2018 Workers' Compensation Part B Fee Schedule

93620-94005

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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)
93620   1 0 0 0 285307 0
93620 26 1 0 0 0 221392 0
93620 TC 1 0 0 0 74893 0
93620   2 0 0 0 281166 0
93620 26 2 0 0 0 220238 0
93620 TC 2 0 0 0 73497 0
93620   3 0 0 0 263837 0
93620 26 3 0 0 0 215434 0
93620 TC 3 0 0 0 67625 0
93620   4 0 0 0 260268 0
93620 26 4 0 0 0 214385 0
93620 TC 4 0 0 0 66562 0
93621 26 1 0 0 0 231984 0
93621 26 2 0 0 0 228906 0
93621 26 3 0 0 0 216072 0
93621 26 4 0 0 0 213323 0
93622 26 1 0 0 0 230490 0
93622 26 2 0 0 0 227461 0
93622 26 3 0 0 0 214844 0
93622 26 4 0 0 0 212112 0
93623 26 1 ZZZ 0 0 46954 0
93623 26 2 ZZZ 0 0 46371 0
93623 26 3 ZZZ 0 0 43916 0
93623 26 4 ZZZ 0 0 43368 0
93624   1 0 0 0 80862 0
93624 26 1 0 0 0 69118 0
93624 TC 1 0 0 0 16638 0
93624   2 0 0 0 79839 0
93624 26 2 0 0 0 68826 0
93624 TC 2 0 0 0 16323 0
93624   3 0 0 0 75573 0
93624 26 3 0 0 0 60571 0
93624 TC 3 0 0 0 15006 0
93624   4 0 0 0 74633 0
93624 26 4 0 0 0 67311 0
93624 TC 4 0 0 0 14773 0
93631   1 0 0 0 168818 0
93631 26 1 0 0 0 222574 0
93631 TC 1 0 0 0 54948 0
93631   2 0 0 0 166077 0
93631 26 2 0 0 0 112340 0
93631 TC 2 0 0 0 53738 0
93631   3 0 0 0 154698 0
93631 26 3 0 0 0 106018 0
93631 TC 3 0 0 0 48686 0
93631   4 0 0 0 152715 0
93631 26 4 0 0 0 219190 0
93631 TC 4 0 0 0 47950 0
93640   1 0 0 0 112274 0
93640 26 1 0 0 0 70628 0
93640 TC 1 0 0 0 60061 0
93640   2 0 0 0 147977 0
93640 26 2 0 0 0 69946 0
93640 TC 2 0 0 0 58944 0
93640   3 0 0 0 137384 0
93640 26 3 0 0 0 83152 0
93640 TC 3 0 0 0 54235 0
93640   4 0 0 0 135417 0
93640 26 4 0 0 0 66563 0
93640 TC 4 0 0 0 53380 0
93641   1 0 0 0 118654 0
93641 26 1 0 0 0 77013 0
93641 TC 1 0 0 0 60061 0
93641   2 0 0 0 167178 0
93641 26 2 0 0 0 76284 0
93641 TC 2 0 0 0 58944 0
93641   3 0 0 0 156007 0
93641 26 3 0 0 0 101774 0
93641 TC 3 0 0 0 54235 0
93641   4 0 0 0 153838 0
93641 26 4 0 0 0 72644 0
93641 TC 4 0 0 0 53380 0
93642   1 0 0 0 116719 0
93642 26 1 0 0 0 75076 0
93642 TC 1 0 0 0 60061 0
93642   2 0 0 0 161348 0
93642 26 2 0 0 0 74362 0
93642 TC 2 0 0 0 58944 0
93642   3 0 0 0 150355 0
93642 26 3 0 0 0 96123 0
