2018 Workers' Compensation Part B Fee Schedule

27179-27468

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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
27179   1 90 2 0 2,168.89 0
27179   2 90 2 0 2,133.83 0
27179   3 90 2 0 1,989.02 0
27179   4 90 2 0 1,965.42 0
27181   1 90 2 0 2,558.39 0
27181   2 90 2 0 2,517.06 0
27181   3 90 2 0 2,346.36 0
27181   4 90 2 0 2,318.49 0
27185   1 90 2 0 1,048.92 0
27185   2 90 2 0 1,033.70 0
27185   3 90 2 0 971.21 0
27185   4 90 2 0 961.25 0
27187   1 90 2 0 3,229.58 0
27187   2 90 2 0 2,738.36 0
27187   3 90 2 0 2,533.17 0
27187   4 90 2 0 2,502.19 0
27197   1 0 2 0 149.61 0
27197   2 0 2 0 135.52 0
27197   3 0 2 0 135.52 0
27197   4 0 2 0 135.52 0
27198   1 0 2 0 381.37 0
27198   2 0 2 0 348.49 0
27198   3 0 2 0 348.49 0
27198   4 0 2 0 348.49 0
27200   1 90 2 0 297.07 0
27200   2 90 2 0 303.36 0
27200   3 90 2 0 280.22 0
27200   4 90 2 0 291.93 0
27202   1 90 2 0 1,187.09 0
27202   2 90 2 0 1,168.83 0
27202   3 90 2 0 1,093.30 0
27202   4 90 2 0 1,080.21 0
27215   1 90 2 0 2,217.48 0
27215   2 90 2 0 2,176.59 0
27215   3 90 2 0 2,007.47 0
27215   4 90 2 0 1,982.72 0
27216   1 90 2 0 1,370.90 0
27216   2 90 2 0 1,371.59 0
27216   3 90 2 0 1,224.61 0
27216   4 90 2 0 1,285.57 0
27217   1 90 2 0 2,649.25 0
27217   2 90 2 0 2,605.03 0
27217   3 90 2 0 2,422.21 0
27217   4 90 2 0 2,392.92 0
27218   1 90 2 0 3,126.14 0
27218   2 90 2 0 3,079.14 0
27218   3 90 2 0 2,885.03 0
27218   4 90 2 0 2,851.48 0
27220   1 90 2 0 1,133.66 0
27220   2 90 2 0 1,119.83 0
27220   3 90 2 0 820.94 0
27220   4 90 2 0 1,037.18 0
27222   1 90 2 0 1,573.06 0
27222   2 90 2 0 1,542.34 0
27222   3 90 2 0 1,463.50 0
27222   4 90 2 0 1,468.90 0
27226   1 90 2 0 2,840.05 0
27226   2 90 2 0 2,792.41 0
27226   3 90 2 0 2,595.24 0
27226   4 90 2 0 2,563.71 0
27227   1 90 2 0 3,582.94 0
27227   2 90 2 0 3,324.60 0
27227   3 90 2 0 3,080.32 0
27227   4 90 2 0 3,042.49 0
27228   1 90 2 0 3,693.78 0
27228   2 90 2 0 3,556.51 0
27228   3 90 2 0 3,306.05 0
27228   4 90 2 0 3,266.00 0
27230   1 90 2 0 614.76 0
27230   2 90 2 0 795.77 0
27230   3 90 2 0 746.27 0
27230   4 90 2 0 691.70 0
27232   1 90 2 0 1,939.30 0
27232   2 90 2 0 1,756.30 0
27232   3 90 2 0 1,802.43 0
27232   4 90 2 0 1,669.29 0
27235   1 90 2 0 2,535.72 0
27235   2 90 2 0 2,489.66 0
27235   3 90 2 0 2,299.09 0
27235   4 90 2 0 2,270.85 0
27236   1 90 2 0 3,282.81 0
