2018 Workers' Compensation Part B Fee Schedule

43262-44145

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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)
43262   1 0 3 0 136832 0
43262   2 0 3 0 135065 0
43262   3 0 3 0 127670 0
43262   4 0 3 0 126029 0
43263   1 0 3 0 93271 0
43263   2 0 3 0 85103 0
43263   3 0 3 0 93453 0
43263   4 0 3 0 84476 0
43264   1 0 3 0 148546 0
43264   2 0 3 0 146687 0
43264   3 0 3 0 140897 0
43264   4 0 3 0 143073 0
43265   1 0 3 0 130506 0
43265   2 0 3 0 128964 0
43265   3 0 3 0 122556 0
43265   4 0 3 0 121079 0
43266   1 0 3 0 32091 0
43266   2 0 3 0 29326 0
43266   3 0 3 0 29326 0
43266   4 0 3 0 29326 0
43270   1 0 3 0 98141 33676
43270   2 0 3 0 86113 30775
43270   3 0 3 0 86113 30775
43270   4 0 3 0 86113 30775
43273   1 ZZZ 0 0 18576 0
43273   2 ZZZ 0 0 17041 0
43273   3 ZZZ 0 0 17041 0
43273   4 ZZZ 0 0 17041 0
43274   1 0 3 0 66333 0
43274   2 0 3 0 60712 0
43274   3 0 3 0 60712 0
43274   4 0 3 0 60712 0
43275   1 0 3 0 54705 0
43275   2 0 3 0 50053 0
43275   3 0 3 0 50053 0
43275   4 0 3 0 50053 0
43276   1 0 3 0 68984 0
43276   2 0 3 0 63160 0
43276   3 0 3 0 63160 0
43276   4 0 3 0 63160 0
43277   1 0 3 0 55030 0
43277   2 0 3 0 50354 0
43277   3 0 3 0 50354 0
43277   4 0 3 0 50354 0
43278   1 0 3 0 62563 0
43278   2 0 3 0 57262 0
43278   3 0 3 0 57262 0
43278   4 0 3 0 57262 0
43279   1 90 2 0 177019 0
43279   2 90 2 0 161312 0
43279   3 90 2 0 161312 0
43279   4 90 2 0 161312 0
43280   1 90 2 0 219298 0
43280   2 90 2 0 196362 0
43280   3 90 2 0 196362 0
43280   4 90 2 0 196362 0
43281   1 90 2 0 231103 0
43281   2 90 2 0 207146 0
43281   3 90 2 0 207146 0
43281   4 90 2 0 207146 0
43282   1 90 2 0 259910 0
43282   2 90 2 0 233056 0
43282   3 90 2 0 233056 0
43282   4 90 2 0 233056 0
43283   1 ZZZ 0 0 24545 0
43283   2 ZZZ 0 0 22178 0
43283   3 ZZZ 0 0 22178 0
43283   4 ZZZ 0 0 22178 0
43284   1 90 2 0 84765 0
43284   2 90 2 0 76836 0
43284   3 90 2 0 76836 0
43284   4 90 2 0 76836 0
43285   1 90 2 0 85755 0
43285   2 90 2 0 77813 0
43285   3 90 2 0 77813 0
43285   4 90 2 0 77813 0
43286   1 90 2 0 399531 0
43286   2 90 2 0 363041 0
43286   3 90 2 0 363041 0
43286   4 90 2 0 363041 0
43287   1 90 2 0 456991 0
43287   2 90 2 0 414901 0
43287   3 90 2 0 414901 0
43287   4 90 2 0 414901 0
43288   1 90 2 0 475823 0
43288   2 90 2 0 432776 0
43288   3 90 2 0 432776 0
43288   4 90 2 0 432776 0
43289     YYY 2 0 0 0
43300   1 90 2 0 201936 0
43300   2 90 2 0 197057 0
