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Health Care Services Review
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Medical Fee Review
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Fee Schedule
>
Fee Schedule 57513-59100
Begin Main Content Area
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Content Editor
2024 Workers' Compensation Part B Fee Schedule
57513-59100
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
57513
001
10
2
X
530.49
X
57513
004
10
2
X
496.39
X
57513
002
10
2
X
508.57
X
57513
003
10
2
X
471.04
X
57520
001
90
2
X
1,052.91
X
57520
004
90
2
X
794.57
X
57520
003
90
2
X
802.13
X
57520
002
90
2
X
1,059.74
X
57522
001
90
2
X
1,052.91
X
57522
003
90
2
X
802.13
X
57522
002
90
2
X
1,059.74
X
57522
004
90
2
X
794.57
X
57530
003
90
2
X
920.28
X
57530
002
90
2
X
1,123.16
X
57530
004
90
2
X
1,017.94
X
57530
001
90
2
X
1,009.16
X
57531
001
90
2
X
4,404.39
X
57531
004
90
2
X
3,835.55
X
57531
002
90
2
X
3,835.55
X
57531
003
90
2
X
3,835.55
X
57540
004
90
2
X
1,468.19
X
57540
001
90
2
X
1,728.68
X
57540
003
90
2
X
1,485.69
X
57540
002
90
2
X
1,616.02
X
57545
004
90
2
X
1,265.12
X
57545
001
90
2
X
1,397.80
X
57545
003
90
2
X
1,651.55
X
57545
002
90
2
X
1,977.25
X
57550
001
90
2
X
1,533.68
X
57550
004
90
2
X
1,356.79
X
57550
003
90
2
X
1,555.80
X
57550
002
90
2
X
1,574.32
X
57555
001
90
2
X
2,357.26
X
57555
004
90
2
X
2,098.20
X
57555
002
90
2
X
2,311.69
X
57555
003
90
2
X
2,123.53
X
57556
003
90
2
X
1,869.63
X
57556
002
90
2
X
1,985.02
X
57556
004
90
2
X
1,945.21
X
57556
001
90
2
X
2,180.60
X
57558
004
10
2
X
205.23
185.22
57558
001
10
2
X
235.78
211.27
57558
002
10
2
X
205.23
185.22
57558
003
10
2
X
205.23
185.22
57700
001
90
2
X
679.39
X
57700
004
90
2
X
622.95
X
57700
002
90
2
X
855.78
X
57700
003
90
2
X
630.29
X
57720
001
90
2
X
809.21
X
57720
002
90
2
X
840.38
X
57720
003
90
2
X
745.31
X
57720
004
90
2
X
736.82
X
57800
001
0
2
X
153.88
X
57800
003
0
2
X
146.53
X
57800
002
0
2
X
153.80
X
57800
004
0
2
X
140.22
X
58100
002
0
2
X
227.50
179.39
58100
003
0
2
X
185.72
145.61
58100
001
0
2
X
260.00
205.32
58100
004
0
2
X
228.10
179.50
58110
002
ZZZ
0
X
97.35
81.61
58110
003
ZZZ
0
X
97.35
81.61
58110
004
ZZZ
0
X
97.35
81.61
58110
001
ZZZ
0
X
110.09
90.86
58120
003
10
2
X
630.65
X
58120
002
10
2
X
684.01
X
58120
004
10
2
X
615.99
X
58120
001
10
2
X
702.37
X
58140
003
90
2
X
1,838.00
X
58140
002
90
2
X
1,991.79
X
58140
004
90
2
X
1,816.28
X
58140
001
90
