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Fee Schedule
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Fee Schedule 15570-19101
Begin Main Content Area
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2024 Workers' Compensation Part B Fee Schedule
15570-19101
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
15570
004
90
2
X
1,518.93
X
15570
001
90
2
X
3,518.08
X
15570
002
90
2
X
4,215.91
X
15570
003
90
2
X
2,891.21
X
15572
001
90
2
X
3,810.20
X
15572
003
90
2
X
3,607.44
X
15572
002
90
2
X
3,880.07
X
15572
004
90
2
X
4,244.40
X
15574
001
90
2
X
3,260.61
X
15574
003
90
2
X
2,866.61
X
15574
002
90
2
X
3,355.47
X
15574
004
90
2
X
3,368.38
X
15576
001
90
2
X
3,473.29
X
15576
004
90
2
X
3,453.16
X
15576
002
90
2
X
4,054.92
X
15576
003
90
2
X
3,498.79
X
15600
003
90
2
X
693.52
X
15600
002
90
2
X
1,092.25
X
15600
004
90
2
X
1,298.23
X
15600
001
90
2
X
783.41
X
15610
001
90
2
X
1,142.33
X
15610
003
90
2
X
1,144.44
X
15610
002
90
2
X
763.65
X
15610
004
90
2
X
687.77
X
15620
002
90
2
X
1,531.69
X
15620
003
90
2
X
844.79
X
15620
004
90
2
X
834.25
X
15620
001
90
2
X
1,465.89
X
15630
001
90
2
X
1,644.53
X
15630
004
90
2
X
902.54
X
15630
002
90
2
X
1,636.14
X
15630
003
90
2
X
1,601.70
X
15650
004
90
2
X
988.85
X
15650
003
90
2
X
1,224.34
X
15650
002
90
2
X
1,238.27
X
15650
001
90
2
X
1,107.53
X
15730
004
90
2
X
2,232.42
1,355.23
15730
002
90
2
X
2,232.42
1,355.23
15730
003
90
2
X
2,232.42
1,355.23
15730
001
90
2
X
2,491.06
1,484.54
15731
001
90
2
X
1,940.59
1,744.05
15731
004
90
2
X
1,699.58
1,538.91
15731
003
90
2
X
1,699.58
1,538.91
15731
002
90
2
X
1,699.58
1,538.91
15733
003
90
2
X
1,548.80
X
15733
002
90
2
X
1,548.80
X
15733
004
90
2
X
1,548.80
X
15733
001
90
2
X
1,695.50
X
15734
004
90
2
X
5,838.32
X
15734
001
90
2
X
5,900.24
X
15734
003
90
2
X
5,858.95
X
15734
002
90
2
X
5,922.19
X
15736
002
90
2
X
4,877.56
X
15736
003
90
2
X
3,592.77
X
15736
001
90
2
X
4,909.23
X
15736
004
90
2
X
3,549.95
X
15738
001
90
2
X
5,542.56
X
15738
003
90
2
X
5,468.89
X
15738
002
90
2
X
5,585.70
X
15738
004
90
2
X
2,949.12
X
15740
003
90
2
X
3,838.44
X
15740
002
90
2
X
3,763.32
X
15740
004
90
2
X
2,208.41
X
15740
001
90
2
X
3,925.25
X
15750
003
90
2
X
2,560.74
X
15750
002
90
2
X
2,759.69
X
15750
004
90
2
X
2,529.84
X
15750
001
90
2
X
2,807.81
X
15756
001
90
2
X
7,917.98
X
15756
002
90
2
X
7,081.76
X
15756
003
90
2
X
6,891.37
X
15756
004
