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Health Care Services Review
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Fee Schedule
>
Fee Schedule 74150-74410
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
74150-74410
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
74150
001
XXX
4
X
793.52
X
74150
004
XXX
4
X
713.79
X
74150
002
XXX
4
X
780.24
X
74150
003
XXX
4
X
724.40
X
74150
26
001
XXX
4
X
206.11
X
74150
TC
001
XXX
4
X
605.99
X
74150
26
002
XXX
4
X
205.40
X
74150
TC
002
XXX
4
X
595.03
X
74150
26
003
XXX
4
X
196.68
X
74150
TC
003
XXX
4
X
548.66
X
74150
26
004
XXX
4
X
191.57
X
74150
TC
004
XXX
4
X
539.93
X
74160
001
XXX
4
X
931.93
X
74160
26
001
XXX
4
X
221.20
X
74160
TC
001
XXX
4
X
730.68
X
74160
002
XXX
4
X
916.28
X
74160
26
002
XXX
4
X
220.51
X
74160
TC
002
XXX
4
X
717.56
X
74160
003
XXX
4
X
850.48
X
74160
26
003
XXX
4
X
211.00
X
74160
TC
003
XXX
4
X
662.15
X
74160
004
XXX
4
X
837.97
X
74160
26
004
XXX
4
X
205.81
X
74160
TC
004
XXX
4
X
651.62
X
74170
002
XXX
4
X
1,111.06
X
74170
26
002
XXX
4
X
243.35
X
74170
TC
002
XXX
4
X
890.86
X
74170
003
XXX
4
X
1,030.79
X
74170
26
003
XXX
4
X
232.78
X
74170
TC
003
XXX
4
X
822.03
X
74170
004
XXX
4
X
1,015.46
X
74170
26
004
XXX
4
X
228.69
X
74170
TC
004
XXX
4
X
808.88
X
74170
001
XXX
4
X
1,130.18
X
74170
26
001
XXX
4
X
244.12
X
74170
TC
001
XXX
4
X
907.13
X
74174
001
XXX
4
X
1,002.97
X
74174
26
001
XXX
4
X
187.21
X
74174
TC
001
XXX
4
X
815.77
X
74174
004
XXX
4
X
878.21
X
74174
26
004
XXX
4
X
175.04
X
74174
TC
004
XXX
4
X
703.13
X
74174
002
XXX
4
X
878.21
X
74174
26
002
XXX
4
X
175.04
X
74174
TC
002
XXX
4
X
703.13
X
74174
003
XXX
4
X
878.21
X
74174
26
003
XXX
4
X
175.04
X
74174
TC
003
XXX
4
X
703.13
X
74175
001
XXX
4
X
1,016.74
X
74175
26
001
XXX
4
X
161.65
X
74175
TC
001
XXX
4
X
855.06
X
74175
003
XXX
4
X
866.31
X
74175
26
003
XXX
4
X
148.48
X
74175
TC
003
XXX
4
X
717.81
X
74175
002
XXX
4
X
866.31
X
74175
26
002
XXX
4
X
148.48
X
74175
TC
002
XXX
4
X
717.81
X
74175
004
XXX
4
X
866.31
X
74175
26
004
XXX
4
X
148.48
X
74175
TC
004
XXX
4
X
717.81
X
74176
004
XXX
4
X
367.02
X
74176
26
004
XXX
4
X
146.58
X
74176
TC
004
XXX
4
X
220.44
X
74176
003
XXX
4
X
367.02
X
74176
26
003
XXX
4
X
146.58
X
74176
TC
003
XXX
4
X
220.44
X
74176
002
XXX
4
X
367.02
X
74176
26
002
XXX
4
X
146.58
X
74176
TC
002
XXX
4
X
220.44
X
74176
001
XXX
4
X
405.68
X
74176
26
001
XXX
4
X
156.08
X
74176
TC
001
XXX
