An Official Pennsylvania Government Website
Translate
Begin Main Content Area

​​

 Content Editor

2024 Workers' Compensation Part B Fee Schedule

44146-45331

View the PDF


CPT/HCPC Code Modifier Medicare Location Global Surgery Indicator Multiple Surgery Indicator Prevailing Charge Amount Fee Schedule Amount Site of Service Amount
44146   004 90 2 X 4,197.09 X
44146   002 90 2 X 4,462.66 X
44146   003 90 2 X 4,315.79 X
44146   001 90 2 X 4,633.81 X
44147   001 90 2 X 4,110.41 X
44147   004 90 2 X 3,690.53 X
44147   002 90 2 X 3,956.64 X
44147   003 90 2 X 3,739.49 X
44150   002 90 2 X 4,164.76 X
44150   003 90 2 X 3,870.46 X
44150   004 90 2 X 3,826.37 X
44150   001 90 2 X 4,383.49 X
44151   002 90 2 X 3,397.74 X
44151   003 90 2 X 3,181.19 X
44151   004 90 2 X 3,146.12 X
44151   001 90 2 X 4,071.27 X
44155   004 90 2 X 4,595.33 X
44155   002 90 2 X 4,825.43 X
44155   003 90 2 X 4,618.78 X
44155   001 90 2 X 4,946.43 X
44156   001 90 2 X 3,909.64 X
44156   004 90 2 X 3,564.92 X
44156   003 90 2 X 3,604.55 X
44156   002 90 2 X 4,464.99 X
44157   001 90 2 X 3,811.53 X
44157   002 90 2 X 3,384.51 X
44157   003 90 2 X 3,384.51 X
44157   004 90 2 X 3,384.51 X
44158   003 90 2 X 3,472.15 X
44158   002 90 2 X 3,472.15 X
44158   004 90 2 X 3,472.15 X
44158   001 90 2 X 3,909.96 X
44160   004 90 2 X 3,013.91 X
44160   001 90 2 X 3,650.39 X
44160   002 90 2 X 3,567.34 X
44160   003 90 2 X 3,132.76 X
44180   004 90 2 X 1,566.90 X
44180   002 90 2 X 1,566.90 X
44180   003 90 2 X 1,566.90 X
44180   001 90 2 X 1,753.46 X
44186   001 90 2 X 1,235.08 X
44186   004 90 2 X 1,099.64 X
44186   003 90 2 X 1,099.64 X
44186   002 90 2 X 1,099.64 X
44187   001 90 2 X 2,038.88 X
44187   004 90 2 X 1,816.34 X
44187   002 90 2 X 1,816.34 X
44187   003 90 2 X 1,816.34 X
44188   004 90 2 X 1,992.97 X
44188   001 90 2 X 2,237.78 X
44188   003 90 2 X 1,992.97 X
44188   002 90 2 X 1,992.97 X
44202   004 90 2 X 3,100.23 X
44202   001 90 2 X 3,453.64 X
44202   003 90 2 X 3,100.23 X
44202   002 90 2 X 3,100.23 X
44203   001 ZZZ 0 X 568.13 X
44203   003 ZZZ 0 X 510.81 X
44203   002 ZZZ 0 X 510.81 X
44203   004 ZZZ 0 X 510.81 X
44204   001 90 2 X 3,249.25 X
44204   004 90 2 X 2,943.95 X
44204   002 90 2 X 2,943.95 X
44204   003 90 2 X 2,943.95 X
44205   002 90 2 X 2,607.76 X
44205   003 90 2 X 2,607.76 X
44205   004 90 2 X 2,607.76 X
44205   001 90 2 X 2,875.14 X
44206   003 90 2 X 3,157.58 X
44206   002 90 2 X 3,157.58 X
44206   004 90 2 X 3,157.58 X
44206   001 90 2 X 3,487.10 X
