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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
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Fee Schedule
>
Fee Schedule 61521-62161
Begin Main Content Area
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Content Editor
2024 Workers' Compensation Part B Fee Schedule
61521-62161
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
61521
003
90
2
X
8,174.07
X
61521
002
90
2
X
8,762.17
X
61521
004
90
2
X
8,752.82
X
61521
001
90
2
X
9,099.43
X
61522
004
90
2
X
5,300.47
X
61522
001
90
2
X
5,830.59
X
61522
003
90
2
X
5,361.68
X
61522
002
90
2
X
5,739.06
X
61524
003
90
2
X
6,108.25
X
61524
002
90
2
X
6,593.76
X
61524
004
90
2
X
6,035.63
X
61524
001
90
2
X
6,711.36
X
61526
002
90
2
X
8,788.29
X
61526
003
90
2
X
7,129.26
X
61526
004
90
2
X
7,041.65
X
61526
001
90
2
X
8,840.69
X
61530
001
90
2
X
7,770.79
X
61530
003
90
2
X
7,129.26
X
61530
002
90
2
X
7,646.00
X
61530
004
90
2
X
7,041.65
X
61531
001
90
2
X
4,174.16
X
61531
004
90
2
X
3,843.70
X
61531
003
90
2
X
3,889.48
X
61531
002
90
2
X
4,118.83
X
61533
001
90
2
X
4,980.01
X
61533
003
90
2
X
4,574.03
X
61533
002
90
2
X
4,900.67
X
61533
004
90
2
X
4,521.98
X
61534
001
90
2
X
3,125.81
X
61534
004
90
2
X
2,864.35
X
61534
003
90
2
X
2,893.86
X
61534
002
90
2
X
4,138.00
X
61535
001
90
2
X
2,165.39
X
61535
004
90
2
X
1,975.99
X
61535
003
90
2
X
1,999.17
X
61535
002
90
2
X
2,133.01
X
61536
001
90
2
X
6,287.73
X
61536
004
90
2
X
5,719.32
X
61536
002
90
2
X
6,189.80
X
61536
003
90
2
X
5,785.76
X
61537
001
90
2
X
4,085.02
X
61537
002
90
2
X
3,526.71
X
61537
003
90
2
X
3,526.71
X
61537
004
90
2
X
3,526.71
X
61538
001
90
2
X
7,081.35
X
61538
004
90
2
X
6,392.45
X
61538
003
90
2
X
6,469.83
X
61538
002
90
2
X
6,961.69
X
61539
002
90
2
X
6,379.16
X
61539
003
90
2
X
5,963.16
X
61539
001
90
2
X
6,480.13
X
61539
004
90
2
X
5,894.40
X
61540
001
90
2
X
4,936.85
X
61540
004
90
2
X
4,255.53
X
61540
003
90
2
X
4,255.53
X
61540
002
90
2
X
4,255.53
X
61541
002
90
2
X
5,654.76
X
61541
003
90
2
X
5,280.44
X
61541
001
90
2
X
5,945.89
X
61541
004
90
2
X
5,220.11
X
61543
001
90
2
X
4,558.00
X
61543
004
90
2
X
4,161.07
X
61543
003
90
2
X
4,210.75
X
61543
002
90
2
X
4,490.35
X
61544
004
90
2
X
5,541.59
X
61544
003
90
2
X
5,613.26
X
61544
002
90
2
X
5,948.01
X
61544
001
90
2
X
6,028.35
X
61545
003
90
2
X
6,787.56
X
61545
002
90
2
X
7,266.75
X
61545
001
90
2
X
7,382.97
X
61545
004
90
2
X
6,709.73
X
61546
001
90
2
X
7,296.82
X
61546
004
90
2
X
6,299.48
X
61546
003
90
2
X
7,023.39
X
61546
002
90
2
X
7,221.92
X
61548
003
90
2
X
7,462.52
X
61548
002
90
2
X
7,568.57
X
61548
004
90
2
X
7,198.79
X
61548
001
90
2
X
6,013.56
X
61550
001
90
2
X
3,034.63
X
61550
004
90
2
X
2,798.89
X
61550
002
90
2
X
2,995.44
X
61550
003
90
2
X
2,832.98
X
61552
004
90
2
X
3,672.70
X
61552
002
90
2
X
4,844.56
X
61552
003
90
2
X
3,715.03
X
61552
001
90
2
X
4,044.36
X
61556
001
90
2
X
6,240.04
X
61556
004
90
2
X
6,240.04
X
61556
002
90
2
X
6,240.04
X
61556
003
90
2
X
6,240.04
X
61557
003
90
2
X
9,360.10
X
61557
002
90
2
X
9,360.10
X