4
X
249.62
X
74177
002
XXX
4
X
573.91
X
74177
26
002
XXX
4
X
153.60
X
74177
TC
002
XXX
4
X
420.32
X
74177
003
XXX
4
X
573.91
X
74177
26
003
XXX
4
X
153.60
X
74177
TC
003
XXX
4
X
420.32
X
74177
004
XXX
4
X
573.91
X
74177
26
004
XXX
4
X
153.60
X
74177
TC
004
XXX
4
X
420.32
X
74177
001
XXX
4
X
639.25
X
74177
26
001
XXX
4
X
163.46
X
74177
TC
001
XXX
4
X
475.83
X
74178
003
XXX
4
X
725.63
X
74178
26
003
XXX
4
X
170.14
X
74178
TC
003
XXX
4
X
555.47
X
74178
002
XXX
4
X
725.63
X
74178
26
002
XXX
4
X
170.14
X
74178
TC
002
XXX
4
X
555.47
X
74178
004
XXX
4
X
725.63
X
74178
26
004
XXX
4
X
170.14
X
74178
TC
004
XXX
4
X
555.47
X
74178
001
XXX
4
X
810.04
X
74178
26
001
XXX
4
X
181.29
X
74178
TC
001
XXX
4
X
628.76
X
74181
001
XXX
4
X
1,453.63
X
74181
26
001
XXX
4
X
279.33
X
74181
TC
001
XXX
4
X
1,198.77
X
74181
004
XXX
4
X
1,304.89
X
74181
26
004
XXX
4
X
260.33
X
74181
TC
004
XXX
4
X
1,068.72
X
74181
003
XXX
4
X
1,324.78
X
74181
26
003
XXX
4
X
266.92
X
74181
TC
003
XXX
4
X
1,085.94
X
74181
002
XXX
4
X
1,428.91
X
74181
26
002
XXX
4
X
278.50
X
74181
TC
002
XXX
4
X
1,177.10
X
74182
004
XXX
4
X
1,286.78
X
74182
26
004
XXX
4
X
155.65
X
74182
TC
004
XXX
4
X
1,131.12
X
74182
003
XXX
4
X
1,286.78
X
74182
26
003
XXX
4
X
155.65
X
74182
TC
003
XXX
4
X
1,131.12
X
74182
002
XXX
4
X
1,286.78
X
74182
26
002
XXX
4
X
155.65
X
74182
TC
002
XXX
4
X
1,131.12
X
74182
001
XXX
4
X
1,513.03
X
74182
26
001
XXX
4
X
168.81
X
74182
TC
001
XXX
4
X
1,344.28
X
74183
001
XXX
4
X
2,709.25
X
74183
26
001
XXX
4
X
223.49
X
74183
TC
001
XXX
4
X
2,485.76
X
74183
002
XXX
4
X
2,297.88
X
74183
26
002
XXX
4
X
204.93
X
74183
TC
002
XXX
4
X
2,092.95
X
74183
003
XXX
4
X
2,297.88
X
74183
26
003
XXX
4
X
204.93
X
74183
TC
003
XXX
4
X
2,092.95
X
74183
004
XXX
4
X
2,297.88
X
74183
26
004
XXX
4
X
204.93
X
74183
TC
004
XXX
4
X
2,092.95
X
74185
001
XXX
4
X
1,474.01
X
74185
26
001
XXX
4
X
275.20
X
74185
TC
001
XXX
4
X
1,198.77
X
74185
002
XXX
4
X
1,449.06
X
74185
26
002
XXX
4
X
271.94
X
74185
TC
002
XXX
4
X
1,177.10
X
74185
003
XXX
4
X
1,344.41
X
74185
26
003
XXX
4
X
258.51
X
74185
TC
003
XXX
4
X
1,085.94
X
74185
004
XXX
4
X
1,324.37
X
74185
26
004
XXX
4
X
255.74
X
74185
TC
004
XXX
4
X
1,068.72
X
74190
002
XXX
0
X
184.54
X
74190
26
002
XXX
0
X
48.05
X
74190
TC
002
XXX
0
X
136.46
X
74190
003
XXX
0
X
171.44
X
74190
26
003
XXX
0
X
45.67
X
74190
TC
003
XXX
0
X
125.78
X
74190
004
XXX
0
X
169.00
X
74190
26
004
XXX
