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2024 Workers' Compensation Part B Fee Schedule

27179-27468

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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
27179   001 90 2 X 2,803.93 X
27179   003 90 2 X 2,571.41 X
27179   002 90 2 X 2,758.62 X
27179   004 90 2 X 2,540.90 X
27181   001 90 2 X 3,307.47 X
27181   002 90 2 X 3,254.05 X
27181   003 90 2 X 3,033.39 X
27181   004 90 2 X 2,997.36 X
27185   003 90 2 X 1,255.58 X
27185   002 90 2 X 1,336.37 X
27185   004 90 2 X 1,242.71 X
27185   001 90 2 X 1,356.05 X
27187   004 90 2 X 3,234.83 X
27187   001 90 2 X 4,175.20 X
27187   002 90 2 X 3,540.15 X
27187   003 90 2 X 3,274.88 X
27197   001 0 2 X 193.41 X
27197   004 0 2 X 175.22 X
27197   003 0 2 X 175.22 X
27197   002 0 2 X 175.22 X
27198   002 0 2 X 450.54 X
27198   003 0 2 X 450.54 X
27198   001 0 2 X 493.02 X
27198   004 0 2 X 450.54 X
27200   002 90 2 X 392.19 X
27200   003 90 2 X 362.27 X
27200   004 90 2 X 377.41 X
27200   001 90 2 X 384.04 X
27202   001 90 2 X 1,534.68 X
27202   004 90 2 X 1,396.49 X
27202   002 90 2 X 1,511.07 X
27202   003 90 2 X 1,413.42 X
27215   001 90 9 X 2,866.75 X
27215   003 90 9 X 2,595.26 X
27215   002 90 9 X 2,813.90 X
27215   004 90 9 X 2,563.27 X
27216   001 90 9 X 1,772.31 X
27216   003 90 9 X 1,583.18 X
27216   002 90 9 X 1,773.20 X
27216   004 90 9 X 1,661.99 X
27217   004 90 9 X 3,093.58 X
27217   001 90 9 X 3,424.95 X
27217   002 90 9 X 3,367.79 X
27217   003 90 9 X 3,131.44 X
27218   002 90 9 X 3,980.71 X
27218   003 90 9 X 3,729.77 X
27218   004 90 9 X 3,686.38 X
27218   001 90 9 X 4,041.47 X
27220   003 90 2 X 1,061.30 X
27220   002 90 2 X 1,447.72 X
27220   001 90 2 X 1,465.58 X
27220   004 90 2 X 1,340.87 X
27222   004 90 2 X 1,898.99 X
27222   002 90 2 X 1,993.93 X
27222   003 90 2 X 1,892.00 X
27222   001 90 2 X 2,033.66 X
27226   003 90 2 X 3,355.12 X
27226   002 90 2 X 3,610.04 X
27226   004 90 2 X 3,314.37 X
27226   001 90 2 X 3,671.62 X
27227   004 90 2 X 3,933.33 X
27227   001 90 2 X 4,632.04 X
27227   003 90 2 X 3,982.25 X
27227   002 90 2 X 4,298.04 X
27228   004 90 2 X 4,222.29 X
27228   002 90 2 X 4,597.86 X
27228   003 90 2 X 4,274.06 X
27228   001 90 2 X 4,775.33 X
27230   001 90 2 X 794.77 X
27230   004 90 2 X 894.24 X
27230   002 90 2 X 1,028.77 X
27230   003 90 2 X 964.79 X
27232   001 90 2 X 2,507.13 X
27232   004 90 2 X 2,158.06 X
27232   002 90 2 X 2,270.54 X
27232   003 90 2 X 2,330.19 X
27235   001 90 2 X 3,278.18 X
27235   004 90 2 X 2,935.76 X
27235   003 90 2 X 2,972.26 X
27235   002 90 2 X 3,218.62 X
27236   002 90 2 X 3,784.60 X
