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2018 Workers' Compensation Part B Fee Schedule

49424-50551

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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
49424   1 0 2 0 107.85 0
49424   2 0 2 0 95.98 0
49424   3 0 2 0 95.98 0
49424   4 0 2 0 95.98 0
49425   1 90 2 0 2,027.84 0
49425   2 90 2 0 2,012.21 0
49425   3 90 2 0 1,961.36 0
49425   4 90 2 0 1,953.42 0
49426   1 90 2 0 1,567.72 0
49426   2 90 2 0 1,559.31 0
49426   3 90 2 0 1,524.59 0
49426   4 90 2 0 1,518.85 0
49427   1 0 2 0 161.77 0
49427   2 0 2 0 161.27 0
49427   3 0 2 0 159.21 0
49427   4 0 2 0 105.93 0
49428   1 10 2 0 306.75 0
49428   2 10 2 0 297.95 0
49428   3 10 2 0 280.22 0
49428   4 10 2 0 276.62 0
49429   1 10 2 0 982.40 0
49429   2 10 2 0 954.14 0
49429   3 10 2 0 897.31 0
49429   4 10 2 0 885.95 0
49435   1 ZZZ 0 0 165.70 0
49435   2 ZZZ 0 0 148.05 0
49435   3 ZZZ 0 0 148.05 0
49435   4 ZZZ 0 0 148.05 0
49436   1 10 2 0 248.35 0
49436   2 10 2 0 219.10 0
49436   3 10 2 0 219.10 0
49436   4 10 2 0 219.10 0
49440   1 10 2 0 1,753.29 353.25
49440   2 10 2 0 1,477.80 316.60
49440   3 10 2 0 1,477.80 316.60
49440   4 10 2 0 1,477.80 316.60
49441   1 10 2 0 2,071.18 377.86
49441   2 10 2 0 1,749.19 344.77
49441   3 10 2 0 1,749.19 344.77
49441   4 10 2 0 1,749.19 344.77
49442   1 10 2 0 1,687.90 313.15
49442   2 10 2 0 1,426.29 286.05
49442   3 10 2 0 1,426.29 286.05
49442   4 10 2 0 1,426.29 286.05
49446   1 0 2 0 1,728.64 245.47
49446   2 0 2 0 1,455.79 225.67
49446   3 0 2 0 1,455.79 225.67
49446   4 0 2 0 1,455.79 225.67
49450   1 0 2 0 1,215.46 99.64
49450   2 0 2 0 1,017.14 91.65
49450   3 0 2 0 1,017.14 91.65
49450   4 0 2 0 1,017.14 91.65
49451   1 0 2 0 1,285.79 137.44
49451   2 0 2 0 1,078.57 126.13
49451   3 0 2 0 1,078.57 126.13
49451   4 0 2 0 1,078.57 126.13
49452   1 0 2 0 1,570.27 214.82
49452   2 0 2 0 1,321.12 196.88
49452   3 0 2 0 1,321.12 196.88
49452   4 0 2 0 1,321.12 196.88
49460   1 0 2 0 1,291.15 69.93
49460   2 0 2 0 1,077.36 64.48
49460   3 0 2 0 1,077.36 64.48
49460   4 0 2 0 1,077.36 64.48
49465   1 0 2 0 267.23 46.21
49465   2 0 2 0 225.90 42.59
49465   3 0 2 0 225.90 42.59
49465   4 0 2 0 225.90 42.59
49491   1 90 2 0 1,201.98 0
49491   2 90 2 0 1,079.11 0
49491   3 90 2 0 1,079.11 0
49491   4 90 2 0 1,079.11 0
49492   1 90 2 0 1,479.42 0
49492   2 90 2 0 1,325.60 0
49492   3 90 2 0 1,325.60 0
49492   4 90 2 0 1,325.60 0
49495   1 90 2 0 1,133.27 0