44207   004 90 2 X 3,457.83 X
44207   001 90 2 X 3,814.11 X
44207   003 90 2 X 3,457.83 X
44207   002 90 2 X 3,457.83 X
44208   002 90 2 X 3,739.33 X
44208   003 90 2 X 3,739.33 X
44208   001 90 2 X 4,121.33 X
44208   004 90 2 X 3,739.33 X
44210   003 90 2 X 3,307.63 X
44210   001 90 2 X 3,653.38 X
44210   002 90 2 X 3,307.63 X
44210   004 90 2 X 3,307.63 X
44211   001 90 2 X 4,529.41 X
44211   004 90 2 X 4,110.95 X
44211   003 90 2 X 4,110.95 X
44211   002 90 2 X 4,110.95 X
44212   001 90 2 X 4,236.03 X
44212   004 90 2 X 3,839.57 X
44212   003 90 2 X 3,839.57 X
44212   002 90 2 X 3,839.57 X
44213   002 ZZZ 0 X 360.30 X
44213   003 ZZZ 0 X 360.30 X
44213   004 ZZZ 0 X 360.30 X
44213   001 ZZZ 0 X 400.86 X
44227   001 90 2 X 3,152.34 X
44227   004 90 2 X 2,822.92 X
44227   002 90 2 X 2,822.92 X
44227   003 90 2 X 2,822.92 X
44238     YYY 2 X # X
44300   003 90 2 X 1,751.88 X
44300   002 90 2 X 1,843.56 X
44300   004 90 2 X 1,757.67 X
44300   001 90 2 X 1,875.36 X
44310   004 90 2 X 2,226.29 X
44310   001 90 2 X 2,349.41 X
44310   003 90 2 X 2,188.94 X
44310   002 90 2 X 2,270.27 X
44312   001 90 2 X 1,073.77 X
44312   004 90 2 X 1,040.82 X
44312   002 90 2 X 1,068.23 X
44312   003 90 2 X 928.74 X
44314   001 90 2 X 1,940.35 X
44314   004 90 2 X 1,801.64 X
44314   002 90 2 X 1,872.77 X
44314   003 90 2 X 1,772.43 X
44316   004 90 2 X 2,592.05 X
44316   001 90 2 X 2,780.95 X
44316   003 90 2 X 2,577.66 X
44316   002 90 2 X 2,741.37 X
44320   001 90 2 X 2,362.91 X
44320   004 90 2 X 2,144.80 X
44320   002 90 2 X 2,215.88 X
44320   003 90 2 X 2,136.59 X
44322   003 90 2 X 2,218.06 X
44322   002 90 2 X 2,391.54 X
44322   001 90 2 X 2,433.66 X
44322   004 90 2 X 2,192.43 X
44340   001 90 2 X 982.48 X
44340   004 90 2 X 955.73 X
44340   003 90 2 X 922.98 X
44340   002 90 2 X 978.40 X
44345   003 90 2 X 1,988.26 X
44345   002 90 2 X 1,774.45 X
44345   004 90 2 X 1,650.77 X
44345   001 90 2 X 1,800.15 X
44346   004 90 2 X 1,801.91 X
44346   001 90 2 X 2,133.13 X
44346   002 90 2 X 2,101.75 X
44346   003 90 2 X 2,005.65 X
44360   002 0 2 X 757.93 X
44360   003 0 2 X 677.96 X
44360   004 0 2 X 669.32 X
44360   001 0 2 X 730.91 X
44361   001 0 3 X 920.26 X
44361   003 0 3 X 894.13 X
44361   002 0 3 X 899.10 X
44361   004 0 3 X 767.31 X
44363   001 0 3 X 764.45 X
44363   004 0 3 X 703.02 X
44363   003 0 3 X 711.39 X
44363   002 0 3 X 754.12 X
44364   003 0 3 X 933.54 X
44364   002 0 3 X 1,003.40 X
44364   004 0 3 X 922.15 X
44364   001 0 3 X 1,020.24 X