2
X
2,029.05
X
58145
002
90
2
X
1,927.27
X
58145
003
90
2
X
1,784.88
X
58145
004
90
2
X
1,763.43
X
58145
001
90
2
X
1,964.13
X
58146
003
90
2
X
2,319.54
X
58146
002
90
2
X
2,319.54
X
58146
004
90
2
X
2,319.54
X
58146
001
90
2
X
2,570.09
X
58150
003
90
2
X
2,576.03
X
58150
002
90
2
X
2,769.22
X
58150
004
90
2
X
2,546.91
X
58150
001
90
2
X
2,816.11
X
58152
002
90
2
X
2,605.98
X
58152
004
90
2
X
2,605.98
X
58152
001
90
2
X
2,989.28
X
58152
003
90
2
X
2,605.98
X
58180
001
90
2
X
2,830.68
X
58180
004
90
2
X
2,723.10
X
58180
003
90
2
X
2,733.90
X
58180
002
90
2
X
2,811.76
X
58200
002
90
2
X
3,961.35
X
58200
003
90
2
X
3,497.51
X
58200
004
90
2
X
3,730.62
X
58200
001
90
2
X
4,160.66
X
58210
001
90
2
X
5,213.23
X
58210
003
90
2
X
4,767.27
X
58210
002
90
2
X
5,126.07
X
58210
004
90
2
X
4,713.27
X
58240
002
90
2
X
7,187.76
X
58240
003
90
2
X
6,882.45
X
58240
001
90
2
X
7,320.99
X
58240
004
90
2
X
6,560.94
X
58260
004
90
2
X
2,358.58
X
58260
002
90
2
X
2,573.21
X
58260
003
90
2
X
2,385.78
X
58260
001
90
2
X
2,618.67
X
58262
003
90
2
X
2,563.22
X
58262
002
90
2
X
2,754.90
X
58262
001
90
2
X
2,801.46
X
58262
004
90
2
X
2,534.31
X
58263
001
90
2
X
3,059.96
X
58263
002
90
2
X
3,009.51
X
58263
003
90
2
X
2,801.77
X
58263
004
90
2
X
2,770.12
X
58267
004
90
2
X
2,883.95
X
58267
001
90
2
X
3,198.74
X
58267
003
90
2
X
2,917.44
X
58267
002
90
2
X
3,143.86
X
58270
001
90
2
X
2,877.18
X
58270
004
90
2
X
2,594.35
X
58270
002
90
2
X
2,827.83
X
58270
003
90
2
X
2,624.40
X
58275
002
90
2
X
3,072.14
X
58275
003
90
2
X
2,978.59
X
58275
004
90
2
X
2,996.38
X
58275
001
90
2
X
3,124.70
X
58280
004
90
2
X
2,806.74
X
58280
001
90
2
X
3,104.08
X
58280
003
90
2
X
2,838.82
X
58280
002
90
2
X
3,052.19
X
58285
002
90
2
X
3,568.78
X
58285
003
90
2
X
3,321.29
X
58285
004
90
2
X
3,284.34
X
58285
001
90
2
X
3,628.97
X
58290
001
90
2
X
2,563.19
X
58290
004
90
2
X
2,321.68
X
58290
003
90
2
X
2,321.68
X
58290
002
90
2
X
2,321.68
X
58291
002
90
2
X
2,551.68
X
58291
003
90
2
X
2,551.68
X
58291
004
90
2
X
2,551.68
X
58291
001
90
2
X
2,820.99
X
58292
001
90
2
X
2,989.12
X
58292
004
90
2
X
2,702.71
X
58292
003
90
2
X
2,702.71
X
58292
002
90
2
X
2,702.71
X
58294
001
90
2
X
2,751.27
X
58294
004
90
2
X
2,489.20
X
58294
002
90
2
X
2,489.20
X
58294
003
90
2
X
2,489.20
X
58301
0
2
X
*
X
58321
0
2
X
*
X
58322
0
2
X
*
X
58323
0
2
X
*
X
58340
003
0
2
X
135.43
X
58340
001
0
2
X
151.74
X
58340
004
0
2
X
135.43
X
58340
002
0
2
X
135.43
X
58345
004