27236   2 90 2 0 2,927.44 0
27236   3 90 2 0 2,717.46 0
27236   4 90 2 0 2,684.28 0
27238   1 90 2 0 634.18 0
27238   2 90 2 0 921.10 0
27238   3 90 2 0 859.55 0
27238   4 90 2 0 586.28 0
27240   1 90 2 0 1,938.05 0
27240   2 90 2 0 1,907.75 0
27240   3 90 2 0 1,874.66 0
27240   4 90 2 0 1,761.46 0
27244   1 90 2 0 3,256.33 0
27244   2 90 2 0 2,882.96 0
27244   3 90 2 0 2,678.82 0
27244   4 90 2 0 2,646.28 0
27245   1 90 2 0 3,436.89 0
27245   2 90 2 0 3,250.63 0
27245   3 90 2 0 3,037.72 0
27245   4 90 2 0 3,001.87 0
27246   1 90 2 0 732.65 0
27246   2 90 2 0 740.72 0
27246   3 90 2 0 712.40 0
27246   4 90 2 0 708.63 0
27248   1 90 2 0 1,943.47 0
27248   2 90 2 0 1,921.49 0
27248   3 90 2 0 1,830.32 0
27248   4 90 2 0 1,816.43 0
27250   1 90 2 0 890.05 0
27250   2 90 2 0 990.93 0
27250   3 90 2 0 830.93 0
27250   4 90 2 0 965.63 0
27252   1 90 2 0 1,268.97 0
27252   2 90 2 0 1,241.43 0
27252   3 90 2 0 1,109.87 0
27252   4 90 2 0 1,163.41 0
27253   1 90 2 0 2,398.03 0
27253   2 90 2 0 2,358.09 0
27253   3 90 2 0 2,287.29 0
27253   4 90 2 0 2,276.21 0
27254   1 90 2 0 2,896.71 0
27254   2 90 2 0 2,852.18 0
27254   3 90 2 0 2,668.49 0
27254   4 90 2 0 2,637.55 0
27256   1 10 2 0 513.30 0
27256   2 10 2 0 746.38 0
27256   3 10 2 0 478.66 0
27256   4 10 2 0 473.37 0
27257   1 10 2 0 892.99 0
27257   2 10 2 0 878.74 0
27257   3 10 2 0 819.76 0
27257   4 10 2 0 809.98 0
27258   1 90 2 0 2,670.33 0
27258   2 90 2 0 2,627.23 0
27258   3 90 2 0 2,449.22 0
27258   4 90 2 0 2,451.70 0
27259   1 90 2 0 3,345.37 0
27259   2 90 2 0 3,291.32 0
27259   3 90 2 0 3,068.12 0
27259   4 90 2 0 3,031.59 0
27265   1 90 2 0 926.32 0
27265   2 90 2 0 979.37 0
27265   3 90 2 0 775.62 0
27265   4 90 2 0 955.56 0
27266   1 90 2 0 1,123.08 0
27266   2 90 2 0 1,146.76 0
27266   3 90 2 0 1,008.30 0
27266   4 90 2 0 1,116.82 0
27267   1 90 2 0 600.67 0
27267   2 90 2 0 524.40 0
27267   3 90 2 0 524.40 0
27267   4 90 2 0 524.40 0
27268   1 90 2 0 738.85 0
27268   2 90 2 0 646.79 0
27268   3 90 2 0 646.79 0
27268   4 90 2 0 646.79 0
27269   1 90 2 0 1,751.04 0
27269   2 90 2 0 1,546.29 0
27269   3 90 2 0 1,546.29 0
27269   4 90 2 0 1,546.29 0
27275   1 10 2 0 356.12 0
27275   2 10 2 0 352.72 0
27275   3 10 2 0 339.03 0
27275   4 10 2 0 332.55 0
27279   1 90 2 0 742.33 0
27279   2 90 2 0 680.13 0
27279   3 90 2 0 680.13 0
27279   4 90 2 0 680.13 0
27280   1 90 2 0 2,079.22 0
27280   2 90 2 0 2,045.85 0
