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2020 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)
1528039039 390127 0 0 0 0 633294 898294 100348 0
1184620486 390130 0 0 0 0 672000 737220 51429 0
1164400131 390133 96119 30636 0 2145 517000 838049 76342 0
1255585303 390137 23063 14230 635 0 455845 738563 72429 0
1821091059 390138 0 0 0 0 791148 735637 53110 0
1508971441 390139 70978 34408 0 4335 408291 898294 87279 0
1902805245 390142 369904 212140 1506 4035 365688 898294 212550 0
1689691214 390145 0 0 360 1235 427067 820895 88329 0
1659360220 390146 0 0 0 0 566000 735637 72780 0
1912905548 390147 0 0 0 0 549750 820895 88386 0
1225417421 390150 0 0 0 0 591382 735637 71431 0
1972982882 390150 0 0 0 0 591382 735637 71431 0
1902804552 390151 0 0 0 0 640294 735637 49407 0
1215042114 390153 0 0 0 0 894406 898294 118732 0
1730173550 390156 159051 111309 1547 0 352862 898294 100915 0
1861486698 390156 159051 111309 1547 0 352862 898294 100915 0
1073598439 390157 0 0 0 35511 621777 820895 84009 0
1962401497 390160 0 0 0 0 539000 820895 84009 0
1740252964 390162 75610 51350 0 0 625314 838049 73300 0
1457408973 390163 0 0 374 0 591000 747475 65178 0
1568577724 390163 0 0 374 0 591000 747475 65178 0
1144384082 390164 429609 170349 862 7967 363586 820895 32692 250366
1821007881 390164 429609 170349 862 7967 363586 820895 32692 250366
1447317896 390168 0 0 732 0 515034 820895 16268 90182
1356334510 390173 0 0 0 0 537053 785993 22314 72834
1134297393 390174 52652 34199 731 45941 383273 898294 13823 180068
1215916002 390174 463742 229874 1399 15681 377172 898294 21558 250134
1225048838 390178 28914 1845 826 0 674040 755325 71144 0
1952465890 390178 28914 1845 826 0 674040 755325 71144 0
1356333579 390179 0 0 260 41582 430116 898294 53191 78157
1457715146 390180 112319 70954 923 9057 384000 898294 96568 0
1437182847 390183 0 0 0 0 569778 735637 74375 0
1144215039 390184 0 0 0 0 815338 820895 52332 0
1548322720 390185 18769 18809 0 15960 461393 738563 64825 0
1528061314 390189 0 0 0 0 1217656 796449 73797 0
1518256726 390192 0 0 0 0 635752 738563 62152 0
1356354567 390194 0 0 0 0 565986 824779 84975 0
1245335629 390195 146350 43945 0 21370 404312 898294 73738 0
1952399933 390197 65092 34620 353 4497 455759 838049 85694 0
1548263973 390198 157011 55037 1444 0 386206 757317 42478 0
1265449870 390199 0 0 840 0 649447 735637 65238 0
1568459436 390201 0 0 0 0 473822 1024054 74375 0
1225091697 390203 0 0 0 2762 460513 898294 138874 0
1124023015 390204 0 0 0 6730 410795 898294 119051 0
1184672214 390211 0 0 359 42894 516785 755325 76946 0
1144255159 390217 0 0 803 0 613350 820895 64873 0
1821015462 390219 51991 28021 360 3160 445265 820895 66469 0
1336110287 390220 0 0 0 0 469486 898294 38705 99236
1407856099 390222 0 0 0 0 402183 898294 65574 0
1245207521 390223 232106 71719 1750 19353 450145 898294 160842 0
1083615587 390225 0 0 0 0 676859 779862 75162 0
1548423684 390225 0 0 0 0 676859 779862 75162 0
1063489342 390226 0 79589 0 4412 431688 898294 7096 248755
1073587119 390228 0 0 0 0 490321 820895 86959 0
1811992084 390231 129440 54408 0 21332 366297 898294 106715 0
1730158981 390233 0 0 0 0 731036 759882 67671 0
1164421335 390236 0 0 0 0 645768 735637 76042 0
1336314384 390236 0 0 0 0 645768 735637 76042 0
1881983039 390237 15748 15537 0 1102 537339 738563 74674 0
1568435477 390256 543218 185283 516 1423 868053 796449 68026 0
1780686931 390258 0 0 0 0 941264 898294 54954 113735
1578560504 390265 0 0 0 0 506455 820895 84009 0
1023000296 390266 0 0 0 0 889640 755325 76370 0
1679592380 390267 51991 29760 0 0 527563 820895 84009 0
1104991801 390268 0 0 0 4552 868457 812453 78314 0
1730173154 390268 0 0 0 4552 868457 812453 78314 0
1780750620 390268 0 0 0 4552 868457 812453 78314 0
1093001653 390270 0 0 0 0 415541 738563 23689 104900
1104292960 390270 0 0 0 0 415541 738563 23689 104900
1174822068 390270 0 0 0 0 415541 738563 23689 104900
1205197894 390270 0 0 0 0 415541 738563 23689 104900
1235424672 390270 0 0 0 0 415541 738563 23689 104900
1265728810 390270 0 0 0 0 415541 738563 23689 104900
1275620585 390270 0 0 0 0 415541 738563 23689 104900
1447538640 390270 0 0 0 0 415541 738563 23689 104900
1649305129 390270 0 0 0 0 415541 738563 23689 104900
1649568403 390270 0 0 0 0 415541 738563 23689 104900
1669768214 390270 0 0 0 0 415541 738563 23689 104900
1760777106 390270 0 0 0 0 415541 738563 23689 104900
1770953994 390270 0 0 0 0 415541 738563 23689 104900
1861791865 390270 0 0 0 0 415541 738563 23689 104900
1881980803 390270 0 0 0 0 415541 738563 23689 104900
1528026671 390272 0 0 500 0 0 898294 33685 0
1467510560 390278 0 0 9140 0 0 898294 126899 0
1023033792 390290 402638 145927 1513 4863 330477 898294 146248 0
1043240351 390302 0 0 0 0 412000 898294 91487 0
1083986129 390304 0 0 294 52838 496395 898294 152194 0
1659392595 390307 0 0 0 0 403000 755325 76370 0
1780919043 390307 0 0 0 0 403000 755325 76370 0
1427097864 390314 0 0 0 0 300000 824779 83196 0
1124193511 390316 0 0 0 0 300000 768937 77727 0
1043456957 390321 0 0 0 0 284000 838049 83222 0
1336378132 390322 0 0 0 0 284000 898294 91487 0
1528398534 390323 0 0 0 0 278000 820895 84007 0
1265664544 390324 0 0 0 0 271000 898294 91487 0
1578881652 390325 0 0 0 0 271000 759882 76821 0
1962758375 390325 0 0 0 0 271000 759882 76821 0
1497050470 390326 0 0 0 0 271000 838049 83222 0
1760787576 390327 0 0 0 0 407000 759882 76821 0
1225323983 390328 0 0 0 0 268000 820895 84009 0
1104192590 390329 0 0 0 0 268000 898294 91487 0
1396194197 390330 0 0 0 0 389000 738563 74674 0
1881899284 390331 0 0 0 0 234000 898294 91487 0
1265096069 390332 0 0 0 0 344000 735637 76042 0
999993 999993 75972 37367 433 8021 431343 796449 80435 0