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2022 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 823524 21136 159623
1255540647 390001 36081 15591 646 36277 485198 823524 21136 159623
1285032128 390001 36081 15591 646 36277 485198 823524 21136 159623
1326446253 390001 36081 15591 646 36277 485198 823524 21136 159623
1336526276 390001 36081 15591 646 36277 485198 823524 21136 159623
1366444507 390001 36081 15591 646 36277 485198 823524 21136 159623
1417334350 390001 36081 15591 646 36277 485198 823524 21136 159623
1467850149 390001 36081 15591 646 36277 485198 823524 21136 159623
1497132336 390001 36081 15591 646 36277 485198 823524 21136 159623
1548648272 390001 36081 15591 646 36277 485198 823524 21136 159623
1770960130 390001 36081 15591 646 36277 485198 823524 21136 159623
1972652063 390001 36081 15591 646 36277 485198 823524 21136 159623
1194734798 390002 135468 52932 414 0 551833 915327 86522 0
1942364898 390002 135468 52932 414 0 551833 915327 86522 0
1821198755 390003 0 0 297 0 579483 823524 80445 0
1841408739 390003 0 0 297 0 579483 823524 80445 0
1891852703 390003 0 0 297 0 579483 823524 80445 0
1881690212 390004 0 0 0 1397 498517 888070 70777 0
1013384809 390006 263657 107593 444 15014 508391 823524 71419 0
1033491741 390006 263657 107593 444 15014 508391 823524 71419 0
1063540011 390006 263657 107593 444 15014 508391 823524 71419 0
1063708501 390006 263657 107593 444 15014 508391 823524 71419 0
1154617694 390006 263657 107593 444 15014 508391 823524 71419 0
1235215427 390006 263657 107593 444 15014 508391 823524 71419 0
1245632231 390006 263657 107593 444 15014 508391 823524 71419 0
1275832164 390006 263657 107593 444 15014 508391 823524 71419 0
1275850620 390006 263657 107593 444 15014 508391 823524 71419 0
1417231937 390006 263657 107593 444 15014 508391 823524 71419 0
1427344969 390006 263657 107593 444 15014 508391 823524 71419 0
1457650343 390006 263657 107593 444 15014 508391 823524 71419 0
1467748475 390006 263657 107593 444 15014 508391 823524 71419 0
1528197720 390006 263657 107593 444 15014 508391 823524 71419 0
1659762862 390006 263657 107593 444 15014 508391 823524 71419 0
1669768289 390006 263657 107593 444 15014 508391 823524 71419 0
1770879215 390006 263657 107593 444 15014 508391 823524 71419 0
1851508162 390006 263657 107593 444 15014 508391 823524 71419 0
1982037966 390006 263657 107593 444 15014 508391 823524 71419 0
1982988408 390006 263657 107593 444 15014 508391 823524 71419 0
1861435042 390009 35262 16381 283 16884 388855 844436 89743 0
1386896306 390012 0 0 0 0 681384 1001631 89165 0
1124076039 390013 0 0 0 0 770580 820261 55624 0
1477538312 390016 0 0 383 46405 645555 915327 93673 0
1184148959 390026 102863 44440 0 0 700974 1001631 71200 0
1962579029 390027 369197 164426 3735 1000 346350 1001631 47525 215198
1568526135 390028 212670 105091 638 19969 407418 915327 99344 0
1881695146 390028 212670 105091 638 19969 407418 915327 99344 0
1235138405 390030 0 0 0 36715 651378 820261 82931 0
1689679581 390032 0 0 0 6702 511963 915327 93673 0
1669405072 390035 0 0 0 0 361107 1001631 102011 0
1063422053 390036 39427 27555 0 969 537674 915327 43097 77918
1588770416 390037 0 0 0 43300 635158 915327 96273 0
1912900168 390039 0 0 825 2588 541040 835249 89136 0
1871594127 390041 0 0 841 23769 496716 915327 93673 0
1609984889 390042 43209 30912 256 42196 0 915327 93673 0
1669530069 390044 84971 23313 0 21042 468000 857392 74501 0