27280   3 90 2 0 1,908.16 0
27280   4 90 2 0 1,885.89 0
27282   1 90 2 0 2,237.90 0
27282   2 90 2 0 1,844.79 0
27282   3 90 2 0 2,156.85 0
27282   4 90 2 0 1,697.52 0
27284   1 90 2 0 3,205.68 0
27284   2 90 2 0 3,207.15 0
27284   3 90 2 0 2,622.92 0
27284   4 90 2 0 2,591.83 0
27286   1 90 2 0 2,902.92 0
27286   2 90 2 0 3,396.43 0
27286   3 90 2 0 2,669.38 0
27286   4 90 2 0 2,637.30 0
27290   1 90 2 0 4,467.74 0
27290   2 90 2 0 4,406.24 0
27290   3 90 2 0 4,168.79 0
27290   4 90 2 0 4,118.58 0
27295   1 90 2 0 3,245.72 0
27295   2 90 2 0 3,191.54 0
27295   3 90 2 0 2,968.02 0
27295   4 90 2 0 2,981.91 0
27299     YYY 2 0 * 0
27301   1 90 2 0 659.73 0
27301   2 90 2 0 651.86 0
27301   3 90 2 0 623.26 0
27301   4 90 2 0 616.72 0
27303   1 90 2 0 1,271.36 0
27303   2 90 2 0 1,252.20 0
27303   3 90 2 0 1,173.07 0
27303   4 90 2 0 1,133.57 0
27305   1 90 2 0 868.19 0
27305   2 90 2 0 854.96 0
27305   3 90 2 0 800.53 0
27305   4 90 2 0 791.36 0
27306   1 90 2 0 570.63 0
27306   2 90 2 0 563.39 0
27306   3 90 2 0 537.84 0
27306   4 90 2 0 527.67 0
27307   1 90 2 0 765.62 0
27307   2 90 2 0 755.15 0
27307   3 90 2 0 712.11 0
27307   4 90 2 0 704.15 0
27310   1 90 2 0 1,810.10 0
27310   2 90 2 0 1,678.35 0
27310   3 90 2 0 1,559.63 0
27310   4 90 2 0 1,603.42 0
27323   1 10 2 0 240.69 0
27323   2 10 2 0 239.09 0
27323   3 10 2 0 301.53 0
27323   4 10 2 0 247.36 0
27324   1 90 2 0 449.52 0
27324   2 90 2 0 438.60 0
27324   3 90 2 0 408.67 0
27324   4 90 2 0 405.86 0
27325   1 90 2 0 726.73 0
27325   2 90 2 0 630.36 0
27325   3 90 2 0 630.36 0
27325   4 90 2 0 630.36 0
27326   1 90 2 0 691.03 0
27326   2 90 2 0 596.03 0
27326   3 90 2 0 596.03 0
27326   4 90 2 0 596.03 0
27327   1 90 2 0 610.98 0
27327   2 90 2 0 602.63 0
27327   3 90 2 0 594.40 0
27327   4 90 2 0 561.96 0
27328   1 90 2 0 782.50 0
27328   2 90 2 0 786.81 0
27328   3 90 2 0 634.71 0
27328   4 90 2 0 633.76 0
27329   1 90 2 0 2,274.01 0
27329   2 90 2 0 2,220.28 0
27329   3 90 2 0 2,061.24 0
27329   4 90 2 0 2,036.81 0
27330   1 90 2 0 1,325.81 0
27330   2 90 2 0 1,243.18 0
27330   3 90 2 0 1,042.45 0
27330   4 90 2 0 1,219.15 0
27331   1 90 2 0 1,653.71 0
27331   2 90 2 0 1,524.26 0
27331   3 90 2 0 1,371.71 0
27331   4 90 2 0 1,476.99 0
27332   1 90 2 0 1,834.77 0
27332   2 90 2 0 1,821.62 0
27332   3 90 2 0 1,591.80 0
27332   4 90 2 0 1,572.28 0
27333   1 90 2 0 2,040.16 0
27333   2 90 2 0 1,998.60 0