93642 TC 3 0 0 0 54235 0
93642   4 0 0 0 148244 0
93642 26 4 0 0 0 70797 0
93642 TC 4 0 0 0 53380 0
93644   1 0 2 0 41151 0
93644 26 1 0 2 0 27144 0
93644 TC 1 0 2 0 14006 0
93644   2 0 2 0 36595 0
93644 26 2 0 2 0 24636 0
93644 TC 2 0 2 0 11958 0
93644   3 0 2 0 36595 0
93644 26 3 0 2 0 24636 0
93644 TC 3 0 2 0 11958 0
93644   4 0 2 0 36595 0
93644 26 4 0 2 0 24636 0
93644 TC 4 0 2 0 11958 0
93650   1 0 0 0 226130 0
93650   2 0 0 0 222839 0
93650   3 0 0 0 209139 0
93650   4 0 0 0 206404 0
93653   1 0 2 0 115004 0
93653   2 0 2 0 103362 0
93653   3 0 2 0 103362 0
93653   4 0 2 0 103362 0
93654   1 0 2 0 153476 0
93654   2 0 2 0 137933 0
93654   3 0 2 0 137933 0
93654   4 0 2 0 137933 0
93655   1 ZZZ 0 0 57490 0
93655   2 ZZZ 0 0 51676 0
93655   3 ZZZ 0 0 51676 0
93655   4 ZZZ 0 0 51676 0
93656   1 0 2 0 153517 0
93656   2 0 2 0 137979 0
93656   3 0 2 0 137979 0
93656   4 0 2 0 137979 0
93657   1 ZZZ 0 0 57559 0
93657   2 ZZZ 0 0 51725 0
93657   3 ZZZ 0 0 51725 0
93657   4 ZZZ 0 0 51725 0
93660     0 0 0 0 0
93662   1 ZZZ 0 0 60793 0
93662 26 1 ZZZ 0 0 29869 0
93662 TC 1 ZZZ 0 0 30923 0
93662   2 ZZZ 0 0 52937 0
93662 26 2 ZZZ 0 0 27408 0
93662 TC 2 ZZZ 0 0 25530 0
93662   3 ZZZ 0 0 52937 0
93662 26 3 ZZZ 0 0 27408 0
93662 TC 3 ZZZ 0 0 25530 0
93662   4 ZZZ 0 0 52937 0
93662 26 4 ZZZ 0 0 27408 0
93662 TC 4 ZZZ 0 0 25530 0
93668     XXX 9 0 0 0
93701   1 XXX 0 0 6680 0
93701 26 1 XXX 0 0 1674 0
93701 TC 1 XXX 0 0 5005 0
93701   2 XXX 0 0 5754 0
93701 26 2 XXX 0 0 1527 0
93701 TC 2 XXX 0 0 4230 0
93701   3 XXX 0 0 5754 0
93701 26 3 XXX 0 0 1527 0
93701 TC 3 XXX 0 0 4230 0
93701   4 XXX 0 0 5754 0
93701 26 4 XXX 0 0 1527 0
93701 TC 4 XXX 0 0 4230 0
93702   1 XXX 6 0 15223 0
93702   2 XXX 6 0 13006 0
93702   3 XXX 6 0 13006 0
93702   4 XXX 6 0 13006 0
93724   1 0 0 0 97379 0
93724 26 1 0 0 0 64109 0
93724 TC 1 0 0 0 33274 0
93724   2 0 0 0 96043 0
93724 26 2 0 0 0 63401 0
93724 TC 2 0 0 0 32646 0
93724   3 0 0 0 90464 0
93724 26 3 0 0 0 60451 0
93724 TC 3 0 0 0 30006 0
93724   4 0 0 0 89290 0
93724 26 4 0 0 0 59752 0
93724 TC 4 0 0 0 29540 0
93740   1 XXX 9 0 0 0
93740 26 1 XXX 9 0 3959 0
93740 TC 1 XXX 9 0 3585 0
93740   2 XXX 9 0 0 0
93740 26 2 XXX 9 0 3895 0
