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2024 Workers' Compensation Part B Fee Schedule

49424-50551

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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
49424   003 0 2 X 124.08 X
49424   002 0 2 X 124.08 X
49424   004 0 2 X 124.08 X
49424   001 0 2 X 139.42 X
49425   001 90 2 X 2,621.58 X
49425   004 90 2 X 2,525.38 X
49425   003 90 2 X 2,535.64 X
49425   002 90 2 X 2,601.39 X
49426   003 90 2 X 1,971.00 X
49426   002 90 2 X 2,015.87 X
49426   004 90 2 X 1,963.57 X
49426   001 90 2 X 2,026.75 X
49427   004 0 2 X 136.95 X
49427   003 0 2 X 205.82 X
49427   002 0 2 X 208.48 X
49427   001 0 2 X 209.13 X
49428   001 10 2 X 396.57 X
49428   004 10 2 X 357.60 X
49428   003 10 2 X 362.27 X
49428   002 10 2 X 385.18 X
49429   001 10 2 X 1,270.05 X
49429   004 10 2 X 1,145.36 X
49429   003 10 2 X 1,160.05 X
49429   002 10 2 X 1,233.51 X
49435   002 ZZZ 0 X 191.40 X
49435   003 ZZZ 0 X 191.40 X
49435   001 ZZZ 0 X 214.21 X
49435   004 ZZZ 0 X 191.40 X
49436   004 10 2 X 283.25 X
49436   002 10 2 X 283.25 X
49436   003 10 2 X 283.25 X
49436   001 10 2 X 321.07 X
49440   004 10 2 X 1,910.50 409.29
49440   002 10 2 X 1,910.50 409.29
49440   001 10 2 X 2,266.65 456.67
49440   003 10 2 X 1,910.50 409.29
49441   004 10 2 X 2,261.34 445.71
49441   002 10 2 X 2,261.34 445.71
49441   003 10 2 X 2,261.34 445.71
49441   001 10 2 X 2,677.63 488.49
49442   001 10 2 X 2,182.12 404.83
49442   004 10 2 X 1,843.90 369.81
49442   002 10 2 X 1,843.90 369.81
49442   003 10 2 X 1,843.90 369.81
49446   001 0 2 X 2,234.79 317.34
49446   004 0 2 X 1,882.05 291.75
49446   002 0 2 X 1,882.05 291.75
49446   003 0 2 X 1,882.05 291.75
49450   001 0 2 X 1,571.36 128.80
49450   003 0 2 X 1,314.96 118.49
49450   002 0 2 X 1,314.96 118.49
49450   004 0 2 X 1,314.96 118.49
49451   004 0 2 X 1,394.37 163.05
49451   001 0 2 X 1,662.26 177.68
49451   003 0 2 X 1,394.37 163.05
49451   002 0 2 X 1,394.37 163.05
49452   003 0 2 X 1,707.96 254.53
49452   002 0 2 X 1,707.96 254.53
49452   001 0 2 X 2,030.05 277.71
49452   004 0 2 X 1,707.96 254.53
49460   004 0 2 X 1,392.82 83.35
49460   003 0 2 X 1,392.82 83.35
49460   002 0 2 X 1,392.82 83.35
49460   001 0 2 X 1,669.20 90.41
49465   002 0 2 X 292.04 55.07
49465   003 0 2 X 292.04 55.07
49465   004 0 2 X 292.04 55.07
49465   001 0 2 X 345.48 59.74
49491   003 90 2 X 1,395.07 X
49491   002 90 2 X 1,395.07 X
49491   004 90 2 X 1,395.07 X
49491   001 90 2 X 1,553.93 X
49492   001 90 2 X 1,912.60 X
49492   004 90 2 X 1,713.73 X
49492   002 90 2 X 1,713.73 X
