
001
90
2
X
2,132.80
X
26992
004
90
2
X
1,917.05
X
26992
002
90
2
X
2,115.20
X
26992
003
90
2
X
2,018.92
X
27000
001
90
2
X
818.56
X
27000
004
90
2
X
764.90
X
27000
002
90
2
X
809.69
X
27000
003
90
2
X
773.28
X
27001
004
90
2
X
1,024.47
X
27001
003
90
2
X
1,039.50
X
27001
002
90
2
X
1,069.67
X
27001
001
90
2
X
1,161.90
X
27003
004
90
2
X
1,479.96
X
27003
001
90
2
X
1,636.25
X
27003
003
90
2
X
1,497.97
X
27003
002
90
2
X
1,608.65
X
27005
002
90
2
X
1,427.15
X
27005
003
90
2
X
1,356.79
X
27005
004
90
2
X
1,342.30
X
27005
001
90
2
X
1,444.26
X
27006
002
90
2
X
1,654.00
X
27006
003
90
2
X
1,563.63
X
27006
001
90
2
X
1,676.02
X
27006
004
90
2
X
1,546.34
X
27025
001
90
2
X
1,950.97
X
27025
003
90
2
X
1,961.63
X
27025
002
90
2
X
1,923.51
X
27025
004
90
2
X
1,790.02
X
27027
003
90
2
X
1,417.04
X
27027
002
90
2
X
1,417.04
X
27027
004
90
2
X
1,417.04
X
27027
001
90
2
X
1,579.85
X
27030
004
90
2
X
2,613.34
X
27030
001
90
2
X
3,028.42
X
27030
003
90
2
X
2,644.86
X
27030
002
90
2
X
3,009.08
X
27033
004
90
2
X
2,932.34
X
27033
001
90
2
X
3,045.92
X
27033
002
90
2
X
3,026.35
X
27033
003
90
2
X
2,685.28
X
27035
002
90
2
X
3,331.55
X
27035
003
90
2
X
3,111.27
X
27035
001
90
2
X
3,384.99
X
27035
004
90
2
X
3,075.56
X
27036
001
90
2
X
2,921.07
X
27036
003
90
2
X
2,543.23
X
27036
002
90
2
X
2,613.40
X
27036
004
90
2
X
2,543.23
X
27040
003
10
2
X
302.91
X
27040
002
10
2
X
324.07
X
27040
001
10
2
X
313.60
X
27040
004
10
2
X
296.08
X
27041
004
90
2
X
817.14
X
27041
002
90
2
X
875.53
X
27041
003
90
2
X
824.41
X
27041
001
90
2
X
879.25
X
27043
001
90
2
X
887.49
X
27043
004
90
2
X
790.07
X
27043
003
90
2
X
790.07
X
27043
002
90
2
X
790.07
X
27045
003
90
2
X
1,256.05
X
27045
002
90
2
X
1,256.05
X
27045
004
90
2
X
1,256.05
X
27045
001
90
2
X
1,409.09
X
27047
003
90
2
X
779.55
X
27047
002
90
2
X
826.64
X
27047
001
90
2
X
858.28
X
27047
004
90
2
X
976.01
X
27048
001
90
2
X
928.90
X
27048
003
90
2
X
1,133.48
X
27048
002
90
2
X
917.36
X
27048
004
90
2
X
864.78
X
27049
001
90
2
X
2,234.20
X
27049
003
90
2
X
2,561.04
X
27049
002
90
2
X
2,208.45
X
27049
004
90
2
X
2,531.36
X
27050
001
90
2
X
1,129.60
X
27050
003
90
2
X
1,023.69
X
27050
002
90
2
X
1,109.05
X
27050
004
90
2
X
1,011.12
X
27052
001
90
2
X
2,349.68
X
27052
003
90
2
X
1,660.05
X
27052
002
90
2
X
2,282.87
X
27052
004
90
2
X
1,639.35
X
27054
002
90
2
X
3,241.99
X
27054
003
90
2
X
3,007.32
X
27054
004
90
2
X
2,274.43
X
27054
001
90
2
X
3,446.54
X
27057
004
90
2
X
1,556.77
X
27057
002
90
2
X
1,556.77
X
27057
003
90
2
X
1,556.77
X
27057
001
90
2
X
1,717.01
X
27059
003
90
2
X
3,089.73
X
27059
002
90
2
X
3,089.73
X
27059
004
90
2
X