10
2
X
877.68
X
58345
002
10
2
X
941.02
X
58345
001
10
2
X
953.83
X
58345
003
10
2
X
888.13
X
58346
001
90
2
X
987.89
X
58346
003
90
2
X
882.23
X
58346
002
90
2
X
882.23
X
58346
004
90
2
X
882.23
X
58350
004
10
2
X
187.08
X
58350
003
10
2
X
189.24
X
58350
002
10
2
X
203.65
X
58350
001
10
2
X
207.21
X
58353
001
10
2
X
555.83
X
58353
004
10
2
X
504.09
X
58353
002
10
2
X
504.09
X
58353
003
10
2
X
504.09
X
58356
001
10
2
X
1,199.46
834.84
58356
004
10
2
X
1,053.02
748.86
58356
003
10
2
X
1,053.02
748.86
58356
002
10
2
X
1,053.02
748.86
58400
004
90
2
X
1,282.91
X
58400
002
90
2
X
1,601.88
X
58400
003
90
2
X
1,298.15
X
58400
001
90
2
X
1,429.02
X
58410
004
90
2
X
1,356.87
X
58410
002
90
2
X
1,465.14
X
58410
003
90
2
X
1,372.98
X
58410
001
90
2
X
1,487.49
X
58520
003
90
2
X
1,211.56
X
58520
001
90
2
X
1,324.03
X
58520
002
90
2
X
1,849.69
X
58520
004
90
2
X
1,198.11
X
58540
001
90
2
X
1,847.97
X
58540
003
90
2
X
1,687.61
X
58540
002
90
2
X
1,816.62
X
58540
004
90
2
X
1,668.78
X
58541
004
90
3
X
1,374.53
X
58541
001
90
3
X
1,548.35
X
58541
003
90
3
X
1,374.53
X
58541
002
90
3
X
1,374.53
X
58542
004
90
2
X
1,522.82
X
58542
002
90
2
X
1,522.82
X
58542
003
90
2
X
1,522.82
X
58542
001
90
2
X
1,707.09
X
58543
001
90
2
X
1,735.87
X
58543
004
90
2
X
1,548.58
X
58543
002
90
2
X
1,548.58
X
58543
003
90
2
X
1,548.58
X
58544
002
90
2
X
1,676.82
X
58544
003
90
2
X
1,676.82
X
58544
004
90
2
X
1,676.82
X
58544
001
90
2
X
1,878.66
X
58545
002
90
2
X
1,858.38
X
58545
003
90
2
X
1,858.38
X
58545
004
90
2
X
1,858.38
X
58545
001
90
2
X
2,077.74
X
58546
002
90
2
X
2,349.20
X
58546
003
90
2
X
2,349.20
X
58546
001
90
2
X
2,604.63
X
58546
004
90
2
X
2,349.20
X
58548
004
90
2
X
2,929.90
X
58548
001
90
2
X
3,293.78
X
58548
003
90
2
X
2,929.90
X
58548
002
90
2
X
2,929.90
X
58550
001
90
3
X
2,233.08
X
58550
004
90
3
X
2,014.34
X
58550
003
90
3
X
2,014.34
X
58550
002
90
3
X
2,014.34
X
58552
001
90
2
X
2,024.55
X
58552
003
90
2
X
1,809.53
X
58552
002
90
2
X
1,809.53
X
58552
004
90
2
X
1,809.53
X
58553
002
90
2
X
2,336.81
X
58553
003
90
2
X
2,336.81
X
58553
004
90
2
X
2,336.81
X
58553
001
90
2
X
2,581.02
X
58554
003
90
2
X
2,313.33
X
58554
002
90
2
X
2,313.33
X
58554
001
90
2
X
2,553.42
X
58554
004
90
2
X
2,313.33
X
58555
001
0
2
X
562.53
501.96
58555
004
0
2
X
505.63
453.88
58555
002
0
2
X
505.63
453.88
58555
003
0
2
X
505.63
453.88
58558
003
0
3
X
660.71
608.88
58558
002
0
3
X
660.71
608.88
58558
004
0
3
X
660.71
608.88