49492   003 90 2 X 1,713.73 X
49495   001 90 2 X 1,465.10 X
49495   004 90 2 X 1,349.43 X
49495   003 90 2 X 1,353.61 X
49495   002 90 2 X 1,431.70 X
49496   001 90 2 X 1,647.29 X
49496   002 90 2 X 1,621.76 X
49496   003 90 2 X 1,516.82 X
49496   004 90 2 X 1,500.00 X
49500   004 90 2 X 1,301.79 X
49500   002 90 2 X 1,382.39 X
49500   003 90 2 X 1,305.46 X
49500   001 90 2 X 1,415.53 X
49501   004 90 2 X 1,383.54 X
49501   003 90 2 X 1,399.25 X
49501   002 90 2 X 1,501.30 X
49501   001 90 2 X 1,526.12 X
49505   001 90 2 X 1,325.93 X
49505   003 90 2 X 1,222.49 X
49505   002 90 2 X 1,305.11 X
49505   004 90 2 X 1,211.44 X
49507   001 90 2 X 1,541.27 X
49507   003 90 2 X 1,413.98 X
49507   002 90 2 X 1,516.32 X
49507   004 90 2 X 1,398.04 X
49520   002 90 2 X 1,591.81 X
49520   004 90 2 X 1,440.42 X
49520   001 90 2 X 1,617.63 X
49520   003 90 2 X 1,447.46 X
49521   003 90 2 X 1,629.13 X
49521   002 90 2 X 1,736.78 X
49521   004 90 2 X 1,611.27 X
49521   001 90 2 X 1,763.04 X
49525   001 90 2 X 1,580.31 X
49525   002 90 2 X 1,566.18 X
49525   003 90 2 X 1,443.42 X
49525   004 90 2 X 1,388.70 X
49540   003 90 2 X 1,488.88 X
49540   002 90 2 X 1,595.51 X
49540   004 90 2 X 1,472.22 X
49540   001 90 2 X 1,621.41 X
49550   001 90 2 X 1,402.35 X
49550   002 90 2 X 1,378.74 X
49550   003 90 2 X 1,284.42 X
49550   004 90 2 X 1,286.86 X
49553   003 90 2 X 1,299.31 X
49553   001 90 2 X 1,417.70 X
49553   002 90 2 X 1,393.96 X
49553   004 90 2 X 1,301.66 X
49555   001 90 2 X 1,755.66 X
49555   004 90 2 X 1,617.29 X
49555   003 90 2 X 1,619.36 X
49555   002 90 2 X 1,724.29 X
49557   004 90 2 X 1,667.35 X
49557   001 90 2 X 1,807.80 X
49557   003 90 2 X 1,669.88 X
49557   002 90 2 X 1,776.07 X
49591   004 0 2 X 393.34 X
49591   001 0 2 X 430.07 X
49591   002 0 2 X 393.34 X
49591   003 0 2 X 393.34 X
49592   001 0 2 X 598.32 X
49592   003 0 2 X 547.58 X
49592   002 0 2 X 547.58 X
49592   004 0 2 X 547.58 X
49593   004 0 2 X 659.71 X
49593   002 0 2 X 659.71 X
49593   003 0 2 X 659.71 X
49593   001 0 2 X 720.34 X
49594   003 0 2 X 859.09 X
49594   002 0 2 X 859.09 X
49594   004 0 2 X 859.09 X
49594   001 0 2 X 937.93 X
49595   001 0 2 X 967.90 X
49595   002 0 2 X 887.09 X
49595   003 0 2 X 887.09 X
49595   004 0 2 X 887.09 X
49596   004 0 2 X 1,178.34 X
49596   001 0 2 X 1,284.85 X
49596   002 0 2 X 1,178.34 X
49596   003 0 2 X 1,178.34 X
49600   004 90 2 X 1,606.73 X
49600   003 90 2 X 1,624.99 X
49600   002 90 2 X 1,719.19 X
49600   001 90 2 X 1,741.98 X
49605   004 90 2 X 3,352.34 X
49605   003 90 2 X 3,388.46 X
49605   002 90 2 X 3,583.70 X
