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2021 Workers' Compensation Part B Fee Schedule

44146-45331

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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
44146   4 90 2 X 3,581.64 X
44146   3 90 2 X 3,682.95 X
44146   2 90 2 X 3,808.27 X
44146   1 90 2 X 3,954.33 X
44147   4 90 2 X 3,149.37 X
44147   3 90 2 X 3,191.14 X
44147   2 90 2 X 3,376.45 X
44147   1 90 2 X 3,507.68 X
44150   4 90 2 X 3,265.28 X
44150   3 90 2 X 3,302.92 X
44150   2 90 2 X 3,554.06 X
44150   1 90 2 X 3,740.71 X
44151   4 90 2 X 2,684.79 X
44151   3 90 2 X 2,714.72 X
44151   2 90 2 X 2,899.51 X
44151   1 90 2 X 3,474.28 X
44155   4 90 2 X 3,921.49 X
44155   3 90 2 X 3,941.50 X
44155   2 90 2 X 4,117.85 X
44155   1 90 2 X 4,221.11 X
44156   4 90 2 X 3,042.18 X
44156   3 90 2 X 3,075.99 X
44156   1 90 2 X 3,336.35 X
44156   2 90 2 X 3,810.26 X
44157   2 90 2 X 2,888.23 X
44157   3 90 2 X 2,888.23 X
44157   4 90 2 X 2,888.23 X
44157   1 90 2 X 3,252.62 X
44158   2 90 2 X 2,963.01 X
44158   3 90 2 X 2,963.01 X
44158   4 90 2 X 2,963.01 X
44158   1 90 2 X 3,336.62 X
44160   4 90 2 X 2,571.96 X
44160   3 90 2 X 2,673.39 X
44160   2 90 2 X 3,044.24 X
44160   1 90 2 X 3,115.11 X
44180   2 90 2 X 1,337.13 X
44180   3 90 2 X 1,337.13 X
44180   4 90 2 X 1,337.13 X
44180   1 90 2 X 1,496.34 X
44186   2 90 2 X 938.40 X
44186   3 90 2 X 938.40 X
44186   4 90 2 X 938.40 X
44186   1 90 2 X 1,053.98 X
44187   2 90 2 X 1,550.00 X
44187   3 90 2 X 1,550.00 X
44187   4 90 2 X 1,550.00 X
44187   1 90 2 X 1,739.91 X
44188   2 90 2 X 1,700.73 X
44188   3 90 2 X 1,700.73 X
44188   4 90 2 X 1,700.73 X
44188   1 90 2 X 1,909.64 X
44202   2 90 2 X 2,645.63 X
44202   3 90 2 X 2,645.63 X
44202   4 90 2 X 2,645.63 X
44202   1 90 2 X 2,947.21 X
44203   2 ZZZ 0 X 435.90 X
44203   3 ZZZ 0 X 435.90 X
44203   4 ZZZ 0 X 435.90 X
44203   1 ZZZ 0 X 484.82 X
44204   2 90 2 X 2,512.26 X
44204   3 90 2 X 2,512.26 X
44204   4 90 2 X 2,512.26 X
44204   1 90 2 X 2,772.80 X
44205   2 90 2 X 2,225.37 X
44205   3 90 2 X 2,225.37 X
44205   4 90 2 X 2,225.37 X
44205   1 90 2 X 2,453.55 X
44206   2 90 2 X 2,694.56 X
44206   3 90 2 X 2,694.56 X
44206   4 90 2 X 2,694.56 X
44206   1 90 2 X 2,975.77 X
44207   2 90 2 X 2,950.79 X
44207   3 90 2 X 2,950.79 X
44207   4 90 2 X 2,950.79 X
44207   1 90 2 X 3,254.82 X
44208   2 90 2 X 3,191.01 X
44208   3 90 2 X 3,191.01 X
44208   4 90 2 X 3,191.01 X
44208   1 90 2 X 3,517.00 X
44210   2 YYY 2 X 2,822.61 X
44210   3 YYY 2 X 2,822.61 X
44210   4 YYY 2 X 2,822.61 X
44210   1 YYY 2 X 3,117.66 X
44211   2 90 2 X 3,508.14 X
44211   3 90 2 X 3,508.14 X
44211   4 90 2 X 3,508.14 X
44211   1 90 2 X 3,865.23 X
44212   2 90 2 X 3,276.55 X
44212   3 90 2 X 3,276.55 X
