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DLI
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Workers' Compensation
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Health Care Services Review
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Medical Fee Review
>
Fee Schedule
>
Fee Schedule 59120-61520
Begin Main Content Area
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Content Editor
2024 Workers' Compensation Part B Fee Schedule
59120-61520
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
59120
003
90
2
X
1,716.02
X
59120
001
90
2
X
1,889.36
X
59120
002
90
2
X
1,855.59
X
59120
004
90
2
X
1,894.26
X
59121
004
90
2
X
1,388.11
X
59121
002
90
2
X
1,507.06
X
59121
003
90
2
X
1,404.17
X
59121
001
90
2
X
1,532.02
X
59130
002
90
2
X
1,609.99
X
59130
003
90
2
X
1,519.17
X
59130
004
90
2
X
1,501.23
X
59130
001
90
2
X
1,631.92
X
59136
001
90
2
X
1,872.95
X
59136
003
90
2
X
1,710.37
X
59136
002
90
2
X
1,841.15
X
59136
004
90
2
X
1,691.21
X
59140
004
90
2
X
1,033.02
X
59140
002
90
2
X
1,101.22
X
59140
003
90
2
X
1,045.94
X
59140
001
90
2
X
1,114.56
X
59150
001
90
2
X
1,364.33
X
59150
002
90
2
X
1,341.18
X
59150
003
90
2
X
1,246.04
X
59150
004
90
2
X
1,232.05
X
59151
004
90
2
X
1,692.93
X
59151
001
90
2
X
1,841.60
X
59151
003
90
2
X
1,714.85
X
59151
002
90
2
X
1,817.05
X
59160
001
10
2
X
626.56
X
59160
004
10
2
X
542.36
X
59160
003
10
2
X
542.36
X
59160
002
10
2
X
542.36
X
59200
0
2
X
*
X
59300
002
0
2
X
384.50
X
59300
003
0
2
X
367.43
X
59300
001
0
2
X
447.99
X
59300
004
0
2
X
471.03
X
59320
003
0
2
X
488.08
X
59320
002
0
2
X
525.14
X
59320
004
0
2
X
482.58
X
59320
001
0
2
X
534.03
X
59325
002
0
2
X
799.35
X
59325
003
0
2
X
757.37
X
59325
001
0
2
X
809.53
X
59325
004
0
2
X
748.45
X
59350
002
0
2
X
1,047.45
X
59350
003
0
2
X
973.04
X
59350
001
0
2
X
1,065.54
X
59350
004
0
2
X
962.15
X
59400
002
MMM
2
X
3,408.18
X
59400
003
MMM
2
X
3,146.94
X
59400
001
MMM
2
X
3,570.56
X
59400
004
MMM
2
X
3,035.30
X
59409
004
MMM
2
X
1,933.60
X
59409
002
MMM
2
X
2,809.19
X
59409
003
MMM
2
X
2,610.10
X
59409
001
MMM
2
X
2,574.94
X
59410
001
MMM
2
X
2,657.34
X
59410
002
MMM
2
X
3,054.41
X
59410
003
MMM
2
X
2,837.53
X
59410
004
MMM
2
X
2,007.90
X
59412
MMM
0
X
*
X
59414
003
MMM
2
X
316.44
X
59414
002
MMM
2
X
340.57
X
59414
004
MMM
2
X
312.95
X
59414
001
MMM
2
X
346.55
X
59425
002
