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Health Care Services Review
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Fee Schedule
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Fee Schedule 45332-47130
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2024 Workers' Compensation Part B Fee Schedule
45332-47130
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
45332
001
0
3
X
471.34
X
45332
004
0
3
X
463.54
X
45332
002
0
3
X
467.82
X
45332
003
0
3
X
438.44
X
45333
004
0
3
X
448.38
X
45333
001
0
3
X
490.82
X
45333
003
0
3
X
453.99
X
45333
002
0
3
X
483.66
X
45334
002
0
3
X
610.83
X
45334
003
0
3
X
577.87
X
45334
001
0
3
X
618.79
X
45334
004
0
3
X
570.75
X
45335
004
0
3
X
302.22
163.47
45335
003
0
3
X
302.22
163.47
45335
002
0
3
X
302.22
163.47
45335
001
0
3
X
342.67
179.55
45337
001
0
3
X
622.78
X
45337
002
0
3
X
613.03
X
45337
003
0
3
X
598.99
X
45337
004
0
3
X
599.61
X
45338
003
0
3
X
453.99
X
45338
002
0
3
X
483.66
X
45338
004
0
3
X
448.38
X
45338
001
0
3
X
490.82
X
45340
002
0
3
X
683.55
196.06
45340
003
0
3
X
683.55
196.06
45340
004
0
3
X
683.55
196.06
45340
001
0
3
X
787.44
214.39
45341
002
0
3
X
457.01
X
45341
003
0
3
X
457.01
X
45341
001
0
3
X
504.07
X
45341
004
0
3
X
457.01
X
45342
001
0
3
X
580.88
X
45342
002
0
3
X
527.16
X
45342
003
0
3
X
527.16
X
45342
004
0
3
X
527.16
X
45346
0
3
X
*
X
45347
0
3
X
*
X
45349
0
3
X
*
X
45350
0
3
X
*
X
45378
003
0
2
X
840.91
X
45378
002
0
2
X
892.93
X
45378
001
0
2
X
911.20
X
45378
004
0
2
X
833.28
X
45379
002
0
3
X
1,198.76
X
45379
003
0
3
X
1,120.71
X
45379
001
0
3
X
1,212.33
X
45379
004
0
3
X
1,126.21
X
45380
002
0
3
X
1,004.78
X
45380
003
0
3
X
966.91
X
45380
001
0
3
X
1,024.44
X
45380
004
0
3
X
961.96
X
45381
002
0
3
X
818.52
481.15
45381
003
0
3
X
818.52
481.15
45381
004
0
3
X
818.52
481.15
45381
001
0
3
X
922.97
526.33
45382
001
0
3
X
1,292.38
X
45382
002
0
3
X
1,278.33
X
45382
003
0
3
X
1,201.53
X
45382
004
0
3
X
1,200.59
X
45384
001
0
3
X
1,444.85
X
45384
004
0
3
X
1,317.77
X
45384
003
0
3
X
1,331.81
X
45384
002
0
3
X
1,418.10
X
45385
004
0
3
X
1,317.77
X
45385
002
0
3
X
1,418.10
X
45385
003
0
3
X
1,331.81
X
45385
001
0
3
X
1,444.85
X
45386
002
0
3
X
1,542.22
522.42
45386
003
0
3
X
1,542.22
522.42
45386
004
0
3
X
1,542.22
522.42
45386
001
0
3
X
1,769.28
570.54
45388
0
3
X
*
X
45389
0
3
X
*
X
45390
0
3
X
*
X
45391
004
0
3
X
573.25
X
45391
001
0
3
X
629.08
X
45391
002
0
3
X
573.25
X
45391
003
0
3
X
573.25
X
45392
003
0
3
X
725.22
X
45392
002
0
3
X
725.22
X
45392
004
0
3
X
725.22
X
45392
001
0
3
X
790.67
X
45393
0
3
X
*
X
45395
002
90
2
X
3,329.16
X
45395
003
90
2
X
3,329.16
X
45395
004
90
2
X
3,329.16
X
45395
001
90
2
X
3,718.69
X
45397
003
90
2
X
3,624.70
X
45397
002
90
2
X
3,624.70
X
45397
004
90
2
X
3,624.70
X
45397
001
90
2
X
4,028.68
X
45398
0
3
X
*
X
45399