3,089.73
X
27059
001
90
2
X
3,449.27
X
27060
004
90
2
X
963.24
X
27060
002
90
2
X
1,008.55
X
27060
003
90
2
X
974.54
X
27060
001
90
2
X
1,060.72
X
27062
002
90
2
X
1,081.12
X
27062
003
90
2
X
1,009.00
X
27062
004
90
2
X
997.08
X
27062
001
90
2
X
1,098.64
X
27065
004
90
2
X
1,179.85
X
27065
002
90
2
X
1,575.77
X
27065
003
90
2
X
1,329.41
X
27065
001
90
2
X
1,307.02
X
27066
003
90
2
X
1,916.29
X
27066
002
90
2
X
2,123.01
X
27066
004
90
2
X
2,037.50
X
27066
001
90
2
X
2,149.80
X
27067
001
90
2
X
2,977.30
X
27067
002
90
2
X
2,944.54
X
27067
003
90
2
X
2,732.13
X
27067
004
90
2
X
2,699.80
X
27070
004
90
2
X
1,878.47
X
27070
001
90
2
X
2,060.40
X
27070
002
90
2
X
1,960.97
X
27070
003
90
2
X
1,900.55
X
27071
002
90
2
X
2,319.03
X
27071
003
90
2
X
2,092.91
X
27071
004
90
2
X
2,081.38
X
27071
001
90
2
X
2,291.06
X
27075
001
90
2
X
3,603.90
X
27075
002
90
2
X
3,546.58
X
27075
003
90
2
X
3,309.91
X
27075
004
90
2
X
3,271.16
X
27076
004
90
2
X
3,803.53
X
27076
001
90
2
X
4,188.45
X
27076
003
90
2
X
3,849.18
X
27076
002
90
2
X
4,122.33
X
27077
001
90
2
X
4,947.73
X
27077
003
90
2
X
4,539.57
X
27077
002
90
2
X
4,868.20
X
27077
004
90
2
X
4,486.15
X
27078
002
90
2
X
2,700.69
X
27078
003
90
2
X
2,373.88
X
27078
001
90
2
X
3,288.60
X
27078
004
90
2
X
2,346.49
X
27080
004
90
2
X
1,163.10
X
27080
002
90
2
X
1,262.75
X
27080
003
90
2
X
1,176.78
X
27080
001
90
2
X
1,283.66
X
27086
003
10
2
X
237.53
X
27086
002
10
2
X
237.75
X
27086
001
10
2
X
274.47
X
27086
004
10
2
X
229.54
X
27087
001
90
2
X
1,187.21
X
27087
003
90
2
X
1,135.67
X
27087
002
90
2
X
1,177.21
X
27087
004
90
2
X
1,269.41
X
27090
001
90
2
X
2,551.22
X
27090
003
90
2
X
2,355.36
X
27090
002
90
2
X
2,513.05
X
27090
004
90
2
X
2,328.10
X
27091
003
90
2
X
5,263.37
X
27091
002
90
2
X
6,389.47
X
27091
004
90
2
X
5,573.16
X
27091
001
90
2
X
6,448.15
X
27093
004
0
2
X
230.07
X
27093
002
0
2
X
242.25
X
27093
003
0
2
X
221.37
X
27093
001
0
2
X
239.12
X
27095
001
0
2
X
269.17
X
27095
004
0
2
X
247.94
X
27095
002
0
2
X
265.61
X
27095
003
0
2
X
249.64
X
27096
001
0
2
X
1,083.58
145.94
27096
004
0
2
X
934.38
132.80
27096
002
0
2
X
934.38
132.80
27096
003
0
2
X
934.38
132.80
27097
001
90
2
X
1,937.76
X
27097
004
90
2
X
1,756.32
X
27097
003
90
2
X
1,777.51
X
27097
002
90
2
X
1,906.51
X
27098
001
90
2
X
1,937.76
X
27098
003
90
2
X
1,777.51
X
27098
002
90
2
X
1,906.51
X
27098
004
90
2
X
1,756.32
X
27100
001
90
2
X
2,411.78
X
27100
004
90
2
X
2,033.39
X
27100
003
90
2
X
2,420.68
X
27100
002
90
2
X
2,200.43
X
27105
001
90
2
X
2,105.21
X
27105
003
90
2
X
1,941.59
X
27105
002
90
2
X
2,073.22
X
27105
004
90
2
X
1,920.50
X
27110
001
90
2
X
