2018 Workers' Compensation Part B Fee Schedule

28270-29358

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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
Implied Decimal 2 (in dollars)
28270   1 90 2 0 63942 52812
28270   2 90 2 0 63210 52230
28270   3 90 2 0 60207 49836
28270   4 90 2 0 59511 49316
28272   1 90 2 0 54380 45117
28272   2 90 2 0 57679 47833
28272   3 90 2 0 57030 47499
28272   4 90 2 0 47104 39209
28280   1 90 2 0 64254 0
28280   2 90 2 0 69898 0
28280   3 90 2 0 68846 0
28280   4 90 2 0 63708 0
28285   1 90 2 0 79295 0
28285   2 90 2 0 78241 0
28285   3 90 2 0 71969 0
28285   4 90 2 0 71668 0
28286   1 90 2 0 72472 0
28286   2 90 2 0 76575 0
28286   3 90 2 0 61532 0
28286   4 90 2 0 66723 0
28288   1 90 2 0 68761 0
28288   2 90 2 0 67774 0
28288   3 90 2 0 63661 0
28288   4 90 2 0 62885 0
28289   1 90 2 0 73529 76063
28289   2 90 2 0 67198 69366
28289   3 90 2 0 67198 69366
28289   4 90 2 0 67198 69366
28291   1 90 2 0 94257 61294
28291   2 90 2 0 84876 56428
28291   3 90 2 0 84876 56428
28291   4 90 2 0 84876 56428
28292   1 90 2 0 122061 0
28292   2 90 2 0 120289 0
28292   3 90 2 0 112935 0
28292   4 90 2 0 111523 0
28295   1 90 2 0 120991 68251
28295   2 90 2 0 108248 62728
28295   3 90 2 0 108248 62728
28295   4 90 2 0 108248 62728
28296   1 90 2 0 160777 0
28296   2 90 2 0 158471 0
28296   3 90 2 0 148905 0
28296   4 90 2 0 147075 0
28297   1 90 2 0 151643 0
28297   2 90 2 0 161044 0
28297   3 90 2 0 151112 0
28297   4 90 2 0 149254 0
28298   1 90 2 0 149052 0
28298   2 90 2 0 146976 0
28298   3 90 2 0 138320 0
28298   4 90 2 0 136564 0
28299   1 90 2 0 151511 0
28299   2 90 2 0 164665 0
28299   3 90 2 0 158221 0
28299   4 90 2 0 156227 0
28300   1 90 2 0 142529 0
28300   2 90 2 0 140626 0
28300   3 90 2 0 132760 0
28300   4 90 2 0 139696 0
28302   1 90 2 0 166926 0
28302   2 90 2 0 164455 0
28302   3 90 2 0 154237 0
28302   4 90 2 0 152368 0
28304   1 90 2 0 136944 0
28304   2 90 2 0 135154 0
28304   3 90 2 0 127750 0
28304   4 90 2 0 126239 0
28305   1 90 2 0 181164 0
28305   2 90 2 0 178631 0
28305   3 90 2 0 168136 0
28305   4 90 2 0 166071 0
28306   1 90 2 0 104038 0
28306   2 90 2 0 95949 0
28306   3 90 2 0 104858 0
28306   4 90 2 0 96371 0
28307   1 90 2 0 110682 0
28307   2 90 2 0 134483 0
28307   3 90 2 0 102191 0
28307   4 90 2 0 100956 0
28308   1 90 2 0 104035 0
28308   2 90 2 0 96559 0
28308   3 90 2 0 90957 0
28308   4 90 2 0 91530 0
28309   1 90 2 0 145802 0
28309   2 90 2 0 143687 0
28309   3 90 2 0 134922 0
28309   4 90 2 0 133339 0
28310   1 90 2 0 95285 0
28310   2 90 2 0 86196 0