YYY
2
X
#
X
45400
004
90
2
X
1,946.47
X
45400
001
90
2
X
2,168.00
X
45400
003
90
2
X
1,946.47
X
45400
002
90
2
X
1,946.47
X
45402
003
90
2
X
2,641.98
X
45402
002
90
2
X
2,641.98
X
45402
004
90
2
X
2,641.98
X
45402
001
90
2
X
2,936.69
X
45499
YYY
2
X
#
X
45500
002
90
2
X
1,678.35
X
45500
003
90
2
X
1,434.30
X
45500
004
90
2
X
1,655.33
X
45500
001
90
2
X
1,639.99
X
45505
003
90
2
X
1,630.83
X
45505
002
90
2
X
1,604.36
X
45505
004
90
2
X
1,624.02
X
45505
001
90
2
X
1,499.04
X
45520
004
0
2
X
121.90
X
45520
001
0
2
X
134.97
X
45520
003
0
2
X
123.42
X
45520
002
0
2
X
158.28
X
45540
002
90
2
X
2,695.70
X
45540
003
90
2
X
2,502.25
X
45540
004
90
2
X
2,529.09
X
45540
001
90
2
X
2,742.63
X
45541
003
90
2
X
2,385.68
X
45541
002
90
2
X
2,478.78
X
45541
001
90
2
X
2,590.32
X
45541
004
90
2
X
2,441.60
X
45550
004
90
2
X
3,256.53
X
45550
002
90
2
X
3,352.99
X
45550
003
90
2
X
3,226.83
X
45550
001
90
2
X
3,468.58
X
45560
001
90
2
X
1,505.24
X
45560
004
90
2
X
1,486.92
X
45560
002
90
2
X
1,481.80
X
45560
003
90
2
X
1,385.62
X
45562
001
90
2
X
2,533.49
X
45562
003
90
2
X
2,301.48
X
45562
002
90
2
X
2,457.75
X
45562
004
90
2
X
2,271.01
X
45563
001
90
2
X
3,996.29
X
45563
004
90
2
X
3,582.30
X
45563
003
90
2
X
3,630.40
X
45563
002
90
2
X
3,876.82
X
45800
004
90
2
X
3,161.42
X
45800
001
90
2
X
3,354.00
X
45800
002
90
2
X
3,262.80
X
45800
003
90
2
X
2,910.69
X
45805
001
90
2
X
3,862.59
X
45805
004
90
2
X
3,653.41
X
45805
002
90
2
X
3,342.09
X
45805
003
90
2
X
3,111.41
X
45820
004
90
2
X
2,430.25
X
45820
001
90
2
X
2,900.08
X
45820
003
90
2
X
3,113.57
X
45820
002
90
2
X
2,607.40
X
45825
001
90
2
X
3,047.29
X
45825
004
90
2
X
2,790.39
X
45825
002
90
2
X
3,003.36
X
45825
003
90
2
X
2,822.49
X
45900
001
10
2
X
265.94
X
45900
004
10
2
X
531.44
X
45900
003
10
2
X
249.50
X
45900
002
10
2
X
444.57
X
45905
001
10
2
X
263.26
X
45905
004
10
2
X
243.12
X
45905
003
10
2
X
253.53
X
45905
002
10
2
X
259.83
X
45910
002
10
2
X
316.08
X
45910
003
10
2
X
299.72
X
45910
001
10
2
X
320.06
X
45910
004
10
2
X
296.41
X
45915
004
10
2
X
269.33
X
45915
001
10
2
X
282.15
X
45915
003
10
2
X
266.17
X
45915
002
10
2
X
280.03
X
45990
002
0
2
X
192.66
X
45990
003
0
2
X
192.66
X
45990
001
0
2
X
213.51
X
45990
004
0
2
X
192.66
X
45999
YYY
2
X
#
X
46020
001
0
2
X
544.90
479.56
46020
004
0
2
X
484.03
428.50
46020
002
0
2
X
484.03
428.50
46020
003
0
2
X
484.03
428.50
46030
002
0
2
X
284.08
X
46030
003
0
2
X
174.75
X
46030
001
0
2
X
314.83
X
46030
004
0
2
X
299.85
X
46040
004
90
2
X
724.39
X
46040
002
90
2
X
767.09
X
46040
003
90
2
X
719.13
X
46040
001
90
2
X
776.71
X
46045
002
90
2
X
682.75
X
46045
003
90
2
X
537.85
X
46045
004
90
2
X
515.64
X
46045
001
90
2
X
549.17
X
46050
004
10
2
X
310.72
X
46050
001
10
2
X
327.20
X
46050
003
10
2
X
230.33
X
46050
002
10
2
X
281.46
X
46060
003
90
2
X
1,218.87
X
