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2018 Workers' Compensation Part B Fee Schedule

27470-27750

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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
27470   1 90 2 0 3,000.93 0
27470   2 90 2 0 2,951.13 0
27470   3 90 2 0 2,744.99 0
27470   4 90 2 0 2,711.65 0
27472   1 90 2 0 3,684.09 0
27472   2 90 2 0 3,597.94 0
27472   3 90 2 0 3,349.64 0
27472   4 90 2 0 3,386.31 0
27475   1 90 2 0 1,505.17 0
27475   2 90 2 0 1,480.87 0
27475   3 90 2 0 1,380.49 0
27475   4 90 2 0 1,364.10 0
27477   1 90 2 0 2,360.32 0
27477   2 90 2 0 2,315.79 0
27477   3 90 2 0 2,131.22 0
27477   4 90 2 0 2,104.71 0
27479   1 90 2 0 2,259.41 0
27479   2 90 2 0 2,223.03 0
27479   3 90 2 0 2,072.77 0
27479   4 90 2 0 2,048.05 0
27485   1 90 2 0 1,539.96 0
27485   2 90 2 0 1,515.11 0
27485   3 90 2 0 1,412.45 0
27485   4 90 2 0 1,395.63 0
27486   1 90 2 0 4,661.82 0
27486   2 90 2 0 4,619.57 0
27486   3 90 2 0 4,595.60 0
27486   4 90 2 0 4,465.17 0
27487   1 90 2 0 5,434.84 0
27487   2 90 2 0 5,331.94 0
27487   3 90 2 0 5,379.50 0
27487   4 90 2 0 5,375.93 0
27488   1 90 2 0 3,447.69 0
27488   2 90 2 0 3,380.46 0
27488   3 90 2 0 3,342.27 0
27488   4 90 2 0 3,328.72 0
27495   1 90 2 0 3,063.42 0
27495   2 90 2 0 3,010.81 0
27495   3 90 2 0 2,793.05 0
27495   4 90 2 0 2,798.12 0
27496   1 90 2 0 880.89 0
27496   2 90 2 0 866.62 0
27496   3 90 2 0 807.92 0
27496   4 90 2 0 798.28 0
27497   1 90 2 0 1,078.34 0
27497   2 90 2 0 1,060.95 0
27497   3 90 2 0 988.96 0
27497   4 90 2 0 977.12 0
27498   1 90 2 0 1,229.75 0
27498   2 90 2 0 1,209.86 0
27498   3 90 2 0 1,127.70 0
27498   4 90 2 0 1,114.34 0
27499   1 90 2 0 1,415.45 0
27499   2 90 2 0 1,392.65 0
27499   3 90 2 0 1,298.38 0
27499   4 90 2 0 1,282.94 0
27500   1 90 2 0 1,131.78 0
27500   2 90 2 0 1,103.94 0
27500   3 90 2 0 1,074.51 0
27500   4 90 2 0 1,072.96 0
27501   1 90 2 0 1,131.78 0
27501   2 90 2 0 1,103.94 0
27501   3 90 2 0 1,074.51 0
27501   4 90 2 0 1,072.96 0
27502   1 90 2 0 1,933.12 0
27502   2 90 2 0 1,958.33 0
27502   3 90 2 0 1,520.35 0
27502   4 90 2 0 1,619.23 0
27503   1 90 2 0 1,933.12 0
27503   2 90 2 0 1,958.33 0
27503   3 90 2 0 1,520.35 0
27503   4 90 2 0 1,619.23 0
27506   1 90 2 0 3,035.10 0
27506   2 90 2 0 2,985.81 0
27506   3 90 2 0 2,782.03 0
27506   4 90 2 0 2,748.69 0
27507   1 90 2 0 2,774.06 0
