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2018 Workers' Compensation Part B Fee Schedule

21436-22849

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CPT/HCPC Code Modifier Medicare Location Global Surgery Indicator Multiple Surgery Indicator Prevailing Charge Amount Fee Schedule Amount Site of Service Amount
21436   1 90 2 0 3,725.41 0
21436   2 90 2 0 3,677.00 0
21436   3 90 2 0 3,477.38 0
21436   4 90 2 0 3,438.17 0
21440     90 2 0 * 0
21445     90 2 0 * 0
21450   1 90 2 0 540.29 0
21450   2 90 2 0 525.62 0
21450   3 90 2 0 510.76 0
21450   4 90 2 0 567.47 0
21451   1 90 2 0 1,057.41 0
21451   2 90 2 0 1,040.85 0
21451   3 90 2 0 971.79 0
21451   4 90 2 0 959.26 0
21452   1 90 2 0 296.21 0
21452   2 90 2 0 377.74 0
21452   3 90 2 0 275.63 0
21452   4 90 2 0 272.41 0
21453   1 90 2 0 1,071.60 0
21453   2 90 2 0 979.78 0
21453   3 90 2 0 994.27 0
21453   4 90 2 0 981.52 0
21454   1 90 2 0 1,753.28 0
21454   2 90 2 0 1,723.40 0
21454   3 90 2 0 1,598.88 0
21454   4 90 2 0 1,577.72 0
21461   1 90 2 0 1,771.74 0
21461   2 90 2 0 1,743.52 0
21461   3 90 2 0 1,625.99 0
21461   4 90 2 0 1,605.09 0
21462   1 90 2 0 1,992.76 0
21462   2 90 2 0 1,981.44 0
21462   3 90 2 0 1,835.60 0
21462   4 90 2 0 2,134.98 0
21465   1 90 2 0 1,783.07 0
21465   2 90 2 0 1,759.12 0
21465   3 90 2 0 1,660.00 0
21465   4 90 2 0 1,640.34 0
21470   1 90 2 0 2,648.95 0
21470   2 90 2 0 2,736.22 0
21470   3 90 2 0 2,248.65 0
21470   4 90 2 0 2,625.41 0
21480   1 0 2 0 204.19 0
21480   2 0 2 0 206.55 0
21480   3 0 2 0 188.75 0
21480   4 0 2 0 214.62 0
21485   1 90 2 0 540.78 0
21485   2 90 2 0 538.19 0
21485   3 90 2 0 527.34 0
21485   4 90 2 0 524.88 0
21490   1 90 2 0 1,538.82 0
21490   2 90 2 0 1,521.51 0
21490   3 90 2 0 1,450.01 0
21490   4 90 2 0 1,433.28 0
21497   1 90 2 0 689.59 0
21497   2 90 2 0 679.99 0
21497   3 90 2 0 640.01 0
21497   4 90 2 0 632.00 0
21499     YYY 2 0 * 0
21501   1 90 2 0 485.13 0
21501   2 90 2 0 478.98 0
21501   3 90 2 0 453.70 0
21501   4 90 2 0 448.62 0
21502   1 90 2 0 999.35 0
21502   2 90 2 0 984.50 0
21502   3 90 2 0 923.42 0
21502   4 90 2 0 912.98 0
21510   1 90 2 0 924.76 0
21510   2 90 2 0 802.78 0
21510   3 90 2 0 831.67 0
21510   4 90 2 0 746.88 0
21550   1 10 2 0 204.59 0
21550   2 10 2 0 209.69 0
21550   3 10 2 0 200.62 0
21550   4 10 2 0 195.33 0
21552   1 90 2 0 655.68 0
21552   2 90 2 0 583.89 0
21552   3 90 2 0 583.89 0
21552   4 90 2 0 583.89 0
21554   1 90 2 0 1,073.58 0
21554   2 90 2 0 959.58 0
