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Workers' Compensation
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PennSERVE
Vocational Rehabilitation
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DLI
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Health Care Services Review
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Medical Fee Review
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Fee Schedule
>
Fee Schedule 24075-25109
Begin Main Content Area
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Content Editor
2024 Workers' Compensation Part B Fee Schedule
24075-25109
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
24075
003
90
2
X
593.89
X
24075
002
90
2
X
592.45
X
24075
004
90
2
X
571.81
X
24075
001
90
2
X
607.03
X
24076
002
90
2
X
1,097.93
X
24076
003
90
2
X
1,063.37
X
24076
001
90
2
X
1,142.79
X
24076
004
90
2
X
988.48
X
24077
001
90
2
X
2,606.17
X
24077
004
90
2
X
2,355.20
X
24077
002
90
2
X
1,844.20
X
24077
003
90
2
X
1,743.49
X
24079
002
90
2
X
2,188.85
X
24079
003
90
2
X
2,188.85
X
24079
001
90
2
X
2,449.74
X
24079
004
90
2
X
2,188.85
X
24100
003
90
2
X
1,000.53
X
24100
002
90
2
X
1,632.21
X
24100
001
90
2
X
1,089.40
X
24100
004
90
2
X
988.67
X
24101
004
90
2
X
1,895.33
X
24101
003
90
2
X
1,903.44
X
24101
002
90
2
X
1,816.16
X
24101
001
90
2
X
2,144.91
X
24102
001
90
2
X
2,404.88
X
24102
003
90
2
X
2,180.96
X
24102
002
90
2
X
2,318.06
X
24102
004
90
2
X
2,204.95
X
24105
001
90
2
X
1,054.64
X
24105
004
90
2
X
946.21
X
24105
003
90
2
X
875.40
X
24105
002
90
2
X
1,025.25
X
24110
001
90
2
X
1,819.68
X
24110
004
90
2
X
1,645.12
X
24110
003
90
2
X
1,665.28
X
24110
002
90
2
X
1,901.32
X
24115
002
90
2
X
2,001.19
X
24115
003
90
2
X
1,866.84
X
24115
004
90
2
X
1,844.97
X
24115
001
90
2
X
2,033.70
X
24116
001
90
2
X
2,526.96
X
24116
004
90
2
X
2,301.04
X
24116
003
90
2
X
2,328.61
X
24116
002
90
2
X
2,488.26
X
24120
002
90
2
X
1,863.72
X
24120
003
90
2
X
1,644.82
X
24120
004
90
2
X
1,814.46
X
24120
001
90
2
X
1,772.23
X
24125
001
90
2
X
1,544.58
X
24125
002
90
2
X
1,524.27
X
24125
003
90
2
X
1,440.14
X
24125
004
90
2
X
1,422.98
X
24126
003
90
2
X
1,706.40
X
24126
002
90
2
X
1,830.29
X
24126
001
90
2
X
1,860.24
X
24126
004
90
2
X
1,686.07
X
24130
003
90
2
X
1,479.36
X
24130
002
90
2
X
1,588.38
X
24130
004
90
2
X
1,495.37
X
24130
001
90
2
X
1,626.04
X
24134
004
90
2
X
1,947.02
X
24134
002
90
2
X
2,107.01
X
24134
003
90
2
X
1,970.74
X
24134
001
90
2
X
2,140.00
X
24136
004
90
2
X
1,748.55
X
24136
002
90
2
X
