2018 Workers' Compensation Part B Fee Schedule

29365-30620

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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)
29365   1 0 2 0 24061 19417
29365   2 0 2 0 24872 20062
29365   3 0 2 0 18903 15229
29365   4 0 2 0 18137 14638
29405   1 0 2 0 17709 13899
29405   2 0 2 0 17950 14046
29405   3 0 2 0 14279 11159
29405   4 0 2 0 15908 12464
29425   1 0 2 0 24571 19120
29425   2 0 2 0 25966 20195
29425   3 0 2 0 21733 16887
29425   4 0 2 0 21066 16371
29435   1 0 2 0 34352 26639
29435   2 0 2 0 34499 26718
29435   3 0 2 0 34232 26468
29435   4 0 2 0 22212 17174
29440   1 0 2 0 7162 6200
29440   2 0 2 0 7273 6283
29440   3 0 2 0 6752 5852
29440   4 0 2 0 7094 6152
29445   1 0 2 0 35419 0
29445   2 0 2 0 34345 0
29445   3 0 2 0 32071 0
29445   4 0 2 0 31631 0
29450   1 0 2 0 15186 0
29450   2 0 2 0 13927 0
29450   3 0 2 0 11730 0
29450   4 0 2 0 11604 0
29505   1 0 2 0 12525 0
29505   2 0 2 0 11729 0
29505   3 0 2 0 11320 0
29505   4 0 2 0 11799 0
29515   1 0 2 0 10978 8967
29515   2 0 2 0 10656 8714
29515   3 0 2 0 10238 8366
29515   4 0 2 0 10121 8285
29520   1 0 2 0 7999 6491
29520   2 0 2 0 7905 6422
29520   3 0 2 0 7516 6112
29520   4 0 2 0 7427 6049
29530   1 0 2 0 7915 6542
29530   2 0 2 0 8070 6664
29530   3 0 2 0 7844 6481
29530   4 0 2 0 7751 6430
29540   1 0 2 0 6959 5774
29540   2 0 2 0 7162 5921
29540   3 0 2 0 6808 5635
29540   4 0 2 0 6647 5526
29550   1 0 2 0 6198 5115
29550   2 0 2 0 6093 5020
29550   3 0 2 0 6324 5233
29550   4 0 2 0 5438 4520
29580   1 0 2 0 9301 6644
29580   2 0 2 0 8793 6252
29580   3 0 2 0 8004 5652
29580   4 0 2 0 7781 5497
29581   1 0 2 0 12929 4741
29581   2 0 2 0 11222 4318
29581   3 0 2 0 11222 4318
29581   4 0 2 0 11222 4318
29584   1 0 2 0 9589 2071
29584   2 0 2 0 8451 1967
29584   3 0 2 0 8451 1967
29584   4 0 2 0 8451 1967
29700     0 2 0 0 0
29705     0 2 0 0 0
29710     0 2 0 0 0
29720   1 0 2 0 7549 0
29720   2 0 2 0 7480 0
29720   3 0 2 0 7721 0
29720   4 0 2 0 7640 0
29730   1 0 2 0 9045 0
29730   2 0 2 0 8948 0
29730   3 0 2 0 8659 0
29730   4 0 2 0 8432 0
29740   1 0 2 0 13378 0
29740   2 0 2 0 13022 0
29740   3 0 2 0 12629 0
29740   4 0 2 0 10755 0
29750   1 0 2 0 15792 0
29750   2 0 2 0 15608 0
29750   3 0 2 0 14858 0
29750   4 0 2 0 14698 0
29799     YYY 2 0 0 0
29800   1 90 2 0 84587 0
29800   2 90 2 0 83452 0
29800   3 90 2 0 78765 0
29800   4 90 2 0 77833 0
29804   1 90 2 0 201945 0
29804   2 90 2 0 198692 0
29804   3 90 2 0 185176 0
29804   4 90 2 0 182763 0
29805   1 90 2 0 67959 0
29805   2 90 2 0 59993 0
29805   3 90 2 0 59993 0
29805   4 90 2 0 59993 0
29806   1 90 2 0 189543 0
29806   2 90 2 0 166603 0
29806   3 90 2 0 166603 0
29806   4 90 2 0 166603 0