21554   3 90 2 0 959.58 0
21554   4 90 2 0 959.58 0
21555   1 90 2 0 497.78 0
21555   2 90 2 0 503.29 0
21555   3 90 2 0 469.34 0
21555   4 90 2 0 463.01 0
21556   1 90 2 0 664.31 0
21556   2 90 2 0 653.66 0
21556   3 90 2 0 755.86 0
21556   4 90 2 0 619.21 0
21557   1 90 2 0 1,422.24 0
21557   2 90 2 0 1,391.33 0
21557   3 90 2 0 1,343.54 0
21557   4 90 2 0 1,333.29 0
21558   1 90 2 0 2,016.07 0
21558   2 90 2 0 1,804.85 0
21558   3 90 2 0 1,804.85 0
21558   4 90 2 0 1,804.85 0
21600   1 90 2 0 1,113.64 0
21600   2 90 2 0 1,030.95 0
21600   3 90 2 0 999.06 0
21600   4 90 2 0 1,074.21 0
21610   1 90 2 0 763.31 0
21610   2 90 2 0 799.78 0
21610   3 90 2 0 734.30 0
21610   4 90 2 0 1,158.67 0
21615   1 90 2 0 1,874.29 0
21615   2 90 2 0 1,840.46 0
21615   3 90 2 0 1,700.90 0
21615   4 90 2 0 1,680.62 0
21616   1 90 2 0 1,918.95 0
21616   2 90 2 0 1,720.95 0
21616   3 90 2 0 1,859.90 0
21616   4 90 2 0 1,589.82 0
21620   1 90 2 0 1,249.94 0
21620   2 90 2 0 1,227.96 0
21620   3 90 2 0 1,174.40 0
21620   4 90 2 0 1,123.70 0
21627   1 90 2 0 1,055.36 0
21627   2 90 2 0 1,038.42 0
21627   3 90 2 0 968.66 0
21627   4 90 2 0 957.39 0
21630   1 90 2 0 2,528.80 0
21630   2 90 2 0 2,489.84 0
21630   3 90 2 0 2,329.12 0
21630   4 90 2 0 2,302.45 0
21632   1 90 2 0 2,668.99 0
21632   2 90 2 0 2,627.44 0
21632   3 90 2 0 2,456.33 0
21632   4 90 2 0 2,428.44 0
21685   1 90 2 0 1,656.71 0
21685   2 90 2 0 1,476.74 0
21685   3 90 2 0 1,476.74 0
21685   4 90 2 0 1,476.74 0
21700   1 90 2 0 912.05 0
21700   2 90 2 0 779.84 0
21700   3 90 2 0 849.65 0
21700   4 90 2 0 839.67 0
21705   1 90 2 0 1,298.14 0
21705   2 90 2 0 1,279.39 0
21705   3 90 2 0 1,202.34 0
21705   4 90 2 0 1,189.08 0
21720   1 90 2 0 1,057.10 0
21720   2 90 2 0 928.69 0
21720   3 90 2 0 792.27 0
21720   4 90 2 0 783.05 0
21725   1 90 2 0 1,059.13 0
21725   2 90 2 0 1,043.67 0
21725   3 90 2 0 979.82 0
21725   4 90 2 0 968.48 0
21740   1 90 2 0 2,277.61 0
21740   2 90 2 0 2,244.82 0
21740   3 90 2 0 2,109.75 0
21740   4 90 2 0 2,086.15 0
21742     90 2 0 * 0
21743     90 2 0 * 0
21750   1 90 2 0 1,657.50 0
21750   2 90 2 0 1,631.07 0
21750   3 90 2 0 1,522.37 0
21750   4 90 2 0 1,505.02 0
21811   1 0 2 0 695.87 721.47
21811   2 0 2 0 652.29 674.16
21811   3 0 2 0 652.29 674.16
21811   4 0 2 0 652.29 674.16
21812   1 0 2 0 831.73 857.31
21812   2 0 2 0 780.65 802.51
21812   3 0 2 0 780.65 802.51
21812   4 0 2 0 780.65 802.51
21813   1 0 2 0 1,135.55 1155.46
21813   2 0 2 0 1,065.94 1082.95
