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2020 Workers' Compensation Part B Fee Schedule

45332-47130

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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
45332   3 0 3 X 357.71 X
45332   4 0 3 X 378.16 X
45332   2 0 3 X 381.66 X
45332   1 0 3 X 384.53 X
45333   4 0 3 X 365.80 X
45333   3 0 3 X 370.38 X
45333   2 0 3 X 394.59 X
45333   1 0 3 X 400.43 X
45334   4 0 3 X 465.64 X
45334   3 0 3 X 471.44 X
45334   2 0 3 X 498.35 X
45334   1 0 3 X 504.83 X
45335   2 0 3 X 246.57 133.36
45335   3 0 3 X 246.57 133.36
45335   4 0 3 X 246.57 133.36
45335   1 0 3 X 279.56 146.48
45337   3 0 3 X 488.67 X
45337   4 0 3 X 489.19 X
45337   2 0 3 X 500.12 X
45337   1 0 3 X 508.09 X
45338   4 0 3 X 365.80 X
45338   3 0 3 X 370.38 X
45338   2 0 3 X 394.59 X
45338   1 0 3 X 400.43 X
45340   2 0 3 X 557.67 159.95
45340   3 0 3 X 557.67 159.95
45340   4 0 3 X 557.67 159.95
45340   1 0 3 X 642.42 174.90
45341   2 0 2 X 372.84 X
45341   3 0 2 X 372.84 X
45341   4 0 2 X 372.84 X
45341   1 0 2 X 411.23 X
45342   2 0 2 X 430.08 X
45342   3 0 2 X 430.08 X
45342   4 0 2 X 430.08 X
45342   1 0 2 X 473.90 X
45346     0 3 X * X
45347     0 3 X * X
45349     0 3 X * X
45350     0 3 X * X
45378   4 0 2 X 679.82 X
45378   3 0 2 X 686.05 X
45378   2 0 2 X 728.49 X
45378   1 0 2 X 743.38 X
45379   3 0 3 X 914.32 X
45379   4 0 3 X 918.80 X
45379   2 0 3 X 977.98 X
45379   1 0 3 X 989.06 X
45380   4 0 3 X 784.80 X
45380   3 0 3 X 788.83 X
45380   2 0 3 X 819.73 X
45380   1 0 3 X 835.77 X
45381   2 0 3 X 667.78 392.53
45381   3 0 3 X 667.78 392.53
45381   4 0 3 X 667.78 392.53
45381   1 0 3 X 752.99 429.41
45382   4 0 3 X 979.48 X
45382   3 0 3 X 980.26 X
45382   2 0 3 X 1,042.91 X
45382   1 0 3 X 1,054.37 X
45384   4 0 3 X 1,075.09 X
45384   3 0 3 X 1,086.54 X
45384   2 0 3 X 1,156.94 X
45384   1 0 3 X 1,178.76 X
45385   4 0 3 X 1,075.09 X
45385   3 0 3 X 1,086.54 X
45385   2 0 3 X 1,156.94 X
45385   1 0 3 X 1,178.76 X
45386   2 0 3 X 1,258.19 426.21
45386   3 0 3 X 1,258.19 426.21
45386   4 0 3 X 1,258.19 426.21
45386   1 0 3 X 1,443.44 465.48
45388     0 3 X * X
45389     0 3 X * X
45390     0 3 X * X
45391   2 0 3 X 467.68 X
45391   3 0 3 X 467.68 X
45391   4 0 3 X 467.68 X
45391   1 0 3 X 513.22 X
45392   2 0 3 X 591.66 X
45392   3 0 3 X 591.66 X
45392   4 0 3 X 591.66 X
45392   1 0 3 X 645.06 X
45393     0 3 X * X
45395   2 90 2 X 2,716.05 X
45395   3 90 2 X 2,716.05 X
45395   4 90 2 X 2,716.05 X
45395   1 90 2 X 3,033.84 X
45397   2 90 2 X 2,957.16 X
45397   3 90 2 X 2,957.16 X
45397   4 90 2 X 2,957.16 X
45397   1 90 2 X 3,286.74 X
45398     0 3 X * X
45399     XXX 2 X * X
45400   2 90 2 X 1,588.00 X
45400   3 90 2 X 1,588.00 X
45400   4 90 2 X 1,588.00 X
