2018 Workers' Compensation Part B Fee Schedule

93313-93619

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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)
93313   1 XXX 0 0 13560 0
93313   2 XXX 0 0 13397 0
93313   3 XXX 0 0 12714 0
93313   4 XXX 0 0 12564 0
93314   1 XXX 0 0 46025 0
93314 26 1 XXX 0 0 13560 0
93314 TC 1 XXX 0 0 32455 0
93314   2 XXX 0 0 45206 0
93314 26 2 XXX 0 0 13397 0
93314 TC 2 XXX 0 0 31811 0
93314   3 XXX 0 0 41793 0
93314 26 3 XXX 0 0 12714 0
93314 TC 3 XXX 0 0 29080 0
93314   4 XXX 0 0 41191 0
93314 26 4 XXX 0 0 12564 0
93314 TC 4 XXX 0 0 28631 0
93315   1 XXX 0 0 61279 0
93315 26 1 XXX 0 0 30219 0
93315 TC 1 XXX 0 0 31059 0
93315   2 XXX 0 0 54325 0
93315 26 2 XXX 0 0 28222 0
93315 TC 2 XXX 0 0 26098 0
93315   3 XXX 0 0 52869 0
93315 26 3 XXX 0 0 27469 0
93315 TC 3 XXX 0 0 25400 0
93315   4 XXX 0 0 52869 0
93315 26 4 XXX 0 0 27469 0
93315 TC 4 XXX 0 0 25400 0
93316   1 XXX 0 0 12125 0
93316   2 XXX 0 0 11157 0
93316   3 XXX 0 0 10854 0
93316   4 XXX 0 0 10854 0
93317   1 XXX 0 0 49074 0
93317 26 1 XXX 0 0 18017 0
93317 TC 1 XXX 0 0 31059 0
93317   2 XXX 0 0 43098 0
93317 26 2 XXX 0 0 17001 0
93317 TC 2 XXX 0 0 26098 0
93317   3 XXX 0 0 41947 0
93317 26 3 XXX 0 0 16543 0
93317 TC 3 XXX 0 0 25400 0
93317   4 XXX 0 0 41947 0
93317 26 4 XXX 0 0 16543 0
93317 TC 4 XXX 0 0 25400 0
93318     XXX 0 0 0 0
93320   1 ZZZ 0 0 21358 0
93320 26 1 ZZZ 0 0 6652 0
93320 TC 1 ZZZ 0 0 14707 0
93320   2 ZZZ 0 0 17964 0
93320 26 2 ZZZ 0 0 5827 0
93320 TC 2 ZZZ 0 0 12138 0
93320   3 ZZZ 0 0 17964 0
93320 26 3 ZZZ 0 0 5827 0
93320 TC 3 ZZZ 0 0 12138 0
93320   4 ZZZ 0 0 17964 0
93320 26 4 ZZZ 0 0 5827 0
93320 TC 4 ZZZ 0 0 12138 0
93321   1 ZZZ 0 0 16866 0
93321 26 1 ZZZ 0 0 6444 0
93321 TC 1 ZZZ 0 0 9457 0
93321   2 ZZZ 0 0 16357 0
93321 26 2 ZZZ 0 0 6515 0
93321 TC 2 ZZZ 0 0 9276 0
93321   3 ZZZ 0 0 14958 0
93321 26 3 ZZZ 0 0 7028 0
93321 TC 3 ZZZ 0 0 8491 0
93321   4 ZZZ 0 0 11437 0
93321 26 4 ZZZ 0 0 8612 0
93321 TC 4 ZZZ 0 0 8363 0
93325   1 ZZZ 0 0 26012 0
93325 26 1 ZZZ 0 0 922 0
93325 TC 1 ZZZ 0 0 25084 0
93325   2 ZZZ 0 0 21470 0
93325 26 2 ZZZ 0 0 815 0
93325 TC 2 ZZZ 0 0 20656 0
93325   3 ZZZ 0 0 21470 0
93325 26 3 ZZZ 0 0 815 0
93325 TC 3 ZZZ 0 0 20656 0
93325   4 ZZZ 0 0 21470 0
93325 26 4 ZZZ 0 0 815 0
93325 TC 4 ZZZ 0 0 20656 0
93350   1 XXX 0 0 85131 0
93350 26 1 XXX 0 0 44452 0