93740 TC 2 XXX 9 0 1266 0
93740   3 XXX 9 0 0 0
93740 26 3 XXX 9 0 3632 0
93740 TC 3 XXX 9 0 1173 0
93740   4 XXX 9 0 0 0
93740 26 4 XXX 9 0 3582 0
93740 TC 4 XXX 9 0 1154 0
93745     XXX 0 0 0 0
93750   1 XXX 0 0 7542 6566
93750   2 XXX 0 0 6924 6100
93750   3 XXX 0 0 6924 6100
93750   4 XXX 0 0 6924 6100
93770   1 XXX 9 0 3057 0
93770 26 1 XXX 9 0 2821 0
93770 TC 1 XXX 9 0 233 0
93770   2 XXX 9 0 4492 0
93770 26 2 XXX 9 0 7099 0
93770 TC 2 XXX 9 0 232 0
93770   3 XXX 9 0 4156 0
93770 26 3 XXX 9 0 7029 0
93770 TC 3 XXX 9 0 218 0
93770   4 XXX 9 0 2791 0
93770 26 4 XXX 9 0 2579 0
93770 TC 4 XXX 9 0 217 0
93784     XXX 0 0 0 0
93786     XXX 0 0 0 0
93788     XXX 0 0 0 0
93790     XXX 0 0 0 0
93792   1 XXX 0 0 6709 0
93792   2 XXX 0 0 5833 0
93792   3 XXX 0 0 5833 0
93792   4 XXX 0 0 5833 0
93793   1 XXX 0 0 1460 0
93793   2 XXX 0 0 1338 0
93793   3 XXX 0 0 1338 0
93793   4 XXX 0 0 1338 0
93797   1 0 0 0 4639 3273
93797   2 0 0 0 4582 3241
93797   3 0 0 0 3994 2819
93797   4 0 0 0 3660 2582
93798   1 0 0 0 6527 4609
93798   2 0 0 0 6439 4539
93798   3 0 0 0 6104 4305
93798   4 0 0 0 5857 4135
93799     XXX 0 0 0 0
93880   1 XXX 0 0 51097 0
93880 26 1 XXX 0 0 22246 0
93880 TC 1 XXX 0 0 30946 0
93880   2 XXX 0 0 50891 0
93880 26 2 XXX 0 0 21821 0
93880 TC 2 XXX 0 0 30278 0
93880   3 XXX 0 0 49716 0
93880 26 3 XXX 0 0 22067 0
93880 TC 3 XXX 0 0 27491 0
93880   4 XXX 0 0 48580 0
93880 26 4 XXX 0 0 20646 0
93880 TC 4 XXX 0 0 27074 0
93882   1 XXX 0 0 49209 0
93882 26 1 XXX 0 0 20361 0
93882 TC 1 XXX 0 0 30946 0
93882   2 XXX 0 0 49026 0
93882 26 2 XXX 0 0 19956 0
93882 TC 2 XXX 0 0 30278 0
93882   3 XXX 0 0 47949 0
93882 26 3 XXX 0 0 20300 0
93882 TC 3 XXX 0 0 27491 0
93882   4 XXX 0 0 46834 0
93882 26 4 XXX 0 0 18903 0
93882 TC 4 XXX 0 0 27074 0
93886   1 XXX 0 0 44512 0
93886 26 1 XXX 0 0 13567 0
93886 TC 1 XXX 0 0 30946 0
93886   2 XXX 0 0 43667 0
93886 26 2 XXX 0 0 13387 0
93886 TC 2 XXX 0 0 30278 0
93886   3 XXX 0 0 40121 0
93886 26 3 XXX 0 0 12634 0
93886 TC 3 XXX 0 0 27491 0
93886   4 XXX 0 0 39560 0
93886 26 4 XXX 0 0 12486 0
93886 TC 4 XXX 0 0 27074 0
93888   1 XXX 0 0 40039 0
93888 26 1 XXX 0 0 9095 0
93888 TC 1 XXX 0 0 30946 0
93888   2 XXX 0 0 39266 0
93888 26 2 XXX 0 0 8986 0