44212   4 90 2 X 3,276.55 X
44212   1 90 2 X 3,614.88 X
44213   2 ZZZ 0 X 307.47 X
44213   3 ZZZ 0 X 307.47 X
44213   4 ZZZ 0 X 307.47 X
44213   1 ZZZ 0 X 342.07 X
44227   2 90 2 X 2,408.99 X
44227   3 90 2 X 2,408.99 X
44227   4 90 2 X 2,408.99 X
44227   1 90 2 X 2,690.09 X
44238     90 2 X # X
44300   3 90 2 X 1,494.99 X
44300   4 90 2 X 1,499.93 X
44300   2 90 2 X 1,573.23 X
44300   1 90 2 X 1,600.37 X
44310   3 90 2 X 1,867.96 X
44310   4 90 2 X 1,899.83 X
44310   2 90 2 X 1,937.36 X
44310   1 90 2 X 2,004.91 X
44312   3 90 2 X 792.55 X
44312   4 90 2 X 888.20 X
44312   2 90 2 X 911.59 X
44312   1 90 2 X 916.31 X
44314   3 90 2 X 1,512.53 X
44314   4 90 2 X 1,537.46 X
44314   2 90 2 X 1,598.15 X
44314   1 90 2 X 1,655.83 X
44316   3 90 2 X 2,199.68 X
44316   4 90 2 X 2,211.97 X
44316   2 90 2 X 2,339.38 X
44316   1 90 2 X 2,373.16 X
44320   3 90 2 X 1,823.28 X
44320   4 90 2 X 1,830.30 X
44320   2 90 2 X 1,890.95 X
44320   1 90 2 X 2,016.43 X
44322   4 90 2 X 1,870.95 X
44322   3 90 2 X 1,892.81 X
44322   2 90 2 X 2,040.85 X
44322   1 90 2 X 2,076.80 X
44340   3 90 2 X 787.64 X
44340   4 90 2 X 815.58 X
44340   2 90 2 X 834.93 X
44340   1 90 2 X 838.41 X
44345   4 90 2 X 1,408.71 X
44345   2 90 2 X 1,514.25 X
44345   1 90 2 X 1,536.18 X
44345   3 90 2 X 1,696.71 X
44346   4 90 2 X 1,537.69 X
44346   3 90 2 X 1,711.55 X
44346   2 90 2 X 1,793.56 X
44346   1 90 2 X 1,820.34 X
44360   4 0 2 X 571.17 X
44360   3 0 2 X 578.55 X
44360   1 0 2 X 623.73 X
44360   2 0 2 X 646.79 X
44361   4 0 3 X 654.79 X
44361   3 0 3 X 763.02 X
44361   2 0 3 X 767.26 X
44361   1 0 3 X 785.32 X
44363   4 0 3 X 599.93 X
44363   3 0 3 X 607.07 X
44363   2 0 3 X 643.55 X
44363   1 0 3 X 652.35 X
44364   4 0 3 X 786.92 X
44364   3 0 3 X 796.64 X
44364   2 0 3 X 856.27 X
44364   1 0 3 X 870.64 X
44365   4 0 3 X 777.74 X
44365   3 0 3 X 787.41 X
44365   2 0 3 X 846.78 X
44365   1 0 3 X 861.10 X
44366   4 0 3 X 925.01 X
44366   3 0 3 X 936.93 X
44366   2 0 3 X 992.94 X
44366   1 0 3 X 1,006.39 X
44369   4 0 3 X 1,001.81 X
44369   3 0 3 X 1,014.86 X
44369   2 0 3 X 1,077.12 X
44369   1 0 3 X 1,092.04 X
44370   2 0 3 X 449.37 X
44370   3 0 3 X 449.37 X
44370   4 0 3 X 449.37 X
44370   1 0 3 X 491.40 X
44372   4 0 3 X 941.18 X
44372   1 0 3 X 1,033.32 X
44372   3 0 3 X 1,033.79 X
44372   2 0 3 X 1,060.88 X
44373   3 0 3 X 798.45 X
44373   1 0 3 X 864.01 X
44373   4 0 3 X 967.34 X
44373   2 0 3 X 993.94 X
44376   4 0 2 X 777.59 X
44376   3 0 2 X 787.01 X
44376   2 0 2 X 826.21 X
44376   1 0 2 X 835.63 X
44377   4 0 3 X 822.41 X
44377   3 0 3 X 832.39 X
44377   2 0 3 X 874.06 X
44377   1 0 3 X 884.11 X
44378   4 0 3 X 1,072.65 X
44378   3 0 3 X 1,085.64 X
44378   2 0 3 X 1,139.95 X
44378   1 0 3 X 1,152.98 X
