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2018 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   1 90 2 0 3,280.96 0
35013   2 90 2 0 3,259.05 0
35013   3 90 2 0 3,168.69 0
35013   4 90 2 0 3,155.46 0
35021   1 90 2 0 3,420.40 0
35021   2 90 2 0 3,363.41 0
35021   3 90 2 0 3,127.66 0
35021   4 90 2 0 3,090.23 0
35022   1 90 2 0 3,402.27 0
35022   2 90 2 0 3,349.43 0
35022   3 90 2 0 3,132.01 0
35022   4 90 2 0 3,096.42 0
35045   1 90 2 0 2,213.33 0
35045   2 90 2 0 2,171.51 0
35045   3 90 2 0 2,043.04 0
35045   4 90 2 0 1,975.10 0
35081   1 90 2 0 4,347.43 0
35081   2 90 2 0 4,351.95 0
35081   3 90 2 0 3,990.21 0
35081   4 90 2 0 4,154.42 0
35082   1 90 2 0 5,267.22 0
35082   2 90 2 0 5,173.87 0
35082   3 90 2 0 4,875.00 0
35082   4 90 2 0 4,828.60 0
35091   1 90 2 0 4,925.54 0
35091   2 90 2 0 4,767.15 0
35091   3 90 2 0 4,382.09 0
35091   4 90 2 0 4,373.38 0
35092   1 90 2 0 7,085.06 0
35092   2 90 2 0 7,044.86 0
35092   3 90 2 0 6,879.66 0
35092   4 90 2 0 6,853.26 0
35102   1 90 2 0 4,728.50 0
35102   2 90 2 0 4,340.72 0
35102   3 90 2 0 4,367.85 0
35102   4 90 2 0 4,382.45 0
35103   1 90 2 0 5,872.01 0
35103   2 90 2 0 5,797.61 0
35103   3 90 2 0 5,409.03 0
35103   4 90 2 0 5,365.63 0
35111   1 90 2 0 3,247.69 0
35111   2 90 2 0 3,100.08 0
35111   3 90 2 0 2,933.75 0
35111   4 90 2 0 2,898.91 0
35112   1 90 2 0 2,641.32 0
35112   2 90 2 0 2,600.67 0
35112   3 90 2 0 2,433.08 0
35112   4 90 2 0 2,406.08 0
35121   1 90 2 0 4,314.00 0
35121   2 90 2 0 4,337.48 0
35121   3 90 2 0 4,136.95 0
35121   4 90 2 0 4,038.77 0
35122   1 90 2 0 4,898.87 0
35122   2 90 2 0 4,789.86 0
35122   3 90 2 0 4,782.71 0
35122   4 90 2 0 4,324.36 0
35131   1 90 2 0 3,516.53 0
35131   2 90 2 0 3,576.61 0
35131   3 90 2 0 3,426.49 0
35131   4 90 2 0 3,413.55 0
35132   1 90 2 0 3,988.90 0
35132   2 90 2 0 3,929.63 0
35132   3 90 2 0 3,676.19 0
35132   4 90 2 0 3,645.93 0
35141   1 90 2 0 3,130.06 0
35141   2 90 2 0 3,076.16 0
35141   3 90 2 0 2,904.06 0
35141   4 90 2 0 2,862.82 0
35142   1 90 2 0 3,341.62 0
35142   2 90 2 0 3,284.32 0
35142   3 90 2 0 3,188.89 0
35142   4 90 2 0 3,175.25 0
35151   1 90 2 0 3,335.53 0
35151   2 90 2 0 3,274.62 0
35151   3 90 2 0 3,113.75 0
35151   4 90 2 0 3,101.43 0
35152   1 90 2 0 2,344.06 0
35152   2 90 2 0 3,370.11 0
35152   3 90 2 0 2,160.01 0
35152   4 90 2 0 2,136.02 0
35180   1 90 2 0 2,551.75 0
35180   2 90 2 0 2,539.98 0
35180   3 90 2 0 1,701.68 0
35180   4 90 2 0 1,682.70 0
35182   1 90 2 0 2,473.74 0
35182   2 90 2 0 2,801.19 0
35182   3 90 2 0 2,295.94 0
35182   4 90 2 0 2,269.61 0
35184   1 90 2 0 2,684.62 0
35184   2 90 2 0 2,670.24 0
35184   3 90 2 0 1,814.20 0
35184   4 90 2 0 2,456.56 0
35188   1 90 2 0 2,617.31 0
35188   2 90 2 0 2,604.63 0
35188   3 90 2 0 1,846.22 0
35188   4 90 2 0 1,825.62 0
35189   1 90 2 0 2,692.82 0