27236   003 90 2 X 3,513.13 X
27236   001 90 2 X 4,244.01 X
27236   004 90 2 X 3,470.24 X
27238   004 90 2 X 757.93 X
27238   001 90 2 X 819.87 X
27238   003 90 2 X 1,111.23 X
27238   002 90 2 X 1,190.81 X
27240   001 90 2 X 2,505.53 X
27240   004 90 2 X 2,277.22 X
27240   002 90 2 X 2,466.35 X
27240   003 90 2 X 2,423.56 X
27244   002 90 2 X 3,727.10 X
27244   003 90 2 X 3,463.17 X
27244   004 90 2 X 3,421.10 X
27244   001 90 2 X 4,209.80 X
27245   001 90 2 X 4,443.21 X
27245   004 90 2 X 3,880.82 X
27245   003 90 2 X 3,927.18 X
27245   002 90 2 X 4,202.41 X
27246   004 90 2 X 916.12 X
27246   002 90 2 X 957.60 X
27246   003 90 2 X 920.99 X
27246   001 90 2 X 947.17 X
27248   001 90 2 X 2,512.52 X
27248   004 90 2 X 2,348.28 X
27248   002 90 2 X 2,484.10 X
27248   003 90 2 X 2,366.24 X
27250   004 0 2 X 1,248.36 X
27250   001 0 2 X 1,150.66 X
27250   003 0 2 X 1,074.22 X
27250   002 0 2 X 1,281.08 X
27252   003 90 2 X 1,434.85 X
27252   002 90 2 X 1,604.92 X
27252   001 90 2 X 1,640.54 X
27252   004 90 2 X 1,504.07 X
27253   003 90 2 X 2,957.02 X
27253   002 90 2 X 3,048.54 X
27253   004 90 2 X 2,942.68 X
27253   001 90 2 X 3,100.17 X
27254   003 90 2 X 3,449.84 X
27254   002 90 2 X 3,687.30 X
27254   004 90 2 X 3,409.83 X
27254   001 90 2 X 3,744.86 X
27256   004 10 2 X 611.98 X
27256   001 10 2 X 663.60 X
27256   002 10 2 X 964.92 X
27256   003 10 2 X 618.81 X
27257   001 10 2 X 1,154.46 X
27257   003 10 2 X 1,059.78 X
27257   002 10 2 X 1,136.03 X
27257   004 10 2 X 1,047.16 X
27258   004 90 2 X 3,169.57 X
27258   002 90 2 X 3,396.50 X
27258   003 90 2 X 3,166.35 X
27258   001 90 2 X 3,452.21 X
27259   004 90 2 X 3,919.24 X
27259   001 90 2 X 4,324.90 X
27259   003 90 2 X 3,966.48 X
27259   002 90 2 X 4,255.01 X
27265   001 90 2 X 1,197.56 X
27265   003 90 2 X 1,002.73 X
27265   002 90 2 X 1,266.14 X
27265   004 90 2 X 1,235.35 X
27266   004 90 2 X 1,443.83 X
27266   003 90 2 X 1,303.54 X
27266   002 90 2 X 1,482.54 X
27266   001 90 2 X 1,451.93 X
27267   001 90 2 X 776.56 X
27267   004 90 2 X 677.93 X
27267   003 90 2 X 677.93 X
27267   002 90 2 X 677.93 X
27268   004 90 2 X 836.17 X
27268   002 90 2 X 836.17 X
27268   003 90 2 X 836.17 X
27268   001 90 2 X 955.19 X
27269   003 90 2 X 1,999.04 X
27269   002 90 2 X 1,999.04 X
27269   004 90 2 X 1,999.04 X
27269   001 90 2 X 2,263.74 X
27275   001 10 2 X 460.39 X
27275   003 10 2 X 438.31 X
27275   002 10 2 X 455.99 X
27275   004 10 2 X 429.92 X
27278   001 90 2 X 14,198.83 541.87
27278   004 90 2 X 12,521.70 498.91
27278   003 90 2 X 12,521.70 498.91
27278   002 90 2 X 12,521.70 498.91
27279   001 90 2 X 959.68 X