0
X
45.20
X
74190
TC
004
XXX
0
X
123.86
X
74190
001
XXX
0
X
187.62
X
74190
26
001
XXX
0
X
48.70
X
74190
TC
001
XXX
0
X
138.94
X
74210
002
XXX
0
X
179.08
X
74210
26
002
XXX
0
X
60.38
X
74210
TC
002
XXX
0
X
123.99
X
74210
003
XXX
0
X
169.63
X
74210
26
003
XXX
0
X
58.06
X
74210
TC
003
XXX
0
X
114.41
X
74210
004
XXX
0
X
164.43
X
74210
26
004
XXX
0
X
56.33
X
74210
TC
004
XXX
0
X
112.59
X
74210
001
XXX
0
X
182.04
X
74210
26
001
XXX
0
X
60.50
X
74210
TC
001
XXX
0
X
126.31
X
74220
002
XXX
0
X
199.39
X
74220
26
002
XXX
0
X
81.06
X
74220
TC
002
XXX
0
X
123.99
X
74220
003
XXX
0
X
189.34
X
74220
26
003
XXX
0
X
77.45
X
74220
TC
003
XXX
0
X
114.41
X
74220
001
XXX
0
X
199.75
X
74220
26
001
XXX
0
X
81.23
X
74220
TC
001
XXX
0
X
126.31
X
74220
004
XXX
0
X
184.36
X
74220
26
004
XXX
0
X
75.66
X
74220
TC
004
XXX
0
X
112.59
X
74221
004
XXX
0
X
145.31
X
74221
26
004
XXX
0
X
48.37
X
74221
TC
004
XXX
0
X
96.97
X
74221
002
XXX
0
X
145.31
X
74221
26
002
XXX
0
X
48.37
X
74221
TC
002
XXX
0
X
96.97
X
74221
003
XXX
0
X
145.31
X
74221
26
003
XXX
0
X
48.37
X
74221
TC
003
XXX
0
X
96.97
X
74221
001
XXX
0
X
163.47
X
74221
26
001
XXX
0
X
51.71
X
74221
TC
001
XXX
0
X
111.74
X
74230
004
XXX
0
X
208.22
X
74230
26
004
XXX
0
X
88.14
X
74230
TC
004
XXX
0
X
123.86
X
74230
003
XXX
0
X
213.87
X
74230
26
003
XXX
0
X
89.98
X
74230
TC
003
XXX
0
X
125.78
X
74230
002
XXX
0
X
225.41
X
74230
26
002
XXX
0
X
94.08
X
74230
TC
002
XXX
0
X
136.46
X
74230
001
XXX
0
X
225.07
X
74230
26
001
XXX
0
X
94.47
X
74230
TC
001
XXX
0
X
138.94
X
74235
001
XXX
0
X
469.99
X
74235
26
001
XXX
0
X
206.11
X
74235
TC
001
XXX
0
X
282.51
X
74235
002
XXX
0
X
469.49
X
74235
26
002
XXX
0
X
205.40
X
74235
TC
002
XXX
0
X
277.28
X
74235
003
XXX
0
X
445.54
X
74235
26
003
XXX
0
X
196.56
X
74235
TC
003
XXX
0
X
255.47
X
74235
004
XXX
0
X
433.96
X
74235
26
004
XXX
0
X
191.57
X
74235
TC
004
XXX
0
X
251.42
X
74240
001
XXX
0
X
267.70
X
74240
26
001
XXX
0
X
120.79
X
74240
TC
001
XXX
0
X
156.72
X
74240
002
XXX
0
X
267.74
X
74240
26
002
XXX
0
X
120.37
X
74240
TC
002
XXX
0
X
153.83
X
74240
004
XXX
0
X
247.54
X
74240
26
004
XXX
0
X
112.43
X
74240
TC
004
XXX
0
X
139.66
X
74240
003
XXX
0
X
254.16
X
74240
26
003
XXX
0
X
115.24
X
74240
TC
003
XXX
0
X
141.91
X
74246
001
XXX
0
X
287.50
X
74246
26
001
XXX
0
X
120.79
X
74246
TC
001
XXX
0
X
176.48
X
74246
004
XXX
0
X
264.51
X
74246
26
004
XXX
0
X
112.23
X
74246
TC
004
XXX
0
X
157.30
X
74246