27507   2 90 2 0 2,726.32 0
27507   3 90 2 0 2,528.70 0
27507   4 90 2 0 2,497.68 0
27508   1 90 2 0 1,004.31 0
27508   2 90 2 0 997.49 0
27508   3 90 2 0 967.38 0
27508   4 90 2 0 971.07 0
27509   1 90 2 0 1,069.97 0
27509   2 90 2 0 1,062.75 0
27509   3 90 2 0 1,031.10 0
27509   4 90 2 0 1,034.25 0
27510   1 90 2 0 1,411.00 0
27510   2 90 2 0 1,389.36 0
27510   3 90 2 0 1,344.00 0
27510   4 90 2 0 1,323.77 0
27511   1 90 2 0 2,743.10 0
27511   2 90 2 0 2,695.57 0
27511   3 90 2 0 2,498.73 0
27511   4 90 2 0 2,467.99 0
27513   1 90 2 0 3,107.07 0
27513   2 90 2 0 3,057.36 0
27513   3 90 2 0 2,851.85 0
27513   4 90 2 0 2,817.85 0
27514   1 90 2 0 3,179.18 0
27514   2 90 2 0 2,964.94 0
27514   3 90 2 0 2,763.37 0
27514   4 90 2 0 2,769.10 0
27516   1 90 2 0 915.54 0
27516   2 90 2 0 901.23 0
27516   3 90 2 0 841.88 0
27516   4 90 2 0 831.75 0
27517   1 90 2 0 1,520.70 0
27517   2 90 2 0 1,496.16 0
27517   3 90 2 0 1,394.90 0
27517   4 90 2 0 1,378.25 0
27519   1 90 2 0 2,506.61 0
27519   2 90 2 0 2,466.86 0
27519   3 90 2 0 2,302.36 0
27519   4 90 2 0 2,275.08 0
27520   1 90 2 0 576.66 0
27520   2 90 2 0 593.94 0
27520   3 90 2 0 496.88 0
27520   4 90 2 0 547.25 0
27524   1 90 2 0 1,882.26 0
27524   2 90 2 0 1,850.89 0
27524   3 90 2 0 1,721.21 0
27524   4 90 2 0 1,700.40 0
27530   1 90 2 0 706.33 0
27530   2 90 2 0 715.12 0
27530   3 90 2 0 576.11 0
27530   4 90 2 0 640.00 0
27532   1 90 2 0 1,174.59 0
27532   2 90 2 0 1,156.49 0
27532   3 90 2 0 1,081.88 0
27532   4 90 2 0 1,069.17 0
27535   1 90 2 0 2,109.22 0
27535   2 90 2 0 1,956.86 0
27535   3 90 2 0 1,927.26 0
27535   4 90 2 0 1,861.35 0
27536   1 90 2 0 2,459.80 0
27536   2 90 2 0 2,125.21 0
27536   3 90 2 0 2,267.43 0
27536   4 90 2 0 2,024.18 0
27538   1 90 2 0 647.26 0
27538   2 90 2 0 725.49 0
27538   3 90 2 0 696.87 0
27538   4 90 2 0 680.96 0
27540   1 90 2 0 2,329.83 0
27540   2 90 2 0 2,164.85 0
27540   3 90 2 0 2,022.99 0
27540   4 90 2 0 2,232.92 0
27550   1 90 2 0 667.86 0
27550   2 90 2 0 724.59 0
27550   3 90 2 0 685.91 0
27550   4 90 2 0 678.36 0
27552   1 90 2 0 983.95 0
27552   2 90 2 0 976.74 0
27552   3 90 2 0 921.07 0
27552   4 90 2 0 910.91 0
27556   1 90 2 0 2,447.84 0
27556   2 90 2 0 2,409.31 0
27556   3 90 2 0 2,250.22 0
27556   4 90 2 0 2,223.50 0
27557   1 90 2 0 2,887.11 0
27557   2 90 2 0 3,325.22 0
27557   3 90 2 0 2,648.61 0
