You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page.
Skip Ribbon Commands
Skip to main content
Turn off Animations
Turn on Animations
An Official
Pennsylvania
Government Website
Translate
DLI
Department of Labor & Industry
I am ...
I am ...
Claimant
Worker
Employer
Researcher
Provider
Services
Services
Unemployment Benefits
Unemployment Tax Services
Workers' Compensation
Disability Determination
Job Search & Career Training
Disability Services
Labor Law Compliance
Occ. & Industrial Safety
Document Downloads
Labor Market & Jobs Data
Divisions
Divisions
Unemployment Compensation
Unemployment Tax Services
Workers' Compensation
PA CareerLink®
PennSERVE
Vocational Rehabilitation
Work Statistics
Labor Law Compliance
Occ. & Industrial Safety
Disability Determinitation
About
About
Contact the Pennsylvania Depar
Equal Opportunity
Guide to Services
Boards
Councils and Committees
Right to Know
Search
Search
Menu
Department of Labor & Industry
Menu
I am ...
I am ...
Claimant
Worker
Employer
Researcher
Provider
Services
Services
Unemployment Benefits
Unemployment Tax Services
Workers' Compensation
Disability Determination
Job Search & Career Training
Disability Services
Labor Law Compliance
Occ. & Industrial Safety
Document Downloads
Labor Market & Jobs Data
Divisions
Divisions
Unemployment Compensation
Unemployment Tax Services
Workers' Compensation
PA CareerLink®
PennSERVE
Vocational Rehabilitation
Work Statistics
Labor Law Compliance
Occ. & Industrial Safety
Disability Determinitation
About
About
Contact the Pennsylvania Depar
Equal Opportunity
Guide to Services
Boards
Councils and Committees
Right to Know
I am a(n)...
Find Services
Bureaus & Offices
Make a Payment
Contact Us
Publications
DLI
>
Businesses
>
Workers' Compensation Services
>
Workers' Compensation
>
Health Care Services Review
>
Medical Fee Review
>
Fee Schedule
>
Fee Schedule 38570-42227
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
38570-42227
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
38570
002
10
3
X
1,346.08
X
38570
003
10
3
X
1,346.08
X
38570
004
10
3
X
1,346.08
X
38570
001
10
3
X
1,497.86
X
38571
002
10
3
X
1,754.76
X
38571
003
10
3
X
1,754.76
X
38571
001
10
3
X
1,937.42
X
38571
004
10
3
X
1,754.76
X
38572
001
10
3
X
2,257.00
X
38572
003
10
3
X
2,038.57
X
38572
002
10
3
X
2,038.57
X
38572
004
10
3
X
2,038.57
X
38573
002
10
3
X
1,738.46
X
38573
003
10
3
X
1,738.46
X
38573
001
10
3
X
1,898.21
X
38573
004
10
3
X
1,738.46
X
38589
YYY
2
X
#
X
38700
004
90
2
X
2,917.97
X
38700
001
90
2
X
3,001.85
X
38700
002
90
2
X
2,987.57
X
38700
003
90
2