44379   2 0 3 X 733.14 X
44379   3 0 3 X 733.14 X
44379   4 0 3 X 733.14 X
44379   1 0 3 X 802.70 X
44380   4 0 2 X 453.70 X
44380   3 0 2 X 569.29 X
44380   2 0 2 X 581.06 X
44380   1 0 2 X 607.90 X
44381     0 3 X * X
44382   3 0 2 X 414.51 X
44382   4 0 2 X 627.76 X
44382   1 0 2 X 628.50 X
44382   2 0 2 X 659.67 X
44384     0 3 X * X
44385   4 0 2 X 428.92 X
44385   2 0 2 X 595.33 X
44385   1 0 2 X 624.88 X
44385   3 0 2 X 673.72 X
44386   4 0 2 X 313.85 X
44386   3 0 2 X 317.64 X
44386   2 0 2 X 335.24 X
44386   1 0 2 X 693.14 X
44388   2 0 2 X 747.96 X
44388   3 0 2 X 777.40 X
44388   1 0 2 X 784.56 X
44388   4 0 2 X 801.18 X
44389   3 0 3 X 802.48 X
44389   4 0 3 X 817.05 X
44389   2 0 3 X 834.29 X
44389   1 0 3 X 838.30 X
44390   4 0 3 X 555.56 X
44390   3 0 3 X 562.16 X
44390   1 0 3 X 601.16 X
44390   2 0 3 X 679.80 X
44391   4 0 3 X 829.51 X
44391   3 0 3 X 840.07 X
44391   1 0 3 X 908.57 X
44391   2 0 3 X 922.01 X
44392   4 0 3 X 1,116.65 X
44392   3 0 3 X 1,146.33 X
44392   2 0 3 X 1,147.37 X
44392   1 0 3 X 1,192.51 X
44394   4 0 3 X 1,116.65 X
44394   3 0 3 X 1,146.33 X
44394   2 0 3 X 1,147.37 X
44394   1 0 3 X 1,192.51 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   4 0 0 X 52.99 X
44500   3 0 0 X 53.68 X
44500   2 0 0 X 56.42 X
44500   1 0 0 X 57.10 X
44602   4 90 2 X 1,765.86 X
44602   3 90 2 X 1,767.89 X
44602   2 90 2 X 1,968.25 X
44602   1 90 2 X 1,976.23 X
44603   4 90 2 X 2,115.87 X
44603   3 90 2 X 2,139.99 X
44603   2 90 2 X 2,297.24 X
44603   1 90 2 X 2,335.48 X
44604   4 90 2 X 1,898.64 X
44604   3 90 2 X 1,904.72 X
44604   2 90 2 X 2,100.61 X
44604   1 90 2 X 2,113.59 X
44605   4 90 2 X 2,166.74 X
44605   3 90 2 X 2,257.26 X
44605   2 90 2 X 2,420.58 X
44605   1 90 2 X 2,460.23 X
44615   4 90 2 X 1,653.79 X
44615   3 90 2 X 1,671.92 X
44615   2 90 2 X 1,785.62 X
44615   1 90 2 X 1,813.22 X
44620   3 90 2 X 1,507.90 X
44620   4 90 2 X 1,510.28 X
44620   2 90 2 X 1,612.50 X
44620   1 90 2 X 1,637.91 X
44625   2 90 2 X 1,877.26 X
44625   3 90 2 X 1,877.26 X
44625   4 90 2 X 1,877.26 X
44625   1 90 2 X 2,140.38 X
44626   2 90 2 X 2,734.01 X
44626   3 90 2 X 2,734.01 X
44626   4 90 2 X 2,734.01 X
44626   1 90 2 X 3,063.78 X
44640   3 90 2 X 1,820.50 X
44640   4 90 2 X 1,850.88 X
44640   2 90 2 X 1,915.01 X
44640   1 90 2 X 1,955.62 X
44650   4 90 2 X 1,994.12 X
44650   3 90 2 X 2,016.35 X
44650   2 90 2 X 2,145.68 X
44650   1 90 2 X 2,177.12 X
44660   4 90 2 X 2,002.06 X
44660   3 90 2 X 2,025.20 X
44660   2 90 2 X 2,147.61 X
44660   1 90 2 X 2,177.30 X
44661   4 90 2 X 2,559.93 X
44661   3 90 2 X 2,571.78 X
44661   2 90 2 X 2,721.07 X
44661   1 90 2 X 2,787.40 X
44680   3 90 2 X 2,162.82 X
44680   4 90 2 X 2,476.21 X
44680   2 90 2 X 2,572.91 X