93888 TC 2 XXX 0 0 30278 0
93888   3 XXX 0 0 36047 0
93888 26 3 XXX 0 0 8557 0
93888 TC 3 XXX 0 0 27491 0
93888   4 XXX 0 0 35534 0
93888 26 4 XXX 0 0 8462 0
93888 TC 4 XXX 0 0 27074 0
93890   1 XXX 0 0 43063 0
93890 26 1 XXX 0 0 9454 0
93890 TC 1 XXX 0 0 33607 0
93890   2 XXX 0 0 35872 0
93890 26 2 XXX 0 0 8673 0
93890 TC 2 XXX 0 0 27198 0
93890   3 XXX 0 0 35872 0
93890 26 3 XXX 0 0 8673 0
93890 TC 3 XXX 0 0 27198 0
93890   4 XXX 0 0 35872 0
93890 26 4 XXX 0 0 8673 0
93890 TC 4 XXX 0 0 27198 0
93892   1 XXX 0 0 45750 0
93892 26 1 XXX 0 0 10799 0
93892 TC 1 XXX 0 0 34954 0
93892   2 XXX 0 0 38251 0
93892 26 2 XXX 0 0 9930 0
93892 TC 2 XXX 0 0 28321 0
93892   3 XXX 0 0 38251 0
93892 26 3 XXX 0 0 9930 0
93892 TC 3 XXX 0 0 28321 0
93892   4 XXX 0 0 38251 0
93892 26 4 XXX 0 0 9930 0
93892 TC 4 XXX 0 0 28321 0
93893   1 XXX 0 0 44873 0
93893 26 1 XXX 0 0 10799 0
93893 TC 1 XXX 0 0 34078 0
93893   2 XXX 0 0 37520 0
93893 26 2 XXX 0 0 9930 0
93893 TC 2 XXX 0 0 27591 0
93893   3 XXX 0 0 37520 0
93893 26 3 XXX 0 0 9930 0
93893 TC 3 XXX 0 0 27591 0
93893   4 XXX 0 0 37520 0
93893 26 4 XXX 0 0 9930 0
93893 TC 4 XXX 0 0 27591 0
93895     XXX 6 0 0 0
93922   1 XXX 0 0 28145 0
93922 26 1 XXX 0 0 15166 0
93922 TC 1 XXX 0 0 18590 0
93922   2 XXX 0 0 29496 0
93922 26 2 XXX 0 0 13651 0
93922 TC 2 XXX 0 0 18093 0
93922   3 XXX 0 0 30182 0
93922 26 3 XXX 0 0 15019 0
93922 TC 3 XXX 0 0 9166 0
93922   4 XXX 0 0 25835 0
93922 26 4 XXX 0 0 14151 0
93922 TC 4 XXX 0 0 9029 0
93923   1 XXX 0 0 32597 0
93923 26 1 XXX 0 0 16589 0
93923 TC 1 XXX 0 0 21623 0
93923   2 XXX 0 0 33862 0
93923 26 2 XXX 0 0 15052 0
93923 TC 2 XXX 0 0 21057 0
93923   3 XXX 0 0 34165 0
93923 26 3 XXX 0 0 16321 0
93923 TC 3 XXX 0 0 17309 0
93923   4 XXX 0 0 29764 0
93923 26 4 XXX 0 0 15432 0
93923 TC 4 XXX 0 0 17048 0
93924   1 XXX 0 0 32650 0
93924 26 1 XXX 0 0 16163 0
93924 TC 1 XXX 0 0 21406 0
93924   2 XXX 0 0 34505 0
93924 26 2 XXX 0 0 15734 0
93924 TC 2 XXX 0 0 20927 0
93924   3 XXX 0 0 34611 0
93924 26 3 XXX 0 0 16386 0
93924 TC 3 XXX 0 0 18922 0
93924   4 XXX 0 0 31045 0
93924 26 4 XXX 0 0 14616 0
93924 TC 4 XXX 0 0 18635 0
93925   1 XXX 0 0 39923 0
93925 26 1 XXX 0 0 8980 0
93925 TC 1 XXX 0 0 30946 0