35189   2 90 2 0 2,890.43 0
35189   3 90 2 0 2,480.56 0
35189   4 90 2 0 2,806.97 0
35190   1 90 2 0 2,672.66 0
35190   2 90 2 0 2,730.34 0
35190   3 90 2 0 2,674.65 0
35190   4 90 2 0 2,662.37 0
35201   1 90 2 0 1,956.53 0
35201   2 90 2 0 1,895.63 0
35201   3 90 2 0 1,684.06 0
35201   4 90 2 0 1,663.91 0
35206   1 90 2 0 1,838.92 0
35206   2 90 2 0 1,804.67 0
35206   3 90 2 0 1,663.52 0
35206   4 90 2 0 1,643.58 0
35207   1 90 2 0 2,641.19 0
35207   2 90 2 0 2,512.20 0
35207   3 90 2 0 2,567.35 0
35207   4 90 2 0 1,732.71 0
35211   1 90 2 0 3,709.69 0
35211   2 90 2 0 3,123.22 0
35211   3 90 2 0 2,922.20 0
35211   4 90 2 0 2,889.14 0
35216   1 90 2 0 2,620.94 0
35216   2 90 2 0 3,367.78 0
35216   3 90 2 0 2,418.55 0
35216   4 90 2 0 2,391.39 0
35221   1 90 2 0 2,500.79 0
35221   2 90 2 0 2,460.65 0
35221   3 90 2 0 2,295.42 0
35221   4 90 2 0 2,269.27 0
35226   1 90 2 0 2,021.96 0
35226   2 90 2 0 2,511.08 0
35226   3 90 2 0 1,641.13 0
35226   4 90 2 0 1,621.28 0
35231   1 90 2 0 3,031.06 0
35231   2 90 2 0 2,933.00 0
35231   3 90 2 0 2,770.75 0
35231   4 90 2 0 2,255.19 0
35236   1 90 2 0 2,162.18 0
35236   2 90 2 0 2,100.65 0
35236   3 90 2 0 1,976.71 0
35236   4 90 2 0 1,905.62 0
35241   1 90 2 0 3,267.81 0
35241   2 90 2 0 3,218.30 0
35241   3 90 2 0 3,014.41 0
35241   4 90 2 0 2,980.51 0
35246   1 90 2 0 3,246.62 0
35246   2 90 2 0 3,199.03 0
35246   3 90 2 0 3,002.18 0
35246   4 90 2 0 2,965.98 0
35251   1 90 2 0 2,418.80 0
35251   2 90 2 0 2,382.74 0
35251   3 90 2 0 2,234.52 0
35251   4 90 2 0 2,209.55 0
35256   1 90 2 0 2,184.70 0
35256   2 90 2 0 2,175.89 0
35256   3 90 2 0 2,023.75 0
35256   4 90 2 0 1,982.82 0
35261   1 90 2 0 2,532.46 0
35261   2 90 2 0 2,293.22 0
35261   3 90 2 0 2,598.53 0
35261   4 90 2 0 2,084.73 0
35266   1 90 2 0 2,059.60 0
35266   2 90 2 0 2,019.86 0
35266   3 90 2 0 1,856.21 0
35266   4 90 2 0 1,833.89 0
35271   1 90 2 0 3,096.20 0
35271   2 90 2 0 3,048.61 0
35271   3 90 2 0 2,852.65 0
35271   4 90 2 0 2,820.77 0
35276   1 90 2 0 2,659.50 0
35276   2 90 2 0 2,900.21 0
35276   3 90 2 0 2,447.23 0
35276   4 90 2 0 2,419.90 0
35281   1 90 2 0 3,176.95 0
35281   2 90 2 0 3,119.12 0
35281   3 90 2 0 3,012.28 0
35281   4 90 2 0 2,845.97 0
35286   1 90 2 0 2,187.10 0
35286   2 90 2 0 2,165.01 0
35286   3 90 2 0 2,006.18 0
35286   4 90 2 0 1,976.56 0
35301   1 90 2 0 3,011.56 0
35301   2 90 2 0 2,949.98 0
35301   3 90 2 0 2,780.13 0
35301   4 90 2 0 2,776.27 0
35302   1 90 2 0 1,679.34 0
35302   2 90 2 0 1,486.64 0
35302   3 90 2 0 1,486.64 0
35302   4 90 2 0 1,486.64 0
35303   1 90 2 0 1,843.85 0
35303   2 90 2 0 1,633.71 0
35303   3 90 2 0 1,633.71 0
35303   4 90 2 0 1,633.71 0
35304   1 90 2 0 1,918.50 0
35304   2 90 2 0 1,699.95 0
35304   3 90 2 0 1,699.95 0
35304   4 90 2 0 1,699.95 0
35305   1 90 2 0 1,843.85 0
35305   2 90 2 0 1,633.71 0