29807   1 90 2 0 184629 0
29807   2 90 2 0 162073 0
29807   3 90 2 0 162073 0
29807   4 90 2 0 162073 0
29819   1 90 3 0 209710 0
29819   2 90 3 0 207281 0
29819   3 90 3 0 194948 0
29819   4 90 3 0 149130 0
29820   1 90 3 0 160970 0
29820   2 90 3 0 157976 0
29820   3 90 3 0 145591 0
29820   4 90 3 0 143799 0
29821   1 90 3 0 190524 0
29821   2 90 3 0 241776 0
29821   3 90 3 0 171810 0
29821   4 90 3 0 169673 0
29822   1 90 3 0 166455 0
29822   2 90 3 0 163399 0
29822   3 90 3 0 150767 0
29822   4 90 3 0 148913 0
29823   1 90 3 0 204214 0
29823   2 90 3 0 200273 0
29823   3 90 3 0 203174 0
29823   4 90 3 0 202190 0
29824   1 90 2 0 115622 0
29824   2 90 2 0 101420 0
29824   3 90 2 0 101420 0
29824   4 90 2 0 101420 0
29825   1 90 3 0 184398 0
29825   2 90 3 0 180890 0
29825   3 90 3 0 166367 0
29825   4 90 3 0 164306 0
29826   1 ZZZ 0 0 219673 0
29826   2 ZZZ 0 0 217754 0
29826   3 ZZZ 0 0 210388 0
29826   4 ZZZ 0 0 189188 0
29827   1 90 3 0 195407 0
29827   2 90 3 0 172722 0
29827   3 90 3 0 172722 0
29827   4 90 3 0 172722 0
29828   1 90 3 0 130516 0
29828   2 90 3 0 114545 0
29828   3 90 3 0 114545 0
29828   4 90 3 0 114545 0
29830   1 90 2 0 103383 0
29830   2 90 2 0 101748 0
29830   3 90 2 0 94988 0
29830   4 90 2 0 93855 0
29834   1 90 3 0 113747 0
29834   2 90 3 0 133083 0
29834   3 90 3 0 104317 0
29834   4 90 3 0 138943 0
29835   1 90 3 0 117397 0
29835   2 90 3 0 115504 0
29835   3 90 3 0 107668 0
29835   4 90 3 0 106392 0
29836   1 90 3 0 136682 0
29836   2 90 3 0 134476 0
29836   3 90 3 0 125372 0
29836   4 90 3 0 123884 0
29837   1 90 3 0 124652 0
29837   2 90 3 0 122631 0
29837   3 90 3 0 149875 0
29837   4 90 3 0 112932 0
29838   1 90 3 0 137142 0
29838   2 90 3 0 165892 0
29838   3 90 3 0 154736 0
29838   4 90 3 0 124356 0
29840   1 90 2 0 80508 0
29840   2 90 2 0 79375 0
29840   3 90 2 0 74693 0
29840   4 90 2 0 73845 0
29843   1 90 3 0 108757 0
29843   2 90 3 0 107008 0
29843   3 90 3 0 99766 0
29843   4 90 3 0 98579 0
29844   1 90 3 0 112200 0
29844   2 90 3 0 110393 0
29844   3 90 3 0 102941 0
29844   4 90 3 0 101725 0
29845   1 90 3 0 157285 0
29845   2 90 3 0 133979 0
29845   3 90 3 0 124894 0
29845   4 90 3 0 123409 0
29846   1 90 3 0 176111 0
29846   2 90 3 0 172554 0
29846   3 90 3 0 157841 0
29846   4 90 3 0 155895 0
29847   1 90 3 0 154092 0
29847   2 90 3 0 126614 0
29847   3 90 3 0 118387 0
29847   4 90 3 0 116960 0
29848   1 90 2 0 74755 0
29848   2 90 2 0 73555 0
29848   3 90 2 0 68589 0
29848   4 90 2 0 67772 0
29850   1 90 2 0 212309 0
29850   2 90 2 0 173029 0
29850   3 90 2 0 160081 0
29850   4 90 2 0 203507 0
29851   1 90 2 0 232983 0
29851   2 90 2 0 216485 0
29851   3 90 2 0 202299 0
29851   4 90 2 0 223292 0
29855   1 90 2 0 203470 0