43300   3 90 2 0 174189 0
43300   4 90 2 0 200507 0
43305   1 90 2 0 268732 0
43305   2 90 2 0 300372 0
43305   3 90 2 0 255232 0
43305   4 90 2 0 252188 0
43310   1 90 2 0 390371 0
43310   2 90 2 0 333344 0
43310   3 90 2 0 359252 0
43310   4 90 2 0 355175 0
43312   1 90 2 0 376492 0
43312   2 90 2 0 371485 0
43312   3 90 2 0 350888 0
43312   4 90 2 0 347011 0
43313   1 90 2 0 494426 0
43313   2 90 2 0 439949 0
43313   3 90 2 0 439949 0
43313   4 90 2 0 439949 0
43314   1 90 2 0 541920 0
43314   2 90 2 0 483836 0
43314   3 90 2 0 483836 0
43314   4 90 2 0 483836 0
43320   1 90 2 0 320707 0
43320   2 90 2 0 288975 0
43320   3 90 2 0 281613 0
43320   4 90 2 0 217459 0
43325   1 90 2 0 251689 0
43325   2 90 2 0 247556 0
43325   3 90 2 0 230510 0
43325   4 90 2 0 227865 0
43327   1 90 2 0 123573 0
43327   2 90 2 0 111218 0
43327   3 90 2 0 111218 0
43327   4 90 2 0 111218 0
43328   1 90 2 0 183411 0
43328   2 90 2 0 163963 0
43328   3 90 2 0 163963 0
43328   4 90 2 0 163963 0
43330   1 90 2 0 290798 0
43330   2 90 2 0 292387 0
43330   3 90 2 0 283924 0
43330   4 90 2 0 284067 0
43331   1 90 2 0 280019 0
43331   2 90 2 0 275262 0
43331   3 90 2 0 255611 0
43331   4 90 2 0 252594 0
43332   1 90 2 0 177116 0
43332   2 90 2 0 159474 0
43332   3 90 2 0 159474 0
43332   4 90 2 0 159474 0
43333   1 90 2 0 192303 0
43333   2 90 2 0 173203 0
43333   3 90 2 0 173203 0
43333   4 90 2 0 173203 0
43334   1 90 2 0 194526 0
43334   2 90 2 0 175238 0
43334   3 90 2 0 175238 0
43334   4 90 2 0 175238 0
43335   1 90 2 0 209560 0
43335   2 90 2 0 188839 0
43335   3 90 2 0 188839 0
43335   4 90 2 0 188839 0
43336   1 90 2 0 230451 0
43336   2 90 2 0 207002 0
43336   3 90 2 0 207002 0
43336   4 90 2 0 207002 0
43337   1 90 2 0 251425 0
43337   2 90 2 0 225776 0
43337   3 90 2 0 225776 0
43337   4 90 2 0 225776 0
43338   1 ZZZ 0 0 20459 0
43338   2 ZZZ 0 0 18367 0
43338   3 ZZZ 0 0 18367 0
43338   4 ZZZ 0 0 18367 0
43340   1 90 2 0 316029 0
43340   2 90 2 0 307940 0
43340   3 90 2 0 279515 0
43340   4 90 2 0 232386 0
43341   1 90 2 0 307750 0
43341   2 90 2 0 253367 0
43341   3 90 2 0 216196 0
43341   4 90 2 0 213725 0
43351   1 90 2 0 207607 0
43351   2 90 2 0 204553 0
43351   3 90 2 0 191962 0
43351   4 90 2 0 189779 0
43352   1 90 2 0 186422 0
43352   2 90 2 0 188141 0
43352   3 90 2 0 174835 0
43352   4 90 2 0 169632 0
43360   1 90 2 0 509590 0
43360   2 90 2 0 447963 0
43360   3 90 2 0 431738 0
43360   4 90 2 0 433518 0
43361   1 90 2 0 567090 0
43361   2 90 2 0 562056 0
