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2018 Workers' Compensation Part B Fee Schedule

61521-62161

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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
61521   1 90 2 0 7,038.54 0
61521   2 90 2 0 6,777.66 0
61521   3 90 2 0 6,322.77 0
61521   4 90 2 0 6,770.43 0
61522   1 90 2 0 4,510.05 0
61522   2 90 2 0 4,439.25 0
61522   3 90 2 0 4,147.34 0
61522   4 90 2 0 4,100.00 0
61524   1 90 2 0 5,191.33 0
61524   2 90 2 0 5,100.37 0
61524   3 90 2 0 4,724.82 0
61524   4 90 2 0 4,668.64 0
61526   1 90 2 0 6,838.39 0
61526   2 90 2 0 6,797.88 0
61526   3 90 2 0 5,514.59 0
61526   4 90 2 0 5,446.82 0
61530   1 90 2 0 6,010.81 0
61530   2 90 2 0 5,914.29 0
61530   3 90 2 0 5,514.59 0
61530   4 90 2 0 5,446.82 0
61531   1 90 2 0 3,228.78 0
61531   2 90 2 0 3,185.97 0
61531   3 90 2 0 3,008.56 0
61531   4 90 2 0 2,973.16 0
61533   1 90 2 0 3,852.12 0
61533   2 90 2 0 3,790.73 0
61533   3 90 2 0 3,538.08 0
61533   4 90 2 0 3,497.82 0
61534   1 90 2 0 2,417.86 0
61534   2 90 2 0 3,200.81 0
61534   3 90 2 0 2,238.45 0
61534   4 90 2 0 2,215.62 0
61535   1 90 2 0 1,674.97 0
61535   2 90 2 0 1,649.91 0
61535   3 90 2 0 1,546.38 0
61535   4 90 2 0 1,528.46 0
61536   1 90 2 0 4,863.65 0
61536   2 90 2 0 4,787.91 0
61536   3 90 2 0 4,475.37 0
61536   4 90 2 0 4,423.98 0
61537   1 90 2 0 3,159.81 0
61537   2 90 2 0 2,727.97 0
61537   3 90 2 0 2,727.97 0
61537   4 90 2 0 2,727.97 0
61538   1 90 2 0 5,477.53 0
61538   2 90 2 0 5,384.97 0
61538   3 90 2 0 5,004.52 0
61538   4 90 2 0 4,944.65 0
61539   1 90 2 0 5,012.47 0
61539   2 90 2 0 4,934.38 0
61539   3 90 2 0 4,612.59 0
61539   4 90 2 0 4,559.40 0
61540   1 90 2 0 3,818.73 0
61540   2 90 2 0 3,291.72 0
61540   3 90 2 0 3,291.72 0
61540   4 90 2 0 3,291.72 0
61541   1 90 2 0 4,599.23 0
61541   2 90 2 0 4,374.05 0
61541   3 90 2 0 4,084.50 0
61541   4 90 2 0 4,037.84 0
61543   1 90 2 0 3,525.68 0
61543   2 90 2 0 3,473.34 0
61543   3 90 2 0 3,257.08 0
61543   4 90 2 0 3,218.65 0
61544   1 90 2 0 4,663.02 0
61544   2 90 2 0 4,600.87 0
61544   3 90 2 0 4,341.94 0
61544   4 90 2 0 4,286.50 0
61545   1 90 2 0 5,710.84 0
61545   2 90 2 0 5,620.93 0
61545   3 90 2 0 5,250.27 0
61545   4 90 2 0 5,190.07 0
61546   1 90 2 0 5,644.19 0
61546   2 90 2 0 5,586.26 0
61546   3 90 2 0 5,432.69 0
61546   4 90 2 0 4,872.74 0
61548   1 90 2 0 4,651.56 0
61548   2 90 2 0 5,854.39 0
61548   3 90 2 0 5,772.37 0