58558
001
0
3
X
731.10
670.58
58559
004
0
3
X
846.10
845.27
58559
001
0
3
X
936.08
935.12
58559
003
0
3
X
846.10
845.27
58559
002
0
3
X
846.10
845.27
58560
001
0
3
X
1,034.45
1,033.46
58560
004
0
3
X
936.52
935.72
58560
002
0
3
X
936.52
935.72
58560
003
0
3
X
936.52
935.72
58561
003
0
3
X
1,316.78
1,315.98
58561
002
0
3
X
1,316.78
1,315.98
58561
001
0
3
X
1,453.03
1,452.03
58561
004
0
3
X
1,316.78
1,315.98
58562
004
0
3
X
659.53
X
58562
001
0
3
X
725.95
X
58562
002
0
3
X
659.53
X
58562
003
0
3
X
659.53
X
58563
002
0
3
X
872.82
X
58563
003
0
3
X
872.82
X
58563
001
0
3
X
967.32
X
58563
004
0
3
X
872.82
X
58565
004
90
3
X
4,230.43
915.51
58565
002
90
3
X
4,230.43
915.51
58565
003
90
3
X
4,230.43
915.51
58565
001
90
3
X
5,011.20
1,037.62
58570
004
90
2
X
1,517.54
X
58570
003
90
2
X
1,517.54
X
58570
002
90
2
X
1,517.54
X
58570
001
90
2
X
1,690.25
X
58571
001
90
2
X
1,841.47
X
58571
004
90
2
X
1,660.85
X
58571
002
90
2
X
1,660.85
X
58571
003
90
2
X
1,660.85
X
58572
004
90
2
X
1,885.70
X
58572
001
90
2
X
2,096.91
X
58572
002
90
2
X
1,885.70
X
58572
003
90
2
X
1,885.70
X
58573
003
90
2
X
2,124.58
X
58573
002
90
2
X
2,124.58
X
58573
004
90
2
X
2,124.58
X
58573
001
90
2
X
2,348.50
X
58575
002
90
2
X
2,774.77
X
58575
003
90
2
X
2,774.77
X
58575
001
90
2
X
3,019.94
X
58575
004
90
2
X
2,774.77
X
58578
YYY
2
X
#
X
58579
YYY
2
X
#
X
58580
002
10
2
X
3,209.19
426.45
58580
003
10
2
X
3,209.19
426.45
58580
004
10
2
X
3,209.19
426.45
58580
001
10
2
X
3,622.63
461.64
58600
003
90
2
X
1,173.08
X
58600
002
90
2
X
1,287.81
X
58600
001
90
2
X
1,473.48
X
58600
004
90
2
X
1,158.87
X
58605
004
90
2
X
912.43
X
58605
002
90
2
X
1,009.18
X
58605
003
90
2
X
974.90
X
58605
001
90
2
X
1,100.39
X
58611
002
ZZZ
0
X
135.43
X
58611
003
ZZZ
0
X
126.06
X
58611
004
ZZZ
0
X
1,396.68
X
58611
001
ZZZ
0
X
1,407.76
X
58615
004
10
2
X
732.80
X
58615
001
10
2
X
796.82
X
58615
002
10
2
X
786.04
X
58615
003
10
2
X
741.56
X
58660
001
90
3
X
1,705.25
X
58660
004
90
3
X
1,535.96
X
58660
002
90
3
X
1,535.96
X
58660
003
90
3
X
1,535.96
X
58661
004
10
3
X
1,560.98
X
58661
001
10
3
X
1,730.23
X
58661
003
10
3
X
1,560.98
X
58661
002
10
3
X
1,560.98
X
58662
001
90
3
X
1,731.49
X
58662
004
90
3
X
1,567.10
X
58662
002
90
3
X
1,567.10
X
58662
003
90
3
X
1,567.10
X
58670
004
90
3
X
871.18
X
58670
001
90
3
X
970.14
X
58670
003
90
3
X
871.18
X
58670
002
90
3
X
871.18
X
58671
002
90
3
X
896.21
X
58671
003
90
3
X
896.21
X
58671
001
90
3
X
999.44
X