49605   001 90 2 X 3,631.30 X
49606   002 90 2 X 2,995.56 X
49606   003 90 2 X 2,851.97 X
49606   004 90 2 X 2,820.17 X
49606   001 90 2 X 3,030.27 X
49610   003 90 2 X 1,736.50 X
49610   002 90 2 X 1,857.08 X
49610   004 90 2 X 1,717.49 X
49610   001 90 2 X 1,886.39 X
49611   004 90 2 X 1,831.27 X
49611   002 90 2 X 1,959.16 X
49611   003 90 2 X 1,854.86 X
49611   001 90 2 X 1,984.16 X
49613   004 0 2 X 484.94 X
49613   001 0 2 X 529.80 X
49613   003 0 2 X 484.94 X
49613   002 0 2 X 484.94 X
49614   002 0 2 X 658.20 X
49614   003 0 2 X 658.20 X
49614   001 0 2 X 718.66 X
49614   004 0 2 X 658.20 X
49615   004 0 2 X 736.16 X
49615   003 0 2 X 736.16 X
49615   002 0 2 X 736.16 X
49615   001 0 2 X 803.78 X
49616   001 0 2 X 1,079.45 X
49616   004 0 2 X 988.99 X
49616   002 0 2 X 988.99 X
49616   003 0 2 X 988.99 X
49617   002 0 2 X 1,018.89 X
49617   003 0 2 X 1,018.89 X
49617   001 0 2 X 1,111.34 X
49617   004 0 2 X 1,018.89 X
49618   001 0 2 X 1,557.13 X
49618   004 0 2 X 1,427.97 X
49618   002 0 2 X 1,427.97 X
49618   003 0 2 X 1,427.97 X
49621   001 0 2 X 929.84 X
49621   002 0 2 X 854.92 X
49621   003 0 2 X 854.92 X
49621   004 0 2 X 854.92 X
49622   001 0 2 X 1,146.96 X
49622   003 0 2 X 1,055.26 X
49622   002 0 2 X 1,055.26 X
49622   004 0 2 X 1,055.26 X
49623   001 ZZZ 0 X 247.15 X
49623   004 ZZZ 0 X 227.64 X
49623   002 ZZZ 0 X 227.64 X
49623   003 ZZZ 0 X 227.64 X
49650   001 90 2 X 1,045.41 X
49650   003 90 2 X 935.63 X
49650   002 90 2 X 935.63 X
49650   004 90 2 X 935.63 X
49651   002 90 2 X 1,200.31 X
49651   003 90 2 X 1,200.31 X
49651   001 90 2 X 1,339.75 X
49651   004 90 2 X 1,200.31 X
49659     YYY 2 X # X
49900   003 90 2 X 934.73 X
49900   001 90 2 X 1,101.39 X
49900   004 90 2 X 972.74 X
49900   002 90 2 X 1,094.11 X
49904   004 90 2 X 2,946.50 X
49904   001 90 2 X 3,314.20 X
49904   003 90 2 X 2,946.50 X
49904   002 90 2 X 2,946.50 X
49905   001 ZZZ 0 X 1,224.44 X
49905   004 ZZZ 0 X 1,116.66 X
49905   002 ZZZ 0 X 1,205.77 X
49905   003 ZZZ 0 X 1,128.86 X
49906     90 2 X * X
49999     YYY 2 X # X
50010   001 90 2 X 2,334.84 X
50010   004 90 2 X 2,535.06 X
50010   003 90 2 X 2,546.09 X
50010   002 90 2 X 2,604.45 X
50020   001 90 2 X 2,180.67 X
50020   002 90 2 X 1,978.91 X
50020   003 90 2 X 1,978.91 X
50020   004 90 2 X 1,978.91 X
50040   002 90 2 X 2,021.54 X
50040   003 90 2 X 2,117.49 X
50040   004 90 2 X 2,294.10 X
50040   001 90 2 X 1,933.38 X
50045   001 90 2 X 2,805.75 X
50045   002 90 2 X 2,771.79 X
50045   003 90 2 X 2,631.46 X
50045   004 90 2 X 2,600.46 X
50060   001 90 2 X 3,510.93 X
