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DLI
>
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Workers' Compensation
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Health Care Services Review
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Medical Fee Review
>
Fee Schedule
>
Fee Schedule 35013-35601
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
35013-35601
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
35013
004
90
2
X
4,079.38
X
35013
001
90
2
X
4,241.63
X
35013
003
90
2
X
4,096.48
X
35013
002
90
2
X
4,213.30
X
35021
002
90
2
X
4,348.21
X
35021
003
90
2
X
4,043.44
X
35021
001
90
2
X
4,421.89
X
35021
004
90
2
X
3,995.06
X
35022
004
90
2
X
4,003.06
X
35022
003
90
2
X
4,049.07
X
35022
002
90
2
X
4,330.14
X
35022
001
90
2
X
4,398.46
X
35045
001
90
2
X
2,861.39
X
35045
004
90
2
X
2,553.42
X
35045
002
90
2
X
2,807.30
X
35045
003
90
2
X
2,641.24
X
35081
002
90
2
X
5,626.19
X
35081
003
90
2
X
5,158.54
X
35081
001
90
2
X
5,620.36
X
35081
004
90
2
X
5,370.84
X
35082
004
90
2
X
6,242.42
X
35082
002
90
2
X
6,688.79
X
35082
003
90
2
X
6,302.40
X
35082
001
90
2
X
6,809.47
X
35091
003
90
2
X
5,665.17
X
35091
002
90
2
X
6,162.97
X
35091
004
90
2
X
5,653.91
X
35091
001
90
2
X
6,367.73
X
35092
003
90
2
X
8,894.02
X
35092
002
90
2
X
9,107.59
X
35092
004
90
2
X
8,859.90
X
35092
001
90
2
X
9,159.57
X
35102
001
90
2
X
6,113.02
X
35102
003
90
2
X
5,646.76
X
35102
002
90
2
X
5,611.69
X
35102
004
90
2
X
5,665.64
X
35103
004
90
2
X
6,936.69
X
35103
001
90
2
X
7,591.34
X
35103
002
90
2
X
7,495.16
X
35103
003
90
2
X
6,992.80
X
35111
002
90
2
X
4,007.79
X
35111
003
90
2
X
3,792.77
X
35111
004
90
2
X
3,747.71
X
35111
001
90
2
X
4,198.62
X
35112
002
90
2
X
3,362.16
X
35112
003
90
2
X
3,145.49
X
35112
004
90
2
X
3,110.58
X
35112
001
90
2
X
3,414.69
X
35121
003
90
2
X
5,348.25
X
35121
002
90
2
X
5,607.49
X
35121
004
90
2
X
5,221.33
X
35121
001
90
2
X
5,577.15
X
35122
004
90
2
X
5,590.53
X
35122
003
90
2
X
6,183.08
X
35122
002
90
2
X
6,192.35
X
35122
001
90
2
X
6,333.26
X
35131
001
90
2
X
4,546.17
X
35131
004
90
2
X
4,413.02
X
35131
003
90
2
X
4,429.76
X
35131
002
90
2
X
4,623.84
X
35132
003
90
2
X
4,752.57
X
35132
002
90
2
X
5,080.22
X
35132
001
90
2
X
5,156.84
X
35132
004
90
2
X
4,713.46
X
35141
002
90
2
X
3,976.86
X
35141
003
90
2
X
3,754.37
X
35141
004
90
2
X
3,701.05
X
35141
001
90
2
