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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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Fee Schedule
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Fee Schedule 11644-15278
Begin Main Content Area
Page Content
2021 Workers' Compensation Part B Fee Schedule
11644-15278
View the PDF
CPT/HCPC Code
Modifier
Medicare Location
Global Surgery Indicator
Multiple Surgery Indicator
Prevailing Charge Amount
Fee Schedule Amount
Site of Service Amount
11644
3
10
2
X
742.60
X
11644
4
10
2
X
759.06
X
11644
2
10
2
X
784.30
X
11644
1
10
2
X
794.30
X
11646
4
10
2
X
949.79
X
11646
3
10
2
X
961.03
X
11646
2
10
2
X
1,021.41
X
11646
1
10
2
X
1,036.03
X
11719
2
0
2
X
27.52
13.57
11719
3
0
2
X
27.52
13.57
11719
4
0
2
X
27.52
13.57
11719
1
0
2
X
31.55
15.19
11720
3
0
0
X
57.82
43.70
11720
4
0
0
X
57.82
43.70
11720
2
0
0
X
59.40
44.97
11720
1
0
0
X
65.52
48.95
11721
3
0
0
X
97.46
73.81
11721
4
0
0
X
97.46
73.81
11721
2
0
0
X
100.15
75.82
11721
1
0
0
X
110.50
82.50
11730
3
0
2
X
118.68
102.49
11730
4
0
2
X
124.63
107.80
11730
1
0
2
X
136.43
117.93
11730
2
0
2
X
138.02
119.42
11732
4
ZZZ
0
X
56.62
46.07
11732
3
ZZZ
0
X
57.33
46.59
11732
2
ZZZ
0
X
60.30
48.87
11732
1
ZZZ
0
X
60.97
49.47
11740
4
0
2
X
73.57
55.96
11740
1
0
2
X
75.88
57.81
11740
3
0
2
X
86.82
65.95
11740
2
0
2
X
87.92
66.89
11750
4
10
2
X
345.47
255.80
11750
1
10
2
X
377.60
279.77
11750
2
10
2
X
389.79
289.05
11750
3
10
2
X
425.57
315.33
11755
4
0
2
X
212.52
X
11755
3
0
2
X
215.03
X
11755
2
0
2
X
227.98
X
11755
1
0
2
X
231.10
X
11760
4
10
2
X
176.85
145.60
11760
3
10
2
X
178.32
147.16
11760
1
10
2
X
184.10
151.23
11760
2
10
2
X
185.11
152.53
11762
3
10
2
X
376.77
292.55
11762
4
10
2
X
380.07
295.36
11762
2
10
2
X
397.88
309.67
11762
1
10
2
X
404.56
313.82
11765
2
10
2
X
122.07
96.36
11765
4
10
2
X
144.43
114.15
11765
3
10
2
X
146.74
115.88
11765
1
10
2
X
152.87
120.66
11770
2
10
2
X
575.47
X
11770
4
10
2
X
686.53
X
11770
3
10
2
X
737.20
X
11770
1
10
2
X
834.32
X
11771
4
90
2
X
932.41
X
11771
3
90
2
X
943.31
X
11771
1
90
2
X
1,034.15
X
11771
2
90
2
X
1,043.49
X
11772
4
90
2
X
1,074.13
X
11772
3
90
2
X
1,076.22
X
11772
2
90
2
X
1,167.49
X
11772
1
90
2
X
1,187.19
X
11900
4
0
2
X
69.96
59.42
11900
3
0
2
X
70.77
60.02
11900
2
0
2
X
74.04
62.60