50060   003 90 2 X 3,301.94 X
50060   002 90 2 X 3,467.48 X
50060   004 90 2 X 3,249.21 X
50065   004 90 2 X 3,603.03 X
50065   001 90 2 X 3,895.95 X
50065   003 90 2 X 3,646.09 X
50065   002 90 2 X 3,847.36 X
50070   001 90 2 X 3,728.33 X
50070   003 90 2 X 3,487.86 X
50070   002 90 2 X 3,681.48 X
50070   004 90 2 X 3,447.07 X
50075   002 90 2 X 4,459.76 X
50075   003 90 2 X 3,966.45 X
50075   001 90 2 X 4,316.75 X
50075   004 90 2 X 4,392.75 X
50080   001 90 2 X 3,056.34 X
50080   004 90 2 X 2,815.58 X
50080   002 90 2 X 3,016.42 X
50080   003 90 2 X 2,850.29 X
50081   002 90 2 X 4,108.76 X
50081   003 90 2 X 3,632.25 X
50081   004 90 2 X 3,782.56 X
50081   001 90 2 X 3,424.69 X
50100   003 90 2 X 2,801.44 X
50100   002 90 2 X 2,968.97 X
50100   001 90 2 X 3,020.52 X
50100   004 90 2 X 2,768.91 X
50120   003 90 2 X 2,835.83 X
50120   002 90 2 X 3,001.10 X
50120   004 90 2 X 2,802.42 X
50120   001 90 2 X 3,041.00 X
50125   001 90 2 X 3,081.45 X
50125   004 90 2 X 2,850.92 X
50125   002 90 2 X 3,043.31 X
50125   003 90 2 X 2,884.91 X
50130   003 90 2 X 3,149.07 X
50130   002 90 2 X 3,325.98 X
50130   004 90 2 X 3,111.32 X
50130   001 90 2 X 3,373.21 X
50135   002 90 2 X 4,066.54 X
50135   003 90 2 X 3,836.64 X
50135   004 90 2 X 3,789.66 X
50135   001 90 2 X 4,121.86 X
50200   004 0 2 X 611.77 X
50200   002 0 2 X 618.05 X
50200   003 0 2 X 610.56 X
50200   001 0 2 X 651.09 X
50205   002 90 2 X 1,877.77 X
50205   003 90 2 X 1,852.75 X
50205   001 90 2 X 1,981.36 X
50205   004 90 2 X 1,843.94 X
50220   002 90 2 X 3,397.73 X
50220   003 90 2 X 3,205.76 X
50220   001 90 2 X 3,444.06 X
50220   004 90 2 X 3,167.27 X
50225   004 90 2 X 3,826.70 X
50225   002 90 2 X 4,124.82 X
50225   003 90 2 X 3,873.52 X
50225   001 90 2 X 4,157.02 X
50230   003 90 2 X 4,465.98 X
50230   002 90 2 X 4,572.74 X
50230   001 90 2 X 4,568.76 X
50230   004 90 2 X 4,444.26 X
50234   002 90 2 X 4,349.46 X
50234   003 90 2 X 4,113.38 X
50234   004 90 2 X 4,064.16 X
50234   001 90 2 X 4,406.45 X
50236   004 90 2 X 4,426.94 X
50236   002 90 2 X 4,653.90 X
50236   003 90 2 X 4,484.34 X
50236   001 90 2 X 4,687.13 X
50240   003 90 2 X 3,960.77 X
50240   002 90 2 X 4,202.41 X
50240   004 90 2 X 3,913.46 X
50240   001 90 2 X 4,249.25 X
50250   001 90 2 X 2,352.38 X
50250   004 90 2 X 2,135.63 X
50250   003 90 2 X 2,135.63 X
50250   002 90 2 X 2,135.63 X
50280   003 90 2 X 2,782.50 X
50280   002 90 2 X 2,942.60 X
50280   004 90 2 X 2,792.47 X
50280   001 90 2 X 2,981.27 X
50290   004 90 2 X 2,454.66 X
50290   001 90 2 X 2,666.04 X
50290   003 90 2 X 2,483.22 X
