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DLI
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Workers' Compensation
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Health Care Services Review
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Medical Fee Review
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Fee Schedule
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Fee Schedule A Part I
Begin Main Content Area
Page Content
Content Editor
2023 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
870465
22341
168722
1255540647
390001
36081
15591
646
36277
485198
870465
22341
168722
1285032128
390001
36081
15591
646
36277
485198
870465
22341
168722
1326446253
390001
36081
15591
646
36277
485198
870465
22341
168722
1336526276
390001
36081
15591
646
36277
485198
870465
22341
168722
1366444507
390001
36081
15591
646
36277
485198
870465
22341
168722
1417334350
390001
36081
15591
646
36277
485198
870465
22341
168722
1467850149
390001
36081
15591
646
36277
485198
870465
22341
168722
1497132336
390001
36081
15591
646
36277
485198
870465
22341
168722
1548648272
390001
36081
15591
646
36277
485198
870465
22341
168722
1770960130
390001
36081
15591
646
36277
485198
870465
22341
168722
1972652063
390001
36081
15591
646
36277
485198
870465
22341
168722
1194734798
390002
135468
52932
414
0
551833
967501
91454
0
1942364898
390002
135468
52932
414
0
551833
967501
91454
0
1821198755
390003
0
0
297
0
579483
870465
85030
0
1841408739
390003
0
0
297
0
579483
870465
85030
0
1891852703
390003
0
0
297
0
579483
870465
85030
0
1881690212
390004
0
0
0
1397
498517
938690
74811
0
1013384809
390006
263657
107593
444
15014
508391
870465
75490
0
1033491741
390006
263657
107593
444
15014
508391
870465
75490
0
1063540011
390006
263657
107593
444
15014
508391
870465
75490
0
1063708501
390006
263657
107593
444
15014
508391
870465
75490
0
1154617694
390006
263657
107593
444
15014
508391
870465
75490
0
1235215427
390006
263657
107593
444
15014
508391
870465
75490
0
1245632231
390006
263657
107593
444
15014
508391
870465
75490
0
1275832164
390006
263657
107593
444
15014
508391
870465
75490
0
1275850620
390006
263657
107593
444
15014
508391
870465
75490
0
1417231937
390006
263657
107593
444
15014
508391
870465
75490
0
1427344969
390006
263657
107593
444
15014
508391
870465
75490
0
1457650343
390006
263657
107593
444
15014
508391
870465
75490
0
1467748475
390006
263657
107593
444
15014
508391
870465
75490
0
1528197720
390006
263657
107593
444
15014
508391
870465
75490
0
1659762862
390006
263657
107593
444
15014
508391
870465
75490
0
1669768289
390006
263657
107593
444
15014
508391
870465
75490
0
1770879215
390006
263657
107593
444
15014
508391
870465
75490
0
1851508162
390006
263657
107593
444
15014
508391
870465
75490
0
1982037966
390006
263657
107593
444
15014
508391
870465
75490
0
1982988408
390006
263657
107593
444
15014
508391
870465
75490
0
1861435042
390009
35262
16381
283
16884
388855
892569
94858
0
1386896306
390012
0
0
0
0
681384
1058724
94247
0
1124076039
390013
0
0
0
0
770580
867016
58795
0
1477538312
390016
0
0
383
46405
645555
967501
99012
0
1437865953
390026
102863
44440
0
0
700974
1058724
75258
0
1962579029
390027
369197
164426
3735
1000
346350
1058724
50234
227464
1568526135
390028
212670
105091
638
19969
407418
967501
105007
0
1881695146
390028
212670
105091
638
19969
407418
967501
105007
0
1235138405
390030
0
0
0
36715
651378
867016
87658
0
1689679581
390032
0
0
0
6702
511963
967501
99012
0
1669405072
390035
0
0
0
0
361107
1058724
107826
0
1063422053
390036
39427
27555
0
969
537674
967501
45554
82359
1588770416
390037