29855   2 90 2 0 193241 0
29855   3 90 2 0 185498 0
29855   4 90 2 0 183773 0
29856   1 90 2 0 235604 0
29856   2 90 2 0 209117 0
29856   3 90 2 0 216675 0
29856   4 90 2 0 199129 0
29860   1 90 2 0 104563 0
29860   2 90 2 0 93356 0
29860   3 90 2 0 93356 0
29860   4 90 2 0 93356 0
29861   1 90 3 0 159160 0
29861   2 90 3 0 137893 0
29861   3 90 3 0 137893 0
29861   4 90 3 0 137893 0
29862   1 90 3 0 175834 0
29862   2 90 3 0 150976 0
29862   3 90 3 0 150976 0
29862   4 90 3 0 150976 0
29863   1 90 3 0 159044 0
29863   2 90 3 0 138413 0
29863   3 90 3 0 138413 0
29863   4 90 3 0 138413 0
29866   1 90 2 0 183421 0
29866   2 90 2 0 160589 0
29866   3 90 2 0 160589 0
29866   4 90 2 0 160589 0
29867   1 90 2 0 218746 0
29867   2 90 2 0 192097 0
29867   3 90 2 0 192097 0
29867   4 90 2 0 192097 0
29868   1 90 2 0 297332 0
29868   2 90 2 0 260303 0
29868   3 90 2 0 260303 0
29868   4 90 2 0 260303 0
29870   1 90 2 0 79192 0
29870   2 90 2 0 83659 0
29870   3 90 2 0 76913 0
29870   4 90 2 0 76555 0
29871   1 90 3 0 131869 0
29871   2 90 3 0 121006 0
29871   3 90 3 0 114360 0
29871   4 90 3 0 117067 0
29873   1 90 3 0 90482 0
29873   2 90 3 0 79501 0
29873   3 90 3 0 79501 0
29873   4 90 3 0 79501 0
29874   1 90 3 0 160306 0
29874   2 90 3 0 157119 0
29874   3 90 3 0 150553 0
29874   4 90 3 0 148030 0
29875   1 90 3 0 174944 0
29875   2 90 3 0 171766 0
29875   3 90 3 0 159393 0
29875   4 90 3 0 153612 0
29876   1 90 3 0 196087 0
29876   2 90 3 0 193031 0
29876   3 90 3 0 179891 0
29876   4 90 3 0 178415 0
29877   1 90 3 0 184220 0
29877   2 90 3 0 180656 0
29877   3 90 3 0 166622 0
29877   4 90 3 0 166266 0
29879   1 90 3 0 210923 0
29879   2 90 3 0 207478 0
29879   3 90 3 0 193855 0
29879   4 90 3 0 193031 0
29880   1 90 3 0 201799 0
29880   2 90 3 0 197986 0
29880   3 90 3 0 182191 0
29880   4 90 3 0 179933 0
29881   1 90 3 0 183707 0
29881   2 90 3 0 180595 0
29881   3 90 3 0 167739 0
29881   4 90 3 0 164694 0
29882   1 90 3 0 194538 0
29882   2 90 3 0 191475 0
29882   3 90 3 0 178239 0
29882   4 90 3 0 166964 0
29883   1 90 3 0 240231 0
29883   2 90 3 0 235525 0
29883   3 90 3 0 216063 0
29883   4 90 3 0 213371 0
29884   1 90 3 0 193552 0
29884   2 90 3 0 194409 0
29884   3 90 3 0 180002 0
29884   4 90 3 0 138628 0
29885   1 90 3 0 166313 0
29885   2 90 3 0 157499 0
29885   3 90 3 0 146829 0
29885   4 90 3 0 145080 0
29886   1 90 3 0 132363 0
29886   2 90 3 0 152772 0
29886   3 90 3 0 121382 0
29886   4 90 3 0 119944 0
29887   1 90 3 0 183812 0
29887   2 90 3 0 180633 0
29887   3 90 3 0 167523 0
29887   4 90 3 0 165474 0
29888   1 90 2 0 308650 0
29888   2 90 2 0 303023 0
29888   3 90 2 0 279741 0
29888   4 90 2 0 276289 0
29889   1 90 2 0 199579 0
29889   2 90 2 0 196350 0
