2018 Workers' Compensation Part B Fee Schedule

50553-51784

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
Implied Decimal 2 (in dollars)
50553   1 0 2 0 66940 0
50553   2 0 2 0 69297 0
50553   3 0 2 0 63691 0
50553   4 0 2 0 67923 0
50555   1 0 3 0 100856 0
50555   2 0 3 0 99598 0
50555   3 0 3 0 94373 0
50555   4 0 3 0 93255 0
50557   1 0 3 0 94705 0
50557   2 0 3 0 92483 0
50557   3 0 3 0 87382 0
50557   4 0 3 0 94382 0
50561   1 0 3 0 121808 0
50561   2 0 3 0 121215 0
50561   3 0 3 0 118785 0
50561   4 0 3 0 105483 0
50562   1 0 3 0 105727 0
50562   2 0 3 0 95859 0
50562   3 0 3 0 95859 0
50562   4 0 3 0 95859 0
50570   1 0 2 0 99060 0
50570   2 0 2 0 94072 0
50570   3 0 2 0 97432 0
50570   4 0 2 0 97052 0
50572   1 0 3 0 158670 0
50572   2 0 3 0 156662 0
50572   3 0 3 0 144459 0
50572   4 0 3 0 146613 0
50574   1 0 3 0 161444 0
50574   2 0 3 0 150862 0
50574   3 0 3 0 151575 0
50574   4 0 3 0 149800 0
50575   1 0 3 0 214870 0
50575   2 0 3 0 212187 0
50575   3 0 3 0 201070 0
50575   4 0 3 0 198696 0
50576   1 0 3 0 176491 0
50576   2 0 3 0 174283 0
50576   3 0 3 0 165100 0
50576   4 0 3 0 163112 0
50580   1 0 3 0 135095 0
50580   2 0 3 0 133791 0
50580   3 0 3 0 128427 0
50580   4 0 3 0 127063 0
50590   1 90 2 0 179479 0
50590   2 90 2 0 176990 0
50590   3 90 2 0 166669 0
50590   4 90 2 0 164595 0
50592   1 10 2 0 969936 60491
50592   2 10 2 0 798125 55084
50592   3 10 2 0 798125 55084
50592   4 10 2 0 798125 55084
50593   1 10 2 0 739357 69917
50593   2 10 2 0 619149 63920
50593   3 10 2 0 619149 63920
50593   4 10 2 0 619149 63920
50600   1 90 2 0 215301 0
50600   2 90 2 0 217461 0
50600   3 90 2 0 203043 0
50600   4 90 2 0 204783 0
50605   1 90 2 0 181347 0
50605   2 90 2 0 179398 0
50605   3 90 2 0 171373 0
50605   4 90 2 0 169476 0
50606   1 ZZZ 0 0 68573 20386
50606   2 ZZZ 0 0 60175 18991
50606   3 ZZZ 0 0 60175 18991
50606   4 ZZZ 0 0 60175 18991
50610   1 90 2 0 240440 0
50610   2 90 2 0 237324 0
50610   3 90 2 0 224431 0
50610   4 90 2 0 221743 0
50620   1 90 2 0 232105 0
50620   2 90 2 0 229071 0
50620   3 90 2 0 216484 0
50620   4 90 2 0 213889 0
50630   1 90 2 0 241714 0
50630   2 90 2 0 238472 0
50630   3 90 2 0 225019 0
50630   4 90 2 0 222280 0
50650   1 90 2 0 256176 0
50650   2 90 2 0 252923 0
50650   3 90 2 0 239439 0
50650   4 90 2 0 236596 0
50660   1 90 2 0 281572 0
50660   2 90 2 0 390374 0
50660   3 90 2 0 383936 0
50660   4 90 2 0 259475 0
50684   1 0 2 0 14976 0
50684   2 0 2 0 14593 0
50684   3 0 2 0 10558 0
50684   4 0 2 0 14628 0
50686   1 0 2 0 16411 0
50686   2 0 2 0 16261 0
50686   3 0 2 0 15633 0
50686   4 0 2 0 15470 0
50688   1 10 2 0 13397 0
50688   2 10 2 0 13712 0
50688   3 10 2 0 12704 0
50688   4 10 2 0 12568 0
50690   1 0 2 0 13106 0
50690   2 0 2 0 13484 0