X
2,928.06
X
38720
001
90
2
X
3,495.69
X
38720
004
90
2
X
3,086.29
X
38720
003
90
2
X
3,235.47
X
38720
002
90
2
X
3,429.71
X
38724
002
90
2
X
3,372.28
X
38724
003
90
2
X
3,210.64
X
38724
001
90
2
X
3,483.13
X
38724
004
90
2
X
3,272.40
X
38740
001
90
2
X
1,370.05
X
38740
004
90
2
X
1,167.21
X
38740
002
90
2
X
1,347.29
X
38740
003
90
2
X
1,157.76
X
38745
001
90
2
X
2,449.68
X
38745
004
90
2
X
2,102.31
X
38745
003
90
2
X
1,927.49
X
38745
002
90
2
X
2,256.05
X
38746
003
ZZZ
0
X
756.72
X
38746
002
ZZZ
0
X
808.14
X
38746
004
ZZZ
0
X
748.54
X
38746
001
ZZZ
0
X
820.63
X
38747
004
ZZZ
0
X
833.57
X
38747
001
ZZZ
0
X
913.89
X
38747
003
ZZZ
0
X
842.73
X
38747
002
ZZZ
0
X
899.94
X
38760
004
90
2
X
1,804.52
X
38760
001
90
2
X
1,880.09
X
38760
003
90
2
X
1,804.41
X
38760
002
90
2
X
1,867.06
X
38765
004
90
2
X
3,041.23
X
38765
001
90
2
X
3,430.06
X
38765
003
90
2
X
3,139.39
X
38765
002
90
2
X
3,373.35
X
38770
001
90
2
X
3,296.89
X
38770
004
90
2
X
2,999.11
X
38770
002
90
2
X
3,246.54
X
38770
003
90
2
X
3,037.43
X
38780
001
90
2
X
3,939.18
X
38780
004
90
2
X
3,614.66
X
38780
003
90
2
X
3,632.48
X
38780
002
90
2
X
3,869.08
X
38790
004
0
2
X
341.02
X
38790
002
0
2
X
413.37
X
38790
003
0
2
X
345.53
X
38790
001
0
2
X
374.66
X
38792
0
2
X
*
X
38794
001
90
2
X
816.89
X
38794
002
90
2
X
805.70
X
38794
003
90
2
X
759.64
X
38794
004
90
2
X
750.87
X
38900
003
ZZZ
0
X
240.12
X
38900
002
ZZZ
0
X
240.12
X
38900
004
ZZZ
0
X
240.12
X
38900
001
ZZZ
0
X
266.19
X
38999
YYY
2
X
#
X
39000
003
90
2
X
1,265.94
X
39000
002
90
2
X
1,368.33
X
39000
004
90
2
X
1,250.63
X
39000
001
90
2
X
1,393.04
X
39010
004
90
2
X
2,450.90
X
39010
002
90
2
X
2,655.99
X
39010
003
90
2
X
2,479.43
X
39010
001
90
2
X
2,698.77
X
39200
004
90
2
X
2,691.99
X
39200
001
90
2
X
2,980.79
X
39200
003
90
2
X
3,130.71
X
39200
002
90
2
X
2,930.69
X
39220
004
90
2
X
3,836.02
X
39220
001
90
2
X
3,995.95
X
39220
002
90
2
X
3,968.20
X
39220
003
90
2
X
3,740.52
X
39401
001
0
2
X
531.84
X
39401
002
0
2
X
485.92
X
39401
003
0
2
X
485.92
X
39401
004
0
2
X
485.92
X
39402
002
0
2
X
635.29
X
39402
003
0
2
X
635.29
X
39402
001
0
2
X
694.42
X
39402
004
0
2
X
635.29
X
39499
YYY
2
X
#
X
39501
001
90
2
X
2,982.90
X
39501
004
90
2
X
2,613.56
X
39501
003
90
2
X
2,593.49
X
39501
002
90
2
X
2,791.84
X
39503
001
90
2
X
6,879.16
X
39503
002
90
2
X
6,786.92
X
39503
003
90
2
X
6,404.95
X
39503
004
90
2
X
6,329.23
X
39540
002
90
2
X
3,305.46
X
39540
003
90
2
X
3,351.59
X
39540
004
90
2
X
2,739.40
X
39540
001
90
2
X
3,610.86
X
39541
003
90
2
X
3,577.57
X
39541
002
90
2
X
3,106.90
X
39541
001
90
2
X
3,694.10
X
39541
004