27279   004 90 2 X 879.27 X
27279   003 90 2 X 879.27 X
27279   002 90 2 X 879.27 X
27280   002 90 2 X 2,644.87 X
27280   003 90 2 X 2,466.87 X
27280   001 90 2 X 2,688.02 X
27280   004 90 2 X 2,438.09 X
27282   004 90 2 X 2,194.55 X
27282   001 90 2 X 2,893.17 X
27282   002 90 2 X 2,384.93 X
27282   003 90 2 X 2,788.38 X
27284   002 90 2 X 4,146.20 X
27284   003 90 2 X 3,390.92 X
27284   004 90 2 X 3,350.71 X
27284   001 90 2 X 4,144.31 X
27286   002 90 2 X 4,390.90 X
27286   003 90 2 X 3,450.98 X
27286   004 90 2 X 3,409.50 X
27286   001 90 2 X 3,752.90 X
27290   001 90 2 X 5,775.90 X
27290   002 90 2 X 5,696.38 X
27290   003 90 2 X 5,389.40 X
27290   004 90 2 X 5,324.51 X
27295   001 90 2 X 4,196.06 X
27295   004 90 2 X 3,855.01 X
27295   003 90 2 X 3,837.05 X
27295   002 90 2 X 4,126.02 X
27299     YYY 2 X # X
27301   004 90 2 X 797.30 X
27301   001 90 2 X 852.89 X
27301   003 90 2 X 805.75 X
27301   002 90 2 X 842.72 X
27303   001 90 2 X 1,643.61 X
27303   004 90 2 X 1,465.48 X
27303   003 90 2 X 1,516.54 X
27303   002 90 2 X 1,618.84 X
27305   001 90 2 X 1,122.40 X
27305   004 90 2 X 1,023.07 X
27305   002 90 2 X 1,105.28 X
27305   003 90 2 X 1,034.92 X
27306   003 90 2 X 695.31 X
27306   002 90 2 X 728.35 X
27306   004 90 2 X 682.17 X
27306   001 90 2 X 737.71 X
27307   001 90 2 X 989.80 X
27307   004 90 2 X 910.32 X
27307   003 90 2 X 920.62 X
27307   002 90 2 X 976.27 X
27310   001 90 2 X 2,340.09 X
27310   004 90 2 X 2,072.90 X
27310   002 90 2 X 2,169.78 X
27310   003 90 2 X 2,016.29 X
27323   001 10 2 X 311.17 X
27323   004 10 2 X 319.78 X
27323   002 10 2 X 309.10 X
27323   003 10 2 X 389.82 X
27324   002 90 2 X 567.03 X
27324   003 90 2 X 528.34 X
27324   004 90 2 X 524.69 X
27324   001 90 2 X 581.14 X
27325   001 90 2 X 939.53 X
27325   004 90 2 X 814.93 X
27325   002 90 2 X 814.93 X
27325   003 90 2 X 814.93 X
27326   002 90 2 X 770.55 X
27326   003 90 2 X 770.55 X
27326   004 90 2 X 770.55 X
27326   001 90 2 X 893.36 X
27327   003 90 2 X 768.45 X
27327   002 90 2 X 779.08 X
27327   004 90 2 X 726.50 X
27327   001 90 2 X 789.88 X
27328   004 90 2 X 819.33 X
27328   001 90 2 X 1,011.62 X
27328   003 90 2 X 820.56 X
27328   002 90 2 X 1,017.18 X
27329   002 90 2 X 2,870.39 X
27329   003 90 2 X 2,664.77 X
27329   004 90 2 X 2,633.20 X
27329   001 90 2 X 2,939.85 X
27330   003 90 2 X 1,347.68 X
27330   002 90 2 X 1,607.17 X
27330   001 90 2 X 1,714.00 X
27330   004 90 2 X 1,576.11 X
27331   003 90 2 X 1,773.35 X
27331   002 90 2 X 1,970.57 X
27331   004 90 2 X 1,909.45 X
27331   001 90 2 X 2,137.92 X
27332   002 90 2 X 2,355.00 X
27332   003 90 2 X 2,057.88 X
