2018 Workers' Compensation Part B Fee Schedule

53515-55520

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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)
53515   1 90 2 0 195306 0
53515   2 90 2 0 192872 0
53515   3 90 2 0 182772 0
53515   4 90 2 0 180615 0
53520   1 90 2 0 76531 0
53520   2 90 2 0 114432 0
53520   3 90 2 0 105098 0
53520   4 90 2 0 108757 0
53600   1 0 2 0 11530 10345
53600   2 0 2 0 11252 10130
53600   3 0 2 0 10006 8995
53600   4 0 2 0 10051 9028
53601   1 0 2 0 10453 9319
53601   2 0 2 0 10310 9182
53601   3 0 2 0 8743 7816
53601   4 0 2 0 8948 7978
53605   1 0 2 0 12939 0
53605   2 0 2 0 12455 0
53605   3 0 2 0 11093 0
53605   4 0 2 0 14387 0
53620   1 0 2 0 13908 12347
53620   2 0 2 0 14541 12984
53620   3 0 2 0 13592 12166
53620   4 0 2 0 12682 11332
53621   1 0 2 0 12749 11415
53621   2 0 2 0 12551 11247
53621   3 0 2 0 10819 9691
53621   4 0 2 0 10860 9728
53660   1 0 2 0 8790 7619
53660   2 0 2 0 8682 7542
53660   3 0 2 0 7572 6552
53660   4 0 2 0 7516 6532
53661   1 0 2 0 8580 7540
53661   2 0 2 0 8491 7460
53661   3 0 2 0 7370 6489
53661   4 0 2 0 7380 6495
53665   1 0 2 0 9679 0
53665   2 0 2 0 9750 0
53665   3 0 2 0 8106 0
53665   4 0 2 0 9280 0
53850   1 90 2 0 129020 0
53850   2 90 2 0 115614 0
53850   3 90 2 0 115614 0
53850   4 90 2 0 115614 0
53852   1 90 2 0 134843 0
53852   2 90 2 0 120835 0
53852   3 90 2 0 120835 0
53852   4 90 2 0 120835 0
53855   1 0 2 0 97552 12042
53855   2 0 2 0 83210 11105
53855   3 0 2 0 83210 11105
53855   4 0 2 0 83210 11105
53860   1 90 2 0 213992 34610
53860   2 90 2 0 189965 31433
53860   3 90 2 0 189965 31433
53860   4 90 2 0 189965 31433
53899     YYY 2 0 0 0
54000     10 2 0 0 0
54001   1 10 2 0 26176 0
54001   2 10 2 0 25406 0
54001   3 10 2 0 24574 0
54001   4 10 2 0 24114 0
54015   1 10 2 0 40039 0
54015   2 10 2 0 39233 0
54015   3 10 2 0 49662 0
54015   4 10 2 0 49167 0
54050   1 10 2 0 11624 0
54050   2 10 2 0 10696 0
54050   3 10 2 0 10996 0
54050   4 10 2 0 11118 0
54055   1 10 2 0 15999 0
54055   2 10 2 0 15344 0
54055   3 10 2 0 15138 0
54055   4 10 2 0 14898 0
54056   1 10 2 0 14066 0
54056   2 10 2 0 14370 0
54056   3 10 2 0 12810 0
54056   4 10 2 0 14119 0
54057   1 10 2 0 23496 0
54057   2 10 2 0 22833 0
54057   3 10 2 0 22056 0
54057   4 10 2 0 25466 0
54060   1 10 2 0 24908 0
54060   2 10 2 0 24606 0
54060   3 10 2 0 23792 0
54060   4 10 2 0 23252 0
54065   1 10 2 0 44199 0
54065   2 10 2 0 63388 0
54065   3 10 2 0 49779 0
54065   4 10 2 0 40506 0
54100   1 0 2 0 18879 0
54100   2 0 2 0 18722 0
54100   3 0 2 0 18203 0
54100   4 0 2 0 21077 0
54105   1 10 2 0 35022 0
54105   2 10 2 0 34801 0
54105   3 10 2 0 33475 0
