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2018 Workers' Compensation Part B Fee Schedule

29365-30620

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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
29365   1 0 2 0 240.61 194.17
29365   2 0 2 0 248.72 200.62
29365   3 0 2 0 189.03 152.29
29365   4 0 2 0 181.37 146.38
29405   1 0 2 0 177.09 138.99
29405   2 0 2 0 179.50 140.46
29405   3 0 2 0 142.79 111.59
29405   4 0 2 0 159.08 124.64
29425   1 0 2 0 245.71 191.20
29425   2 0 2 0 259.66 201.95
29425   3 0 2 0 217.33 168.87
29425   4 0 2 0 210.66 163.71
29435   1 0 2 0 343.52 266.39
29435   2 0 2 0 344.99 267.18
29435   3 0 2 0 342.32 264.68
29435   4 0 2 0 222.12 171.74
29440   1 0 2 0 71.62 62.00
29440   2 0 2 0 72.73 62.83
29440   3 0 2 0 67.52 58.52
29440   4 0 2 0 70.94 61.52
29445   1 0 2 0 354.19 0
29445   2 0 2 0 343.45 0
29445   3 0 2 0 320.71 0
29445   4 0 2 0 316.31 0
29450   1 0 2 0 151.86 0
29450   2 0 2 0 139.27 0
29450   3 0 2 0 117.30 0
29450   4 0 2 0 116.04 0
29505   1 0 2 0 125.25 0
29505   2 0 2 0 117.29 0
29505   3 0 2 0 113.20 0
29505   4 0 2 0 117.99 0
29515   1 0 2 0 109.78 89.67
29515   2 0 2 0 106.56 87.14
29515   3 0 2 0 102.38 83.66
29515   4 0 2 0 101.21 82.85
29520   1 0 2 0 79.99 64.91
29520   2 0 2 0 79.05 64.22
29520   3 0 2 0 75.16 61.12
29520   4 0 2 0 74.27 60.49
29530   1 0 2 0 79.15 65.42
29530   2 0 2 0 80.70 66.64
29530   3 0 2 0 78.44 64.81
29530   4 0 2 0 77.51 64.30
29540   1 0 2 0 69.59 57.74
29540   2 0 2 0 71.62 59.21
29540   3 0 2 0 68.08 56.35
29540   4 0 2 0 66.47 55.26
29550   1 0 2 0 61.98 51.15
29550   2 0 2 0 60.93 50.20
29550   3 0 2 0 63.24 52.33
29550   4 0 2 0 54.38 45.20
29580   1 0 2 0 93.01 66.44
29580   2 0 2 0 87.93 62.52
29580   3 0 2 0 80.04 56.52
29580   4 0 2 0 77.81 54.97
29581   1 0 2 0 129.29 47.41
29581   2 0 2 0 112.22 43.18
29581   3 0 2 0 112.22 43.18
29581   4 0 2 0 112.22 43.18
29584   1 0 2 0 95.89 20.71
29584   2 0 2 0 84.51 19.67
29584   3 0 2 0 84.51 19.67
29584   4 0 2 0 84.51 19.67
29700     0 2 0 * 0
29705     0 2 0 * 0
29710     0 2 0 * 0
29720   1 0 2 0 75.49 0
29720   2 0 2 0 74.80 0
29720   3 0 2 0 77.21 0
29720   4 0 2 0 76.40 0
29730   1 0 2 0 90.45 0
29730   2 0 2 0 89.48 0
29730   3 0 2 0 86.59 0
29730   4 0 2 0 84.32 0
29740   1 0 2 0 133.78 0
29740   2 0 2 0 130.22 0
29740   3 0 2 0 126.29 0
29740   4 0 2 0 107.55 0
29750   1 0 2 0 157.92 0
29750   2 0 2 0 156.08 0