11900
1
0
2
X
74.86
63.29
11901
4
0
2
X
109.25
91.92
11901
3
0
2
X
110.49
92.87
11901
2
0
2
X
115.58
97.01
11901
1
0
2
X
116.87
97.97
11920
0
2
X
*
X
11921
0
2
X
*
X
11922
ZZZ
0
X
*
X
11950
0
2
X
*
X
11951
0
2
X
*
X
11952
0
2
X
*
X
11954
0
2
X
*
X
11960
4
90
2
X
1,338.32
X
11960
3
90
2
X
1,354.67
X
11960
2
90
2
X
1,469.91
X
11960
1
90
2
X
1,497.84
X
11970
4
90
2
X
1,470.09
X
11970
3
90
2
X
1,488.13
X
11970
1
90
2
X
1,644.46
X
11970
2
90
2
X
1,996.42
X
11971
4
90
2
X
544.38
X
11971
1
90
2
X
623.06
X
11971
3
90
2
X
760.63
X
11971
2
90
2
X
785.28
X
11976
XXX
2
X
*
X
11980
2
0
2
X
222.85
158.02
11980
3
0
2
X
222.85
158.02
11980
4
0
2
X
222.85
158.02
11980
1
0
2
X
249.52
173.64
11981
2
XXX
2
X
212.52
148.21
11981
3
XXX
2
X
212.52
148.21
11981
4
XXX
2
X
212.52
148.21
11981
1
XXX
2
X
240.23
164.71
11982
2
XXX
2
X
242.68
178.37
11982
3
XXX
2
X
242.68
178.37
11982
4
XXX
2
X
242.68
178.37
11982
1
XXX
2
X
273.88
198.29
11983
2
XXX
2
X
394.94
330.62
11983
3
XXX
2
X
394.94
330.62
11983
4
XXX
2
X
394.94
330.62
11983
1
XXX
2
X
442.93
367.37
12001
3
10
2
X
164.08
X
12001
4
10
2
X
165.58
X
12001
2
10
2
X
182.51
X
12001
1
10
2
X
186.28
X
12002
4
10
2
X
221.28
X
12002
3
10
2
X
223.73
X
12002
1
10
2
X
229.83
X
12002
2
10
2
X
232.66
X
12004
1
10
2
X
261.87
X
12004
3
10
2
X
319.07
X
12004
4
10
2
X
324.89
X
12004
2
10
2
X
325.47
X
12005
4
10
2
X
398.57
X
12005
3
10
2
X
409.72
X
12005
2
10
2
X
413.98
X
12005
1
10
2
X
419.52
X
12006
3
10
2
X
467.65
X
12006
4
10
2
X
468.98
X
12006
2
10
2
X
491.16
X
12006
1
10
2
X
496.82
X
12007
4
10
2
X
536.65
X
12007
3
10
2
X
542.72
X
12007
2
10
2
X
568.86
X
12007
1
10
2
X
575.17
X
12011
4
10
2
X
178.27
X
12011
3
10
2
X
178.63
X
12011
2
10
2
X
196.65
X
12011
1
10
2
X
203.76
X
12013
1
10
2
X
242.57
X
12013
4
10
2
X
243.25
X
12013
2
10
2
X
255.38
X
12013
3
10
2
X
257.15
X
12014
4
10
2
X
268.70
X
12014
1
10
2
X
270.79
X
12014
2
10
2
X
286.08
X
12014
3
10
2
X
293.12
X
12015
1
10
2
X
339.51
X
12015
3
10
2
X
409.56
X
12015
2
10
2
X
435.35
X
12015
4
10
2
X
442.00
X
12016
4
10
2
X
522.84
X
12016
3
10
2
X
584.58
X
12016
2
10
2
X
657.87
X
12016
1
10
2
X
713.02
X
12017
3
10
2
X
694.64
X
12017
1
10
2
X
741.68
X
12017
4
10
2
X
838.56
X
12017
2
10
2
X
857.93
X
12018
4
10
2
X
976.31
X
12018
3
10
2
X
988.43
X
12018
2
10
2
X
1,047.39
X
12018
1
10
2
X
1,061.54