61548   4 90 2 0 5,568.37 0
61550   1 90 2 0 2,347.33 0
61550   2 90 2 0 2,317.02 0
61550   3 90 2 0 2,191.35 0
61550   4 90 2 0 2,164.98 0
61552   1 90 2 0 3,128.37 0
61552   2 90 2 0 3,747.33 0
61552   3 90 2 0 2,873.63 0
61552   4 90 2 0 2,840.89 0
61556   1 90 2 0 4,826.76 0
61556   2 90 2 0 4,826.76 0
61556   3 90 2 0 4,826.76 0
61556   4 90 2 0 4,826.76 0
61557   1 90 2 0 7,240.18 0
61557   2 90 2 0 7,240.18 0
61557   3 90 2 0 7,240.18 0
61557   4 90 2 0 7,240.18 0
61558   1 90 2 0 4,298.34 0
61558   2 90 2 0 4,169.71 0
61558   3 90 2 0 3,904.53 0
61558   4 90 2 0 3,852.78 0
61559   1 90 2 0 5,574.09 0
61559   2 90 2 0 5,407.22 0
61559   3 90 2 0 5,063.38 0
61559   4 90 2 0 4,996.28 0
61563   1 90 2 0 6,986.12 0
61563   2 90 2 0 6,986.12 0
61563   3 90 2 0 6,986.12 0
61563   4 90 2 0 6,986.12 0
61564   1 90 2 0 8,891.40 0
61564   2 90 2 0 8,891.40 0
61564   3 90 2 0 8,891.40 0
61564   4 90 2 0 8,891.40 0
61566   1 90 2 0 3,747.37 0
61566   2 90 2 0 3,276.46 0
61566   3 90 2 0 3,276.46 0
61566   4 90 2 0 3,276.46 0
61567   1 90 2 0 4,262.58 0
61567   2 90 2 0 3,751.40 0
61567   3 90 2 0 3,751.40 0
61567   4 90 2 0 3,751.40 0
61570   1 90 2 0 3,911.12 0
61570   2 90 2 0 3,668.79 0
61570   3 90 2 0 3,661.56 0
61570   4 90 2 0 3,390.98 0
61571   1 90 2 0 4,042.49 0
61571   2 90 2 0 3,980.35 0
61571   3 90 2 0 3,723.84 0
61571   4 90 2 0 3,680.97 0
61575   1 90 2 0 6,180.90 0
61575   2 90 2 0 6,081.70 0
61575   3 90 2 0 5,935.36 0
61575   4 90 2 0 5,603.07 0
61576   1 90 2 0 5,755.40 0
61576   2 90 2 0 5,671.33 0
61576   3 90 2 0 5,323.76 0
61576   4 90 2 0 5,260.73 0
61580   1 90 2 0 4,753.57 0
61580   2 90 2 0 4,677.96 0
61580   3 90 2 0 4,366.43 0
61580   4 90 2 0 4,316.71 0
61581   1 90 2 0 5,395.03 0
61581   2 90 2 0 5,309.25 0
61581   3 90 2 0 4,955.73 0
61581   4 90 2 0 4,899.21 0
61582   1 90 2 0 4,896.91 0
61582   2 90 2 0 4,819.10 0
61582   3 90 2 0 4,498.35 0
61582   4 90 2 0 4,447.11 0
61583   1 90 2 0 5,588.35 0
61583   2 90 2 0 5,499.45 0
61583   3 90 2 0 5,133.24 0
61583   4 90 2 0 5,074.75 0
61584   1 90 2 0 5,411.86 0
61584   2 90 2 0 5,325.73 0
61584   3 90 2 0 4,970.97 0
61584   4 90 2 0 4,914.29 0
61585   1 90 2 0 6,054.23 0
61585   2 90 2 0 5,957.87 0
61585   3 90 2 0 5,561.00 0
61585   4 90 2 0 5,497.69 0
61586   1 90 2 0 4,184.78 0
61586   2 90 2 0 3,795.88 0
61586   3 90 2 0 3,693.85 0
61586   4 90 2 0 3,693.85 0
61590   1 90 2 0 6,582.88 0