28310   3 90 2 0 77899 0
28310   4 90 2 0 90823 0
28312   1 90 2 0 80778 0
28312   2 90 2 0 79646 0
28312   3 90 2 0 74926 0
28312   4 90 2 0 71607 0
28313   1 90 2 0 65885 0
28313   2 90 2 0 65081 0
28313   3 90 2 0 61768 0
28313   4 90 2 0 63014 0
28315   1 90 2 0 80053 0
28315   2 90 2 0 78985 0
28315   3 90 2 0 74543 0
28315   4 90 2 0 68804 0
28320   1 90 2 0 160998 0
28320   2 90 2 0 152603 0
28320   3 90 2 0 148944 0
28320   4 90 2 0 147127 0
28322   1 90 2 0 114222 0
28322   2 90 2 0 112823 0
28322   3 90 2 0 107047 0
28322   4 90 2 0 105819 0
28340   1 90 2 0 121057 0
28340   2 90 2 0 119191 0
28340   3 90 2 0 117877 0
28340   4 90 2 0 110122 0
28341   1 90 2 0 143785 0
28341   2 90 2 0 141667 0
28341   3 90 2 0 132877 0
28341   4 90 2 0 131264 0
28344   1 90 2 0 71989 0
28344   2 90 2 0 70828 0
28344   3 90 2 0 66037 0
28344   4 90 2 0 65252 0
28345   1 90 2 0 101349 0
28345   2 90 2 0 99810 0
28345   3 90 2 0 93434 0
28345   4 90 2 0 92303 0
28360   1 90 2 0 101349 0
28360   2 90 2 0 99810 0
28360   3 90 2 0 93434 0
28360   4 90 2 0 92303 0
28400   1 90 2 0 52710 0
28400   2 90 2 0 47285 0
28400   3 90 2 0 56726 0
28400   4 90 2 0 52756 0
28405   1 90 2 0 85181 0
28405   2 90 2 0 96407 0
28405   3 90 2 0 77511 0
28405   4 90 2 0 69838 0
28406   1 90 2 0 112781 0
28406   2 90 2 0 113292 0
28406   3 90 2 0 103831 0
28406   4 90 2 0 102173 0
28415   1 90 2 0 206736 0
28415   2 90 2 0 203787 0
28415   3 90 2 0 178589 0
28415   4 90 2 0 177641 0
28420   1 90 2 0 254899 0
28420   2 90 2 0 243462 0
28420   3 90 2 0 240507 0
28420   4 90 2 0 226392 0
28430   1 90 2 0 50215 0
28430   2 90 2 0 41113 0
28430   3 90 2 0 49037 0
28430   4 90 2 0 48325 0
28435   1 90 2 0 62510 0
28435   2 90 2 0 69522 0
28435   3 90 2 0 68185 0
28435   4 90 2 0 56684 0
28436   1 90 2 0 81544 0
28436   2 90 2 0 80234 0
28436   3 90 2 0 74809 0
28436   4 90 2 0 73917 0
28445   1 90 2 0 166953 0
28445   2 90 2 0 164246 0
28445   3 90 2 0 153057 0
28445   4 90 2 0 151223 0
28446   1 90 2 0 167914 0
28446   2 90 2 0 148505 0
28446   3 90 2 0 148505 0
28446   4 90 2 0 148505 0
28450   1 90 2 0 34848 0
28450   2 90 2 0 34575 0
28450   3 90 2 0 32798 0
28450   4 90 2 0 33022 0
28455   1 90 2 0 52036 0
28455   2 90 2 0 49973 0
28455   3 90 2 0 47984 0
28455   4 90 2 0 51812 0
28456   1 90 2 0 44358 0
28456   2 90 2 0 26949 0
28456   3 90 2 0 40675 0
28456   4 90 2 0 40193 0
28465   1 90 2 0 112271 0
28465   2 90 2 0 110147 0
28465   3 90 2 0 104093 0
28465   4 90 2 0 103328 0
28470   1 90 2 0 33067 25459
28470   2 90 2 0 33255 25578
28470   3 90 2 0 32692 25113
28470   4 90 2 0 30144 23167