44365   002 0 3 X 992.28 X
44365   003 0 3 X 922.71 X
44365   001 0 3 X 1,009.06 X
44365   004 0 3 X 911.38 X
44366   001 0 3 X 1,179.32 X
44366   004 0 3 X 1,083.96 X
44366   002 0 3 X 1,163.55 X
44366   003 0 3 X 1,097.93 X
44369   004 0 3 X 1,173.95 X
44369   003 0 3 X 1,189.24 X
44369   002 0 3 X 1,262.21 X
44369   001 0 3 X 1,279.68 X
44370   001 0 3 X 575.84 X
44370   004 0 3 X 526.58 X
44370   002 0 3 X 526.58 X
44370   003 0 3 X 526.58 X
44372   004 0 3 X 1,102.91 X
44372   002 0 3 X 1,243.17 X
44372   003 0 3 X 1,211.43 X
44372   001 0 3 X 1,210.88 X
44373   003 0 3 X 935.66 X
44373   002 0 3 X 1,164.73 X
44373   004 0 3 X 1,133.56 X
44373   001 0 3 X 1,012.47 X
44376   001 0 2 X 979.21 X
44376   004 0 2 X 911.21 X
44376   002 0 2 X 968.18 X
44376   003 0 2 X 922.24 X
44377   003 0 3 X 975.43 X
44377   002 0 3 X 1,024.25 X
44377   004 0 3 X 963.73 X
44377   001 0 3 X 1,036.03 X
44378   001 0 3 X 1,351.11 X
44378   004 0 3 X 1,256.96 X
44378   002 0 3 X 1,335.84 X
44378   003 0 3 X 1,272.19 X
44379   001 0 3 X 940.63 X
44379   003 0 3 X 859.12 X
44379   002 0 3 X 859.12 X
44379   004 0 3 X 859.12 X
44380   002 0 2 X 680.91 X
44380   003 0 2 X 667.11 X
44380   001 0 2 X 712.36 X
44380   004 0 2 X 531.66 X
44381     0 3 X * X
44382   004 0 3 X 735.62 X
44382   001 0 3 X 736.50 X
44382   003 0 3 X 485.74 X
44382   002 0 3 X 773.02 X
44384     0 3 X * X
44385   001 0 2 X 732.25 X
44385   003 0 2 X 789.50 X
44385   002 0 2 X 697.62 X
44385   004 0 2 X 502.62 X
44386   003 0 2 X 372.22 X
44386   002 0 2 X 392.85 X
44386   004 0 2 X 367.78 X
44386   001 0 2 X 812.25 X
44388   004 0 2 X 938.85 X
44388   002 0 2 X 876.49 X
44388   003 0 2 X 910.99 X
44388   001 0 2 X 919.37 X
44389   002 0 3 X 977.64 X
44389   003 0 3 X 940.37 X
44389   001 0 3 X 982.35 X
44389   004 0 3 X 957.46 X
44390   004 0 3 X 651.03 X
44390   001 0 3 X 704.46 X
44390   002 0 3 X 796.62 X
44390   003 0 3 X 658.76 X
44391   002 0 3 X 1,080.44 X
44391   003 0 3 X 984.41 X
44391   004 0 3 X 972.05 X
44391   001 0 3 X 1,064.70 X
44392   004 0 3 X 1,308.53 X
44392   002 0 3 X 1,344.53 X
44392   003 0 3 X 1,343.31 X
44392   001 0 3 X 1,397.43 X
44394   001 0 3 X 1,397.43 X
44394   004 0 3 X 1,308.53 X
44394   002 0 3 X 1,344.53 X
44394   003 0 3 X 1,343.31 X
44401     0 3 X * X
44402     0 3 X * X
44403     0 3 X * X
44404     0 3 X * X
44405     0 3 X * X
44406     0 3 X * X
44407     0 3 X * X
44408     0 3 X * X
44500   001 0 0 X 66.91 X
44500   003 0 0 X 62.90 X
