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Medical Fee Review
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Fee Schedule
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Fee Schedule D Part I
Begin Main Content Area
Page Content
2021 Workers' Compensation Fee Schedule
Table D: Home Health Agency
NPI or Provider #
Provider #
MSA #
Skilled Nursing Rate
Physical Therapy Rate
Speech Therapy Rate
Occupational Therapy Rate
Social Services Rate
Home Aid Allowance
Implied Decimal 2 (in dollars)
1619953775
397001
6680
24261
23324
24233
23198
33638
13056
1386645323
397002
280
24586
23635
24564
23507
34087
13234
1437172301
397004
9280
24278
23332
24248
23207
33655
13067
1871548560
397006
9140
23590
22671
23564
22550
32708
12695
1912983974
397008
6160
28371
27268
28341
27112
39310
15268
1386631513
397009
6160
28371
27268
28341
27112
39310
15268
1215967468
397012
6160
28371
27268
28341
27112
39310
15268
1891755393
397013
4000
24877
23913
24853
23781
34490
13392
1225218761
397014
240
25880
24877
25849
24741
35876
13932
1467412296
397015
6160
28371
27268
28341
27112
39310
15268
1710129762
397021
7560
24048
23119
24020
22992
33340
12943
1821061979
397023
240
25880
24877
25849
24741
35876
13932
1831193598
397025
6160
28371
27268
28341
27112
39310
15268
1598725210
397028
39
23734
25291
26454
25514
39671
11032
1255328191
397029
39
23734
25291
26454
25514
39671
11032
1851394571
397031
7560
24048
23119
24020
22992
33340
12943
1184682528
397032
6160
28371
27268
28341
27112
39310
15268
1932196136
397034
2360
24564
23607
24539
23483
34058
13227
1396797163
397047
3240
25556
24567
25528
24427
35422
13759
1508946948
397050
7560
24048
23119
24020
22992
33340
12943
1043278500
397051
6160
28371
27268
28341
27112
39310
15268
1386631216
397053
39
23734
25291
26454
25514
39671
11032
1891817458
397061
9280
24278
23332
24248
23207
33655
13067
1891741138
397061
9280
24278
23332
24248
23207
33655
13067
1023098985
397071
6280
26415
25397
26390
25250
36615
14221
1811997315
397076
6280
26415
25397
26390
25250
36615
14221
1073579900
397083
6160
28371
27268
28341
27112
39310
15268
1366448268
397086
7560
24048
23119
24020
22992
33340
12943
1730250689
397087
280
24586
23635
24564
23507
34087
13234
1780687913
397089
2360
24564
23607
24539
23483
34058
13227
1063583797
397090
6280
26415
25397
26390
25250
36615
14221
1538143268
397091
39
23734
25291
26454
25514
39671
11032
1760471551
397092
39
23734
25291
26454
25514
39671
11032
1104889567
397094
39
23734
25291
26454
25514
39671
11032
1992705438
397095
39
23734
25291
26454
25514
39671
11032
1437259611
397096
39
23734
25291
26454
25514
39671
11032
1588693410
397097
39
23734
25291
26454
25514
39671
11032
1710941471
397101
39
23734
25291
26454
25514
39671
11032
1265857130
397102
7610
24257
23323
24232
23193
33635
13053
1972577617
397104
6160
28371
27268
28341
27112
39310
15268
1902825896
397105
240
25880
24877
25849
24741
35876
13932
1578503090
397107
6160
28371
27268
28341
27112
39310
15268
1790758928
397116
39
23734
25291
26454
25514
39671
11032
1265438733
397120
39
23734
25291
26454
25514
39671
11032
1992746366
397125
6160
28371
27268
28341
27112
39310
15268
1093702938
397126
8050
26170
25151
26135
25009
36264
14082
1265487029
397128
3240
25556
24567
25528
24427
35422
13759
1508139817
397129
39
23734
25291
26454
25514
39671
11032
1689673022
397130
39
23734
25291
26454
25514
39671
11032
1144203811
397133
39
23734
25291
26454
25514
39671
11032
1336485655
397134
6280
26415
25397
26390
25250
36615
14221
1598719379
397139
6280
26415
25397
26390
25250
36615
14221
1205839156
397141
6280
26415
25397
26390
25250
36615
14221
1164403358
397145
6160
28371
27268
28341
27112
39310
15268
1881004026
397157
2360
24564
23607
24539
23483
34058
13227
1801893219
397167
7560
24048
23119
24020
22992
33340
12943
1366431520
397173
39
23734
25291
26454
25514
39671
11032
1033213186
397183
6280
26415
25397
26390
25250
36615
14221
1659376887
397184
6160
28371
27268
28341
27112
39310
15268
1821027939
397188
6280
26415
25397
26390
25250
36615
14221
1982601852
397196
3680
24110
23175
24082
23052
33429
12983
1598810848
397197
6160
28371
27268
28341
27112
39310
15268
1245282714
397202
280
24586
23635
24564
23507
34087
13234
1306882709
397203
6160
28371
27268
28341
27112
39310
15268
1619956117
397212
6160
28371
27268
28341
27112
39310
15268
1457350548
397214
6680
24261
23324
24233
23198
33638
13056
1700997244
397221
6280
26415
25397
26390
25250
36615
14221
1598711038
397231
6160
28371
27268
28341
27112
39310
15268
1508823923
397232
39
23734
25291
26454
25514
39671
11032
1871590992
397234
6160
28371
27268
28341
27112
39310
15268
1780614412
397237
4000
24877
23913
24853
23781
34490
13392
1174519979
397250
3240
25556
24567
25528
24427
35422
13759
1134171309
397255
6280
26415
25397
26390
25250
36615
14221
1053362012
397259
6280
26415
25397
26390
25250
36615
14221
1366496556
397265
6160
28371
27268
28341
27112
39310
15268
1639103534
397272
7560
24048
23119
24020
22992
33340
12943
1407809114
397278
6280
26415
25397
26390
25250
36615
14221
1942255237
397282
6160
28371
27268
28341
27112
39310
15268
1053304345
397286
7560
24048
23119
24020
22992
33340
12943
1972642551
397294
6280
26415
25397
26390
25250
36615
14221
1518952456
397302
6160
28371
27268
28341
27112
39310
15268