54105   4 10 2 0 33674 0
54110   1 90 2 0 140727 0
54110   2 90 2 0 139018 0
54110   3 90 2 0 131938 0
54110   4 90 2 0 130410 0
54111   1 90 2 0 200393 0
54111   2 90 2 0 197841 0
54111   3 90 2 0 187275 0
54111   4 90 2 0 185071 0
54112   1 90 2 0 276192 0
54112   2 90 2 0 274937 0
54112   3 90 2 0 219130 0
54112   4 90 2 0 216547 0
54115   1 90 2 0 89055 0
54115   2 90 2 0 135923 0
54115   3 90 2 0 120963 0
54115   4 90 2 0 82185 0
54120   1 90 2 0 140939 0
54120   2 90 2 0 139196 0
54120   3 90 2 0 131963 0
54120   4 90 2 0 130404 0
54125   1 90 2 0 221194 0
54125   2 90 2 0 218208 0
54125   3 90 2 0 205820 0
54125   4 90 2 0 213762 0
54130   1 90 2 0 301100 0
54130   2 90 2 0 297333 0
54130   3 90 2 0 281713 0
54130   4 90 2 0 283731 0
54135   1 90 2 0 384332 0
54135   2 90 2 0 379527 0
54135   3 90 2 0 359632 0
54135   4 90 2 0 355389 0
54150     10 2 0 0 0
54160     10 2 0 0 0
54161   1 10 2 0 48544 0
54161   2 10 2 0 47938 0
54161   3 10 2 0 45422 0
54161   4 10 2 0 44761 0
54162   1 10 2 0 41191 0
54162   2 10 2 0 36811 0
54162   3 10 2 0 36811 0
54162   4 10 2 0 36811 0
54163   1 10 2 0 38633 0
54163   2 10 2 0 34636 0
54163   3 10 2 0 34636 0
54163   4 10 2 0 34636 0
54164   1 10 2 0 33948 0
54164   2 10 2 0 30356 0
54164   3 10 2 0 30356 0
54164   4 10 2 0 30356 0
54200   1 10 2 0 9074 0
54200   2 10 2 0 8985 0
54200   3 10 2 0 11024 0
54200   4 10 2 0 10907 0
54205   1 90 2 0 110702 0
54205   2 90 2 0 109317 0
54205   3 90 2 0 103575 0
54205   4 90 2 0 102353 0
54220   1 0 2 0 60543 0
54220   2 0 2 0 58507 0
54220   3 0 2 0 51970 0
54220   4 0 2 0 33360 0
54230   1 0 2 0 16365 0
54230   2 0 2 0 16151 0
54230   3 0 2 0 15300 0
54230   4 0 2 0 22273 0
54231   1 0 2 0 38199 0
54231   2 0 2 0 37718 0
54231   3 0 2 0 35722 0
54231   4 0 2 0 35304 0
54235   1 0 2 0 12622 11013
54235   2 0 2 0 12763 11157
54235   3 0 2 0 11792 10347
54235   4 0 2 0 12091 10607
54240   1 0 2 0 20474 0
54240 26 1 0 2 0 14937 0
54240 TC 1 0 2 0 4872 0
54240   2 0 2 0 20496 0
54240 26 2 0 2 0 14828 0
54240 TC 2 0 2 0 5794 0
54240   3 0 2 0 19482 0
54240 26 3 0 2 0 13998 0
54240 TC 3 0 2 0 4308 0
54240   4 0 2 0 18574 0
54240 26 4 0 2 0 12401 0
54240 TC 4 0 2 0 4241 0
54250   1 0 2 0 19682 0
54250 26 1 0 2 0 23651 0
54250 TC 1 0 2 0 2894 0
54250   2 0 2 0 19437 0
54250 26 2 0 2 0 17910 0
54250 TC 2 0 2 0 2836 0
54250   3 0 2 0 18839 0
54250 26 3 0 2 0 17406 0
54250 TC 3 0 2 0 2582 0
54250   4 0 2 0 18732 0
54250 26 4 0 2 0 22336 0
54250 TC 4 0 2 0 2543 0
54300   1 90 2 0 95561 0
54300   2 90 2 0 94493 0
54300   3 90 2 0 143926 0
54300   4 90 2 0 142253 0
54304   1 90 2 0 187525 0
54304   2 90 2 0 196203 0
54304   3 90 2 0 175259 0
54304   4 90 2 0 173195 0