21813   3 0 2 0 1,065.94 1082.95
21813   4 0 2 0 1,065.94 1082.95
21820   1 90 2 0 264.91 0
21820   2 90 2 0 260.86 0
21820   3 90 2 0 256.95 0
21820   4 90 2 0 255.84 0
21825   1 90 2 0 1,306.07 0
21825   2 90 2 0 933.39 0
21825   3 90 2 0 884.71 0
21825   4 90 2 0 1,182.10 0
21899     YYY 2 0 * 0
21920   1 10 2 0 201.41 0
21920   2 10 2 0 209.67 0
21920   3 10 2 0 192.80 0
21920   4 10 2 0 200.07 0
21925   1 90 2 0 447.22 0
21925   2 90 2 0 432.12 0
21925   3 90 2 0 426.10 0
21925   4 90 2 0 521.38 0
21930   1 90 2 0 733.83 0
21930   2 90 2 0 726.71 0
21930   3 90 2 0 701.87 0
21930   4 90 2 0 697.13 0
21931   1 90 2 0 687.60 0
21931   2 90 2 0 612.02 0
21931   3 90 2 0 612.02 0
21931   4 90 2 0 612.02 0
21932   1 90 2 0 988.29 0
21932   2 90 2 0 878.83 0
21932   3 90 2 0 878.83 0
21932   4 90 2 0 878.83 0
21933   1 90 2 0 1,089.58 0
21933   2 90 2 0 970.28 0
21933   3 90 2 0 970.28 0
21933   4 90 2 0 970.28 0
21935   1 90 2 0 1,536.39 0
21935   2 90 2 0 1,523.60 0
21935   3 90 2 0 1,456.90 0
21935   4 90 2 0 2,009.76 0
21936   1 90 2 0 2,105.47 0
21936   2 90 2 0 1,881.78 0
21936   3 90 2 0 1,881.78 0
21936   4 90 2 0 1,881.78 0
22010   1 90 2 0 1,319.59 0
22010   2 90 2 0 1,151.96 0
22010   3 90 2 0 1,151.96 0
22010   4 90 2 0 1,151.96 0
22015   1 90 2 0 1,308.02 0
22015   2 90 2 0 1,141.86 0
22015   3 90 2 0 1,141.86 0
22015   4 90 2 0 1,141.86 0
22100   1 90 2 0 1,339.22 0
22100   2 90 2 0 1,320.46 0
22100   3 90 2 0 1,242.82 0
22100   4 90 2 0 1,228.15 0
22101   1 90 2 0 1,402.01 0
22101   2 90 2 0 1,379.72 0
22101   3 90 2 0 1,287.70 0
22101   4 90 2 0 1,272.77 0
22102   1 90 2 0 1,194.34 0
22102   2 90 2 0 1,179.36 0
22102   3 90 2 0 1,485.25 0
22102   4 90 2 0 1,105.27 0
22103   1 ZZZ 0 0 463.62 0
22103   2 ZZZ 0 0 442.39 0
22103   3 ZZZ 0 0 413.96 0
22103   4 ZZZ 0 0 407.70 0
22110   1 90 2 0 1,741.46 0
22110   2 90 2 0 1,984.04 0
22110   3 90 2 0 1,853.21 0
22110   4 90 2 0 1,831.50 0
22112   1 90 2 0 1,749.40 0
22112   2 90 2 0 1,997.72 0
22112   3 90 2 0 1,866.43 0
22112   4 90 2 0 1,844.50 0
22114   1 90 2 0 1,745.07 0
22114   2 90 2 0 1,720.46 0
22114   3 90 2 0 1,619.24 0
22114   4 90 2 0 1,600.83 0
22116   1 ZZZ 0 0 458.81 0
22116   2 ZZZ 0 0 437.94 0
22116   3 ZZZ 0 0 409.85 0
22116   4 ZZZ 0 0 403.69 0
22206   1 90 2 0 3,384.34 0
22206   2 90 2 0 2,985.12 0
22206   3 90 2 0 2,985.12 0
22206   4 90 2 0 2,985.12 0
22207   1 90 2 0 3,339.66 0
22207   2 90 2 0 2,946.90 0
22207   3 90 2 0 2,946.90 0
22207   4 90 2 0 2,946.90 0