28475   1 90 2 0 46850 36932
28475   2 90 2 0 46176 36395
28475   3 90 2 0 43413 34170
28475   4 90 2 0 42895 33817
28476   1 90 2 0 61028 0
28476   2 90 2 0 60081 0
28476   3 90 2 0 56153 0
28476   4 90 2 0 55466 0
28485   1 90 2 0 92320 0
28485   2 90 2 0 80003 0
28485   3 90 2 0 75502 0
28485   4 90 2 0 75723 0
28490   1 90 2 0 18266 14230
28490   2 90 2 0 17883 13965
28490   3 90 2 0 17206 13413
28490   4 90 2 0 16844 13141
28495   1 90 2 0 23671 0
28495   2 90 2 0 23355 0
28495   3 90 2 0 23308 0
28495   4 90 2 0 22072 0
28496   1 90 2 0 39862 0
28496   2 90 2 0 39246 0
28496   3 90 2 0 36680 0
28496   4 90 2 0 36240 0
28505   1 90 2 0 68754 0
28505   2 90 2 0 59917 0
28505   3 90 2 0 65523 0
28505   4 90 2 0 67147 0
28510   1 90 2 0 18127 14135
28510   2 90 2 0 17514 13671
28510   3 90 2 0 16900 13227
28510   4 90 2 0 16758 13084
28515   1 90 2 0 22410 17681
28515   2 90 2 0 22120 17455
28515   3 90 2 0 22821 18038
28515   4 90 2 0 20969 16589
28525   1 90 2 0 49407 0
28525   2 90 2 0 46487 0
28525   3 90 2 0 48019 0
28525   4 90 2 0 47813 0
28530   1 90 2 0 18266 0
28530   2 90 2 0 18016 0
28530   3 90 2 0 16966 0
28530   4 90 2 0 16758 0
28531   1 90 2 0 37233 0
28531   2 90 2 0 36633 0
28531   3 90 2 0 34136 0
28531   4 90 2 0 33734 0
28540   1 90 2 0 30666 0
28540   2 90 2 0 30374 0
28540   3 90 2 0 29574 0
28540   4 90 2 0 30978 0
28545   1 90 2 0 31328 0
28545   2 90 2 0 30949 0
28545   3 90 2 0 29380 0
28545   4 90 2 0 29038 0
28546   1 90 2 0 53367 0
28546   2 90 2 0 52515 0
28546   3 90 2 0 48966 0
28546   4 90 2 0 48388 0
28555   1 90 2 0 106032 0
28555   2 90 2 0 104455 0
28555   3 90 2 0 96752 0
28555   4 90 2 0 96721 0
28570   1 90 2 0 37334 0
28570   2 90 2 0 31651 0
28570   3 90 2 0 26768 0
28570   4 90 2 0 26437 0
28575   1 90 2 0 53409 0
28575   2 90 2 0 52575 0
28575   3 90 2 0 49125 0
28575   4 90 2 0 48535 0
28576   1 90 2 0 60516 0
28576   2 90 2 0 59642 0
28576   3 90 2 0 56023 0
28576   4 90 2 0 55372 0
28585   1 90 2 0 112259 0
28585   2 90 2 0 113460 0
28585   3 90 2 0 67844 0
28585   4 90 2 0 125244 0
28600   1 90 2 0 21524 0
28600   2 90 2 0 21455 0
28600   3 90 2 0 20489 0
28600   4 90 2 0 20261 0
28605   1 90 2 0 44015 0
28605   2 90 2 0 43335 0
28605   3 90 2 0 39518 0
28605   4 90 2 0 40031 0
28606   1 90 2 0 73993 0
28606   2 90 2 0 73856 0
28606   3 90 2 0 68866 0
28606   4 90 2 0 68065 0
28615   1 90 2 0 95465 0
28615   2 90 2 0 93940 0
28615   3 90 2 0 87631 0
28615   4 90 2 0 86582 0
28630   1 10 2 0 22968 0
28630   2 10 2 0 22532 0
28630   3 10 2 0 21271 0
28630   4 10 2 0 22304 0
28635   1 10 2 0 30333 0
