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2019 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 716356 18385 138851
1255540647 390001 36081 15591 646 36277 485198 716356 18385 138851
1285032128 390001 36081 15591 646 36277 485198 716356 18385 138851
1326446253 390001 36081 15591 646 36277 485198 716356 18385 138851
1336526276 390001 36081 15591 646 36277 485198 716356 18385 138851
1366444507 390001 36081 15591 646 36277 485198 716356 18385 138851
1417334350 390001 36081 15591 646 36277 485198 716356 18385 138851
1467850149 390001 36081 15591 646 36277 485198 716356 18385 138851
1497132336 390001 36081 15591 646 36277 485198 716356 18385 138851
1548648272 390001 36081 15591 646 36277 485198 716356 18385 138851
1770960130 390001 36081 15591 646 36277 485198 716356 18385 138851
1972652063 390001 36081 15591 646 36277 485198 716356 18385 138851
1194734798 390002 135468 52932 414 0 551833 796212 75263 0
1942364898 390002 135468 52932 414 0 551833 796212 75263 0
1821198755 390003 0 0 297 0 579483 716356 69976 0
1841408739 390003 0 0 297 0 579483 716356 69976 0
1891852703 390003 0 0 297 0 579483 716356 69976 0
1881690212 390004 0 0 0 1397 498517 772501 61566 0
1013384809 390006 263657 107593 444 15014 508391 716356 62125 0
1033491741 390006 263657 107593 444 15014 508391 716356 62125 0
1063540011 390006 263657 107593 444 15014 508391 716356 62125 0
1063708501 390006 263657 107593 444 15014 508391 716356 62125 0
1154617694 390006 263657 107593 444 15014 508391 716356 62125 0
1235215427 390006 263657 107593 444 15014 508391 716356 62125 0
1245632231 390006 263657 107593 444 15014 508391 716356 62125 0
1275832164 390006 263657 107593 444 15014 508391 716356 62125 0
1275850620 390006 263657 107593 444 15014 508391 716356 62125 0
1417231937 390006 263657 107593 444 15014 508391 716356 62125 0
1427344969 390006 263657 107593 444 15014 508391 716356 62125 0
1457650343 390006 263657 107593 444 15014 508391 716356 62125 0
1467748475 390006 263657 107593 444 15014 508391 716356 62125 0
1528197720 390006 263657 107593 444 15014 508391 716356 62125 0
1659762862 390006 263657 107593 444 15014 508391 716356 62125 0
1669768289 390006 263657 107593 444 15014 508391 716356 62125 0
1770879215 390006 263657 107593 444 15014 508391 716356 62125 0
1851508162 390006 263657 107593 444 15014 508391 716356 62125 0
1982037966 390006 263657 107593 444 15014 508391 716356 62125 0
1982988408 390006 263657 107593 444 15014 508391 716356 62125 0
1710087069 390008 0 0 0 0 642456 796212 62124 0
1861435042 390009 35262 16381 283 16884 388855 734546 78065 0
1386896306 390012 0 0 0 0 681384 871284 77562 0
1124076039 390013 0 0 0 0 770580 713518 48385 0
1477538312 390016 0 0 383 46405 645555 796212 81483 0
1356313464 390026 102863 44440 0 0 700974 871284 61935 0
1962579029 390027 369197 164426 3735 1000 346350 871284 41340 187193
1568526135 390028 212670 105091 638 19969 407418 796212 86416 0
1881695146 390028 212670 105091 638 19969 407418 796212 86416 0
1235138405 390030 0 0 0 36715 651378 713518 72139 0
1689679581 390032 0 0 0 6702 511963 796212 81483 0
1669405072 390035 0 0 0 0 361107 871284 88736 0
1063422053 390036 39427 27555 0 969 537674 796212 37489 67779
1588770416 390037 0 0 0 43300 635158 796212 83744 0
1912900168 390039 0 0 825 2588 541040 726555 77536 0
1871594127 390041 0 0 841 23769 496716 796212 81483 0
1609984889 390042 43209 30912 256 42196 0 796212 81483 0