27557   4 90 2 0 2,617.25 0
27558   1 90 2 0 2,967.40 0
27558   2 90 2 0 3,364.87 0
27558   3 90 2 0 2,726.57 0
27558   4 90 2 0 2,694.52 0
27560   1 90 2 0 505.69 0
27560   2 90 2 0 497.96 0
27560   3 90 2 0 447.61 0
27560   4 90 2 0 382.24 0
27562   1 90 2 0 1,000.56 0
27562   2 90 2 0 868.98 0
27562   3 90 2 0 921.08 0
27562   4 90 2 0 818.00 0
27566   1 90 2 0 2,083.15 0
27566   2 90 2 0 2,050.33 0
27566   3 90 2 0 1,914.54 0
27566   4 90 2 0 1,891.82 0
27570   1 10 2 0 402.26 0
27570   2 10 2 0 399.57 0
27570   3 10 2 0 390.90 0
27570   4 10 2 0 386.26 0
27580   1 90 2 0 3,006.33 0
27580   2 90 2 0 2,927.73 0
27580   3 90 2 0 2,791.75 0
27580   4 90 2 0 2,762.57 0
27590   1 90 2 0 1,869.74 0
27590   2 90 2 0 1,837.89 0
27590   3 90 2 0 1,706.61 0
27590   4 90 2 0 1,686.74 0
27591   1 90 2 0 2,206.41 0
27591   2 90 2 0 2,168.43 0
27591   3 90 2 0 2,011.44 0
27591   4 90 2 0 1,987.41 0
27592   1 90 2 0 1,693.23 0
27592   2 90 2 0 1,686.74 0
27592   3 90 2 0 1,595.31 0
27592   4 90 2 0 1,473.19 0
27594   1 90 2 0 944.85 0
27594   2 90 2 0 916.59 0
27594   3 90 2 0 886.60 0
27594   4 90 2 0 889.57 0
27596   1 90 2 0 1,691.69 0
27596   2 90 2 0 1,647.58 0
27596   3 90 2 0 1,563.48 0
27596   4 90 2 0 1,574.82 0
27598   1 90 2 0 1,888.88 0
27598   2 90 2 0 1,856.53 0
27598   3 90 2 0 1,745.27 0
27598   4 90 2 0 1,773.03 0
27599     YYY 2 0 * 0
27600   1 90 2 0 967.52 0
27600   2 90 2 0 952.61 0
27600   3 90 2 0 908.08 0
27600   4 90 2 0 922.45 0
27601   1 90 2 0 967.41 0
27601   2 90 2 0 898.90 0
27601   3 90 2 0 901.26 0
27601   4 90 2 0 916.61 0
27602   1 90 2 0 1,002.73 0
27602   2 90 2 0 987.78 0
27602   3 90 2 0 926.38 0
27602   4 90 2 0 916.06 0
27603   1 90 2 0 552.91 0
27603   2 90 2 0 567.45 0
27603   3 90 2 0 549.71 0
27603   4 90 2 0 546.20 0
27604   1 90 2 0 360.42 0
27604   2 90 2 0 357.79 0
27604   3 90 2 0 439.20 0
27604   4 90 2 0 331.60 0
27605   1 10 2 0 356.00 0
27605   2 10 2 0 351.96 0
27605   3 10 2 0 335.58 0
27605   4 10 2 0 331.92 0
27606   1 10 2 0 551.01 0
27606   2 10 2 0 460.29 0
27606   3 10 2 0 412.99 0
27606   4 10 2 0 507.10 0
27607   1 90 2 0 1,232.10 0
27607   2 90 2 0 1,212.89 0
27607   3 90 2 0 1,133.57 0
27607   4 90 2 0 1,120.25 0
27610   1 90 2 0 1,389.39 0
27610   2 90 2 0 1,367.13 0
27610   3 90 2 0 1,275.15 0
27610   4 90 2 0 1,301.52 0
27612   1 90 2 0 1,382.65 0
27612   2 90 2 0 1,358.59 0
