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Health Care Services Review
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Fee Schedule
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Fee Schedule A4709-D5225
Begin Main Content Area
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2024 Workers' Compensation Part B Fee Schedule
A4709-D5225
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
A4709
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9
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A4714
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9
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A4719
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9
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A4720
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A4737
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A4740
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33.87
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A4760
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1,272.81
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A4765
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A4766
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6.20
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4.43
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4.59
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3.81
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4.38
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9
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8.47
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9
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17.38
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A5061
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9.00
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A5062
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6.22
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5.97
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12.76
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9.94
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8.59
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8.81
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31.70
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5.17
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78.37
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108.69
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A5112
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76.14
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A5113
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12.55
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A5114
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23.81
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0.50
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0.45
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17.46
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29.18
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3.52
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42.30
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26.40
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61.72
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13.92
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16.37
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77.38
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25.57
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27.10
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2.46
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6.82
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5.63
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17.22
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44.35
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71.86
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A6237
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9
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20.81
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A6238
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9
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60.05
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A6239
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#
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A6240
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9
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32.25
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9
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6.78
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9
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15.98
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A6243
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9
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32.48
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A6244
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9
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103.53
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A6245
XXX
9
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19.13
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A6246
XXX
9
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26.15
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A6247
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9
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62.66
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A6248
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9
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42.84
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A6250
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9
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#
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A6251
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9
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5.25
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9
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8.57
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16.75
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3.21
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8.02
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A6257
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4.04
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11.36
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28.82
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A6260
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5.04
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0.33
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1.10
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4.09
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0.88
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0.37
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0.59
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1.24
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0.69
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0.89
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1.46
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2.55
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3.81
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12.80
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1.32
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1.70
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3.02
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2.79
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2.31
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59.53
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482.74
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98.06
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19.48
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69.73
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8.09
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A7003
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6.38
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3.56
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64.92
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19.02
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9.26
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88.54
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54.44
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8.30
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1.73
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9.44
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3.83
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15.23
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234.85
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63.80
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332.66
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91.86
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37.54
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418.54
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154.77
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89.95
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63.03
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260.96
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78.58
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40.39
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86.95
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10.14
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34.03
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212.37
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103.10
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102.16
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98.05
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168.05
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7.29
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294.68
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221.02
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294.68
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221.02
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9
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9
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9
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9
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9
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9
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9
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9
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9
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9
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9
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9
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9
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9
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X
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