1,887.90
X
24136
003
90
2
X
1,500.54
X
24136
001
90
2
X
1,916.02
X
24138
001
90
2
X
1,680.74
X
24138
004
90
2
X
1,526.58
X
24138
002
90
2
X
1,582.71
X
24138
003
90
2
X
1,544.75
X
24140
003
90
2
X
1,957.84
X
24140
002
90
2
X
2,104.25
X
24140
004
90
2
X
1,934.41
X
24140
001
90
2
X
2,139.61
X
24145
004
90
2
X
1,497.49
X
24145
002
90
2
X
1,622.75
X
24145
003
90
2
X
1,515.42
X
24145
001
90
2
X
1,648.69
X
24147
002
90
2
X
1,642.01
X
24147
003
90
2
X
1,520.91
X
24147
001
90
2
X
1,668.87
X
24147
004
90
2
X
1,513.02
X
24149
003
90
2
X
2,809.40
X
24149
002
90
2
X
2,886.97
X
24149
001
90
2
X
3,227.15
X
24149
004
90
2
X
2,809.40
X
24150
002
90
2
X
3,219.43
X
24150
003
90
2
X
2,992.74
X
24150
004
90
2
X
2,956.37
X
24150
001
90
2
X
3,578.91
X
24152
002
90
2
X
1,948.87
X
24152
003
90
2
X
1,826.42
X
24152
004
90
2
X
1,805.49
X
24152
001
90
2
X
1,978.55
X
24155
001
90
2
X
3,328.75
X
24155
004
90
2
X
2,428.33
X
24155
003
90
2
X
2,777.21
X
24155
002
90
2
X
3,288.38
X
24160
002
90
2
X
1,454.12
X
24160
003
90
2
X
1,366.51
X
24160
004
90
2
X
1,350.93
X
24160
001
90
2
X
1,475.40
X
24164
004
90
2
X
1,258.15
X
24164
003
90
2
X
1,273.31
X
24164
002
90
2
X
1,365.75
X
24164
001
90
2
X
1,388.13
X
24200
004
10
2
X
227.20
X
24200
002
10
2
X
188.21
X
24200
003
10
2
X
203.64
X
24200
001
10
2
X
210.79
X
24201
001
90
2
X
887.57
X
24201
003
90
2
X
820.71
X
24201
002
90
2
X
872.45
X
24201
004
90
2
X
811.21
X
24220
001
0
2
X
167.84
X
24220
004
0
2
X
122.91
X
24220
003
0
2
X
183.68
X
24220
002
0
2
X
192.05
X
24300
001
90
2
X
862.89
X
24300
004
90
2
X
752.29
X
24300
002
90
2
X
752.29
X
24300
003
90
2
X
752.29
X
24301
004
90
2
X
1,950.87
X
24301
001
90
2
X
2,139.42
X
24301
003
90
2
X
1,773.16
X
24301
002
90
2
X
1,898.75
X
24305
001
90
2
X
1,167.56
X
24305
003
90
2
X
1,104.02
X
24305
002
90
2
X
1,155.18
X
24305
004
90
2
X
1,091.75
X
24310
001
90
2
X
1,028.70
X
24310
002
90
2
X
1,015.04
X
24310
003
90
2
X
958.70
X
24310
004
90
2
X
948.04
X
24320
004
90
2
X
2,675.73
X
24320
003
90
2
X
2,136.53
X
24320
002
90
2
X
2,281.01
X
24320
001
90
2
X
2,847.44
X
24330
001
90
2
X
2,200.15
X
24330
004
90
2
X
2,199.75
X
24330
002
90
2
X
1,259.60
X
24330
003
90
2
X
2,017.75
X
24331
004
90
2
X
2,193.50
X
24331
001
90
2
X
2,420.19
X
24331
003
90
2
X
2,219.91
X
24331
002
90
2
X
2,381.14
X
24332
001
90
2
X
1,181.29
X
24332
004
90
2
X
1,050.42
X
24332
003
90
2
X
1,050.42
X
24332
002
90
2
X
1,050.42
X
24340
002
90
2
X
1,754.86
X
24340
003
90
2
X
1,784.97
X
24340
004
90
2
X
1,618.25
X
24340
001
90
2
X
1,958.52
X
24341