90
2
X
6,891.37
X
15757
002
90
2
X
7,081.76
X
15757
003
90
2
X
6,891.37
X
15757
001
90
2
X
7,917.98
X
15757
004
90
2
X
6,891.37
X
15758
004
90
2
X
6,891.37
X
15758
002
90
2
X
7,081.76
X
15758
001
90
2
X
7,917.98
X
15758
003
90
2
X
6,891.37
X
15760
001
90
2
X
2,480.15
X
15760
004
90
2
X
1,718.75
X
15760
003
90
2
X
2,417.75
X
15760
002
90
2
X
2,467.98
X
15769
003
90
2
X
669.19
X
15769
002
90
2
X
669.19
X
15769
004
90
2
X
669.19
X
15769
001
90
2
X
740.50
X
15770
004
90
2
X
1,569.04
X
15770
001
90
2
X
1,724.11
X
15770
003
90
2
X
1,588.52
X
15770
002
90
2
X
1,697.78
X
15771
002
90
2
X
795.33
664.63
15771
003
90
2
X
795.33
664.63
15771
001
90
2
X
885.53
735.06
15771
004
90
2
X
795.33
664.63
15772
001
ZZZ
0
X
278.94
216.91
15772
004
ZZZ
0
X
251.99
198.13
15772
002
ZZZ
0
X
251.99
198.13
15772
003
ZZZ
0
X
251.99
198.13
15773
001
90
2
X
893.35
742.86
15773
004
90
2
X
802.63
671.96
15773
003
90
2
X
802.63
671.96
15773
002
90
2
X
802.63
671.96
15774
004
ZZZ
0
X
244.19
190.33
15774
002
ZZZ
0
X
244.19
190.33
15774
003
ZZZ
0
X
244.19
190.33
15774
001
ZZZ
0
X
270.23
208.22
15775
0
2
X
*
X
15776
0
2
X
*
X
15777
001
ZZZ
0
X
397.75
X
15777
004
ZZZ
0
X
357.00
X
15777
002
ZZZ
0
X
357.00
X
15777
003
ZZZ
0
X
357.00
X
15778
001
0
2
X
481.38
X
15778
002
0
2
X
442.20
X
15778
003
0
2
X
442.20
X
15778
004
0
2
X
442.20
X
15780
004
90
2
X
874.55
X
15780
001
90
2
X
924.80
X
15780
003
90
2
X
1,958.68
X
15780
002
90
2
X
916.68
X
15781
004
90
2
X
909.53
X
15781
003
90
2
X
1,021.43
X
15781
002
90
2
X
974.28
X
15781
001
90
2
X
1,041.94
X
15782
001
90
2
X
609.94
X
15782
004
90
2
X
943.22
X
15782
003
90
2
X
579.77
X
15782
002
90
2
X
604.06
X
15783
001
90
2
X
863.68
X
15783
004
90
2
X
643.23
X
15783
002
90
2
X
681.57
X
15783
003
90
2
X
650.45
X
15786
004
10
2
X
276.72
X
15786
001
10
2
X
294.37
X
15786
003
10
2
X
279.70
X
15786
002
10
2
X
291.54
X
15787
003
ZZZ
0
X
60.98
X
15787
002
ZZZ
0
X
64.69
X
15787
001
ZZZ
0
X
65.53
X
15787
004
ZZZ
0
X
60.25
X
15788
90
2
X
*
X
15789
90
2
X
*
X
15792
90
2
X
*
X
15793
90
2
X
*
X
15819
003
90
2
X
1,850.70
X
15819
002
90
2
X
1,964.63
X
15819
001
90
2
X
1,992.18
X
15819
004
90
2
X
1,828.28
X
15820
004
90
2
X
1,202.18
X
15820
002
90
2
X
1,299.45
X
15820
003
90
2
X
1,217.64
X
15820
001
90
2
X
1,319.10
X
15821
002
90
2
X
1,488.65
X
15821
003
90
2
X
1,396.66
X
15821
004
90
2
X
1,378.69
X
15821
001
90
2
X
1,510.72
X
15822
002
90
2
X
2,110.06