0
0
0
43300
635158
967501
101761
0
1912900168
390039
0
0
825
2588
541040
882858
94217
0
1871594127
390041
0
0
841
23769
496716
967501
99012
0
1609984889
390042
43209
30912
256
42196
0
967501
99012
0
1669530069
390044
84971
23313
0
21042
468000
906263
78748
0
1609801976
390045
44467
21869
287
5640
402000
855794
17553
139276
1326060492
390046
144496
64117
259
5922
604415
895592
70489
0
1609263946
390048
8240
34578
0
0
770000
867016
85698
0
1639560550
390048
8240
34578
0
0
770000
867016
85698
0
1689061921
390048
8240
34578
0
0
770000
867016
85698
0
1750778981
390048
8240
34578
0
0
770000
867016
85698
0
1861545683
390048
8240
34578
0
0
770000
867016
85698
0
1013933175
390049
68656
32236
0
133798
607630
987719
98084
0
1548293954
390049
68656
32236
0
133798
607630
987719
98084
0
1952399933
390049
68656
32236
0
133798
607630
987719
98084
0
1285667493
390050
248542
77734
534
3112
387091
967501
49811
124069
1700878840
390056
0
0
0
0
597279
867016
12554
198027
1568459287
390057
0
0
0
0
450593
1058724
116416
0
1689107328
390058
0
0
0
3047
554630
938690
78269
0
1497708473
390062
0
0
0
0
734000
909359
89987
0
1487647590
390063
52946
32583
539
6973
397020
892569
90237
0
1265466957
390065
0
0
0
0
736431
1056412
107609
0
1407928500
390066
39353
17255
0
0
492272
938690
73052
0
1407813603
390067
130828
52674
433
2232
445000
938690
83567
0
1285167916
390068
58594
33076
854
0
193955
919141
93947
0
1528319621
390070
9153
2964
0
0
431480
1058724
62000
0
1841712882
390071
0
0
0
0
686000
867016
86292
0
1316919699
390072
0
0
710
0
519617
870465
80558
0
1649278730
390073
37941
30974
410
25331
446000
909359
91916
0
1083614382
390079
112108
37346
0
20184
634945
867016
29214
176195
1134734528
390079
112108
37346
0
20184
634945
867016
29214
176195
1548624851
390081
29962
0
0
0
351953
1058724
76409
0
1144249657
390086
0
0
400
0
677485
867016
85705
0
1316537228
390086
0
0
400
0
677485
867016
85705
0
1194744805
390090
174532
60762
649
37073
356554
967501
99012
0
1619069440
390091
0
0
0
3356
597181
867016
92065
0
1265422901
390093
30411
20351
0
0
620784
867016
6529
127079
1699734665
390096
26367
33298
859
3219
528137
906263
30980
85808
1750371522
390097
0
0
0
570
357027
1058724
95528
0
1104875103
390100
56910
18259
0
19607
724335
919141
67565
0
1245571942
390100
56910
18259
0
19607
724335
919141
67565
0
1063945707
390101
92128
52381
390
0
497259
895592
64080
0
1750445607
390102
110841
116437
0
14691
462514
967501
105630
0
1790795359
390102
110841
116437
0
14691
462514
967501
105630
0
1861478307
390104
0
0
0
0
0
955205
87658
0
1225047699
390107
0
0
0
0
560569
967501
78300
0
1639218936
390107
0
0
0
0
560569
967501
78300
0
1801897038
390110
126380
68584
690
37359
416925
868883
29611
118578
1851370910
390111
539305
313211
1585
7937
321731
1058724
28002
362381
1275620536
390112
0
0
0
0
607604
868883
9076
104584
1942276423
390113
0
0
1000
0
802026
886413
78671
0
1659435501
390114
147995
110633
1702
0
479453
967501
41045
166363
1952311508
390114
147995
110633
1702
0
479453
967501
41045
166363
1114095791
390115
60642
41217
671
31461
288789
1058724
59270
103660
1205904885
390115
60642
41217
671
31461
288789
1058724
59270
103660
1215952106
390115
60642
41217
671
31461
288789
1058724
59270
103660
1801963343
390115
60642
41217
671
31461
288789
1058724
59270
103660
1124495239
390116
219851
95443
268
894
449520
1058724
113302
167482
1295724193
390117
0
0
0
0
726684
867016
70468
0
1578569885
390118
0
0
0
0
414013
867016
75188
0
1922376136
390119
24716
27385
0
0
428010
870465
7681
156335
1649794421
390123
0
0
0
0
475055
1058724
94031
0
1124026182
390125
0
0
0
0
562680
867016
87658
0