003
90
2
X
1,553.49
X
24341
002
90
2
X
1,596.36
X
24341
004
90
2
X
1,553.49
X
24341
001
90
2
X
1,784.23
X
24342
004
90
2
X
2,292.90
X
24342
002
90
2
X
2,495.76
X
24342
003
90
2
X
2,320.64
X
24342
001
90
2
X
2,538.13
X
24343
001
90
2
X
1,572.52
X
24343
004
90
2
X
1,379.51
X
24343
003
90
2
X
1,379.51
X
24343
002
90
2
X
1,379.51
X
24344
004
90
2
X
2,085.10
X
24344
002
90
2
X
2,085.10
X
24344
003
90
2
X
2,085.10
X
24344
001
90
2
X
2,371.27
X
24345
002
90
2
X
1,379.51
X
24345
003
90
2
X
1,379.51
X
24345
001
90
2
X
1,572.52
X
24345
004
90
2
X
1,379.51
X
24346
002
90
2
X
2,085.10
X
24346
003
90
2
X
2,085.10
X
24346
001
90
2
X
2,371.27
X
24346
004
90
2
X
2,085.10
X
24357
004
90
2
X
720.78
X
24357
001
90
2
X
828.51
X
24357
002
90
2
X
720.78
X
24357
003
90
2
X
720.78
X
24358
004
90
2
X
847.78
X
24358
002
90
2
X
847.78
X
24358
003
90
2
X
847.78
X
24358
001
90
2
X
972.24
X
24359
001
90
2
X
1,191.11
X
24359
002
90
2
X
1,044.76
X
24359
003
90
2
X
1,044.76
X
24359
004
90
2
X
1,044.76
X
24360
003
90
2
X
3,686.36
X
24360
002
90
2
X
3,971.24
X
24360
001
90
2
X
3,346.42
X
24360
004
90
2
X
3,007.98
X
24361
001
90
2
X
3,247.46
X
24361
004
90
2
X
2,948.33
X
24361
003
90
2
X
2,984.07
X
24361
002
90
2
X
3,196.14
X
24362
003
90
2
X
2,954.37
X
24362
002
90
2
X
3,110.30
X
24362
004
90
2
X
2,917.70
X
24362
001
90
2
X
3,525.80
X
24363
001
90
2
X
5,328.54
X
24363
003
90
2
X
4,834.26
X
24363
002
90
2
X
5,210.63
X
24363
004
90
2
X
4,677.74
X
24365
001
90
2
X
2,795.93
X
24365
002
90
2
X
1,858.31
X
24365
003
90
2
X
1,734.20
X
24365
004
90
2
X
1,713.61
X
24366
004
90
2
X
2,210.59
X
24366
001
90
2
X
3,785.19
X
24366
003
90
2
X
2,238.09
X
24366
002
90
2
X
3,739.35
X
24370
004
90
2
X
2,477.30
X
24370
003
90
2
X
2,477.30
X
24370
002
90
2
X
2,477.30
X
24370
001
90
2
X
2,760.85
X
24371
002
90
2
X
2,856.67
X
24371
003
90
2
X
2,856.67
X
24371
004
90
2
X
2,856.67
X
24371
001
90
2
X
3,181.88
X
24400
001
90
2
X
2,305.92
X
24400
004
90
2
X
2,100.32
X
24400
002
90
2
X
2,270.63
X
24400
003
90
2
X
2,125.13
X
24410
004
90
2
X
3,128.00
X
24410
001
90
2
X
3,442.37
X
24410
002
90
2
X
3,233.42
X
24410
003
90
2
X
3,166.06
X
24420
002
90
2
X
3,042.43
X
24420
003
90
2
X
2,836.42
X
24420
004
90
2
X
2,802.65
X
24420
001
90
2
X
3,092.26
X
24430
001
90
2
X
3,336.77
X
24430
004
90
2
X
3,007.68
X
24430
002
90
2
X
3,279.93
X
24430
003
90
2
X
3,044.88
X
24435
001
90
2
X
3,594.80
X
24435
004
90
2
X
3,220.53
X
24435
003
90
2
X
3,260.60
X
24435
002
90
2
X
3,529.78
X
24470
003
90
2
X
1,828.03
X
24470
002
90
2
X
1,960.91