45400   1 90 2 X 1,768.73 X
45402   2 90 2 X 2,155.43 X
45402   3 90 2 X 2,155.43 X
45402   4 90 2 X 2,155.43 X
45402   1 90 2 X 2,395.86 X
45499     YYY 2 X * X
45500   3 90 2 X 1,170.15 X
45500   1 90 2 X 1,337.95 X
45500   4 90 2 X 1,350.48 X
45500   2 90 2 X 1,369.25 X
45505   1 90 2 X 1,222.96 X
45505   2 90 2 X 1,308.89 X
45505   4 90 2 X 1,324.93 X
45505   3 90 2 X 1,330.50 X
45520   4 0 2 X 99.45 X
45520   3 0 2 X 100.69 X
45520   1 0 2 X 110.11 X
45520   2 0 2 X 129.13 X
45540   3 90 2 X 2,041.42 X
45540   4 90 2 X 2,063.33 X
45540   2 90 2 X 2,199.24 X
45540   1 90 2 X 2,237.53 X
45541   3 90 2 X 1,946.32 X
45541   4 90 2 X 1,991.94 X
45541   2 90 2 X 2,022.28 X
45541   1 90 2 X 2,113.28 X
45550   3 90 2 X 2,632.56 X
45550   4 90 2 X 2,656.80 X
45550   2 90 2 X 2,735.49 X
45550   1 90 2 X 2,829.79 X
45560   3 90 2 X 1,130.44 X
45560   2 90 2 X 1,208.91 X
45560   4 90 2 X 1,213.08 X
45560   1 90 2 X 1,228.03 X
45562   4 90 2 X 1,852.76 X
45562   3 90 2 X 1,877.63 X
45562   2 90 2 X 2,005.11 X
45562   1 90 2 X 2,066.91 X
45563   4 90 2 X 2,922.57 X
45563   3 90 2 X 2,961.82 X
45563   2 90 2 X 3,162.85 X
45563   1 90 2 X 3,260.32 X
45800   3 90 2 X 2,374.64 X
45800   4 90 2 X 2,579.20 X
45800   2 90 2 X 2,661.91 X
45800   1 90 2 X 2,736.32 X
45805   3 90 2 X 2,538.40 X
45805   2 90 2 X 2,726.61 X
45805   4 90 2 X 2,980.57 X
45805   1 90 2 X 3,151.24 X
45820   4 90 2 X 1,982.69 X
45820   2 90 2 X 2,127.22 X
45820   1 90 2 X 2,365.98 X
45820   3 90 2 X 2,540.16 X
45825   4 90 2 X 2,276.50 X
45825   3 90 2 X 2,302.69 X
45825   2 90 2 X 2,450.25 X
45825   1 90 2 X 2,486.09 X
45900   3 10 2 X 203.55 X
45900   1 10 2 X 216.96 X
45900   2 10 2 X 362.70 X
45900   4 10 2 X 433.57 X
45905   4 10 2 X 198.35 X
45905   3 10 2 X 206.84 X
45905   2 10 2 X 211.99 X
45905   1 10 2 X 214.77 X
45910   4 10 2 X 241.83 X
45910   3 10 2 X 244.52 X
45910   2 10 2 X 257.87 X
45910   1 10 2 X 261.11 X
45915   3 10 2 X 217.15 X
45915   4 10 2 X 219.72 X
45915   2 10 2 X 228.46 X
45915   1 10 2 X 230.19 X
45990   2 0 2 X 157.18 X
45990   3 0 2 X 157.18 X
45990   4 0 2 X 157.18 X
45990   1 0 2 X 174.19 X
45999     YYY 2 X * X
46020   2 10 2 X 394.89 349.59
46020   3 10 2 X 394.89 349.59
46020   4 10 2 X 394.89 349.59
46020   1 10 2 X 444.55 391.24
46030   3 10 2 X 142.57 X
46030   2 10 2 X 231.76 X
46030   4 10 2 X 244.63 X
46030   1 10 2 X 256.85 X
46040   3 90 2 X 586.69 X
46040   4 90 2 X 590.98 X
46040   2 90 2 X 625.82 X
46040   1 90 2 X 633.67 X
46045   4 90 2 X 420.68 X
46045   3 90 2 X 438.80 X
46045   1 90 2 X 448.03 X
46045   2 90 2 X 557.02 X
46050   3 10 2 X 187.92 X
46050   2 10 2 X 229.63 X
46050   4 10 2 X 253.50 X
46050   1 10 2 X 266.94 X
46060   4 90 2 X 989.61 X
46060   3 90 2 X 994.40 X
46060   2 90 2 X 1,059.47 X