X
15822
003
90
2
X
1,778.49
X
15822
001
90
2
X
1,266.94
X
15822
004
90
2
X
1,881.91
X
15823
004
90
2
X
2,032.89
X
15823
002
90
2
X
2,183.26
X
15823
003
90
2
X
2,085.31
X
15823
001
90
2
X
2,218.30
X
15824
0
2
X
*
X
15825
0
2
X
*
X
15826
0
2
X
*
X
15828
0
2
X
*
X
15829
0
2
X
*
X
15830
001
90
2
X
2,120.47
X
15830
003
90
2
X
1,837.77
X
15830
002
90
2
X
1,837.77
X
15830
004
90
2
X
1,837.77
X
15832
90
2
X
*
X
15833
90
2
X
*
X
15834
90
2
X
*
X
15835
90
2
X
*
X
15836
90
2
X
*
X
15837
90
2
X
*
X
15838
90
2
X
*
X
15839
90
2
X
*
X
15840
002
90
2
X
3,365.84
X
15840
003
90
2
X
3,128.28
X
15840
001
90
2
X
3,423.13
X
15840
004
90
2
X
3,089.60
X
15841
001
90
2
X
4,662.13
X
15841
004
90
2
X
4,248.46
X
15841
003
90
2
X
4,298.49
X
15841
002
90
2
X
4,591.30
X
15842
004
90
2
X
6,974.58
X
15842
002
90
2
X
7,459.13
X
15842
003
90
2
X
7,059.56
X
15842
001
90
2
X
7,555.46
X
15845
002
90
2
X
3,376.57
X
15845
003
90
2
X
3,126.46
X
15845
004
90
2
X
3,087.94
X
15845
001
90
2
X
3,436.91
X
15847
YYY
0
X
*
X
15851
0
2
X
*
X
15852
004
0
2
X
126.25
X
15852
002
0
2
X
131.46
X
15852
003
0
2
X
127.08
X
15852
001
0
2
X
132.60
X
15853
001
ZZZ
2
X
14.52
X
15853
003
ZZZ
2
X
12.63
X
15853
002
ZZZ
2
X
12.63
X
15853
004
ZZZ
2
X
12.63
X
15854
004
ZZZ
2
X
17.82
X
15854
001
ZZZ
2
X
20.51
X
15854
002
ZZZ
2
X
17.82
X
15854
003
ZZZ
2
X
17.82
X
15860
0
2
X
*
X
15876
0
2
X
*
X
15877
0
2
X
*
X
15878
0
2
X
#
X
15879
0
2
X
*
X
15920
004
90
2
X
1,137.53
X
15920
002
90
2
X
1,217.64
X
15920
003
90
2
X
1,149.76
X
15920
001
90
2
X
1,234.20
X
15922
001
90
2
X
1,855.81
X
15922
003
90
2
X
1,709.22
X
15922
002
90
2
X
1,827.14
X
15922
004
90
2
X
1,689.95
X
15931
001
90
2
X
1,085.41
X
15931
004
90
2
X
1,167.25
X
15931
002
90
2
X
1,296.60
X
15931
003
90
2
X
1,198.29
X
15933
004
90
2
X
1,860.36
X
15933
002
90
2
X
2,011.27
X
15933
003
90
2
X
1,881.62
X
15933
001
90
2
X
2,030.36
X
15934
001
90
2
X
2,314.45
X
15934
003
90
2
X
2,130.30
X
15934
002
90
2
X
2,278.45
X
15934
004
90
2
X
2,159.35
X
15935
004
90
2
X
2,740.69
X
15935
003
90
2
X
2,772.74
X
15935
002
90
2
X
2,985.80
X
15935
001
90
2
X
3,037.43
X
15936
001
90
2
X
2,703.00
X
15936
004
90
2
X
2,436.23
X
15936
002
90
2
X
3,506.13
X
15936
003
90
2
X
3,425.77
X
15937
003
90
2
X
3,983.53
X
15937
002
90
2
X
4,086.65
X
15937
004
90
2
X
2,998.35
X
15937
001
90
2
X
4,111.58
X
15940
004
90
2
X
1,294.81
X
15940
001
90
2
X
1,406.50
X
15940
002
90
2
X
1,387.36