44500   002 0 0 X 66.11 X
44500   004 0 0 X 62.10 X
44602   004 90 2 X 2,069.30 X
44602   002 90 2 X 2,306.45 X
44602   003 90 2 X 2,071.67 X
44602   001 90 2 X 2,315.81 X
44603   001 90 2 X 2,736.79 X
44603   004 90 2 X 2,479.44 X
44603   003 90 2 X 2,507.71 X
44603   002 90 2 X 2,691.99 X
44604   003 90 2 X 2,232.01 X
44604   002 90 2 X 2,461.57 X
44604   004 90 2 X 2,224.89 X
44604   001 90 2 X 2,476.78 X
44605   004 90 2 X 2,539.06 X
44605   001 90 2 X 2,882.98 X
44605   003 90 2 X 2,645.14 X
44605   002 90 2 X 2,836.52 X
44615   001 90 2 X 2,124.78 X
44615   004 90 2 X 1,937.97 X
44615   003 90 2 X 1,959.21 X
44615   002 90 2 X 2,092.45 X
44620   001 90 2 X 1,919.35 X
44620   004 90 2 X 1,769.80 X
44620   002 90 2 X 1,889.59 X
44620   003 90 2 X 1,767.00 X
44625   004 90 2 X 2,199.84 X
44625   001 90 2 X 2,508.17 X
44625   003 90 2 X 2,199.84 X
44625   002 90 2 X 2,199.84 X
44626   001 90 2 X 3,590.24 X
44626   004 90 2 X 3,203.79 X
44626   003 90 2 X 3,203.79 X
44626   002 90 2 X 3,203.79 X
44640   003 90 2 X 2,133.32 X
44640   002 90 2 X 2,244.07 X
44640   004 90 2 X 2,168.92 X
44640   001 90 2 X 2,291.66 X
44650   003 90 2 X 2,362.83 X
44650   002 90 2 X 2,514.38 X
44650   001 90 2 X 2,551.22 X
44650   004 90 2 X 2,336.78 X
44660   004 90 2 X 2,346.08 X
44660   002 90 2 X 2,516.63 X
44660   003 90 2 X 2,373.20 X
44660   001 90 2 X 2,551.43 X
44661   003 90 2 X 3,013.70 X
44661   002 90 2 X 3,188.64 X
44661   004 90 2 X 2,999.82 X
44661   001 90 2 X 3,266.37 X
44680   001 90 2 X 3,073.41 X
44680   003 90 2 X 2,534.47 X
44680   002 90 2 X 3,015.02 X
44680   004 90 2 X 2,901.70 X
44700   004 90 2 X 2,471.07 X
44700   001 90 2 X 2,831.54 X
44700   002 90 2 X 2,471.07 X
44700   003 90 2 X 2,471.07 X
44701   004 ZZZ 0 X 344.60 X
44701   001 ZZZ 0 X 378.37 X
44701   002 ZZZ 0 X 344.60 X
44701   003 ZZZ 0 X 344.60 X
44705     XXX 9 X * X
44715     XXX 2 X * X
44720   001 XXX 2 X 593.63 X
44720   002 XXX 2 X 544.09 X
44720   003 XXX 2 X 544.09 X
44720   004 XXX 2 X 544.09 X
44721   001 XXX 2 X 880.45 X
44721   004 XXX 2 X 790.28 X
44721   003 XXX 2 X 790.28 X
44721   002 XXX 2 X 790.28 X
44799     YYY 2 X # X
44800   004 90 2 X 1,858.63 X
44800   001 90 2 X 1,960.11 X
44800   002 90 2 X 1,887.92 X
44800   003 90 2 X 1,833.09 X
44820   002 90 2 X 1,948.87 X
44820   003 90 2 X 2,010.78 X
44820   001 90 2 X 2,072.45 X
44820   004 90 2 X 1,855.33 X
44850   004 90 2 X 1,595.15 X
44850   001 90 2 X 1,754.67 X
44850   003 90 2 X 1,613.20 X
44850   002 90 2 X 2,136.43 X
