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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