MMM
0
X
852.35
697.04
59425
003
MMM
0
X
792.13
645.41
59425
004
MMM
0
X
783.23
639.07
59425
001
MMM
0
X
867.01
709.66
59426
001
MMM
0
X
1,486.25
1,216.40
59426
003
MMM
0
X
1,357.71
1,106.26
59426
002
MMM
0
X
1,461.08
1,194.74
59426
004
MMM
0
X
1,342.48
1,095.26
59430
004
MMM
2
X
256.13
X
59430
001
MMM
2
X
272.29
X
59430
002
MMM
2
X
269.58
X
59430
003
MMM
2
X
258.77
X
59510
001
MMM
2
X
5,092.84
X
59510
004
MMM
2
X
4,599.15
X
59510
002
MMM
2
X
5,006.46
X
59510
003
MMM
2
X
4,651.26
X
59514
004
MMM
2
X
2,990.81
X
59514
002
MMM
2
X
3,255.84
X
59514
003
MMM
2
X
3,024.73
X
59514
001
MMM
2
X
2,935.26
X
59515
004
MMM
2
X
3,214.68
X
59515
001
MMM
2
X
3,016.93
X
59515
003
MMM
2
X
3,251.12
X
59515
002
MMM
2
X
3,499.00
X
59525
003
ZZZ
0
X
1,388.72
X
59525
002
ZZZ
0
X
1,476.90
X
59525
004
ZZZ
0
X
1,373.77
X
59525
001
ZZZ
0
X
1,498.39
X
59610
003
MMM
2
X
4,458.18
X
59610
002
MMM
2
X
4,746.32
X
59610
001
MMM
2
X
4,978.63
X
59610
004
MMM
2
X
4,393.90
X
59612
004
MMM
2
X
2,844.59
X
59612
002
MMM
2
X
3,069.75
X
59612
003
MMM
2
X
2,885.85
X
59612
001
MMM
2
X
3,218.28
X
59614
001
MMM
2
X
3,478.34
X
59614
002
MMM
2
X
3,317.37
X
59614
003
MMM
2
X
3,117.86
X
59614
004
MMM
2
X
3,073.14
X
59618
001
MMM
2
X
5,591.12
X
59618
004
MMM
2
X
4,932.63
X
59618
002
MMM
2
X
5,329.49
X
59618
003
MMM
2
X
5,004.82
X
59620
003
MMM
2
X
3,316.57
X
59620
002
MMM
2
X
3,529.13
X
59620
001
MMM
2
X
3,700.64
X
59620
004
MMM
2
X
3,268.98
X
59622
004
MMM
2
X
3,501.26
X
59622
003
MMM
2
X
3,552.28
X
59622
002
MMM
2
X
3,780.29
X
59622
001
MMM
2
X
3,964.07
X
59812
003
90
2
X
778.55
X
59812
002
90
2
X
846.12
X
59812
001
90
2
X
862.58
X
59812
004
90
2
X
769.33
X
59820
001
90
2
X
1,023.70
X
59820
003
90
2
X
948.68
X
59820
002
90
2
X
983.56
X
59820
004
90
2
X
849.80
X
59821
001
90
2
X
998.34
X
59821
004
90
2
X
787.04
X
59821
002
90
2
X
853.92
X
59821
003
90
2
X
795.93
X
59830
002
90
2
X
1,218.89
X
59830
003
90
2
X
1,150.47
X
59830
001
90
2
X
1,235.42
X
59830
004
90
2
X
1,136.84
X
59840
001
10
2
X
786.54
X
59840
003
10
2
X
710.88
X
59840
002
10
2
X
915.52
X
59840
004
10
2
X
702.44
X
59841
001
10
2
X
1,087.41
X
59841
004
10
2
X
797.77
X
59841
003
10
2
X
1,051.66
X
59841
002
10
2
X
875.69
X
59850
004
90
2
X
1,064.99
X
59850
003
90
2
X
1,077.19
X
59850
002
90
2
X
1,157.10
X
59850
001
90
2
X
1,150.28
X
59851
004
90
2
X
1,113.53
X
59851
001
90
2