46060
002
90
2
X
1,298.64
X
46060
004
90
2
X
1,213.00
X
46060
001
90
2
X
1,322.87
X
46070
001
90
2
X
492.73
X
46070
004
90
2
X
449.12
X
46070
002
90
2
X
485.19
X
46070
003
90
2
X
454.05
X
46080
002
10
2
X
789.21
X
46080
003
10
2
X
741.22
X
46080
004
10
2
X
703.72
X
46080
001
10
2
X
770.97
X
46083
001
10
2
X
214.86
182.48
46083
003
10
2
X
201.90
171.75
46083
002
10
2
X
212.36
180.36
46083
004
10
2
X
199.67
169.96
46200
002
90
2
X
883.78
X
46200
003
90
2
X
755.14
X
46200
001
90
2
X
974.43
X
46200
004
90
2
X
748.11
X
46220
001
10
2
X
270.76
X
46220
004
10
2
X
262.56
X
46220
002
10
2
X
269.38
X
46220
003
10
2
X
263.68
X
46221
002
10
2
X
214.58
183.26
46221
003
10
2
X
208.74
177.62
46221
004
10
2
X
217.34
185.73
46221
001
10
2
X
212.49
181.63
46230
004
10
2
X
361.13
319.50
46230
001
10
2
X
362.65
319.75
46230
003
10
2
X
365.00
322.60
46230
002
10
2
X
382.35
337.51
46250
001
90
2
X
790.70
X
46250
004
90
2
X
791.56
X
46250
002
90
2
X
854.52
X
46250
003
90
2
X
800.68
X
46255
001
90
2
X
1,199.22
X
46255
004
90
2
X
1,083.19
X
46255
003
90
2
X
1,096.19
X
46255
002
90
2
X
1,262.06
X
46257
001
90
2
X
1,504.52
X
46257
003
90
2
X
1,304.77
X
46257
002
90
2
X
1,437.33
X
46257
004
90
2
X
1,281.52
X
46258
004
90
2
X
1,376.44
X
46258
002
90
2
X
1,503.86
X
46258
003
90
2
X
1,392.66
X
46258
001
90
2
X
1,530.86
X
46260
001
90
2
X
1,605.09
X
46260
002
90
2
X
1,731.61
X
46260
003
90
2
X
1,518.40
X
46260
004
90
2
X
1,541.77
X
46261
001
90
2
X
1,662.21
X
46261
004
90
2
X
1,492.51
X
46261
003
90
2
X
1,510.30
X
46261
002
90
2
X
1,632.53
X
46262
002
90
2
X
1,678.26
X
46262
003
90
2
X
1,551.86
X
46262
004
90
2
X
1,533.71
X
46262
001
90
2
X
1,708.90
X
46270
001
90
2
X
841.27
X
46270
004
90
2
X
790.09
X
46270
002
90
2
X
856.39
X
46270
003
90
2
X
764.52
X
46275
002
90
2
X
1,241.98
X
46275
003
90
2
X
1,223.46
X
46275
004
90
2
X
1,227.13
X
46275
001
90
2
X
1,322.03
X
46280
001
90
2
X
1,618.72
X
46280
004
90
2
X
1,597.70
X
46280
003
90
2
X
1,549.01
X
46280
002
90
2
X
1,618.34
X
46285
004
90
2
X
794.16
X
46285
003
90
2
X
689.63
X
46285
002
90
2
X
734.25
X
46285
001
90
2
X
799.66
X
46288
001
90
2
X
1,277.07
X
46288
004
90
2
X
1,164.81
X
46288
003
90
2
X
1,177.58
X
46288
002
90
2
X
1,257.59
X
46320
002
10
2
X
264.78
226.92
46320
003
10
2
X
251.12
215.29
46320
001
10
2
X
295.71
253.53
46320
004
10
2
X
248.35
213.13
46500
001
10
2
X
174.58
160.67
46500
004
10
2
X
170.50
156.93
46500
003
10
2
X
157.12
145.14
46500
002
10
2
X
158.16
145.27
46505
001
10
2
X
470.25
383.52
46505
002
10
2
X
416.19
345.37
46505
003
10
2
X
416.19
345.37
46505
004
10
2
X
416.19
345.37
46600
004
0
2
X
78.15
65.26
46600
001
0
2
X
80.17
66.87
46600
003
0
2
X
78.68
65.57
46600
002
0
2
X
79.66
66.41
46601
0
3
X
*
X
46604
001
0
3
X
210.44
188.66
46604
004
0
3
X
188.84
169.44
46604
002
0
3
X
181.51
162.80
46604
003
