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2024 Workers' Compensation Fee Schedule

Table A: Prospective Payment System

NPI or Provider # Provider # Indirect Medical Education Add-On Direct Medical Education Add-On Disproportionate Share Add-On Paramedical Education Add-On Aggregate RCC DRG Rate Capital Rate Hold Harmless Rate
Implied Decimal 6 (in percentages) Implied Decimal 4 (in percentages) Implied Decimal 6 (in percentages) Implied Decimal 2 (in dollars)
1124405592 390001 36081 15591 646 36277 485198 905284 23235 175471
1255540647 390001 36081 15591 646 36277 485198 905284 23235 175471
1285032128 390001 36081 15591 646 36277 485198 905284 23235 175471
1326446253 390001 36081 15591 646 36277 485198 905284 23235 175471
1336526276 390001 36081 15591 646 36277 485198 905284 23235 175471
1366444507 390001 36081 15591 646 36277 485198 905284 23235 175471
1417334350 390001 36081 15591 646 36277 485198 905284 23235 175471
1467850149 390001 36081 15591 646 36277 485198 905284 23235 175471
1497132336 390001 36081 15591 646 36277 485198 905284 23235 175471
1548648272 390001 36081 15591 646 36277 485198 905284 23235 175471
1770960130 390001 36081 15591 646 36277 485198 905284 23235 175471
1972652063 390001 36081 15591 646 36277 485198 905284 23235 175471
1194734798 390002 135468 52932 414 0 551833 1006201 95112 0
1942364898 390002 135468 52932 414 0 551833 1006201 95112 0
1821198755 390003 0 0 297 0 579483 905284 88431 0
1841408739 390003 0 0 297 0 579483 905284 88431 0
1891852703 390003 0 0 297 0 579483 905284 88431 0
1881690212 390004 0 0 0 1397 498517 976238 77803 0
1013384809 390006 263657 107593 444 15014 508391 905284 78510 0
1033491741 390006 263657 107593 444 15014 508391 905284 78510 0
1063540011 390006 263657 107593 444 15014 508391 905284 78510 0
1063708501 390006 263657 107593 444 15014 508391 905284 78510 0
1154617694 390006 263657 107593 444 15014 508391 905284 78510 0
1235215427 390006 263657 107593 444 15014 508391 905284 78510 0
1245632231 390006 263657 107593 444 15014 508391 905284 78510 0
1275832164 390006 263657 107593 444 15014 508391 905284 78510 0
1275850620 390006 263657 107593 444 15014 508391 905284 78510 0
1417231937 390006 263657 107593 444 15014 508391 905284 78510 0
1427344969 390006 263657 107593 444 15014 508391 905284 78510 0
1457650343 390006 263657 107593 444 15014 508391 905284 78510 0
1467748475 390006 263657 107593 444 15014 508391 905284 78510 0
1528197720 390006 263657 107593 444 15014 508391 905284 78510 0
1659762862 390006 263657 107593 444 15014 508391 905284 78510 0
1669768289 390006 263657 107593 444 15014 508391 905284 78510 0
1770879215 390006 263657 107593 444 15014 508391 905284 78510 0
1851508162 390006 263657 107593 444 15014 508391 905284 78510 0
1982037966 390006 263657 107593 444 15014 508391 905284 78510 0
1982988408 390006 263657 107593 444 15014 508391 905284 78510 0
1861435042 390009 35262 16381 283 16884 388855 928272 98652 0
1386896306 390012 0 0 0 0 681384 1101073 98017 0
1124076039 390013 0 0 0 0 770580 901697 61147 0
1477538312 390016 0 0 383 46405 645555 1006201 102972 0
1437865953 390026 102863 44440 0 0 700974 1101073 78268 0
1962579029 390027 369197 164426 3735 1000 346350 1101073 52243 236563
1568526135 390028 212670 105091 638 19969 407418 1006201 109207 0
1881695146 390028 212670 105091 638 19969 407418 1006201 109207 0
1235138405 390030 0 0 0 36715 651378 901697 91164 0
1689679581 390032 0 0 0 6702 511963 1006201 102972 0
1669405072 390035 0 0 0 0 361107 1101073 112139 0
1063422053 390036 39427 27555 0 969 537674 1006201 47376 85653
1588770416 390037 0 0 0 43300 635158 1006201 105831 0