54308   1 90 2 0 157032 0
54308   2 90 2 0 155128 0
54308   3 90 2 0 147268 0
54308   4 90 2 0 145619 0
54312   1 90 2 0 202386 0
54312   2 90 2 0 199860 0
54312   3 90 2 0 189401 0
54312   4 90 2 0 187167 0
54316   1 90 2 0 245572 0
54316   2 90 2 0 242498 0
54316   3 90 2 0 229766 0
54316   4 90 2 0 227049 0
54318   1 90 2 0 166626 0
54318   2 90 2 0 164247 0
54318   3 90 2 0 154437 0
54318   4 90 2 0 152652 0
54322   1 90 2 0 178368 0
54322   2 90 2 0 176236 0
54322   3 90 2 0 167400 0
54322   4 90 2 0 165454 0
54324   1 90 2 0 237610 0
54324   2 90 2 0 240690 0
54324   3 90 2 0 235524 0
54324   4 90 2 0 219705 0
54326   1 90 2 0 227516 0
54326   2 90 2 0 224673 0
54326   3 90 2 0 212901 0
54326   4 90 2 0 210385 0
54328   1 90 2 0 231883 0
54328   2 90 2 0 228816 0
54328   3 90 2 0 216163 0
54328   4 90 2 0 213625 0
54332   1 90 2 0 257326 0
54332   2 90 2 0 254111 0
54332   3 90 2 0 240747 0
54332   4 90 2 0 237864 0
54336   1 90 2 0 337474 0
54336   2 90 2 0 333180 0
54336   3 90 2 0 315287 0
54336   4 90 2 0 311355 0
54340   1 90 2 0 131435 0
54340   2 90 2 0 129791 0
54340   3 90 2 0 122996 0
54340   4 90 2 0 121544 0
54344   1 90 2 0 283468 0
54344   2 90 2 0 279880 0
54344   3 90 2 0 264920 0
54344   4 90 2 0 261555 0
54348   1 90 2 0 251518 0
54348   2 90 2 0 248372 0
54348   3 90 2 0 235358 0
54348   4 90 2 0 232576 0
54352   1 90 2 0 357956 0
54352   2 90 2 0 353615 0
54352   3 90 2 0 335621 0
54352   4 90 2 0 331671 0
54360   1 90 2 0 165273 0
54360   2 90 2 0 163258 0
54360   3 90 2 0 154925 0
54360   4 90 2 0 153130 0
54380   1 90 2 0 195904 0
54380   2 90 2 0 193547 0
54380   3 90 2 0 183779 0
54380   4 90 2 0 181581 0
54385   1 90 2 0 224804 0
54385   2 90 2 0 222098 0
54385   3 90 2 0 210889 0
54385   4 90 2 0 208382 0
54390   1 90 2 0 312671 0
54390   2 90 2 0 308670 0
54390   3 90 2 0 292141 0
54390   4 90 2 0 288754 0
54400   1 90 2 0 232761 0
54400   2 90 2 0 231528 0
54400   3 90 2 0 226401 0
54400   4 90 2 0 225454 0
54401   1 90 2 0 253476 0
54401   2 90 2 0 251851 0
54401   3 90 2 0 245105 0
54401   4 90 2 0 243893 0
54405   1 90 2 0 316709 0
54405   2 90 2 0 314723 0
54405   3 90 2 0 306438 0
54405   4 90 2 0 304933 0
54406   1 90 2 0 127738 0
54406   2 90 2 0 115601 0
54406   3 90 2 0 115601 0
54406   4 90 2 0 115601 0
54408   1 90 2 0 134511 0
54408   2 90 2 0 121852 0
54408   3 90 2 0 121852 0
54408   4 90 2 0 121852 0
54410   1 90 2 0 158562 0
54410   2 90 2 0 144383 0
54410   3 90 2 0 144383 0
54410   4 90 2 0 144383 0
54411   1 90 2 0 173012 0
54411   2 90 2 0 157052 0
54411   3 90 2 0 157052 0
54411   4 90 2 0 157052 0
54415   1 90 2 0 95099 0
54415   2 90 2 0 85577 0
54415   3 90 2 0 85577 0