X
12020
3
10
2
X
372.87
X
12020
1
10
2
X
376.17
X
12020
2
10
2
X
382.90
X
12020
4
10
2
X
393.71
X
12021
4
10
2
X
427.04
X
12021
3
10
2
X
444.97
X
12021
1
10
2
X
489.93
X
12021
2
10
2
X
490.20
X
12031
4
10
2
X
209.11
X
12031
3
10
2
X
212.80
X
12031
2
10
2
X
228.14
X
12031
1
10
2
X
235.90
X
12032
1
10
2
X
261.79
X
12032
4
10
2
X
273.12
X
12032
3
10
2
X
280.51
X
12032
2
10
2
X
287.34
X
12034
1
10
2
X
346.36
X
12034
4
10
2
X
396.90
X
12034
3
10
2
X
401.45
X
12034
2
10
2
X
423.37
X
12035
4
10
2
X
488.26
X
12035
3
10
2
X
493.91
X
12035
2
10
2
X
520.76
X
12035
1
10
2
X
527.26
X
12036
4
10
2
X
590.55
X
12036
3
10
2
X
602.86
X
12036
2
10
2
X
624.51
X
12036
1
10
2
X
636.64
X
12037
4
10
2
X
722.39
X
12037
3
10
2
X
730.77
X
12037
2
10
2
X
777.04
X
12037
1
10
2
X
788.35
X
12041
4
10
2
X
211.55
X
12041
3
10
2
X
217.15
X
12041
2
10
2
X
233.27
X
12041
1
10
2
X
244.45
X
12042
4
10
2
X
287.63
X
12042
2
10
2
X
304.30
X
12042
1
10
2
X
307.21
X
12042
3
10
2
X
308.12
X
12044
1
10
2
X
291.34
X
12044
4
10
2
X
403.25
X
12044
3
10
2
X
407.91
X
12044
2
10
2
X
428.72
X
12045
4
10
2
X
491.07
X
12045
3
10
2
X
496.75
X
12045
2
10
2
X
523.33
X
12045
1
10
2
X
529.76
X
12046
4
10
2
X
651.46
X
12046
3
10
2
X
661.01
X
12046
2
10
2
X
698.18
X
12046
1
10
2
X
707.70
X
12047
4
10
2
X
755.54
X
12047
3
10
2
X
764.64
X
12047
2
10
2
X
815.58
X
12047
1
10
2
X
827.87
X
12051
4
10
2
X
245.75
X
12051
3
10
2
X
257.69
X
12051
2
10
2
X
272.43
X
12051
1
10
2
X
286.84
X
12052
4
10
2
X
329.63
X
12052
3
10
2
X
345.76
X
12052
1
10
2
X
354.61
X
12052
2
10
2
X
361.36
X
12053
4
10
2
X
365.69
X
12053
2
10
2
X
378.18
X
12053
3
10
2
X
398.22
X
12053
1
10
2
X
407.49
X
12054
4
10
2
X
551.09
X
12054
3
10
2
X
557.74
X
12054
2
10
2
X
589.00
X
12054
1
10
2
X
684.46
X
12055
4
10
2
X
703.78
X
12055
3
10
2
X
712.25
X
12055
2
10
2
X
753.89
X
12055
1
10
2
X
763.97
X
12056
4
10
2
X
918.63
X
12056
3
10
2
X
929.94
X
12056
2
10
2
X
987.72
X
12056
1
10
2
X
1,001.70
X
12057
4
10
2
X
1,050.94
X
12057
3
10
2
X
1,063.97
X
12057
2
10
2
X
1,126.00
X
12057
1
10
2
X
1,140.92
X
13100
4
10
2
X
337.31
X
13100
3
10
2
X
340.59
X
13100
2
10
2
X
355.71
X
13100
1
10
2
X
361.65
X
13101
4
10
2
X
479.84
X
13101
3
10
2
X
480.37
X
13101
2
10
2
X
499.53
X
13101
1
10
2
X
503.43
X
13102
2
ZZZ
0
X
148.36
138.42
13102
3
ZZZ
0
X
148.36
138.42
13102