49495   2 90 2 0 1,107.43 0
49495   3 90 2 0 1,047.04 0
49495   4 90 2 0 1,043.81 0
49496   1 90 2 0 1,274.19 0
49496   2 90 2 0 1,254.46 0
49496   3 90 2 0 1,173.28 0
49496   4 90 2 0 1,160.27 0
49500   1 90 2 0 1,094.94 0
49500   2 90 2 0 1,069.30 0
49500   3 90 2 0 1,009.79 0
49500   4 90 2 0 1,006.96 0
49501   1 90 2 0 1,180.48 0
49501   2 90 2 0 1,161.27 0
49501   3 90 2 0 1,082.35 0
49501   4 90 2 0 1,070.20 0
49505   1 90 2 0 1,025.62 0
49505   2 90 2 0 1,009.52 0
49505   3 90 2 0 945.61 0
49505   4 90 2 0 937.07 0
49507   1 90 2 0 1,192.19 0
49507   2 90 2 0 1,172.89 0
49507   3 90 2 0 1,093.73 0
49507   4 90 2 0 1,081.41 0
49520   1 90 2 0 1,251.25 0
49520   2 90 2 0 1,231.29 0
49520   3 90 2 0 1,119.64 0
49520   4 90 2 0 1,114.18 0
49521   1 90 2 0 1,363.73 0
49521   2 90 2 0 1,343.42 0
49521   3 90 2 0 1,260.16 0
49521   4 90 2 0 1,246.33 0
49525   1 90 2 0 1,222.39 0
49525   2 90 2 0 1,211.46 0
49525   3 90 2 0 1,116.50 0
49525   4 90 2 0 1,074.17 0
49540   1 90 2 0 1,254.19 0
49540   2 90 2 0 1,234.14 0
49540   3 90 2 0 1,151.67 0
49540   4 90 2 0 1,138.79 0
49550   1 90 2 0 1,084.74 0
49550   2 90 2 0 1,066.48 0
49550   3 90 2 0 993.52 0
49550   4 90 2 0 995.41 0
49553   1 90 2 0 1,096.61 0
49553   2 90 2 0 1,078.26 0
49553   3 90 2 0 1,005.04 0
49553   4 90 2 0 1,006.86 0
49555   1 90 2 0 1,358.03 0
49555   2 90 2 0 1,333.75 0
49555   3 90 2 0 1,252.60 0
49555   4 90 2 0 1,251.01 0
49557   1 90 2 0 1,398.36 0
49557   2 90 2 0 1,373.82 0
49557   3 90 2 0 1,291.67 0
49557   4 90 2 0 1,289.72 0
49560   1 90 2 0 1,283.93 0
49560   2 90 2 0 1,138.77 0
49560   3 90 2 0 1,138.77 0
49560   4 90 2 0 1,138.77 0
49561   1 90 2 0 1,594.52 0
49561   2 90 2 0 1,571.59 0
49561   3 90 2 0 1,477.45 0
49561   4 90 2 0 1,299.44 0
49565   1 90 2 0 1,361.95 0
49565   2 90 2 0 1,200.55 0
49565   3 90 2 0 1,200.55 0
49565   4 90 2 0 1,200.55 0
49566   1 90 2 0 1,680.69 0
49566   2 90 2 0 1,655.40 0
49566   3 90 2 0 1,406.97 0
49566   4 90 2 0 1,394.25 0
49568   1 ZZZ 0 0 616.02 0
49568   2 ZZZ 0 0 547.05 0
49568   3 ZZZ 0 0 547.05 0
49568   4 ZZZ 0 0 547.05 0
49570   1 90 2 0 1,023.71 0
49570   2 90 2 0 1,008.29 0
49570   3 90 2 0 947.02 0
49570   4 90 2 0 925.08 0
49572   1 90 2 0 1,226.25 0
49572   2 90 2 0 1,191.43 0
49572   3 90 2 0 1,134.79 0
49572   4 90 2 0 1,132.31 0
49580   1 90 2 0 923.11 0
49580   2 90 2 0 1,008.37 0
49580   3 90 2 0 952.30 0
49580   4 90 2 0 944.59 0
49582   1 90 2 0 985.56 0