46060   1 90 2 X 1,079.24 X
46070   4 90 2 X 366.41 X
46070   3 90 2 X 370.44 X
46070   2 90 2 X 395.83 X
46070   1 90 2 X 401.99 X
46080   4 10 2 X 574.12 X
46080   3 10 2 X 604.71 X
46080   1 10 2 X 628.99 X
46080   2 10 2 X 643.87 X
46083   4 10 2 X 162.90 138.66
46083   3 10 2 X 164.71 140.11
46083   2 10 2 X 173.25 147.14
46083   1 10 2 X 175.30 148.87
46200   4 90 2 X 610.33 X
46200   3 90 2 X 616.07 X
46200   2 90 2 X 721.01 X
46200   1 90 2 X 794.97 X
46220   4 10 2 X 214.21 X
46220   3 10 2 X 215.12 X
46220   2 10 2 X 219.77 X
46220   1 10 2 X 220.90 X
46221   3 10 2 X 170.30 144.91
46221   1 10 2 X 173.36 148.17
46221   2 10 2 X 175.06 149.51
46221   4 10 2 X 177.31 151.53
46230   4 10 2 X 294.62 260.66
46230   1 10 2 X 295.86 260.86
46230   3 10 2 X 297.77 263.18
46230   2 10 2 X 311.93 275.35
46250   1 90 2 X 645.09 X
46250   4 90 2 X 645.79 X
46250   3 90 2 X 653.21 X
46250   2 90 2 X 697.14 X
46255   4 90 2 X 883.70 X
46255   3 90 2 X 894.31 X
46255   1 90 2 X 978.37 X
46255   2 90 2 X 1,029.64 X
46257   4 90 2 X 1,045.51 X
46257   3 90 2 X 1,064.47 X
46257   2 90 2 X 1,172.63 X
46257   1 90 2 X 1,227.44 X
46258   4 90 2 X 1,122.95 X
46258   3 90 2 X 1,136.19 X
46258   2 90 2 X 1,226.90 X
46258   1 90 2 X 1,248.93 X
46260   3 90 2 X 1,238.77 X
46260   4 90 2 X 1,257.83 X
46260   1 90 2 X 1,309.49 X
46260   2 90 2 X 1,412.71 X
46261   4 90 2 X 1,217.65 X
46261   3 90 2 X 1,232.16 X
46261   2 90 2 X 1,331.87 X
46261   1 90 2 X 1,356.09 X
46262   4 90 2 X 1,251.25 X
46262   3 90 2 X 1,266.06 X
46262   2 90 2 X 1,369.19 X
46262   1 90 2 X 1,394.18 X
46270   3 90 2 X 623.73 X
46270   4 90 2 X 644.58 X
46270   1 90 2 X 686.34 X
46270   2 90 2 X 698.67 X
46275   3 90 2 X 998.14 X
46275   4 90 2 X 1,001.14 X
46275   2 90 2 X 1,013.25 X
46275   1 90 2 X 1,078.56 X
46280   3 90 2 X 1,263.74 X
46280   4 90 2 X 1,303.46 X
46280   2 90 2 X 1,320.31 X
46280   1 90 2 X 1,320.61 X
46285   3 90 2 X 562.63 X
46285   2 90 2 X 599.03 X
46285   4 90 2 X 647.91 X
46285   1 90 2 X 652.39 X
46288   4 90 2 X 950.30 X
46288   3 90 2 X 960.72 X
46288   2 90 2 X 1,025.98 X
46288   1 90 2 X 1,041.87 X
46320   4 10 2 X 202.61 173.88
46320   3 10 2 X 204.88 175.64
46320   2 10 2 X 216.02 185.12
46320   1 10 2 X 241.25 206.84
46500   3 10 2 X 128.18 118.41
46500   2 10 2 X 129.03 118.52
46500   4 10 2 X 139.10 128.02
46500   1 10 2 X 142.44 131.08
46505   2 10 2 X 339.54 281.77
46505   3 10 2 X 339.54 281.77
46505   4 10 2 X 339.54 281.77
46505   1 10 2 X 383.64 312.89
46600   4 0 2 X 63.76 53.24
46600   3 0 2 X 64.19 53.50
46600   2 0 2 X 64.99 54.19
46600   1 0 2 X 65.40 54.55
46601     0 3 X * X
46604   2 0 3 X 148.09 132.82
46604   3 0 3 X 149.43 133.83
46604   4 0 3 X 154.06 138.23
46604   1 0 3 X 171.69 153.91