61590   2 90 2 0 6,478.25 0
61590   3 90 2 0 6,047.11 0
61590   4 90 2 0 5,978.24 0
61591   1 90 2 0 6,905.35 0
61591   2 90 2 0 6,795.54 0
61591   3 90 2 0 6,342.93 0
61591   4 90 2 0 6,270.68 0
61592   1 90 2 0 6,262.99 0
61592   2 90 2 0 6,163.34 0
61592   3 90 2 0 5,752.89 0
61592   4 90 2 0 5,687.35 0
61595   1 90 2 0 4,625.67 0
61595   2 90 2 0 4,552.09 0
61595   3 90 2 0 4,248.91 0
61595   4 90 2 0 4,200.49 0
61596   1 90 2 0 5,621.44 0
61596   2 90 2 0 5,532.03 0
61596   3 90 2 0 5,163.61 0
61596   4 90 2 0 5,104.78 0
61597   1 90 2 0 5,941.77 0
61597   2 90 2 0 5,847.32 0
61597   3 90 2 0 5,457.88 0
61597   4 90 2 0 5,395.66 0
61598   1 90 2 0 5,234.90 0
61598   2 90 2 0 5,151.62 0
61598   3 90 2 0 4,808.61 0
61598   4 90 2 0 4,753.85 0
61600   1 90 2 0 4,014.28 0
61600   2 90 2 0 3,950.44 0
61600   3 90 2 0 3,687.58 0
61600   4 90 2 0 3,645.59 0
61601   1 90 2 0 4,304.47 0
61601   2 90 2 0 4,235.98 0
61601   3 90 2 0 3,953.86 0
61601   4 90 2 0 3,908.84 0
61605   1 90 2 0 4,544.72 0
61605   2 90 2 0 4,472.42 0
61605   3 90 2 0 4,174.55 0
61605   4 90 2 0 4,126.97 0
61606   1 90 2 0 6,086.01 0
61606   2 90 2 0 5,989.27 0
61606   3 90 2 0 5,590.56 0
61606   4 90 2 0 5,526.86 0
61607   1 90 2 0 5,684.78 0
61607   2 90 2 0 5,594.37 0
61607   3 90 2 0 5,221.96 0
61607   4 90 2 0 5,162.47 0
61608   1 90 2 0 6,615.20 0
61608   2 90 2 0 6,510.02 0
61608   3 90 2 0 6,076.71 0
61608   4 90 2 0 6,007.48 0
61610   1 ZZZ 0 0 3,854.59 0
61610   2 ZZZ 0 0 3,793.28 0
61610   3 ZZZ 0 0 3,540.51 0
61610   4 ZZZ 0 0 3,500.15 0
61611   1 ZZZ 0 0 962.68 0
61611   2 ZZZ 0 0 947.39 0
61611   3 ZZZ 0 0 884.32 0
61611   4 ZZZ 0 0 874.25 0
61612   1 ZZZ 0 0 2,891.87 0
61612   2 ZZZ 0 0 2,845.87 0
61612   3 ZZZ 0 0 2,656.13 0
61612   4 ZZZ 0 0 2,625.93 0
61613   1 90 2 0 6,487.73 0
61613   2 90 2 0 6,384.53 0
61613   3 90 2 0 5,959.20 0
61613   4 90 2 0 5,891.30 0
61615   1 90 2 0 4,994.63 0
61615   2 90 2 0 4,915.20 0
61615   3 90 2 0 4,587.93 0
61615   4 90 2 0 4,535.63 0
61616   1 90 2 0 6,792.95 0
61616   2 90 2 0 6,684.92 0
61616   3 90 2 0 6,239.84 0
61616   4 90 2 0 6,168.73 0
61618   1 90 2 0 2,568.60 0
61618   2 90 2 0 2,527.76 0
61618   3 90 2 0 2,359.52 0
61618   4 90 2 0 2,332.62 0
61619   1 90 2 0 3,210.93 0
61619   2 90 2 0 3,159.92 0
61619   3 90 2 0 2,949.60 0
61619   4 90 2 0 2,916.02 0
61623   1 90 2 0 979.44 0
61623   2 90 2 0 894.36 0
61623   3 90 2 0 894.36 0
61623   4 90 2 0 894.36 0