44899     YYY 2 X # X
44900   002 90 2 X 1,232.52 X
44900   003 90 2 X 1,232.52 X
44900   004 90 2 X 1,232.52 X
44900   001 90 2 X 1,377.72 X
44950   002 90 2 X 1,383.75 X
44950   003 90 2 X 1,297.93 X
44950   001 90 2 X 1,426.12 X
44950   004 90 2 X 1,262.49 X
44955   004 ZZZ 0 X 884.40 X
44955   001 ZZZ 0 X 874.54 X
44955   002 ZZZ 0 X 875.98 X
44955   003 ZZZ 0 X 491.98 X
44960   001 90 2 X 1,886.62 X
44960   003 90 2 X 1,770.50 X
44960   002 90 2 X 1,891.93 X
44960   004 90 2 X 1,750.79 X
44970   003 90 2 X 1,220.89 X
44970   002 90 2 X 1,220.89 X
44970   001 90 2 X 1,359.99 X
44970   004 90 2 X 1,220.89 X
44979     YYY 2 X # X
45000   004 90 2 X 635.15 X
45000   002 90 2 X 672.98 X
45000   003 90 2 X 642.01 X
45000   001 90 2 X 682.31 X
45005   003 10 2 X 386.54 X
45005   002 10 2 X 384.01 X
45005   004 10 2 X 395.54 X
45005   001 10 2 X 409.31 X
45020   001 90 2 X 821.34 X
45020   004 90 2 X 776.71 X
45020   003 90 2 X 767.07 X
45020   002 90 2 X 798.65 X
45100   002 90 2 X 703.64 X
45100   003 90 2 X 682.99 X
45100   004 90 2 X 687.01 X
45100   001 90 2 X 720.45 X
45108   002 90 2 X 835.79 X
45108   003 90 2 X 782.54 X
45108   004 90 2 X 773.76 X
45108   001 90 2 X 848.71 X
45110   004 90 2 X 4,258.71 X
45110   001 90 2 X 4,832.24 X
45110   002 90 2 X 4,652.03 X
45110   003 90 2 X 4,329.31 X
45111   004 90 2 X 3,388.87 X
45111   002 90 2 X 3,403.04 X
45111   003 90 2 X 3,321.81 X
45111   001 90 2 X 3,565.47 X
45112   001 90 2 X 4,947.02 X
45112   003 90 2 X 4,544.53 X
45112   002 90 2 X 4,868.34 X
45112   004 90 2 X 4,347.42 X
45113   002 90 2 X 4,868.34 X
45113   003 90 2 X 4,544.53 X
45113   001 90 2 X 4,947.02 X
45113   004 90 2 X 4,347.42 X
45114   002 90 2 X 4,470.88 X
45114   003 90 2 X 4,158.40 X
45114   001 90 2 X 4,828.38 X
45114   004 90 2 X 4,116.96 X
45116   003 90 2 X 3,373.05 X
45116   002 90 2 X 3,602.30 X
45116   001 90 2 X 3,658.03 X
45116   004 90 2 X 3,335.96 X
45119   003 90 2 X 4,016.58 X
45119   002 90 2 X 4,016.58 X
45119   001 90 2 X 4,542.76 X
45119   004 90 2 X 4,016.58 X
45120   004 90 2 X 4,414.05 X
45120   001 90 2 X 4,876.23 X
45120   003 90 2 X 4,464.43 X
45120   002 90 2 X 4,795.79 X
45121   004 90 2 X 3,919.96 X
45121   001 90 2 X 4,553.49 X
45121   002 90 2 X 4,457.53 X
45121   003 90 2 X 4,251.67 X
45123   003 90 2 X 3,321.81 X
45123   002 90 2 X 3,403.04 X
45123   001 90 2 X 3,565.47 X
45123   004 90 2 X 3,388.87 X
45126   004 90 2 X 4,775.58 4,753.35
45126   002 90 2 X 4,775.58 4,753.35
