2018 Workers' Compensation Part B Fee Schedule

38570-42227

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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)
38570   1 10 3 0 115862 0
38570   2 10 3 0 104121 0
38570   3 10 3 0 104121 0
38570   4 10 3 0 104121 0
38571   1 10 2 0 149861 0
38571   2 10 2 0 135733 0
38571   3 10 2 0 135733 0
38571   4 10 2 0 135733 0
38572   1 10 2 0 174582 0
38572   2 10 2 0 157686 0
38572   3 10 2 0 157686 0
38572   4 10 2 0 157686 0
38573   1 10 3 0 146829 0
38573   2 10 3 0 133660 0
38573   3 10 3 0 133660 0
38573   4 10 3 0 133660 0
38589     YYY 2 0 0 0
38700   1 90 2 0 232197 0
38700   2 90 2 0 231092 0
38700   3 90 2 0 226489 0
38700   4 90 2 0 225709 0
38720   1 90 2 0 270397 0
38720   2 90 2 0 265293 0
38720   3 90 2 0 250268 0
38720   4 90 2 0 238729 0
38724   1 90 2 0 269424 0
38724   2 90 2 0 260851 0
38724   3 90 2 0 248347 0
38724   4 90 2 0 253125 0
38740   1 90 2 0 105976 0
38740   2 90 2 0 104215 0
38740   3 90 2 0 89554 0
38740   4 90 2 0 90286 0
38745   1 90 2 0 189487 0
38745   2 90 2 0 174508 0
38745   3 90 2 0 149095 0
38745   4 90 2 0 162616 0
38746   1 ZZZ 0 0 63477 0
38746   2 ZZZ 0 0 62511 0
38746   3 ZZZ 0 0 58534 0
38746   4 ZZZ 0 0 57901 0
38747   1 ZZZ 0 0 70690 0
38747   2 ZZZ 0 0 69612 0
38747   3 ZZZ 0 0 65187 0
38747   4 ZZZ 0 0 64478 0
38760   1 90 2 0 145427 0
38760   2 90 2 0 144419 0
38760   3 90 2 0 139574 0
38760   4 90 2 0 139583 0
38765   1 90 2 0 265320 0
38765   2 90 2 0 260934 0
38765   3 90 2 0 242836 0
38765   4 90 2 0 235244 0
38770   1 90 2 0 255020 0
38770   2 90 2 0 251124 0
38770   3 90 2 0 234950 0
38770   4 90 2 0 231985 0
38780   1 90 2 0 304702 0
38780   2 90 2 0 299280 0
38780   3 90 2 0 280978 0
38780   4 90 2 0 279599 0
38790   1 0 2 0 28980 0
38790   2 0 2 0 31976 0
38790   3 0 2 0 26726 0
38790   4 0 2 0 26377 0
38792     0 2 0 0 0
38792 26   0 2 0 0 0
38792 TC   0 2 0 0 0
38794   1 90 2 0 63187 0
38794   2 90 2 0 62322 0
38794   3 90 2 0 58760 0
38794   4 90 2 0 58081 0
38900   1 ZZZ 0 0 20590 0
38900   2 ZZZ 0 0 18574 0
38900   3 ZZZ 0 0 18574 0
38900   4 ZZZ 0 0 18574 0
38999     YYY 2 0 0 0
39000   1 90 2 0 107754 0
39000   2 90 2 0 105842 0
39000   3 90 2 0 97923 0
39000   4 90 2 0 96738 0
39010   1 90 2 0 208754 0
39010   2 90 2 0 205445 0
39010   3 90 2 0 191788 0
39010   4 90 2 0 189581 0
39200   1 90 2 0 230569 0
39200   2 90 2 0 226694 0
39200   3 90 2 0 242165 0
39200   4 90 2 0 208228 0
39220   1 90 2 0 309093 0
39220   2 90 2 0 306946 0
39220   3 90 2 0 289334 0
39220   4 90 2 0 296721 0
39401   1 0 2 0 41138 0
39401   2 0 2 0 37586 0
39401   3 0 2 0 37586 0