29750   3 0 2 0 148.58 0
29750   4 0 2 0 146.98 0
29799     YYY 2 0 * 0
29800   1 90 2 0 845.87 0
29800   2 90 2 0 834.52 0
29800   3 90 2 0 787.65 0
29800   4 90 2 0 778.33 0
29804   1 90 2 0 2,019.45 0
29804   2 90 2 0 1,986.92 0
29804   3 90 2 0 1,851.76 0
29804   4 90 2 0 1,827.63 0
29805   1 90 2 0 679.59 0
29805   2 90 2 0 599.93 0
29805   3 90 2 0 599.93 0
29805   4 90 2 0 599.93 0
29806   1 90 2 0 1,895.43 0
29806   2 90 2 0 1,666.03 0
29806   3 90 2 0 1,666.03 0
29806   4 90 2 0 1,666.03 0
29807   1 90 2 0 1,846.29 0
29807   2 90 2 0 1,620.73 0
29807   3 90 2 0 1,620.73 0
29807   4 90 2 0 1,620.73 0
29819   1 90 3 0 2,097.10 0
29819   2 90 3 0 2,072.81 0
29819   3 90 3 0 1,949.48 0
29819   4 90 3 0 1,491.30 0
29820   1 90 3 0 1,609.70 0
29820   2 90 3 0 1,579.76 0
29820   3 90 3 0 1,455.91 0
29820   4 90 3 0 1,437.99 0
29821   1 90 3 0 1,905.24 0
29821   2 90 3 0 2,417.76 0
29821   3 90 3 0 1,718.10 0
29821   4 90 3 0 1,696.73 0
29822   1 90 3 0 1,664.55 0
29822   2 90 3 0 1,633.99 0
29822   3 90 3 0 1,507.67 0
29822   4 90 3 0 1,489.13 0
29823   1 90 3 0 2,042.14 0
29823   2 90 3 0 2,002.73 0
29823   3 90 3 0 2,031.74 0
29823   4 90 3 0 2,021.90 0
29824   1 90 2 0 1,156.22 0
29824   2 90 2 0 1,014.20 0
29824   3 90 2 0 1,014.20 0
29824   4 90 2 0 1,014.20 0
29825   1 90 3 0 1,843.98 0
29825   2 90 3 0 1,808.90 0
29825   3 90 3 0 1,663.67 0
29825   4 90 3 0 1,643.06 0
29826   1 ZZZ 0 0 2,196.73 0
29826   2 ZZZ 0 0 2,177.54 0
29826   3 ZZZ 0 0 2,103.88 0
29826   4 ZZZ 0 0 1,891.88 0
29827   1 90 3 0 1,954.07 0
29827   2 90 3 0 1,727.22 0
29827   3 90 3 0 1,727.22 0
29827   4 90 3 0 1,727.22 0
29828   1 90 3 0 1,305.16 0
29828   2 90 3 0 1,145.45 0
29828   3 90 3 0 1,145.45 0
29828   4 90 3 0 1,145.45 0
29830   1 90 2 0 1,033.83 0
29830   2 90 2 0 1,017.48 0
29830   3 90 2 0 949.88 0
29830   4 90 2 0 938.55 0
29834   1 90 3 0 1,137.47 0
29834   2 90 3 0 1,330.83 0
29834   3 90 3 0 1,043.17 0
29834   4 90 3 0 1,389.43 0
29835   1 90 3 0 1,173.97 0
29835   2 90 3 0 1,155.04 0
29835   3 90 3 0 1,076.68 0
29835   4 90 3 0 1,063.92 0
29836   1 90 3 0 1,366.82 0
29836   2 90 3 0 1,344.76 0
29836   3 90 3 0 1,253.72 0
29836   4 90 3 0 1,238.84 0
29837   1 90 3 0 1,246.52 0
29837   2 90 3 0 1,226.31 0
29837   3 90 3 0 1,498.75 0
29837   4 90 3 0 1,129.32 0
29838   1 90 3 0 1,371.42 0
29838   2 90 3 0 1,658.92 0
29838   3 90 3 0 1,547.36 0
29838   4 90 3 0 1,243.56 0
29840   1 90 2 0 805.08 0