45126   001 90 2 X 5,331.44 5,305.38
45126   003 90 2 X 4,775.58 4,753.35
45130   002 90 2 X 2,935.20 X
45130   003 90 2 X 2,907.76 X
45130   004 90 2 X 2,454.10 X
45130   001 90 2 X 2,899.96 X
45135   004 90 2 X 3,586.18 X
45135   001 90 2 X 4,010.80 X
45135   003 90 2 X 3,628.59 X
45135   002 90 2 X 3,936.23 X
45136   004 90 2 X 3,314.00 X
45136   001 90 2 X 3,673.75 X
45136   002 90 2 X 3,314.00 X
45136   003 90 2 X 3,314.00 X
45150   001 90 2 X 1,051.38 X
45150   004 90 2 X 959.55 X
45150   002 90 2 X 1,302.37 X
45150   003 90 2 X 1,452.70 X
45160   001 90 2 X 2,277.27 X
45160   004 90 2 X 2,153.48 X
45160   002 90 2 X 2,255.87 X
45160   003 90 2 X 1,902.66 X
45171   002 90 2 X 996.95 X
45171   003 90 2 X 996.95 X
45171   001 90 2 X 1,121.04 X
45171   004 90 2 X 996.95 X
45172   001 90 2 X 1,538.56 X
45172   003 90 2 X 1,374.26 X
45172   002 90 2 X 1,374.26 X
45172   004 90 2 X 1,374.26 X
45190   001 90 2 X 1,578.02 X
45190   004 90 2 X 1,436.27 X
45190   003 90 2 X 1,452.57 X
45190   002 90 2 X 1,554.92 X
45300   004 0 2 X 146.05 116.23
45300   003 0 2 X 137.71 109.74
45300   002 0 2 X 146.90 116.99
45300   001 0 2 X 148.99 118.65
45303   001 0 3 X 154.03 114.54
45303   004 0 3 X 138.03 101.81
45303   002 0 3 X 151.23 112.24
45303   003 0 3 X 147.72 107.84
45305   004 0 3 X 268.99 X
45305   001 0 3 X 266.99 X
45305   003 0 3 X 258.18 X
45305   002 0 3 X 265.62 X
45307   004 0 3 X 462.53 X
45307   002 0 3 X 456.97 X
45307   003 0 3 X 465.97 X
45307   001 0 3 X 436.78 X
45308   004 0 3 X 350.77 X
45308   002 0 3 X 408.61 X
45308   003 0 3 X 405.02 X
45308   001 0 3 X 432.47 X
45309   004 0 3 X 350.77 X
45309   003 0 3 X 405.02 X
45309   002 0 3 X 408.61 X
45309   001 0 3 X 432.47 X
45315   002 0 3 X 423.16 X
45315   003 0 3 X 405.74 X
45315   004 0 3 X 348.99 X
45315   001 0 3 X 451.22 X
45317   001 0 3 X 528.15 X
45317   003 0 3 X 515.62 X
45317   002 0 3 X 518.33 X
45317   004 0 3 X 513.57 X
45320   003 0 3 X 706.84 X
45320   002 0 3 X 688.76 X
45320   004 0 3 X 704.25 X
45320   001 0 3 X 725.39 X
45321   004 0 3 X 565.82 X
45321   003 0 3 X 567.73 X
45321   002 0 3 X 579.21 X
45321   001 0 3 X 582.05 X
45327   004 0 3 X 204.69 X
45327   001 0 3 X 227.46 X
45327   002 0 3 X 204.69 X
45327   003 0 3 X 204.69 X
45330   001 0 2 X 242.31 179.56
45330   004 0 2 X 221.31 163.77
45330   003 0 2 X 275.09 201.70
45330   002 0 2 X 238.84 176.85
45331   004 0 3 X 418.08 X
45331   002 0 3 X 440.21 X
45331   003 0 3 X 431.41 X
45331   001 0 3 X 441.73 X