1669530069 390044 84971 23313 0 21042 468000 745817 64806 0
1609801976 390045 44467 21869 287 5640 402000 704282 14445 114618
1326060492 390046 144496 64117 259 5922 604415 737034 58010 0
1609263946 390048 8240 34578 0 0 770000 713518 70526 0
1639560550 390048 8240 34578 0 0 770000 713518 70526 0
1689061921 390048 8240 34578 0 0 770000 713518 70526 0
1750778981 390048 8240 34578 0 0 770000 713518 70526 0
1861545683 390048 8240 34578 0 0 770000 713518 70526 0
1013933175 390049 68656 32236 0 133798 607630 812851 80720 0
1548293954 390049 68656 32236 0 133798 607630 812851 80720 0
1285667493 390050 248542 77734 534 3112 387091 796212 40992 102104
1427022078 390052 0 0 0 4853 513732 713518 54310 0
1700878840 390056 0 0 0 0 597279 713518 10332 162968
1568459287 390057 0 0 0 0 450593 871284 95805 0
1689107328 390058 0 0 0 3047 554630 772501 64411 0
1083147656 390061 0 0 286 18710 628825 756413 80352 0
1497708473 390062 0 0 0 0 734000 748364 74055 0
1487647590 390063 52946 32583 539 6973 397020 734546 74261 0
1265466957 390065 0 0 0 0 736431 869383 88558 0
1407928500 390066 39353 17255 0 0 492272 772501 60119 0
1407813603 390067 130828 52674 433 2232 445000 772501 68772 0
1285167916 390068 58594 33076 854 0 193955 756413 77314 0
1528319621 390070 9153 2964 0 0 431480 871284 51023 0
1841712882 390071 0 0 0 0 686000 713518 71015 0
1316919699 390072 0 0 710 0 519617 716356 66296 0
1649278730 390073 37941 30974 410 25331 446000 748364 75643 0
1083685622 390076 0 0 411 33214 487369 871284 35009 133093
1083614382 390079 112108 37346 0 20184 634945 713518 24043 145000
1912902206 390080 7099 5644 0 0 387978 871284 26126 151113
1548624851 390081 29962 0 0 0 351953 871284 62882 0
1710409750 390084 0 0 0 0 554025 713518 49818 0
1144249657 390086 0 0 400 0 677485 713518 70532 0
1194744805 390090 174532 60762 649 37073 356554 796212 81483 0
1619069440 390091 0 0 0 3356 597181 713518 75765 0
1265422901 390093 30411 20351 0 0 620784 713518 5373 104580
1699734665 390096 26367 33298 859 3219 528137 745817 25495 70617
1750371522 390097 0 0 0 570 357027 871284 78616 0
1104875103 390100 56910 18259 0 19607 724335 756413 55602 0
1063945707 390101 92128 52381 390 0 497259 737034 52735 0
1750445607 390102 110841 116437 0 14691 462514 796212 86929 0
1790795359 390102 110841 116437 0 14691 462514 796212 86929 0
1861478307 390104 0 0 0 0 0 786093 72139 0
1225047699 390107 0 0 0 0 560569 796212 64438 0
1639218936 390107 0 0 0 0 560569 796212 64438 0
1801897038 390110 126380 68584 690 37359 416925 715053 24369 97585
1851370910 390111 539305 313211 1585 7937 321731 871284 23045 298224
1275620536 390112 0 0 0 0 607604 715053 7469 86068
1942276423 390113 0 0 1000 0 802026 729480 64743 0
1659435501 390114 147995 110633 1702 0 479453 796212 33779 136910
1952311508 390114 147995 110633 1702 0 479453 796212 33779 136910
1114095791 390115 60642 41217 671 31461 288789 871284 48777 85307
1205904885 390115 60642 41217 671 31461 288789 871284 48777 85307
1215952106 390115 60642 41217 671 31461 288789 871284 48777 85307
1801963343 390115 60642 41217 671 31461 288789 871284 48777 85307
1124495239 390116 219851 95443 268 894 449520 871284 93242 137830
1295724193 390117 0 0 0 0 726684 713518 57992 0
1578569885 390118 0 0 0 0 414013 713518 61876 0
1922376136 390119 24716 27385 0 0 428010 716356 6321 128657
1891768099 390123 0 0 0 0 475055 871284 77383 0
1124026182 390125 0 0 0 0 562680 713518 72139 0