93925   2 XXX 0 0 39139 0
93925 26 2 XXX 0 0 8862 0
93925 TC 2 XXX 0 0 30278 0
93925   3 XXX 0 0 35867 0
93925 26 3 XXX 0 0 8373 0
93925 TC 3 XXX 0 0 27491 0
93925   4 XXX 0 0 35347 0
93925 26 4 XXX 0 0 8271 0
93925 TC 4 XXX 0 0 27074 0
93926   1 XXX 0 0 35455 0
93926 26 1 XXX 0 0 4508 0
93926 TC 1 XXX 0 0 30946 0
93926   2 XXX 0 0 34721 0
93926 26 2 XXX 0 0 4448 0
93926 TC 2 XXX 0 0 30278 0
93926   3 XXX 0 0 31675 0
93926 26 3 XXX 0 0 4189 0
93926 TC 3 XXX 0 0 27491 0
93926   4 XXX 0 0 31209 0
93926 26 4 XXX 0 0 4136 0
93926 TC 4 XXX 0 0 27074 0
93930   1 XXX 0 0 38396 0
93930 26 1 XXX 0 0 7453 0
93930 TC 1 XXX 0 0 30946 0
93930   2 XXX 0 0 37630 0
93930 26 2 XXX 0 0 7351 0
93930 TC 2 XXX 0 0 30278 0
93930   3 XXX 0 0 34445 0
93930 26 3 XXX 0 0 6957 0
93930 TC 3 XXX 0 0 27491 0
93930   4 XXX 0 0 33943 0
93930 26 4 XXX 0 0 6878 0
93930 TC 4 XXX 0 0 27074 0
93931   1 XXX 0 0 34634 0
93931 26 1 XXX 0 0 3684 0
93931 TC 1 XXX 0 0 30946 0
93931   2 XXX 0 0 33915 0
93931 26 2 XXX 0 0 3639 0
93931 TC 2 XXX 0 0 30278 0
93931   3 XXX 0 0 30925 0
93931 26 3 XXX 0 0 3439 0
93931 TC 3 XXX 0 0 27491 0
93931   4 XXX 0 0 30467 0
93931 26 4 XXX 0 0 3397 0
93931 TC 4 XXX 0 0 27074 0
93970   1 XXX 0 0 41574 0
93970 26 1 XXX 0 0 10629 0
93970 TC 1 XXX 0 0 30946 0
93970   2 XXX 0 0 40757 0
93970 26 2 XXX 0 0 10477 0
93970 TC 2 XXX 0 0 30278 0
93970   3 XXX 0 0 37356 0
93970 26 3 XXX 0 0 9869 0
93970 TC 3 XXX 0 0 27491 0
93970   4 XXX 0 0 36824 0
93970 26 4 XXX 0 0 9751 0
93970 TC 4 XXX 0 0 27074 0
93971   1 XXX 0 0 36235 0
93971 26 1 XXX 0 0 5290 0
93971 TC 1 XXX 0 0 30946 0
93971   2 XXX 0 0 35498 0
93971 26 2 XXX 0 0 5225 0
93971 TC 2 XXX 0 0 30278 0
93971   3 XXX 0 0 32423 0
93971 26 3 XXX 0 0 4937 0
93971 TC 3 XXX 0 0 27491 0
93971   4 XXX 0 0 31951 0
93971 26 4 XXX 0 0 4876 0
93971 TC 4 XXX 0 0 27074 0
93975   1 XXX 0 0 52854 0
93975 26 1 XXX 0 0 21913 0
93975 TC 1 XXX 0 0 30946 0
93975   2 XXX 0 0 51941 0
93975 26 2 XXX 0 0 21666 0
93975 TC 2 XXX 0 0 30278 0
93975   3 XXX 0 0 48153 0
93975 26 3 XXX 0 0 20665 0
93975 TC 3 XXX 0 0 27491 0
93975   4 XXX 0 0 47506 0
93975 26 4 XXX 0 0 20436 0
93975 TC 4 XXX 0 0 27074 0
93976   1 XXX 0 0 41921 0
93976 26 1 XXX 0 0 10974 0