27333   3 90 2 0 1,874.65 0
27333   4 90 2 0 1,803.57 0
27334   1 90 2 0 2,052.97 0
27334   2 90 2 0 2,036.11 0
27334   3 90 2 0 1,972.50 0
27334   4 90 2 0 1,942.30 0
27335   1 90 2 0 2,164.07 0
27335   2 90 2 0 2,148.68 0
27335   3 90 2 0 2,084.74 0
27335   4 90 2 0 2,025.29 0
27337   1 90 2 0 611.45 0
27337   2 90 2 0 543.52 0
27337   3 90 2 0 543.52 0
27337   4 90 2 0 543.52 0
27339   1 90 2 0 1,101.34 0
27339   2 90 2 0 981.16 0
27339   3 90 2 0 981.16 0
27339   4 90 2 0 981.16 0
27340   1 90 2 0 879.25 0
27340   2 90 2 0 845.14 0
27340   3 90 2 0 687.12 0
27340   4 90 2 0 776.21 0
27345   1 90 2 0 1,134.58 0
27345   2 90 2 0 1,083.25 0
27345   3 90 2 0 983.83 0
27345   4 90 2 0 990.91 0
27347   1 90 2 0 648.07 677.16
27347   2 90 2 0 579.01 603.85
27347   3 90 2 0 579.01 603.85
27347   4 90 2 0 579.01 603.85
27350   1 90 2 0 1,630.59 0
27350   2 90 2 0 1,602.12 0
27350   3 90 2 0 1,484.51 0
27350   4 90 2 0 1,466.19 0
27355   1 90 2 0 1,638.27 0
27355   2 90 2 0 1,533.35 0
27355   3 90 2 0 1,390.60 0
27355   4 90 2 0 1,262.54 0
27356   1 90 2 0 1,594.50 0
27356   2 90 2 0 1,568.76 0
27356   3 90 2 0 1,462.69 0
27356   4 90 2 0 1,445.27 0
27357   1 90 2 0 1,745.30 0
27357   2 90 2 0 1,717.57 0
27357   3 90 2 0 1,602.81 0
27357   4 90 2 0 1,583.85 0
27358   1 ZZZ 0 0 1,555.00 0
27358   2 ZZZ 0 0 1,537.09 0
27358   3 ZZZ 0 0 1,512.68 0
27358   4 ZZZ 0 0 1,466.50 0
27360   1 90 2 0 1,687.10 0
27360   2 90 2 0 1,660.06 0
27360   3 90 2 0 1,548.41 0
27360   4 90 2 0 1,529.97 0
27364   1 90 2 0 2,299.60 0
27364   2 90 2 0 2,054.89 0
27364   3 90 2 0 2,054.89 0
27364   4 90 2 0 2,054.89 0
27365   1 90 2 0 2,664.55 0
27365   2 90 2 0 2,398.31 0
27365   3 90 2 0 2,249.20 0
27365   4 90 2 0 2,405.78 0
27370   1 0 2 0 129.76 0
27370   2 0 2 0 140.40 0
27370   3 0 2 0 122.07 0
27370   4 0 2 0 124.40 0
27372   1 90 2 0 721.10 0
27372   2 90 2 0 702.94 0
27372   3 90 2 0 660.55 0
27372   4 90 2 0 663.63 0
27380   1 90 2 0 1,429.80 0
27380   2 90 2 0 1,396.60 0
27380   3 90 2 0 1,300.00 0
27380   4 90 2 0 1,313.31 0
27381   1 90 2 0 2,006.93 0
27381   2 90 2 0 1,972.91 0
27381   3 90 2 0 1,831.94 0
27381   4 90 2 0 1,809.64 0
27385   1 90 2 0 1,539.03 0
27385   2 90 2 0 1,512.61 0
27385   3 90 2 0 1,402.97 0
27385   4 90 2 0 1,418.59 0
27386   1 90 2 0 2,136.30 0
27386   2 90 2 0 2,099.13 0
27386   3 90 2 0 1,945.11 0
27386   4 90 2 0 1,979.69 0