X
4,046.54
X
35142
003
90
2
X
4,122.58
X
35142
002
90
2
X
4,245.97
X
35142
004
90
2
X
4,104.96
X
35142
001
90
2
X
4,320.04
X
35151
003
90
2
X
4,025.47
X
35151
002
90
2
X
4,233.43
X
35151
004
90
2
X
4,009.52
X
35151
001
90
2
X
4,312.18
X
35152
004
90
2
X
2,761.45
X
35152
003
90
2
X
2,792.47
X
35152
002
90
2
X
4,356.88
X
35152
001
90
2
X
3,030.40
X
35180
004
90
2
X
2,175.39
X
35180
001
90
2
X
3,298.89
X
35180
003
90
2
X
2,199.94
X
35180
002
90
2
X
3,283.69
X
35182
001
90
2
X
3,198.06
X
35182
004
90
2
X
2,934.15
X
35182
002
90
2
X
3,621.37
X
35182
003
90
2
X
2,968.19
X
35184
003
90
2
X
2,345.40
X
35184
002
90
2
X
3,452.09
X
35184
004
90
2
X
3,175.83
X
35184
001
90
2
X
3,470.69
X
35188
001
90
2
X
3,383.65
X
35188
004
90
2
X
2,360.17
X
35188
003
90
2
X
2,386.79
X
35188
002
90
2
X
3,367.27
X
35189
004
90
2
X
3,628.85
X
35189
001
90
2
X
3,481.28
X
35189
003
90
2
X
3,206.87
X
35189
002
90
2
X
3,736.74
X
35190
003
90
2
X
3,457.79
X
35190
002
90
2
X
3,529.80
X
35190
004
90
2
X
3,441.91
X
35190
001
90
2
X
3,455.21
X
35201
002
90
2
X
2,450.68
X
35201
003
90
2
X
2,177.16
X
35201
004
90
2
X
2,151.10
X
35201
001
90
2
X
2,529.39
X
35206
001
90
2
X
2,377.37
X
35206
004
90
2
X
2,124.81
X
35206
003
90
2
X
2,150.61
X
35206
002
90
2
X
2,333.08
X
35207
004
90
2
X
2,240.05
X
35207
002
90
2
X
3,247.76
X
35207
003
90
2
X
3,319.08
X
35207
001
90
2
X
3,414.53
X
35211
003
90
2
X
3,777.82
X
35211
002
90
2
X
4,037.70
X
35211
001
90
2
X
4,795.89
X
35211
004
90
2
X
3,735.08
X
35216
004
90
2
X
3,091.59
X
35216
001
90
2
X
3,388.35
X
35216
002
90
2
X
4,353.87
X
35216
003
90
2
X
3,126.71
X
35221
001
90
2
X
3,233.03
X
35221
004
90
2
X
2,933.72
X
35221
003
90
2
X
2,967.52
X
35221
002
90
2
X
3,181.12
X
35226
001
90
2
X
2,614.00
X
35226
002
90
2
X
3,246.32
X
35226
003
90
2
X
2,121.66
X
35226
004
90
2
X
2,096.00
X
35231
004
90
2
X
2,915.52
X
35231
003
90
2
X
3,582.04
X
35231
002
90
2
X
3,791.78
X
35231
001
90
2
X
3,918.55
X
35236
002
90
2
X
2,715.73
X
35236
003
90
2
X
2,555.49
X
35236
001
90
2
X
2,795.27
X
35236
004
90
2
X
2,463.57
X
35241
002
90
2
X
4,160.61
X
35241
003
90
2
X
3,897.04
X
35241
004
90
2
X
3,853.20
X
35241
001
90
2
X
4,224.63
X
35246
002
90
2
X
4,135.72
X
35246
003
90
2
X
3,881.23
X
35246
001
90
2
X
4,197.24
X
35246
004
90
2
X
3,834.42
X
35251
001
90
2
X
3,127.02
X
35251
004
90
2
X
2,856.51
X
35251
003
90
2
X
2,888.78
X