22208   1 ZZZ 0 0 865.81 0
22208   2 ZZZ 0 0 757.42 0
22208   3 ZZZ 0 0 757.42 0
22208   4 ZZZ 0 0 757.42 0
22210   1 90 2 0 3,545.80 0
22210   2 90 2 0 3,340.11 0
22210   3 90 2 0 3,138.27 0
22210   4 90 2 0 3,102.90 0
22212   1 90 2 0 3,363.40 0
22212   2 90 2 0 3,309.13 0
22212   3 90 2 0 3,084.90 0
22212   4 90 2 0 3,048.19 0
22214   1 90 2 0 3,160.06 0
22214   2 90 2 0 3,109.63 0
22214   3 90 2 0 2,901.10 0
22214   4 90 2 0 2,867.32 0
22216   1 ZZZ 0 0 1,125.57 0
22216   2 ZZZ 0 0 1,074.86 0
22216   3 ZZZ 0 0 1,007.75 0
22216   4 ZZZ 0 0 992.83 0
22220   1 90 2 0 3,453.19 0
22220   2 90 2 0 3,400.52 0
22220   3 90 2 0 3,182.74 0
22220   4 90 2 0 3,145.40 0
22222   1 90 2 0 3,929.24 0
22222   2 90 2 0 3,611.47 0
22222   3 90 2 0 2,857.11 0
22222   4 90 2 0 2,823.85 0
22224   1 90 2 0 3,290.56 0
22224   2 90 2 0 3,239.69 0
22224   3 90 2 0 3,029.98 0
22224   4 90 2 0 2,995.29 0
22226   1 ZZZ 0 0 1,125.57 0
22226   2 ZZZ 0 0 1,074.86 0
22226   3 ZZZ 0 0 1,007.75 0
22226   4 ZZZ 0 0 992.83 0
22310   1 90 2 0 905.19 0
22310   2 90 2 0 894.42 0
22310   3 90 2 0 728.67 0
22310   4 90 2 0 780.85 0
22315   1 90 2 0 1,284.54 0
22315   2 90 2 0 1,323.53 0
22315   3 90 2 0 1,191.23 0
22315   4 90 2 0 1,287.09 0
22318   1 90 2 0 2,948.63 0
22318   2 90 2 0 2,583.65 0
22318   3 90 2 0 2,583.65 0
22318   4 90 2 0 2,583.65 0
22319   1 90 2 0 3,331.63 0
22319   2 90 2 0 2,918.41 0
22319   3 90 2 0 2,918.41 0
22319   4 90 2 0 2,918.41 0
22325   1 90 2 0 3,247.02 0
22325   2 90 2 0 3,234.39 0
22325   3 90 2 0 2,176.82 0
22325   4 90 2 0 2,152.78 0
22326   1 90 2 0 3,261.48 0
22326   2 90 2 0 3,209.36 0
22326   3 90 2 0 2,994.27 0
22326   4 90 2 0 2,959.15 0
22327   1 90 2 0 3,140.42 0
22327   2 90 2 0 3,092.36 0
22327   3 90 2 0 3,244.45 0
22327   4 90 2 0 2,859.02 0
22328   1 ZZZ 0 0 912.99 0
22328   2 ZZZ 0 0 871.39 0
22328   3 ZZZ 0 0 815.45 0
22328   4 ZZZ 0 0 803.12 0
22505   1 10 2 0 195.93 0
22505   2 10 2 0 191.61 0
22505   3 10 2 0 292.92 0
22505   4 10 2 0 183.56 0
22510   1 10 2 0 2,301.97 583.70
22510   2 10 2 0 2,010.16 541.66
22510   3 10 2 0 2,010.16 541.66
22510   4 10 2 0 2,010.16 541.66
22511   1 10 2 0 2,281.50 547.12
22511   2 10 2 0 1,989.66 507.38
22511   3 10 2 0 1,989.66 507.38
22511   4 10 2 0 1,989.66 507.38
22512   1 ZZZ 0 0 1,275.74 265.16
22512   2 ZZZ 0 0 1,111.36 247.66
22512   3 ZZZ 0 0 1,111.36 247.66
22512   4 ZZZ 0 0 1,111.36 247.66
22513   1 10 2 0 9,769.52 666.32
22513   2 10 2 0 8,396.50 616.48
22513   3 10 2 0 8,396.50 616.48