1912900168 390039 0 0 825 2588 541040 918172 97986 0
1871594127 390041 0 0 841 23769 496716 1006201 102972 0
1609984889 390042 43209 30912 256 42196 0 1006201 102972 0
1669530069 390044 84971 23313 0 21042 468000 942514 81898 0
1609801976 390045 44467 21869 287 5640 402000 890026 18255 144847
1326060492 390046 144496 64117 259 5922 604415 931416 73309 0
1609263946 390048 8240 34578 0 0 770000 901697 89126 0
1639560550 390048 8240 34578 0 0 770000 901697 89126 0
1689061921 390048 8240 34578 0 0 770000 901697 89126 0
1750778981 390048 8240 34578 0 0 770000 901697 89126 0
1861545683 390048 8240 34578 0 0 770000 901697 89126 0
1013933175 390049 68656 32236 0 133798 607630 1027228 102007 0
1548293954 390049 68656 32236 0 133798 607630 1027228 102007 0
1952399933 390049 68656 32236 0 133798 607630 1027228 102007 0
1285667493 390050 248542 77734 534 3112 387091 1006201 51803 129032
1700878840 390056 0 0 0 0 597279 901697 13056 205948
1568459287 390057 0 0 0 0 450593 1101073 121073 0
1689107328 390058 0 0 0 3047 554630 976238 81400 0
1497708473 390062 0 0 0 0 734000 945733 93586 0
1487647590 390063 52946 32583 539 6973 397020 928272 93846 0
1265466957 390065 0 0 0 0 736431 1098668 111913 0
1407928500 390066 39353 17255 0 0 492272 976238 75974 0
1407813603 390067 130828 52674 433 2232 445000 976238 86910 0
1285167916 390068 58594 33076 854 0 193955 955907 97705 0
1528319621 390070 9153 2964 0 0 431480 1101073 64480 0
1841712882 390071 0 0 0 0 686000 901697 89744 0
1316919699 390072 0 0 710 0 519617 905284 83780 0
1649278730 390073 37941 30974 410 25331 446000 945733 95593 0
1083614382 390079 112108 37346 0 20184 634945 901697 30383 183243
1134734528 390079 112108 37346 0 20184 634945 901697 30383 183243
1548624851 390081 29962 0 0 0 351953 1101073 79465 0
1144249657 390086 0 0 400 0 677485 901697 89133 0
1316537228 390086 0 0 400 0 677485 901697 89133 0
1194744805 390090 174532 60762 649 37073 356554 1006201 102972 0
1619069440 390091 0 0 0 3356 597181 901697 95748 0
1265422901 390093 30411 20351 0 0 620784 901697 6790 132162
1699734665 390096 26367 33298 859 3219 528137 942514 32219 89240
1750371522 390097 0 0 0 570 357027 1101073 99349 0
1104875103 390100 56910 18259 0 19607 724335 955907 70268 0
1245571942 390100 56910 18259 0 19607 724335 955907 70268 0
1063945707 390101 92128 52381 390 0 497259 931416 66643 0
1750445607 390102 110841 116437 0 14691 462514 1006201 109855 0
1790795359 390102 110841 116437 0 14691 462514 1006201 109855 0
1861478307 390104 0 0 0 0 0 993413 91164 0
1225047699 390107 0 0 0 0 560569 1006201 81432 0
1639218936 390107 0 0 0 0 560569 1006201 81432 0
1801897038 390110 126380 68584 690 37359 416925 903638 30795 123321
1851370910 390111 539305 313211 1585 7937 321731 1101073 29122 376876
1275620536 390112 0 0 0 0 607604 903638 9439 108767
1942276423 390113 0 0 1000 0 802026 921870 81818 0
1659435501 390114 147995 110633 1702 0 479453 1006201 42687 173018
1952311508 390114 147995 110633 1702 0 479453 1006201 42687 173018
1114095791 390115 60642 41217 671 31461 288789 1101073 61641 107806
1205904885 390115 60642 41217 671 31461 288789 1101073 61641 107806
1215952106 390115 60642 41217 671 31461 288789 1101073 61641 107806
1801963343 390115 60642 41217 671 31461 288789 1101073 61641 107806
1124495239 390116 219851 95443 268 894 449520 1101073 117834 174181
1295724193 390117 0 0 0 0 726684 901697 73287 0
1578569885 390118 0 0 0 0 414013 901697 78196 0
1922376136 390119 24716 27385 0 0 428010 905284 7988 162588
1649794421 390123 0 0 0 0 475055 1101073 97792 0
1124026182 390125 0 0 0 0 562680 901697 91164 0​