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2018 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   1 90 2 0 3,584.32 0
44146   2 90 2 0 3,451.93 0
44146   3 90 2 0 3,338.33 0
44146   4 90 2 0 3,246.50 0
44147   1 90 2 0 3,179.46 0
44147   2 90 2 0 3,060.51 0
44147   3 90 2 0 2,892.54 0
44147   4 90 2 0 2,854.68 0
44150   1 90 2 0 3,390.68 0
44150   2 90 2 0 3,221.51 0
44150   3 90 2 0 2,993.87 0
44150   4 90 2 0 2,959.75 0
44151   1 90 2 0 3,149.19 0
44151   2 90 2 0 2,628.20 0
44151   3 90 2 0 2,460.69 0
44151   4 90 2 0 2,433.57 0
44155   1 90 2 0 3,826.14 0
44155   2 90 2 0 3,732.54 0
44155   3 90 2 0 3,572.69 0
44155   4 90 2 0 3,554.55 0
44156   1 90 2 0 3,024.16 0
44156   2 90 2 0 3,453.73 0
44156   3 90 2 0 2,788.17 0
44156   4 90 2 0 2,757.52 0
44157   1 90 2 0 2,948.27 0
44157   2 90 2 0 2,617.98 0
44157   3 90 2 0 2,617.98 0
44157   4 90 2 0 2,617.98 0
44158   1 90 2 0 3,024.42 0
44158   2 90 2 0 2,685.77 0
44158   3 90 2 0 2,685.77 0
44158   4 90 2 0 2,685.77 0
44160   1 90 2 0 2,823.63 0
44160   2 90 2 0 2,759.38 0
44160   3 90 2 0 2,423.24 0
44160   4 90 2 0 2,331.30 0
44180   1 90 2 0 1,356.33 0
44180   2 90 2 0 1,212.01 0
44180   3 90 2 0 1,212.01 0
44180   4 90 2 0 1,212.01 0
44186   1 90 2 0 955.36 0
44186   2 90 2 0 850.60 0
44186   3 90 2 0 850.60 0
44186   4 90 2 0 850.60 0
44187   1 90 2 0 1,577.11 0
44187   2 90 2 0 1,404.97 0
44187   3 90 2 0 1,404.97 0
44187   4 90 2 0 1,404.97 0
44188   1 90 2 0 1,730.96 0
44188   2 90 2 0 1,541.59 0
44188   3 90 2 0 1,541.59 0
44188   4 90 2 0 1,541.59 0
44202   1 90 2 0 2,671.44 0
44202   2 90 2 0 2,398.07 0
44202   3 90 2 0 2,398.07 0
44202   4 90 2 0 2,398.07 0
44203   1 ZZZ 0 0 439.45 0
44203   2 ZZZ 0 0 395.11 0
44203   3 ZZZ 0 0 395.11 0
44203   4 ZZZ 0 0 395.11 0
44204   1 90 2 0 2,513.34 0
44204   2 90 2 0 2,277.18 0
44204   3 90 2 0 2,277.18 0
44204   4 90 2 0 2,277.18 0
44205   1 90 2 0 2,223.97 0
44205   2 90 2 0 2,017.14 0
44205   3 90 2 0 2,017.14 0
44205   4 90 2 0 2,017.14 0
44206   1 90 2 0 2,697.32 0
44206   2 90 2 0 2,442.42 0
44206   3 90 2 0 2,442.42 0
44206   4 90 2 0 2,442.42 0
44207   1 90 2 0 2,950.26 0
44207   2 90 2 0 2,674.68 0
44207   3 90 2 0 2,674.68 0
44207   4 90 2 0 2,674.68 0
44208   1 90 2 0 3,187.91 0
44208   2 90 2 0 2,892.42 0
44208   3 90 2 0 2,892.42 0
44208   4 90 2 0 2,892.42 0
44210   1 YYY 2 0 2,825.93 0
44210   2 YYY 2 0 2,558.49 0
44210   3 YYY 2 0 2,558.49 0
44210   4 YYY 2 0 2,558.49 0
44211   1 90 2 0 3,503.56 0
44211   2 90 2 0 3,179.88 0
44211   3 90 2 0 3,179.88 0
44211   4 90 2 0 3,179.88 0
44212   1 90 2 0 3,276.64 0
44212   2 90 2 0 2,969.96 0
44212   3 90 2 0 2,969.96 0
44212   4 90 2 0 2,969.96 0
44213   1 ZZZ 0 0 310.07 0
44213   2 ZZZ 0 0 278.70 0