4
ZZZ
0
X
148.36
138.42
13102
1
ZZZ
0
X
163.76
152.10
13120
3
10
2
X
359.46
X
13120
4
10
2
X
368.33
X
13120
2
10
2
X
382.79
X
13120
1
10
2
X
386.03
X
13121
3
10
2
X
555.68
X
13121
4
10
2
X
563.03
X
13121
2
10
2
X
589.15
X
13121
1
10
2
X
594.19
X
13122
2
ZZZ
0
X
172.53
160.44
13122
3
ZZZ
0
X
172.53
160.44
13122
4
ZZZ
0
X
172.53
160.44
13122
1
ZZZ
0
X
190.34
176.19
13131
4
10
2
X
437.28
X
13131
3
10
2
X
468.11
X
13131
1
10
2
X
487.98
X
13131
2
10
2
X
488.54
X
13132
4
10
2
X
737.95
X
13132
3
10
2
X
743.74
X
13132
2
10
2
X
775.66
X
13132
1
10
2
X
783.46
X
13133
2
ZZZ
0
X
255.72
243.58
13133
3
ZZZ
0
X
255.72
243.58
13133
4
ZZZ
0
X
255.72
243.58
13133
1
ZZZ
0
X
281.07
266.90
13151
4
10
2
X
642.09
X
13151
3
10
2
X
646.18
X
13151
2
10
2
X
666.10
X
13151
1
10
2
X
672.44
X
13152
4
10
2
X
1,064.48
X
13152
3
10
2
X
1,077.19
X
13152
2
10
2
X
1,146.08
X
13152
1
10
2
X
1,162.74
X
13153
2
ZZZ
0
X
280.81
265.16
13153
3
ZZZ
0
X
280.81
265.16
13153
4
ZZZ
0
X
280.81
265.16
13153
1
ZZZ
0
X
309.54
291.22
13160
4
90
2
X
1,191.46
X
13160
3
90
2
X
1,193.81
X
13160
2
90
2
X
1,238.06
X
13160
1
90
2
X
1,242.71
X
14000
4
90
2
X
813.19
X
14000
3
90
2
X
822.69
X
14000
2
90
2
X
868.00
X
14000
1
90
2
X
878.89
X
14001
4
90
2
X
1,173.54
X
14001
3
90
2
X
1,187.04
X
14001
1
90
2
X
1,234.70
X
14001
2
90
2
X
1,260.51
X
14020
4
90
2
X
1,009.36
X
14020
3
90
2
X
1,021.61
X
14020
2
90
2
X
1,080.94
X
14020
1
90
2
X
1,095.31
X
14021
4
90
2
X
1,456.91
X
14021
1
90
2
X
1,588.12
X
14021
3
90
2
X
1,597.49
X
14021
2
90
2
X
1,623.19
X
14040
1
90
2
X
1,519.35
X
14040
3
90
2
X
1,535.83
X
14040
4
90
2
X
1,567.08
X
14040
2
90
2
X
1,574.17
X
14041
4
90
2
X
1,730.45
X
14041
3
90
2
X
1,750.90
X
14041
2
90
2
X
1,857.87
X
14041
1
90
2
X
1,905.36
X
14060
4
90
2
X
1,688.17
X
14060
1
90
2
X
1,706.37
X
14060
3
90
2
X
1,739.40
X
14060
2
90
2
X
1,803.94
X
14061
4
90
2
X
2,037.32
X
14061
3
90
2
X
2,062.28
X
14061
2
90
2
X
2,194.49
X
14061
1
90
2
X
2,226.39
X
14301
2
90
2
X
1,497.31
1,276.40
14301
3
90
2
X
1,497.31
1,276.40
14301
4
90
2
X
1,497.31
1,276.40
14301
1
90
2
X
1,691.84
1,429.81
14302
2
ZZZ
0
X
333.40
X
14302
3
ZZZ
0
X
333.40
X
14302
4
ZZZ
0
X
333.40
X
14302
1
ZZZ
0
X
370.74
X
14350
4
90
2
X
1,426.57
X
14350
3
90
2
X
1,443.01
X
14350
2
90
2
X
1,501.64
X
14350
1
90
2
X
1,554.90
X
15002
2
0
0
X
434.70
302.96