39401   4 0 2 0 37586 0
39402   1 0 2 0 53715 0
39402   2 0 2 0 49142 0
39402   3 0 2 0 49142 0
39402   4 0 2 0 49142 0
39499     YYY 2 0 0 0
39501   1 90 2 0 230732 0
39501   2 90 2 0 215953 0
39501   3 90 2 0 200610 0
39501   4 90 2 0 202163 0
39503   1 90 2 0 532113 0
39503   2 90 2 0 524978 0
39503   3 90 2 0 495432 0
39503   4 90 2 0 489575 0
39540   1 90 2 0 279305 0
39540   2 90 2 0 255682 0
39540   3 90 2 0 259249 0
39540   4 90 2 0 211896 0
39541   1 90 2 0 285744 0
39541   2 90 2 0 240323 0
39541   3 90 2 0 276730 0
39541   4 90 2 0 275633 0
39545   1 90 2 0 190454 0
39545   2 90 2 0 251723 0
39545   3 90 2 0 175540 0
39545   4 90 2 0 173556 0
39560   1 90 2 0 161873 0
39560   2 90 2 0 144502 0
39560   3 90 2 0 144502 0
39560   4 90 2 0 144502 0
39561   1 90 2 0 221587 0
39561   2 90 2 0 198322 0
39561   3 90 2 0 198322 0
39561   4 90 2 0 198322 0
39599     YYY 2 0 0 0
40490   1 0 2 0 17464 14327
40490   2 0 2 0 17257 14161
40490   3 0 2 0 17023 14017
40490   4 0 2 0 17079 14081
40500   1 90 2 0 130025 0
40500   2 90 2 0 123743 0
40500   3 90 2 0 121851 0
40500   4 90 2 0 122073 0
40510   1 90 2 0 124495 0
40510   2 90 2 0 119894 0
40510   3 90 2 0 117400 0
40510   4 90 2 0 117569 0
40520   1 90 2 0 93799 0
40520   2 90 2 0 94808 0
40520   3 90 2 0 87868 0
40520   4 90 2 0 77420 0
40525   1 90 2 0 158635 0
40525   2 90 2 0 204283 0
40525   3 90 2 0 189153 0
40525   4 90 2 0 198809 0
40527   1 90 2 0 187339 0
40527   2 90 2 0 185873 0
40527   3 90 2 0 173084 0
40527   4 90 2 0 170938 0
40530   1 90 2 0 99985 0
40530   2 90 2 0 99353 0
40530   3 90 2 0 96741 0
40530   4 90 2 0 96299 0
40650   1 90 2 0 75811 0
40650   2 90 2 0 105069 0
40650   3 90 2 0 122023 0
40650   4 90 2 0 68422 0
40652   1 90 2 0 89063 0
40652   2 90 2 0 110452 0
40652   3 90 2 0 81294 0
40652   4 90 2 0 80291 0
40654   1 90 2 0 141672 0
40654   2 90 2 0 141517 0
40654   3 90 2 0 135445 0
40654   4 90 2 0 100869 0
40700   1 90 2 0 189890 0
40700   2 90 2 0 187175 0
40700   3 90 2 0 175980 0
40700   4 90 2 0 173952 0
40701   1 90 2 0 312348 0
40701   2 90 2 0 307977 0
40701   3 90 2 0 289777 0
40701   4 90 2 0 286060 0
40702   1 90 2 0 197875 0
40702   2 90 2 0 195216 0
40702   3 90 2 0 184201 0
40702   4 90 2 0 182034 0
40720   1 90 2 0 226634 0
40720   2 90 2 0 210173 0
40720   3 90 2 0 196324 0
40720   4 90 2 0 194081 0
40761   1 90 2 0 232722 0
40761   2 90 2 0 229219 0
40761   3 90 2 0 214758 0
40761   4 90 2 0 212257 0
40799     YYY 2 0 0 0
40800   1 10 2 0 16623 0
40800   2 10 2 0 16427 0
40800   3 10 2 0 15595 0
40800   4 10 2 0 15411 0
40801   1 10 2 0 36936 0