X
24470
001
90
2
X
1,993.04
X
24470
004
90
2
X
1,806.36
X
24495
004
90
2
X
1,741.45
X
24495
002
90
2
X
1,794.10
X
24495
003
90
2
X
1,748.70
X
24495
001
90
2
X
1,641.93
X
24498
001
90
2
X
2,642.59
X
24498
003
90
2
X
2,429.81
X
24498
002
90
2
X
2,601.19
X
24498
004
90
2
X
2,400.91
X
24500
003
90
2
X
686.78
X
24500
002
90
2
X
733.81
X
24500
001
90
2
X
719.13
X
24500
004
90
2
X
686.98
X
24505
001
90
2
X
1,162.75
X
24505
004
90
2
X
1,087.00
X
24505
002
90
2
X
1,161.68
X
24505
003
90
2
X
1,072.07
X
24515
001
90
2
X
2,508.24
X
24515
003
90
2
X
2,306.88
X
24515
002
90
2
X
2,468.96
X
24515
004
90
2
X
2,279.62
X
24516
001
90
2
X
2,508.24
X
24516
004
90
2
X
2,279.62
X
24516
002
90
2
X
2,468.96
X
24516
003
90
2
X
2,306.88
X
24530
001
90
2
X
729.34
X
24530
004
90
2
X
694.64
X
24530
003
90
2
X
696.05
X
24530
002
90
2
X
718.37
X
24535
001
90
2
X
1,301.39
X
24535
004
90
2
X
1,235.35
X
24535
002
90
2
X
1,310.44
X
24535
003
90
2
X
1,150.62
X
24538
002
90
2
X
1,690.04
X
24538
003
90
2
X
1,511.71
X
24538
001
90
2
X
2,051.31
X
24538
004
90
2
X
1,578.00
X
24545
001
90
2
X
2,467.00
X
24545
004
90
2
X
2,334.53
X
24545
002
90
2
X
2,444.19
X
24545
003
90
2
X
2,349.92
X
24546
003
90
2
X
2,614.00
X
24546
002
90
2
X
2,714.65
X
24546
004
90
2
X
2,596.12
X
24546
001
90
2
X
2,739.09
X
24560
004
90
2
X
585.10
X
24560
001
90
2
X
610.56
X
24560
003
90
2
X
580.11
X
24560
002
90
2
X
598.36
X
24565
001
90
2
X
890.57
X
24565
003
90
2
X
838.85
X
24565
002
90
2
X
884.85
X
24565
004
90
2
X
952.92
X
24566
001
90
2
X
1,608.57
X
24566
003
90
2
X
1,489.57
X
24566
002
90
2
X
1,587.08
X
24566
004
90
2
X
1,463.61
X
24575
003
90
2
X
1,977.72
X
24575
002
90
2
X
2,110.90
X
24575
004
90
2
X
1,954.59
X
24575
001
90
2
X
2,143.21
X
24576
001
90
2
X
610.55
X
24576
004
90
2
X
564.83
X
24576
002
90
2
X
609.03
X
24576
003
90
2
X
570.44
X
24577
002
90
2
X
1,080.44
X
24577
003
90
2
X
1,050.88
X
24577
001
90
2
X
1,094.42
X
24577
004
90
2
X
1,038.70
X
24579
004
90
2
X
2,122.48
X
24579
003
90
2
X
2,147.48
X
24579
002
90
2
X
2,291.88
X
24579
001
90
2
X
2,333.70
X
24582
002
90
2
X
1,773.94
X
24582
003
90
2
X
1,618.33
X
24582
001
90
2
X
1,807.32
X
24582
004
90
2
X
1,599.27
X
24586
001
90
2
X
3,576.93
X
24586
004
90
2
X
3,237.32
X
24586
002
90
2
X
3,538.36
X
24586
003
90
2
X
3,095.93
X
24587
003
90
2
X
3,142.25
X
24587
002
90
2
X
3,368.09
X
24587
004
90
2
X
3,104.74
X
24587
001
90
2
X
3,422.70
X
24600
003
90
2
X
659.44
X
24600
002
90
2
X
694.42
X
24600
004
90
2
X
652.12
X
24600
001
90
2
X
728.57
X
24605
001
90
2
X