29889   3 90 2 0 183034 0
29889   4 90 2 0 180855 0
29891   1 90 2 0 149902 0
29891   2 90 2 0 129285 0
29891   3 90 2 0 129285 0
29891   4 90 2 0 129285 0
29892   1 90 2 0 154177 0
29892   2 90 2 0 133414 0
29892   3 90 2 0 133414 0
29892   4 90 2 0 133414 0
29893   1 90 2 0 84516 0
29893   2 90 2 0 74860 0
29893   3 90 2 0 74860 0
29893   4 90 2 0 74860 0
29894   1 90 2 0 160149 0
29894   2 90 2 0 167833 0
29894   3 90 2 0 143057 0
29894   4 90 2 0 146781 0
29895   1 90 2 0 163761 0
29895   2 90 2 0 149904 0
29895   3 90 2 0 141455 0
29895   4 90 2 0 136910 0
29897   1 90 2 0 165163 0
29897   2 90 2 0 162092 0
29897   3 90 2 0 149377 0
29897   4 90 2 0 157205 0
29898   1 90 2 0 188964 0
29898   2 90 2 0 185544 0
29898   3 90 2 0 179101 0
29898   4 90 2 0 169261 0
29899   1 90 2 0 180159 0
29899   2 90 2 0 158422 0
29899   3 90 2 0 158422 0
29899   4 90 2 0 158422 0
29900   1 90 2 0 82000 0
29900   2 90 2 0 71960 0
29900   3 90 2 0 71960 0
29900   4 90 2 0 71960 0
29901   1 90 2 0 90442 0
29901   2 90 2 0 79358 0
29901   3 90 2 0 79358 0
29901   4 90 2 0 79358 0
29902   1 90 2 0 97066 0
29902   2 90 2 0 85203 0
29902   3 90 2 0 85203 0
29902   4 90 2 0 85203 0
29904   1 90 2 0 87243 0
29904   2 90 2 0 76753 0
29904   3 90 2 0 76753 0
29904   4 90 2 0 76753 0
29905   1 90 2 0 94049 0
29905   2 90 2 0 82664 0
29905   3 90 2 0 82664 0
29905   4 90 2 0 82664 0
29906   1 90 2 0 99063 0
29906   2 90 2 0 87060 0
29906   3 90 2 0 87060 0
29906   4 90 2 0 87060 0
29914   1 90 3 0 153200 0
29914   2 90 3 0 137920 0
29914   3 90 3 0 137920 0
29914   4 90 3 0 137920 0
29915   1 90 3 0 156027 0
29915   2 90 3 0 140512 0
29915   3 90 3 0 140512 0
29915   4 90 3 0 140512 0
29916   1 90 3 0 156027 0
29916   2 90 3 0 140512 0
29916   3 90 3 0 140512 0
29916   4 90 3 0 140512 0
29999     YYY 2 0 0 0
30000   1 10 2 0 17291 0
30000   2 10 2 0 20449 0
30000   3 10 2 0 19550 0
30000   4 10 2 0 16192 0
30020   1 10 2 0 21517 0
30020   2 10 2 0 20507 0
30020   3 10 2 0 20256 0
30020   4 10 2 0 20646 0
30100   1 0 2 0 15792 12695
30100   2 0 2 0 15710 12589
30100   3 0 2 0 15371 12351
30100   4 0 2 0 15301 12281
30110   1 10 2 0 26054 20621
30110   2 10 2 0 25709 20344
30110   3 10 2 0 25037 19826
30110   4 10 2 0 23977 18994
30115   1 90 2 0 57020 0
30115   2 90 2 0 62559 0
30115   3 90 2 0 59503 0
30115   4 90 2 0 48415 0
30117   1 90 2 0 46116 0
30117   2 90 2 0 45257 0
30117   3 90 2 0 43852 0
30117   4 90 2 0 42430 0
30118   1 90 2 0 157749 0
30118   2 90 2 0 155559 0
30118   3 90 2 0 146482 0
30118   4 90 2 0 152243 0
30120   1 90 2 0 147457 0
30120   2 90 2 0 146653 0
30120   3 90 2 0 143328 0
30120   4 90 2 0 142793 0
30124   1 90 2 0 38697 0
30124   2 90 2 0 43242 0
30124   3 90 2 0 43568 0