44213   3 ZZZ 0 0 278.70 0
44213   4 ZZZ 0 0 278.70 0
44227   1 90 2 0 2,438.38 0
44227   2 90 2 0 2,183.58 0
44227   3 90 2 0 2,183.58 0
44227   4 90 2 0 2,183.58 0
44238     90 2 0 * 0
44300   1 90 2 0 1,450.63 0
44300   2 90 2 0 1,426.02 0
44300   3 90 2 0 1,355.10 0
44300   4 90 2 0 1,359.58 0
44310   1 90 2 0 1,817.31 0
44310   2 90 2 0 1,756.08 0
44310   3 90 2 0 1,693.17 0
44310   4 90 2 0 1,722.06 0
44312   1 90 2 0 830.57 0
44312   2 90 2 0 826.30 0
44312   3 90 2 0 718.40 0
44312   4 90 2 0 805.09 0
44314   1 90 2 0 1,500.89 0
44314   2 90 2 0 1,448.61 0
44314   3 90 2 0 1,371.00 0
44314   4 90 2 0 1,393.60 0
44316   1 90 2 0 2,151.10 0
44316   2 90 2 0 2,120.48 0
44316   3 90 2 0 1,993.85 0
44316   4 90 2 0 2,005.00 0
44320   1 90 2 0 1,827.75 0
44320   2 90 2 0 1,714.01 0
44320   3 90 2 0 1,652.68 0
44320   4 90 2 0 1,659.04 0
44322   1 90 2 0 1,882.47 0
44322   2 90 2 0 1,849.88 0
44322   3 90 2 0 1,715.70 0
44322   4 90 2 0 1,695.88 0
44340   1 90 2 0 759.96 0
44340   2 90 2 0 756.80 0
44340   3 90 2 0 713.94 0
44340   4 90 2 0 739.27 0
44345   1 90 2 0 1,392.43 0
44345   2 90 2 0 1,372.56 0
44345   3 90 2 0 1,537.95 0
44345   4 90 2 0 1,276.90 0
44346   1 90 2 0 1,650.01 0
44346   2 90 2 0 1,625.73 0
44346   3 90 2 0 1,551.40 0
44346   4 90 2 0 1,393.81 0
44360   1 0 2 0 565.37 0
44360   2 0 2 0 586.28 0
44360   3 0 2 0 524.42 0
44360   4 0 2 0 517.72 0
44361   1 0 3 0 711.84 0
44361   2 0 3 0 695.46 0
44361   3 0 3 0 691.62 0
44361   4 0 3 0 593.52 0
44363   1 0 3 0 591.31 0
44363   2 0 3 0 583.33 0
44363   3 0 3 0 550.26 0
44363   4 0 3 0 543.79 0
44364   1 0 3 0 789.17 0
44364   2 0 3 0 776.15 0
44364   3 0 3 0 722.10 0
44364   4 0 3 0 713.28 0
44365   1 0 3 0 780.53 0
44365   2 0 3 0 767.55 0
44365   3 0 3 0 713.73 0
44365   4 0 3 0 704.97 0
44366   1 0 3 0 912.22 0
44366   2 0 3 0 900.03 0
44366   3 0 3 0 849.27 0
44366   4 0 3 0 838.46 0
44369   1 0 3 0 989.86 0
44369   2 0 3 0 976.33 0
44369   3 0 3 0 919.90 0
44369   4 0 3 0 908.06 0
44370   1 0 3 0 445.42 0
44370   2 0 3 0 407.32 0
44370   3 0 3 0 407.32 0
44370   4 0 3 0 407.32 0
44372   1 0 3 0 936.64 0
44372   2 0 3 0 961.61 0
44372   3 0 3 0 937.06 0
44372   4 0 3 0 853.12 0
44373   1 0 3 0 783.16 0
44373   2 0 3 0 900.94 0
44373   3 0 3 0 723.74 0
44373   4 0 3 0 876.82 0
44376   1 0 2 0 757.44 0
44376   2 0 2 0 748.91 0
44376   3 0 2 0 713.37 0
44376   4 0 2 0 704.83 0
44377   1 0 3 0 801.39 0
44377   2 0 3 0 792.27 0
44377   3 0 3 0 754.50 0
44377   4 0 3 0 745.45 0
44378   1 0 3 0 1,045.10 0
44378   2 0 3 0 1,033.28 0
44378   3 0 3 0 984.06 0
44378   4 0 3 0 972.29 0
44379   1 0 3 0 727.60 0
44379   2 0 3 0 664.55 0
44379   3 0 3 0 664.55 0
44379   4 0 3 0 664.55 0
44380   1 0 2 0 551.03 0