X
1,230.11
X
59851
002
90
2
X
1,209.96
X
59851
003
90
2
X
1,126.36
X
59852
002
90
2
X
1,629.06
X
59852
003
90
2
X
1,513.81
X
59852
001
90
2
X
1,657.07
X
59852
004
90
2
X
1,496.86
X
59855
002
90
2
X
1,056.19
X
59855
003
90
2
X
986.00
X
59855
001
90
2
X
1,090.71
X
59855
004
90
2
X
973.00
X
59856
001
90
2
X
1,646.42
X
59856
004
90
2
X
1,468.11
X
59856
003
90
2
X
1,487.67
X
59856
002
90
2
X
1,593.98
X
59857
004
90
2
X
1,785.62
X
59857
001
90
2
X
2,002.00
X
59857
003
90
2
X
1,809.39
X
59857
002
90
2
X
1,938.45
X
59866
003
0
2
X
752.65
X
59866
002
0
2
X
773.40
X
59866
004
0
2
X
752.65
X
59866
001
0
2
X
863.14
X
59870
002
90
2
X
862.49
X
59870
003
90
2
X
801.46
X
59870
004
90
2
X
792.42
X
59870
001
90
2
X
877.34
X
59871
002
0
2
X
378.81
X
59871
003
0
2
X
378.81
X
59871
004
0
2
X
378.81
X
59871
001
0
2
X
436.78
X
59897
YYY
2
X
#
X
59898
YYY
2
X
#
X
59899
YYY
2
X
#
X
60000
001
10
2
X
270.56
X
60000
003
10
2
X
236.37
X
60000
002
10
2
X
258.93
X
60000
004
10
2
X
233.89
X
60100
001
0
2
X
255.31
194.82
60100
004
0
2
X
233.15
177.00
60100
003
0
2
X
237.53
180.55
60100
002
0
2
X
248.27
189.34
60200
001
90
2
X
1,798.58
X
60200
003
90
2
X
1,661.72
X
60200
002
90
2
X
1,771.83
X
60200
004
90
2
X
1,642.77
X
60210
004
90
2
X
2,270.47
X
60210
001
90
2
X
2,579.15
X
60210
002
90
2
X
2,463.53
X
60210
003
90
2
X
2,301.41
X
60212
002
90
2
X
2,553.96
X
60212
003
90
2
X
2,382.98
X
60212
001
90
2
X
2,697.74
X
60212
004
90
2
X
2,355.74
X
60220
004
90
2
X
2,063.68
X
60220
001
90
2
X
2,281.92
X
60220
003
90
2
X
2,088.00
X
60220
002
90
2
X
2,244.02
X
60225
004
90
2
X
2,480.82
X
60225
001
90
2
X
2,789.85
X
60225
003
90
2
X
2,510.24
X
60225
002
90
2
X
2,697.66
X
60240
004
90
2
X
2,978.83
X
60240
002
90
2
X
3,105.95
X
60240
003
90
2
X
2,948.55
X
60240
001
90
2
X
3,197.54
X
60252
002
90
2
X
3,544.20
X
60252
003
90
2
X
3,452.00
X
60252
001
90
2
X
3,604.09
X
60252
004
90
2
X
3,432.02
X
60254
001
90
2
X
4,879.23
X
60254
002
90
2
X
4,655.38
X
60254
003
90
2
X
4,569.28
X
60254
004
90
2
X
4,646.93
X
60260
001
90
2
X
2,127.01
X
60260
004
90
2
X
1,754.92
X
60260
003
90
2
X
2,088.88
X
60260
002
90
2
X
1,931.01
X
60270
004
90
2
X
3,399.28
X
60270
002
90
2
X
3,690.80
X
60270
003
90
2
X
3,439.40
X
60270
001
90
2
X
3,751.81
X
60271
002
90
2
X
3,222.91
X
60271
003
90
2
X
2,948.95
X
60271
004
90
2
X
2,929.04
X
60271
001
90
2
X
3,254.80