27332   004 90 2 X 2,032.64 X
27332   001 90 2 X 2,372.00 X
27333   003 90 2 X 2,423.55 X
27333   002 90 2 X 2,583.80 X
27333   001 90 2 X 2,637.51 X
27333   004 90 2 X 2,331.65 X
27334   004 90 2 X 2,511.00 X
27334   002 90 2 X 2,632.29 X
27334   003 90 2 X 2,550.05 X
27334   001 90 2 X 2,654.08 X
27335   004 90 2 X 2,618.29 X
27335   001 90 2 X 2,797.70 X
27335   003 90 2 X 2,695.15 X
27335   002 90 2 X 2,777.82 X
27337   004 90 2 X 702.67 X
27337   002 90 2 X 702.67 X
27337   003 90 2 X 702.67 X
27337   001 90 2 X 790.48 X
27339   002 90 2 X 1,268.45 X
27339   003 90 2 X 1,268.45 X
27339   001 90 2 X 1,423.81 X
27339   004 90 2 X 1,268.45 X
27340   001 90 2 X 1,136.69 X
27340   004 90 2 X 1,003.49 X
27340   002 90 2 X 1,092.59 X
27340   003 90 2 X 888.31 X
27345   001 90 2 X 1,466.80 X
27345   004 90 2 X 1,281.04 X
27345   002 90 2 X 1,400.41 X
27345   003 90 2 X 1,271.90 X
27347   004 90 2 X 748.54 780.67
27347   001 90 2 X 837.82 875.42
27347   002 90 2 X 748.54 780.67
27347   003 90 2 X 748.54 780.67
27350   001 90 2 X 2,108.03 X
27350   004 90 2 X 1,895.49 X
27350   002 90 2 X 2,071.23 X
27350   003 90 2 X 1,919.16 X
27355   002 90 2 X 1,982.32 X
27355   003 90 2 X 1,797.76 X
27355   004 90 2 X 1,632.21 X
27355   001 90 2 X 2,117.95 X
27356   004 90 2 X 1,868.43 X
27356   002 90 2 X 2,028.09 X
27356   003 90 2 X 1,890.97 X
27356   001 90 2 X 2,061.37 X
27357   002 90 2 X 2,220.47 X
27357   003 90 2 X 2,072.11 X
27357   004 90 2 X 2,047.60 X
27357   001 90 2 X 2,256.33 X
27358   002 ZZZ 0 X 1,987.15 X
27358   003 ZZZ 0 X 1,955.58 X
27358   004 ZZZ 0 X 1,895.90 X
27358   001 ZZZ 0 X 2,010.30 X
27360   003 90 2 X 2,001.77 X
27360   002 90 2 X 2,146.12 X
27360   001 90 2 X 2,181.07 X
27360   004 90 2 X 1,977.94 X
27364   001 90 2 X 2,972.92 X
27364   004 90 2 X 2,656.57 X
27364   002 90 2 X 2,656.57 X
27364   003 90 2 X 2,656.57 X
27365   001 90 2 X 3,444.73 X
27365   003 90 2 X 2,907.76 X
27365   002 90 2 X 3,100.54 X
27365   004 90 2 X 3,110.18 X
27369   001 0 2 X 217.02 62.10
27369   003 0 2 X 192.60 57.55
27369   002 0 2 X 192.60 57.55
27369   004 0 2 X 192.60 57.55
27372   001 90 2 X 932.26 X
27372   004 90 2 X 857.95 X
27372   002 90 2 X 908.75 X
27372   003 90 2 X 853.96 X
27380   004 90 2 X 1,697.86 X
27380   002 90 2 X 1,805.52 X
27380   003 90 2 X 1,680.65 X
27380   001 90 2 X 1,848.45 X
27381   004 90 2 X 2,339.51 X
27381   003 90 2 X 2,368.33 X
27381   002 90 2 X 2,550.58 X
27381   001 90 2 X 2,594.56 X
27385   003 90 2 X 1,813.76 X
27385   002 90 2 X 1,955.51 X
27385   004 90 2 X 1,833.96 X
27385   001 90 2 X 1,989.67 X
27386   004 90 2 X 2,559.35 X