90
2
X
3,563.39
X
39545
001
90
2
X
2,462.19
X
39545
004
90
2
X
2,243.73
X
39545
002
90
2
X
3,254.28
X
39545
003
90
2
X
2,269.38
X
39560
001
90
2
X
2,092.69
X
39560
004
90
2
X
1,868.14
X
39560
003
90
2
X
1,868.14
X
39560
002
90
2
X
1,868.14
X
39561
004
90
2
X
2,563.89
X
39561
003
90
2
X
2,563.89
X
39561
002
90
2
X
2,563.89
X
39561
001
90
2
X
2,864.68
X
39599
YYY
2
X
#
X
40490
004
0
2
X
220.81
182.04
40490
001
0
2
X
225.78
185.21
40490
003
0
2
X
220.08
181.22
40490
002
0
2
X
223.10
183.07
40500
004
90
2
X
1,578.17
X
40500
001
90
2
X
1,680.96
X
40500
002
90
2
X
1,599.75
X
40500
003
90
2
X
1,575.29
X
40510
002
90
2
X
1,550.00
X
40510
003
90
2
X
1,517.74
X
40510
004
90
2
X
1,519.93
X
40510
001
90
2
X
1,609.46
X
40520
001
90
2
X
1,212.64
X
40520
003
90
2
X
1,135.96
X
40520
002
90
2
X
1,225.68
X
40520
004
90
2
X
1,000.89
X
40525
001
90
2
X
2,050.84
X
40525
004
90
2
X
2,570.21
X
40525
003
90
2
X
2,445.38
X
40525
002
90
2
X
2,640.97
X
40527
004
90
2
X
2,209.90
X
40527
002
90
2
X
2,402.97
X
40527
001
90
2
X
2,421.92
X
40527
003
90
2
X
2,237.63
X
40530
004
90
2
X
1,244.95
X
40530
002
90
2
X
1,284.43
X
40530
003
90
2
X
1,250.67
X
40530
001
90
2
X
1,292.61
X
40650
004
90
2
X
884.57
X
40650
001
90
2
X
980.09
X
40650
002
90
2
X
1,358.33
X
40650
003
90
2
X
1,577.52
X
40652
002
90
2
X
1,427.92
X
40652
003
90
2
X
1,050.96
X
40652
004
90
2
X
1,037.99
X
40652
001
90
2
X
1,151.39
X
40654
002
90
2
X
1,829.54
X
40654
003
90
2
X
1,751.02
X
40654
004
90
2
X
1,304.05
X
40654
001
90
2
X
1,831.53
X
40700
001
90
2
X
2,454.89
X
40700
004
90
2
X
2,248.86
X
40700
003
90
2
X
2,275.08
X
40700
002
90
2
X
2,419.80
X
40701
001
90
2
X
4,038.03
X
40701
004
90
2
X
3,698.19
X
40701
002
90
2
X
3,981.53
X
40701
003
90
2
X
3,746.25
X
40702
002
90
2
X
2,523.75
X
40702
003
90
2
X
2,381.36
X
40702
004
90
2
X
2,353.35
X
40702
001
90
2
X
2,558.12
X
40720
004
90
2
X
2,509.08
X
40720
001
90
2
X
2,929.93
X
40720
003
90
2
X
2,538.07
X
40720
002
90
2
X
2,717.11
X
40761
003
90
2
X
2,776.38
X
40761
002
90
2
X
2,963.34
X
40761
004
90
2
X
2,744.06
X
40761
001
90
2
X
3,008.63
X
40799
YYY
2
X
#
X
40800
002
10
2
X
212.37
X
40800
003
10
2
X
201.62
X
40800
001
10
2
X
214.88
X
40800
004
10
2
X
199.23
X
40801
001
10
2
X
477.51
X
40801
003
10
2
X
454.84
X
40801
002
10
2
X
475.83
X
40801
004
10
2
X
448.34
X
40804
002
10
2
X
199.23
X
40804
003
10
2
X
191.83
X
40804
004
10
2
X
149.13
X
40804
001
10
2
X
208.32
X
40805
001
10
2
X
612.16
X
40805
004
10
2
X
559.97
X
40805
002
10
2
X
603.38
X
40805
003
10
2
X
566.92
X
40806
0
2
X
*
X
40808
002
10
2
X
219.20
172.61
40808
003
10
2
X
221.68
174.89