50690   3 0 2 0 13277 0
50690   4 0 2 0 13224 0
50693   1 0 2 0 137766 28262
50693   2 0 2 0 119867 26279
50693   3 0 2 0 119867 26279
50693   4 0 2 0 119867 26279
50694   1 0 2 0 151545 36514
50694   2 0 2 0 132293 33981
50694   3 0 2 0 132293 33981
50694   4 0 2 0 132293 33981
50695   1 0 2 0 184702 46312
50695   2 0 2 0 161416 43142
50695   3 0 2 0 161416 43142
50695   4 0 2 0 161416 43142
50700   1 90 2 0 242308 0
50700   2 90 2 0 239037 0
50700   3 90 2 0 225475 0
50700   4 90 2 0 222735 0
50705   1 ZZZ 0 0 222471 26129
50705   2 ZZZ 0 0 192125 24321
50705   3 ZZZ 0 0 192125 24321
50705   4 ZZZ 0 0 192125 24321
50706   1 ZZZ 0 0 99360 24221
50706   2 ZZZ 0 0 86827 22611
50706   3 ZZZ 0 0 86827 22611
50706   4 ZZZ 0 0 86827 22611
50715   1 90 2 0 263410 0
50715   2 90 2 0 259910 0
50715   3 90 2 0 245475 0
50715   4 90 2 0 242654 0
50722   1 90 2 0 240604 0
50722   2 90 2 0 236893 0
50722   3 90 2 0 221592 0
50722   4 90 2 0 219079 0
50725   1 90 2 0 290355 0
50725   2 90 2 0 265613 0
50725   3 90 2 0 249932 0
50725   4 90 2 0 247033 0
50727   1 90 2 0 116104 0
50727   2 90 2 0 114661 0
50727   3 90 2 0 108688 0
50727   4 90 2 0 107407 0
50728   1 90 2 0 170974 0
50728   2 90 2 0 168835 0
50728   3 90 2 0 159996 0
50728   4 90 2 0 158104 0
50740   1 90 2 0 278415 0
50740   2 90 2 0 273051 0
50740   3 90 2 0 258710 0
50740   4 90 2 0 258577 0
50750   1 90 2 0 288535 0
50750   2 90 2 0 284928 0
50750   3 90 2 0 269974 0
50750   4 90 2 0 266739 0
50760   1 90 2 0 278007 0
50760   2 90 2 0 274302 0
50760   3 90 2 0 258958 0
50760   4 90 2 0 255876 0
50770   1 90 2 0 302157 0
50770   2 90 2 0 298164 0
50770   3 90 2 0 281611 0
50770   4 90 2 0 278214 0
50780   1 90 2 0 280343 0
50780   2 90 2 0 276622 0
50780   3 90 2 0 261217 0
50780   4 90 2 0 258089 0
50782   1 90 2 0 289715 0
50782   2 90 2 0 285943 0
50782   3 90 2 0 270307 0
50782   4 90 2 0 267100 0
50783   1 90 2 0 297667 0
50783   2 90 2 0 293841 0
50783   3 90 2 0 278022 0
50783   4 90 2 0 274746 0
50785   1 90 2 0 315741 0
50785   2 90 2 0 313555 0
50785   3 90 2 0 293570 0
50785   4 90 2 0 290073 0
50800   1 90 2 0 267244 0
50800   2 90 2 0 259266 0
50800   3 90 2 0 235677 0
50800   4 90 2 0 232732 0
50810   1 90 2 0 282467 0
50810   2 90 2 0 278554 0
50810   3 90 2 0 262425 0
50810   4 90 2 0 259383 0
50815   1 90 2 0 363648 0
50815   2 90 2 0 350611 0
50815   3 90 2 0 327331 0
50815   4 90 2 0 323332 0
50820   1 90 2 0 363323 0
50820   2 90 2 0 357919 0
50820   3 90 2 0 335547 0
50820   4 90 2 0 331495 0
50825   1 90 2 0 523100 0
50825   2 90 2 0 515363 0
50825   3 90 2 0 483217 0
50825   4 90 2 0 477177 0
50830   1 90 2 0 454338 0
50830   2 90 2 0 448477 0
50830   3 90 2 0 424214 0
50830   4 90 2 0 419228 0
50840   1 90 2 0 283703 0
50840   2 90 2 0 323082 0