X
15940
003
90
2
X
1,308.90
X
15941
002
90
2
X
2,047.33
X
15941
003
90
2
X
1,944.07
X
15941
004
90
2
X
1,922.11
X
15941
001
90
2
X
1,981.32
X
15944
004
90
2
X
2,513.89
X
15944
001
90
2
X
2,430.21
X
15944
003
90
2
X
2,524.70
X
15944
002
90
2
X
2,596.62
X
15945
001
90
2
X
3,071.65
X
15945
004
90
2
X
2,528.75
X
15945
002
90
2
X
3,051.42
X
15945
003
90
2
X
2,968.00
X
15946
004
90
2
X
4,092.28
X
15946
001
90
2
X
4,525.88
X
15946
003
90
2
X
4,140.16
X
15946
002
90
2
X
4,450.56
X
15950
003
90
2
X
1,164.96
X
15950
002
90
2
X
1,221.59
X
15950
004
90
2
X
1,189.71
X
15950
001
90
2
X
1,169.66
X
15951
001
90
2
X
2,149.20
X
15951
003
90
2
X
1,964.63
X
15951
002
90
2
X
2,113.18
X
15951
004
90
2
X
1,942.21
X
15952
003
90
2
X
2,094.96
X
15952
002
90
2
X
2,089.93
X
15952
001
90
2
X
2,166.27
X
15952
004
90
2
X
1,931.01
X
15953
003
90
2
X
2,573.45
X
15953
002
90
2
X
2,509.31
X
15953
004
90
2
X
2,306.79
X
15953
001
90
2
X
2,552.08
X
15956
004
90
2
X
3,545.69
X
15956
001
90
2
X
3,968.73
X
15956
003
90
2
X
3,716.02
X
15956
002
90
2
X
3,894.70
X
15958
001
90
2
X
4,091.62
X
15958
004
90
2
X
3,640.89
X
15958
003
90
2
X
3,888.59
X
15958
002
90
2
X
4,012.38
X
15999
YYY
2
X
#
X
16000
003
0
2
X
123.47
107.40
16000
002
0
2
X
130.04
112.42
16000
004
0
2
X
123.02
106.81
16000
001
0
2
X
131.18
113.43
16020
004
0
2
X
113.32
97.57
16020
003
0
2
X
114.62
98.55
16020
002
0
2
X
119.82
102.82
16020
001
0
2
X
121.09
103.86
16025
002
0
2
X
256.81
232.75
16025
003
0
2
X
246.93
224.28
16025
004
0
2
X
244.37
222.04
16025
001
0
2
X
259.30
234.88
16030
001
0
2
X
297.78
X
16030
004
0
2
X
279.36
X
16030
003
0
2
X
282.24
X
16030
002
0
2
X
294.72
X
16035
004
0
2
X
700.42
X
16035
001
0
2
X
757.21
X
16035
003
0
2
X
708.03
X
16035
002
0
2
X
747.65
X
16036
002
ZZZ
0
X
196.32
X
16036
003
ZZZ
0
X
196.32
X
16036
004
ZZZ
0
X
196.32
X
16036
001
ZZZ
0
X
219.64
X
17000
001
10
2
X
103.77
81.32
17000
004
10
2
X
93.57
74.44
17000
003
10
2
X
93.57
74.44
17000
002
10
2
X
93.57
74.44
17003
001
ZZZ
0
X
28.90
22.00
17003
004
ZZZ
0
X
25.82
19.90
17003
003
ZZZ
0
X
25.82
19.90
17003
002
ZZZ
0
X
25.82
19.90
17004
002
10
0
X
466.08
363.84
17004
003
10
0
X
466.08
363.84
17004
004
10
0
X
466.08
363.84
17004
001
10
0
X
521.79
401.68
17106
002
90
2
X
729.38
X
17106
003
90
2
X
697.31
X
17106
004
90
2
X
689.63
X
17106
001
90
2
X
737.24
X
17107
004
90
2
X
1,364.46
X
17107
002
90
2
X
1,444.24
X
17107
003
90
2
X