43361   3 90 2 0 486498 0
43361   4 90 2 0 480861 0
43400   1 90 2 0 273882 0
43400   2 90 2 0 240719 0
43400   3 90 2 0 226372 0
43400   4 90 2 0 223755 0
43401   1 90 2 0 243690 0
43401   2 90 2 0 240030 0
43401   3 90 2 0 224988 0
43401   4 90 2 0 222490 0
43405   1 90 2 0 280019 0
43405   2 90 2 0 275262 0
43405   3 90 2 0 255611 0
43405   4 90 2 0 252594 0
43410   1 90 2 0 176609 0
43410   2 90 2 0 180571 0
43410   3 90 2 0 161798 0
43410   4 90 2 0 159878 0
43415   1 90 2 0 305375 0
43415   2 90 2 0 303473 0
43415   3 90 2 0 290183 0
43415   4 90 2 0 248530 0
43420   1 90 2 0 84406 0
43420   2 90 2 0 83336 0
43420   3 90 2 0 136455 0
43420   4 90 2 0 134901 0
43425   1 90 2 0 238023 0
43425   2 90 2 0 234572 0
43425   3 90 2 0 220329 0
43425   4 90 2 0 217831 0
43450   1 0 2 0 19114 0
43450   2 0 2 0 18227 0
43450   3 0 2 0 17217 0
43450   4 0 2 0 19835 0
43453   1 0 2 0 25282 0
43453   2 0 2 0 24964 0
43453   3 0 2 0 23627 0
43453   4 0 2 0 23338 0
43460   1 0 2 0 39494 0
43460   2 0 2 0 38888 0
43460   3 0 2 0 36971 0
43460   4 0 2 0 37029 0
43496     90 2 0 0 0
43499     YYY 2 0 0 0
43500   1 90 2 0 141232 0
43500   2 90 2 0 147260 0
43500   3 90 2 0 147305 0
43500   4 90 2 0 126431 0
43501   1 90 2 0 200656 0
43501   2 90 2 0 197135 0
43501   3 90 2 0 180083 0
43501   4 90 2 0 181917 0
43502   1 90 2 0 200656 0
43502   2 90 2 0 197135 0
43502   3 90 2 0 180083 0
43502   4 90 2 0 181917 0
43510   1 90 2 0 150387 0
43510   2 90 2 0 154060 0
43510   3 90 2 0 154048 0
43510   4 90 2 0 137913 0
43520   1 90 2 0 131561 0
43520   2 90 2 0 106762 0
43520   3 90 2 0 99973 0
43520   4 90 2 0 98845 0
43605   1 90 2 0 136297 0
43605   2 90 2 0 134046 0
43605   3 90 2 0 129139 0
43605   4 90 2 0 123355 0
43610   1 90 2 0 183681 0
43610   2 90 2 0 178415 0
43610   3 90 2 0 171782 0
43610   4 90 2 0 173433 0
43611   1 90 2 0 190169 0
43611   2 90 2 0 184867 0
43611   3 90 2 0 178077 0
43611   4 90 2 0 179678 0
43620   1 90 2 0 365330 0
43620   2 90 2 0 349258 0
43620   3 90 2 0 339395 0
43620   4 90 2 0 336102 0
43621   1 90 2 0 366570 0
43621   2 90 2 0 350493 0
43621   3 90 2 0 340607 0
43621   4 90 2 0 337297 0
43622   1 90 2 0 370323 0
43622   2 90 2 0 354225 0
43622   3 90 2 0 344251 0
43622   4 90 2 0 340908 0
43631   1 90 2 0 292661 0
43631   2 90 2 0 287920 0
43631   3 90 2 0 268417 0
43631   4 90 2 0 265397 0
43632   1 90 2 0 292661 0
43632   2 90 2 0 287920 0
43632   3 90 2 0 268417 0
43632   4 90 2 0 265397 0