50840   3 90 2 0 289879 0
50840   4 90 2 0 261959 0
50845   1 90 2 0 300020 0
50845   2 90 2 0 296271 0
50845   3 90 2 0 280756 0
50845   4 90 2 0 277435 0
50860   1 90 2 0 225752 0
50860   2 90 2 0 222784 0
50860   3 90 2 0 210496 0
50860   4 90 2 0 207988 0
50900   1 90 2 0 205707 0
50900   2 90 2 0 222198 0
50900   3 90 2 0 191402 0
50900   4 90 2 0 212817 0
50920   1 90 2 0 228893 0
50920   2 90 2 0 220616 0
50920   3 90 2 0 191788 0
50920   4 90 2 0 189524 0
50930   1 90 2 0 270532 0
50930   2 90 2 0 267159 0
50930   3 90 2 0 253186 0
50930   4 90 2 0 250190 0
50940   1 90 2 0 210010 0
50940   2 90 2 0 224057 0
50940   3 90 2 0 196453 0
50940   4 90 2 0 194121 0
50945   1 90 2 0 181407 0
50945   2 90 2 0 165551 0
50945   3 90 2 0 165551 0
50945   4 90 2 0 165551 0
50947   1 90 2 0 276337 0
50947   2 90 2 0 250138 0
50947   3 90 2 0 250138 0
50947   4 90 2 0 250138 0
50948   1 90 2 0 252658 0
50948   2 90 2 0 228733 0
50948   3 90 2 0 228733 0
50948   4 90 2 0 228733 0
50949     YYY 2 0 0 0
50951   1 0 2 0 65684 0
50951   2 0 2 0 88950 0
50951   3 0 2 0 87867 0
50951   4 0 2 0 86267 0
50953   1 0 3 0 68905 0
50953   2 0 3 0 87903 0
50953   3 0 3 0 86798 0
50953   4 0 3 0 64947 0
50955   1 0 3 0 93633 0
50955   2 0 3 0 93280 0
50955   3 0 3 0 77614 0
50955   4 0 3 0 76763 0
50957   1 0 3 0 81853 0
50957   2 0 3 0 81008 0
50957   3 0 3 0 91793 0
50957   4 0 3 0 76697 0
50961   1 0 3 0 76712 0
50961   2 0 3 0 105816 0
50961   3 0 3 0 104381 0
50961   4 0 3 0 100354 0
50970   1 0 2 0 110958 0
50970   2 0 2 0 109548 0
50970   3 0 2 0 103718 0
50970   4 0 2 0 102489 0
50972   1 0 2 0 73426 0
50972   2 0 2 0 72759 0
50972   3 0 2 0 70060 0
50972   4 0 2 0 69331 0
50974   1 0 3 0 145338 0
50974   2 0 3 0 143511 0
50974   3 0 3 0 135924 0
50974   4 0 3 0 134301 0
50976   1 0 3 0 138763 0
50976   2 0 3 0 137031 0
50976   3 0 3 0 129869 0
50976   4 0 3 0 128337 0
50980   1 0 2 0 88267 0
50980   2 0 2 0 128203 0
50980   3 0 2 0 67501 0
50980   4 0 2 0 82420 0
51020   1 90 2 0 129160 0
51020   2 90 2 0 130910 0
51020   3 90 2 0 128911 0
51020   4 90 2 0 128340 0
51030   1 90 2 0 126580 0
51030   2 90 2 0 140695 0
51030   3 90 2 0 126698 0
51030   4 90 2 0 87761 0
51040   1 90 2 0 123666 0
51040   2 90 2 0 124772 0
51040   3 90 2 0 124333 0
51040   4 90 2 0 121585 0
51045   1 90 2 0 126425 0
51045   2 90 2 0 110637 0
51045   3 90 2 0 124542 0
51045   4 90 2 0 124076 0
51050   1 90 2 0 132567 0
51050   2 90 2 0 131643 0
51050   3 90 2 0 128820 0
51050   4 90 2 0 128233 0
51060   1 90 2 0 177776 0
51060   2 90 2 0 175054 0
51060   3 90 2 0 163737 0
51060   4 90 2 0 161643 0
51065   1 90 2 0 137236 0
51065   2 90 2 0 159708 0
51065   3 90 2 0 143044 0
51065   4 90 2 0 126233 0
51080   1 90 2 0 97041 0
51080   2 90 2 0 102254 0