93350 TC 1 XXX 0 0 29117 0
93350   2 XXX 0 0 84703 0
93350 26 2 XXX 0 0 44259 0
93350 TC 2 XXX 0 0 56311 0
93350   3 XXX 0 0 82922 0
93350 26 3 XXX 0 0 43463 0
93350 TC 3 XXX 0 0 26205 0
93350   4 XXX 0 0 82584 0
93350 26 4 XXX 0 0 43296 0
93350 TC 4 XXX 0 0 25800 0
93351   1 XXX 0 0 42230 0
93351   2 XXX 0 0 36396 0
93351   3 XXX 0 0 36396 0
93351   4 XXX 0 0 36396 0
93352   1 XXX 0 0 5890 0
93352   2 XXX 0 0 5046 0
93352   3 XXX 0 0 5046 0
93352   4 XXX 0 0 5046 0
93355   1 XXX 6 0 29134 0
93355   2 XXX 6 0 27416 0
93355   3 XXX 6 0 27416 0
93355   4 XXX 6 0 27416 0
93451   1 0 2 0 112345 0
93451 26 1 0 2 0 22309 0
93451 TC 1 0 2 0 90038 0
93451   2 0 2 0 99634 0
93451 26 2 0 2 0 20107 0
93451 TC 2 0 2 0 79528 0
93451   3 0 2 0 99634 0
93451 26 3 0 2 0 20107 0
93451 TC 3 0 2 0 79528 0
93451   4 0 2 0 99634 0
93451 26 4 0 2 0 20107 0
93451 TC 4 0 2 0 79528 0
93452   1 0 2 0 125184 0
93452 26 1 0 2 0 39171 0
93452 TC 1 0 2 0 86012 0
93452   2 0 2 0 111226 0
93452 26 2 0 2 0 35257 0
93452 TC 2 0 2 0 75969 0
93452   3 0 2 0 111226 0
93452 26 3 0 2 0 35257 0
93452 TC 3 0 2 0 75969 0
93452   4 0 2 0 111226 0
93452 26 4 0 2 0 35257 0
93452 TC 4 0 2 0 75969 0
93453   1 0 2 0 163769 0
93453 26 1 0 2 0 51290 0
93453 TC 1 0 2 0 112478 0
93453   2 0 2 0 145546 0
93453 26 2 0 2 0 46203 0
93453 TC 2 0 2 0 99345 0
93453   3 0 2 0 145546 0
93453 26 3 0 2 0 46203 0
93453 TC 3 0 2 0 99345 0
93453   4 0 2 0 145546 0
93453 26 4 0 2 0 46203 0
93453 TC 4 0 2 0 99345 0
93454   1 0 2 0 129047 0
93454 26 1 0 2 0 39456 0
93454 TC 1 0 2 0 89590 0
93454   2 0 2 0 114661 0
93454 26 2 0 2 0 35530 0
93454 TC 2 0 2 0 79131 0
93454   3 0 2 0 114661 0
93454 26 3 0 2 0 35530 0
93454 TC 3 0 2 0 79131 0
93454   4 0 2 0 114661 0
93454 26 4 0 2 0 35530 0
93454 TC 4 0 2 0 79131 0
93455   1 0 2 0 150525 0
93455 26 1 0 2 0 45502 0
93455 TC 1 0 2 0 105025 0
93455   2 0 2 0 133755 0
93455 26 2 0 2 0 40999 0
93455 TC 2 0 2 0 92756 0
93455   3 0 2 0 133755 0
93455 26 3 0 2 0 40999 0
93455 TC 3 0 2 0 92756 0
93455   4 0 2 0 133755 0
93455 26 4 0 2 0 40999 0
93455 TC 4 0 2 0 92756 0
93456   1 0 2 0 161462 0
93456 26 1 0 2 0 50424 0
93456 TC 1 0 2 0 111037 0
93456   2 0 2 0 143527 0
93456 26 2 0 2 0 45457 0
93456 TC 2 0 2 0 98072 0
93456   3 0 2 0 143527 0
93456 26 3 0 2 0 45457 0
93456 TC 3 0 2 0 98072 0
93456   4 0 2 0 143527 0