X
60280
001
90
2
X
1,766.77
X
60280
004
90
2
X
1,630.27
X
60280
002
90
2
X
1,747.94
X
60280
003
90
2
X
1,705.69
X
60281
004
90
2
X
1,447.80
X
60281
003
90
2
X
1,464.32
X
60281
002
90
2
X
1,561.98
X
60281
001
90
2
X
1,585.74
X
60300
002
0
2
X
172.53
85.33
60300
003
0
2
X
172.53
85.33
60300
004
0
2
X
172.53
85.33
60300
001
0
2
X
198.40
93.29
60500
004
90
2
X
3,316.30
X
60500
001
90
2
X
3,515.50
X
60500
003
90
2
X
3,404.72
X
60500
002
90
2
X
3,487.80
X
60502
001
90
2
X
3,741.86
X
60502
004
90
2
X
3,413.95
X
60502
003
90
2
X
3,578.98
X
60502
002
90
2
X
3,685.17
X
60505
001
90
2
X
2,789.45
X
60505
002
90
2
X
2,761.98
X
60505
003
90
2
X
2,592.94
X
60505
004
90
2
X
2,602.25
X
60512
001
ZZZ
0
X
889.34
X
60512
004
ZZZ
0
X
802.02
X
60512
003
ZZZ
0
X
812.33
X
60512
002
ZZZ
0
X
863.77
X
60520
003
90
2
X
3,457.99
X
60520
002
90
2
X
3,704.65
X
60520
001
90
2
X
3,764.49
X
60520
004
90
2
X
3,418.03
X
60521
002
90
2
X
3,704.65
X
60521
003
90
2
X
3,457.99
X
60521
004
90
2
X
3,418.03
X
60521
001
90
2
X
3,764.49
X
60522
002
90
2
X
3,704.65
X
60522
003
90
2
X
3,457.99
X
60522
004
90
2
X
3,418.03
X
60522
001
90
2
X
3,764.49
X
60540
004
90
2
X
3,080.68
X
60540
002
90
2
X
3,331.91
X
60540
003
90
2
X
3,116.72
X
60540
001
90
2
X
3,384.06
X
60545
002
90
2
X
4,233.26
X
60545
004
90
2
X
4,110.95
X
60545
001
90
2
X
4,258.53
X
60545
003
90
2
X
4,128.74
X
60600
004
90
2
X
3,044.85
X
60600
001
90
2
X
3,332.51
X
60600
003
90
2
X
3,080.32
X
60600
002
90
2
X
3,287.04
X
60605
004
90
2
X
3,221.65
X
60605
003
90
2
X
3,656.21
X
60605
002
90
2
X
3,847.69
X
60605
001
90
2
X
3,906.28
X
60650
90
2
X
*
X
60659
YYY
2
X
#
X
60699
YYY
2
X
#
X
61000
004
0
2
X
291.28
X
61000
001
0
2
X
318.06
X
61000
003
0
2
X
294.72
X
61000
002
0
2
X
313.52
X
61001
003
0
2
X
266.12
X
61001
002
0
2
X
283.51
X
61001
004
0
2
X
263.18
X
61001
001
0
2
X
287.77
X
61020
001
0
2
X
550.63
X
61020
004
0
2
X
306.03
X
61020
002
0
2
X
548.48
X
61020
003
0
2
X
539.58
X
61026
004
0
2
X
530.44
X
61026
003
0
2
X
383.08
X
61026
002
0
2
X
509.57
X
61026
001
0
2
X
532.23
X
61050
003
0
2
X
463.44
X
61050
002
0
2
X
430.80
X
61050
004
0
2
X
278.69
X
61050
001
0
2
X
434.13
X
61055
001
0
0
X
436.43
X
61055
004
0
0
X
507.85
X
61055
002
0
0
X
517.36
X
61055
003
0
0
X
497.45
X
61070
001
0
2
X
209.13
X
61070
002
0
2
X
208.48
X
61070
003
0
2
X
205.82
X
61070
004
0
2
X
136.95