40808
004
10
2
X
217.18
171.51
40808
001
10
2
X
217.24
171.08
40810
002
10
2
X
328.37
254.39
40810
003
10
2
X
327.28
252.97
40810
001
10
2
X
312.77
241.88
40810
004
10
2
X
347.98
270.05
40812
004
10
2
X
440.41
359.02
40812
001
10
2
X
435.34
353.05
40812
003
10
2
X
467.01
379.96
40812
002
10
2
X
441.32
358.24
40814
002
90
2
X
849.00
X
40814
003
90
2
X
830.75
X
40814
004
90
2
X
702.03
X
40814
001
90
2
X
936.45
X
40816
002
90
2
X
1,133.60
X
40816
003
90
2
X
934.95
X
40816
004
90
2
X
1,131.27
X
40816
001
90
2
X
932.61
X
40818
004
90
2
X
485.20
X
40818
001
90
2
X
527.46
X
40818
003
90
2
X
491.25
X
40818
002
90
2
X
520.41
X
40819
90
2
X
*
X
40820
001
10
2
X
202.44
X
40820
004
10
2
X
190.70
X
40820
003
10
2
X
187.24
X
40820
002
10
2
X
192.64
X
40830
001
10
2
X
244.57
X
40830
004
10
2
X
238.95
X
40830
002
10
2
X
240.62
X
40830
003
10
2
X
241.33
X
40831
004
10
2
X
470.08
X
40831
001
10
2
X
469.96
X
40831
003
10
2
X
475.73
X
40831
002
10
2
X
413.11
X
40840
90
2
X
*
X
40842
90
2
X
*
X
40843
90
2
X
*
X
40844
90
2
X
*
X
40845
90
2
X
*
X
40899
YYY
2
X
#
X
41000
001
10
2
X
232.89
X
41000
004
10
2
X
223.32
X
41000
003
10
2
X
223.39
X
41000
002
10
2
X
229.98
X
41005
002
10
2
X
209.16
X
41005
003
10
2
X
198.94
X
41005
001
10
2
X
244.55
X
41005
004
10
2
X
196.68
X
41006
001
90
2
X
427.38
X
41006
004
90
2
X
409.44
X
41006
002
90
2
X
414.40
X
41006
003
90
2
X
402.54
X
41007
002
90
2
X
464.18
X
41007
003
90
2
X
633.46
X
41007
004
90
2
X
625.64
X
41007
001
90
2
X
682.46
X
41008
002
90
2
X
342.46
X
41008
003
90
2
X
332.09
X
41008
001
90
2
X
480.13
X
41008
004
90
2
X
450.47
X
41009
003
90
2
X
729.33
X
41009
002
90
2
X
601.90
X
41009
001
90
2
X
785.29
X
41009
004
90
2
X
720.30
X
41010
001
10
2
X
176.42
X
41010
004
10
2
X
165.72
X
41010
002
10
2
X
174.71
X
41010
003
10
2
X
167.43
X
41015
001
90
2
X
381.09
X
41015
004
90
2
X
488.82
X
41015
003
90
2
X
493.92
X
41015
002
90
2
X
381.51
X
41016
003
90
2
X
810.66
X
41016
002
90
2
X
680.91
X
41016
001
90
2
X
688.72
X
41016
004
90
2
X
623.69
X
41017
001
90
2
X
583.53
X
41017
003
90
2
X
388.06
X
41017
002
90
2
X
401.37
X
41017
004
90
2
X
546.51
X
41018
001
90
2
X
1,011.61
X
41018
002
90
2
X
998.42
X
41018
003
90
2
X
944.05
X
41018
004
90
2
X
932.66
X
41019
001
0
2
X
875.92
X
41019
004
0
2
X
800.52
X
41019
002
0
2
X
800.52
X
41019
003
0
2
X
800.52
X
41100
002
10
2
X
270.81
227.58
41100
003
10
2
X
265.67
224.12
41100
001
10
2
X
273.90
230.11
41100
004
10
2
X
281.73
237.35
41105
002
10
2
X
278.96
X
41105
003
10
2
X
263.36
X
41105
004
10
2
X
260.30
X
41105
001
10
2
X
282.72
X
41108
001
10
2
X
217.18
170.62
41108
