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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)
1750805552 390127 0 0 0 0 633294 1001631 111892 0
1184620486 390130 0 0 0 0 672000 822027 57345 0
1164400131 390133 96119 30636 0 2145 517000 934455 85124 0
1255585303 390137 23063 14230 635 0 455845 823524 80761 0
1821091059 390138 0 0 0 0 791148 820261 59220 0
1508971441 390139 70978 34408 0 4335 408291 1001631 97319 0
1902805245 390142 369904 212140 1506 4035 365688 1001631 237001 0
1689691214 390145 0 0 360 1235 427067 915327 98490 0
1659360220 390146 0 0 0 0 566000 820261 81152 0
1912905548 390147 0 0 0 0 549750 915327 98554 0
1225417421 390150 0 0 0 0 591382 820261 79648 0
1972982882 390150 0 0 0 0 591382 820261 79648 0
1902804552 390151 0 0 0 0 640294 820261 55091 0
1215042114 390153 0 0 0 0 894406 1001631 132391 0
1730173550 390156 159051 111309 1547 0 352862 1001631 112524 0
1861486698 390156 159051 111309 1547 0 352862 1001631 112524 0
1073598439 390157 0 0 0 35511 621777 915327 93673 0
1962401497 390160 0 0 0 0 539000 915327 93673 0
1073047981 390162 75610 51350 0 0 625314 934455 81732 0
1457408973 390163 0 0 374 0 591000 833462 72676 0
1568577724 390163 0 0 374 0 591000 833462 72676 0
1144384082 390164 429609 170349 862 7967 363586 915327 36453 279167
1821007881 390164 429609 170349 862 7967 363586 915327 36453 279167
1447317896 390168 0 0 732 0 515034 915327 18139 100556
1356334510 390173 0 0 0 0 537053 876411 24880 81212
1134297393 390174 52652 34199 731 45941 383273 1001631 15413 200782
1215916002 390174 463742 229874 1399 15681 377172 1001631 24038 278908
1225048838 390178 28914 1845 826 0 674040 842215 79329 0
1952465890 390178 28914 1845 826 0 674040 842215 79329 0
1356333579 390179 0 0 260 41582 430116 1001631 59310 87148
1457715146 390180 112319 70954 923 9057 384000 1001631 107677 0
1437182847 390183 0 0 0 0 569778 820261 82931 0
1144215039 390184 0 0 0 0 815338 915327 58352 0
1548322720 390185 18769 18809 0 15960 461393 823524 72282 0
1518256726 390192 0 0 0 0 635752 823524 69302 0
1356354567 390194 0 0 0 0 565986 919658 94750 0
1245335629 390195 146350 43945 0 21370 404312 1001631 82221 0
1548263973 390198 157011 55037 1444 0 386206 844436 47365 0
1265449870 390199 0 0 840 0 649447 820261 72743 0
1568459436 390201 0 0 0 0 473822 1141857 82931 0
1225091697 390203 0 0 0 2762 460513 1001631 154849 0
1124023015 390204 0 0 0 6730 410795 1001631 132746 0
1184672214 390211 0 0 359 42894 516785 842215 85798 0
1144255159 390217 0 0 803 0 613350 915327 72336 0
1821015462 390219 51991 28021 360 3160 445265 915327 74116 0
1760906549 390220 0 0 0 0 469486 1001631 43157 110652
1407856099 390222 0 0 0 0 402183 1001631 73117 0
1245207521 390223 232106 71719 1750 19353 450145 1001631 179345 0
1083615587 390225 0 0 0 0 676859 869575 83808 0
1548423684 390225 0 0 0 0 676859 869575 83808 0
1063489342 390226 0 79589 0 4412 431688 1001631 7912 277371
1073587119 390228 0 0 0 0 490321 915327 96962 0
1811992084 390231 129440 54408 0 21332 366297 1001631 118991 0
1730158981 390233 0 0 0 0 731036 847296 75456 0
1881983039 390237 15748 15537 0 1102 537339 823524 83264 0
1568435477 390256 543218 185283 516 1423 868053 888070 75851 0
1780686931 390258 0 0 0 0 941264 1001631 61276 126819
1578560504 390265 0 0 0 0 506455 915327 93673 0
1023000296 390266 0 0 0 0 889640 842215 85155 0
1679592380 390267 51991 29760 0 0 527563 915327 93673 0
1104991801 390268 0 0 0 4552 868457 905915 87322 0
1730173154 390268 0 0 0 4552 868457 905915 87322 0
1780750620 390268 0 0 0 4552 868457 905915 87322 0
1093001653 390270 0 0 0 0 415541 823524 26414 116967
1104292960 390270 0 0 0 0 415541 823524 26414 116967
1174822068 390270 0 0 0 0 415541 823524 26414 116967
1205197894 390270 0 0 0 0 415541 823524 26414 116967
1235424672 390270 0 0 0 0 415541 823524 26414 116967
1265728810 390270 0 0 0 0 415541 823524 26414 116967
1275620585 390270 0 0 0 0 415541 823524 26414 116967
1447538640 390270 0 0 0 0 415541 823524 26414 116967
1649305129 390270 0 0 0 0 415541 823524 26414 116967
1649568403 390270 0 0 0 0 415541 823524 26414 116967
1669768214 390270 0 0 0 0 415541 823524 26414 116967
1760777106 390270 0 0 0 0 415541 823524 26414 116967
1770953994 390270 0 0 0 0 415541 823524 26414 116967
1861791865 390270 0 0 0 0 415541 823524 26414 116967
1881980803 390270 0 0 0 0 415541 823524 26414 116967
1528026671 390272 0 0 500 0 0 1001631 37561 0
1467510560 390278 0 0 9140 0 0 1001631 141497 0
1083986129 390304 0 0 294 52838 496395 1001631 169702 0
1659392595 390307 0 0 0 0 403000 842215 85155 0
1780919043 390307 0 0 0 0 403000 842215 85155 0
1225678881 390314 0 0 0 0 300000 919658 92767 0
1124193511 390316 0 0 0 0 300000 857392 86668 0
1033759626 390321 0 0 0 0 284000 934455 92795 0
1336378132 390322 0 0 0 0 284000 1001631 102011 0
1528398534 390323 0 0 0 0 278000 915327 93670 0
1265664544 390324 0 0 0 0 271000 1001631 102011 0
1578881652 390325 0 0 0 0 271000 847296 85658 0
1962758375 390325 0 0 0 0 271000 847296 85658 0
1497050470 390326 0 0 0 0 271000 934455 92795 0
1760787576 390327 0 0 0 0 407000 847296 85658 0
1225323983 390328 0 0 0 0 268000 915327 93673 0
1104192590 390329 0 0 0 0 268000 1001631 102011 0
1396194197 390330 0 0 0 0 389000 823524 83264 0
1881899284 390331 0 0 0 0 234000 1001631 102011 0
1265096069 390332 0 0 0 0 344000 820261 84790 0
1215598156 390333 0 0 0 0 326000 915327 93673 0
1285295899 390333 0 0 0 0 326000 915327 93673 0
1578124418 390333 0 0 0 0 326000 915327 93673 0
1699235374 390333 0 0 0 0 326000 915327 93673 0
1164029658 390336 0 0 0 0 326000 888070 75851 0
999993 999993 75972 37367 433 8021 431343 888070 89688 0
1609541853 BWC006 0 0 0 0 326000 820261 84790 0