29840   2 90 2 0 793.75 0
29840   3 90 2 0 746.93 0
29840   4 90 2 0 738.45 0
29843   1 90 3 0 1,087.57 0
29843   2 90 3 0 1,070.08 0
29843   3 90 3 0 997.66 0
29843   4 90 3 0 985.79 0
29844   1 90 3 0 1,122.00 0
29844   2 90 3 0 1,103.93 0
29844   3 90 3 0 1,029.41 0
29844   4 90 3 0 1,017.25 0
29845   1 90 3 0 1,572.85 0
29845   2 90 3 0 1,339.79 0
29845   3 90 3 0 1,248.94 0
29845   4 90 3 0 1,234.09 0
29846   1 90 3 0 1,761.11 0
29846   2 90 3 0 1,725.54 0
29846   3 90 3 0 1,578.41 0
29846   4 90 3 0 1,558.95 0
29847   1 90 3 0 1,540.92 0
29847   2 90 3 0 1,266.14 0
29847   3 90 3 0 1,183.87 0
29847   4 90 3 0 1,169.60 0
29848   1 90 2 0 747.55 0
29848   2 90 2 0 735.55 0
29848   3 90 2 0 685.89 0
29848   4 90 2 0 677.72 0
29850   1 90 2 0 2,123.09 0
29850   2 90 2 0 1,730.29 0
29850   3 90 2 0 1,600.81 0
29850   4 90 2 0 2,035.07 0
29851   1 90 2 0 2,329.83 0
29851   2 90 2 0 2,164.85 0
29851   3 90 2 0 2,022.99 0
29851   4 90 2 0 2,232.92 0
29855   1 90 2 0 2,034.70 0
29855   2 90 2 0 1,932.41 0
29855   3 90 2 0 1,854.98 0
29855   4 90 2 0 1,837.73 0
29856   1 90 2 0 2,356.04 0
29856   2 90 2 0 2,091.17 0
29856   3 90 2 0 2,166.75 0
29856   4 90 2 0 1,991.29 0
29860   1 90 2 0 1,045.63 0
29860   2 90 2 0 933.56 0
29860   3 90 2 0 933.56 0
29860   4 90 2 0 933.56 0
29861   1 90 3 0 1,591.60 0
29861   2 90 3 0 1,378.93 0
29861   3 90 3 0 1,378.93 0
29861   4 90 3 0 1,378.93 0
29862   1 90 3 0 1,758.34 0
29862   2 90 3 0 1,509.76 0
29862   3 90 3 0 1,509.76 0
29862   4 90 3 0 1,509.76 0
29863   1 90 3 0 1,590.44 0
29863   2 90 3 0 1,384.13 0
29863   3 90 3 0 1,384.13 0
29863   4 90 3 0 1,384.13 0
29866   1 90 2 0 1,834.21 0
29866   2 90 2 0 1,605.89 0
29866   3 90 2 0 1,605.89 0
29866   4 90 2 0 1,605.89 0
29867   1 90 2 0 2,187.46 0
29867   2 90 2 0 1,920.97 0
29867   3 90 2 0 1,920.97 0
29867   4 90 2 0 1,920.97 0
29868   1 90 2 0 2,973.32 0
29868   2 90 2 0 2,603.03 0
29868   3 90 2 0 2,603.03 0
29868   4 90 2 0 2,603.03 0
29870   1 90 2 0 791.92 0
29870   2 90 2 0 836.59 0
29870   3 90 2 0 769.13 0
29870   4 90 2 0 765.55 0
29871   1 90 3 0 1,318.69 0
29871   2 90 3 0 1,210.06 0
29871   3 90 3 0 1,143.60 0
29871   4 90 3 0 1,170.67 0
29873   1 90 3 0 904.82 0
29873   2 90 3 0 795.01 0
29873   3 90 3 0 795.01 0
29873   4 90 3 0 795.01 0
29874   1 90 3 0 1,603.06 0
29874   2 90 3 0 1,571.19 0
29874   3 90 3 0 1,505.53 0
29874   4 90 3 0 1,480.30 0
29875   1 90 3 0 1,749.44 0