002
XXX
0
X
286.21
X
74246
26
002
XXX
0
X
120.37
X
74246
TC
002
XXX
0
X
173.26
X
74246
003
XXX
0
X
271.60
X
74246
26
003
XXX
0
X
115.17
X
74246
TC
003
XXX
0
X
159.87
X
74248
004
ZZZ
0
X
110.66
X
74248
26
004
ZZZ
0
X
48.37
X
74248
TC
004
ZZZ
0
X
62.31
X
74248
002
ZZZ
0
X
110.66
X
74248
26
002
ZZZ
0
X
48.37
X
74248
TC
002
ZZZ
0
X
62.31
X
74248
003
ZZZ
0
X
110.66
X
74248
26
003
ZZZ
0
X
48.37
X
74248
TC
003
ZZZ
0
X
62.31
X
74248
001
ZZZ
0
X
123.45
X
74248
26
001
ZZZ
0
X
51.71
X
74248
TC
001
ZZZ
0
X
71.73
X
74250
001
XXX
0
X
213.45
X
74250
26
001
XXX
0
X
81.88
X
74250
TC
001
XXX
0
X
138.94
X
74250
002
XXX
0
X
212.95
X
74250
26
002
XXX
0
X
81.70
X
74250
TC
002
XXX
0
X
136.46
X
74250
003
XXX
0
X
202.01
X
74250
26
003
XXX
0
X
78.19
X
74250
TC
003
XXX
0
X
125.78
X
74250
004
XXX
0
X
196.77
X
74250
26
004
XXX
0
X
76.56
X
74250
TC
004
XXX
0
X
123.86
X
74251
001
XXX
0
X
213.45
X
74251
26
001
XXX
0
X
81.88
X
74251
TC
001
XXX
0
X
138.94
X
74251
002
XXX
0
X
212.95
X
74251
26
002
XXX
0
X
81.70
X
74251
TC
002
XXX
0
X
136.46
X
74251
003
XXX
0
X
202.01
X
74251
26
003
XXX
0
X
78.19
X
74251
TC
003
XXX
0
X
125.78
X
74251
004
XXX
0
X
196.77
X
74251
26
004
XXX
0
X
76.56
X
74251
TC
004
XXX
0
X
123.86
X
74261
001
XXX
4
X
586.29
X
74261
26
001
XXX
4
X
206.74
X
74261
TC
001
XXX
4
X
379.55
X
74261
004
XXX
4
X
512.23
X
74261
26
004
XXX
4
X
192.35
X
74261
TC
004
XXX
4
X
319.88
X
74261
003
XXX
4
X
512.23
X
74261
26
003
XXX
4
X
192.35
X
74261
TC
003
XXX
4
X
319.88
X
74261
002
XXX
4
X
512.23
X
74261
26
002
XXX
4
X
192.35
X
74261
TC
002
XXX
4
X
319.88
X
74262
001
XXX
4
X
804.23
X
74262
26
001
XXX
4
X
226.94
X
74262
TC
001
XXX
4
X
577.26
X
74262
004
XXX
4
X
697.73
X
74262
26
004
XXX
4
X
211.15
X
74262
TC
004
XXX
4
X
486.58
X
74262
003
XXX
4
X
697.73
X
74262
26
003
XXX
4
X
211.15
X
74262
TC
003
XXX
4
X
486.58
X
74262
002
XXX
4
X
697.73
X
74262
26
002
XXX
4
X
211.15
X
74262
TC
002
XXX
4
X
486.58
X
74263
XXX
9
X
*
X
74270
004
XXX
0
X
269.57
X
74270
26
004
XXX
0
X
112.46
X
74270
TC
004
XXX
0
X
162.90
X
74270
003
XXX
0
X
276.79
X
74270
26
003
XXX
0
X
115.26
X
74270
TC
003
XXX
0
X
165.51
X
74270
002
XXX
0
X
289.35
X
74270
26
002
XXX
0
X
120.37
X
74270
TC
002
XXX
0
X
179.68
X
74270
001
XXX
0
X
294.14
X
74270
26
001
XXX
0
X
120.79
X
74270
TC
001
XXX
0
X
183.09
X
74280
003
XXX
0
X
375.84
X
74280
26
003
XXX
0
X
164.24
X
74280
TC
003
XXX
0
X
216.60
X
74280
002
XXX
0
X
395.99
X
74280
26