15002
3
0
0
X
434.70
302.96
15002
4
0
0
X
434.70
302.96
15002
1
0
0
X
504.97
343.78
15003
2
ZZZ
0
X
96.37
62.24
15003
3
ZZZ
0
X
96.37
62.24
15003
4
ZZZ
0
X
96.37
62.24
15003
1
ZZZ
0
X
112.06
70.29
15004
2
0
0
X
524.61
375.26
15004
3
0
0
X
524.61
375.26
15004
4
0
0
X
524.61
375.26
15004
1
0
0
X
608.22
425.48
15005
2
ZZZ
0
X
162.88
124.49
15005
3
ZZZ
0
X
162.88
124.49
15005
4
ZZZ
0
X
162.88
124.49
15005
1
ZZZ
0
X
187.56
140.56
15040
2
0
0
X
391.92
199.37
15040
3
0
0
X
391.92
199.37
15040
4
0
0
X
391.92
199.37
15040
1
0
0
X
459.80
224.14
15050
4
90
2
X
923.56
X
15050
3
90
2
X
927.61
X
15050
2
90
2
X
948.14
X
15050
1
90
2
X
967.55
X
15100
4
90
2
X
1,541.70
X
15100
3
90
2
X
1,547.37
X
15100
2
90
2
X
1,580.22
X
15100
1
90
2
X
1,588.22
X
15101
3
ZZZ
0
X
1,167.20
X
15101
4
ZZZ
0
X
1,176.02
X
15101
1
ZZZ
0
X
1,185.22
X
15101
2
ZZZ
0
X
1,186.69
X
15110
2
90
2
X
1,253.90
1,047.94
15110
3
90
2
X
1,253.90
1,047.94
15110
4
90
2
X
1,253.90
1,047.94
15110
1
90
2
X
1,444.61
1,192.48
15111
2
ZZZ
0
X
200.00
172.04
15111
3
ZZZ
0
X
200.00
172.04
15111
4
ZZZ
0
X
200.00
172.04
15111
1
ZZZ
0
X
227.35
193.12
15115
2
90
2
X
1,183.96
1,078.75
15115
3
90
2
X
1,183.96
1,078.75
15115
4
90
2
X
1,183.96
1,078.75
15115
1
90
2
X
1,351.04
1,222.24
15116
2
ZZZ
0
X
260.08
234.30
15116
3
ZZZ
0
X
260.08
234.30
15116
4
ZZZ
0
X
260.08
234.30
15116
1
ZZZ
0
X
294.24
262.72
15120
4
90
2
X
2,300.20
X
15120
3
90
2
X
2,307.12
X
15120
2
90
2
X
2,345.16
X
15120
1
90
2
X
2,354.36
X
15121
3
ZZZ
0
X
543.24
X
15121
4
ZZZ
0
X
1,825.44
X
15121
2
ZZZ
0
X
1,846.31
X
15121
1
ZZZ
0
X
1,850.74
X
15130
2
90
2
X
1,036.43
838.85
15130
3
90
2
X
1,036.43
838.85
15130
4
90
2
X
1,036.43
838.85
15130
1
90
2
X
1,202.25
960.43
15131
2
ZZZ
0
X
163.47
139.39
15131
3
ZZZ
0
X
163.47
139.39
15131
4
ZZZ
0
X
163.47
139.39
15131
1
ZZZ
0
X
185.92
156.46
15135
2
90
2
X
1,267.17
1,169.22
15135
3
90
2
X
1,267.17
1,169.22
15135
4
90
2
X
1,267.17
1,169.22
15135
1
90
2
X
1,445.92
1,326.11
15136
2
ZZZ
0
X
152.87
140.56
15136
3
ZZZ
0
X
152.87
140.56
15136
4
ZZZ
0
X
152.87
140.56
15136
1
ZZZ
0
X
172.75
157.67
15150
2
90
2
X
1,043.58
930.52
15150
3
90
2
X
1,043.58
930.52
15150
4
90
2
X
1,043.58
930.52
15150
1
90
2
X
1,199.09
1,060.70
15151
2
ZZZ
0
X
211.46
185.68
15151
3
ZZZ
0
X
211.46
185.68
15151
4
ZZZ
0
X
211.46
185.68
15151
1
ZZZ
0
X