61624   1 0 2 0 3,022.02 0
61624   2 0 2 0 2,981.34 0
61624   3 0 2 0 2,813.36 0
61624   4 0 2 0 2,780.09 0
61626   1 0 2 0 2,491.83 0
61626   2 0 2 0 2,458.41 0
61626   3 0 2 0 2,319.90 0
61626   4 0 2 0 2,292.49 0
61630     90 9 0 * 0
61635     90 9 0 * 0
61640     0 9 0 * 0
61641     ZZZ 9 0 * 0
61642     ZZZ 9 0 * 0
61645   1 0 0 0 1,021.53 0
61645   2 0 0 0 942.03 0
61645   3 0 0 0 942.03 0
61645   4 0 0 0 942.03 0
61650   1 ZZZ 2 0 679.85 0
61650   2 ZZZ 2 0 627.88 0
61650   3 ZZZ 2 0 627.88 0
61650   4 ZZZ 2 0 627.88 0
61651   1 ZZZ 2 0 288.73 0
61651   2 ZZZ 2 0 266.67 0
61651   3 ZZZ 2 0 266.67 0
61651   4 ZZZ 2 0 266.67 0
61680   1 90 2 0 6,461.45 0
61680   2 90 2 0 6,355.40 0
61680   3 90 2 0 5,918.10 0
61680   4 90 2 0 5,849.28 0
61682   1 90 2 0 7,381.61 0
61682   2 90 2 0 7,262.79 0
61682   3 90 2 0 6,772.43 0
61682   4 90 2 0 6,693.57 0
61684   1 90 2 0 6,288.11 0
61684   2 90 2 0 6,203.74 0
61684   3 90 2 0 5,854.57 0
61684   4 90 2 0 5,785.43 0
61686   1 90 2 0 7,602.84 0
61686   2 90 2 0 7,500.77 0
61686   3 90 2 0 7,078.41 0
61686   4 90 2 0 6,994.73 0
61690   1 90 2 0 5,715.28 0
61690   2 90 2 0 5,630.30 0
61690   3 90 2 0 5,279.20 0
61690   4 90 2 0 5,217.11 0
61692   1 90 2 0 6,082.38 0
61692   2 90 2 0 6,000.76 0
61692   3 90 2 0 5,662.86 0
61692   4 90 2 0 5,595.95 0
61697   1 90 2 0 6,504.10 0
61697   2 90 2 0 5,681.48 0
61697   3 90 2 0 5,681.48 0
61697   4 90 2 0 5,681.48 0
61698   1 90 2 0 6,262.58 0
61698   2 90 2 0 5,466.79 0
61698   3 90 2 0 5,466.79 0
61698   4 90 2 0 5,466.79 0
61700   1 90 2 0 6,383.17 0
61700   2 90 2 0 6,256.81 0
61700   3 90 2 0 5,824.33 0
61700   4 90 2 0 5,753.47 0
61702   1 90 2 0 7,243.81 0
61702   2 90 2 0 7,123.06 0
61702   3 90 2 0 6,624.70 0
61702   4 90 2 0 6,546.74 0
61703   1 90 2 0 2,699.15 0
61703   2 90 2 0 2,656.87 0
61703   3 90 2 0 2,482.55 0
61703   4 90 2 0 2,454.09 0
61705   1 90 2 0 6,170.51 0
61705   2 90 2 0 6,071.20 0
61705   3 90 2 0 5,760.02 0
61705   4 90 2 0 5,594.68 0
61708   1 90 2 0 5,274.39 0
61708   2 90 2 0 5,192.30 0
61708   3 90 2 0 4,935.48 0
61708   4 90 2 0 4,876.61 0
61710   1 90 2 0 4,324.87 0
61710   2 90 2 0 3,966.00 0
61710   3 90 2 0 3,765.64 0
61710   4 90 2 0 3,722.29 0
61711   1 90 2 0 6,080.85 0
61711   2 90 2 0 5,885.85 0
61711   3 90 2 0 5,958.01 0
61711   4 90 2 0 5,887.91 0
61720   1 90 2 0 4,837.33 0
61720   2 90 2 0 4,923.63 0
61720   3 90 2 0 3,417.70 0
61720   4 90 2 0 3,375.61 0