35251
002
90
2
X
3,080.39
X
35256
004
90
2
X
2,563.39
X
35256
002
90
2
X
2,812.99
X
35256
003
90
2
X
2,616.32
X
35256
001
90
2
X
2,824.37
X
35261
004
90
2
X
2,695.14
X
35261
001
90
2
X
3,273.97
X
35261
002
90
2
X
2,964.67
X
35261
003
90
2
X
3,359.39
X
35266
004
90
2
X
2,370.85
X
35266
002
90
2
X
2,611.28
X
35266
003
90
2
X
2,399.72
X
35266
001
90
2
X
2,662.66
X
35271
001
90
2
X
4,002.76
X
35271
004
90
2
X
3,646.71
X
35271
003
90
2
X
3,687.91
X
35271
002
90
2
X
3,941.25
X
35276
002
90
2
X
3,749.38
X
35276
003
90
2
X
3,163.78
X
35276
001
90
2
X
3,438.21
X
35276
004
90
2
X
3,128.46
X
35281
002
90
2
X
4,032.40
X
35281
003
90
2
X
3,894.28
X
35281
001
90
2
X
4,107.17
X
35281
004
90
2
X
3,679.27
X
35286
001
90
2
X
2,827.48
X
35286
004
90
2
X
2,555.30
X
35286
003
90
2
X
2,593.58
X
35286
002
90
2
X
2,798.93
X
35301
001
90
2
X
3,893.35
X
35301
004
90
2
X
3,589.16
X
35301
003
90
2
X
3,594.15
X
35301
002
90
2
X
3,813.73
X
35302
001
90
2
X
2,171.05
X
35302
004
90
2
X
1,921.94
X
35302
003
90
2
X
1,921.94
X
35302
002
90
2
X
1,921.94
X
35303
004
90
2
X
2,112.07
X
35303
002
90
2
X
2,112.07
X
35303
003
90
2
X
2,112.07
X
35303
001
90
2
X
2,383.73
X
35304
001
90
2
X
2,480.24
X
35304
003
90
2
X
2,197.71
X
35304
002
90
2
X
2,197.71
X
35304
004
90
2
X
2,197.71
X
35305
001
90
2
X
2,383.73
X
35305
004
90
2
X
2,112.07
X
35305
002
90
2
X
2,112.07
X
35305
003
90
2
X
2,112.07
X
35306
002
ZZZ
0
X
792.98
X
35306
003
ZZZ
0
X
792.98
X
35306
001
ZZZ
0
X
892.90
X
35306
004
ZZZ
0
X
792.98
X
35311
004
90
2
X
5,078.84
X
35311
002
90
2
X
5,031.50
X
35311
003
90
2
X
4,887.22
X
35311
001
90
2
X
5,657.52
X
35321
004
90
2
X
2,749.23
X
35321
001
90
2
X
3,078.89
X
35321
003
90
2
X
2,782.41
X
35321
002
90
2
X
3,021.05
X
35331
001
90
2
X
4,327.61
X
35331
003
90
2
X
4,567.83
X
35331
002
90
2
X
4,746.76
X
35331
004
90
2
X
3,949.68
X
35341
004
90
2
X
4,604.77
X
35341
001
90
2
X
5,079.04
X
35341
003
90
2
X
4,657.63
X
35341
002
90
2
X
4,996.69
X
35351
004
90
2
X
4,189.96
X
35351
001
90
2
X
4,486.49
X
35351
003
90
2
X
4,145.28
X
35351
002
90
2
X
4,410.61
X
35355
001
90
2
X
4,364.12
X
35355
003
90
2
X
4,218.87
X
35355
002
90
2
X
4,335.75
X
35355
004
90
2
X
4,201.54
X
35361
001
90
2
X
5,191.10
X
35361
002
90
2
X
5,102.67
X
35361
003
90
2
X
5,252.54
X
35361
004
90
2
X
4,683.56
X
35363
004
90
2
X
5,185.29
X
35363
003
90
2
X
5,247.04
X
35363
002
90
2
X
5,660.13