27386   001 90 2 X 2,761.81 X
27386   002 90 2 X 2,713.74 X
27386   003 90 2 X 2,514.65 X
27390   004 90 2 X 1,026.54 X
27390   002 90 2 X 1,222.49 X
27390   003 90 2 X 1,038.82 X
27390   001 90 2 X 1,218.16 X
27391   001 90 2 X 1,472.49 X
27391   004 90 2 X 1,339.79 X
27391   002 90 2 X 1,449.72 X
27391   003 90 2 X 1,355.67 X
27392   004 90 2 X 1,800.23 X
27392   002 90 2 X 1,952.66 X
27392   003 90 2 X 1,821.77 X
27392   001 90 2 X 1,984.33 X
27393   001 90 2 X 1,426.61 X
27393   004 90 2 X 1,292.88 X
27393   002 90 2 X 1,403.56 X
27393   003 90 2 X 1,308.42 X
27394   001 90 2 X 1,655.46 X
27394   003 90 2 X 1,529.67 X
27394   002 90 2 X 1,630.93 X
27394   004 90 2 X 1,512.06 X
27395   003 90 2 X 2,407.29 X
27395   002 90 2 X 2,579.82 X
27395   004 90 2 X 2,378.56 X
27395   001 90 2 X 2,621.64 X
27396   001 90 2 X 1,759.35 X
27396   003 90 2 X 1,615.40 X
27396   002 90 2 X 2,471.13 X
27396   004 90 2 X 1,596.14 X
27397   004 90 2 X 2,025.42 X
27397   001 90 2 X 2,234.80 X
27397   002 90 2 X 2,198.76 X
27397   003 90 2 X 2,049.76 X
27400   003 90 2 X 1,834.52 X
27400   002 90 2 X 1,964.60 X
27400   004 90 2 X 1,812.57 X
27400   001 90 2 X 2,600.18 X
27403   002 90 2 X 2,262.35 X
27403   003 90 2 X 2,025.06 X
27403   001 90 2 X 2,056.82 X
27403   004 90 2 X 1,855.29 X
27405   003 90 2 X 2,708.12 X
27405   002 90 2 X 2,776.86 X
27405   001 90 2 X 2,793.45 X
27405   004 90 2 X 2,697.49 X
27407   004 90 2 X 2,033.70 X
27407   001 90 2 X 2,241.77 X
27407   003 90 2 X 2,058.19 X
27407   002 90 2 X 2,205.93 X
27409   001 90 2 X 3,357.81 X
27409   003 90 2 X 3,055.67 X
27409   002 90 2 X 3,299.06 X
27409   004 90 2 X 3,018.20 X
27412   001 90 2 X 3,641.58 X
27412   004 90 2 X 3,192.22 X
27412   003 90 2 X 3,192.22 X
27412   002 90 2 X 3,192.22 X
27415   001 90 2 X 3,062.58 X
27415   004 90 2 X 2,653.19 X
27415   003 90 2 X 2,653.19 X
27415   002 90 2 X 2,653.19 X
27416   003 90 2 X 1,566.49 X
27416   002 90 2 X 1,566.49 X
27416   004 90 2 X 1,566.49 X
27416   001 90 2 X 1,782.64 X
27418   004 90 2 X 2,455.38 X
27418   002 90 2 X 2,781.40 X
27418   003 90 2 X 2,486.08 X
27418   001 90 2 X 2,721.85 X
27420   001 90 2 X 2,312.10 X
27420   004 90 2 X 2,248.26 X
27420   003 90 2 X 2,276.11 X
27420   002 90 2 X 2,512.68 X
27422   004 90 2 X 2,497.53 X
27422   002 90 2 X 2,619.10 X
27422   003 90 2 X 2,327.72 X
27422   001 90 2 X 2,708.86 X
27424   001 90 2 X 2,592.14 X
27424   004 90 2 X 2,331.30 X
27424   002 90 2 X 2,546.99 X
27424   003 90 2 X 2,360.34 X
27425   003 90 2 X 1,984.68 X
27425   001 90 2 X 2,041.49 X
27425   002 90 2 X 1,817.70 X
27425   004 90 2 X 1,979.83 X
27427   001 90 2 X 2,719.86 X
