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2024 Workers' Compensation Part B Fee Schedule

35013-35601

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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
35013   004 90 2 X 4,079.38 X
35013   001 90 2 X 4,241.63 X
35013   003 90 2 X 4,096.48 X
35013   002 90 2 X 4,213.30 X
35021   002 90 2 X 4,348.21 X
35021   003 90 2 X 4,043.44 X
35021   001 90 2 X 4,421.89 X
35021   004 90 2 X 3,995.06 X
35022   004 90 2 X 4,003.06 X
35022   003 90 2 X 4,049.07 X
35022   002 90 2 X 4,330.14 X
35022   001 90 2 X 4,398.46 X
35045   001 90 2 X 2,861.39 X
35045   004 90 2 X 2,553.42 X
35045   002 90 2 X 2,807.30 X
35045   003 90 2 X 2,641.24 X
35081   002 90 2 X 5,626.19 X
35081   003 90 2 X 5,158.54 X
35081   001 90 2 X 5,620.36 X
35081   004 90 2 X 5,370.84 X
35082   004 90 2 X 6,242.42 X
35082   002 90 2 X 6,688.79 X
35082   003 90 2 X 6,302.40 X
35082   001 90 2 X 6,809.47 X
35091   003 90 2 X 5,665.17 X
35091   002 90 2 X 6,162.97 X
35091   004 90 2 X 5,653.91 X
35091   001 90 2 X 6,367.73 X
35092   003 90 2 X 8,894.02 X
35092   002 90 2 X 9,107.59 X
35092   004 90 2 X 8,859.90 X
35092   001 90 2 X 9,159.57 X
35102   001 90 2 X 6,113.02 X
35102   003 90 2 X 5,646.76 X
35102   002 90 2 X 5,611.69 X
35102   004 90 2 X 5,665.64 X
35103   004 90 2 X 6,936.69 X
35103   001 90 2 X 7,591.34 X
35103   002 90 2 X 7,495.16 X
35103   003 90 2 X 6,992.80 X
35111   002 90 2 X 4,007.79 X
35111   003 90 2 X 3,792.77 X
35111   004 90 2 X 3,747.71 X
35111   001 90 2 X 4,198.62 X
35112   002 90 2 X 3,362.16 X
35112   003 90 2 X 3,145.49 X
35112   004 90 2 X 3,110.58 X
35112   001 90 2 X 3,414.69 X
35121   003 90 2 X 5,348.25 X
35121   002 90 2 X 5,607.49 X
35121   004 90 2 X 5,221.33 X
35121   001 90 2 X 5,577.15 X
35122   004 90 2 X 5,590.53 X
35122   003 90 2 X 6,183.08 X
35122   002 90 2 X 6,192.35 X
35122   001 90 2 X 6,333.26 X
35131   001 90 2 X 4,546.17 X
35131   004 90 2 X 4,413.02 X
35131   003 90 2 X 4,429.76 X
35131   002 90 2 X 4,623.84 X
35132   003 90 2 X 4,752.57 X
35132   002 90 2 X 5,080.22 X
35132   001 90 2 X 5,156.84 X
35132   004 90 2 X 4,713.46 X
35141   002 90 2 X 3,976.86 X
35141   003 90 2 X 3,754.37 X
35141   004 90 2 X 3,701.05 X
35141   001 90 2 X 4,046.54 X
35142   003 90 2 X 4,122.58 X
35142   002 90 2 X 4,245.97 X
35142   004 90 2 X 4,104.96 X
35142   001 90 2 X 4,320.04 X
35151   003 90 2 X 4,025.47 X
35151   002 90 2 X 4,233.43 X
