2017 Workers' Compensation Part B Fee Schedules

Please click on the appropriate CPT/HCPC code ranges

PLEASE NOTE THAT THERE IS AN IMPLIED DECIMAL OF 2 (IN DOLLARS) IN THE PREVAILING CHARGE, FEE SCHEDULE AND SITE OF SERVICE AMOUNT COLUMNS ON THE FOLLOWING PAGES

"Effective Jan. 1, 2017, CMS (Medicare) has deleted the PT and OT evaluation and re-evaluation HCPCS codes as follows:

97001 PT Evaluation
97002 PT Re-evaluation
97003 OT Evaluation
97004 OT Re-evaluation

CMS has added the following new HCPCS codes for these services:

97161 PT Eval Low Complex 20 min
97162 PT Eval Mod Complex 30 min
97163 PT Eval High Complex 45 min

97165 OT Eval Low Complex 30 min
97166 OT Eval Mod Complex 45 min
97167 OT Eval High Complex 60 min

97164 PT Re-eval Est Plan Care
97168 OT Re-eval Est Plan Care

The Pennsylvania Workers’ Compensation Part B Fee Schedule reimbursement for all new HCPCS codes have been calculated in compliance with 34 Pa. Code Section 127.153(c), which states on or after Jan. 1, 1995, payment rates under the act for new HCPCS codes will be based on the rates allowed in the Medicare fee schedule on the effective date of the new codes, and 34 Pa. Code Section 127.104, which requires payments to outpatient providers for services rendered under the act be calculated by multiplying the Medicare Part B reimbursement for the services by 113%. Furthermore, CMS has determined that the 2017 Medicare fee schedule reimbursement amounts will remain the same for all three levels of the physical and occupational evaluation services regardless of the time indicator or acuity of services rendered. The re-evaluation codes are not impacted by the newly-introduced tier complexity stratification."

100-842 844-1820 1829-11643 11644-15278
15570-19101 19105-21014 21015-21435 21436-22849
22850-24073 24075-25109 25110-25920 25922-26565
26567-27178 27179-27468 27470-27750 27752-28264
28270-29358 29365-30620 30630-31635 31636-33211
33212-33676 33677-35011 35013-35601 35606-36578
36580-38564 38570-42227 42235-43261 43262-44145
44146-45331 45332-47130 47135-49423 49424-50551
50553-51784 51785-53510 53515-55520 55530-57511
57513-59100 59120-61520 61521-62161 62162-63286
63287-64766 64771-66150 66155-67880 67882-69643
69644-70450 70460-71111 71120-72157 72158-73206
73218-74022 74150-74410 74415-75716 75726-75902
75952-76519 76529-76941 76942-77285 77290-77778
77789-78261 78262-78605 78606-80436 80438-84630
84681-87400 87420-88333 88334-90847 90849-92134
92136-92626 92627-93312 93313-93619 93620-94005
94010-95806 95807-95933 95937-97016 97018-99347
99348-A4708 A4709-D5225 D5226-E0660 E0665-E2310
E2311-L1660 L1680-L5999 L6000-V5364