49582   2 90 2 0 1,070.35 0
49582   3 90 2 0 1,012.49 0
49582   4 90 2 0 1,004.17 0
49585   1 90 2 0 960.20 0
49585   2 90 2 0 944.08 0
49585   3 90 2 0 876.58 0
49585   4 90 2 0 869.08 0
49587   1 90 2 0 987.82 0
49587   2 90 2 0 971.52 0
49587   3 90 2 0 903.33 0
49587   4 90 2 0 895.67 0
49590   1 90 2 0 1,316.80 0
49590   2 90 2 0 1,299.01 0
49590   3 90 2 0 1,222.40 0
49590   4 90 2 0 1,213.07 0
49600   1 90 2 0 1,347.45 0
49600   2 90 2 0 1,329.82 0
49600   3 90 2 0 1,256.96 0
49600   4 90 2 0 1,242.83 0
49605   1 90 2 0 2,808.86 0
49605   2 90 2 0 2,772.05 0
49605   3 90 2 0 2,621.03 0
49605   4 90 2 0 2,593.08 0
49606   1 90 2 0 2,343.96 0
49606   2 90 2 0 2,317.11 0
49606   3 90 2 0 2,206.04 0
49606   4 90 2 0 2,181.44 0
49610   1 90 2 0 1,459.16 0
49610   2 90 2 0 1,436.48 0
49610   3 90 2 0 1,343.21 0
49610   4 90 2 0 1,328.50 0
49611   1 90 2 0 1,534.79 0
49611   2 90 2 0 1,515.44 0
49611   3 90 2 0 1,434.76 0
49611   4 90 2 0 1,416.52 0
49650   1 90 2 0 808.64 0
49650   2 90 2 0 723.72 0
49650   3 90 2 0 723.72 0
49650   4 90 2 0 723.72 0
49651   1 90 2 0 1,036.31 0
49651   2 90 2 0 928.46 0
49651   3 90 2 0 928.46 0
49651   4 90 2 0 928.46 0
49652   1 90 2 0 1,079.52 0
49652   2 90 2 0 978.73 0
49652   3 90 2 0 978.73 0
49652   4 90 2 0 978.73 0
49653   1 90 2 0 1,345.39 0
49653   2 90 2 0 1,221.60 0
49653   3 90 2 0 1,221.60 0
49653   4 90 2 0 1,221.60 0
49654   1 90 2 0 1,236.30 0
49654   2 90 2 0 1,123.64 0
49654   3 90 2 0 1,123.64 0
49654   4 90 2 0 1,123.64 0
49655   1 90 2 0 1,488.85 0
49655   2 90 2 0 1,352.94 0
49655   3 90 2 0 1,352.94 0
49655   4 90 2 0 1,352.94 0
49656   1 90 2 0 1,241.81 0
49656   2 90 2 0 1,128.22 0
49656   3 90 2 0 1,128.22 0
49656   4 90 2 0 1,128.22 0
49657   1 90 2 0 1,792.75 0
49657   2 90 2 0 1,630.62 0
49657   3 90 2 0 1,630.62 0
49657   4 90 2 0 1,630.62 0
49659     YYY 2 0 * 0
49900   1 90 2 0 851.95 0
49900   2 90 2 0 846.31 0
49900   3 90 2 0 723.02 0
49900   4 90 2 0 752.42 0
49904   1 90 2 0 2,563.58 0
49904   2 90 2 0 2,279.16 0
49904   3 90 2 0 2,279.16 0
49904   4 90 2 0 2,279.16 0
49905   1 ZZZ 0 0 947.13 0
49905   2 ZZZ 0 0 932.68 0
49905   3 ZZZ 0 0 873.20 0
49905   4 ZZZ 0 0 863.75 0
49906     90 2 0 * 0
49999     YYY 2 0 * 0
50010   1 90 2 0 1,806.04 0
50010   2 90 2 0 2,014.57 0
50010   3 90 2 0 1,969.43 0
50010   4 90 2 0 1,960.90 0
50020   1 90 2 0 1,686.78 0
50020   2 90 2 0 1,530.71 0
50020   3 90 2 0 1,530.71 0
50020   4 90 2 0 1,530.71 0