44380   2 0 2 0 526.70 0
44380   3 0 2 0 516.02 0
44380   4 0 2 0 411.25 0
44381     0 3 0 * 0
44382   1 0 2 0 569.69 0
44382   2 0 2 0 597.95 0
44382   3 0 2 0 375.72 0
44382   4 0 2 0 569.01 0
44384     0 3 0 * 0
44385   1 0 2 0 566.41 0
44385   2 0 2 0 539.63 0
44385   3 0 2 0 610.67 0
44385   4 0 2 0 388.79 0
44386   1 0 2 0 628.29 0
44386   2 0 2 0 303.87 0
44386   3 0 2 0 287.92 0
44386   4 0 2 0 284.49 0
44388   1 0 2 0 711.15 0
44388   2 0 2 0 677.98 0
44388   3 0 2 0 704.65 0
44388   4 0 2 0 726.22 0
44389   1 0 3 0 759.85 0
44389   2 0 3 0 756.23 0
44389   3 0 3 0 727.39 0
44389   4 0 3 0 740.60 0
44390   1 0 3 0 544.91 0
44390   2 0 3 0 616.19 0
44390   3 0 3 0 509.56 0
44390   4 0 3 0 503.58 0
44391   1 0 3 0 823.55 0
44391   2 0 3 0 835.74 0
44391   3 0 3 0 761.47 0
44391   4 0 3 0 751.90 0
44392   1 0 3 0 1,080.93 0
44392   2 0 3 0 1,040.01 0
44392   3 0 3 0 1,039.07 0
44392   4 0 3 0 1,012.16 0
44394   1 0 3 0 1,080.93 0
44394   2 0 3 0 1,040.01 0
44394   3 0 3 0 1,039.07 0
44394   4 0 3 0 1,012.16 0
44401     0 3 0 * 0
44402     0 3 0 * 0
44403     0 3 0 * 0
44404     0 3 0 * 0
44405     0 3 0 * 0
44406     0 3 0 * 0
44407     0 3 0 * 0
44408     0 3 0 * 0
44500   1 0 0 0 51.76 0
44500   2 0 0 0 51.14 0
44500   3 0 0 0 48.66 0
44500   4 0 0 0 48.04 0
44602   1 90 2 0 1,791.31 0
44602   2 90 2 0 1,784.08 0
44602   3 90 2 0 1,602.46 0
44602   4 90 2 0 1,600.63 0
44603   1 90 2 0 2,116.95 0
44603   2 90 2 0 2,082.28 0
44603   3 90 2 0 1,939.75 0
44603   4 90 2 0 1,917.89 0
44604   1 90 2 0 1,915.82 0
44604   2 90 2 0 1,904.06 0
44604   3 90 2 0 1,726.50 0
44604   4 90 2 0 1,720.98 0
44605   1 90 2 0 2,230.03 0
44605   2 90 2 0 2,194.09 0
44605   3 90 2 0 2,046.04 0
44605   4 90 2 0 1,964.00 0
44615   1 90 2 0 1,643.56 0
44615   2 90 2 0 1,618.53 0
44615   3 90 2 0 1,515.47 0
44615   4 90 2 0 1,499.04 0
44620   1 90 2 0 1,484.65 0
44620   2 90 2 0 1,461.62 0
44620   3 90 2 0 1,366.80 0
44620   4 90 2 0 1,368.96 0
44625   1 90 2 0 1,940.10 0
44625   2 90 2 0 1,701.60 0
44625   3 90 2 0 1,701.60 0
44625   4 90 2 0 1,701.60 0
44626   1 90 2 0 2,777.10 0
44626   2 90 2 0 2,478.19 0
44626   3 90 2 0 2,478.19 0
44626   4 90 2 0 2,478.19 0
44640   1 90 2 0 1,772.63 0
44640   2 90 2 0 1,735.82 0
44640   3 90 2 0 1,650.16 0
44640   4 90 2 0 1,677.69 0
44650   1 90 2 0 1,973.41 0
44650   2 90 2 0 1,944.91 0
44650   3 90 2 0 1,827.68 0
44650   4 90 2 0 1,807.53 0
44660   1 90 2 0 1,973.57 0
44660   2 90 2 0 1,946.66 0
44660   3 90 2 0 1,835.70 0
44660   4 90 2 0 1,814.73 0
44661   1 90 2 0 2,526.58 0
44661   2 90 2 0 2,466.46 0
44661   3 90 2 0 2,331.13 0
44661   4 90 2 0 2,320.39 0
44680   1 90 2 0 2,377.33 0
44680   2 90 2 0 2,332.16 0
44680   3 90 2 0 1,960.45 0