93976 TC 1 XXX 0 0 30946 0
93976   2 XXX 0 0 41131 0
93976 26 2 XXX 0 0 10852 0
93976 TC 2 XXX 0 0 30278 0
93976   3 XXX 0 0 37860 0
93976 26 3 XXX 0 0 10372 0
93976 TC 3 XXX 0 0 27491 0
93976   4 XXX 0 0 37332 0
93976 26 4 XXX 0 0 10257 0
93976 TC 4 XXX 0 0 27074 0
93978   1 XXX 0 0 40983 0
93978 26 1 XXX 0 0 10041 0
93978 TC 1 XXX 0 0 30946 0
93978   2 XXX 0 0 40185 0
93978 26 2 XXX 0 0 9903 0
93978 TC 2 XXX 0 0 30278 0
93978   3 XXX 0 0 36836 0
93978 26 3 XXX 0 0 9346 0
93978 TC 3 XXX 0 0 27491 0
93978   4 XXX 0 0 36306 0
93978 26 4 XXX 0 0 9237 0
93978 TC 4 XXX 0 0 27074 0
93979   1 XXX 0 0 36082 0
93979 26 1 XXX 0 0 5137 0
93979 TC 1 XXX 0 0 30946 0
93979   2 XXX 0 0 35347 0
93979 26 2 XXX 0 0 5066 0
93979 TC 2 XXX 0 0 30278 0
93979   3 XXX 0 0 32273 0
93979 26 3 XXX 0 0 4786 0
93979 TC 3 XXX 0 0 27491 0
93979   4 XXX 0 0 31802 0
93979 26 4 XXX 0 0 4726 0
93979 TC 4 XXX 0 0 27074 0
93980   1 XXX 0 0 52696 0
93980 26 1 XXX 0 0 21745 0
93980 TC 1 XXX 0 0 30946 0
93980   2 XXX 0 0 51798 0
93980 26 2 XXX 0 0 21517 0
93980 TC 2 XXX 0 0 30278 0
93980   3 XXX 0 0 48059 0
93980 26 3 XXX 0 0 20575 0
93980 TC 3 XXX 0 0 27491 0
93980   4 XXX 0 0 47417 0
93980 26 4 XXX 0 0 20344 0
93980 TC 4 XXX 0 0 27074 0
93981   1 XXX 0 0 37172 0
93981 26 1 XXX 0 0 8580 0
93981 TC 1 XXX 0 0 28595 0
93981   2 XXX 0 0 36455 0
93981 26 2 XXX 0 0 8488 0
93981 TC 2 XXX 0 0 27972 0
93981   3 XXX 0 0 33450 0
93981 26 3 XXX 0 0 8088 0
93981 TC 3 XXX 0 0 25365 0
93981   4 XXX 0 0 32973 0
93981 26 4 XXX 0 0 7993 0
93981 TC 4 XXX 0 0 24981 0
93990   1 XXX 0 0 34634 0
93990 26 1 XXX 0 0 3684 0
93990 TC 1 XXX 0 0 30946 0
93990   2 XXX 0 0 33915 0
93990 26 2 XXX 0 0 3639 0
93990 TC 2 XXX 0 0 30278 0
93990   3 XXX 0 0 30925 0
93990 26 3 XXX 0 0 3439 0
93990 TC 3 XXX 0 0 27491 0
93990   4 XXX 0 0 30467 0
93990 26 4 XXX 0 0 3397 0
93990 TC 4 XXX 0 0 27074 0
93998     XXX 0 0 0 0
94002   1 XXX 0 0 12392 0
94002   2 XXX 0 0 11525 0
94002   3 XXX 0 0 11525 0
94002   4 XXX 0 0 11525 0
94003   1 XXX 0 0 9072 0
94003   2 XXX 0 0 8375 0
94003   3 XXX 0 0 8375 0
94003   4 XXX 0 0 8375 0
94004   1 XXX 0 0 6602 0
94004   2 XXX 0 0 6106 0
94004   3 XXX 0 0 6106 0
94004   4 XXX 0 0 6106 0
94005     XXX 9 0 0 0