27427   003 90 2 X 2,459.83 X
27427   002 90 2 X 3,099.73 X
27427   004 90 2 X 2,429.38 X
27428   001 90 2 X 3,268.27 X
27428   003 90 2 X 2,956.23 X
27428   002 90 2 X 3,207.43 X
27428   004 90 2 X 2,919.87 X
27429   002 90 2 X 3,928.93 X
27429   003 90 2 X 2,602.43 X
27429   004 90 2 X 2,571.39 X
27429   001 90 2 X 2,836.37 X
27430   004 90 2 X 2,172.79 X
27430   002 90 2 X 2,247.42 X
27430   003 90 2 X 2,094.36 X
27430   001 90 2 X 2,300.05 X
27435   001 90 2 X 2,622.19 X
27435   004 90 2 X 1,743.96 X
27435   002 90 2 X 2,609.93 X
27435   003 90 2 X 2,559.40 X
27437   004 90 2 X 1,972.52 X
27437   002 90 2 X 2,324.85 X
27437   003 90 2 X 2,155.29 X
27437   001 90 2 X 2,318.82 X
27438   003 90 2 X 5,394.69 X
27438   002 90 2 X 5,558.31 X
27438   004 90 2 X 2,624.98 X
27438   001 90 2 X 5,372.12 X
27440   002 90 2 X 2,758.01 X
27440   003 90 2 X 2,436.44 X
27440   004 90 2 X 2,406.81 X
27440   001 90 2 X 2,683.19 X
27441   001 90 2 X 2,325.87 X
27441   004 90 2 X 2,108.45 X
27441   002 90 2 X 2,288.41 X
27441   003 90 2 X 2,133.75 X
27442   001 90 2 X 3,576.58 X
27442   004 90 2 X 3,188.80 X
27442   003 90 2 X 3,228.75 X
27442   002 90 2 X 3,508.85 X
27443   001 90 2 X 3,621.90 X
27443   002 90 2 X 3,549.94 X
27443   003 90 2 X 3,252.22 X
27443   004 90 2 X 3,211.64 X
27445   004 90 2 X 6,325.94 X
27445   001 90 2 X 6,639.43 X
27445   002 90 2 X 6,571.40 X
27445   003 90 2 X 6,393.75 X
27446   003 90 2 X 5,018.74 X
27446   002 90 2 X 5,172.07 X
27446   004 90 2 X 4,918.86 X
27446   001 90 2 X 4,715.64 X
27447   001 90 2 X 6,865.02 X
27447   004 90 2 X 6,553.66 X
27447   003 90 2 X 6,555.52 X
27447   002 90 2 X 6,810.13 X
27448   004 90 2 X 2,588.79 X
27448   002 90 2 X 3,260.47 X
27448   003 90 2 X 2,758.89 X
27448   001 90 2 X 2,877.27 X
27450   001 90 2 X 3,449.40 X
27450   004 90 2 X 3,114.00 X
27450   003 90 2 X 3,152.27 X
27450   002 90 2 X 3,497.18 X
27454   001 90 2 X 3,779.54 X
27454   004 90 2 X 3,205.85 X
27454   003 90 2 X 3,245.59 X
27454   002 90 2 X 3,728.56 X
27455   001 90 2 X 2,952.59 X
27455   003 90 2 X 2,705.33 X
27455   002 90 2 X 2,904.39 X
27455   004 90 2 X 2,672.96 X
27457   001 90 2 X 3,104.87 X
27457   003 90 2 X 2,920.41 X
27457   002 90 2 X 3,137.98 X
27457   004 90 2 X 2,885.18 X
27465   004 90 2 X 2,789.45 X
27465   002 90 2 X 3,453.16 X
27465   003 90 2 X 2,822.99 X
27465   001 90 2 X 3,496.31 X
27466   004 90 2 X 3,173.87 X
27466   001 90 2 X 3,499.37 X
27466   003 90 2 X 3,211.74 X
27466   002 90 2 X 3,443.33 X
27468   004 90 2 X 3,836.66 X
27468   002 90 2 X 4,165.05 X
27468   003 90 2 X 3,882.91 X
27468   001 90 2 X 4,233.28 X