54415   4 90 2 0 85577 0
54416   1 90 2 0 123406 0
54416   2 90 2 0 111668 0
54416   3 90 2 0 111668 0
54416   4 90 2 0 111668 0
54417   1 90 2 0 151501 0
54417   2 90 2 0 138069 0
54417   3 90 2 0 138069 0
54417   4 90 2 0 138069 0
54420   1 90 2 0 167737 0
54420   2 90 2 0 165542 0
54420   3 90 2 0 156476 0
54420   4 90 2 0 154635 0
54430   1 90 2 0 148947 0
54430   2 90 2 0 147068 0
54430   3 90 2 0 139262 0
54430   4 90 2 0 137607 0
54435   1 90 2 0 87748 0
54435   2 90 2 0 72777 0
54435   3 90 2 0 82127 0
54435   4 90 2 0 81146 0
54437   1 90 2 0 88058 0
54437   2 90 2 0 80902 0
54437   3 90 2 0 80902 0
54437   4 90 2 0 80902 0
54438   1 90 2 0 177491 0
54438   2 90 2 0 163597 0
54438   3 90 2 0 163597 0
54438   4 90 2 0 163597 0
54440   1 90 2 0 165273 0
54440   2 90 2 0 163258 0
54440   3 90 2 0 154925 0
54440   4 90 2 0 153130 0
54450   1 0 2 0 16121 0
54450   2 0 2 0 15927 0
54450   3 0 2 0 15126 0
54450   4 0 2 0 14951 0
54500   1 0 2 0 15366 0
54500   2 0 2 0 12440 0
54500   3 0 2 0 14556 0
54500   4 0 2 0 14396 0
54505   1 10 2 0 47417 0
54505   2 10 2 0 46840 0
54505   3 10 2 0 44464 0
54505   4 10 2 0 43957 0
54512   1 90 2 0 101493 0
54512   2 90 2 0 92009 0
54512   3 90 2 0 92009 0
54512   4 90 2 0 92009 0
54520   1 90 2 0 93391 0
54520   2 90 2 0 92075 0
54520   3 90 2 0 86623 0
54520   4 90 2 0 85545 0
54522   1 90 2 0 115493 0
54522   2 90 2 0 104518 0
54522   3 90 2 0 104518 0
54522   4 90 2 0 104518 0
54530   1 90 2 0 136362 0
54530   2 90 2 0 136188 0
54530   3 90 2 0 130410 0
54530   4 90 2 0 128481 0
54535   1 90 2 0 182120 0
54535   2 90 2 0 179674 0
54535   3 90 2 0 169538 0
54535   4 90 2 0 167537 0
54550   1 90 2 0 114619 0
54550   2 90 2 0 113112 0
54550   3 90 2 0 106861 0
54550   4 90 2 0 105608 0
54560   1 90 2 0 160192 0
54560   2 90 2 0 158125 0
54560   3 90 2 0 149583 0
54560   4 90 2 0 147831 0
54600   1 90 2 0 101073 0
54600   2 90 2 0 99788 0
54600   3 90 2 0 94479 0
54600   4 90 2 0 93373 0
54620   1 10 2 0 71998 0
54620   2 10 2 0 71098 0
54620   3 10 2 0 67377 0
54620   4 10 2 0 66582 0
54640   1 90 2 0 133359 0
54640   2 90 2 0 134103 0
54640   3 90 2 0 133359 0
54640   4 90 2 0 132707 0
54650   1 90 2 0 170425 0
54650   2 90 2 0 146267 0
54650   3 90 2 0 145225 0
54650   4 90 2 0 144469 0
54660   1 90 2 0 73716 0
54660   2 90 2 0 72796 0
54660   3 90 2 0 68970 0
54660   4 90 2 0 68153 0
54670   1 90 2 0 24738 0
54670   2 90 2 0 24496 0
54670   3 90 2 0 23474 0
54670   4 90 2 0 23221 0
54680   1 90 2 0 177214 0
54680   2 90 2 0 174999 0
54680   3 90 2 0 165829 0
54680   4 90 2 0 163876 0
54690   1 90 2 0 137354 0
54690   2 90 2 0 124174 0
54690   3 90 2 0 124174 0
