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Individuals
Individuals
Unemployment Benefits
Disability Services
Find A Job
Workers' Compensation Services
Workforce Development
PennSERVE
Individual Services
Uniform Construction Code
Labor Management Relations
Misclassified Workers
Businesses
Businesses
Employer UC Info
Finding Skilled Workers
Disability Services
Workforce Development
Workers' Compensation Services
Labor-Management Relations
Pennsylvania Business One-Stop
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Employer Services
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About L&I
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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
>
Fee Schedule
>
Fee Schedule A Part II
Begin Main Content Area
Page Content
2021 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
939616
104964
0
1184620486
390130
0
0
0
0
672000
771132
53795
0
1164400131
390133
96119
30636
0
2145
517000
876599
79854
0
1255585303
390137
23063
14230
635
0
455845
772537
75761
0
1821091059
390138
0
0
0
0
791148
769476
55553
0
1508971441
390139
70978
34408
0
4335
408291
939616
91294
0
1902805245
390142
369904
212140
1506
4035
365688
939616
222327
0
1689691214
390145
0
0
360
1235
427067
858656
92392
0
1659360220
390146
0
0
0
0
566000
769476
76128
0
1912905548
390147
0
0
0
0
549750
858656
92452
0
1225417421
390150
0
0
0
0
591382
769476
74717
0
1972982882
390150
0
0
0
0
591382
769476
74717
0
1902804552
390151
0
0
0
0
640294
769476
51680
0
1215042114
390153
0
0
0
0
894406
939616
124194
0
1730173550
390156
159051
111309
1547
0
352862
939616
105557
0
1861486698
390156
159051
111309
1547
0
352862
939616
105557
0
1073598439
390157
0
0
0
35511
621777
858656
87873
0
1962401497
390160
0
0
0
0
539000
858656
87873
0
1073047981
390162
75610
51350
0
0
625314
876599
76672
0
1457408973
390163
0
0
374
0
591000
781859
68176
0
1568577724
390163
0
0
374
0
591000
781859
68176
0
1144384082
390164
429609
170349
862
7967
363586
858656
34196
261883
1821007881
390164
429609
170349
862
7967
363586
858656
34196
261883
1447317896
390168
0
0
732
0
515034
858656
17016
94330
1356334510
390173
0
0
0
0
537053
822149
23340
76184
1134297393
390174
52652
34199
731
45941
383273
939616
14459
188351
1215916002
390174
463742
229874
1399
15681
377172
939616
22550
261640
1225048838
390178
28914
1845
826
0
674040
790070
74417
0
1952465890
390178
28914
1845
826
0
674040
790070
74417
0
1356333579
390179
0
0
260
41582
430116
939616
55638
81752
1457715146
390180
112319
70954
923
9057
384000
939616
101010
0
1437182847
390183
0
0
0
0
569778
769476
77796
0
1144215039
390184
0
0
0
0
815338
858656
54739
0
1548322720
390185
18769
18809
0
15960
461393
772537
67807
0
1528061314
390189
0
0
0
0
1217656
833086
77192
0
1518256726
390192
0
0
0
0
635752
772537
65011
0
1356354567
390194
0
0
0
0
565986
862719
88884
0
1245335629
390195
146350
43945
0
21370
404312
939616
77130
0
1952399933
390197
65092
34620
353
4497
455759
876599
89636
0
1548263973
390198
157011
55037
1444
0
386206
792154
44432
0
1265449870
390199
0
0
840
0
649447
769476
68239
0
1568459436
390201
0
0
0
0
473822
1071160
77796
0
1225091697
390203
0
0
0
2762
460513
939616
145262
0
1124023015
390204
0
0
0
6730
410795
939616
124527