44680   4 90 2 0 2,244.51 0
44700   1 90 2 0 2,190.23 0
44700   2 90 2 0 1,911.40 0
44700   3 90 2 0 1,911.40 0
44700   4 90 2 0 1,911.40 0
44701   1 90 2 0 292.68 0
44701   2 90 2 0 266.56 0
44701   3 90 2 0 266.56 0
44701   4 90 2 0 266.56 0
44705     XXX 9 0 * 0
44715     XXX 2 0 * 0
44720   1 XXX 2 0 459.19 0
44720   2 XXX 2 0 420.86 0
44720   3 XXX 2 0 420.86 0
44720   4 XXX 2 0 420.86 0
44721   1 XXX 2 0 681.05 0
44721   2 XXX 2 0 611.28 0
44721   3 XXX 2 0 611.28 0
44721   4 XXX 2 0 611.28 0
44799     YYY 2 0 * 0
44800   1 90 2 0 1,516.17 0
44800   2 90 2 0 1,460.34 0
44800   3 90 2 0 1,417.93 0
44800   4 90 2 0 1,437.68 0
44820   1 90 2 0 1,603.07 0
44820   2 90 2 0 1,507.48 0
44820   3 90 2 0 1,555.37 0
44820   4 90 2 0 1,435.12 0
44850   1 90 2 0 1,357.26 0
44850   2 90 2 0 1,652.55 0
44850   3 90 2 0 1,247.83 0
44850   4 90 2 0 1,233.88 0
44899     YYY 2 0 * 0
44900   1 90 2 0 1,065.68 0
44900   2 90 2 0 953.38 0
44900   3 90 2 0 953.38 0
44900   4 90 2 0 953.38 0
44950   1 90 2 0 1,103.13 0
44950   2 90 2 0 1,070.35 0
44950   3 90 2 0 1,003.97 0
44950   4 90 2 0 976.55 0
44955   1 ZZZ 0 0 676.46 0
44955   2 ZZZ 0 0 677.59 0
44955   3 ZZZ 0 0 380.56 0
44955   4 ZZZ 0 0 684.10 0
44960   1 90 2 0 1,459.33 0
44960   2 90 2 0 1,463.43 0
44960   3 90 2 0 1,369.51 0
44960   4 90 2 0 1,354.26 0
44970   1 90 2 0 1,051.96 0
44970   2 90 2 0 944.37 0
44970   3 90 2 0 944.37 0
44970   4 90 2 0 944.37 0
44979     YYY 2 0 * 0
45000   1 90 2 0 527.77 0
45000   2 90 2 0 520.56 0
45000   3 90 2 0 496.61 0
45000   4 90 2 0 491.30 0
45005   1 10 2 0 316.62 0
45005   2 10 2 0 297.04 0
45005   3 10 2 0 298.99 0
45005   4 10 2 0 305.96 0
45020   1 90 2 0 635.32 0
45020   2 90 2 0 617.77 0
45020   3 90 2 0 593.34 0
45020   4 90 2 0 600.80 0
45100   1 90 2 0 557.27 0
45100   2 90 2 0 544.27 0
45100   3 90 2 0 528.31 0
45100   4 90 2 0 531.43 0
45108   1 90 2 0 656.49 0
45108   2 90 2 0 646.49 0
45108   3 90 2 0 605.30 0
45108   4 90 2 0 598.51 0
45110   1 90 2 0 3,737.80 0
45110   2 90 2 0 3,598.42 0
45110   3 90 2 0 3,348.79 0
45110   4 90 2 0 3,294.17 0
45111   1 90 2 0 2,757.95 0
45111   2 90 2 0 2,632.30 0
45111   3 90 2 0 2,569.47 0
45111   4 90 2 0 2,621.34 0
45112   1 90 2 0 3,826.60 0
45112   2 90 2 0 3,765.74 0
45112   3 90 2 0 3,515.26 0
45112   4 90 2 0 3,362.80 0
45113   1 90 2 0 3,826.60 0
45113   2 90 2 0 3,765.74 0
45113   3 90 2 0 3,515.26 0
45113   4 90 2 0 3,362.80 0
45114   1 90 2 0 3,734.83 0
45114   2 90 2 0 3,458.29 0
45114   3 90 2 0 3,216.58 0
45114   4 90 2 0 3,184.54 0
45116   1 90 2 0 2,829.54 0
45116   2 90 2 0 2,786.42 0
45116   3 90 2 0 2,609.10 0
45116   4 90 2 0 2,580.41 0
45119   1 90 2 0 3,513.89 0
45119   2 90 2 0 3,106.88 0
45119   3 90 2 0 3,106.88 0