002
XXX
0
X
171.75
X
74280
TC
002
XXX
0
X
235.01
X
74280
001
XXX
0
X
396.98
X
74280
26
001
XXX
0
X
172.22
X
74280
TC
001
XXX
0
X
239.39
X
74280
004
XXX
0
X
366.06
X
74280
26
004
XXX
0
X
160.31
X
74280
TC
004
XXX
0
X
213.21
X
74283
001
XXX
0
X
579.59
X
74283
26
001
XXX
0
X
299.35
X
74283
TC
001
XXX
0
X
280.25
X
74283
003
XXX
0
X
503.43
X
74283
26
003
XXX
0
X
270.88
X
74283
TC
003
XXX
0
X
232.54
X
74283
002
XXX
0
X
503.43
X
74283
26
002
XXX
0
X
270.88
X
74283
TC
002
XXX
0
X
232.54
X
74283
004
XXX
0
X
503.43
X
74283
26
004
XXX
0
X
270.88
X
74283
TC
004
XXX
0
X
232.54
X
74290
001
XXX
0
X
130.30
X
74290
26
001
XXX
0
X
54.66
X
74290
TC
001
XXX
0
X
79.64
X
74290
003
XXX
0
X
122.15
X
74290
26
003
XXX
0
X
52.06
X
74290
TC
003
XXX
0
X
71.93
X
74290
002
XXX
0
X
128.22
X
74290
26
002
XXX
0
X
54.44
X
74290
TC
002
XXX
0
X
78.16
X
74290
004
XXX
0
X
119.00
X
74290
26
004
XXX
0
X
51.06
X
74290
TC
004
XXX
0
X
70.78
X
74300
004
XXX
0
X
128.13
X
74300
26
004
XXX
0
X
58.00
X
74300
TC
004
XXX
0
X
75.40
X
74300
002
XXX
0
X
139.25
X
74300
26
002
XXX
0
X
61.78
X
74300
TC
002
XXX
0
X
83.13
X
74300
003
XXX
0
X
130.01
X
74300
26
003
XXX
0
X
59.20
X
74300
TC
003
XXX
0
X
76.62
X
74300
001
XXX
0
X
141.45
X
74300
26
001
XXX
0
X
61.90
X
74300
TC
001
XXX
0
X
84.69
X
74301
001
ZZZ
0
X
117.63
X
74301
26
001
ZZZ
0
X
36.00
X
74301
TC
001
ZZZ
0
X
84.69
X
74301
002
ZZZ
0
X
115.72
X
74301
26
002
ZZZ
0
X
35.92
X
74301
TC
002
ZZZ
0
X
83.13
X
74301
003
ZZZ
0
X
107.65
X
74301
26
003
ZZZ
0
X
34.40
X
74301
TC
003
ZZZ
0
X
76.62
X
74301
004
ZZZ
0
X
106.12
X
74301
26
004
ZZZ
0
X
33.53
X
74301
TC
004
ZZZ
0
X
75.40
X
74328
003
XXX
0
X
414.61
X
74328
26
003
XXX
0
X
116.67
X
74328
002
XXX
0
X
440.72
X
74328
26
002
XXX
0
X
122.00
X
74328
004
XXX
0
X
403.47
X
74328
26
004
XXX
0
X
117.88
X
74328
001
XXX
0
X
448.24
X
74328
26
001
XXX
0
X
122.36
X
74328
TC
001
XXX
0
X
336.17
X
74328
TC
002
XXX
0
X
330.12
X
74328
TC
003
XXX
0
X
304.55
X
74328
TC
004
XXX
0
X
299.73
X
74329
001
XXX
0
X
448.24
X
74329
26
001
XXX
0
X
122.36
X
74329
TC
001
XXX
0
X
336.17
X
74329
004
XXX
0
X
403.47
X
74329
26
004
XXX
0
X
113.68
X
74329
TC
004
XXX
0
X
299.73
X
74329
003
XXX
0
X
414.61
X
74329
26
003
XXX
0
X
116.67
X
74329
TC
003
XXX
0
X
304.55
X
74329
002
XXX
0
X
440.72
X
74329
26
002
XXX
0
X
122.00
X
74329
TC
002
XXX
0
X
330.12
X
74330
004
XXX
0
X
403.47
X
74330
26
004
XXX
0
X
113.68
X
74330
TC
004
XXX
0
X
299.73
X
74330