51080   3 90 2 0 89996 0
51080   4 90 2 0 98353 0
51100   1 0 2 0 9780 5865
51100   2 0 2 0 8621 5377
51100   3 0 2 0 8621 5377
51100   4 0 2 0 8621 5377
51101   1 0 2 0 20324 7860
51101   2 0 2 0 17468 7130
51101   3 0 2 0 17468 7130
51101   4 0 2 0 17468 7130
51102   1 10 2 0 51763 37427
51102   2 10 2 0 45705 33817
51102   3 10 2 0 45705 33817
51102   4 10 2 0 45705 33817
51500   1 90 2 0 154434 0
51500   2 90 2 0 152083 0
51500   3 90 2 0 142396 0
51500   4 90 2 0 140764 0
51520   1 90 2 0 156942 0
51520   2 90 2 0 160631 0
51520   3 90 2 0 156853 0
51520   4 90 2 0 143957 0
51525   1 90 2 0 212085 0
51525   2 90 2 0 209303 0
51525   3 90 2 0 197747 0
51525   4 90 2 0 195363 0
51530   1 90 2 0 187226 0
51530   2 90 2 0 204947 0
51530   3 90 2 0 207482 0
51530   4 90 2 0 206212 0
51535   1 90 2 0 177135 0
51535   2 90 2 0 174659 0
51535   3 90 2 0 164456 0
51535   4 90 2 0 162567 0
51550   1 90 2 0 227049 0
51550   2 90 2 0 224082 0
51550   3 90 2 0 211788 0
51550   4 90 2 0 209276 0
51555   1 90 2 0 273886 0
51555   2 90 2 0 285517 0
51555   3 90 2 0 263468 0
51555   4 90 2 0 261683 0
51565   1 90 2 0 324952 0
51565   2 90 2 0 320668 0
51565   3 90 2 0 302928 0
51565   4 90 2 0 299313 0
51570   1 90 2 0 340961 0
51570   2 90 2 0 336638 0
51570   3 90 2 0 318745 0
51570   4 90 2 0 314989 0
51575   1 90 2 0 458808 0
51575   2 90 2 0 452832 0
51575   3 90 2 0 428054 0
51575   4 90 2 0 422898 0
51580   1 90 2 0 433695 0
51580   2 90 2 0 428215 0
51580   3 90 2 0 405534 0
51580   4 90 2 0 400752 0
51585   1 90 2 0 516501 0
51585   2 90 2 0 509903 0
51585   3 90 2 0 482530 0
51585   4 90 2 0 476764 0
51590   1 90 2 0 516228 0
51590   2 90 2 0 489637 0
51590   3 90 2 0 500162 0
51590   4 90 2 0 492479 0
51595   1 90 2 0 619028 0
51595   2 90 2 0 610524 0
51595   3 90 2 0 583537 0
51595   4 90 2 0 583431 0
51596   1 90 2 0 576603 0
51596   2 90 2 0 573532 0
51596   3 90 2 0 562880 0
51596   4 90 2 0 593865 0
51597   1 90 2 0 613344 0
51597   2 90 2 0 604221 0
51597   3 90 2 0 566514 0
51597   4 90 2 0 559779 0
51600   1 0 2 0 8575 0
51600   2 0 2 0 8437 0
51600   3 0 2 0 8228 0
51600   4 0 2 0 8185 0
51605   1 0 2 0 12436 0
51605   2 0 2 0 12314 0
51605   3 0 2 0 11842 0
51605   4 0 2 0 11718 0
51610   1 0 2 0 13289 0
51610   2 0 2 0 13462 0
51610   3 0 2 0 12639 0
51610   4 0 2 0 12580 0
51700   1 0 2 0 9451 8554
51700   2 0 2 0 9141 8258
51700   3 0 2 0 8570 7757
51700   4 0 2 0 7999 7258
51701   1 0 2 0 10806 4875
51701   2 0 2 0 9485 4442
51701   3 0 2 0 9485 4442
51701   4 0 2 0 9485 4442
51702   1 0 2 0 17075 5358
51702   2 0 2 0 14823 4853
51702   3 0 2 0 14823 4853
51702   4 0 2 0 14823 4853
51703   1 0 2 0 23462 14362
51703   2 0 2 0 20818 13077
51703   3 0 2 0 20818 13077
51703   4 0 2 0 20818 13077