40801   2 10 2 0 36806 0
40801   3 10 2 0 35183 0
40801   4 10 2 0 34679 0
40804   1 10 2 0 16114 0
40804   2 10 2 0 15411 0
40804   3 10 2 0 14838 0
40804   4 10 2 0 11535 0
40805   1 10 2 0 47352 0
40805   2 10 2 0 46673 0
40805   3 10 2 0 43851 0
40805   4 10 2 0 43314 0
40806     0 2 0 0 0
40808   1 10 2 0 16804 13233
40808   2 10 2 0 16954 13352
40808   3 10 2 0 17147 13528
40808   4 10 2 0 16800 13266
40810   1 10 2 0 24193 18711
40810   2 10 2 0 25400 19677
40810   3 10 2 0 25316 19567
40810   4 10 2 0 26917 20890
40812   1 10 2 0 33674 27309
40812   2 10 2 0 34137 27710
40812   3 10 2 0 36123 29391
40812   4 10 2 0 34066 27770
40814   1 90 2 0 72436 0
40814   2 90 2 0 65672 0
40814   3 90 2 0 64259 0
40814   4 90 2 0 54303 0
40816   1 90 2 0 72138 0
40816   2 90 2 0 87685 0
40816   3 90 2 0 72320 0
40816   4 90 2 0 87505 0
40818   1 90 2 0 40800 0
40818   2 90 2 0 40254 0
40818   3 90 2 0 37999 0
40818   4 90 2 0 37531 0
40819     90 2 0 0 0
40820   1 10 2 0 15658 0
40820   2 10 2 0 14900 0
40820   3 10 2 0 14483 0
40820   4 10 2 0 14751 0
40830   1 10 2 0 18918 0
40830   2 10 2 0 18613 0
40830   3 10 2 0 18668 0
40830   4 10 2 0 18483 0
40831   1 10 2 0 36351 0
40831   2 10 2 0 31955 0
40831   3 10 2 0 36799 0
40831   4 10 2 0 36362 0
40840     90 2 0 0 0
40842     90 2 0 0 0
40843     90 2 0 0 0
40844     90 2 0 0 0
40845     90 2 0 0 0
40899     YYY 2 0 0 0
41000   1 10 2 0 18014 0
41000   2 10 2 0 17790 0
41000   3 10 2 0 17281 0
41000   4 10 2 0 17274 0
41005   1 10 2 0 18916 0
41005   2 10 2 0 16179 0
41005   3 10 2 0 15388 0
41005   4 10 2 0 15214 0
41006   1 90 2 0 33059 0
41006   2 90 2 0 32054 0
41006   3 90 2 0 31138 0
41006   4 90 2 0 31671 0
41007   1 90 2 0 52789 0
41007   2 90 2 0 35905 0
41007   3 90 2 0 48999 0
41007   4 90 2 0 48394 0
41008   1 90 2 0 37138 0
41008   2 90 2 0 26490 0
41008   3 90 2 0 25688 0
41008   4 90 2 0 34844 0
41009   1 90 2 0 60744 0
41009   2 90 2 0 46558 0
41009   3 90 2 0 56414 0
41009   4 90 2 0 55717 0
41010   1 10 2 0 13645 0
41010   2 10 2 0 13513 0
41010   3 10 2 0 12951 0
41010   4 10 2 0 12819 0
41015   1 90 2 0 29478 0
41015   2 90 2 0 29510 0
41015   3 90 2 0 38204 0
41015   4 90 2 0 37811 0
41016   1 90 2 0 53274 0
41016   2 90 2 0 52670 0
41016   3 90 2 0 62706 0
41016   4 90 2 0 48242 0
41017   1 90 2 0 45137 0
41017   2 90 2 0 31046 0
41017   3 90 2 0 30017 0
41017   4 90 2 0 42273 0
41018   1 90 2 0 78249 0
41018   2 90 2 0 77230 0
41018   3 90 2 0 73023 0
41018   4 90 2 0 72143 0
41019   1 0 2 0 67754 0
41019   2 0 2 0 61921 0
41019   3 0 2 0 61921 0
41019   4 0 2 0 61921 0
41100   1 10 2 0 21187 17800