27390   1 90 2 0 942.27 0
27390   2 90 2 0 945.61 0
27390   3 90 2 0 803.54 0
27390   4 90 2 0 794.05 0
27391   1 90 2 0 1,139.00 0
27391   2 90 2 0 1,121.38 0
27391   3 90 2 0 1,048.63 0
27391   4 90 2 0 1,036.34 0
27392   1 90 2 0 1,534.91 0
27392   2 90 2 0 1,510.41 0
27392   3 90 2 0 1,409.16 0
27392   4 90 2 0 1,392.50 0
27393   1 90 2 0 1,103.50 0
27393   2 90 2 0 1,085.68 0
27393   3 90 2 0 1,012.09 0
27393   4 90 2 0 1,000.06 0
27394   1 90 2 0 1,280.52 0
27394   2 90 2 0 1,261.53 0
27394   3 90 2 0 1,183.23 0
27394   4 90 2 0 1,169.60 0
27395   1 90 2 0 2,027.87 0
27395   2 90 2 0 1,995.53 0
27395   3 90 2 0 1,862.08 0
27395   4 90 2 0 1,839.85 0
27396   1 90 2 0 1,360.87 0
27396   2 90 2 0 1,911.46 0
27396   3 90 2 0 1,249.54 0
27396   4 90 2 0 1,234.64 0
27397   1 90 2 0 1,728.65 0
27397   2 90 2 0 1,700.76 0
27397   3 90 2 0 1,585.52 0
27397   4 90 2 0 1,566.70 0
27400   1 90 2 0 2,011.28 0
27400   2 90 2 0 1,519.65 0
27400   3 90 2 0 1,419.03 0
27400   4 90 2 0 1,402.05 0
27403   1 90 2 0 1,590.99 0
27403   2 90 2 0 1,749.96 0
27403   3 90 2 0 1,566.40 0
27403   4 90 2 0 1,435.09 0
27405   1 90 2 0 2,160.78 0
27405   2 90 2 0 2,147.94 0
27405   3 90 2 0 2,094.77 0
27405   4 90 2 0 2,086.55 0
27407   1 90 2 0 1,734.05 0
27407   2 90 2 0 1,706.32 0
27407   3 90 2 0 1,592.04 0
27407   4 90 2 0 1,573.10 0
27409   1 90 2 0 2,597.31 0
27409   2 90 2 0 2,551.87 0
27409   3 90 2 0 2,363.61 0
27409   4 90 2 0 2,334.62 0
27412   1 90 2 0 2,816.82 0
27412   2 90 2 0 2,469.23 0
27412   3 90 2 0 2,469.23 0
27412   4 90 2 0 2,469.23 0
27415   1 90 2 0 2,368.95 0
27415   2 90 2 0 2,052.29 0
27415   3 90 2 0 2,052.29 0
27415   4 90 2 0 2,052.29 0
27416   1 90 2 0 1,378.91 0
27416   2 90 2 0 1,211.69 0
27416   3 90 2 0 1,211.69 0
27416   4 90 2 0 1,211.69 0
27418   1 90 2 0 2,105.39 0
27418   2 90 2 0 2,151.46 0
27418   3 90 2 0 1,923.02 0
27418   4 90 2 0 1,899.27 0
27420   1 90 2 0 1,788.44 0
27420   2 90 2 0 1,943.59 0
27420   3 90 2 0 1,760.61 0
27420   4 90 2 0 1,739.06 0
27422   1 90 2 0 2,095.34 0
27422   2 90 2 0 2,025.91 0
27422   3 90 2 0 1,800.52 0
27422   4 90 2 0 1,931.87 0
27424   1 90 2 0 2,005.05 0
27424   2 90 2 0 1,970.14 0
27424   3 90 2 0 1,825.76 0
27424   4 90 2 0 1,803.29 0
27425   1 90 2 0 1,579.12 0
27425   2 90 2 0 1,406.01 0
27425   3 90 2 0 1,535.18 0
27425   4 90 2 0 1,531.42 0
27427   1 90 2 0 2,103.85 0
27427   2 90 2 0 2,397.68 0