50290   002 90 2 X 2,684.90 X
50320     90 2 X * X
50323     XXX 2 X * X
50325     XXX 2 X * X
50327   001 XXX 2 X 472.70 X
50327   004 XXX 2 X 433.56 X
50327   002 XXX 2 X 433.56 X
50327   003 XXX 2 X 433.56 X
50328   001 XXX 2 X 414.19 X
50328   004 XXX 2 X 379.70 X
50328   003 XXX 2 X 379.70 X
50328   002 XXX 2 X 379.70 X
50329   001 XXX 2 X 395.81 X
50329   004 XXX 2 X 362.72 X
50329   002 XXX 2 X 362.72 X
50329   003 XXX 2 X 362.72 X
50340   003 90 2 X 2,837.24 X
50340   002 90 2 X 3,000.47 X
50340   004 90 2 X 2,617.87 X
50340   001 90 2 X 3,096.37 X
50360   002 90 2 X 6,239.60 X
50360   003 90 2 X 5,814.23 X
50360   004 90 2 X 5,745.74 X
50360   001 90 2 X 6,342.70 X
50365   001 90 2 X 7,879.34 X
50365   002 90 2 X 7,457.09 X
50365   003 90 2 X 7,453.61 X
50365   004 90 2 X 6,912.40 X
50370   004 90 2 X 2,809.00 X
50370   001 90 2 X 2,920.36 X
50370   002 90 2 X 2,901.06 X
50370   003 90 2 X 2,821.50 X
50380   002 90 2 X 3,150.66 X
50380   003 90 2 X 2,963.08 X
50380   004 90 2 X 2,929.65 X
50380   001 90 2 X 4,151.49 X
50382   003 0 2 X 2,795.47 542.52
50382   002 0 2 X 2,795.47 542.52
50382   004 0 2 X 2,795.47 542.52
50382   001 0 2 X 3,348.21 590.72
50384   003 0 2 X 2,698.28 493.92
50384   002 0 2 X 2,698.28 493.92
50384   004 0 2 X 2,698.28 493.92
50384   001 0 2 X 3,235.99 537.90
50385   002 0 2 X 2,272.46 426.44
50385   003 0 2 X 2,272.46 426.44
50385   004 0 2 X 2,272.46 426.44
50385   001 0 2 X 2,694.35 468.68
50386   003 0 2 X 1,470.16 322.77
50386   002 0 2 X 1,470.16 322.77
50386   004 0 2 X 1,470.16 322.77
50386   001 0 2 X 1,738.63 355.27
50387   004 0 2 X 1,350.13 196.40
50387   001 0 2 X 1,625.71 213.65
50387   002 0 2 X 1,350.13 196.40
50387   003 0 2 X 1,350.13 196.40
50389   004 0 2 X 922.30 108.37
50389   003 0 2 X 922.30 108.37
50389   002 0 2 X 922.30 108.37
50389   001 0 2 X 1,114.29 118.04
50390   002 0 2 X 522.60 X
50390   003 0 2 X 544.29 X
50390   001 0 2 X 528.46 X
50390   004 0 2 X 526.28 X
50391   002 0 2 X 278.98 210.06
50391   003 0 2 X 278.98 210.06
50391   004 0 2 X 278.98 210.06
50391   001 0 2 X 311.31 228.64
50396   002 0 2 X 270.51 X
50396   003 0 2 X 260.33 X
50396   004 0 2 X 257.63 X
50396   001 0 2 X 273.01 X
50400   004 90 2 X 3,542.64 X
50400   003 90 2 X 3,455.13 X
50400   002 90 2 X 3,761.52 X
50400   001 90 2 X 3,698.59 X
50405   003 90 2 X 4,625.08 X
50405   002 90 2 X 4,739.50 X
50405   004 90 2 X 4,278.45 X
50405   001 90 2 X 4,763.53 X
50430   004 0 2 X 767.48 259.53
50430   003 0 2 X 767.48 259.53
50430   002 0 2 X 767.48 259.53
50430   001 0 2 X 873.95 279.58