46606   4 0 3 X 88.22 X
46606   3 0 3 X 88.87 X
46606   2 0 3 X 92.22 X
46606   1 0 3 X 93.03 X
46607     0 3 X * X
46608   1 0 3 X 230.73 X
46608   4 0 3 X 293.93 X
46608   2 0 3 X 303.19 X
46608   3 0 3 X 304.08 X
46610   4 0 3 X 222.76 X
46610   3 0 3 X 223.78 X
46610   2 0 3 X 227.94 X
46610   1 0 3 X 231.22 X
46611   4 0 3 X 222.76 X
46611   3 0 3 X 223.78 X
46611   2 0 3 X 227.94 X
46611   1 0 3 X 231.22 X
46612   4 0 3 X 269.47 X
46612   3 0 3 X 272.70 X
46612   1 0 3 X 295.26 X
46612   2 0 3 X 311.31 X
46614   4 0 3 X 378.46 303.09
46614   2 0 3 X 401.41 321.61
46614   3 0 3 X 403.45 323.69
46614   1 0 3 X 414.79 332.49
46615   4 0 3 X 397.53 322.12
46615   2 0 3 X 421.12 341.24
46615   3 0 3 X 422.65 342.92
46615   1 0 3 X 434.60 352.28
46700   3 90 2 X 1,304.27 X
46700   2 90 2 X 1,331.76 X
46700   4 90 2 X 1,341.62 X
46700   1 90 2 X 1,349.95 X
46705   4 90 2 X 908.55 X
46705   3 90 2 X 918.72 X
46705   2 90 2 X 980.75 X
46705   1 90 2 X 995.81 X
46706   2 90 2 X 242.88 X
46706   3 90 2 X 242.88 X
46706   4 90 2 X 242.88 X
46706   1 90 2 X 268.95 X
46707   2 90 2 X 620.99 X
46707   3 90 2 X 620.99 X
46707   4 90 2 X 620.99 X
46707   1 90 2 X 693.81 X
46710   2 90 2 X 1,430.92 X
46710   3 90 2 X 1,430.92 X
46710   4 90 2 X 1,430.92 X
46710   1 90 2 X 1,586.71 X
46712   2 90 2 X 2,998.90 X
46712   3 90 2 X 2,998.90 X
46712   4 90 2 X 2,998.90 X
46712   1 90 2 X 3,337.78 X
46715   4 90 2 X 935.29 X
46715   3 90 2 X 945.55 X
46715   2 90 2 X 1,009.83 X
46715   1 90 2 X 1,025.52 X
46716   4 90 2 X 1,610.31 X
46716   3 90 2 X 1,628.02 X
46716   2 90 2 X 1,738.43 X
46716   1 90 2 X 2,684.45 X
46730   4 90 2 X 2,857.59 X
46730   3 90 2 X 2,889.01 X
46730   2 90 2 X 3,085.31 X
46730   1 90 2 X 3,133.07 X
46735   4 90 2 X 3,245.18 X
46735   3 90 2 X 3,504.67 X
46735   2 90 2 X 3,742.81 X
46735   1 90 2 X 3,800.77 X
46740   4 90 2 X 3,071.76 X
46740   3 90 2 X 3,105.46 X
46740   2 90 2 X 3,316.15 X
46740   1 90 2 X 3,367.39 X
46742   4 90 2 X 4,168.92 X
46742   3 90 2 X 4,218.75 X
46742   2 90 2 X 4,451.89 X
46742   1 90 2 X 4,508.18 X
46744   4 90 2 X 4,680.34 X
46744   3 90 2 X 4,736.30 X
46744   2 90 2 X 4,998.05 X
46744   1 90 2 X 5,061.28 X
46746   4 90 2 X 5,121.00 X
46746   3 90 2 X 5,182.21 X
46746   2 90 2 X 5,468.78 X
46746   1 90 2 X 5,537.91 X
46748   4 90 2 X 5,704.83 X
46748   3 90 2 X 5,773.08 X
46748   2 90 2 X 6,092.18 X
46748   1 90 2 X 6,169.22 X
46750   4 90 2 X 1,303.54 X
46750   3 90 2 X 1,309.50 X
46750   2 90 2 X 1,334.78 X
46750   1 90 2 X 1,357.47 X
46751   4 90 2 X 1,083.26 X
46751   3 90 2 X 1,095.20 X
46751   2 90 2 X 1,169.70 X
46751   1 90 2 X 1,187.79 X
46753   4 90 2 X 1,189.65 X
46753   3 90 2 X 1,194.58 X
46753   2 90 2 X 1,219.15 X
46753   1 90 2 X 1,234.98 X