27612   3 90 2 0 1,324.79 0
27612   4 90 2 0 1,243.57 0
27613   1 10 2 0 209.44 0
27613   2 10 2 0 197.96 0
27613   3 10 2 0 234.91 0
27613   4 10 2 0 209.55 0
27614   1 90 2 0 462.55 0
27614   2 90 2 0 455.03 0
27614   3 90 2 0 424.08 0
27614   4 90 2 0 421.21 0
27615   1 90 2 0 1,877.96 0
27615   2 90 2 0 1,543.44 0
27615   3 90 2 0 1,733.80 0
27615   4 90 2 0 1,472.71 0
27616   1 90 2 0 1,875.22 0
27616   2 90 2 0 1,674.77 0
27616   3 90 2 0 1,674.77 0
27616   4 90 2 0 1,674.77 0
27618   1 90 2 0 575.04 0
27618   2 90 2 0 528.25 0
27618   3 90 2 0 502.60 0
27618   4 90 2 0 483.85 0
27619   1 90 2 0 810.55 0
27619   2 90 2 0 803.10 0
27619   3 90 2 0 763.03 0
27619   4 90 2 0 1,024.99 0
27620   1 90 2 0 1,202.11 0
27620   2 90 2 0 1,260.33 0
27620   3 90 2 0 1,178.89 0
27620   4 90 2 0 1,193.71 0
27625   1 90 2 0 1,567.93 0
27625   2 90 2 0 1,542.72 0
27625   3 90 2 0 1,438.23 0
27625   4 90 2 0 1,467.94 0
27626   1 90 2 0 1,797.98 0
27626   2 90 2 0 1,770.34 0
27626   3 90 2 0 1,655.36 0
27626   4 90 2 0 1,634.48 0
27630   1 90 2 0 715.36 0
27630   2 90 2 0 705.32 0
27630   3 90 2 0 663.92 0
27630   4 90 2 0 656.29 0
27632   1 90 2 0 601.51 0
27632   2 90 2 0 536.10 0
27632   3 90 2 0 536.10 0
27632   4 90 2 0 536.10 0
27634   1 90 2 0 978.68 0
27634   2 90 2 0 875.89 0
27634   3 90 2 0 875.89 0
27634   4 90 2 0 875.89 0
27635   1 90 2 0 1,460.82 0
27635   2 90 2 0 1,533.21 0
27635   3 90 2 0 1,449.47 0
27635   4 90 2 0 1,510.98 0
27637   1 90 2 0 1,671.20 0
27637   2 90 2 0 1,644.34 0
27637   3 90 2 0 1,533.25 0
27637   4 90 2 0 1,515.09 0
27638   1 90 2 0 1,807.89 0
27638   2 90 2 0 1,778.81 0
27638   3 90 2 0 1,664.18 0
27638   4 90 2 0 1,638.92 0
27640   1 90 2 0 1,909.75 0
27640   2 90 2 0 1,866.71 0
27640   3 90 2 0 1,740.85 0
27640   4 90 2 0 1,709.57 0
27641   1 90 2 0 1,512.23 0
27641   2 90 2 0 1,467.05 0
27641   3 90 2 0 1,371.51 0
27641   4 90 2 0 1,377.65 0
27645   1 90 2 0 2,352.97 0
27645   2 90 2 0 2,315.26 0
27645   3 90 2 0 2,159.61 0
27645   4 90 2 0 2,134.21 0
27646   1 90 2 0 2,120.06 0
27646   2 90 2 0 2,086.58 0
27646   3 90 2 0 1,948.11 0
27646   4 90 2 0 1,924.98 0
27647   1 90 2 0 1,963.93 0
27647   2 90 2 0 1,934.91 0
27647   3 90 2 0 1,815.04 0
27647   4 90 2 0 1,793.33 0
27648   1 0 2 0 123.46 0
27648   2 0 2 0 122.07 0
27648   3 0 2 0 116.17 0
27648   4 0 2 0 114.86 0