0
1184672214
390211
0
0
359
42894
516785
790070
80486
0
1144255159
390217
0
0
803
0
613350
858656
67857
0
1821015462
390219
51991
28021
360
3160
445265
858656
69527
0
1760906549
390220
0
0
0
0
469486
939616
40485
103801
1407856099
390222
0
0
0
0
402183
939616
68590
0
1245207521
390223
232106
71719
1750
19353
450145
939616
168241
0
1083615587
390225
0
0
0
0
676859
815736
78619
0
1548423684
390225
0
0
0
0
676859
815736
78619
0
1063489342
390226
0
79589
0
4412
431688
939616
7422
260198
1073587119
390228
0
0
0
0
490321
858656
90959
0
1811992084
390231
129440
54408
0
21332
366297
939616
111624
0
1730158981
390233
0
0
0
0
731036
794837
70784
0
1164421335
390236
0
0
0
0
645768
769476
79540
0
1336314384
390236
0
0
0
0
645768
769476
79540
0
1881983039
390237
15748
15537
0
1102
537339
772537
78109
0
1568435477
390256
543218
185283
516
1423
868053
833086
71155
0
1780686931
390258
0
0
0
0
941264
939616
57482
118967
1578560504
390265
0
0
0
0
506455
858656
87873
0
1023000296
390266
0
0
0
0
889640
790070
79883
0
1679592380
390267
51991
29760
0
0
527563
858656
87873
0
1104991801
390268
0
0
0
4552
868457
849826
81916
0
1730173154
390268
0
0
0
4552
868457
849826
81916
0
1780750620
390268
0
0
0
4552
868457
849826
81916
0
1093001653
390270
0
0
0
0
415541
772537
24779
109725
1104292960
390270
0
0
0
0
415541
772537
24779
109725
1174822068
390270
0
0
0
0
415541
772537
24779
109725
1205197894
390270
0
0
0
0
415541
772537
24779
109725
1235424672
390270
0
0
0
0
415541
772537
24779
109725
1265728810
390270
0
0
0
0
415541
772537
24779
109725
1275620585
390270
0
0
0
0
415541
772537
24779
109725
1447538640
390270
0
0
0
0
415541
772537
24779
109725
1649305129
390270
0
0
0
0
415541
772537
24779
109725
1649568403
390270
0
0
0
0
415541
772537
24779
109725
1669768214
390270
0
0
0
0
415541
772537
24779
109725
1760777106
390270
0
0
0
0
415541
772537
24779
109725
1770953994
390270
0
0
0
0
415541
772537
24779
109725
1861791865
390270
0
0
0
0
415541
772537
24779
109725
1881980803
390270
0
0
0
0
415541
772537
24779
109725
1528026671
390272
0
0
500
0
0
939616
35235
0
1467510560
390278
0
0
9140
0
0
939616
132736
0
1083986129
390304
0
0
294
52838
496395
939616
159195
0
1659392595
390307
0
0
0
0
403000
790070
79883
0
1780919043
390307
0
0
0
0
403000
790070
79883
0
1225678881
390314
0
0
0
0
300000
862719
87023
0
1124193511
390316
0
0
0
0
300000
804308
81302
0
1033759626
390321
0
0
0
0
284000
876599
87050
0
1336378132
390322
0
0
0
0
284000
939616
95695
0
1528398534
390323
0
0
0
0
278000
858656
87871
0
1265664544
390324
0
0
0
0
271000
939616
95695
0
1578881652
390325
0
0
0
0
271000
794837
80355
0
1962758375
390325
0
0
0
0
271000
794837
80355
0
1497050470
390326
0
0
0
0
271000
876599
87050
0
1760787576
390327
0
0
0
0
407000
794837
80355
0
1225323983
390328
0
0
0
0
268000
858656
87873
0
1104192590
390329
0
0
0
0
268000
939616
95695
0
1396194197
390330
0
0
0
0
389000
772537
78109
0
1881899284
390331
0
0
0
0
234000
939616
95695
0
1265096069
390332
0
0
0
0
344000
769476
79540
0
1215598156
390333
0
0
0
0
326000
858656
87873
0
1285295899
390333
0
0
0
0
326000
858656
87873
0
1578124418
390333
0
0
0
0
326000
858656
87873
0
1699215374
390333
0
0
0
0
326000
858656
87873
0
999993
999993
75972
37367
433
8021
431343
833086
84135
0