X
35363
001
90
2
X
5,760.15
X
35371
001
90
2
X
3,527.50
X
35371
004
90
2
X
3,185.86
X
35371
003
90
2
X
3,242.06
X
35371
002
90
2
X
3,479.91
X
35372
001
90
2
X
3,548.00
X
35372
004
90
2
X
3,236.50
X
35372
002
90
2
X
3,496.23
X
35372
003
90
2
X
3,266.40
X
35390
001
ZZZ
0
X
596.76
X
35390
003
ZZZ
0
X
550.46
X
35390
002
ZZZ
0
X
587.74
X
35390
004
ZZZ
0
X
544.43
X
35400
002
ZZZ
0
X
491.31
X
35400
003
ZZZ
0
X
491.31
X
35400
004
ZZZ
0
X
491.31
X
35400
001
ZZZ
0
X
551.89
X
35500
ZZZ
0
X
*
X
35501
002
90
2
X
4,613.77
X
35501
003
90
2
X
4,278.68
X
35501
004
90
2
X
4,227.64
X
35501
001
90
2
X
4,694.92
X
35506
004
90
2
X
4,224.59
X
35506
001
90
2
X
4,933.83
X
35506
003
90
2
X
4,275.40
X
35506
002
90
2
X
4,879.69
X
35508
001
90
2
X
4,437.24
X
35508
002
90
2
X
4,359.30
X
35508
003
90
2
X
4,037.30
X
35508
004
90
2
X
3,989.27
X
35509
002
90
2
X
4,465.14
X
35509
003
90
2
X
4,115.99
X
35509
001
90
2
X
4,549.79
X
35509
004
90
2
X
4,067.14
X
35510
002
90
2
X
2,762.01
X
35510
003
90
2
X
2,762.01
X
35510
004
90
2
X
2,762.01
X
35510
001
90
2
X
3,043.06
X
35511
001
90
2
X
3,142.25
X
35511
004
90
2
X
2,865.00
X
35511
002
90
2
X
3,354.51
X
35511
003
90
2
X
3,339.20
X
35512
001
90
2
X
2,986.56
X
35512
004
90
2
X
2,708.70
X
35512
002
90
2
X
2,708.70
X
35512
003
90
2
X
2,708.70
X
35515
002
90
2
X
3,398.13
X
35515
003
90
2
X
3,187.22
X
35515
004
90
2
X
3,151.13
X
35515
001
90
2
X
3,449.26
X
35516
002
90
2
X
4,043.42
X
35516
003
90
2
X
3,726.57
X
35516
004
90
2
X
3,682.09
X
35516
001
90
2
X
4,120.13
X
35518
003
90
2
X
3,631.65
X
35518
001
90
2
X
4,013.65
X
35518
002
90
2
X
3,939.17
X
35518
004
90
2
X
3,749.64
X
35521
001
90
2
X
5,139.31
X
35521
004
90
2
X
5,002.64
X
35521
002
90
2
X
5,113.97
X
35521
003
90
2
X
4,893.04
X
35522
003
90
2
X
2,629.14
X
35522
002
90
2
X
2,629.14
X
35522
001
90
2
X
2,902.18
X
35522
004
90
2
X
2,629.14
X
35523
003
90
2
X
2,229.81
X
35523
002
90
2
X
2,229.81
X
35523
004
90
2
X
2,229.81
X
35523
001
90
2
X
2,459.89
X
35525
001
90
2
X
2,773.97
X
35525
003
90
2
X
2,508.22
X
35525
002
90
2
X
2,508.22
X
35525
004
90
2
X
2,508.22
X
35526
004
90
2
X
3,516.57
X
35526
001
90
2
X
3,862.82
X
35526
003
90
2
X
3,557.05
X
35526
002
90
2
X
3,803.05
X
35531
002
90
2
X
5,558.61
X
35531
003
90
2
X
5,425.88
X
35531
004
90
2
X
4,986.08
X
35531
001
90
2
X
5,622.96
X
35533
003
90
2
X
5,896.35
X
35533
002
90
2
X
6,061.46
X