50040   1 90 2 0 1,495.49 0
50040   2 90 2 0 1,563.69 0
50040   3 90 2 0 1,637.91 0
50040   4 90 2 0 1,774.53 0
50045   1 90 2 0 2,170.28 0
50045   2 90 2 0 2,144.03 0
50045   3 90 2 0 2,035.47 0
50045   4 90 2 0 2,011.50 0
50060   1 90 2 0 2,715.76 0
50060   2 90 2 0 2,682.14 0
50060   3 90 2 0 2,554.10 0
50060   4 90 2 0 2,513.31 0
50065   1 90 2 0 3,013.58 0
50065   2 90 2 0 2,975.98 0
50065   3 90 2 0 2,820.30 0
50065   4 90 2 0 2,787.00 0
50070   1 90 2 0 2,883.91 0
50070   2 90 2 0 2,847.67 0
50070   3 90 2 0 2,697.92 0
50070   4 90 2 0 2,666.35 0
50075   1 90 2 0 3,339.07 0
50075   2 90 2 0 3,449.69 0
50075   3 90 2 0 3,068.10 0
50075   4 90 2 0 3,397.86 0
50080   1 90 2 0 2,364.13 0
50080   2 90 2 0 2,333.25 0
50080   3 90 2 0 2,204.74 0
50080   4 90 2 0 2,177.90 0
50081   1 90 2 0 2,649.04 0
50081   2 90 2 0 3,178.18 0
50081   3 90 2 0 2,809.60 0
50081   4 90 2 0 2,925.87 0
50100   1 90 2 0 2,336.42 0
50100   2 90 2 0 2,296.54 0
50100   3 90 2 0 2,166.96 0
50100   4 90 2 0 2,141.80 0
50120   1 90 2 0 2,352.26 0
50120   2 90 2 0 2,321.39 0
50120   3 90 2 0 2,193.57 0
50120   4 90 2 0 2,167.71 0
50125   1 90 2 0 2,383.55 0
50125   2 90 2 0 2,354.05 0
50125   3 90 2 0 2,231.52 0
50125   4 90 2 0 2,205.23 0
50130   1 90 2 0 2,609.22 0
50130   2 90 2 0 2,572.69 0
50130   3 90 2 0 2,435.85 0
50130   4 90 2 0 2,406.65 0
50135   1 90 2 0 3,188.32 0
50135   2 90 2 0 3,145.52 0
50135   3 90 2 0 2,967.70 0
50135   4 90 2 0 2,931.36 0
50200   1 0 2 0 503.64 0
50200   2 0 2 0 478.07 0
50200   3 0 2 0 472.28 0
50200   4 0 2 0 473.21 0
50205   1 90 2 0 1,532.61 0
50205   2 90 2 0 1,452.48 0
50205   3 90 2 0 1,433.13 0
50205   4 90 2 0 1,426.32 0
50220   1 90 2 0 2,664.04 0
50220   2 90 2 0 2,628.19 0
50220   3 90 2 0 2,479.70 0
50220   4 90 2 0 2,449.93 0
50225   1 90 2 0 3,215.51 0
50225   2 90 2 0 3,190.61 0
50225   3 90 2 0 2,996.23 0
50225   4 90 2 0 2,960.01 0
50230   1 90 2 0 3,534.01 0
50230   2 90 2 0 3,537.08 0
50230   3 90 2 0 3,454.51 0
50230   4 90 2 0 3,437.70 0
50234   1 90 2 0 3,408.46 0
50234   2 90 2 0 3,364.37 0
50234   3 90 2 0 3,181.76 0
50234   4 90 2 0 3,143.69 0
50236   1 90 2 0 3,625.56 0
50236   2 90 2 0 3,599.86 0
50236   3 90 2 0 3,468.71 0
50236   4 90 2 0 3,424.30 0
50240   1 90 2 0 3,286.85 0
50240   2 90 2 0 3,250.63 0
50240   3 90 2 0 3,063.71 0
50240   4 90 2 0 3,027.12 0
50250   1 90 2 0 1,819.60 0
50250   2 90 2 0 1,651.94 0
50250   3 90 2 0 1,651.94 0
50250   4 90 2 0 1,651.94 0