1,379.61
X
17107
001
90
2
X
1,459.97
X
17108
001
90
2
X
2,568.18
X
17108
004
90
2
X
2,385.33
X
17108
002
90
2
X
2,538.16
X
17108
003
90
2
X
2,414.10
X
17110
004
10
2
X
96.19
77.99
17110
002
10
2
X
96.19
77.99
17110
003
10
2
X
96.19
77.99
17110
001
10
2
X
106.29
84.90
17111
003
10
2
X
139.74
112.46
17111
001
10
2
X
154.99
122.91
17111
002
10
2
X
139.74
112.46
17111
004
10
2
X
139.74
112.46
17250
002
0
2
X
97.28
79.10
17250
003
0
2
X
92.07
74.90
17250
001
0
2
X
98.55
80.20
17250
004
0
2
X
90.91
74.10
17260
004
10
2
X
300.40
X
17260
002
10
2
X
306.59
X
17260
003
10
2
X
299.81
X
17260
001
10
2
X
308.51
X
17261
004
10
2
X
353.15
X
17261
001
10
2
X
366.22
X
17261
003
10
2
X
354.46
X
17261
002
10
2
X
367.04
X
17262
004
10
2
X
405.17
X
17262
001
10
2
X
458.36
X
17262
002
10
2
X
450.01
X
17262
003
10
2
X
444.93
X
17263
002
10
2
X
547.49
X
17263
003
10
2
X
544.36
X
17263
001
10
2
X
532.30
X
17263
004
10
2
X
492.18
X
17264
001
10
2
X
679.27
X
17264
003
10
2
X
664.93
X
17264
002
10
2
X
698.79
X
17264
004
10
2
X
679.42
X
17266
004
10
2
X
972.14
X
17266
001
10
2
X
980.32
X
17266
002
10
2
X
972.16
X
17266
003
10
2
X
855.38
X
17270
004
10
2
X
362.17
X
17270
003
10
2
X
359.65
X
17270
002
10
2
X
374.74
X
17270
001
10
2
X
382.55
X
17271
003
10
2
X
460.10
X
17271
002
10
2
X
468.98
X
17271
004
10
2
X
398.30
X
17271
001
10
2
X
479.25
X
17272
001
10
2
X
515.31
X
17272
004
10
2
X
456.40
X
17272
003
10
2
X
499.61
X
17272
002
10
2
X
507.38
X
17273
002
10
2
X
576.92
X
17273
003
10
2
X
568.65
X
17273
004
10
2
X
536.10
X
17273
001
10
2
X
538.95
X
17274
001
10
2
X
745.27
X
17274
004
10
2
X
697.98
X
17274
003
10
2
X
721.35
X
17274
002
10
2
X
732.36
X
17276
001
10
2
X
888.30
X
17276
004
10
2
X
853.96
X
17276
003
10
2
X
807.28
X
17276
002
10
2
X
877.04
X
17280
004
10
2
X
394.53
X
17280
002
10
2
X
419.21
X
17280
003
10
2
X
388.04
X
17280
001
10
2
X
426.65
X
17281
001
10
2
X
507.54
X
17281
002
10
2
X
508.57
X
17281
003
10
2
X
492.63
X
17281
004
10
2
X
456.65
X
17282
004
10
2
X
507.47
X
17282
001
10
2
X
607.26
X
17282
002
10
2
X
598.04
X
17282
003
10
2
X
601.36
X
17283
001
10
2
X
654.21
X
17283
003
10
2
X
698.07
X
17283
002
10
2
X
707.15
X
17283
004
10
2
X
630.49
X
17284
001
10
2
X
850.92
X
17284
004
10
2
X
838.55
X
17284
003
10
2
X
737.29
X
17284
002
10
2
X
817.88
X
17286
001
10
2
X
1,054.03
X
17286
003
10
2
X
970.69
X
17286
002
10
2
X
1,037.77
X
17286
004
10
2
X
959.08