27650   1 90 2 0 1,665.99 0
27650   2 90 2 0 1,625.11 0
27650   3 90 2 0 1,519.30 0
27650   4 90 2 0 1,533.82 0
27652   1 90 2 0 1,897.51 0
27652   2 90 2 0 1,811.71 0
27652   3 90 2 0 1,739.68 0
27652   4 90 2 0 1,794.51 0
27654   1 90 2 0 1,866.40 0
27654   2 90 2 0 2,063.31 0
27654   3 90 2 0 2,007.75 0
27654   4 90 2 0 1,742.44 0
27656   1 90 2 0 704.67 0
27656   2 90 2 0 693.96 0
27656   3 90 2 0 674.18 0
27656   4 90 2 0 642.36 0
27658   1 90 2 0 807.74 0
27658   2 90 2 0 795.41 0
27658   3 90 2 0 744.55 0
27658   4 90 2 0 735.77 0
27659   1 90 2 0 1,139.72 0
27659   2 90 2 0 1,122.19 0
27659   3 90 2 0 1,049.51 0
27659   4 90 2 0 1,037.00 0
27664   1 90 2 0 723.00 0
27664   2 90 2 0 712.25 0
27664   3 90 2 0 652.71 0
27664   4 90 2 0 659.97 0
27665   1 90 2 0 949.56 0
27665   2 90 2 0 934.53 0
27665   3 90 2 0 872.31 0
27665   4 90 2 0 861.91 0
27675   1 90 2 0 1,237.00 0
27675   2 90 2 0 1,217.84 0
27675   3 90 2 0 1,138.80 0
27675   4 90 2 0 1,125.16 0
27676   1 90 2 0 1,452.55 0
27676   2 90 2 0 1,429.75 0
27676   3 90 2 0 1,335.68 0
27676   4 90 2 0 1,319.64 0
27680   1 90 2 0 882.66 0
27680   2 90 2 0 869.75 0
27680   3 90 2 0 816.52 0
27680   4 90 2 0 806.98 0
27681   1 90 2 0 1,154.82 0
27681   2 90 2 0 1,137.07 0
27681   3 90 2 0 1,063.89 0
27681   4 90 2 0 1,051.12 0
27685   1 90 2 0 920.75 0
27685   2 90 2 0 896.63 0
27685   3 90 2 0 834.50 0
27685   4 90 2 0 824.80 0
27686   1 90 2 0 1,153.27 0
27686   2 90 2 0 1,238.86 0
27686   3 90 2 0 1,160.23 0
27686   4 90 2 0 1,146.24 0
27687   1 90 2 0 1,035.17 0
27687   2 90 2 0 1,037.35 0
27687   3 90 2 0 971.34 0
27687   4 90 2 0 959.74 0
27690   1 90 2 0 1,369.03 0
27690   2 90 2 0 1,349.46 0
27690   3 90 2 0 1,268.36 0
27690   4 90 2 0 1,253.33 0
27691   1 90 2 0 1,608.83 0
27691   2 90 2 0 1,584.21 0
27691   3 90 2 0 1,482.31 0
27691   4 90 2 0 1,464.84 0
27692   1 ZZZ 0 0 366.79 0
27692   2 ZZZ 0 0 361.00 0
27692   3 ZZZ 0 0 336.89 0
27692   4 ZZZ 0 0 332.81 0
27695   1 90 2 0 1,602.70 0
27695   2 90 2 0 1,564.19 0
27695   3 90 2 0 1,431.93 0
27695   4 90 2 0 1,485.26 0
27696   1 90 2 0 1,400.74 0
27696   2 90 2 0 1,378.42 0
27696   3 90 2 0 1,286.10 0
27696   4 90 2 0 1,270.84 0
27698   1 90 2 0 1,994.92 0
27698   2 90 2 0 1,926.77 0
27698   3 90 2 0 1,785.03 0
27698   4 90 2 0 1,927.14 0
27700   1 90 2 0 1,880.23 0
27700   2 90 2 0 1,849.59 0
27700   3 90 2 0 1,722.42 0