61557
004
90
2
X
9,360.10
X
61557
001
90
2
X
9,360.10
X
61558
001
90
2
X
5,556.90
X
61558
004
90
2
X
4,980.86
X
61558
002
90
2
X
5,390.59
X
61558
003
90
2
X
5,047.76
X
61559
004
90
2
X
6,459.18
X
61559
001
90
2
X
7,206.19
X
61559
003
90
2
X
6,545.95
X
61559
002
90
2
X
6,990.46
X
61563
004
90
2
X
9,031.65
X
61563
001
90
2
X
9,031.65
X
61563
002
90
2
X
9,031.65
X
61563
003
90
2
X
9,031.65
X
61564
002
90
2
X
11,494.80
X
61564
003
90
2
X
11,494.80
X
61564
004
90
2
X
11,494.80
X
61564
001
90
2
X
11,494.80
X
61566
002
90
2
X
4,235.82
X
61566
003
90
2
X
4,235.82
X
61566
004
90
2
X
4,235.82
X
61566
001
90
2
X
4,844.60
X
61567
002
90
2
X
4,849.81
X
61567
003
90
2
X
4,849.81
X
61567
001
90
2
X
5,510.67
X
61567
004
90
2
X
4,849.81
X
61570
002
90
2
X
4,743.02
X
61570
003
90
2
X
4,733.67
X
61570
004
90
2
X
4,383.86
X
61570
001
90
2
X
5,056.30
X
61571
004
90
2
X
4,758.75
X
61571
001
90
2
X
5,226.15
X
61571
003
90
2
X
4,814.18
X
61571
002
90
2
X
5,145.80
X
61575
001
90
2
X
7,990.66
X
61575
004
90
2
X
7,243.65
X
61575
002
90
2
X
7,862.42
X
61575
003
90
2
X
7,673.22
X
61576
001
90
2
X
7,440.58
X
61576
004
90
2
X
6,801.07
X
61576
003
90
2
X
6,882.56
X
61576
002
90
2
X
7,331.89
X
61580
004
90
2
X
5,580.64
X
61580
001
90
2
X
6,145.41
X
61580
003
90
2
X
5,644.92
X
61580
002
90
2
X
6,047.66
X
61581
004
90
2
X
6,333.70
X
61581
001
90
2
X
6,974.70
X
61581
002
90
2
X
6,863.79
X
61581
003
90
2
X
6,406.76
X
61582
004
90
2
X
5,749.22
X
61582
001
90
2
X
6,330.73
X
61582
002
90
2
X
6,230.14
X
61582
003
90
2
X
5,815.47
X
61583
004
90
2
X
6,560.64
X
61583
002
90
2
X
7,109.69
X
61583
003
90
2
X
6,636.25
X
61583
001
90
2
X
7,224.62
X
61584
003
90
2
X
6,426.47
X
61584
002
90
2
X
6,885.10
X
61584
001
90
2
X
6,996.45
X
61584
004
90
2
X
6,353.21
X
61585
002
90
2
X
7,702.33
X
61585
003
90
2
X
7,189.26
X
61585
001
90
2
X
7,826.92
X
61585
004
90
2
X
7,107.41
X
61586
001
90
2
X
5,410.08
X
61586
002
90
2
X
4,907.31
X
61586
003
90
2
X
4,775.40
X
61586
004
90
2
X
4,775.40
X
61590
002
90
2
X
8,375.08
X
61590
003
90
2
X
7,817.70
X
61590
004
90
2
X
7,728.69
X
61590
001
90
2
X
8,510.35
X
61591
004
90
2
X
8,106.74
X
61591
001
90
2
X
8,927.25
X
61591
002
90
2
X
8,785.30
X
61591
003
90
2
X
8,200.14
X
61592
004
90
2
X
7,352.60
X
61592
003
90
2
X
7,437.34
X
61592
002
90
2
X
7,967.98
X
61592
001
90
2
X
8,096.81
X
61595
001
90
2
X
5,980.06
X
61595
004
90
2
X
5,430.39
X
61595
002
90
2
X
5,884.94
X
61595
003
90
2
X
5,492.99
X
61596
004
90
2
X
6,599.48
X
61596
002
90
2
X
7,151.83
X
61596
003
90
2
X
6,675.51
X
61596
001
90
2
X
7,267.38
X
61597
002
90
2
X
7,559.42
X
61597
003
90
2
X
7,055.96
X
61597
001
90
2
X
7,681.52
X
61597
004
90
2
X
6,975.50
X
61598
004
90
2
X
6,145.78
X
61598
002
90
2
X
6,660.02
X
61598
003
90
2
X
6,216.58
X
61598
001
90
2
X
6,767.68
X
61600
001
90
2
X
5,189.65
X
61600
002
90
2
X
5,107.13
X
61600
003
90
2
X
4,767.29
X
61600
004
90
2
X
4,713.02
X
61601
001
90
2
X
5,564.82
X
61601
004
90
2
X
5,053.34
X
61601
002
90
2
X
5,476.30
X
61601
003
90
2
X
5,111.55
X
61605
003
90
2
X
5,396.86
X
61605
002
90
2
X
5,781.95
X
61605
001
90