X
17311
001
0
2
X
1,239.85
656.30
17311
004
0
2
X
1,070.41
593.44
17311
002
0
2
X
1,070.41
593.44
17311
003
0
2
X
1,070.41
593.44
17312
004
ZZZ
0
X
643.43
315.87
17312
001
ZZZ
0
X
750.14
349.41
17312
003
ZZZ
0
X
643.43
315.87
17312
002
ZZZ
0
X
643.43
315.87
17313
004
0
2
X
976.99
531.92
17313
001
0
2
X
1,132.96
588.46
17313
003
0
2
X
976.99
531.92
17313
002
0
2
X
976.99
531.92
17314
004
ZZZ
0
X
595.89
292.12
17314
002
ZZZ
0
X
595.89
292.12
17314
003
ZZZ
0
X
595.89
292.12
17314
001
ZZZ
0
X
694.73
323.08
17315
002
ZZZ
0
X
127.05
82.63
17315
003
ZZZ
0
X
127.05
82.63
17315
004
ZZZ
0
X
127.05
82.63
17315
001
ZZZ
0
X
145.57
91.27
17340
001
10
2
X
113.68
98.51
17340
004
10
2
X
106.82
92.96
17340
003
10
2
X
99.37
86.69
17340
002
10
2
X
112.52
97.57
17360
004
10
2
X
176.55
163.17
17360
001
10
2
X
167.39
154.11
17360
002
10
2
X
184.60
170.26
17360
003
10
2
X
178.38
164.79
17380
0
2
X
*
X
17999
YYY
2
X
#
X
19000
001
0
2
X
149.98
128.52
19000
004
0
2
X
139.85
119.97
19000
003
0
2
X
143.25
122.99
19000
002
0
2
X
144.71
124.38
19001
002
ZZZ
0
X
78.45
X
19001
003
ZZZ
0
X
73.51
X
19001
004
ZZZ
0
X
72.76
X
19001
001
ZZZ
0
X
79.66
X
19020
002
90
2
X
580.38
X
19020
003
90
2
X
570.15
X
19020
004
90
2
X
484.76
X
19020
001
90
2
X
568.82
X
19030
001
0
2
X
213.77
X
19030
003
0
2
X
203.37
X
19030
002
0
2
X
211.74
X
19030
004
0
2
X
201.21
X
19081
001
0
2
X
1,180.64
328.07
19081
004
0
2
X
1,029.57
297.74
19081
002
0
2
X
1,029.57
297.74
19081
003
0
2
X
1,029.57
297.74
19082
004
ZZZ
0
X
824.36
141.29
19082
003
ZZZ
0
X
824.36
141.29
19082
002
ZZZ
0
X
824.36
141.29
19082
001
ZZZ
0
X
949.41
153.63
19083
003
0
2
X
1,021.24
278.82
19083
002
0
2
X
1,021.24
278.82
19083
004
0
2
X
1,021.24
278.82
19083
001
0
2
X
1,171.72
306.79
19084
001
ZZZ
0
X
936.35
144.25
19084
004
ZZZ
0
X
812.61
132.75
19084
003
ZZZ
0
X
812.61
132.75
19084
002
ZZZ
0
X
812.61
132.75
19085
003
0
2
X
1,538.94
325.43
19085
002
0
2
X
1,538.94
325.43
19085
001
0
2
X
1,771.40
357.61
19085
004
0
2
X
1,538.94
325.43
19086
001
ZZZ
0
X
1,403.73
152.94
19086
004
ZZZ
0
X
1,217.46
143.85
19086
002
ZZZ
0
X
1,217.46
143.85
19086
003
ZZZ
0
X
1,217.46
143.85
19100
003
0
2
X
307.86
X
19100
002
0
2
X
297.25
X
19100
001
0
2
X
270.71
X
19100
004
0
2
X
271.49
X
19101
001
10
2
X
691.59
X
19101
002
10
2
X
707.38
X
19101
003
10
2
X
617.90
X
19101
004
10
2
X
610.84
X
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