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2024 Workers' Compensation Part B Fee Schedule

45332-47130

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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
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