X
61105
002
90
2
X
2,068.83
X
61105
003
90
2
X
1,703.28
X
61105
001
90
2
X
2,081.42
X
61105
004
90
2
X
1,683.46
X
61107
001
0
0
X
1,886.39
X
61107
004
0
0
X
1,227.45
X
61107
002
0
0
X
1,826.59
X
61107
003
0
0
X
1,782.73
X
61108
002
90
2
X
4,060.08
X
61108
003
90
2
X
3,918.87
X
61108
004
90
2
X
3,959.17
X
61108
001
90
2
X
3,572.42
X
61120
004
90
2
X
1,690.03
X
61120
002
90
2
X
1,822.15
X
61120
003
90
2
X
1,709.28
X
61120
001
90
2
X
1,906.14
X
61140
002
90
2
X
3,050.39
X
61140
003
90
2
X
2,920.22
X
61140
004
90
2
X
2,898.00
X
61140
001
90
2
X
3,006.50
X
61150
004
90
2
X
3,468.87
X
61150
002
90
2
X
3,769.70
X
61150
003
90
2
X
3,569.10
X
61150
001
90
2
X
3,832.63
X
61151
003
90
2
X
1,225.96
X
61151
002
90
2
X
1,249.19
X
61151
004
90
2
X
1,451.25
X
61151
001
90
2
X
1,279.05
X
61154
004
90
2
X
4,377.10
X
61154
002
90
2
X
4,459.81
X
61154
003
90
2
X
4,356.76
X
61154
001
90
2
X
4,035.05
X
61156
001
90
2
X
3,946.52
X
61156
004
90
2
X
3,548.01
X
61156
003
90
2
X
3,590.77
X
61156
002
90
2
X
3,877.15
X
61210
001
0
2
X
2,497.11
X
61210
004
0
2
X
1,406.38
X
61210
003
0
2
X
2,874.99
X
61210
002
0
2
X
2,920.21
X
61215
90
2
X
*
X
61250
001
90
2
X
2,326.16
X
61250
002
90
2
X
2,599.86
X
61250
003
90
2
X
2,537.87
X
61250
004
90
2
X
2,118.00
X
61253
004
90
2
X
2,510.87
X
61253
001
90
2
X
2,757.02
X
61253
003
90
2
X
2,540.05
X
61253
002
90
2
X
2,714.64
X
61304
001
90
2
X
5,903.18
X
61304
004
90
2
X
5,538.44
X
61304
002
90
2
X
5,795.58
X
61304
003
90
2
X
5,525.75
X
61305
004
90
2
X
6,059.55
X
61305
001
90
2
X
6,739.12
X
61305
003
90
2
X
6,133.84
X
61305
002
90
2
X
6,683.23
X
61312
004
90
2
X
5,052.81
X
61312
003
90
2
X
5,088.45
X
61312
002
90
2
X
5,531.73
X
61312
001
90
2
X
5,632.75
X
61313
002
90
2
X
5,509.90
X
61313
003
90
2
X
5,096.87
X
61313
004
90
2
X
5,035.44
X
61313
001
90
2
X
5,609.78
X
61314
004
90
2
X
5,460.69
X
61314
001
90
2
X
6,076.98
X
61314
003
90
2
X
5,263.77
X
61314
002
90
2
X
5,969.78
X
61315
001
90
2
X
6,252.08
X
61315
004
90
2
X
5,646.39
X
61315
002
90
2
X
6,147.11
X
61315
003
90
2
X
5,627.38
X
61316
001
ZZZ
0
X
216.46
X
61316
004
ZZZ
0
X
182.58
X
61316
002
ZZZ
0
X
182.58
X
61316
003
ZZZ
0
X
182.58
X
61320
004
90
2
X
4,750.90
X
61320
002
90
2
X
5,130.86
X
61320
003
90
2
X
4,806.30
X
61320
001
90
2
X
5,278.82
X
61321
003
90
2
X
5,227.79
X
61321
002
90
2
X
5,589.99
X
61321
001
90
2
X