41100   2 10 2 0 20948 17604
41100   3 10 2 0 20549 17336
41100   4 10 2 0 21792 18359
41105   1 10 2 0 21869 0
41105   2 10 2 0 21579 0
41105   3 10 2 0 20371 0
41105   4 10 2 0 20134 0
41108   1 10 2 0 16800 13197
41108   2 10 2 0 17626 13816
41108   3 10 2 0 18929 14872
41108   4 10 2 0 15989 12591
41110   1 10 2 0 38660 0
41110   2 10 2 0 39404 0
41110   3 10 2 0 38696 0
41110   4 10 2 0 31275 0
41112   1 90 2 0 64536 0
41112   2 90 2 0 58024 0
41112   3 90 2 0 58584 0
41112   4 90 2 0 59257 0
41113   1 90 2 0 104035 0
41113   2 90 2 0 97870 0
41113   3 90 2 0 97341 0
41113   4 90 2 0 98606 0
41114   1 90 2 0 130216 0
41114   2 90 2 0 128441 0
41114   3 90 2 0 121108 0
41114   4 90 2 0 119662 0
41115   1 10 2 0 31546 0
41115   2 10 2 0 31113 0
41115   3 10 2 0 30075 0
41115   4 10 2 0 28942 0
41116   1 90 2 0 47246 0
41116   2 90 2 0 46972 0
41116   3 90 2 0 45863 0
41116   4 90 2 0 45648 0
41120   1 90 2 0 147701 0
41120   2 90 2 0 145641 0
41120   3 90 2 0 137143 0
41120   4 90 2 0 135509 0
41130   1 90 2 0 208157 0
41130   2 90 2 0 199931 0
41130   3 90 2 0 195588 0
41130   4 90 2 0 197352 0
41135   1 90 2 0 402641 0
41135   2 90 2 0 386326 0
41135   3 90 2 0 292669 0
41135   4 90 2 0 374890 0
41140   1 90 2 0 390038 0
41140   2 90 2 0 384524 0
41140   3 90 2 0 361713 0
41140   4 90 2 0 357431 0
41145   1 90 2 0 471115 0
41145   2 90 2 0 457698 0
41145   3 90 2 0 430362 0
41145   4 90 2 0 425243 0
41150   1 90 2 0 327140 0
41150   2 90 2 0 298444 0
41150   3 90 2 0 281063 0
41150   4 90 2 0 324738 0
41153   1 90 2 0 571601 0
41153   2 90 2 0 568830 0
41153   3 90 2 0 557337 0
41153   4 90 2 0 391017 0
41155   1 90 2 0 515313 0
41155   2 90 2 0 519310 0
41155   3 90 2 0 474237 0
41155   4 90 2 0 464083 0
41250   1 10 2 0 26171 0
41250   2 10 2 0 23520 0
41250   3 10 2 0 22439 0
41250   4 10 2 0 24298 0
41251   1 10 2 0 38918 0
41251   2 10 2 0 28793 0
41251   3 10 2 0 36193 0
41251   4 10 2 0 27639 0
41252   1 10 2 0 47927 0
41252   2 10 2 0 47285 0
41252   3 10 2 0 44629 0
41252   4 10 2 0 44093 0
41500   1 90 2 0 60809 0
41500   2 90 2 0 60040 0
41500   3 90 2 0 63719 0
41500   4 90 2 0 56123 0
41510   1 90 2 0 55293 0
41510   2 90 2 0 54442 0
41510   3 90 2 0 50905 0
41510   4 90 2 0 50321 0
41512   1 90 2 0 84241 0
41512   2 90 2 0 75230 0
41512   3 90 2 0 75230 0
41512   4 90 2 0 75230 0
41520     90 2 0 0 0
41530   1 10 2 0 425369 55249
41530   2 10 2 0 361373 49283
41530   3 10 2 0 361373 49283
41530   4 10 2 0 361373 49283
41599     YYY 2 0 0 0
41800     10 2 0 0 0
41805   1 10 2 0 18178 0
41805   2 10 2 0 14734 0
41805   3 10 2 0 17024 0