45119   4 90 2 0 3,106.88 0
45120   1 90 2 0 3,771.83 0
45120   2 90 2 0 3,709.62 0
45120   3 90 2 0 3,453.30 0
45120   4 90 2 0 3,414.33 0
45121   1 90 2 0 3,522.19 0
45121   2 90 2 0 3,447.97 0
45121   3 90 2 0 3,288.72 0
45121   4 90 2 0 3,032.14 0
45123   1 90 2 0 2,757.95 0
45123   2 90 2 0 2,632.30 0
45123   3 90 2 0 2,569.47 0
45123   4 90 2 0 2,621.34 0
45126   1 90 2 0 4,123.94 4103.79
45126   2 90 2 0 3,693.98 3676.78
45126   3 90 2 0 3,693.98 3676.78
45126   4 90 2 0 3,693.98 3676.78
45130   1 90 2 0 2,243.16 0
45130   2 90 2 0 2,270.42 0
45130   3 90 2 0 2,249.20 0
45130   4 90 2 0 1,898.28 0
45135   1 90 2 0 3,102.40 0
45135   2 90 2 0 3,044.73 0
45135   3 90 2 0 2,806.76 0
45135   4 90 2 0 2,773.97 0
45136   1 90 2 0 2,841.70 0
45136   2 90 2 0 2,563.43 0
45136   3 90 2 0 2,563.43 0
45136   4 90 2 0 2,563.43 0
45150   1 90 2 0 813.25 0
45150   2 90 2 0 1,007.40 0
45150   3 90 2 0 1,123.68 0
45150   4 90 2 0 742.23 0
45160   1 90 2 0 1,761.51 0
45160   2 90 2 0 1,744.95 0
45160   3 90 2 0 1,471.74 0
45160   4 90 2 0 1,665.74 0
45171   1 90 2 0 867.14 0
45171   2 90 2 0 771.16 0
45171   3 90 2 0 771.16 0
45171   4 90 2 0 771.16 0
45172   1 90 2 0 1,190.10 0
45172   2 90 2 0 1,063.01 0
45172   3 90 2 0 1,063.01 0
45172   4 90 2 0 1,063.01 0
45190   1 90 2 0 1,220.63 0
45190   2 90 2 0 1,202.76 0
45190   3 90 2 0 1,123.59 0
45190   4 90 2 0 1,110.99 0
45300   1 0 2 0 115.25 91.79
45300   2 0 2 0 113.64 90.49
45300   3 0 2 0 106.51 84.89
45300   4 0 2 0 112.97 89.90
45303   1 0 3 0 119.14 88.59
45303   2 0 3 0 116.97 86.82
45303   3 0 3 0 114.27 83.41
45303   4 0 3 0 106.76 78.75
45305   1 0 3 0 206.52 0
45305   2 0 3 0 205.45 0
45305   3 0 3 0 199.71 0
45305   4 0 3 0 208.06 0
45307   1 0 3 0 337.86 0
45307   2 0 3 0 353.47 0
45307   3 0 3 0 360.44 0
45307   4 0 3 0 357.77 0
45308   1 0 3 0 334.53 0
45308   2 0 3 0 316.07 0
45308   3 0 3 0 313.28 0
45308   4 0 3 0 271.33 0
45309   1 0 3 0 334.53 0
45309   2 0 3 0 316.07 0
45309   3 0 3 0 313.28 0
45309   4 0 3 0 271.33 0
45315   1 0 3 0 349.03 0
45315   2 0 3 0 327.32 0
45315   3 0 3 0 313.84 0
45315   4 0 3 0 269.94 0
45317   1 0 3 0 408.52 0
45317   2 0 3 0 400.94 0
45317   3 0 3 0 398.84 0
45317   4 0 3 0 397.25 0
45320   1 0 3 0 561.10 0
45320   2 0 3 0 532.77 0
45320   3 0 3 0 546.74 0
45320   4 0 3 0 544.74 0
45321   1 0 3 0 450.22 0
45321   2 0 3 0 448.03 0
45321   3 0 3 0 439.13 0
45321   4 0 3 0 437.67 0
45327   1 0 3 0 175.94 0
45327   2 0 3 0 158.34 0
45327   3 0 3 0 158.34 0
45327   4 0 3 0 158.34 0
45330   1 0 2 0 187.44 138.90
45330   2 0 2 0 184.75 136.79
45330   3 0 2 0 212.80 156.01
45330   4 0 2 0 171.18 126.68
45331   1 0 3 0 341.68 0
45331   2 0 3 0 340.51 0
45331   3 0 3 0 333.70 0
45331   4 0 3 0 323.38 0