004
10
2
X
206.71
162.78
41108
003
10
2
X
244.70
192.28
41108
002
10
2
X
227.85
178.61
41110
002
10
2
X
509.41
X
41110
003
10
2
X
500.26
X
41110
001
10
2
X
499.80
X
41110
004
10
2
X
404.31
X
41112
004
90
2
X
766.07
X
41112
002
90
2
X
750.14
X
41112
003
90
2
X
757.37
X
41112
001
90
2
X
834.32
X
41113
004
90
2
X
1,274.78
X
41113
001
90
2
X
1,344.96
X
41113
003
90
2
X
1,258.43
X
41113
002
90
2
X
1,265.26
X
41114
001
90
2
X
1,683.44
X
41114
004
90
2
X
1,546.99
X
41114
003
90
2
X
1,565.68
X
41114
002
90
2
X
1,660.48
X
41115
003
10
2
X
388.81
X
41115
002
10
2
X
402.25
X
41115
004
10
2
X
374.16
X
41115
001
10
2
X
407.84
X
41116
001
90
2
X
610.79
X
41116
004
90
2
X
590.15
X
41116
003
90
2
X
592.90
X
41116
002
90
2
X
607.26
X
41120
002
90
2
X
1,882.86
X
41120
003
90
2
X
1,772.98
X
41120
001
90
2
X
1,909.48
X
41120
004
90
2
X
1,751.86
X
41130
001
90
2
X
2,691.06
X
41130
004
90
2
X
2,551.37
X
41130
002
90
2
X
2,584.70
X
41130
003
90
2
X
2,528.56
X
41135
003
90
2
X
3,783.61
X
41135
002
90
2
X
4,994.42
X
41135
001
90
2
X
5,205.36
X
41135
004
90
2
X
4,846.58
X
41140
004
90
2
X
4,620.87
X
41140
002
90
2
X
4,971.12
X
41140
003
90
2
X
4,676.21
X
41140
001
90
2
X
5,042.41
X
41145
004
90
2
X
5,497.54
X
41145
001
90
2
X
6,090.57
X
41145
003
90
2
X
5,563.72
X
41145
002
90
2
X
5,917.12
X
41150
004
90
2
X
4,198.21
X
41150
001
90
2
X
4,229.27
X
41150
003
90
2
X
3,633.57
X
41150
002
90
2
X
3,858.30
X
41153
001
90
2
X
7,389.66
X
41153
004
90
2
X
5,055.07
X
41153
003
90
2
X
7,205.26
X
41153
002
90
2
X
7,353.83
X
41155
004
90
2
X
5,999.67
X
41155
002
90
2
X
6,713.65
X
41155
003
90
2
X
6,130.92
X
41155
001
90
2
X
6,661.97
X
41250
004
10
2
X
314.13
X
41250
001
10
2
X
338.34
X
41250
003
10
2
X
290.10
X
41250
002
10
2
X
304.08
X
41251
004
10
2
X
357.33
X
41251
001
10
2
X
503.13
X
41251
003
10
2
X
467.90
X
41251
002
10
2
X
372.23
X
41252
001
10
2
X
619.60
X
41252
003
10
2
X
576.96
X
41252
002
10
2
X
611.31
X
41252
004
10
2
X
570.03
X
41510
002
90
2
X
703.82
X
41510
003
90
2
X
658.10
X
41510
004
90
2
X
650.54
X
41510
001
90
2
X
714.84
X
41512
001
90
2
X
1,089.08
X
41512
004
90
2
X
972.58
X
41512
003
90
2
X
972.58
X
41512
002
90
2
X
972.58
X
41520
90
2
X
*
X
41530
002
0
2
X
4,671.84
637.14
41530
003
0
2
X
4,671.84
637.14
41530
004
0
2
X
4,671.84
637.14
41530
001
0
2
X
5,499.17
714.27
41599
YYY
2
X
#
X
41800
10
2
X
*
X
41805
004
10
2
X
217.47
X
41805
002
10
2
X
190.49
X
41805
003
10
2
X
220.10
X
41805
001
10
2
X
235.01
X
41806
001
10
2
X
493.20
X
41806
004
10
2
X
457.95
X
41806
002
10
2
X
487.43
X
41806
003
10
2
X
463.36
X
41820
0
2
X
*
X
41821
0
2
X
*
X
41822