29875   2 90 3 0 1,717.66 0
29875   3 90 3 0 1,593.93 0
29875   4 90 3 0 1,536.12 0
29876   1 90 3 0 1,960.87 0
29876   2 90 3 0 1,930.31 0
29876   3 90 3 0 1,798.91 0
29876   4 90 3 0 1,784.15 0
29877   1 90 3 0 1,842.20 0
29877   2 90 3 0 1,806.56 0
29877   3 90 3 0 1,666.22 0
29877   4 90 3 0 1,662.66 0
29879   1 90 3 0 2,109.23 0
29879   2 90 3 0 2,074.78 0
29879   3 90 3 0 1,938.55 0
29879   4 90 3 0 1,930.31 0
29880   1 90 3 0 2,017.99 0
29880   2 90 3 0 1,979.86 0
29880   3 90 3 0 1,821.91 0
29880   4 90 3 0 1,799.33 0
29881   1 90 3 0 1,837.07 0
29881   2 90 3 0 1,805.95 0
29881   3 90 3 0 1,677.39 0
29881   4 90 3 0 1,646.94 0
29882   1 90 3 0 1,945.38 0
29882   2 90 3 0 1,914.75 0
29882   3 90 3 0 1,782.39 0
29882   4 90 3 0 1,669.64 0
29883   1 90 3 0 2,402.31 0
29883   2 90 3 0 2,355.25 0
29883   3 90 3 0 2,160.63 0
29883   4 90 3 0 2,133.71 0
29884   1 90 3 0 1,935.52 0
29884   2 90 3 0 1,944.09 0
29884   3 90 3 0 1,800.02 0
29884   4 90 3 0 1,386.28 0
29885   1 90 3 0 1,663.13 0
29885   2 90 3 0 1,574.99 0
29885   3 90 3 0 1,468.29 0
29885   4 90 3 0 1,450.80 0
29886   1 90 3 0 1,323.63 0
29886   2 90 3 0 1,527.72 0
29886   3 90 3 0 1,213.82 0
29886   4 90 3 0 1,199.44 0
29887   1 90 3 0 1,838.12 0
29887   2 90 3 0 1,806.33 0
29887   3 90 3 0 1,675.23 0
29887   4 90 3 0 1,654.74 0
29888   1 90 2 0 3,086.50 0
29888   2 90 2 0 3,030.23 0
29888   3 90 2 0 2,797.41 0
29888   4 90 2 0 2,762.89 0
29889   1 90 2 0 1,995.79 0
29889   2 90 2 0 1,963.50 0
29889   3 90 2 0 1,830.34 0
29889   4 90 2 0 1,808.55 0
29891   1 90 2 0 1,499.02 0
29891   2 90 2 0 1,292.85 0
29891   3 90 2 0 1,292.85 0
29891   4 90 2 0 1,292.85 0
29892   1 90 2 0 1,541.77 0
29892   2 90 2 0 1,334.14 0
29892   3 90 2 0 1,334.14 0
29892   4 90 2 0 1,334.14 0
29893   1 90 2 0 845.16 0
29893   2 90 2 0 748.60 0
29893   3 90 2 0 748.60 0
29893   4 90 2 0 748.60 0
29894   1 90 2 0 1,601.49 0
29894   2 90 2 0 1,678.33 0
29894   3 90 2 0 1,430.57 0
29894   4 90 2 0 1,467.81 0
29895   1 90 2 0 1,637.61 0
29895   2 90 2 0 1,499.04 0
29895   3 90 2 0 1,414.55 0
29895   4 90 2 0 1,369.10 0
29897   1 90 2 0 1,651.63 0
29897   2 90 2 0 1,620.92 0
29897   3 90 2 0 1,493.77 0
29897   4 90 2 0 1,572.05 0
29898   1 90 2 0 1,889.64 0
29898   2 90 2 0 1,855.44 0
29898   3 90 2 0 1,791.01 0
29898   4 90 2 0 1,692.61 0
29899   1 90 2 0 1,801.59 0
29899   2 90 2 0 1,584.22 0
29899   3 90 2 0 1,584.22 0
29899   4 90 2 0 1,584.22 0
