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2019 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 21377 124776 22193 95212 0
1528049160 391674 GRANE HOSPICE-PITTSBURGH 0 0 0 0 0 0 22382 130642 23010 99377 0
1972918878 391693 GRANE HOSPICE-HOLLIDAYSBURG 0 0 0 0 0 0 21660 126422 22422 96381 0
1316352214 391732 GRANE HOSPICE-LEMOYNE 0 0 0 0 0 0 22814 133159 23362 101165 0
1851706873 391765 GRANE HOSPICE-KING OF PRUSSIA 0 0 0 0 0 0 24361 142190 24624 107577 0
1962583922 392300 GEISINGER MEDICAL CENTER-ESRD 0 0 0 0 0 0 0 0 0 0 27646
1780831198 392632 FRESEBIUS MEDICAL CARE PENN HILLS 0 0 0 0 0 0 0 0 0 0 29054
1083677587 392691 DCA OF MECHANICSBURG 0 0 0 0 0 0 0 0 0 0 28823
1306808472 392723 DUNMORE DIALYSIS 0 0 0 0 0 0 0 0 0 0 27646
1265739411 392786 USRC ALTOONA DIALYSIS CENTER 0 0 0 0 0 0 0 0 0 0 28320
1023384013 392791 WESTTOWN DIALYSIS 0 0 0 0 0 0 0 0 0 0 30610
1811257108 392803 SUBURBAN CAMPUS DIALYSIS 0 0 0 0 0 0 0 0 0 0 29054
1538391248 393518 GEISINGER MEDICAL CENTER-ESRD 0 0 0 0 0 0 0 0 0 0 27646
1215922471 394527 TRINDLE REHAB MEDICINE ASSOC 21569 0 0 0 0 0 0 0 0 0 0
1619911914 396578 MONTGOMERY COUNTY REHAB AND SPORTS THERAPY 21223 0 0 0 0 0 0 0 0 0 0
1851563076 396582 DR. DAVID POTOKER 0 0 14662 0 0 0 0 0 0 0 0
1295992683 396603 THERAPEUTIC REHAB (TRAC) 11445 0 33568 0 0 0 0 0 0 0 0
1972501757 396616 MAHONING PT/TWOLICK VALLEY PT 11775 0 0 0 0 0 0 0 0 0 0
1235519398 396854 GENESIS PROSTEP LLC D/B/A ADULT SERVICES UNLIMITED 34091 32195 42468 0 0 32195 0 0 0 0 0
999996 999996 OUT-OF-STATE PROVIDER 21569 0 0 0 0 0 0 0 0 0 0