93456 26 4 0 2 0 45457 0
93456 TC 4 0 2 0 98072 0
93457   1 0 2 0 182968 0
93457 26 1 0 2 0 56571 0
93457 TC 1 0 2 0 126396 0
93457   2 0 2 0 162625 0
93457 26 2 0 2 0 50981 0
93457 TC 2 0 2 0 111645 0
93457   3 0 2 0 162625 0
93457 26 3 0 2 0 50981 0
93457 TC 3 0 2 0 111645 0
93457   4 0 2 0 162625 0
93457 26 4 0 2 0 50981 0
93457 TC 4 0 2 0 111645 0
93458   1 0 2 0 155744 0
93458 26 1 0 2 0 48136 0
93458 TC 1 0 2 0 107608 0
93458   2 0 2 0 138391 0
93458 26 2 0 2 0 43352 0
93458 TC 2 0 2 0 95039 0
93458   3 0 2 0 138391 0
93458 26 3 0 2 0 43352 0
93458 TC 3 0 2 0 95039 0
93458   4 0 2 0 138391 0
93458 26 4 0 2 0 43352 0
93458 TC 4 0 2 0 95039 0
93459   1 0 2 0 171953 0
93459 26 1 0 2 0 54106 0
93459 TC 1 0 2 0 117848 0
93459   2 0 2 0 152862 0
93459 26 2 0 2 0 48772 0
93459 TC 2 0 2 0 104088 0
93459   3 0 2 0 152862 0
93459 26 3 0 2 0 48772 0
93459 TC 3 0 2 0 104088 0
93459   4 0 2 0 152862 0
93459 26 4 0 2 0 48772 0
93459 TC 4 0 2 0 104088 0
93460   1 0 2 0 184089 0
93460 26 1 0 2 0 60275 0
93460 TC 1 0 2 0 123811 0
93460   2 0 2 0 163696 0
93460 26 2 0 2 0 54335 0
93460 TC 2 0 2 0 109360 0
93460   3 0 2 0 163696 0
93460 26 3 0 2 0 54335 0
93460 TC 3 0 2 0 109360 0
93460   4 0 2 0 163696 0
93460 26 4 0 2 0 54335 0
93460 TC 4 0 2 0 109360 0
93461   1 0 2 0 210909 0
93461 26 1 0 2 0 66542 0
93461 TC 1 0 2 0 144365 0
93461   2 0 2 0 187464 0
93461 26 2 0 2 0 59958 0
93461 TC 2 0 2 0 127510 0
93461   3 0 2 0 187464 0
93461 26 3 0 2 0 59958 0
93461 TC 3 0 2 0 127510 0
93461   4 0 2 0 187464 0
93461 26 4 0 2 0 59958 0
93461 TC 4 0 2 0 127510 0
93462   1 ZZZ 0 0 30604 0
93462   2 ZZZ 0 0 27600 0
93462   3 ZZZ 0 0 27600 0
93462   4 ZZZ 0 0 27600 0
93463   1 ZZZ 0 0 16130 0
93463   2 ZZZ 0 0 14610 0
93463   3 ZZZ 0 0 14610 0
93463   4 ZZZ 0 0 14610 0
93464   1 ZZZ 0 0 37196 0
93464 26 1 ZZZ 0 0 14206 0
93464 TC 1 ZZZ 0 0 22987 0
93464   2 ZZZ 0 0 33176 0
93464 26 2 ZZZ 0 0 12874 0
93464 TC 2 ZZZ 0 0 20301 0
93464   3 ZZZ 0 0 33176 0
93464 26 3 ZZZ 0 0 12874 0
93464 TC 3 ZZZ 0 0 20301 0
93464   4 ZZZ 0 0 33176 0
93464 26 4 ZZZ 0 0 12874 0
93464 TC 4 ZZZ 0 0 20301 0
93503   1 0 0 0 51664 0
93503   2 0 0 0 53683 0
93503   3 0 0 0 48219 0
93503   4 0 0 0 49214 0
93505   1 0 2 0 80535 0
93505 26 1 0 2 0 68133 0
93505 TC 1 0 2 0 17118 0
93505   2 0 2 0 79425 0
93505 26 2 0 2 0 67660 0
93505 TC 2 0 2 0 16764 0