29900   1 90 2 0 820.00 0
29900   2 90 2 0 719.60 0
29900   3 90 2 0 719.60 0
29900   4 90 2 0 719.60 0
29901   1 90 2 0 904.42 0
29901   2 90 2 0 793.58 0
29901   3 90 2 0 793.58 0
29901   4 90 2 0 793.58 0
29902   1 90 2 0 970.66 0
29902   2 90 2 0 852.03 0
29902   3 90 2 0 852.03 0
29902   4 90 2 0 852.03 0
29904   1 90 2 0 872.43 0
29904   2 90 2 0 767.53 0
29904   3 90 2 0 767.53 0
29904   4 90 2 0 767.53 0
29905   1 90 2 0 940.49 0
29905   2 90 2 0 826.64 0
29905   3 90 2 0 826.64 0
29905   4 90 2 0 826.64 0
29906   1 90 2 0 990.63 0
29906   2 90 2 0 870.60 0
29906   3 90 2 0 870.60 0
29906   4 90 2 0 870.60 0
29914   1 90 3 0 1,532.00 0
29914   2 90 3 0 1,379.20 0
29914   3 90 3 0 1,379.20 0
29914   4 90 3 0 1,379.20 0
29915   1 90 3 0 1,560.27 0
29915   2 90 3 0 1,405.12 0
29915   3 90 3 0 1,405.12 0
29915   4 90 3 0 1,405.12 0
29916   1 90 3 0 1,560.27 0
29916   2 90 3 0 1,405.12 0
29916   3 90 3 0 1,405.12 0
29916   4 90 3 0 1,405.12 0
29999     YYY 2 0 * 0
30000   1 10 2 0 172.91 0
30000   2 10 2 0 204.49 0
30000   3 10 2 0 195.50 0
30000   4 10 2 0 161.92 0
30020   1 10 2 0 215.17 0
30020   2 10 2 0 205.07 0
30020   3 10 2 0 202.56 0
30020   4 10 2 0 206.46 0
30100   1 0 2 0 157.92 126.95
30100   2 0 2 0 157.10 125.89
30100   3 0 2 0 153.71 123.51
30100   4 0 2 0 153.01 122.81
30110   1 10 2 0 260.54 206.21
30110   2 10 2 0 257.09 203.44
30110   3 10 2 0 250.37 198.26
30110   4 10 2 0 239.77 189.94
30115   1 90 2 0 570.20 0
30115   2 90 2 0 625.59 0
30115   3 90 2 0 595.03 0
30115   4 90 2 0 484.15 0
30117   1 90 2 0 461.16 0
30117   2 90 2 0 452.57 0
30117   3 90 2 0 438.52 0
30117   4 90 2 0 424.30 0
30118   1 90 2 0 1,577.49 0
30118   2 90 2 0 1,555.59 0
30118   3 90 2 0 1,464.82 0
30118   4 90 2 0 1,522.43 0
30120   1 90 2 0 1,474.57 0
30120   2 90 2 0 1,466.53 0
30120   3 90 2 0 1,433.28 0
30120   4 90 2 0 1,427.93 0
30124   1 90 2 0 386.97 0
30124   2 90 2 0 432.42 0
30124   3 90 2 0 435.68 0
30124   4 90 2 0 453.90 0
30125   1 90 2 0 1,138.95 0
30125   2 90 2 0 1,193.66 0
30125   3 90 2 0 1,237.64 0
30125   4 90 2 0 1,043.00 0
30130   1 90 2 0 431.73 0
30130   2 90 2 0 426.78 0
30130   3 90 2 0 406.26 0
30130   4 90 2 0 401.64 0
30140   1 90 2 0 655.38 0
30140   2 90 2 0 650.48 0
30140   3 90 2 0 643.36 0
30140   4 90 2 0 632.56 0
30150   1 90 2 0 2,181.60 0
30150   2 90 2 0 2,172.03 0
30150   3 90 2 0 2,132.35 0
30150   4 90 2 0 1,391.40 0