868.23
X
24605
004
90
2
X
803.44
X
24605
002
90
2
X
857.27
X
24605
003
90
2
X
819.90
X
24615
003
90
2
X
2,034.40
X
24615
002
90
2
X
2,227.43
X
24615
004
90
2
X
2,137.88
X
24615
001
90
2
X
2,222.44
X
24620
004
90
2
X
1,135.41
X
24620
001
90
2
X
1,232.88
X
24620
002
90
2
X
1,216.40
X
24620
003
90
2
X
1,148.39
X
24635
003
90
2
X
2,634.83
X
24635
002
90
2
X
2,820.94
X
24635
004
90
2
X
2,603.61
X
24635
001
90
2
X
2,865.96
X
24640
001
10
2
X
233.15
X
24640
002
10
2
X
216.05
X
24640
003
10
2
X
205.25
X
24640
004
10
2
X
215.37
X
24650
001
90
2
X
520.89
397.53
24650
004
90
2
X
548.37
417.00
24650
003
90
2
X
541.52
412.19
24650
002
90
2
X
579.77
441.84
24655
001
90
2
X
861.47
X
24655
004
90
2
X
788.67
X
24655
002
90
2
X
849.07
X
24655
003
90
2
X
797.86
X
24665
004
90
2
X
1,750.61
X
24665
001
90
2
X
1,923.96
X
24665
003
90
2
X
1,758.91
X
24665
002
90
2
X
1,783.16
X
24666
001
90
2
X
2,361.31
X
24666
002
90
2
X
2,321.82
X
24666
003
90
2
X
2,158.42
X
24666
004
90
2
X
2,132.05
X
24670
004
90
2
X
475.31
X
24670
002
90
2
X
512.03
X
24670
001
90
2
X
512.41
X
24670
003
90
2
X
480.99
X
24675
001
90
2
X
969.35
X
24675
004
90
2
X
885.04
X
24675
003
90
2
X
895.40
X
24675
002
90
2
X
955.04
X
24685
003
90
2
X
1,882.77
X
24685
002
90
2
X
2,020.49
X
24685
004
90
2
X
1,860.16
X
24685
001
90
2
X
2,053.72
X
24800
004
90
2
X
2,357.15
X
24800
003
90
2
X
2,385.82
X
24800
002
90
2
X
2,553.63
X
24800
001
90
2
X
2,815.35
X
24802
004
90
2
X
2,777.21
X
24802
002
90
2
X
3,014.70
X
24802
003
90
2
X
2,810.68
X
24802
001
90
2
X
3,064.05
X
24900
001
90
2
X
2,032.35
X
24900
004
90
2
X
1,839.83
X
24900
002
90
2
X
1,999.02
X
24900
003
90
2
X
1,861.61
X
24920
003
90
2
X
1,740.45
X
24920
002
90
2
X
1,862.10
X
24920
004
90
2
X
1,720.34
X
24920
001
90
2
X
1,891.57
X
24925
002
90
2
X
1,512.07
X
24925
003
90
2
X
1,078.86
X
24925
001
90
2
X
1,534.25
X
24925
004
90
2
X
1,402.99
X
24930
001
90
2
X
2,115.43
X
24930
002
90
2
X
2,083.80
X
24930
003
90
2
X
1,953.00
X
24930
004
90
2
X
1,929.78
X
24931
002
90
2
X
2,764.48
X
24931
003
90
2
X
2,576.66
X
24931
001
90
2
X
2,809.96
X
24931
004
90
2
X
2,545.97
X
24935
001
90
2
X
3,444.02
X
24935
004
90
2
X
3,121.56
X
24935
003
90
2
X
3,159.17
X
24935
002
90
2
X
3,388.55
X
24940
004
90
2
X
3,121.56
X
24940
001
90
2
X
3,444.02
X
24940
003
90
2
X
3,159.17
X
24940
002
90
2
X
3,388.55
X
24999
YYY
2
X
#
X
25000
001
90
2
X
1,187.86
X
25000
004
90
2
X
1,088.85
X
25000
002
90
2
X
1,116.87
X
25000
003
90
2
X
1,021.99
X
25001
002
90
2
X
629.60
X
25001
003
90
2
X
629.60
X
25001