44680   1 90 2 X 2,622.74 X
44700   2 90 2 X 2,108.72 X
44700   3 90 2 X 2,108.72 X
44700   4 90 2 X 2,108.72 X
44700   1 90 2 X 2,416.33 X
44701   2 90 2 X 294.07 X
44701   3 90 2 X 294.07 X
44701   4 90 2 X 294.07 X
44701   1 90 2 X 322.89 X
44705     XXX 9 X * X
44715     XXX 2 X * X
44720   2 XXX 2 X 464.31 X
44720   3 XXX 2 X 464.31 X
44720   4 XXX 2 X 464.31 X
44720   1 XXX 2 X 506.59 X
44721   2 XXX 2 X 674.39 X
44721   3 XXX 2 X 674.39 X
44721   4 XXX 2 X 674.39 X
44721   1 XXX 2 X 751.35 X
44799     YYY 2 X # X
44800   3 90 2 X 1,564.30 X
44800   4 90 2 X 1,586.09 X
44800   2 90 2 X 1,611.09 X
44800   1 90 2 X 1,672.68 X
44820   4 90 2 X 1,583.27 X
44820   2 90 2 X 1,663.10 X
44820   3 90 2 X 1,715.93 X
44820   1 90 2 X 1,768.56 X
44850   4 90 2 X 1,361.25 X
44850   3 90 2 X 1,376.64 X
44850   1 90 2 X 1,497.37 X
44850   2 90 2 X 1,823.15 X
44899     YYY 2 X # X
44900   2 90 2 X 1,051.79 X
44900   3 90 2 X 1,051.79 X
44900   4 90 2 X 1,051.79 X
44900   1 90 2 X 1,175.69 X
44950   4 90 2 X 1,077.36 X
44950   3 90 2 X 1,107.61 X
44950   2 90 2 X 1,180.84 X
44950   1 90 2 X 1,217.00 X
44955   3 ZZZ 0 X 419.84 X
44955   1 ZZZ 0 X 746.29 X
44955   2 ZZZ 0 X 747.53 X
44955   4 ZZZ 0 X 754.71 X
44960   4 90 2 X 1,494.06 X
44960   3 90 2 X 1,510.88 X
44960   1 90 2 X 1,609.97 X
44960   2 90 2 X 1,614.50 X
44970   2 90 2 X 1,041.86 X
44970   3 90 2 X 1,041.86 X
44970   4 90 2 X 1,041.86 X
44970   1 90 2 X 1,160.56 X
44979     YYY 2 X # X
45000   4 90 2 X 542.02 X
45000   3 90 2 X 547.87 X
45000   2 90 2 X 574.30 X
45000   1 90 2 X 582.26 X
45005   2 10 2 X 327.70 X
45005   3 10 2 X 329.86 X
45005   4 10 2 X 337.54 X
45005   1 10 2 X 349.30 X
45020   3 90 2 X 654.60 X
45020   4 90 2 X 662.82 X
45020   2 90 2 X 681.54 X
45020   1 90 2 X 700.90 X
45100   3 90 2 X 582.84 X
45100   4 90 2 X 586.28 X
45100   2 90 2 X 600.46 X
45100   1 90 2 X 614.80 X
45108   4 90 2 X 660.30 X
45108   3 90 2 X 667.79 X
45108   2 90 2 X 713.23 X
45108   1 90 2 X 724.26 X
45110   4 90 2 X 3,634.23 X
45110   3 90 2 X 3,694.48 X
45110   2 90 2 X 3,969.88 X
45110   1 90 2 X 4,123.66 X
45111   3 90 2 X 2,834.72 X
45111   4 90 2 X 2,891.94 X
45111   2 90 2 X 2,904.03 X
45111   1 90 2 X 3,042.65 X
45112   4 90 2 X 3,709.93 X
45112   3 90 2 X 3,878.14 X
45112   2 90 2 X 4,154.47 X
45112   1 90 2 X 4,221.61 X
45113   4 90 2 X 3,709.93 X
45113   3 90 2 X 3,878.14 X
45113   2 90 2 X 4,154.47 X
45113   1 90 2 X 4,221.61 X
45114   4 90 2 X 3,513.27 X
45114   3 90 2 X 3,548.63 X
45114   2 90 2 X 3,815.29 X
45114   1 90 2 X 4,120.37 X
45116   4 90 2 X 2,846.78 X
45116   3 90 2 X 2,878.44 X
45116   2 90 2 X 3,074.07 X
45116   1 90 2 X 3,121.63 X
45119   2 90 2 X 3,427.61 X
45119   3 90 2 X 3,427.61 X
45119   4 90 2 X 3,427.61 X