93505   3 0 2 0 74805 0
93505 26 3 0 2 0 63428 0
93505 TC 3 0 2 0 15307 0
93505   4 0 2 0 73875 0
93505 26 4 0 2 0 66192 0
93505 TC 4 0 2 0 15074 0
93530   1 0 2 0 207696 0
93530 26 1 0 2 0 63185 0
93530 TC 1 0 2 0 144509 0
93530   2 0 2 0 175764 0
93530 26 2 0 2 0 56247 0
93530 TC 2 0 2 0 119518 0
93530   3 0 2 0 175764 0
93530 26 3 0 2 0 56247 0
93530 TC 3 0 2 0 119518 0
93530   4 0 2 0 175764 0
93530 26 4 0 2 0 56247 0
93530 TC 4 0 2 0 119518 0
93531   1 0 2 0 521206 0
93531 26 1 0 2 0 108198 0
93531 TC 1 0 2 0 413005 0
93531   2 0 2 0 439331 0
93531 26 2 0 2 0 97786 0
93531 TC 2 0 2 0 341547 0
93531   3 0 2 0 439331 0
93531 26 3 0 2 0 97786 0
93531 TC 3 0 2 0 341547 0
93531   4 0 2 0 439331 0
93531 26 4 0 2 0 97786 0
93531 TC 4 0 2 0 341547 0
93532   1 0 2 0 536946 0
93532 26 1 0 2 0 134959 0
93532 TC 1 0 2 0 401987 0
93532   2 0 2 0 454017 0
93532 26 2 0 2 0 121587 0
93532 TC 2 0 2 0 332433 0
93532   3 0 2 0 454017 0
93532 26 3 0 2 0 121587 0
93532 TC 3 0 2 0 332433 0
93532   4 0 2 0 454017 0
93532 26 4 0 2 0 121587 0
93532 TC 4 0 2 0 332433 0
93533   1 0 2 0 476003 0
93533 26 1 0 2 0 74014 0
93533 TC 1 0 2 0 401989 0
93533   2 0 2 0 400263 0
93533 26 2 0 2 0 67832 0
93533 TC 2 0 2 0 332433 0
93533   3 0 2 0 400263 0
93533 26 3 0 2 0 67832 0
93533 TC 3 0 2 0 332433 0
93533   4 0 2 0 400263 0
93533 26 4 0 2 0 67832 0
93533 TC 4 0 2 0 332433 0
93561   1 0 0 0 20946 0
93561 26 1 0 0 0 16114 0
93561 TC 1 0 0 0 4833 0
93561   2 0 0 0 18418 0
93561 26 2 0 0 0 15906 0
93561 TC 2 0 0 0 4722 0
93561   3 0 0 0 16769 0
93561 26 3 0 0 0 14243 0
93561 TC 3 0 0 0 5670 0
93561   4 0 0 0 19066 0
93561 26 4 0 0 0 14872 0
93561 TC 4 0 0 0 4194 0
93562   1 0 0 0 10125 0
93562 26 1 0 0 0 10923 0
93562 TC 1 0 0 0 2828 0
93562   2 0 0 0 10600 0
93562 26 2 0 0 0 9175 0
93562 TC 2 0 0 0 2765 0
93562   3 0 0 0 9442 0
93562 26 3 0 0 0 10809 0
93562 TC 3 0 0 0 2492 0
93562   4 0 0 0 9070 0
93562 26 4 0 0 0 12192 0
93562 TC 4 0 0 0 2458 0
93563   1 ZZZ 0 0 8096 0
93563   2 ZZZ 0 0 7528 0
93563   3 ZZZ 0 0 7528 0
93563   4 ZZZ 0 0 7528 0
93564   1 ZZZ 0 0 8262 0
93564   2 ZZZ 0 0 7669 0
93564   3 ZZZ 0 0 7669 0
93564   4 ZZZ 0 0 7669 0
93565   1 ZZZ 0 0 6236 0
93565   2 ZZZ 0 0 5796 0
93565   3 ZZZ 0 0 5796 0
93565   4 ZZZ 0 0 5796 0
93566   1 ZZZ 0 0 24676 6236
93566   2 ZZZ 0 0 22092 5796
93566   3 ZZZ 0 0 22092 5796