22513   4 10 2 0 8,396.50 616.48
22514   1 10 2 0 9,734.71 622.95
22514   2 10 2 0 8,363.19 575.86
22514   3 10 2 0 8,363.19 575.86
22514   4 10 2 0 8,363.19 575.86
22515   1 ZZZ 0 0 5,909.68 277.57
22515   2 ZZZ 0 0 5,071.68 258.23
22515   3 ZZZ 0 0 5,071.68 258.23
22515   4 ZZZ 0 0 5,071.68 258.23
22526   1 10 2 0 3,132.67 504.36
22526   2 10 2 0 2,587.74 439.46
22526   3 10 2 0 2,587.74 439.46
22526   4 10 2 0 2,587.74 439.46
22527   1 ZZZ 0 0 2,550.38 232.07
22527   2 ZZZ 0 0 2,098.19 203.28
22527   3 ZZZ 0 0 2,098.19 203.28
22527   4 ZZZ 0 0 2,098.19 203.28
22532   1 90 2 0 2,951.60 0
22532   2 90 2 0 2,591.23 0
22532   3 90 2 0 2,591.23 0
22532   4 90 2 0 2,591.23 0
22533   1 90 2 0 2,740.91 0
22533   2 90 2 0 2,422.97 0
22533   3 90 2 0 2,422.97 0
22533   4 90 2 0 2,422.97 0
22534   1 ZZZ 0 0 695.89 0
22534   2 ZZZ 0 0 611.07 0
22534   3 ZZZ 0 0 611.07 0
22534   4 ZZZ 0 0 611.07 0
22548   1 90 2 0 4,317.76 0
22548   2 90 2 0 4,382.95 0
22548   3 90 2 0 4,083.92 0
22548   4 90 2 0 4,035.46 0
22551   1 90 2 0 2,648.49 0
22551   2 90 2 0 2,344.19 0
22551   3 90 2 0 2,344.19 0
22551   4 90 2 0 2,344.19 0
22552   1 ZZZ 0 0 615.58 0
22552   2 ZZZ 0 0 547.81 0
22552   3 ZZZ 0 0 547.81 0
22552   4 ZZZ 0 0 547.81 0
22554   1 90 2 0 3,666.39 0
22554   2 90 2 0 3,570.13 0
22554   3 90 2 0 3,285.37 0
22554   4 90 2 0 3,262.33 0
22556   1 90 2 0 4,258.07 0
22556   2 90 2 0 4,189.55 0
22556   3 90 2 0 3,906.23 0
22556   4 90 2 0 3,859.91 0
22558   1 90 2 0 4,015.76 0
22558   2 90 2 0 3,951.20 0
22558   3 90 2 0 3,684.59 0
22558   4 90 2 0 3,641.06 0
22585   1 ZZZ 0 0 1,044.96 0
22585   2 ZZZ 0 0 1,027.65 0
22585   3 ZZZ 0 0 956.12 0
22585   4 ZZZ 0 0 944.78 0
22586   1 90 2 0 2,167.64 0
22586   2 90 2 0 1,940.25 0
22586   3 90 2 0 1,940.25 0
22586   4 90 2 0 1,940.25 0
22590   1 90 2 0 3,874.52 0
22590   2 90 2 0 3,621.19 0
22590   3 90 2 0 3,454.87 0
22590   4 90 2 0 3,379.19 0
22595   1 90 2 0 4,028.31 0
22595   2 90 2 0 3,958.19 0
22595   3 90 2 0 3,668.23 0
22595   4 90 2 0 3,623.85 0
22600   1 90 2 0 3,639.02 0
22600   2 90 2 0 3,486.55 0
22600   3 90 2 0 3,282.02 0
22600   4 90 2 0 3,242.60 0
22610   1 90 2 0 3,168.18 0
22610   2 90 2 0 3,093.87 0
22610   3 90 2 0 3,209.67 0
22610   4 90 2 0 2,840.72 0
22612   1 90 2 0 3,569.09 0
22612   2 90 2 0 3,642.61 0
22612   3 90 2 0 3,595.85 0
22612   4 90 2 0 3,553.54 0
22614   1 ZZZ 0 0 1,219.77 0
22614   2 ZZZ 0 0 1,165.52 0
22614   3 ZZZ 0 0 1,092.69 0
22614   4 ZZZ 0 0 1,076.41 0
22630   1 90 2 0 4,031.26 0