51705   1 10 2 0 11180 9697
51705   2 10 2 0 11012 9548
51705   3 10 2 0 10638 9245
51705   4 10 2 0 10744 9361
51710   1 10 2 0 14621 0
51710   2 10 2 0 14508 0
51710   3 10 2 0 14060 0
51710   4 10 2 0 13952 0
51715   1 0 2 0 57508 0
51715   2 0 2 0 56789 0
51715   3 0 2 0 53785 0
51715   4 0 2 0 53152 0
51720   1 0 2 0 16492 14947
51720   2 0 2 0 16306 14817
51720   3 0 2 0 15822 14374
51720   4 0 2 0 15635 14238
51725   1 0 2 0 22281 0
51725 26 1 0 2 0 19052 0
51725 TC 1 0 2 0 3690 0
51725   2 0 2 0 22459 0
51725 26 2 0 2 0 18844 0
51725 TC 2 0 2 0 3614 0
51725   3 0 2 0 18700 0
51725 26 3 0 2 0 16004 0
51725 TC 3 0 2 0 3287 0
51725   4 0 2 0 18286 0
51725 26 4 0 2 0 15690 0
51725 TC 4 0 2 0 3239 0
51726   1 0 2 0 24694 0
51726 26 1 0 2 0 22067 0
51726 TC 1 0 2 0 4743 0
51726   2 0 2 0 26013 0
51726 26 2 0 2 0 20632 0
51726 TC 2 0 2 0 4645 0
51726   3 0 2 0 21007 0
51726 26 3 0 2 0 17786 0
51726 TC 3 0 2 0 4229 0
51726   4 0 2 0 21186 0
51726 26 4 0 2 0 17440 0
51726 TC 4 0 2 0 4162 0
51727   1 0 2 0 43378 0
51727 26 1 0 2 0 15862 0
51727 TC 1 0 2 0 27515 0
51727   2 0 2 0 37773 0
51727 26 2 0 2 0 14585 0
51727 TC 2 0 2 0 23188 0
51727   3 0 2 0 37773 0
51727 26 3 0 2 0 14585 0
51727 TC 3 0 2 0 23188 0
51727   4 0 2 0 37773 0
51727 26 4 0 2 0 14585 0
51727 TC 4 0 2 0 23188 0
51728   1 0 2 0 43272 0
51728 26 1 0 2 0 15594 0
51728 TC 1 0 2 0 27680 0
51728   2 0 2 0 37714 0
51728 26 2 0 2 0 14390 0
51728 TC 2 0 2 0 23327 0
51728   3 0 2 0 37714 0
51728 26 3 0 2 0 14390 0
51728 TC 3 0 2 0 23327 0
51728   4 0 2 0 37714 0
51728 26 4 0 2 0 14390 0
51728 TC 4 0 2 0 23327 0
51729   1 0 2 0 46420 0
51729 26 1 0 2 0 18416 0
51729 TC 1 0 2 0 28005 0
51729   2 0 2 0 40637 0
51729 26 2 0 2 0 17036 0
51729 TC 2 0 2 0 23600 0
51729   3 0 2 0 40637 0
51729 26 3 0 2 0 17036 0
51729 TC 3 0 2 0 23600 0
51729   4 0 2 0 40637 0
51729 26 4 0 2 0 17036 0
51729 TC 4 0 2 0 23600 0
51736   1 0 2 0 10116 0
51736 26 1 0 2 0 8580 0
51736 TC 1 0 2 0 1381 0
51736   2 0 2 0 9744 0
51736 26 2 0 2 0 8527 0
51736 TC 2 0 2 0 1364 0
51736   3 0 2 0 9532 0
51736 26 3 0 2 0 9169 0
51736 TC 3 0 2 0 1250 0
51736   4 0 2 0 9276 0
51736 26 4 0 2 0 7480 0
51736 TC 4 0 2 0 1232 0
51741   1 0 2 0 14287 0
51741 26 1 0 2 0 12644 0
51741 TC 1 0 2 0 2014 0
51741   2 0 2 0 14912 0
51741 26 2 0 2 0 12560 0
51741 TC 2 0 2 0 9692 0
51741   3 0 2 0 13674 0
51741 26 3 0 2 0 12180 0
51741 TC 3 0 2 0 1798 0
51741   4 0 2 0 13608 0
51741 26 4 0 2 0 12110 0
51741 TC 4 0 2 0 1774 0
51784   1 0 2 0 24946 0
51784 26 1 0 2 0 20853 0
51784 TC 1 0 2 0 4091 0
51784   2 0 2 0 24341 0
51784 26 2 0 2 0 20412 0
51784 TC 2 0 2 0 3932 0
51784   3 0 2 0 23042 0
51784 26 3 0 2 0 19474 0
51784 TC 3 0 2 0 3568 0
51784   4 0 2 0 22737 0
51784 26 4 0 2 0 19231 0
51784 TC 4 0 2 0 3503 0