28635   2 10 2 0 27380 0
28635   3 10 2 0 28194 0
28635   4 10 2 0 27856 0
28636   1 10 2 0 49646 0
28636   2 10 2 0 48842 0
28636   3 10 2 0 45539 0
28636   4 10 2 0 44996 0
28645   1 90 2 0 65780 0
28645   2 90 2 0 64879 0
28645   3 90 2 0 61145 0
28645   4 90 2 0 60419 0
28660   1 10 2 0 16996 0
28660   2 10 2 0 15895 0
28660   3 10 2 0 16231 0
28660   4 10 2 0 17442 0
28665   1 10 2 0 25504 0
28665   2 10 2 0 25203 0
28665   3 10 2 0 23959 0
28665   4 10 2 0 23688 0
28666   1 10 2 0 47460 0
28666   2 10 2 0 46694 0
28666   3 10 2 0 43547 0
28666   4 10 2 0 43027 0
28675   1 90 2 0 54164 0
28675   2 90 2 0 52440 0
28675   3 90 2 0 48964 0
28675   4 90 2 0 50625 0
28705   1 90 2 0 278732 0
28705   2 90 2 0 221415 0
28705   3 90 2 0 255355 0
28705   4 90 2 0 252269 0
28715   1 90 2 0 231884 0
28715   2 90 2 0 228171 0
28715   3 90 2 0 218373 0
28715   4 90 2 0 212735 0
28725   1 90 2 0 178856 0
28725   2 90 2 0 187474 0
28725   3 90 2 0 175427 0
28725   4 90 2 0 173349 0
28730   1 90 2 0 168678 0
28730   2 90 2 0 174429 0
28730   3 90 2 0 152500 0
28730   4 90 2 0 161274 0
28735   1 90 2 0 185562 0
28735   2 90 2 0 174025 0
28735   3 90 2 0 170932 0
28735   4 90 2 0 168873 0
28737   1 90 2 0 165723 0
28737   2 90 2 0 154472 0
28737   3 90 2 0 152212 0
28737   4 90 2 0 150364 0
28740   1 90 2 0 105324 0
28740   2 90 2 0 103777 0
28740   3 90 2 0 100451 0
28740   4 90 2 0 99153 0
28750   1 90 2 0 112310 0
28750   2 90 2 0 112323 0
28750   3 90 2 0 111315 0
28750   4 90 2 0 105925 0
28755   1 90 2 0 75004 0
28755   2 90 2 0 73950 0
28755   3 90 2 0 73503 0
28755   4 90 2 0 68779 0
28760   1 90 2 0 100411 0
28760   2 90 2 0 104890 0
28760   3 90 2 0 97222 0
28760   4 90 2 0 113270 0
28800   1 90 2 0 145068 0
28800   2 90 2 0 143818 0
28800   3 90 2 0 138247 0
28800   4 90 2 0 139983 0
28805   1 90 2 0 142475 0
28805   2 90 2 0 130742 0
28805   3 90 2 0 121705 0
28805   4 90 2 0 128513 0
28810   1 90 2 0 89554 0
28810   2 90 2 0 91209 0
28810   3 90 2 0 83620 0
28810   4 90 2 0 81440 0
28820   1 90 2 0 65030 0
28820   2 90 2 0 57086 0
28820   3 90 2 0 53409 0
28820   4 90 2 0 52794 0
28825   1 90 2 0 60198 0
28825   2 90 2 0 52342 0
28825   3 90 2 0 47942 0
28825   4 90 2 0 47387 0
28890   1 90 2 0 57633 35031
28890   2 90 2 0 49488 31022
28890   3 90 2 0 49488 31022
28890   4 90 2 0 49488 31022
28899     YYY 2 0 0 0
29000   1 0 2 0 37330 0
29000   2 0 2 0 37686 0
29000   3 0 2 0 42415 0
29000   4 0 2 0 22859 0
29010   1 0 2 0 53367 0
29010   2 0 2 0 40836 0
29010   3 0 2 0 38056 0
29010   4 0 2 0 37590 0
29015   1 0 2 0 44388 0