41805   4 10 2 0 16822 0
41806   1 10 2 0 38150 0
41806   2 10 2 0 37704 0
41806   3 10 2 0 35841 0
41806   4 10 2 0 35423 0
41820     XXX 2 0 0 0
41821     XXX 2 0 0 0
41822     10 2 0 0 0
41823     90 2 0 0 0
41825   1 10 2 0 33685 0
41825   2 10 2 0 32508 0
41825   3 10 2 0 30659 0
41825   4 10 2 0 30542 0
41826   1 10 2 0 45889 0
41826   2 10 2 0 45817 0
41826   3 10 2 0 41551 0
41826   4 10 2 0 42176 0
41827   1 90 2 0 64523 0
41827   2 90 2 0 63598 0
41827   3 90 2 0 59758 0
41827   4 90 2 0 59004 0
41828     10 2 0 0 0
41830     10 2 0 0 0
41850     XXX 2 0 0 0
41870     XXX 2 0 0 0
41872     90 2 0 0 0
41874     90 2 0 0 0
41899     YYY 2 0 0 0
42000   1 10 2 0 16733 0
42000   2 10 2 0 16579 0
42000   3 10 2 0 16338 0
42000   4 10 2 0 16268 0
42100   1 10 2 0 24755 20281
42100   2 10 2 0 23537 19280
42100   3 10 2 0 23691 19414
42100   4 10 2 0 23222 19073
42104   1 10 2 0 40882 0
42104   2 10 2 0 40708 0
42104   3 10 2 0 39987 0
42104   4 10 2 0 39845 0
42106   1 10 2 0 43687 0
42106   2 10 2 0 87230 0
42106   3 10 2 0 83748 0
42106   4 10 2 0 40278 0
42107   1 90 2 0 138603 0
42107   2 90 2 0 132825 0
42107   3 90 2 0 77337 0
42107   4 90 2 0 130289 0
42120   1 90 2 0 200844 0
42120   2 90 2 0 199977 0
42120   3 90 2 0 196379 0
42120   4 90 2 0 111863 0
42140   1 90 2 0 26350 0
42140   2 90 2 0 24191 0
42140   3 90 2 0 23191 0
42140   4 90 2 0 23350 0
42145   1 90 2 0 198758 0
42145   2 90 2 0 197483 0
42145   3 90 2 0 192165 0
42145   4 90 2 0 191247 0
42160   1 10 2 0 40433 0
42160   2 10 2 0 39792 0
42160   3 10 2 0 45367 0
42160   4 10 2 0 27425 0
42180   1 10 2 0 42990 0
42180   2 10 2 0 42382 0
42180   3 10 2 0 29766 0
42180   4 10 2 0 30955 0
42182   1 10 2 0 66197 0
42182   2 10 2 0 65281 0
42182   3 10 2 0 52124 0
42182   4 10 2 0 54515 0
42200   1 90 2 0 152083 0
42200   2 90 2 0 150033 0
42200   3 90 2 0 141558 0
42200   4 90 2 0 139880 0
42205   1 90 2 0 177588 0
42205   2 90 2 0 175223 0
42205   3 90 2 0 165377 0
42205   4 90 2 0 163261 0
42210   1 90 2 0 202899 0
42210   2 90 2 0 200151 0
42210   3 90 2 0 188704 0
42210   4 90 2 0 186282 0
42215   1 90 2 0 147362 0
42215   2 90 2 0 164771 0
42215   3 90 2 0 136764 0
42215   4 90 2 0 135109 0
42220   1 90 2 0 112410 0
42220   2 90 2 0 110736 0
42220   3 90 2 0 103810 0
42220   4 90 2 0 102589 0
42225   1 90 2 0 192348 0
42225   2 90 2 0 172868 0
42225   3 90 2 0 137839 0
42225   4 90 2 0 136235 0
42226   1 90 2 0 175748 0
42226   2 90 2 0 155435 0
42226   3 90 2 0 146606 0
42226   4 90 2 0 144845 0
42227   1 90 2 0 142757 0
42227   2 90 2 0 141159 0
42227   3 90 2 0 134492 0
42227   4 90 2 0 132839 0