43633   1 90 2 0 296424 0
43633   2 90 2 0 291663 0
43633   3 90 2 0 272067 0
43633   4 90 2 0 269022 0
43634   1 90 2 0 403643 0
43634   2 90 2 0 424039 0
43634   3 90 2 0 365094 0
43634   4 90 2 0 360823 0
43635   1 ZZZ 0 0 29852 0
43635   2 ZZZ 0 0 29398 0
43635   3 ZZZ 0 0 27502 0
43635   4 ZZZ 0 0 27205 0
43640   1 90 2 0 234339 0
43640   2 90 2 0 259841 0
43640   3 90 2 0 203063 0
43640   4 90 2 0 197699 0
43641   1 90 2 0 227983 0
43641   2 90 2 0 224164 0
43641   3 90 2 0 208435 0
43641   4 90 2 0 206053 0
43644   1 90 2 0 276082 0
43644   2 90 2 0 249034 0
43644   3 90 2 0 249034 0
43644   4 90 2 0 249034 0
43645   1 90 2 0 298019 0
43645   2 90 2 0 268465 0
43645   3 90 2 0 268465 0
43645   4 90 2 0 268465 0
43647     YYY 2 0 0 0
43648     YYY 2 0 0 0
43651   1 90 2 0 119170 0
43651   2 90 2 0 107108 0
43651   3 90 2 0 107108 0
43651   4 90 2 0 107108 0
43652   1 90 2 0 142311 0
43652   2 90 2 0 128413 0
43652   3 90 2 0 128413 0
43652   4 90 2 0 128413 0
43653   1 90 2 0 103117 0
43653   2 90 2 0 92222 0
43653   3 90 2 0 92222 0
43653   4 90 2 0 92222 0
43659     YYY 2 0 0 0
43752     0 0 0 0 0
43753   1 0 0 0 2963 0
43753   2 0 0 0 2786 0
43753   3 0 0 0 2786 0
43753   4 0 0 0 2786 0
43754   1 0 0 0 11489 4577
43754   2 0 0 0 10304 4197
43754   3 0 0 0 10304 4197
43754   4 0 0 0 10304 4197
43755   1 0 0 0 17495 8350
43755   2 0 0 0 15783 7700
43755   3 0 0 0 15783 7700
43755   4 0 0 0 15783 7700
43756   1 0 0 0 31788 7482
43756   2 0 0 0 28384 6902
43756   3 0 0 0 28384 6902
43756   4 0 0 0 28384 6902
43757   1 0 0 0 40852 10782
43757   2 0 0 0 36578 10002
43757   3 0 0 0 36578 10002
43757   4 0 0 0 36578 10002
43760   1 0 2 0 13694 0
43760   2 0 2 0 13611 0
43760   3 0 2 0 13108 0
43760   4 0 2 0 13035 0
43761   1 0 2 0 27273 0
43761   2 0 2 0 26856 0
43761   3 0 2 0 25138 0
43761   4 0 2 0 24862 0
43770   1 90 2 0 160483 0
43770   2 90 2 0 143087 0
43770   3 90 2 0 143087 0
43770   4 90 2 0 143087 0
43771   1 90 2 0 184700 0
43771   2 90 2 0 164874 0
43771   3 90 2 0 164874 0
43771   4 90 2 0 164874 0
43772   1 90 2 0 140676 0
43772   2 90 2 0 125743 0
43772   3 90 2 0 125743 0
43772   4 90 2 0 125743 0
43773   1 90 2 0 184775 0
43773   2 90 2 0 164918 0
43773   3 90 2 0 164918 0
43773   4 90 2 0 164918 0
43774   1 90 2 0 140919 0
43774   2 90 2 0 126091 0
43774   3 90 2 0 126091 0
43774   4 90 2 0 126091 0
43775   1 90 2 0 193998 0
43775   2 90 2 0 173541 0
43775   3 90 2 0 173541 0
43775   4 90 2 0 173541 0