35151   004 90 2 X 4,009.52 X
35151   001 90 2 X 4,312.18 X
35152   004 90 2 X 2,761.45 X
35152   003 90 2 X 2,792.47 X
35152   002 90 2 X 4,356.88 X
35152   001 90 2 X 3,030.40 X
35180   004 90 2 X 2,175.39 X
35180   001 90 2 X 3,298.89 X
35180   003 90 2 X 2,199.94 X
35180   002 90 2 X 3,283.69 X
35182   001 90 2 X 3,198.06 X
35182   004 90 2 X 2,934.15 X
35182   002 90 2 X 3,621.37 X
35182   003 90 2 X 2,968.19 X
35184   003 90 2 X 2,345.40 X
35184   002 90 2 X 3,452.09 X
35184   004 90 2 X 3,175.83 X
35184   001 90 2 X 3,470.69 X
35188   001 90 2 X 3,383.65 X
35188   004 90 2 X 2,360.17 X
35188   003 90 2 X 2,386.79 X
35188   002 90 2 X 3,367.27 X
35189   004 90 2 X 3,628.85 X
35189   001 90 2 X 3,481.28 X
35189   003 90 2 X 3,206.87 X
35189   002 90 2 X 3,736.74 X
35190   003 90 2 X 3,457.79 X
35190   002 90 2 X 3,529.80 X
35190   004 90 2 X 3,441.91 X
35190   001 90 2 X 3,455.21 X
35201   002 90 2 X 2,450.68 X
35201   003 90 2 X 2,177.16 X
35201   004 90 2 X 2,151.10 X
35201   001 90 2 X 2,529.39 X
35206   001 90 2 X 2,377.37 X
35206   004 90 2 X 2,124.81 X
35206   003 90 2 X 2,150.61 X
35206   002 90 2 X 2,333.08 X
35207   004 90 2 X 2,240.05 X
35207   002 90 2 X 3,247.76 X
35207   003 90 2 X 3,319.08 X
35207   001 90 2 X 3,414.53 X
35211   003 90 2 X 3,777.82 X
35211   002 90 2 X 4,037.70 X
35211   001 90 2 X 4,795.89 X
35211   004 90 2 X 3,735.08 X
35216   004 90 2 X 3,091.59 X
35216   001 90 2 X 3,388.35 X
35216   002 90 2 X 4,353.87 X
35216   003 90 2 X 3,126.71 X
35221   001 90 2 X 3,233.03 X
35221   004 90 2 X 2,933.72 X
35221   003 90 2 X 2,967.52 X
35221   002 90 2 X 3,181.12 X
35226   001 90 2 X 2,614.00 X
35226   002 90 2 X 3,246.32 X
35226   003 90 2 X 2,121.66 X
35226   004 90 2 X 2,096.00 X
35231   004 90 2 X 2,915.52 X
35231   003 90 2 X 3,582.04 X
35231   002 90 2 X 3,791.78 X
35231   001 90 2 X 3,918.55 X
35236   002 90 2 X 2,715.73 X
35236   003 90 2 X 2,555.49 X
35236   001 90 2 X 2,795.27 X
35236   004 90 2 X 2,463.57 X
35241   002 90 2 X 4,160.61 X
35241   003 90 2 X 3,897.04 X
35241   004 90 2 X 3,853.20 X
35241   001 90 2 X 4,224.63 X
35246   002 90 2 X 4,135.72 X
35246   003 90 2 X 3,881.23 X
35246   001 90 2 X 4,197.24 X
35246   004 90 2 X 3,834.42 X
35251   001 90 2 X 3,127.02 X
35251   004 90 2 X 2,856.51 X
35251   003 90 2 X 2,888.78 X
35251   002 90 2 X 3,080.39 X
35256   004 90 2 X 2,563.39 X
35256   002 90 2 X 2,812.99 X
35256   003 90 2 X 2,616.32 X
35256   001 90 2 X 2,824.37 X