29015   2 0 2 0 53927 0
29015   3 0 2 0 40898 0
29015   4 0 2 0 40409 0
29035   1 0 2 0 35559 0
29035   2 0 2 0 55136 0
29035   3 0 2 0 47813 0
29035   4 0 2 0 32105 0
29040   1 0 2 0 39653 0
29040   2 0 2 0 39051 0
29040   3 0 2 0 36537 0
29040   4 0 2 0 36100 0
29044   1 0 2 0 39918 0
29044   2 0 2 0 39266 0
29044   3 0 2 0 36591 0
29044   4 0 2 0 36161 0
29046   1 0 2 0 43852 0
29046   2 0 2 0 43156 0
29046   3 0 2 0 40287 0
29046   4 0 2 0 39806 0
29049   1 0 2 0 11812 0
29049   2 0 2 0 11667 0
29049   3 0 2 0 11071 0
29049   4 0 2 0 10098 0
29055   1 0 2 0 27365 0
29055   2 0 2 0 35067 0
29055   3 0 2 0 25431 0
29055   4 0 2 0 36277 0
29058   1 0 2 0 17719 0
29058   2 0 2 0 17502 0
29058   3 0 2 0 16597 0
29058   4 0 2 0 24665 0
29065   1 0 2 0 24536 19281
29065   2 0 2 0 24657 19340
29065   3 0 2 0 23836 18656
29065   4 0 2 0 22521 17651
29075   1 0 2 0 17981 14387
29075   2 0 2 0 19258 15367
29075   3 0 2 0 17330 13831
29075   4 0 2 0 14424 11503
29085   1 0 2 0 9641 7986
29085   2 0 2 0 9531 7929
29085   3 0 2 0 9135 7581
29085   4 0 2 0 9059 7556
29086   1 0 2 0 10250 8105
29086   2 0 2 0 8997 7171
29086   3 0 2 0 8997 7171
29086   4 0 2 0 8997 7171
29105   1 0 2 0 12627 10497
29105   2 0 2 0 12483 10373
29105   3 0 2 0 11605 9616
29105   4 0 2 0 11641 9685
29125   1 0 2 0 8757 7205
29125   2 0 2 0 8640 7115
29125   3 0 2 0 8579 7082
29125   4 0 2 0 8069 6651
29126   1 0 2 0 10639 8967
29126   2 0 2 0 9241 7765
29126   3 0 2 0 10261 8643
29126   4 0 2 0 7965 6723
29130   1 0 2 0 5945 5233
29130   2 0 2 0 5882 5183
29130   3 0 2 0 7237 6379
29130   4 0 2 0 7275 6422
29131   1 0 2 0 14720 0
29131   2 0 2 0 13867 0
29131   3 0 2 0 14498 0
29131   4 0 2 0 7983 0
29200   1 0 2 0 6547 5643
29200   2 0 2 0 6593 5685
29200   3 0 2 0 6317 5440
29200   4 0 2 0 6287 5447
29240   1 0 2 0 7922 0
29240   2 0 2 0 8088 0
29240   3 0 2 0 7872 0
29240   4 0 2 0 7572 0
29260   1 0 2 0 6271 5406
29260   2 0 2 0 6257 5410
29260   3 0 2 0 6017 5190
29260   4 0 2 0 6014 5193
29280   1 0 2 0 6366 0
29280   2 0 2 0 6298 0
29280   3 0 2 0 6023 0
29280   4 0 2 0 5956 0
29305   1 0 2 0 46956 0
29305   2 0 2 0 46963 0
29305   3 0 2 0 38861 0
29305   4 0 2 0 33579 0
29325   1 0 2 0 39649 0
29325   2 0 2 0 39065 0
29325   3 0 2 0 37428 0
29325   4 0 2 0 36214 0
29345   1 0 2 0 29282 23646
29345   2 0 2 0 29761 24031
29345   3 0 2 0 23504 19009
29345   4 0 2 0 22333 18038
29355   1 0 2 0 24433 19794
29355   2 0 2 0 25422 20545
29355   3 0 2 0 22626 18297
29355   4 0 2 0 20711 16779
29358   1 0 2 0 34231 0
29358   2 0 2 0 33990 0
29358   3 0 2 0 29429 0
29358   4 0 2 0 29069 0