22630   2 90 2 0 3,970.58 0
22630   3 90 2 0 3,431.14 0
22630   4 90 2 0 3,776.54 0
22632   1 ZZZ 0 0 1,035.96 0
22632   2 ZZZ 0 0 988.70 0
22632   3 ZZZ 0 0 925.18 0
22632   4 ZZZ 0 0 911.21 0
22633   1 90 2 0 2,704.03 0
22633   2 90 2 0 2,395.78 0
22633   3 90 2 0 2,395.78 0
22633   4 90 2 0 2,395.78 0
22634   1 ZZZ 0 0 734.78 0
22634   2 ZZZ 0 0 651.36 0
22634   3 ZZZ 0 0 651.36 0
22634   4 ZZZ 0 0 651.36 0
22800   1 90 2 0 3,727.58 0
22800   2 90 2 0 3,662.18 0
22800   3 90 2 0 3,391.49 0
22800   4 90 2 0 3,349.89 0
22802   1 90 2 0 5,393.95 0
22802   2 90 2 0 5,325.95 0
22802   3 90 2 0 5,169.30 0
22802   4 90 2 0 5,121.80 0
22804   1 90 2 0 6,364.08 0
22804   2 90 2 0 6,087.21 0
22804   3 90 2 0 5,716.64 0
22804   4 90 2 0 5,632.53 0
22808   1 90 2 0 4,360.66 0
22808   2 90 2 0 4,172.68 0
22808   3 90 2 0 3,924.35 0
22808   4 90 2 0 3,867.43 0
22810   1 90 2 0 4,418.88 0
22810   2 90 2 0 4,354.97 0
22810   3 90 2 0 4,091.40 0
22810   4 90 2 0 4,045.02 0
22812   1 90 2 0 5,044.21 0
22812   2 90 2 0 4,962.83 0
22812   3 90 2 0 4,626.49 0
22812   4 90 2 0 4,571.46 0
22818   1 90 2 0 5,063.17 0
22818   2 90 2 0 4,428.12 0
22818   3 90 2 0 4,428.12 0
22818   4 90 2 0 4,428.12 0
22819   1 90 2 0 5,391.49 0
22819   2 90 2 0 4,745.22 0
22819   3 90 2 0 4,745.22 0
22819   4 90 2 0 4,745.22 0
22830   1 90 2 0 2,252.22 0
22830   2 90 2 0 2,212.57 0
22830   3 90 2 0 2,048.64 0
22830   4 90 2 0 2,023.52 0
22840   1 ZZZ 0 0 3,746.92 0
22840   2 ZZZ 0 0 3,696.68 0
22840   3 ZZZ 0 0 3,118.66 0
22840   4 ZZZ 0 0 2,881.03 0
22841     XXX 9 0 * 0
22842   1 ZZZ 0 0 3,620.81 0
22842   2 ZZZ 0 0 3,789.60 0
22842   3 ZZZ 0 0 3,267.13 0
22842   4 ZZZ 0 0 3,226.60 0
22843   1 ZZZ 0 0 1,775.25 0
22843   2 ZZZ 0 0 1,694.48 0
22843   3 ZZZ 0 0 1,585.71 0
22843   4 ZZZ 0 0 1,561.75 0
22844   1 ZZZ 0 0 2,169.30 0
22844   2 ZZZ 0 0 2,070.62 0
22844   3 ZZZ 0 0 1,937.74 0
22844   4 ZZZ 0 0 1,908.46 0
22845   1 ZZZ 0 0 2,954.09 0
22845   2 ZZZ 0 0 2,898.34 0
22845   3 ZZZ 0 0 2,668.00 0
22845   4 ZZZ 0 0 2,635.35 0
22846   1 ZZZ 0 0 1,639.16 0
22846   2 ZZZ 0 0 1,564.59 0
22846   3 ZZZ 0 0 1,464.19 0
22846   4 ZZZ 0 0 1,442.08 0
22847   1 ZZZ 0 0 1,821.27 0
22847   2 ZZZ 0 0 1,738.29 0
22847   3 ZZZ 0 0 1,626.69 0
22847   4 ZZZ 0 0 1,602.12 0
22848   1 ZZZ 0 0 1,187.94 0
22848   2 ZZZ 0 0 1,133.84 0
22848   3 ZZZ 0 0 1,061.00 0
22848   4 ZZZ 0 0 1,044.94 0
22849   1 90 2 0 2,337.43 0
22849   2 90 2 0 2,299.84 0
22849   3 90 2 0 2,144.61 0
22849   4 90 2 0 2,119.21 0