54690   4 90 2 0 124174 0
54692   1 90 2 0 140793 0
54692   2 90 2 0 128130 0
54692   3 90 2 0 128130 0
54692   4 90 2 0 128130 0
54699     YYY 2 0 0 0
54700   1 10 2 0 31646 0
54700   2 10 2 0 31345 0
54700   3 10 2 0 30559 0
54700   4 10 2 0 30576 0
54800   1 0 2 0 38828 0
54800   2 0 2 0 38323 0
54800   3 0 2 0 36226 0
54800   4 0 2 0 35784 0
54830   1 90 2 0 77620 0
54830   2 90 2 0 76627 0
54830   3 90 2 0 72508 0
54830   4 90 2 0 73330 0
54840   1 90 2 0 92295 0
54840   2 90 2 0 88383 0
54840   3 90 2 0 89200 0
54840   4 90 2 0 83733 0
54860   1 90 2 0 104567 0
54860   2 90 2 0 99830 0
54860   3 90 2 0 100088 0
54860   4 90 2 0 96502 0
54861   1 90 2 0 143308 0
54861   2 90 2 0 141415 0
54861   3 90 2 0 133558 0
54861   4 90 2 0 131942 0
54865   1 90 2 0 50095 0
54865   2 90 2 0 44663 0
54865   3 90 2 0 44663 0
54865   4 90 2 0 44663 0
54900   1 90 2 0 193676 0
54900   2 90 2 0 191261 0
54900   3 90 2 0 181256 0
54900   4 90 2 0 179112 0
54901   1 90 2 0 265843 0
54901   2 90 2 0 262520 0
54901   3 90 2 0 248780 0
54901   4 90 2 0 245842 0
55000   1 0 2 0 15927 14269
55000   2 0 2 0 15971 14282
55000   3 0 2 0 14776 13260
55000   4 0 2 0 14346 12856
55040   1 90 2 0 93289 0
55040   2 90 2 0 90707 0
55040   3 90 2 0 89508 0
55040   4 90 2 0 84262 0
55041   1 90 2 0 136094 0
55041   2 90 2 0 136115 0
55041   3 90 2 0 129570 0
55041   4 90 2 0 130513 0
55060   1 90 2 0 87905 0
55060   2 90 2 0 87058 0
55060   3 90 2 0 85355 0
55060   4 90 2 0 84578 0
55100   1 10 2 0 17883 0
55100   2 10 2 0 17709 0
55100   3 10 2 0 17201 0
55100   4 10 2 0 17060 0
55110   1 90 2 0 69945 0
55110   2 90 2 0 69383 0
55110   3 90 2 0 67051 0
55110   4 90 2 0 72959 0
55120   1 90 2 0 58249 0
55120   2 90 2 0 57619 0
55120   3 90 2 0 49261 0
55120   4 90 2 0 48464 0
55150   1 90 2 0 109505 0
55150   2 90 2 0 108051 0
55150   3 90 2 0 102006 0
55150   4 90 2 0 100781 0
55175   1 90 2 0 85929 0
55175   2 90 2 0 84232 0
55175   3 90 2 0 79822 0
55175   4 90 2 0 78853 0
55180   1 90 2 0 135605 0
55180   2 90 2 0 134451 0
55180   3 90 2 0 143292 0
55180   4 90 2 0 141628 0
55200   1 90 2 0 54268 0
55200   2 90 2 0 53665 0
55200   3 90 2 0 51167 0
55200   4 90 2 0 50591 0
55250   1 90 2 0 61776 0
55250   2 90 2 0 62639 0
55250   3 90 2 0 58757 0
55250   4 90 2 0 58952 0
55300   1 0 2 0 56085 0
55300   2 0 2 0 55368 0
55300   3 0 2 0 52385 0
55300   4 0 2 0 51760 0
55400   1 90 2 0 133324 0
55400   2 90 2 0 131615 0
55400   3 90 2 0 124542 0
55400   4 90 2 0 123051 0
55500   1 90 2 0 85050 0
55500   2 90 2 0 84351 0
55500   3 90 2 0 79919 0
55500   4 90 2 0 79613 0
55520   1 90 2 0 81377 0
55520   2 90 2 0 80271 0
55520   3 90 2 0 75723 0
55520   4 90 2 0 74884 0