61735   1 90 2 0 2,737.04 0
61735   2 90 2 0 3,396.60 0
61735   3 90 2 0 2,548.25 0
61735   4 90 2 0 2,518.15 0
61750   1 90 2 0 4,345.07 0
61750   2 90 2 0 4,316.36 0
61750   3 90 2 0 4,197.67 0
61750   4 90 2 0 4,182.58 0
61751   1 90 2 0 4,708.77 0
61751   2 90 2 0 4,691.33 0
61751   3 90 2 0 4,561.49 0
61751   4 90 2 0 4,543.34 0
61760   1 90 2 0 3,595.29 0
61760   2 90 2 0 3,550.25 0
61760   3 90 2 0 3,364.19 0
61760   4 90 2 0 3,325.53 0
61770   1 90 2 0 3,902.37 0
61770   2 90 2 0 3,737.03 0
61770   3 90 2 0 3,053.79 0
61770   4 90 2 0 3,016.61 0
61781   1 ZZZ 0 0 373.20 0
61781   2 ZZZ 0 0 328.61 0
61781   3 ZZZ 0 0 328.61 0
61781   4 ZZZ 0 0 328.61 0
61782   1 ZZZ 0 0 302.06 0
61782   2 ZZZ 0 0 268.80 0
61782   3 ZZZ 0 0 268.80 0
61782   4 ZZZ 0 0 268.80 0
61783   1 ZZZ 0 0 373.20 0
61783   2 ZZZ 0 0 328.61 0
61783   3 ZZZ 0 0 328.61 0
61783   4 ZZZ 0 0 328.61 0
61790   1 90 2 0 3,559.57 0
61790   2 90 2 0 3,334.00 0
61790   3 90 2 0 3,450.40 0
61790   4 90 2 0 3,438.28 0
61791   1 90 2 0 3,343.79 0
61791   2 90 2 0 3,322.89 0
61791   3 90 2 0 2,022.23 0
61791   4 90 2 0 3,225.60 0
61796   1 90 0 0 1,136.10 0
61796   2 90 0 0 997.95 0
61796   3 90 0 0 997.95 0
61796   4 90 0 0 997.95 0
61797   1 ZZZ 0 0 308.17 0
61797   2 ZZZ 0 0 274.61 0
61797   3 ZZZ 0 0 274.61 0
61797   4 ZZZ 0 0 274.61 0
61798   1 90 0 0 1,136.10 0
61798   2 90 0 0 997.95 0
61798   3 90 0 0 997.95 0
61798   4 90 0 0 997.95 0
61799   1 ZZZ 0 0 426.21 0
61799   2 ZZZ 0 0 379.72 0
61799   3 ZZZ 0 0 379.72 0
61799   4 ZZZ 0 0 379.72 0
61800   1 ZZZ 0 0 221.05 0
61800   2 ZZZ 0 0 194.45 0
61800   3 ZZZ 0 0 194.45 0
61800   4 ZZZ 0 0 194.45 0
61850   1 90 2 0 2,629.38 0
61850   2 90 2 0 2,310.74 0
61850   3 90 2 0 2,415.47 0
61850   4 90 2 0 2,387.94 0
61860   1 90 2 0 1,841.95 0
61860   2 90 2 0 1,812.64 0
61860   3 90 2 0 1,691.92 0
61860   4 90 2 0 1,672.66 0
61863   1 90 2 0 2,267.67 0
61863   2 90 2 0 1,963.03 0
61863   3 90 2 0 1,963.03 0
61863   4 90 2 0 1,963.03 0
61864   1 ZZZ 0 0 543.95 0
61864   2 ZZZ 0 0 470.86 0
61864   3 ZZZ 0 0 470.86 0
61864   4 ZZZ 0 0 470.86 0
61867   1 90 2 0 3,372.79 0
61867   2 90 2 0 3,003.36 0
61867   3 90 2 0 3,003.36 0
61867   4 90 2 0 3,003.36 0
61868   1 ZZZ 0 0 889.44 0
61868   2 ZZZ 0 0 790.60 0
61868   3 ZZZ 0 0 790.60 0
61868   4 ZZZ 0 0 790.60 0
61870   1 90 2 0 948.86 0
61870   2 90 2 0 933.80 0
61870   3 90 2 0 871.52 0
61870   4 90 2 0 861.56 0