58671
004
90
3
X
896.21
X
58672
003
90
3
X
1,692.11
X
58672
002
90
3
X
1,692.11
X
58672
001
90
3
X
1,871.42
X
58672
004
90
3
X
1,692.11
X
58673
001
90
3
X
1,990.68
X
58673
003
90
3
X
1,802.15
X
58673
002
90
3
X
1,802.15
X
58673
004
90
3
X
1,802.15
X
58674
002
90
2
X
1,228.16
X
58674
003
90
2
X
1,228.16
X
58674
001
90
2
X
1,332.55
X
58674
004
90
2
X
1,228.16
X
58679
YYY
2
X
#
X
58700
001
90
2
X
1,714.49
X
58700
004
90
2
X
1,557.95
X
58700
003
90
2
X
1,412.83
X
58700
002
90
2
X
1,698.48
X
58720
003
90
2
X
1,634.30
X
58720
002
90
2
X
1,768.50
X
58720
004
90
2
X
1,576.86
X
58720
001
90
2
X
2,122.75
X
58740
001
90
2
X
2,980.56
X
58740
002
90
2
X
2,844.70
X
58740
003
90
2
X
2,723.36
X
58740
004
90
2
X
2,845.95
X
58750
90
2
X
*
X
58752
90
2
X
*
X
58760
90
2
X
*
X
58770
90
2
X
*
X
58800
003
90
2
X
766.54
X
58800
002
90
2
X
782.05
X
58800
004
90
2
X
721.68
X
58800
001
90
2
X
794.65
X
58805
004
90
2
X
1,356.47
X
58805
001
90
2
X
1,521.08
X
58805
002
90
2
X
1,496.97
X
58805
003
90
2
X
1,372.75
X
58820
004
90
2
X
659.08
X
58820
001
90
2
X
743.70
X
58820
003
90
2
X
659.08
X
58820
002
90
2
X
659.08
X
58822
003
90
2
X
1,104.22
X
58822
002
90
2
X
1,181.40
X
58822
004
90
2
X
1,092.11
X
58822
001
90
2
X
1,200.17
X
58825
004
90
2
X
1,094.06
X
58825
003
90
2
X
1,106.47
X
58825
002
90
2
X
1,190.85
X
58825
001
90
2
X
1,211.41
X
58900
004
90
2
X
1,211.10
X
58900
003
90
2
X
1,559.70
X
58900
002
90
2
X
1,522.01
X
58900
001
90
2
X
1,650.04
X
58920
004
90
2
X
1,490.75
X
58920
002
90
2
X
1,635.03
X
58920
001
90
2
X
1,665.66
X
58920
003
90
2
X
1,508.53
X
58925
002
90
2
X
1,618.79
X
58925
003
90
2
X
1,494.80
X
58925
001
90
2
X
1,648.84
X
58925
004
90
2
X
1,531.63
X
58940
001
90
2
X
1,931.34
X
58940
004
90
2
X
1,586.23
X
58940
003
90
2
X
1,525.68
X
58940
002
90
2
X
1,745.91
X
58943
003
90
2
X
4,036.46
X
58943
002
90
2
X
3,616.77
X
58943
004
90
2
X
4,020.58
X
58943
001
90
2
X
3,946.76
X
58950
004
90
2
X
3,592.95
X
58950
001
90
2
X
3,722.17
X
58950
002
90
2
X
3,653.96
X
58950
003
90
2
X
3,606.82
X
58951
004
90
2
X
5,474.30
X
58951
001
90
2
X
5,681.38
X
58951
003
90
2
X
5,495.93
X
58951
002
90
2
X
5,645.17
X
58952
002
90
2
X
5,716.63
X
58952
003
90
2
X
5,567.05
X
58952
004
90
2
X
5,545.16
X
58952
001
90
2
X
5,752.92
X
58953
001
90
2
X
4,446.68
X
58953
003
90
2
X
3,981.86
X
58953
002
90
2
X
3,981.86
X
58953
004
90
2
X
3,981.86
X
58954
002
90
2
X
4,329.17
X
58954
003
90
2
X
4,329.17
X
58954
004
90
2
X
4,329.17
X
58954