35533
004
90
2
X
4,592.74
X
35533
001
90
2
X
6,101.50
X
35535
004
90
2
X
3,629.89
X
35535
001
90
2
X
4,000.99
X
35535
003
90
2
X
3,629.89
X
35535
002
90
2
X
3,629.89
X
35536
004
90
2
X
4,862.29
X
35536
002
90
2
X
5,240.50
X
35536
003
90
2
X
4,920.13
X
35536
001
90
2
X
5,404.08
X
35537
004
90
2
X
3,715.73
X
35537
001
90
2
X
4,188.56
X
35537
003
90
2
X
3,715.73
X
35537
002
90
2
X
3,715.73
X
35538
003
90
2
X
4,151.52
X
35538
002
90
2
X
4,151.52
X
35538
004
90
2
X
4,151.52
X
35538
001
90
2
X
4,677.68
X
35539
002
90
2
X
3,901.91
X
35539
003
90
2
X
3,901.91
X
35539
001
90
2
X
4,397.06
X
35539
004
90
2
X
3,901.91
X
35540
002
90
2
X
4,349.85
X
35540
003
90
2
X
4,349.85
X
35540
001
90
2
X
4,901.10
X
35540
004
90
2
X
4,349.85
X
35556
002
90
2
X
4,449.49
X
35556
003
90
2
X
4,472.12
X
35556
001
90
2
X
4,659.20
X
35556
004
90
2
X
4,454.39
X
35558
003
90
2
X
3,718.83
X
35558
002
90
2
X
4,022.27
X
35558
004
90
2
X
3,828.18
X
35558
001
90
2
X
4,020.72
X
35560
001
90
2
X
6,832.38
X
35560
003
90
2
X
6,637.90
X
35560
002
90
2
X
6,790.83
X
35560
004
90
2
X
6,614.03
X
35563
003
90
2
X
2,496.24
X
35563
002
90
2
X
4,011.29
X
35563
004
90
2
X
2,468.47
X
35563
001
90
2
X
2,706.72
X
35565
003
90
2
X
4,046.10
X
35565
002
90
2
X
4,239.76
X
35565
004
90
2
X
4,076.17
X
35565
001
90
2
X
4,314.26
X
35566
001
90
2
X
5,993.82
X
35566
004
90
2
X
5,626.82
X
35566
002
90
2
X
5,373.58
X
35566
003
90
2
X
5,276.30
X
35570
002
90
2
X
2,799.51
X
35570
003
90
2
X
2,799.51
X
35570
004
90
2
X
2,799.51
X
35570
001
90
2
X
3,086.44
X
35571
004
90
2
X
6,193.20
X
35571
002
90
2
X
6,369.30
X
35571
003
90
2
X
6,209.60
X
35571
001
90
2
X
6,404.89
X
35572
002
ZZZ
0
X
785.12
X
35572
003
ZZZ
0
X
785.12
X
35572
004
ZZZ
0
X
785.12
X
35572
001
ZZZ
0
X
871.10
X
35583
001
90
2
X
4,674.88
X
35583
004
90
2
X
4,526.32
X
35583
003
90
2
X
4,580.59
X
35583
002
90
2
X
4,585.95
X
35585
004
90
2
X
5,635.57
X
35585
003
90
2
X
5,344.07
X
35585
002
90
2
X
5,268.43
X
35585
001
90
2
X
6,070.62
X
35587
004
90
2
X
6,320.60
X
35587
001
90
2
X
6,539.92
X
35587
002
90
2
X
6,440.86
X
35587
003
90
2
X
6,329.90
X
35600
004
ZZZ
0
X
633.46
X
35600
001
ZZZ
0
X
705.76
X
35600
002
ZZZ
0
X
633.46
X
35600
003
ZZZ
0
X
633.46
X
35601
001
90
2
X
4,388.32
X
35601
004
90
2
X
3,944.04
X
35601
003
90
2
X
3,992.24
X
35601
002
90
2
X
4,311.10
X
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