50431   002 0 2 X 239.23 102.33
50431   003 0 2 X 239.23 102.33
50431   004 0 2 X 239.23 102.33
50431   001 0 2 X 271.54 111.34
50432   001 0 2 X 1,419.38 369.38
50432   004 0 2 X 1,240.86 343.48
50432   003 0 2 X 1,240.86 343.48
50432   002 0 2 X 1,240.86 343.48
50433   001 0 2 X 1,911.46 455.31
50433   004 0 2 X 1,668.22 423.72
50433   002 0 2 X 1,668.22 423.72
50433   003 0 2 X 1,668.22 423.72
50434   001 0 2 X 1,513.09 349.37
50434   004 0 2 X 1,319.24 324.64
50434   003 0 2 X 1,319.24 324.64
50434   002 0 2 X 1,319.24 324.64
50435   001 0 2 X 794.83 170.08
50435   002 0 2 X 691.19 157.24
50435   003 0 2 X 691.19 157.24
50435   004 0 2 X 691.19 157.24
50436   001 0 2 X 231.18 X
50436   004 0 2 X 214.36 X
50436   003 0 2 X 214.36 X
50436   002 0 2 X 214.36 X
50437   002 0 2 X 358.29 X
50437   004 0 2 X 358.29 X
50437   001 0 2 X 385.08 X
50437   003 0 2 X 358.29 X
50500   004 90 2 X 3,344.39 X
50500   003 90 2 X 3,383.61 X
50500   002 90 2 X 3,586.55 X
50500   001 90 2 X 3,635.72 X
50520   004 90 2 X 2,872.06 X
50520   002 90 2 X 3,082.79 X
50520   003 90 2 X 2,905.39 X
50520   001 90 2 X 3,125.78 X
50525   001 90 2 X 3,964.03 X
50525   003 90 2 X 3,682.21 X
50525   002 90 2 X 3,909.01 X
50525   004 90 2 X 3,640.51 X
50526   004 90 2 X 3,317.31 X
50526   001 90 2 X 3,620.09 X
50526   002 90 2 X 3,567.37 X
50526   003 90 2 X 3,351.58 X
50540   004 90 2 X 3,521.56 X
50540   001 90 2 X 3,819.32 X
50540   003 90 2 X 3,563.33 X
50540   002 90 2 X 3,769.44 X
50541   001 90 2 X 2,218.77 X
50541   004 90 2 X 2,023.41 X
50541   002 90 2 X 2,023.41 X
50541   003 90 2 X 2,023.41 X
50542   001 90 2 X 2,569.87 X
50542   004 90 2 X 2,332.53 X
50542   002 90 2 X 2,332.53 X
50542   003 90 2 X 2,332.53 X
50543   001 90 2 X 3,219.80 X
50543   004 90 2 X 2,938.72 X
50543   002 90 2 X 2,938.72 X
50543   003 90 2 X 2,938.72 X
50544   002 90 2 X 2,791.10 X
50544   003 90 2 X 2,791.10 X
50544   001 90 2 X 3,054.24 X
50544   004 90 2 X 2,791.10 X
50545   003 90 2 X 3,004.93 X
50545   002 90 2 X 3,004.93 X
50545   001 90 2 X 3,309.04 X
50545   004 90 2 X 3,004.93 X
50546   003 90 2 X 2,584.41 X
50546   002 90 2 X 2,584.41 X
50546   001 90 2 X 2,837.43 X
50546   004 90 2 X 2,584.41 X
50547   004 90 2 X 3,311.12 X
50547   002 90 2 X 3,311.12 X
50547   003 90 2 X 3,311.12 X
50547   001 90 2 X 3,651.26 X
50548   004 90 2 X 3,037.77 X
50548   002 90 2 X 3,037.77 X
50548   003 90 2 X 3,037.77 X
50548   001 90 2 X 3,325.57 X
50549     YYY 2 X # X
50551   001 0 2 X 886.05 X
50551   004 0 2 X 921.67 X
50551   003 0 2 X 898.31 X
50551   002 0 2 X 941.45 X