1609801976 390045 44467 21869 287 5640 402000 809644 16606 131765
1326060492 390046 144496 64117 259 5922 604415 847296 66688 0
1609263946 390048 8240 34578 0 0 770000 820261 81077 0
1639560550 390048 8240 34578 0 0 770000 820261 81077 0
1689061921 390048 8240 34578 0 0 770000 820261 81077 0
1750778981 390048 8240 34578 0 0 770000 820261 81077 0
1861545683 390048 8240 34578 0 0 770000 820261 81077 0
1013933175 390049 68656 32236 0 133798 607630 934455 92795 0
1548293954 390049 68656 32236 0 133798 607630 934455 92795 0
1952399933 390049 68656 32236 0 133798 607630 934455 92795 0
1285667493 390050 248542 77734 534 3112 387091 915327 47125 117378
1700878840 390056 0 0 0 0 597279 820261 11877 187348
1568459287 390057 0 0 0 0 450593 1001631 110138 0
1689107328 390058 0 0 0 3047 554630 888070 74048 0
1497708473 390062 0 0 0 0 734000 860321 85134 0
1487647590 390063 52946 32583 539 6973 397020 844436 85371 0
1265466957 390065 0 0 0 0 736431 999444 101806 0
1407928500 390066 39353 17255 0 0 492272 888070 69113 0
1407813603 390067 130828 52674 433 2232 445000 888070 79061 0
1285167916 390068 58594 33076 854 0 193955 869575 88881 0
1528319621 390070 9153 2964 0 0 431480 1001631 58657 0
1841712882 390071 0 0 0 0 686000 820261 81639 0
1316919699 390072 0 0 710 0 519617 823524 76214 0
1649278730 390073 37941 30974 410 25331 446000 860321 86959 0
1194249961 390076 0 0 411 33214 487369 1001631 40246 153004
1083614382 390079 112108 37346 0 20184 634945 820261 27639 166693
1134734528 390079 112108 37346 0 20184 634945 820261 27639 166693
1548624851 390081 29962 0 0 0 351953 1001631 72289 0
1144249657 390086 0 0 400 0 677485 820261 81083 0
1316537228 390086 0 0 400 0 677485 820261 81083 0
1194744805 390090 174532 60762 649 37073 356554 915327 93673 0
1619069440 390091 0 0 0 3356 597181 820261 87100 0
1265422901 390093 30411 20351 0 0 620784 820261 6177 120226
1699734665 390096 26367 33298 859 3219 528137 857392 29309 81181
1750371522 390097 0 0 0 570 357027 1001631 90377 0
1104875103 390100 56910 18259 0 19607 724335 869575 63921 0
1245571942 390100 56910 18259 0 19607 724335 869575 63921 0
1063945707 390101 92128 52381 390 0 497259 847296 60624 0
1750445607 390102 110841 116437 0 14691 462514 915327 99934 0
1790795359 390102 110841 116437 0 14691 462514 915327 99934 0
1861478307 390104 0 0 0 0 0 903694 82931 0
1225047699 390107 0 0 0 0 560569 915327 74078 0
1639218936 390107 0 0 0 0 560569 915327 74078 0
1801897038 390110 126380 68584 690 37359 416925 822027 28014 112184
1851370910 390111 539305 313211 1585 7937 321731 1001631 26492 342839
1275620536 390112 0 0 0 0 607604 822027 8587 98944
1942276423 390113 0 0 1000 0 802026 838612 74429 0
1659435501 390114 147995 110633 1702 0 479453 915327 38832 157392
1952311508 390114 147995 110633 1702 0 479453 915327 38832 157392
1114095791 390115 60642 41217 671 31461 288789 1001631 56074 98070
1205904885 390115 60642 41217 671 31461 288789 1001631 56074 98070
1215952106 390115 60642 41217 671 31461 288789 1001631 56074 98070
1801963343 390115 60642 41217 671 31461 288789 1001631 56074 98070
1124495239 390116 219851 95443 268 894 449520 1001631 107192 158450
1295724193 390117 0 0 0 0 726684 820261 66668 0
1578569885 390118 0 0 0 0 414013 820261 71133 0
1922376136 390119 24716 27385 0 0 428010 823524 7267 147904
1649794421 390123 0 0 0 0 475055 1001631 88960 0
1124026182 390125 0 0 0 0 562680 820261 82931 0