0
3
X
183.16
164.05
46606
004
0
3
X
108.14
X
46606
001
0
3
X
114.03
X
46606
003
0
3
X
108.94
X
46606
002
0
3
X
113.04
X
46607
0
3
X
*
X
46608
002
0
3
X
371.63
X
46608
003
0
3
X
372.73
X
46608
001
0
3
X
282.81
X
46608
004
0
3
X
360.28
X
46610
004
0
3
X
273.05
X
46610
001
0
3
X
283.42
X
46610
003
0
3
X
274.29
X
46610
002
0
3
X
279.41
X
46611
001
0
3
X
283.42
X
46611
004
0
3
X
273.05
X
46611
002
0
3
X
279.41
X
46611
003
0
3
X
274.29
X
46612
001
0
3
X
361.91
X
46612
004
0
3
X
330.30
X
46612
003
0
3
X
334.26
X
46612
002
0
3
X
381.59
X
46614
001
0
3
X
508.42
407.53
46614
004
0
3
X
463.89
371.50
46614
003
0
3
X
494.52
396.76
46614
002
0
3
X
492.01
394.20
46615
004
0
3
X
487.27
394.84
46615
002
0
3
X
516.17
418.28
46615
003
0
3
X
518.06
420.32
46615
001
0
3
X
532.70
431.80
46700
003
90
2
X
1,598.70
X
46700
002
90
2
X
1,632.38
X
46700
004
90
2
X
1,644.47
X
46700
001
90
2
X
1,654.69
X
46705
002
90
2
X
1,202.14
X
46705
003
90
2
X
1,126.10
X
46705
001
90
2
X
1,220.61
X
46705
004
90
2
X
1,113.63
X
46706
001
10
2
X
329.66
X
46706
004
10
2
X
297.71
X
46706
003
10
2
X
297.71
X
46706
002
10
2
X
297.71
X
46707
002
90
2
X
761.18
X
46707
003
90
2
X
761.18
X
46707
004
90
2
X
761.18
X
46707
001
90
2
X
850.44
X
46710
001
90
2
X
1,944.89
X
46710
004
90
2
X
1,753.92
X
46710
003
90
2
X
1,753.92
X
46710
002
90
2
X
1,753.92
X
46712
003
90
2
X
3,675.86
X
46712
002
90
2
X
3,675.86
X
46712
004
90
2
X
3,675.86
X
46712
001
90
2
X
4,091.25
X
46715
001
90
2
X
1,257.02
X
46715
004
90
2
X
1,146.41
X
46715
003
90
2
X
1,159.01
X
46715
002
90
2
X
1,237.78
X
46716
004
90
2
X
1,973.82
X
46716
001
90
2
X
3,290.42
X
46716
003
90
2
X
1,995.52
X
46716
002
90
2
X
2,130.86
X
46730
004
90
2
X
3,502.66
X
46730
001
90
2
X
3,840.31
X
46730
003
90
2
X
3,541.17
X
46730
002
90
2
X
3,781.77
X
46735
002
90
2
X
4,587.70
X
46735
003
90
2
X
4,295.80
X
46735
004
90
2
X
3,977.73
X
46735
001
90
2
X
4,658.75
X
46740
003
90
2
X
3,806.47
X
46740
002
90
2
X
4,064.72
X
46740
004
90
2
X
3,765.16
X
46740
001
90
2
X
4,127.53
X
46742
003
90
2
X
5,171.08
X
46742
002
90
2
X
5,456.85
X
46742
004
90
2
X
5,110.00
X
46742
001
90
2
X
5,525.85
X
46744
004
90
2
X
5,736.87
X
46744
001
90
2
X
6,203.80
X
46744
003
90
2
X
5,805.47
X
46744
002
90
2
X
6,126.30
X
46746
001
90
2
X
6,788.01
X
46746
004
90
2
X
6,277.00
X
46746
002
90
2
X
6,703.28
X
46746
003
90
2
X
6,352.03
X
46748
002
90
2
X
7,467.41
X
46748
003
90
2
X
7,076.27
X
46748
004
90
2
X
6,992.62
X
46748
001
90
2
X
7,561.84
X
46750
001
90
2
X
1,663.90
X
46750
003
90
2
X
1,605.10
X
46750
002
90
2
X
1,636.09
X
46750
004
90
2
X
1,597.79
X
46751
002
90
2
X
1,433.74
X
46751
003
90
2
X
1,342.43
X
46751
001
90
2
X
1,455.92
X
46751
004
90
2
X
1,327.79
X
46753
004
90
2
X
1,458.19
X
46753
003
90
2
X
1,464.24
X
46753
002
90
2
X
1,494.37
X
46753
001
90
2
X
1,513.76
X
46754
001
10