46754   2 10 2 X 217.62 X
46754   4 10 2 X 276.86 X
46754   3 10 2 X 280.12 X
46754   1 10 2 X 307.92 X
46760   4 90 2 X 1,589.48 X
46760   3 90 2 X 1,607.44 X
46760   2 90 2 X 1,719.86 X
46760   1 90 2 X 1,747.26 X
46761   4 90 2 X 1,547.71 X
46761   3 90 2 X 1,565.40 X
46761   2 90 2 X 1,649.33 X
46761   1 90 2 X 1,701.15 X
46900   4 10 2 X 171.57 157.23
46900   3 10 2 X 171.62 157.80
46900   2 10 2 X 176.00 161.25
46900   1 10 2 X 178.48 163.73
46910   4 10 2 X 214.72 X
46910   2 10 2 X 296.34 X
46910   3 10 2 X 316.34 X
46910   1 10 2 X 325.16 X
46916   4 10 2 X 215.41 X
46916   2 10 2 X 297.24 X
46916   3 10 2 X 325.34 X
46916   1 10 2 X 346.35 X
46917   4 10 2 X 340.33 X
46917   3 10 2 X 478.76 X
46917   2 10 2 X 489.50 X
46917   1 10 2 X 492.07 X
46922   4 10 2 X 426.23 X
46922   1 10 2 X 430.34 X
46922   3 10 2 X 445.06 X
46922   2 10 2 X 450.45 X
46924   3 10 2 X 607.53 X
46924   4 10 2 X 613.59 X
46924   2 10 2 X 629.77 X
46924   1 10 2 X 656.91 X
46930   2 90 2 X 263.77 193.14
46930   3 90 2 X 263.77 193.14
46930   4 90 2 X 263.77 193.14
46930   1 90 2 X 301.70 217.90
46940   2 10 2 X 207.79 X
46940   3 10 2 X 209.98 X
46940   1 10 2 X 222.98 X
46940   4 10 2 X 246.63 X
46942   2 10 2 X 187.77 X
46942   4 10 2 X 217.11 X
46942   3 10 2 X 219.36 X
46942   1 10 2 X 231.44 X
46945   4 90 2 X 251.03 231.23
46945   1 90 2 X 255.90 234.22
46945   2 90 2 X 259.00 238.38
46945   3 90 2 X 260.12 239.61
46946   3 90 2 X 349.57 X
46946   4 90 2 X 437.60 X
46946   2 90 2 X 461.98 X
46946   1 90 2 X 466.85 X
46947   2 90 2 X 535.86 X
46947   3 90 2 X 535.86 X
46947   4 90 2 X 535.86 X
46947   1 90 2 X 602.57 X
46948   2 90 2 X 499.41 X
46948   3 90 2 X 499.41 X
46948   4 90 2 X 499.41 X
46948   1 90 2 X 555.67 X
46999     YYY 2 X * X
47000   4 0 2 X 270.37 X
47000   3 0 2 X 273.64 X
47000   2 0 2 X 288.65 X
47000   1 0 2 X 292.32 X
47001   4 ZZZ 0 X 291.56 X
47001   3 ZZZ 0 X 292.37 X
47001   1 ZZZ 0 X 312.33 X
47001   2 ZZZ 0 X 336.11 X
47010   2 90 2 X 1,308.35 X
47010   3 90 2 X 1,308.35 X
47010   4 90 2 X 1,308.35 X
47010   1 90 2 X 1,473.92 X
47015   4 90 2 X 1,665.43 X
47015   3 90 2 X 1,672.33 X
47015   2 90 2 X 1,712.95 X
47015   1 90 2 X 1,717.46 X
47100   3 90 2 X 974.82 X
47100   1 90 2 X 988.46 X
47100   2 90 2 X 1,035.55 X
47100   4 90 2 X 1,064.80 X
47120   2 90 2 X 3,144.31 X
47120   1 90 2 X 3,193.05 X
47120   4 90 2 X 3,201.43 X
47120   3 90 2 X 3,214.96 X
47122   4 90 2 X 4,540.77 X
47122   3 90 2 X 4,591.30 X
47122   2 90 2 X 4,890.08 X
47122   1 90 2 X 4,962.74 X
47125   3 90 2 X 4,462.17 X
47125   4 90 2 X 4,751.12 X
47125   2 90 2 X 4,894.51 X
47125   1 90 2 X 4,924.48 X
47130   4 90 2 X 4,613.52 X
47130   3 90 2 X 4,852.55 X
47130   2 90 2 X 4,878.75 X
47130   1 90 2 X 5,103.12 X