5,677.81
X
61321
004
90
2
X
5,167.73
X
61322
002
90
2
X
3,748.65
X
61322
003
90
2
X
3,748.65
X
61322
004
90
2
X
3,748.65
X
61322
001
90
2
X
4,275.38
X
61323
002
90
2
X
3,884.83
X
61323
003
90
2
X
3,884.83
X
61323
004
90
2
X
3,884.83
X
61323
001
90
2
X
4,418.45
X
61330
001
90
2
X
3,333.01
X
61330
002
90
2
X
3,290.02
X
61330
003
90
2
X
3,111.65
X
61330
004
90
2
X
3,074.08
X
61333
003
90
2
X
5,272.28
X
61333
002
90
2
X
5,624.96
X
61333
004
90
2
X
5,210.99
X
61333
001
90
2
X
5,710.43
X
61340
004
90
2
X
2,968.79
X
61340
001
90
2
X
3,351.23
X
61340
003
90
2
X
3,005.58
X
61340
002
90
2
X
3,236.63
X
61343
003
90
2
X
6,582.31
X
61343
002
90
2
X
7,094.60
X
61343
004
90
2
X
6,503.39
X
61343
001
90
2
X
6,781.34
X
61345
001
90
2
X
5,448.70
X
61345
004
90
2
X
4,955.56
X
61345
003
90
2
X
5,013.24
X
61345
002
90
2
X
5,363.70
X
61450
002
90
2
X
5,380.15
X
61450
003
90
2
X
5,025.78
X
61450
001
90
2
X
5,465.99
X
61450
004
90
2
X
4,966.94
X
61458
001
90
2
X
7,193.74
X
61458
003
90
2
X
6,830.02
X
61458
002
90
2
X
7,053.76
X
61458
004
90
2
X
5,982.06
X
61460
004
90
2
X
5,746.59
X
61460
001
90
2
X
7,065.02
X
61460
003
90
2
X
5,815.82
X
61460
002
90
2
X
6,930.52
X
61500
003
90
2
X
4,361.41
X
61500
002
90
2
X
4,563.64
X
61500
001
90
2
X
4,646.04
X
61500
004
90
2
X
4,172.25
X
61501
004
90
2
X
3,553.53
X
61501
003
90
2
X
3,597.31
X
61501
002
90
2
X
3,902.32
X
61501
001
90
2
X
3,976.19
X
61510
001
90
2
X
6,335.14
X
61510
004
90
2
X
5,922.60
X
61510
003
90
2
X
5,951.70
X
61510
002
90
2
X
6,222.94
X
61512
001
90
2
X
6,711.22
X
61512
004
90
2
X
6,020.73
X
61512
003
90
2
X
6,094.32
X
61512
002
90
2
X
6,591.01
X
61514
002
90
2
X
6,044.69
X
61514
003
90
2
X
5,597.79
X
61514
004
90
2
X
5,530.91
X
61514
001
90
2
X
6,447.90
X
61516
001
90
2
X
6,158.28
X
61516
003
90
2
X
5,608.45
X
61516
002
90
2
X
6,051.14
X
61516
004
90
2
X
5,540.52
X
61517
004
ZZZ
0
X
158.88
X
61517
002
ZZZ
0
X
158.88
X
61517
001
ZZZ
0
X
174.36
X
61517
003
ZZZ
0
X
158.88
X
61518
002
90
2
X
7,597.54
X
61518
003
90
2
X
7,065.33
X
61518
004
90
2
X
6,982.27
X
61518
001
90
2
X
7,509.09
X
61519
002
90
2
X
7,946.41
X
61519
003
90
2
X
7,387.83
X
61519
001
90
2
X
7,749.35
X
61519
004
90
2
X
7,301.10
X
61520
001
90
2
X
9,308.20
X
61520
004
90
2
X
8,052.65
X
61520
003
90
2
X
8,148.37
X
61520
002
90
2
X
9,247.94
X
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