2
X
377.43
X
46754
002
10
2
X
266.74
X
46754
003
10
2
X
343.36
X
46754
004
10
2
X
339.36
X
46760
001
90
2
X
2,141.67
X
46760
004
90
2
X
1,948.28
X
46760
003
90
2
X
1,970.29
X
46760
002
90
2
X
2,108.09
X
46761
003
90
2
X
1,918.77
X
46761
002
90
2
X
2,021.65
X
46761
001
90
2
X
2,085.16
X
46761
004
90
2
X
1,897.08
X
46900
004
10
2
X
210.29
192.71
46900
001
10
2
X
218.76
200.69
46900
002
10
2
X
215.74
197.65
46900
003
10
2
X
210.36
193.42
46910
003
10
2
X
387.75
X
46910
002
10
2
X
363.23
X
46910
004
10
2
X
263.19
X
46910
001
10
2
X
398.57
X
46916
003
10
2
X
398.79
X
46916
002
10
2
X
364.33
X
46916
004
10
2
X
264.04
X
46916
001
10
2
X
424.53
X
46917
003
10
2
X
586.83
X
46917
002
10
2
X
600.00
X
46917
004
10
2
X
417.16
X
46917
001
10
2
X
603.15
X
46922
003
10
2
X
545.52
X
46922
002
10
2
X
552.14
X
46922
004
10
2
X
522.45
X
46922
001
10
2
X
527.49
X
46924
001
10
2
X
805.20
X
46924
003
10
2
X
744.67
X
46924
002
10
2
X
771.94
X
46924
004
10
2
X
752.11
X
46930
004
90
2
X
323.30
236.72
46930
003
90
2
X
323.30
236.72
46930
002
90
2
X
323.30
236.72
46930
001
90
2
X
369.81
267.08
46940
002
10
2
X
254.71
X
46940
003
10
2
X
257.39
X
46940
004
10
2
X
302.31
X
46940
001
10
2
X
273.31
X
46942
004
10
2
X
266.13
X
46942
001
10
2
X
283.69
X
46942
003
10
2
X
268.87
X
46942
002
10
2
X
230.15
X
46945
004
90
2
X
307.69
283.43
46945
001
90
2
X
313.66
287.09
46945
003
90
2
X
318.84
293.70
46945
002
90
2
X
317.46
292.20
46946
001
90
2
X
572.24
X
46946
004
90
2
X
536.38
X
46946
002
90
2
X
566.26
X
46946
003
90
2
X
428.48
X
46947
001
90
2
X
738.60
X
46947
004
90
2
X
656.82
X
46947
002
90
2
X
656.82
X
46947
003
90
2
X
656.82
X
46948
004
90
2
X
612.14
X
46948
002
90
2
X
612.14
X
46948
003
90
2
X
612.14
X
46948
001
90
2
X
681.11
X
46999
YYY
2
X
#
X
47000
004
0
2
X
331.41
X
47000
003
0
2
X
335.41
X
47000
002
0
2
X
353.82
X
47000
001
0
2
X
358.31
X
47001
003
ZZZ
0
X
358.36
X
47001
002
ZZZ
0
X
411.98
X
47001
004
ZZZ
0
X
357.38
X
47001
001
ZZZ
0
X
382.83
X
47010
003
90
2
X
1,603.68
X
47010
002
90
2
X
1,603.68
X
47010
004
90
2
X
1,603.68
X
47010
001
90
2
X
1,806.64
X
47015
001
90
2
X
2,105.16
X
47015
004
90
2
X
2,041.37
X
47015
002
90
2
X
2,099.64
X
47015
003
90
2
X
2,049.84
X
47100
004
90
2
X
1,305.17
X
47100
003
90
2
X
1,194.88
X
47100
002
90
2
X
1,269.32
X
47100
001
90
2
X
1,211.59
X
47120
001
90
2
X
3,913.84
X
47120
002
90
2
X
3,854.09
X
47120
003
90
2
X
3,940.70
X
47120
004
90
2
X
3,924.11
X
47122
003
90
2
X
5,627.73
X
47122
002
90
2
X
5,993.95
X
47122
004
90
2
X
5,565.80
X
47122
001
90
2
X
6,083.02
X
47125
002
90
2
X
5,999.39
X
47125
003
90
2
X
5,469.44
X
47125
001
90
2
X
6,036.13
X
47125
004
90
2
X
5,823.63
X
47130
003
90
2
X
5,947.95
X
47130
002
90
2
X
5,980.06
X
47130
001
90
2
X
6,255.08
X
47130
004
90
2
X
5,654.96
X
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