35305   3 90 2 0 1,633.71 0
35305   4 90 2 0 1,633.71 0
35306   1 ZZZ 0 0 690.67 0
35306   2 ZZZ 0 0 613.38 0
35306   3 ZZZ 0 0 613.38 0
35306   4 ZZZ 0 0 613.38 0
35311   1 90 2 0 4,376.18 0
35311   2 90 2 0 3,891.95 0
35311   3 90 2 0 3,780.33 0
35311   4 90 2 0 3,928.55 0
35321   1 90 2 0 2,381.55 0
35321   2 90 2 0 2,336.82 0
35321   3 90 2 0 2,152.24 0
35321   4 90 2 0 2,126.58 0
35331   1 90 2 0 3,347.46 0
35331   2 90 2 0 3,671.68 0
35331   3 90 2 0 3,533.28 0
35331   4 90 2 0 3,055.13 0
35341   1 90 2 0 3,928.71 0
35341   2 90 2 0 3,865.01 0
35341   3 90 2 0 3,602.75 0
35341   4 90 2 0 3,561.85 0
35351   1 90 2 0 3,470.36 0
35351   2 90 2 0 3,411.68 0
35351   3 90 2 0 3,206.43 0
35351   4 90 2 0 3,241.00 0
35355   1 90 2 0 3,375.71 0
35355   2 90 2 0 3,353.76 0
35355   3 90 2 0 3,263.35 0
35355   4 90 2 0 3,249.94 0
35361   1 90 2 0 4,015.40 0
35361   2 90 2 0 3,946.99 0
35361   3 90 2 0 4,062.91 0
35361   4 90 2 0 3,622.80 0
35363   1 90 2 0 4,455.56 0
35363   2 90 2 0 4,378.18 0
35363   3 90 2 0 4,058.67 0
35363   4 90 2 0 4,010.89 0
35371   1 90 2 0 2,728.57 0
35371   2 90 2 0 2,691.76 0
35371   3 90 2 0 2,507.78 0
35371   4 90 2 0 2,464.32 0
35372   1 90 2 0 2,744.44 0
35372   2 90 2 0 2,704.39 0
35372   3 90 2 0 2,526.61 0
35372   4 90 2 0 2,503.48 0
35390   1 ZZZ 0 0 461.60 0
35390   2 ZZZ 0 0 454.61 0
35390   3 ZZZ 0 0 425.80 0
35390   4 ZZZ 0 0 421.12 0
35400   1 ZZZ 0 0 426.89 0
35400   2 ZZZ 0 0 380.03 0
35400   3 ZZZ 0 0 380.03 0
35400   4 ZZZ 0 0 380.03 0
35500     ZZZ 0 0 * 0
35501   1 90 2 0 3,631.59 0
35501   2 90 2 0 3,568.82 0
35501   3 90 2 0 3,309.63 0
35501   4 90 2 0 3,270.14 0
35506   1 90 2 0 3,816.39 0
35506   2 90 2 0 3,774.52 0
35506   3 90 2 0 3,307.08 0
35506   4 90 2 0 3,267.79 0
35508   1 90 2 0 3,432.28 0
35508   2 90 2 0 3,371.97 0
35508   3 90 2 0 3,122.91 0
35508   4 90 2 0 3,085.77 0
35509   1 90 2 0 3,519.33 0
35509   2 90 2 0 3,453.84 0
35509   3 90 2 0 3,183.77 0
35509   4 90 2 0 3,145.99 0
35510   1 90 2 0 2,353.85 0
35510   2 90 2 0 2,136.46 0
35510   3 90 2 0 2,136.46 0
35510   4 90 2 0 2,136.46 0
35511   1 90 2 0 2,430.58 0
35511   2 90 2 0 2,594.76 0
35511   3 90 2 0 2,582.92 0
35511   4 90 2 0 2,216.12 0
35512   1 90 2 0 2,310.15 0
35512   2 90 2 0 2,095.22 0
35512   3 90 2 0 2,095.22 0
35512   4 90 2 0 2,095.22 0
35515   1 90 2 0 2,668.05 0
35515   2 90 2 0 2,628.49 0
35515   3 90 2 0 2,465.37 0
35515   4 90 2 0 2,437.44 0
35516   1 90 2 0 3,186.98 0
35516   2 90 2 0 3,127.64 0
35516   3 90 2 0 2,882.56 0
35516   4 90 2 0 2,848.16 0
35518   1 90 2 0 3,104.60 0
35518   2 90 2 0 3,047.01 0
35518   3 90 2 0 2,809.13 0
35518   4 90 2 0 2,900.39 0
35521   1 90 2 0 3,975.33 0
35521   2 90 2 0 3,955.73 0
35521   3 90 2 0 3,784.84 0
35521   4 90 2 0 3,869.61 0
35522   1 90 2 0 2,244.89 0
35522   2 90 2 0 2,033.68 0
35522   3 90 2 0 2,033.68 0