45119   1 90 2 X 3,876.63 X
45120   4 90 2 X 3,766.79 X
45120   3 90 2 X 3,809.78 X
45120   2 90 2 X 4,092.56 X
45120   1 90 2 X 4,161.20 X
45121   4 90 2 X 3,345.15 X
45121   3 90 2 X 3,628.22 X
45121   2 90 2 X 3,803.90 X
45121   1 90 2 X 3,885.79 X
45123   3 90 2 X 2,834.72 X
45123   4 90 2 X 2,891.94 X
45123   2 90 2 X 2,904.03 X
45123   1 90 2 X 3,042.65 X
45126   2 90 2 X 4,075.31 4,056.34
45126   3 90 2 X 4,075.31 4,056.34
45126   4 90 2 X 4,075.31 4,056.34
45126   1 90 2 X 4,549.65 4,527.42
45130   4 90 2 X 2,094.24 X
45130   1 90 2 X 2,474.72 X
45130   3 90 2 X 2,481.38 X
45130   2 90 2 X 2,504.79 X
45135   4 90 2 X 3,060.32 X
45135   3 90 2 X 3,096.51 X
45135   2 90 2 X 3,359.04 X
45135   1 90 2 X 3,422.67 X
45136   2 90 2 X 2,828.05 X
45136   3 90 2 X 2,828.05 X
45136   4 90 2 X 2,828.05 X
45136   1 90 2 X 3,135.05 X
45150   4 90 2 X 818.85 X
45150   1 90 2 X 897.20 X
45150   2 90 2 X 1,111.40 X
45150   3 90 2 X 1,239.68 X
45160   3 90 2 X 1,623.66 X
45160   4 90 2 X 1,837.70 X
45160   2 90 2 X 1,925.08 X
45160   1 90 2 X 1,943.34 X
45171   2 90 2 X 850.77 X
45171   3 90 2 X 850.77 X
45171   4 90 2 X 850.77 X
45171   1 90 2 X 956.65 X
45172   2 90 2 X 1,172.74 X
45172   3 90 2 X 1,172.74 X
45172   4 90 2 X 1,172.74 X
45172   1 90 2 X 1,312.95 X
45190   4 90 2 X 1,225.67 X
45190   3 90 2 X 1,239.57 X
45190   2 90 2 X 1,326.91 X
45190   1 90 2 X 1,346.63 X
45300   3 0 2 X 117.51 93.65
45300   4 0 2 X 124.63 99.18
45300   2 0 2 X 125.36 99.83
45300   1 0 2 X 127.14 101.26
45303   4 0 3 X 117.79 86.88
45303   3 0 3 X 126.06 92.03
45303   2 0 3 X 129.05 95.78
45303   1 0 3 X 131.44 97.74
45305   3 0 3 X 220.32 X
45305   2 0 3 X 226.67 X
45305   1 0 3 X 227.84 X
45305   4 0 3 X 229.54 X
45307   1 0 3 X 372.73 X
45307   2 0 3 X 389.96 X
45307   4 0 3 X 394.71 X
45307   3 0 3 X 397.65 X
45308   4 0 3 X 299.33 X
45308   3 0 3 X 345.63 X
45308   2 0 3 X 348.69 X
45308   1 0 3 X 369.06 X
45309   4 0 3 X 299.33 X
45309   3 0 3 X 345.63 X
45309   2 0 3 X 348.69 X
45309   1 0 3 X 369.06 X
45315   4 0 3 X 297.81 X
45315   3 0 3 X 346.24 X
45315   2 0 3 X 361.11 X
45315   1 0 3 X 385.06 X
45317   4 0 3 X 438.26 X
45317   3 0 3 X 440.01 X
45317   2 0 3 X 442.32 X
45317   1 0 3 X 450.70 X
45320   2 0 3 X 587.77 X
45320   4 0 3 X 600.98 X
45320   3 0 3 X 603.19 X
45320   1 0 3 X 619.02 X
45321   4 0 3 X 482.85 X
45321   3 0 3 X 484.47 X
45321   2 0 3 X 494.28 X
45321   1 0 3 X 496.70 X
45327   2 0 3 X 174.68 X
45327   3 0 3 X 174.68 X
45327   4 0 3 X 174.68 X
45327   1 0 3 X 194.11 X
45330   4 0 2 X 188.86 139.76
45330   2 0 2 X 203.82 150.92
45330   1 0 2 X 206.78 153.23
45330   3 0 2 X 234.76 172.12
45331   4 0 3 X 356.77 X
45331   3 0 3 X 368.15 X
45331   2 0 3 X 375.66 X
45331   1 0 3 X 376.96 X