239.90
208.43
15152
2
ZZZ
0
X
259.95
231.95
15152
3
ZZZ
0
X
259.95
231.95
15152
4
ZZZ
0
X
259.95
231.95
15152
1
ZZZ
0
X
294.58
260.33
15155
2
90
2
X
1,049.78
1,001.65
15155
3
90
2
X
1,049.78
1,001.65
15155
4
90
2
X
1,049.78
1,001.65
15155
1
90
2
X
1,194.80
1,135.86
15156
2
ZZZ
0
X
275.97
258.04
15156
3
ZZZ
0
X
275.97
258.04
15156
4
ZZZ
0
X
275.97
258.04
15156
1
ZZZ
0
X
311.22
289.27
15157
2
ZZZ
0
X
305.25
281.22
15157
3
ZZZ
0
X
305.25
281.22
15157
4
ZZZ
0
X
305.25
281.22
15157
1
ZZZ
0
X
344.59
315.16
15200
1
90
2
X
1,180.77
X
15200
3
90
2
X
1,422.75
X
15200
4
90
2
X
1,490.40
X
15200
2
90
2
X
1,514.39
X
15201
4
ZZZ
0
X
371.87
X
15201
3
ZZZ
0
X
376.53
X
15201
2
ZZZ
0
X
413.03
X
15201
1
ZZZ
0
X
421.93
X
15220
4
90
2
X
1,537.29
X
15220
3
90
2
X
1,545.38
X
15220
1
90
2
X
1,607.42
X
15220
2
90
2
X
1,616.69
X
15221
4
ZZZ
0
X
356.08
X
15221
3
ZZZ
0
X
360.60
X
15221
2
ZZZ
0
X
1,150.31
X
15221
1
ZZZ
0
X
1,154.03
X
15240
3
90
2
X
1,522.35
X
15240
4
90
2
X
1,549.48
X
15240
2
90
2
X
1,591.70
X
15240
1
90
2
X
1,604.49
X
15241
4
ZZZ
0
X
1,252.95
X
15241
3
ZZZ
0
X
1,255.57
X
15241
2
ZZZ
0
X
1,274.30
X
15241
1
ZZZ
0
X
1,278.79
X
15260
4
90
2
X
1,714.26
X
15260
3
90
2
X
1,716.53
X
15260
2
90
2
X
1,762.68
X
15260
1
90
2
X
1,772.71
X
15261
4
ZZZ
0
X
588.54
X
15261
3
ZZZ
0
X
897.33
X
15261
1
ZZZ
0
X
938.51
X
15261
2
ZZZ
0
X
1,014.21
X
15271
2
0
2
X
198.51
124.29
15271
3
0
2
X
198.51
124.29
15271
4
0
2
X
198.51
124.29
15271
1
0
2
X
223.45
137.39
15272
2
ZZZ
0
X
37.57
24.61
15272
3
ZZZ
0
X
37.57
24.61
15272
4
ZZZ
0
X
37.57
24.61
15272
1
ZZZ
0
X
41.86
26.82
15273
2
0
2
X
410.64
296.23
15273
3
0
2
X
410.64
296.23
15273
4
0
2
X
410.64
296.23
15273
1
0
2
X
461.06
328.32
15274
2
ZZZ
0
X
96.06
62.54
15274
3
ZZZ
0
X
96.06
62.54
15274
4
ZZZ
0
X
96.06
62.54
15274
1
ZZZ
0
X
107.30
68.43
15275
2
0
2
X
214.37
144.66
15275
3
0
2
X
214.37
144.66
15275
4
0
2
X
214.37
144.66
15275
1
0
2
X
240.46
159.59
15276
2
ZZZ
0
X
47.02
35.39
15276
3
ZZZ
0
X
47.02
35.39
15276
4
ZZZ
0
X
47.02
35.39
15276
1
ZZZ
0
X
51.89
38.41
15277
2
0
2
X
414.71
306.98
15277
3
0
2
X
414.71
306.98
15277
4
0
2
X
414.71
306.98
15277
1
0
2
X
461.73
336.75
15278
2
ZZZ
0
X
113.32
77.57
15278
3
ZZZ
0
X
113.32
77.57
15278
4
ZZZ
0
X
113.32
77.57
15278
1
ZZZ
0
X
126.36
84.87
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