43800   1 90 2 0 192491 0
43800   2 90 2 0 190205 0
43800   3 90 2 0 184997 0
43800   4 90 2 0 186245 0
43810   1 90 2 0 169706 0
43810   2 90 2 0 193084 0
43810   3 90 2 0 155545 0
43810   4 90 2 0 179358 0
43820   1 90 2 0 208483 0
43820   2 90 2 0 207204 0
43820   3 90 2 0 199561 0
43820   4 90 2 0 199946 0
43825   1 90 2 0 235922 0
43825   2 90 2 0 245595 0
43825   3 90 2 0 233674 0
43825   4 90 2 0 235604 0
43830   1 90 2 0 127599 0
43830   2 90 2 0 125003 0
43830   3 90 2 0 109953 0
43830   4 90 2 0 120674 0
43831   1 90 2 0 110272 0
43831   2 90 2 0 95904 0
43831   3 90 2 0 101278 0
43831   4 90 2 0 82848 0
43832   1 90 2 0 175310 0
43832   2 90 2 0 172638 0
43832   3 90 2 0 161614 0
43832   4 90 2 0 159750 0
43840   1 90 2 0 176307 0
43840   2 90 2 0 173381 0
43840   3 90 2 0 195571 0
43840   4 90 2 0 159497 0
43842   1 90 2 0 254285 0
43842   2 90 2 0 249463 0
43842   3 90 2 0 229592 0
43842   4 90 2 0 226870 0
43843   1 90 2 0 254285 0
43843   2 90 2 0 249463 0
43843   3 90 2 0 229592 0
43843   4 90 2 0 226870 0
43845     90 2 0 0 0
43846   1 90 2 0 275887 0
43846   2 90 2 0 347293 0
43846   3 90 2 0 248571 0
43846   4 90 2 0 245636 0
43847   1 90 2 0 204366 0
43847   2 90 2 0 339886 0
43847   3 90 2 0 324786 0
43847   4 90 2 0 188029 0
43848   1 90 2 0 275887 0
43848   2 90 2 0 347293 0
43848   3 90 2 0 248571 0
43848   4 90 2 0 245636 0
43850   1 90 2 0 281004 0
43850   2 90 2 0 276737 0
43850   3 90 2 0 272092 0
43850   4 90 2 0 256245 0
43855   1 90 2 0 279929 0
43855   2 90 2 0 275704 0
43855   3 90 2 0 258332 0
43855   4 90 2 0 255503 0
43860   1 90 2 0 282956 0
43860   2 90 2 0 278459 0
43860   3 90 2 0 259954 0
43860   4 90 2 0 257066 0
43865   1 90 2 0 313825 0
43865   2 90 2 0 308634 0
43865   3 90 2 0 295164 0
43865   4 90 2 0 284044 0
43870   1 90 2 0 135563 0
43870   2 90 2 0 132386 0
43870   3 90 2 0 125789 0
43870   4 90 2 0 128466 0
43880   1 90 2 0 291724 0
43880   2 90 2 0 286461 0
43880   3 90 2 0 272921 0
43880   4 90 2 0 225963 0
43881     YYY 2 0 0 0
43882     YYY 2 0 0 0
43886   1 90 2 0 44305 0
43886   2 90 2 0 39562 0
43886   3 90 2 0 39562 0
43886   4 90 2 0 39562 0
43887   1 90 2 0 43811 0
43887   2 90 2 0 38632 0
43887   3 90 2 0 38632 0
43887   4 90 2 0 38632 0
43888   1 90 2 0 62008 0
43888   2 90 2 0 54923 0
43888   3 90 2 0 54923 0
43888   4 90 2 0 54923 0
43999     YYY 2 0 0 0
44005   1 90 2 0 194281 0
44005   2 90 2 0 192227 0
44005   3 90 2 0 187388 0
44005   4 90 2 0 185390 0
44010   1 90 2 0 174580 0