10
2
X
*
X
41823
90
2
X
*
X
41825
001
10
2
X
435.48
X
41825
004
10
2
X
394.85
X
41825
003
10
2
X
396.34
X
41825
002
10
2
X
420.26
X
41826
004
10
2
X
545.25
X
41826
003
10
2
X
537.18
X
41826
002
10
2
X
592.32
X
41826
001
10
2
X
593.24
X
41827
003
90
2
X
772.54
X
41827
002
90
2
X
822.20
X
41827
004
90
2
X
762.80
X
41827
001
90
2
X
834.14
X
41828
10
2
X
*
X
41830
10
2
X
*
X
41850
0
2
X
*
X
41870
0
2
X
*
X
41872
90
2
X
*
X
41874
90
2
X
*
X
41899
YYY
2
X
#
X
42000
001
10
2
X
216.33
X
42000
004
10
2
X
210.32
X
42000
002
10
2
X
214.32
X
42000
003
10
2
X
211.22
X
42100
001
10
2
X
320.02
262.19
42100
004
10
2
X
300.22
246.58
42100
003
10
2
X
306.27
250.99
42100
002
10
2
X
304.28
249.24
42104
004
10
2
X
515.11
X
42104
001
10
2
X
528.51
X
42104
002
10
2
X
526.27
X
42104
003
10
2
X
516.96
X
42106
002
10
2
X
1,127.69
X
42106
003
10
2
X
1,082.69
X
42106
004
10
2
X
520.71
X
42106
001
10
2
X
564.79
X
42107
001
90
2
X
1,791.87
X
42107
002
90
2
X
1,717.15
X
42107
003
90
2
X
999.81
X
42107
004
90
2
X
1,684.38
X
42120
001
90
2
X
2,596.50
X
42120
004
90
2
X
1,446.17
X
42120
002
90
2
X
2,585.29
X
42120
003
90
2
X
2,538.80
X
42140
002
90
2
X
312.74
X
42140
003
90
2
X
299.81
X
42140
004
90
2
X
301.86
X
42140
001
90
2
X
340.65
X
42145
003
90
2
X
2,484.31
X
42145
002
90
2
X
2,553.05
X
42145
004
90
2
X
2,472.44
X
42145
001
90
2
X
2,569.54
X
42160
002
10
2
X
514.43
X
42160
003
10
2
X
586.50
X
42160
004
10
2
X
354.56
X
42160
001
10
2
X
522.71
X
42180
001
10
2
X
555.78
X
42180
004
10
2
X
400.19
X
42180
003
10
2
X
384.81
X
42180
002
10
2
X
547.91
X
42182
002
10
2
X
843.94
X
42182
003
10
2
X
673.86
X
42182
001
10
2
X
855.81
X
42182
004
10
2
X
704.77
X
42200
001
90
2
X
1,966.14
X
42200
003
90
2
X
1,830.06
X
42200
002
90
2
X
1,939.62
X
42200
004
90
2
X
1,808.37
X
42205
003
90
2
X
2,138.01
X
42205
002
90
2
X
2,265.29
X
42205
004
90
2
X
2,110.64
X
42205
001
90
2
X
2,295.87
X
42210
001
90
2
X
2,623.09
X
42210
002
90
2
X
2,587.55
X
42210
003
90
2
X
2,439.56
X
42210
004
90
2
X
2,408.26
X
42215
002
90
2
X
2,130.15
X
42215
003
90
2
X
1,768.08
X
42215
004
90
2
X
1,746.70
X
42215
001
90
2
X
1,905.09
X
42220
002
90
2
X
1,431.60
X
42220
003
90
2
X
1,342.07
X
42220
001
90
2
X
1,453.23
X
42220
004
90
2
X
1,326.27
X
42225
003
90
2
X
1,781.97
X
42225
002
90
2
X
2,234.84
X
42225
004
90
2
X
1,761.24
X
42225
001
90
2
X
2,486.67
X
42226
004
90
2
X
1,872.55
X
42226
001
90
2
X
2,272.07
X
42226
003
90
2
X
1,895.33
X
42226
002
90
2
X
2,009.46
X
42227
003
90
2
X
1,738.71
X
42227
002
90
2
X
1,824.92
X
42227
001
90
2
X
1,845.56
X
42227
004
90
2
X
1,717.34
X
Return to CPT/HCPC List