50280   1 90 2 0 2,306.06 0
50280   2 90 2 0 2,276.15 0
50280   3 90 2 0 2,152.30 0
50280   4 90 2 0 2,160.01 0
50290   1 90 2 0 2,062.22 0
50290   2 90 2 0 2,076.80 0
50290   3 90 2 0 1,920.81 0
50290   4 90 2 0 1,898.72 0
50320     90 2 0 * 0
50323     XXX 2 0 * 0
50325     XXX 2 0 * 0
50327   1 XXX 2 0 365.64 0
50327   2 XXX 2 0 335.36 0
50327   3 XXX 2 0 335.36 0
50327   4 XXX 2 0 335.36 0
50328   1 XXX 2 0 320.38 0
50328   2 XXX 2 0 293.70 0
50328   3 XXX 2 0 293.70 0
50328   4 XXX 2 0 293.70 0
50329   1 XXX 2 0 306.18 0
50329   2 XXX 2 0 280.57 0
50329   3 XXX 2 0 280.57 0
50329   4 XXX 2 0 280.57 0
50340   1 90 2 0 2,395.09 0
50340   2 90 2 0 2,320.92 0
50340   3 90 2 0 2,194.64 0
50340   4 90 2 0 2,024.97 0
50360   1 90 2 0 4,906.18 0
50360   2 90 2 0 4,826.42 0
50360   3 90 2 0 4,497.39 0
50360   4 90 2 0 4,444.41 0
50365   1 90 2 0 6,094.79 0
50365   2 90 2 0 5,768.16 0
50365   3 90 2 0 5,765.47 0
50365   4 90 2 0 5,346.85 0
50370   1 90 2 0 2,258.93 0
50370   2 90 2 0 2,244.02 0
50370   3 90 2 0 2,182.47 0
50370   4 90 2 0 2,172.80 0
50380   1 90 2 0 3,211.24 0
50380   2 90 2 0 2,437.08 0
50380   3 90 2 0 2,291.98 0
50380   4 90 2 0 2,266.12 0
50382   1 0 2 0 2,589.89 456.93
50382   2 0 2 0 2,162.34 419.64
50382   3 0 2 0 2,162.34 419.64
50382   4 0 2 0 2,162.34 419.64
50384   1 0 2 0 2,503.09 416.07
50384   2 0 2 0 2,087.17 382.04
50384   3 0 2 0 2,087.17 382.04
50384   4 0 2 0 2,087.17 382.04
50385   1 0 2 0 2,084.13 362.52
50385   2 0 2 0 1,757.79 329.86
50385   3 0 2 0 1,757.79 329.86
50385   4 0 2 0 1,757.79 329.86
50386   1 0 2 0 1,344.86 274.81
50386   2 0 2 0 1,137.20 249.67
50386   3 0 2 0 1,137.20 249.67
50386   4 0 2 0 1,137.20 249.67
50387   1 0 2 0 1,257.51 165.26
50387   2 0 2 0 1,044.34 151.93
50387   3 0 2 0 1,044.34 151.93
50387   4 0 2 0 1,044.34 151.93
50389   1 0 2 0 861.92 91.30
50389   2 0 2 0 713.42 83.82
50389   3 0 2 0 713.42 83.82
50389   4 0 2 0 713.42 83.82
50390   1 0 2 0 408.78 0
50390   2 0 2 0 404.24 0
50390   3 0 2 0 421.02 0
50390   4 0 2 0 407.09 0
50391   1 0 2 0 240.81 176.85
50391   2 0 2 0 215.80 162.49
50391   3 0 2 0 215.80 162.49
50391   4 0 2 0 215.80 162.49
50395   1 0 2 0 889.62 0
50395   2 0 2 0 843.64 0
50395   3 0 2 0 837.13 0
50395   4 0 2 0 826.93 0
50396   1 0 2 0 211.16 0
50396   2 0 2 0 209.24 0
50396   3 0 2 0 201.37 0
50396   4 0 2 0 199.28 0
50400   1 90 2 0 2,860.92 0
50400   2 90 2 0 2,909.60 0
50400   3 90 2 0 2,672.58 0