2,838.11
X
27110
004
90
2
X
2,574.79
X
27110
003
90
2
X
2,665.42
X
27110
002
90
2
X
3,137.09
X
27111
003
90
2
X
2,575.66
X
27111
002
90
2
X
3,121.77
X
27111
004
90
2
X
2,544.48
X
27111
001
90
2
X
2,800.09
X
27120
003
90
2
X
3,901.83
X
27120
002
90
2
X
4,319.75
X
27120
004
90
2
X
4,000.56
X
27120
001
90
2
X
4,344.72
X
27122
001
90
2
X
4,222.43
X
27122
004
90
2
X
3,760.07
X
27122
002
90
2
X
4,088.58
X
27122
003
90
2
X
3,750.77
X
27125
003
90
2
X
3,749.15
X
27125
002
90
2
X
4,017.59
X
27125
004
90
2
X
3,693.79
X
27125
001
90
2
X
4,082.58
X
27130
001
90
2
X
6,203.37
X
27130
004
90
2
X
5,597.13
X
27130
003
90
2
X
5,725.12
X
27130
002
90
2
X
6,091.89
X
27132
002
90
2
X
6,765.05
X
27132
003
90
2
X
6,321.90
X
27132
004
90
2
X
5,709.28
X
27132
001
90
2
X
6,376.96
X
27134
003
90
2
X
7,445.20
X
27134
002
90
2
X
7,901.57
X
27134
004
90
2
X
7,276.09
X
27134
001
90
2
X
7,855.38
X
27137
003
90
2
X
5,878.18
X
27137
002
90
2
X
6,256.54
X
27137
001
90
2
X
6,312.57
X
27137
004
90
2
X
5,838.93
X
27138
001
90
2
X
5,568.06
X
27138
004
90
2
X
5,073.93
X
27138
003
90
2
X
5,113.86
X
27138
002
90
2
X
5,500.26
X
27140
001
90
2
X
2,745.16
X
27140
004
90
2
X
2,491.33
X
27140
003
90
2
X
2,235.34
X
27140
002
90
2
X
2,535.52
X
27146
002
90
2
X
2,874.96
X
27146
003
90
2
X
2,707.87
X
27146
004
90
2
X
2,675.80
X
27146
001
90
2
X
2,915.41
X
27147
004
90
2
X
3,843.37
X
27147
002
90
2
X
4,128.92
X
27147
003
90
2
X
3,889.74
X
27147
001
90
2
X
4,241.42
X
27151
001
90
2
X
4,454.95
X
27151
004
90
2
X
4,037.42
X
27151
002
90
2
X
4,383.02
X
27151
003
90
2
X
4,086.13
X
27156
001
90
2
X
4,722.70
X
27156
004
90
2
X
4,282.26
X
27156
002
90
2
X
4,646.89
X
27156
003
90
2
X
4,333.43
X
27158
004
90
2
X
3,629.18
X
27158
001
90
2
X
3,998.72
X
27158
003
90
2
X
3,671.62
X
27158
002
90
2
X
3,934.87
X
27161
001
90
2
X
3,615.14
X
27161
004
90
2
X
3,278.77
X
27161
002
90
2
X
3,557.28
X
27161
003
90
2
X
3,318.23
X
27165
002
90
2
X
3,979.94
X
27165
003
90
2
X
3,707.92
X
27165
004
90
2
X
3,663.25
X
27165
001
90
2
X
4,045.71
X
27170
003
90
2
X
3,899.51
X
27170
002
90
2
X
4,185.58
X
27170
004
90
2
X
3,945.17
X
27170
001
90
2
X
4,286.39
X
27175
002
90
2
X
941.87
X
27175
003
90
2
X
907.29
X
27175
004
90
2
X
898.24
X
27175
001
90
2
X
950.38
X
27176
002
90
2
X
2,570.42
X
27176
003
90
2
X
2,396.17
X
27176
001
90
2
X
2,612.58
X
27176
004
90
2
X
2,367.64
X
27177
003
90
2
X
2,940.97
X
27177
002
90
2
X
3,722.40
X
27177
004
90
2
X
2,906.27
X
27177
001
90
2
X
3,202.71
X
27178
003
90
2
X
2,373.78
X
27178
002
90
2
X
2,540.90
X
27178
001
90
2
X
2,581.24
X
27178
004
90
2
X
2,345.26
X
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