27700   4 90 2 0 1,700.89 0
27702   1 90 2 0 3,408.62 0
27702   2 90 2 0 3,341.65 0
27702   3 90 2 0 3,064.74 0
27702   4 90 2 0 3,026.42 0
27703   1 90 2 0 2,686.64 0
27703   2 90 2 0 2,643.37 0
27703   3 90 2 0 2,464.40 0
27703   4 90 2 0 2,435.07 0
27704   1 90 2 0 1,181.06 0
27704   2 90 2 0 1,162.87 0
27704   3 90 2 0 1,098.35 0
27704   4 90 2 0 1,119.26 0
27705   1 90 2 0 1,951.59 0
27705   2 90 2 0 2,035.57 0
27705   3 90 2 0 1,782.53 0
27705   4 90 2 0 1,760.95 0
27707   1 90 2 0 940.95 0
27707   2 90 2 0 928.93 0
27707   3 90 2 0 785.57 0
27707   4 90 2 0 734.76 0
27709   1 90 2 0 2,078.05 0
27709   2 90 2 0 2,040.36 0
27709   3 90 2 0 1,884.34 0
27709   4 90 2 0 1,861.27 0
27712   1 90 2 0 2,139.94 0
27712   2 90 2 0 2,404.23 0
27712   3 90 2 0 1,970.07 0
27712   4 90 2 0 1,946.54 0
27715   1 90 2 0 2,407.09 0
27715   2 90 2 0 2,369.36 0
27715   3 90 2 0 2,213.31 0
27715   4 90 2 0 2,186.72 0
27720   1 90 2 0 2,446.15 0
27720   2 90 2 0 2,391.92 0
27720   3 90 2 0 2,225.41 0
27720   4 90 2 0 2,159.29 0
27722   1 90 2 0 2,024.88 0
27722   2 90 2 0 2,524.41 0
27722   3 90 2 0 2,130.91 0
27722   4 90 2 0 1,837.39 0
27724   1 90 2 0 2,771.91 0
27724   2 90 2 0 2,721.42 0
27724   3 90 2 0 2,512.53 0
27724   4 90 2 0 2,481.73 0
27725   1 90 2 0 2,014.98 0
27725   2 90 2 0 1,983.82 0
27725   3 90 2 0 1,854.94 0
27725   4 90 2 0 2,558.71 0
27726   1 90 2 0 1,273.04 0
27726   2 90 2 0 1,139.93 0
27726   3 90 2 0 1,139.93 0
27726   4 90 2 0 1,139.93 0
27727   1 90 2 0 2,121.66 0
27727   2 90 2 0 2,087.80 0
27727   3 90 2 0 1,948.54 0
27727   4 90 2 0 1,926.34 0
27730   1 90 2 0 994.94 0
27730   2 90 2 0 979.73 0
27730   3 90 2 0 917.31 0
27730   4 90 2 0 907.38 0
27732   1 90 2 0 940.02 0
27732   2 90 2 0 924.82 0
27732   3 90 2 0 862.08 0
27732   4 90 2 0 851.83 0
27734   1 90 2 0 1,464.05 0
27734   2 90 2 0 1,440.48 0
27734   3 90 2 0 1,343.03 0
27734   4 90 2 0 1,327.02 0
27740   1 90 2 0 1,624.26 0
27740   2 90 2 0 1,598.03 0
27740   3 90 2 0 1,489.78 0
27740   4 90 2 0 1,472.07 0
27742   1 90 2 0 1,805.40 0
27742   2 90 2 0 1,776.21 0
27742   3 90 2 0 1,655.69 0
27742   4 90 2 0 1,635.99 0
27745   1 90 2 0 1,733.50 0
27745   2 90 2 0 1,706.08 0
27745   3 90 2 0 1,592.51 0
27745   4 90 2 0 1,573.50 0
27750   1 90 2 0 693.43 0
27750   2 90 2 0 727.88 0
27750   3 90 2 0 591.26 0
27750   4 90 2 0 627.92 0