35261   004 90 2 X 2,695.14 X
35261   001 90 2 X 3,273.97 X
35261   002 90 2 X 2,964.67 X
35261   003 90 2 X 3,359.39 X
35266   004 90 2 X 2,370.85 X
35266   002 90 2 X 2,611.28 X
35266   003 90 2 X 2,399.72 X
35266   001 90 2 X 2,662.66 X
35271   001 90 2 X 4,002.76 X
35271   004 90 2 X 3,646.71 X
35271   003 90 2 X 3,687.91 X
35271   002 90 2 X 3,941.25 X
35276   002 90 2 X 3,749.38 X
35276   003 90 2 X 3,163.78 X
35276   001 90 2 X 3,438.21 X
35276   004 90 2 X 3,128.46 X
35281   002 90 2 X 4,032.40 X
35281   003 90 2 X 3,894.28 X
35281   001 90 2 X 4,107.17 X
35281   004 90 2 X 3,679.27 X
35286   001 90 2 X 2,827.48 X
35286   004 90 2 X 2,555.30 X
35286   003 90 2 X 2,593.58 X
35286   002 90 2 X 2,798.93 X
35301   001 90 2 X 3,893.35 X
35301   004 90 2 X 3,589.16 X
35301   003 90 2 X 3,594.15 X
35301   002 90 2 X 3,813.73 X
35302   001 90 2 X 2,171.05 X
35302   004 90 2 X 1,921.94 X
35302   003 90 2 X 1,921.94 X
35302   002 90 2 X 1,921.94 X
35303   004 90 2 X 2,112.07 X
35303   002 90 2 X 2,112.07 X
35303   003 90 2 X 2,112.07 X
35303   001 90 2 X 2,383.73 X
35304   001 90 2 X 2,480.24 X
35304   003 90 2 X 2,197.71 X
35304   002 90 2 X 2,197.71 X
35304   004 90 2 X 2,197.71 X
35305   001 90 2 X 2,383.73 X
35305   004 90 2 X 2,112.07 X
35305   002 90 2 X 2,112.07 X
35305   003 90 2 X 2,112.07 X
35306   002 ZZZ 0 X 792.98 X
35306   003 ZZZ 0 X 792.98 X
35306   001 ZZZ 0 X 892.90 X
35306   004 ZZZ 0 X 792.98 X
35311   004 90 2 X 5,078.84 X
35311   002 90 2 X 5,031.50 X
35311   003 90 2 X 4,887.22 X
35311   001 90 2 X 5,657.52 X
35321   004 90 2 X 2,749.23 X
35321   001 90 2 X 3,078.89 X
35321   003 90 2 X 2,782.41 X
35321   002 90 2 X 3,021.05 X
35331   001 90 2 X 4,327.61 X
35331   003 90 2 X 4,567.83 X
35331   002 90 2 X 4,746.76 X
35331   004 90 2 X 3,949.68 X
35341   004 90 2 X 4,604.77 X
35341   001 90 2 X 5,079.04 X
35341   003 90 2 X 4,657.63 X
35341   002 90 2 X 4,996.69 X
35351   004 90 2 X 4,189.96 X
35351   001 90 2 X 4,486.49 X
35351   003 90 2 X 4,145.28 X
35351   002 90 2 X 4,410.61 X
35355   001 90 2 X 4,364.12 X
35355   003 90 2 X 4,218.87 X
35355   002 90 2 X 4,335.75 X
35355   004 90 2 X 4,201.54 X
35361   001 90 2 X 5,191.10 X
35361   002 90 2 X 5,102.67 X
35361   003 90 2 X 5,252.54 X
35361   004 90 2 X 4,683.56 X
35363   004 90 2 X 5,185.29 X
35363   003 90 2 X 5,247.04 X
35363   002 90 2 X 5,660.13 X
35363   001 90 2 X 5,760.15 X
35371   001 90 2 X 3,527.50 X