93566   4 ZZZ 0 0 22092 5796
93567   1 ZZZ 0 0 20318 6997
93567   2 ZZZ 0 0 18293 6520
93567   3 ZZZ 0 0 18293 6520
93567   4 ZZZ 0 0 18293 6520
93568   1 ZZZ 0 0 22285 6380
93568   2 ZZZ 0 0 19990 5933
93568   3 ZZZ 0 0 19990 5933
93568   4 ZZZ 0 0 19990 5933
93571   1 ZZZ 0 0 55249 0
93571 26 1 ZZZ 0 0 18180 0
93571 TC 1 ZZZ 0 0 37072 0
93571   2 ZZZ 0 0 47875 0
93571 26 2 ZZZ 0 0 16779 0
93571 TC 2 ZZZ 0 0 31100 0
93571   3 ZZZ 0 0 47875 0
93571 26 3 ZZZ 0 0 16779 0
93571 TC 3 ZZZ 0 0 31100 0
93571   4 ZZZ 0 0 47875 0
93571 26 4 ZZZ 0 0 16779 0
93571 TC 4 ZZZ 0 0 31100 0
93572   1 ZZZ 0 0 50765 0
93572 26 1 ZZZ 0 0 14606 0
93572 TC 1 ZZZ 0 0 36163 0
93572   2 ZZZ 0 0 44086 0
93572 26 2 ZZZ 0 0 13470 0
93572 TC 2 ZZZ 0 0 30620 0
93572   3 ZZZ 0 0 44086 0
93572 26 3 ZZZ 0 0 13470 0
93572 TC 3 ZZZ 0 0 30620 0
93572   4 ZZZ 0 0 44086 0
93572 26 4 ZZZ 0 0 13470 0
93572 TC 4 ZZZ 0 0 30620 0
93580   1 ZZZ 0 0 177012 0
93580   2 ZZZ 0 0 160997 0
93580   3 ZZZ 0 0 160997 0
93580   4 ZZZ 0 0 160997 0
93581   1 0 2 0 235770 0
93581   2 0 2 0 215804 0
93581   3 0 2 0 215804 0
93581   4 0 2 0 215804 0
93582   1 0 2 0 94229 0
93582   2 0 2 0 85785 0
93582   3 0 2 0 85785 0
93582   4 0 2 0 85785 0
93583   1 0 2 0 104878 0
93583   2 0 2 0 95488 0
93583   3 0 2 0 95488 0
93583   4 0 2 0 95488 0
93590   1 0 2 0 156421 0
93590   2 0 2 0 142930 0
93590   3 0 2 0 142930 0
93590   4 0 2 0 142930 0
93591   1 0 2 0 129835 0
93591   2 0 2 0 118617 0
93591   3 0 2 0 118617 0
93591   4 0 2 0 118617 0
93592   1 ZZZ 0 0 57211 0
93592   2 ZZZ 0 0 52296 0
93592   3 ZZZ 0 0 52296 0
93592   4 ZZZ 0 0 52296 0
93600   1 0 0 0 59524 0
93600 26 1 0 0 0 54204 0
93600 TC 1 0 0 0 16399 0
93600   2 0 0 0 58606 0
93600 26 2 0 0 0 52667 0
93600 TC 2 0 0 0 16092 0
93600   3 0 0 0 54767 0
93600 26 3 0 0 0 51486 0
93600 TC 3 0 0 0 14786 0
93600   4 0 0 0 54016 0
93600 26 4 0 0 0 51435 0
93600 TC 4 0 0 0 14555 0
93602   1 0 0 0 41792 0
93602 26 1 0 0 0 32452 0
93602 TC 1 0 0 0 9339 0
93602   2 0 0 0 41216 0
93602 26 2 0 0 0 32785 0
93602 TC 2 0 0 0 9158 0
93602   3 0 0 0 38808 0
93602 26 3 0 0 0 32758 0
93602 TC 3 0 0 0 8418 0
93602   4 0 0 0 38313 0
93602 26 4 0 0 0 32597 0
93602 TC 4 0 0 0 8286 0
93603   1 0 0 0 50103 0
93603 26 1 0 0 0 52621 0
93603 TC 1 0 0 0 14123 0
93603   2 0 0 0 57975 0
93603 26 2 0 0 0 52161 0
93603 TC 2 0 0 0 13858 0
