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Workers' Compensation Services
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Misclassified Workers
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Finding Skilled Workers
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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
>
Fee Schedule A Part I
Begin Main Content Area
Page Content
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