27427   3 90 2 0 1,902.72 0
27427   4 90 2 0 1,879.16 0
27428   1 90 2 0 2,528.05 0
27428   2 90 2 0 2,481.00 0
27428   3 90 2 0 2,286.69 0
27428   4 90 2 0 2,258.56 0
27429   1 90 2 0 2,193.98 0
27429   2 90 2 0 3,039.08 0
27429   3 90 2 0 2,013.02 0
27429   4 90 2 0 1,989.00 0
27430   1 90 2 0 1,779.13 0
27430   2 90 2 0 1,738.42 0
27430   3 90 2 0 1,620.01 0
27430   4 90 2 0 1,680.68 0
27435   1 90 2 0 2,028.30 0
27435   2 90 2 0 2,018.82 0
27435   3 90 2 0 1,979.74 0
27435   4 90 2 0 1,348.97 0
27437   1 90 2 0 1,793.64 0
27437   2 90 2 0 1,798.30 0
27437   3 90 2 0 1,667.15 0
27437   4 90 2 0 1,525.76 0
27438   1 90 2 0 4,155.41 0
27438   2 90 2 0 4,299.43 0
27438   3 90 2 0 4,172.87 0
27438   4 90 2 0 2,030.47 0
27440   1 90 2 0 2,075.48 0
27440   2 90 2 0 2,133.35 0
27440   3 90 2 0 1,884.61 0
27440   4 90 2 0 1,861.70 0
27441   1 90 2 0 1,799.09 0
27441   2 90 2 0 1,770.11 0
27441   3 90 2 0 1,650.48 0
27441   4 90 2 0 1,630.92 0
27442   1 90 2 0 2,766.54 0
27442   2 90 2 0 2,714.14 0
27442   3 90 2 0 2,497.49 0
27442   4 90 2 0 2,466.58 0
27443   1 90 2 0 2,801.60 0
27443   2 90 2 0 2,745.93 0
27443   3 90 2 0 2,515.64 0
27443   4 90 2 0 2,484.25 0
27445   1 90 2 0 5,135.69 0
27445   2 90 2 0 5,083.08 0
27445   3 90 2 0 4,945.66 0
27445   4 90 2 0 4,893.21 0
27446   1 90 2 0 3,647.61 0
27446   2 90 2 0 4,000.67 0
27446   3 90 2 0 3,882.06 0
27446   4 90 2 0 3,804.81 0
27447   1 90 2 0 5,310.20 0
27447   2 90 2 0 5,267.73 0
27447   3 90 2 0 5,070.78 0
27447   4 90 2 0 5,069.35 0
27448   1 90 2 0 2,225.62 0
27448   2 90 2 0 2,522.02 0
27448   3 90 2 0 2,134.04 0
27448   4 90 2 0 2,002.47 0
27450   1 90 2 0 2,668.15 0
27450   2 90 2 0 2,705.11 0
27450   3 90 2 0 2,438.33 0
27450   4 90 2 0 2,408.72 0
27454   1 90 2 0 2,923.53 0
27454   2 90 2 0 2,884.10 0
27454   3 90 2 0 2,510.51 0
27454   4 90 2 0 2,479.78 0
27455   1 90 2 0 2,283.86 0
27455   2 90 2 0 2,246.58 0
27455   3 90 2 0 2,092.61 0
27455   4 90 2 0 2,067.57 0
27457   1 90 2 0 2,401.67 0
27457   2 90 2 0 2,427.27 0
27457   3 90 2 0 2,258.98 0
27457   4 90 2 0 2,231.73 0
27465   1 90 2 0 2,704.45 0
27465   2 90 2 0 2,671.08 0
27465   3 90 2 0 2,183.62 0
27465   4 90 2 0 2,157.67 0
27466   1 90 2 0 2,706.81 0
27466   2 90 2 0 2,663.46 0
27466   3 90 2 0 2,484.32 0
27466   4 90 2 0 2,455.03 0
27468   1 90 2 0 3,274.51 0
27468   2 90 2 0 3,221.73 0
27468   3 90 2 0 3,003.49 0
27468   4 90 2 0 2,967.71 0