61880   1 90 2 0 974.41 0
61880   2 90 2 0 1,227.82 0
61880   3 90 2 0 901.26 0
61880   4 90 2 0 890.55 0
61885   1 90 2 0 1,042.62 0
61885   2 90 2 0 395.96 0
61885   3 90 2 0 371.23 0
61885   4 90 2 0 366.84 0
61886   1 90 2 0 1,139.88 0
61886   2 90 2 0 998.32 0
61886   3 90 2 0 998.32 0
61886   4 90 2 0 998.32 0
61888   1 10 2 0 508.19 0
61888   2 10 2 0 500.15 0
61888   3 10 2 0 466.92 0
61888   4 10 2 0 461.63 0
62000   1 90 2 0 1,560.41 0
62000   2 90 2 0 2,036.31 0
62000   3 90 2 0 1,454.41 0
62000   4 90 2 0 1,804.00 0
62005   1 90 2 0 2,447.04 0
62005   2 90 2 0 2,409.24 0
62005   3 90 2 0 2,930.76 0
62005   4 90 2 0 2,227.28 0
62010   1 90 2 0 3,622.13 0
62010   2 90 2 0 3,560.40 0
62010   3 90 2 0 3,305.29 0
62010   4 90 2 0 3,453.68 0
62100   1 90 2 0 4,370.10 0
62100   2 90 2 0 4,201.24 0
62100   3 90 2 0 4,077.41 0
62100   4 90 2 0 3,671.96 0
62115   1 90 2 0 7,621.26 0
62115   2 90 2 0 7,621.26 0
62115   3 90 2 0 7,621.26 0
62115   4 90 2 0 7,621.26 0
62117   1 90 2 0 8,891.40 0
62117   2 90 2 0 8,891.40 0
62117   3 90 2 0 8,891.40 0
62117   4 90 2 0 8,891.40 0
62120   1 90 2 0 3,636.47 0
62120   2 90 2 0 3,575.38 0
62120   3 90 2 0 3,323.79 0
62120   4 90 2 0 3,285.26 0
62121   1 90 2 0 3,636.47 0
62121   2 90 2 0 3,575.38 0
62121   3 90 2 0 3,323.79 0
62121   4 90 2 0 3,285.26 0
62140   1 90 2 0 2,654.38 0
62140   2 90 2 0 2,570.98 0
62140   3 90 2 0 2,506.76 0
62140   4 90 2 0 2,519.48 0
62141   1 90 2 0 3,101.00 0
62141   2 90 2 0 2,925.42 0
62141   3 90 2 0 2,809.08 0
62141   4 90 2 0 2,770.86 0
62142   1 90 2 0 3,285.07 0
62142   2 90 2 0 3,266.62 0
62142   3 90 2 0 3,190.38 0
62142   4 90 2 0 2,032.18 0
62143   1 90 2 0 2,013.65 0
62143   2 90 2 0 1,982.19 0
62143   3 90 2 0 1,852.57 0
62143   4 90 2 0 1,831.24 0
62145   1 90 2 0 2,906.81 0
62145   2 90 2 0 4,217.76 0
62145   3 90 2 0 2,678.46 0
62145   4 90 2 0 2,647.55 0
62146   1 90 2 0 2,486.01 0
62146   2 90 2 0 2,446.46 0
62146   3 90 2 0 2,283.58 0
62146   4 90 2 0 2,257.54 0
62147   1 90 2 0 2,982.00 0
62147   2 90 2 0 2,934.58 0
62147   3 90 2 0 2,739.35 0
62147   4 90 2 0 2,708.15 0
62148   1 90 2 0 224.06 0
62148   2 90 2 0 193.98 0
62148   3 90 2 0 193.98 0
62148   4 90 2 0 193.98 0
62160   1 ZZZ 0 0 320.08 0
62160   2 ZZZ 0 0 280.75 0
62160   3 ZZZ 0 0 280.75 0
62160   4 ZZZ 0 0 280.75 0
62161   1 ZZZ 0 0 2,291.02 0
62161   2 ZZZ 0 0 1,998.92 0
62161   3 ZZZ 0 0 1,998.92 0
62161   4 ZZZ 0 0 1,998.92 0