001
90
2
X
4,832.93
X
58956
001
90
2
X
3,014.30
X
58956
004
90
2
X
2,649.70
X
58956
003
90
2
X
2,649.70
X
58956
002
90
2
X
2,649.70
X
58957
002
90
2
X
2,371.55
X
58957
003
90
2
X
2,371.55
X
58957
004
90
2
X
2,371.55
X
58957
001
90
2
X
2,661.44
X
58958
003
90
2
X
2,626.05
X
58958
002
90
2
X
2,626.05
X
58958
004
90
2
X
2,626.05
X
58958
001
90
2
X
2,945.14
X
58960
004
90
2
X
3,997.18
X
58960
002
90
2
X
4,115.39
X
58960
003
90
2
X
4,010.71
X
58960
001
90
2
X
4,140.80
X
58970
0
2
X
*
X
58974
0
2
X
*
X
58976
0
2
X
*
X
58999
YYY
2
X
#
X
59000
001
0
2
X
265.38
X
59000
002
0
2
X
262.92
X
59000
003
0
2
X
252.62
X
59000
004
0
2
X
252.31
X
59001
004
0
2
X
361.88
X
59001
002
0
2
X
361.88
X
59001
003
0
2
X
361.88
X
59001
001
0
2
X
400.60
X
59012
004
0
2
X
658.18
X
59012
003
0
2
X
666.12
X
59012
002
0
2
X
705.84
X
59012
001
0
2
X
715.53
X
59015
001
0
2
X
387.61
X
59015
004
0
2
X
361.31
X
59015
002
0
2
X
383.32
X
59015
003
0
2
X
365.58
X
59020
001
0
0
X
269.81
X
59020
26
001
0
0
X
304.06
X
59020
TC
001
0
0
X
71.73
X
59020
004
0
0
X
236.89
X
59020
26
004
0
0
X
175.92
X
59020
TC
004
0
0
X
61.06
X
59020
003
0
0
X
239.98
X
59020
26
003
0
0
X
178.01
X
59020
TC
003
0
0
X
61.90
X
59020
002
0
0
X
263.96
X
59020
26
002
0
0
X
194.13
X
59020
TC
002
0
0
X
69.80
X
59025
002
0
0
X
120.92
X
59025
26
002
0
0
X
101.22
X
59025
TC
002
0
0
X
29.66
X
59025
003
0
0
X
114.19
X
59025
26
003
0
0
X
104.36
X
59025
TC
003
0
0
X
26.38
X
59025
001
0
0
X
121.74
X
59025
26
001
0
0
X
102.24
X
59025
TC
001
0
0
X
30.42
X
59025
004
0
0
X
113.17
X
59025
26
004
0
0
X
103.22
X
59025
TC
004
0
0
X
26.00
X
59030
0
2
X
*
X
59050
004
XXX
0
X
162.84
X
59050
001
XXX
0
X
186.96
X
59050
002
XXX
0
X
162.84
X
59050
003
XXX
0
X
162.84
X
59051
004
XXX
0
X
259.33
X
59051
001
XXX
0
X
282.24
X
59051
003
XXX
0
X
262.19
X
59051
002
XXX
0
X
278.36
X
59070
001
0
2
X
919.41
679.55
59070
004
0
2
X
828.16
624.09
59070
002
0
2
X
828.16
624.09
59070
003
0
2
X
828.16
624.09
59072
004
0
2
X
1,007.95
X
59072
001
0
2
X
1,099.61
X
59072
002
0
2
X
1,007.95
X
59072
003
0
2
X
1,007.95
X
59074
004
0
2
X
789.74
624.09
59074
001
0
2
X
874.31
679.55
59074
003
0
2
X
789.74
624.09
59074
002
0
2
X
789.74
624.09
59076
001
0
2
X
1,099.61
X
59076
004
0
2
X
1,007.95
X
59076
003
0
2
X
1,007.95
X
59076
002
0
2
X
1,007.95
X
59100
001
90
2
X
1,266.08
X
59100
003
90
2
X
1,157.41
X
59100
002
90
2
X
1,244.90
X
59100
004
90
2
X
1,144.44
X
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