Begin Main Content Area

2018 Workers' Compensation Fee Schedule

Table G: Physical Therapy Per Visit Based Provider
& OP End Stage Renal Dialysis Table

NPI or Provider # Prov. # Provider Name Rev Code 420-429 Rev Code 430-439 Rev Code 440-449 Rev Code 550-559 Rev Code 560-569 Rev Code 910-919 Routine Care Continuous Care Respite Care General Inpt Rev Code 820-859
Implied Decimal 2 (in dollars)
1063498541 391656 HOSPICE OF THE SACRED HEART 0 0 0 0 0 0 20896 121971 21694 93071 0
1528049160 391674 GRANE HOSPICE- PITTSBURGH 0 0 0 0 0 0 21879 127705 22493 97143 0
1972918878 391693 GRANE HOSPICE- HOLLIDAYSBURG 0 0 0 0 0 0 21173 123580 21918 94214 0
1316352214 391732 GRANE HOSPICE- LEMOYNE 0 0 0 0 0 0 22301 130165 22837 98891 0
1851706873 391765 GRANE HOSPICE- KING OF PRUSSIA 0 0 0 0 0 0 23813 138993 24070 105158 0
1962583922 392300 GEISINGER MEDICAL CENTER- ESRD 0 0 0 0 0 0 0 0 0 0 27024
1780831198 392632 FRESENIUS MEDICAL CARE- PENN HILLS 0 0 0 0 0 0 0 0 0 0 28401
1083677587 392691 DCA OF MECHANICSBURG 0 0 0 0 0 0 0 0 0 0 28175
1306808472 392723 DUNMORE DIALYSIS 0 0 0 0 0 0 0 0 0 0 27024
1265739411 392786 USRC ALTOONA DIALYSIS CENTER 0 0 0 0 0 0 0 0 0 0 27683
1023384013 392791 WESTTOWN DIALYSIS 0 0 0 0 0 0 0 0 0 0 29922
1811257108 392803 SUBURBAN CAMPUS DIALYSIS 0 0 0 0 0 0 0 0 0 0 28401
1538391248 393518 GEISINGER MEDICAL CENTER- ESRD 0 0 0 0 0 0 0 0 0 0 27024
1215922471 394527 TRINDLE REHAB MEDICINE ASSOC 21084 0 0 0 0 0 0 0 0 0 0
1619911914 396578 MONTGOMERY COUNTY REHAB SPORTS THERAPY 20746 0 0 0 0 0 0 0 0 0 0
1851563076 396582 DR. DAVID POTOKER 0 0 14332 0 0 0 0 0 0 0 0
1295992683 396603 THERAPEUTIC REHAB (TRAC) 11188 0 32813 0 0 0 0 0 0 0 0
1972501757 396616 MAHONING PT/TWOLICK VALLEY PT 11510 0 0 0 0 0 0 0 0 0 0
1235519398 396854 GENESIS PROSTEP LLC D/B/A ADULT SERVICES UNLIMITED 33325 31471 41513 0 0 31471 0 0 0 0 0
999996 999996 OUT-OF-STATE PROVIDER 21084 0 0 0 0 0 0 0 0 0 0