001
XXX
0
X
448.24
X
74330
26
001
XXX
0
X
122.36
X
74330
TC
001
XXX
0
X
336.17
X
74330
002
XXX
0
X
440.72
X
74330
26
002
XXX
0
X
122.00
X
74330
TC
002
XXX
0
X
330.12
X
74330
003
XXX
0
X
414.61
X
74330
26
003
XXX
0
X
117.08
X
74330
TC
003
XXX
0
X
304.55
X
74340
001
XXX
0
X
369.69
X
74340
26
001
XXX
0
X
95.91
X
74340
TC
001
XXX
0
X
282.51
X
74340
003
XXX
0
X
337.04
X
74340
26
003
XXX
0
X
91.74
X
74340
TC
003
XXX
0
X
255.47
X
74340
002
XXX
0
X
363.38
X
74340
26
002
XXX
0
X
95.70
X
74340
TC
002
XXX
0
X
277.28
X
74340
004
XXX
0
X
332.11
X
74340
26
004
XXX
0
X
89.17
X
74340
TC
004
XXX
0
X
251.42
X
74355
004
XXX
0
X
363.75
X
74355
26
004
XXX
0
X
125.94
X
74355
TC
004
XXX
0
X
251.42
X
74355
003
XXX
0
X
375.54
X
74355
26
003
XXX
0
X
126.46
X
74355
TC
003
XXX
0
X
255.47
X
74355
002
XXX
0
X
396.96
X
74355
26
002
XXX
0
X
132.09
X
74355
TC
002
XXX
0
X
277.28
X
74355
001
XXX
0
X
403.60
X
74355
26
001
XXX
0
X
132.48
X
74355
TC
001
XXX
0
X
282.51
X
74360
004
XXX
0
X
380.35
X
74360
26
004
XXX
0
X
89.17
X
74360
TC
004
XXX
0
X
299.73
X
74360
003
XXX
0
X
386.13
X
74360
26
003
XXX
0
X
91.49
X
74360
TC
003
XXX
0
X
304.55
X
74360
002
XXX
0
X
416.25
X
74360
26
002
XXX
0
X
95.70
X
74360
TC
002
XXX
0
X
330.12
X
74360
001
XXX
0
X
423.44
X
74360
26
001
XXX
0
X
95.91
X
74360
TC
001
XXX
0
X
336.17
X
74363
002
XXX
0
X
778.04
X
74363
26
002
XXX
0
X
847.44
X
74363
TC
002
XXX
0
X
639.85
X
74363
003
XXX
0
X
721.29
X
74363
26
003
XXX
0
X
814.75
X
74363
TC
003
XXX
0
X
590.20
X
74363
004
XXX
0
X
710.51
X
74363
26
004
XXX
0
X
787.12
X
74363
TC
004
XXX
0
X
580.87
X
74363
001
XXX
0
X
791.52
X
74363
26
001
XXX
0
X
845.51
X
74363
TC
001
XXX
0
X
651.62
X
74400
001
XXX
0
X
258.63
X
74400
26
001
XXX
0
X
85.47
X
74400
TC
001
XXX
0
X
181.07
X
74400
002
XXX
0
X
254.36
X
74400
26
002
XXX
0
X
85.20
X
74400
TC
002
XXX
0
X
177.67
X
74400
003
XXX
0
X
241.18
X
74400
26
003
XXX
0
X
81.71
X
74400
TC
003
XXX
0
X
163.62
X
74400
004
XXX
0
X
233.16
X
74400
26
004
XXX
0
X
80.75
X
74400
TC
004
XXX
0
X
161.10
X
74410
002
XXX
0
X
281.75
X
74410
26
002
XXX
0
X
85.20
X
74410
TC
002
XXX
0
X
205.15
X
74410
003
XXX
0
X
266.12
X
74410
26
003
XXX
0
X
81.62
X
74410
TC
003
XXX
0
X
189.21
X
74410
001
XXX
0
X
286.44
X
74410
26
001
XXX
0
X
85.47
X
74410
TC
001
XXX
0
X
208.92
X
74410
004
XXX
0
X
258.19
X
74410
26
004
XXX
0
X
79.49
X
74410
TC
004
XXX
0
X
186.13
X
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