30160   1 90 2 0 1,948.76 0
30160   2 90 2 0 1,899.61 0
30160   3 90 2 0 1,786.31 0
30160   4 90 2 0 1,764.16 0
30200   1 0 2 0 93.59 79.37
30200   2 0 2 0 91.67 78.08
30200   3 0 2 0 76.01 64.89
30200   4 0 2 0 88.24 75.01
30210   1 10 2 0 112.61 101.73
30210   2 10 2 0 111.56 100.78
30210   3 10 2 0 107.13 97.06
30210   4 10 2 0 106.01 96.09
30220   1 10 2 0 274.85 0
30220   2 10 2 0 271.00 0
30220   3 10 2 0 254.94 0
30220   4 10 2 0 251.81 0
30300   1 10 2 0 129.38 0
30300   2 10 2 0 128.69 0
30300   3 10 2 0 123.14 0
30300   4 10 2 0 119.55 0
30310   1 10 2 0 321.75 0
30310   2 10 2 0 313.51 0
30310   3 10 2 0 299.24 0
30310   4 10 2 0 295.59 0
30320   1 90 2 0 789.69 0
30320   2 90 2 0 778.94 0
30320   3 90 2 0 733.93 0
30320   4 90 2 0 724.90 0
30400   1 90 2 0 1,932.72 0
30400   2 90 2 0 1,875.89 0
30400   3 90 2 0 1,753.45 0
30400   4 90 2 0 1,728.83 0
30410     90 2 0 * 0
30420   1 90 2 0 3,322.53 0
30420   2 90 2 0 3,226.08 0
30420   3 90 2 0 3,015.94 0
30420   4 90 2 0 2,973.23 0
30430   1 90 2 0 861.93 0
30430   2 90 2 0 851.57 0
30430   3 90 2 0 808.67 0
30430   4 90 2 0 799.23 0
30435   1 90 2 0 1,198.34 0
30435   2 90 2 0 1,181.46 0
30435   3 90 2 0 1,111.70 0
30435   4 90 2 0 1,098.22 0
30450   1 90 2 0 1,956.98 0
30450   2 90 2 0 1,923.84 0
30450   3 90 2 0 1,786.31 0
30450   4 90 2 0 1,764.16 0
30460   1 90 2 0 1,649.06 0
30460   2 90 2 0 1,626.29 0
30460   3 90 2 0 1,532.00 0
30460   4 90 2 0 1,513.41 0
30462   1 90 2 0 3,299.39 0
30462   2 90 2 0 3,253.84 0
30462   3 90 2 0 3,064.83 0
30462   4 90 2 0 3,027.74 0
30465   1 90 2 0 1,578.06 0
30465   2 90 2 0 1,416.21 0
30465   3 90 2 0 1,416.21 0
30465   4 90 2 0 1,416.21 0
30520   1 90 2 0 1,263.80 0
30520   2 90 2 0 1,243.50 0
30520   3 90 2 0 1,159.03 0
30520   4 90 2 0 1,144.30 0
30540   1 90 2 0 1,282.41 0
30540   2 90 2 0 1,264.89 0
30540   3 90 2 0 1,192.44 0
30540   4 90 2 0 1,177.98 0
30545   1 90 2 0 1,957.80 0
30545   2 90 2 0 1,931.91 0
30545   3 90 2 0 1,824.31 0
30545   4 90 2 0 1,801.65 0
30560   1 10 2 0 156.58 0
30560   2 10 2 0 133.45 0
30560   3 10 2 0 129.31 0
30560   4 10 2 0 128.36 0
30580   1 90 2 0 1,151.15 0
30580   2 90 2 0 1,135.71 0
30580   3 90 2 0 1,071.87 0
30580   4 90 2 0 1,058.63 0
30600   1 90 2 0 861.93 0
30600   2 90 2 0 964.87 0
30600   3 90 2 0 808.67 0
30600   4 90 2 0 799.23 0
30620   1 90 2 0 1,342.03 0
30620   2 90 2 0 1,319.63 0
30620   3 90 2 0 1,226.60 0
30620   4 90 2 0 1,210.87 0