44010   2 90 2 0 168148 0
44010   3 90 2 0 161978 0
44010   4 90 2 0 165397 0
44015   1 ZZZ 0 0 118235 0
44015   2 ZZZ 0 0 117858 0
44015   3 ZZZ 0 0 113602 0
44015   4 ZZZ 0 0 115291 0
44020   1 90 2 0 184491 0
44020   2 90 2 0 178331 0
44020   3 90 2 0 170076 0
44020   4 90 2 0 170951 0
44021   1 90 2 0 170069 0
44021   2 90 2 0 167378 0
44021   3 90 2 0 156323 0
44021   4 90 2 0 154578 0
44025   1 90 2 0 184433 0
44025   2 90 2 0 177118 0
44025   3 90 2 0 171680 0
44025   4 90 2 0 172264 0
44050   1 90 2 0 181549 0
44050   2 90 2 0 169154 0
44050   3 90 2 0 158650 0
44050   4 90 2 0 155500 0
44055   1 90 2 0 186416 0
44055   2 90 2 0 183492 0
44055   3 90 2 0 166800 0
44055   4 90 2 0 169536 0
44100   1 0 2 0 32390 0
44100   2 0 2 0 27814 0
44100   3 0 2 0 31348 0
44100   4 0 2 0 24017 0
44110   1 90 2 0 177186 0
44110   2 90 2 0 192176 0
44110   3 90 2 0 171255 0
44110   4 90 2 0 159600 0
44111   1 90 2 0 202952 0
44111   2 90 2 0 210421 0
44111   3 90 2 0 186813 0
44111   4 90 2 0 182411 0
44120   1 90 2 0 227122 0
44120   2 90 2 0 224384 0
44120   3 90 2 0 212929 0
44120   4 90 2 0 211412 0
44121   1 ZZZ 0 0 68791 0
44121   2 ZZZ 0 0 66813 0
44121   3 ZZZ 0 0 62835 0
44121   4 ZZZ 0 0 62037 0
44125   1 90 2 0 235671 0
44125   2 90 2 0 234969 0
44125   3 90 2 0 225402 0
44125   4 90 2 0 227663 0
44126   1 90 2 0 358095 0
44126   2 90 2 0 330367 0
44126   3 90 2 0 330367 0
44126   4 90 2 0 330367 0
44127   1 90 2 0 411701 0
44127   2 90 2 0 379977 0
44127   3 90 2 0 379977 0
44127   4 90 2 0 379977 0
44128   1 ZZZ 0 0 45189 0
44128   2 ZZZ 0 0 40571 0
44128   3 ZZZ 0 0 40571 0
44128   4 ZZZ 0 0 40571 0
44130   1 90 2 0 203345 0
44130   2 90 2 0 201360 0
44130   3 90 2 0 190695 0
44130   4 90 2 0 190545 0
44132     XXX 0 0 0 0
44133     XXX 0 0 0 0
44135     XXX 0 0 0 0
44136     XXX 0 0 0 0
44137     XXX 2 0 0 0
44139   1 ZZZ 0 0 34532 0
44139   2 ZZZ 0 0 33539 0
44139   3 ZZZ 0 0 31544 0
44139   4 ZZZ 0 0 31142 0
44140   1 90 2 0 273191 0
44140   2 90 2 0 268394 0
44140   3 90 2 0 249156 0
44140   4 90 2 0 244208 0
44141   1 90 2 0 283732 0
44141   2 90 2 0 279819 0
44141   3 90 2 0 262030 0
44141   4 90 2 0 259964 0
44143   1 90 2 0 288516 0
44143   2 90 2 0 284140 0
44143   3 90 2 0 266401 0
44143   4 90 2 0 265085 0
44144   1 90 2 0 280457 0
44144   2 90 2 0 275819 0
44144   3 90 2 0 259057 0
44144   4 90 2 0 258518 0
44145   1 90 2 0 331685 0
44145   2 90 2 0 322174 0
44145   3 90 2 0 309621 0
44145   4 90 2 0 306178 0