35371   004 90 2 X 3,185.86 X
35371   003 90 2 X 3,242.06 X
35371   002 90 2 X 3,479.91 X
35372   001 90 2 X 3,548.00 X
35372   004 90 2 X 3,236.50 X
35372   002 90 2 X 3,496.23 X
35372   003 90 2 X 3,266.40 X
35390   001 ZZZ 0 X 596.76 X
35390   003 ZZZ 0 X 550.46 X
35390   002 ZZZ 0 X 587.74 X
35390   004 ZZZ 0 X 544.43 X
35400   002 ZZZ 0 X 491.31 X
35400   003 ZZZ 0 X 491.31 X
35400   004 ZZZ 0 X 491.31 X
35400   001 ZZZ 0 X 551.89 X
35500     ZZZ 0 X * X
35501   002 90 2 X 4,613.77 X
35501   003 90 2 X 4,278.68 X
35501   004 90 2 X 4,227.64 X
35501   001 90 2 X 4,694.92 X
35506   004 90 2 X 4,224.59 X
35506   001 90 2 X 4,933.83 X
35506   003 90 2 X 4,275.40 X
35506   002 90 2 X 4,879.69 X
35508   001 90 2 X 4,437.24 X
35508   002 90 2 X 4,359.30 X
35508   003 90 2 X 4,037.30 X
35508   004 90 2 X 3,989.27 X
35509   002 90 2 X 4,465.14 X
35509   003 90 2 X 4,115.99 X
35509   001 90 2 X 4,549.79 X
35509   004 90 2 X 4,067.14 X
35510   002 90 2 X 2,762.01 X
35510   003 90 2 X 2,762.01 X
35510   004 90 2 X 2,762.01 X
35510   001 90 2 X 3,043.06 X
35511   001 90 2 X 3,142.25 X
35511   004 90 2 X 2,865.00 X
35511   002 90 2 X 3,354.51 X
35511   003 90 2 X 3,339.20 X
35512   001 90 2 X 2,986.56 X
35512   004 90 2 X 2,708.70 X
35512   002 90 2 X 2,708.70 X
35512   003 90 2 X 2,708.70 X
35515   002 90 2 X 3,398.13 X
35515   003 90 2 X 3,187.22 X
35515   004 90 2 X 3,151.13 X
35515   001 90 2 X 3,449.26 X
35516   002 90 2 X 4,043.42 X
35516   003 90 2 X 3,726.57 X
35516   004 90 2 X 3,682.09 X
35516   001 90 2 X 4,120.13 X
35518   003 90 2 X 3,631.65 X
35518   001 90 2 X 4,013.65 X
35518   002 90 2 X 3,939.17 X
35518   004 90 2 X 3,749.64 X
35521   001 90 2 X 5,139.31 X
35521   004 90 2 X 5,002.64 X
35521   002 90 2 X 5,113.97 X
35521   003 90 2 X 4,893.04 X
35522   003 90 2 X 2,629.14 X
35522   002 90 2 X 2,629.14 X
35522   001 90 2 X 2,902.18 X
35522   004 90 2 X 2,629.14 X
35523   003 90 2 X 2,229.81 X
35523   002 90 2 X 2,229.81 X
35523   004 90 2 X 2,229.81 X
35523   001 90 2 X 2,459.89 X
35525   001 90 2 X 2,773.97 X
35525   003 90 2 X 2,508.22 X
35525   002 90 2 X 2,508.22 X
35525   004 90 2 X 2,508.22 X
35526   004 90 2 X 3,516.57 X
35526   001 90 2 X 3,862.82 X
35526   003 90 2 X 3,557.05 X
35526   002 90 2 X 3,803.05 X
35531   002 90 2 X 5,558.61 X
35531   003 90 2 X 5,425.88 X
35531   004 90 2 X 4,986.08 X
35531   001 90 2 X 5,622.96 X
35533   003 90 2 X 5,896.35 X
35533   002 90 2 X 6,061.46 X