35522   4 90 2 0 2,033.68 0
35523   1 90 2 0 1,902.76 0
35523   2 90 2 0 1,724.79 0
35523   3 90 2 0 1,724.79 0
35523   4 90 2 0 1,724.79 0
35525   1 90 2 0 2,145.70 0
35525   2 90 2 0 1,940.14 0
35525   3 90 2 0 1,940.14 0
35525   4 90 2 0 1,940.14 0
35526   1 90 2 0 2,987.94 0
35526   2 90 2 0 2,941.71 0
35526   3 90 2 0 2,751.43 0
35526   4 90 2 0 2,720.13 0
35531   1 90 2 0 4,349.44 0
35531   2 90 2 0 4,299.66 0
35531   3 90 2 0 4,197.00 0
35531   4 90 2 0 3,856.80 0
35533   1 90 2 0 4,719.60 0
35533   2 90 2 0 4,688.63 0
35533   3 90 2 0 4,560.92 0
35533   4 90 2 0 3,552.56 0
35535   1 90 2 0 3,094.83 0
35535   2 90 2 0 2,807.78 0
35535   3 90 2 0 2,807.78 0
35535   4 90 2 0 2,807.78 0
35536   1 90 2 0 4,180.14 0
35536   2 90 2 0 4,053.60 0
35536   3 90 2 0 3,805.80 0
35536   4 90 2 0 3,761.07 0
35537   1 90 2 0 3,239.90 0
35537   2 90 2 0 2,874.16 0
35537   3 90 2 0 2,874.16 0
35537   4 90 2 0 2,874.16 0
35538   1 90 2 0 3,618.24 0
35538   2 90 2 0 3,211.26 0
35538   3 90 2 0 3,211.26 0
35538   4 90 2 0 3,211.26 0
35539   1 90 2 0 3,401.19 0
35539   2 90 2 0 3,018.19 0
35539   3 90 2 0 3,018.19 0
35539   4 90 2 0 3,018.19 0
35540   1 90 2 0 3,791.08 0
35540   2 90 2 0 3,364.68 0
35540   3 90 2 0 3,364.68 0
35540   4 90 2 0 3,364.68 0
35556   1 90 2 0 3,603.96 0
35556   2 90 2 0 3,441.75 0
35556   3 90 2 0 3,459.26 0
35556   4 90 2 0 3,445.53 0
35558   1 90 2 0 3,110.09 0
35558   2 90 2 0 3,111.29 0
35558   3 90 2 0 2,876.58 0
35558   4 90 2 0 2,961.14 0
35560   1 90 2 0 5,284.96 0
35560   2 90 2 0 5,252.81 0
35560   3 90 2 0 5,134.52 0
35560   4 90 2 0 5,116.04 0
35563   1 90 2 0 2,093.69 0
35563   2 90 2 0 3,102.80 0
35563   3 90 2 0 1,930.88 0
35563   4 90 2 0 1,909.39 0
35565   1 90 2 0 3,337.15 0
35565   2 90 2 0 3,279.52 0
35565   3 90 2 0 3,129.73 0
35565   4 90 2 0 3,152.97 0
35566   1 90 2 0 4,636.31 0
35566   2 90 2 0 4,156.54 0
35566   3 90 2 0 4,081.30 0
35566   4 90 2 0 4,352.42 0
35570   1 90 2 0 2,387.41 0
35570   2 90 2 0 2,165.47 0
35570   3 90 2 0 2,165.47 0
35570   4 90 2 0 2,165.47 0
35571   1 90 2 0 4,954.27 0
35571   2 90 2 0 4,926.75 0
35571   3 90 2 0 4,803.22 0
35571   4 90 2 0 4,790.54 0
35572   1 90 2 0 673.81 0
35572   2 90 2 0 607.30 0
35572   3 90 2 0 607.30 0
35572   4 90 2 0 607.30 0
35583   1 90 2 0 3,616.09 0
35583   2 90 2 0 3,547.30 0
35583   3 90 2 0 3,543.16 0
35583   4 90 2 0 3,501.17 0
35585   1 90 2 0 4,695.71 0
35585   2 90 2 0 4,075.20 0
35585   3 90 2 0 4,133.72 0
35585   4 90 2 0 4,359.20 0
35587   1 90 2 0 5,058.72 0
35587   2 90 2 0 4,982.09 0
35587   3 90 2 0 4,896.27 0
35587   4 90 2 0 4,889.07 0
35600   1 ZZZ 0 0 545.91 0
35600   2 ZZZ 0 0 489.99 0
35600   3 ZZZ 0 0 489.99 0
35600   4 ZZZ 0 0 489.99 0
35601   1 90 2 0 3,394.43 0
35601   2 90 2 0 3,334.70 0
35601   3 90 2 0 3,088.05 0
35601   4 90 2 0 3,050.77 0