004
90
2
X
629.60
X
25001
001
90
2
X
719.98
X
25020
004
90
2
X
1,101.62
X
25020
001
90
2
X
1,211.89
X
25020
002
90
2
X
1,197.29
X
25020
003
90
2
X
1,114.46
X
25023
004
90
2
X
1,838.39
X
25023
003
90
2
X
1,851.14
X
25023
002
90
2
X
1,952.49
X
25023
001
90
2
X
1,933.55
X
25024
004
90
2
X
1,467.49
X
25024
001
90
2
X
1,665.88
X
25024
003
90
2
X
1,467.49
X
25024
002
90
2
X
1,467.49
X
25025
003
90
2
X
2,378.14
X
25025
002
90
2
X
2,378.14
X
25025
004
90
2
X
2,378.14
X
25025
001
90
2
X
2,685.09
X
25028
001
90
2
X
756.17
X
25028
004
90
2
X
689.20
X
25028
003
90
2
X
706.66
X
25028
002
90
2
X
749.37
X
25031
002
90
2
X
509.03
X
25031
003
90
2
X
490.60
X
25031
004
90
2
X
410.96
X
25031
001
90
2
X
513.57
X
25035
003
90
2
X
1,352.86
X
25035
001
90
2
X
1,560.82
X
25035
002
90
2
X
1,539.71
X
25035
004
90
2
X
1,457.33
X
25040
004
90
2
X
1,360.36
X
25040
001
90
2
X
1,495.22
X
25040
003
90
2
X
1,376.59
X
25040
002
90
2
X
1,561.98
X
25065
003
10
2
X
340.11
X
25065
002
10
2
X
285.13
X
25065
004
10
2
X
265.23
X
25065
001
10
2
X
358.94
X
25066
002
90
2
X
458.47
X
25066
003
90
2
X
590.83
X
25066
004
90
2
X
584.43
X
25066
001
90
2
X
463.87
X
25071
001
90
2
X
800.69
X
25071
003
90
2
X
711.84
X
25071
002
90
2
X
711.84
X
25071
004
90
2
X
711.84
X
25073
004
90
2
X
885.20
X
25073
002
90
2
X
885.20
X
25073
003
90
2
X
885.20
X
25073
001
90
2
X
996.69
X
25075
001
90
2
X
706.40
X
25075
004
90
2
X
677.65
X
25075
003
90
2
X
706.90
X
25075
002
90
2
X
763.52
X
25076
003
90
2
X
961.56
X
25076
002
90
2
X
1,018.98
X
25076
004
90
2
X
936.40
X
25076
001
90
2
X
1,046.08
X
25077
002
90
2
X
1,864.61
X
25077
003
90
2
X
2,023.20
X
25077
001
90
2
X
1,886.53
X
25077
004
90
2
X
1,999.58
X
25078
001
90
2
X
2,138.00
X
25078
004
90
2
X
1,908.67
X
25078
003
90
2
X
1,908.67
X
25078
002
90
2
X
1,908.67
X
25085
002
90
2
X
1,304.71
X
25085
003
90
2
X
1,091.36
X
25085
004
90
2
X
1,078.39
X
25085
001
90
2
X
1,185.82
X
25100
004
90
2
X
1,181.26
X
25100
001
90
2
X
1,045.42
X
25100
003
90
2
X
950.39
X
25100
002
90
2
X
1,251.81
X
25101
001
90
2
X
1,277.32
X
25101
003
90
2
X
1,161.63
X
25101
002
90
2
X
1,239.31
X
25101
004
90
2
X
1,173.95
X
25105
001
90
2
X
1,960.03
X
25105
004
90
2
X
1,423.30
X
25105
003
90
2
X
1,899.82
X
25105
002
90
2
X
1,863.89
X
25107
004
90
2
X
1,243.81
X
25107
001
90
2
X
1,371.40
X
25107
002
90
2
X
1,349.37
X
25107
003
90
2
X
1,258.61
X
25109
002
90
2
X
805.01
X
25109
003
90
2
X
805.01
X
25109
001
90
2
X
927.34
X
25109
004
90
2
X
805.01
X
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