30124   4 90 2 0 45390 0
30125   1 90 2 0 113895 0
30125   2 90 2 0 119366 0
30125   3 90 2 0 123764 0
30125   4 90 2 0 104300 0
30130   1 90 2 0 43173 0
30130   2 90 2 0 42678 0
30130   3 90 2 0 40626 0
30130   4 90 2 0 40164 0
30140   1 90 2 0 65538 0
30140   2 90 2 0 65048 0
30140   3 90 2 0 64336 0
30140   4 90 2 0 63256 0
30150   1 90 2 0 218160 0
30150   2 90 2 0 217203 0
30150   3 90 2 0 213235 0
30150   4 90 2 0 139140 0
30160   1 90 2 0 194876 0
30160   2 90 2 0 189961 0
30160   3 90 2 0 178631 0
30160   4 90 2 0 176416 0
30200   1 0 2 0 9359 7937
30200   2 0 2 0 9167 7808
30200   3 0 2 0 7601 6489
30200   4 0 2 0 8824 7501
30210   1 10 2 0 11261 10173
30210   2 10 2 0 11156 10078
30210   3 10 2 0 10713 9706
30210   4 10 2 0 10601 9609
30220   1 10 2 0 27485 0
30220   2 10 2 0 27100 0
30220   3 10 2 0 25494 0
30220   4 10 2 0 25181 0
30300   1 10 2 0 12938 0
30300   2 10 2 0 12869 0
30300   3 10 2 0 12314 0
30300   4 10 2 0 11955 0
30310   1 10 2 0 32175 0
30310   2 10 2 0 31351 0
30310   3 10 2 0 29924 0
30310   4 10 2 0 29559 0
30320   1 90 2 0 78969 0
30320   2 90 2 0 77894 0
30320   3 90 2 0 73393 0
30320   4 90 2 0 72490 0
30400   1 90 2 0 193272 0
30400   2 90 2 0 187589 0
30400   3 90 2 0 175345 0
30400   4 90 2 0 172883 0
30410     90 2 0 0 0
30420   1 90 2 0 332253 0
30420   2 90 2 0 322608 0
30420   3 90 2 0 301594 0
30420   4 90 2 0 297323 0
30430   1 90 2 0 86193 0
30430   2 90 2 0 85157 0
30430   3 90 2 0 80867 0
30430   4 90 2 0 79923 0
30435   1 90 2 0 119834 0
30435   2 90 2 0 118146 0
30435   3 90 2 0 111170 0
30435   4 90 2 0 109822 0
30450   1 90 2 0 195698 0
30450   2 90 2 0 192384 0
30450   3 90 2 0 178631 0
30450   4 90 2 0 176416 0
30460   1 90 2 0 164906 0
30460   2 90 2 0 162629 0
30460   3 90 2 0 153200 0
30460   4 90 2 0 151341 0
30462   1 90 2 0 329939 0
30462   2 90 2 0 325384 0
30462   3 90 2 0 306483 0
30462   4 90 2 0 302774 0
30465   1 90 2 0 157806 0
30465   2 90 2 0 141621 0
30465   3 90 2 0 141621 0
30465   4 90 2 0 141621 0
30520   1 90 2 0 126380 0
30520   2 90 2 0 124350 0
30520   3 90 2 0 115903 0
30520   4 90 2 0 114430 0
30540   1 90 2 0 128241 0
30540   2 90 2 0 126489 0
30540   3 90 2 0 119244 0
30540   4 90 2 0 117798 0
30545   1 90 2 0 195780 0
30545   2 90 2 0 193191 0
30545   3 90 2 0 182431 0
30545   4 90 2 0 180165 0
30560   1 10 2 0 15658 0
30560   2 10 2 0 13345 0
30560   3 10 2 0 12931 0
30560   4 10 2 0 12836 0
30580   1 90 2 0 115115 0
30580   2 90 2 0 113571 0
30580   3 90 2 0 107187 0
30580   4 90 2 0 105863 0
30600   1 90 2 0 86193 0
30600   2 90 2 0 96487 0
30600   3 90 2 0 80867 0
30600   4 90 2 0 79923 0
30620   1 90 2 0 134203 0
30620   2 90 2 0 131963 0
30620   3 90 2 0 122660 0
30620   4 90 2 0 121087 0