50400   4 90 2 0 2,740.28 0
50405   1 90 2 0 3,684.66 0
50405   2 90 2 0 3,666.07 0
50405   3 90 2 0 3,577.57 0
50405   4 90 2 0 3,309.44 0
50430   1 0 2 0 676.01 216.26
50430   2 0 2 0 593.65 200.74
50430   3 0 2 0 593.65 200.74
50430   4 0 2 0 593.65 200.74
50431   1 0 2 0 210.05 86.13
50431   2 0 2 0 185.05 79.15
50431   3 0 2 0 185.05 79.15
50431   4 0 2 0 185.05 79.15
50432   1 0 2 0 1,097.91 285.73
50432   2 0 2 0 959.81 265.68
50432   3 0 2 0 959.81 265.68
50432   4 0 2 0 959.81 265.68
50433   1 0 2 0 1,478.54 352.19
50433   2 0 2 0 1,290.39 327.76
50433   3 0 2 0 1,290.39 327.76
50433   4 0 2 0 1,290.39 327.76
50434   1 0 2 0 1,170.39 270.23
50434   2 0 2 0 1,020.45 251.12
50434   3 0 2 0 1,020.45 251.12
50434   4 0 2 0 1,020.45 251.12
50435   1 0 2 0 614.81 131.56
50435   2 0 2 0 534.64 121.62
50435   3 0 2 0 534.64 121.62
50435   4 0 2 0 534.64 121.62
50500   1 90 2 0 2,812.28 0
50500   2 90 2 0 2,774.25 0
50500   3 90 2 0 2,617.27 0
50500   4 90 2 0 2,586.94 0
50520   1 90 2 0 2,417.83 0
50520   2 90 2 0 2,384.58 0
50520   3 90 2 0 2,247.36 0
50520   4 90 2 0 2,221.59 0
50525   1 90 2 0 3,066.25 0
50525   2 90 2 0 3,023.68 0
50525   3 90 2 0 2,848.24 0
50525   4 90 2 0 2,815.99 0
50526   1 90 2 0 2,800.20 0
50526   2 90 2 0 2,759.40 0
50526   3 90 2 0 2,592.48 0
50526   4 90 2 0 2,565.98 0
50540   1 90 2 0 2,954.30 0
50540   2 90 2 0 2,915.72 0
50540   3 90 2 0 2,756.29 0
50540   4 90 2 0 2,723.98 0
50541   1 90 2 0 1,716.24 0
50541   2 90 2 0 1,565.13 0
50541   3 90 2 0 1,565.13 0
50541   4 90 2 0 1,565.13 0
50542   1 90 2 0 1,987.84 0
50542   2 90 2 0 1,804.24 0
50542   3 90 2 0 1,804.24 0
50542   4 90 2 0 1,804.24 0
50543   1 90 2 0 2,490.57 0
50543   2 90 2 0 2,273.14 0
50543   3 90 2 0 2,273.14 0
50543   4 90 2 0 2,273.14 0
50544   1 90 2 0 2,362.50 0
50544   2 90 2 0 2,158.95 0
50544   3 90 2 0 2,158.95 0
50544   4 90 2 0 2,158.95 0
50545   1 90 2 0 2,559.60 0
50545   2 90 2 0 2,324.37 0
50545   3 90 2 0 2,324.37 0
50545   4 90 2 0 2,324.37 0
50546   1 90 2 0 2,194.80 0
50546   2 90 2 0 1,999.07 0
50546   3 90 2 0 1,999.07 0
50546   4 90 2 0 1,999.07 0
50547   1 90 2 0 2,824.29 0
50547   2 90 2 0 2,561.20 0
50547   3 90 2 0 2,561.20 0
50547   4 90 2 0 2,561.20 0
50548   1 90 2 0 2,572.38 0
50548   2 90 2 0 2,349.77 0
50548   3 90 2 0 2,349.77 0
50548   4 90 2 0 2,349.77 0
50549     YYY 2 0 * 0
50551   1 0 2 0 685.38 0
50551   2 0 2 0 728.23 0
50551   3 0 2 0 694.86 0
50551   4 0 2 0 712.92 0