35533   004 90 2 X 4,592.74 X
35533   001 90 2 X 6,101.50 X
35535   004 90 2 X 3,629.89 X
35535   001 90 2 X 4,000.99 X
35535   003 90 2 X 3,629.89 X
35535   002 90 2 X 3,629.89 X
35536   004 90 2 X 4,862.29 X
35536   002 90 2 X 5,240.50 X
35536   003 90 2 X 4,920.13 X
35536   001 90 2 X 5,404.08 X
35537   004 90 2 X 3,715.73 X
35537   001 90 2 X 4,188.56 X
35537   003 90 2 X 3,715.73 X
35537   002 90 2 X 3,715.73 X
35538   003 90 2 X 4,151.52 X
35538   002 90 2 X 4,151.52 X
35538   004 90 2 X 4,151.52 X
35538   001 90 2 X 4,677.68 X
35539   002 90 2 X 3,901.91 X
35539   003 90 2 X 3,901.91 X
35539   001 90 2 X 4,397.06 X
35539   004 90 2 X 3,901.91 X
35540   002 90 2 X 4,349.85 X
35540   003 90 2 X 4,349.85 X
35540   001 90 2 X 4,901.10 X
35540   004 90 2 X 4,349.85 X
35556   002 90 2 X 4,449.49 X
35556   003 90 2 X 4,472.12 X
35556   001 90 2 X 4,659.20 X
35556   004 90 2 X 4,454.39 X
35558   003 90 2 X 3,718.83 X
35558   002 90 2 X 4,022.27 X
35558   004 90 2 X 3,828.18 X
35558   001 90 2 X 4,020.72 X
35560   001 90 2 X 6,832.38 X
35560   003 90 2 X 6,637.90 X
35560   002 90 2 X 6,790.83 X
35560   004 90 2 X 6,614.03 X
35563   003 90 2 X 2,496.24 X
35563   002 90 2 X 4,011.29 X
35563   004 90 2 X 2,468.47 X
35563   001 90 2 X 2,706.72 X
35565   003 90 2 X 4,046.10 X
35565   002 90 2 X 4,239.76 X
35565   004 90 2 X 4,076.17 X
35565   001 90 2 X 4,314.26 X
35566   001 90 2 X 5,993.82 X
35566   004 90 2 X 5,626.82 X
35566   002 90 2 X 5,373.58 X
35566   003 90 2 X 5,276.30 X
35570   002 90 2 X 2,799.51 X
35570   003 90 2 X 2,799.51 X
35570   004 90 2 X 2,799.51 X
35570   001 90 2 X 3,086.44 X
35571   004 90 2 X 6,193.20 X
35571   002 90 2 X 6,369.30 X
35571   003 90 2 X 6,209.60 X
35571   001 90 2 X 6,404.89 X
35572   002 ZZZ 0 X 785.12 X
35572   003 ZZZ 0 X 785.12 X
35572   004 ZZZ 0 X 785.12 X
35572   001 ZZZ 0 X 871.10 X
35583   001 90 2 X 4,674.88 X
35583   004 90 2 X 4,526.32 X
35583   003 90 2 X 4,580.59 X
35583   002 90 2 X 4,585.95 X
35585   004 90 2 X 5,635.57 X
35585   003 90 2 X 5,344.07 X
35585   002 90 2 X 5,268.43 X
35585   001 90 2 X 6,070.62 X
35587   004 90 2 X 6,320.60 X
35587   001 90 2 X 6,539.92 X
35587   002 90 2 X 6,440.86 X
35587   003 90 2 X 6,329.90 X
35600   004 ZZZ 0 X 633.46 X
35600   001 ZZZ 0 X 705.76 X
35600   002 ZZZ 0 X 633.46 X
35600   003 ZZZ 0 X 633.46 X
35601   001 90 2 X 4,388.32 X
35601   004 90 2 X 3,944.04 X
35601   003 90 2 X 3,992.24 X
35601   002 90 2 X 4,311.10 X