93603   3 0 0 0 46343 0
93603 26 3 0 0 0 55626 0
93603 TC 3 0 0 0 12739 0
93603   4 0 0 0 45722 0
93603 26 4 0 0 0 53663 0
93603 TC 4 0 0 0 12530 0
93609   1 0 0 0 136255 0
93609 26 1 0 0 0 147249 0
93609 TC 1 0 0 0 22794 0
93609   2 0 0 0 134722 0
93609 26 2 0 0 0 112355 0
93609 TC 2 0 0 0 22369 0
93609   3 0 0 0 128380 0
93609 26 3 0 0 0 144881 0
93609 TC 3 0 0 0 20570 0
93609   4 0 0 0 126866 0
93609 26 4 0 0 0 144385 0
93609 TC 4 0 0 0 20245 0
93610   1 0 0 0 66038 0
93610 26 1 0 0 0 61259 0
93610 TC 1 0 0 0 11378 0
93610   2 0 0 0 65734 0
93610 26 2 0 0 0 61041 0
93610 TC 2 0 0 0 11160 0
93610   3 0 0 0 51799 0
93610 26 3 0 0 0 59638 0
93610 TC 3 0 0 0 10250 0
93610   4 0 0 0 64160 0
93610 26 4 0 0 0 59926 0
93610 TC 4 0 0 0 10085 0
93612   1 0 0 0 67091 0
93612 26 1 0 0 0 61361 0
93612 TC 1 0 0 0 13656 0
93612   2 0 0 0 66343 0
93612 26 2 0 0 0 60720 0
93612 TC 2 0 0 0 13396 0
93612   3 0 0 0 64011 0
93612 26 3 0 0 0 58855 0
93612 TC 3 0 0 0 12298 0
93612   4 0 0 0 53367 0
93612 26 4 0 0 0 60020 0
93612 TC 4 0 0 0 12109 0
93613 26 1 XXX 0 0 69333 0
93613 26 2 XXX 0 0 62841 0
93613 26 3 XXX 0 0 62841 0
93613 26 4 XXX 0 0 62841 0
93615   1 0 0 0 10922 0
93615 26 1 0 0 0 10817 0
93615 TC 1 0 0 0 2586 0
93615   2 0 0 0 10627 0
93615 26 2 0 0 0 10710 0
93615 TC 2 0 0 0 2542 0
93615   3 0 0 0 12648 0
93615 26 3 0 0 0 10308 0
93615 TC 3 0 0 0 2343 0
93615   4 0 0 0 12497 0
93615 26 4 0 0 0 10195 0
93615 TC 4 0 0 0 2307 0
93616   1 0 0 0 26175 0
93616 26 1 0 0 0 23592 0
93616 TC 1 0 0 0 2586 0
93616   2 0 0 0 25854 0
93616 26 2 0 0 0 23311 0
93616 TC 2 0 0 0 2542 0
93616   3 0 0 0 24498 0
93616 26 3 0 0 0 22155 0
93616 TC 3 0 0 0 2343 0
93616   4 0 0 0 24184 0
93616 26 4 0 0 0 21880 0
93616 TC 4 0 0 0 2307 0
93618   1 0 0 0 183226 0
93618 26 1 0 0 0 169271 0
93618 TC 1 0 0 0 33274 0
93618   2 0 0 0 182468 0
93618 26 2 0 0 0 168776 0
93618 TC 2 0 0 0 32646 0
93618   3 0 0 0 107641 0
93618 26 3 0 0 0 166723 0
93618 TC 3 0 0 0 30006 0
93618   4 0 0 0 178679 0
93618 26 4 0 0 0 166289 0
93618 TC 4 0 0 0 29540 0
93619   1 0 0 0 217956 0
93619 26 1 0 0 0 202530 0
93619 TC 1 0 0 0 64698 0
93619   2 0 0 0 214558 0
93619 26 2 0 0 0 201564 0
93619 TC 2 0 0 0 63477 0
93619   3 0 0 0 200308 0
93619 26 3 0 0 0 197528 0
93619 TC 3 0 0 0 58339 0
93619   4 0 0 0 197535 0
93619 26 4 0 0 0 196696 0
93619 TC 4 0 0 0 57426 0