2
X
5,875.43
X
61605
004
90
2
X
5,335.36
X
61606
004
90
2
X
7,145.13
X
61606
001
90
2
X
7,868.00
X
61606
002
90
2
X
7,742.94
X
61606
003
90
2
X
7,227.48
X
61607
001
90
2
X
7,349.30
X
61607
002
90
2
X
7,232.39
X
61607
003
90
2
X
6,750.95
X
61607
004
90
2
X
6,674.05
X
61608
004
90
2
X
7,766.47
X
61608
001
90
2
X
8,552.14
X
61608
003
90
2
X
7,855.96
X
61608
002
90
2
X
8,416.17
X
61611
002
ZZZ
0
X
1,224.78
X
61611
003
ZZZ
0
X
1,143.24
X
61611
001
ZZZ
0
X
1,244.56
X
61611
004
ZZZ
0
X
1,130.25
X
61613
003
90
2
X
7,704.05
X
61613
002
90
2
X
8,253.92
X
61613
004
90
2
X
7,616.27
X
61613
001
90
2
X
8,387.34
X
61615
003
90
2
X
5,931.28
X
61615
002
90
2
X
6,354.38
X
61615
004
90
2
X
5,863.66
X
61615
001
90
2
X
6,457.05
X
61616
003
90
2
X
8,066.86
X
61616
002
90
2
X
8,642.26
X
61616
004
90
2
X
7,974.94
X
61616
001
90
2
X
8,781.93
X
61618
002
90
2
X
3,267.89
X
61618
003
90
2
X
3,050.39
X
61618
004
90
2
X
3,015.62
X
61618
001
90
2
X
3,320.70
X
61619
002
90
2
X
4,085.14
X
61619
003
90
2
X
3,813.25
X
61619
004
90
2
X
3,769.84
X
61619
001
90
2
X
4,151.09
X
61623
003
0
2
X
1,156.22
X
61623
002
0
2
X
1,156.22
X
61623
001
0
2
X
1,266.23
X
61623
004
0
2
X
1,156.22
X
61624
003
0
2
X
3,637.12
X
61624
002
0
2
X
3,854.28
X
61624
001
0
2
X
3,906.87
X
61624
004
0
2
X
3,594.09
X
61626
001
0
2
X
3,221.44
X
61626
004
0
2
X
2,963.73
X
61626
002
0
2
X
3,178.22
X
61626
003
0
2
X
2,999.16
X
61630
XXX
2
X
*
X
61635
XXX
2
X
*
X
61640
0
9
X
*
X
61641
ZZZ
9
X
*
X
61642
ZZZ
9
X
*
X
61645
003
0
0
X
1,217.85
X
61645
002
0
0
X
1,217.85
X
61645
001
0
0
X
1,320.64
X
61645
004
0
0
X
1,217.85
X
61650
001
0
2
X
878.90
X
61650
003
0
2
X
811.72
X
61650
002
0
2
X
811.72
X
61650
004
0
2
X
811.72
X
61651
004
ZZZ
0
X
344.76
X
61651
003
ZZZ
0
X
344.76
X
61651
002
ZZZ
0
X
344.76
X
61651
001
ZZZ
0
X
373.27
X
61680
002
90
2
X
8,216.26
X
61680
003
90
2
X
7,650.94
X
61680
004
90
2
X
7,561.94
X
61680
001
90
2
X
8,353.36
X
61682
003
90
2
X
8,755.41
X
61682
001
90
2
X
9,542.95
X
61682
004
90
2
X
8,653.44
X
61682
002
90
2
X
9,389.34
X
61684
002
90
2
X
8,020.20
X
61684
003
90
2
X
7,568.81
X
61684
004
90
2
X
7,479.39
X
61684
001
90
2
X
8,129.27
X
61686
001
90
2
X
9,828.97
X
61686
004
90
2
X
9,042.79
X
61686
003
90
2
X
9,150.97
X
61686
002
90
2
X
9,696.99
X
61690
002
90
2
X
7,278.85
X
61690
003
90
2
X
6,824.96
X
61690
004
90
2
X
6,744.68
X
61690
001
90
2
X
7,388.72
X
61692
002
90
2
X
7,757.79
X
61692
003
90
2
X
7,320.96
X
61692
004
90
2
X
7,234.45
X
61692
001
90
2
X
7,863.30
X
61697
001
90
2
X
8,408.49
X
61697
003
90
2
X
7,345.03
X
61697
002
90
2
X
7,345.03
X
61697
004
90
2
X
7,345.03
X
61698
001
90
2
X
8,096.28
X
61698
003
90
2
X
7,067.47
X
61698
002
90
2
X
7,067.47
X
61698
004
90
2
X
7,067.47
X
61700
003
90
2
X
7,529.70
X
61700
002
90
2
X
8,088.81
X
61700
001
90
2
X
8,252.16
X
61700
004
90
2
X
7,438.09
X
61702
004
90
2
X
8,463.64
X
61702
001
90
2
X
9,364.79
X
61702
003
90
2
X
8,564.42
X
61702
002
90
2
X
9,208.69
X
61703
004
90
2
X
3,172.64
X
61703
001
90
2
X
3,489.46
X
61703
002
90
2
X
3,434.81
X
61703
003
90
2
X
3,209.45
X
61705
002
90
2
X
7,848.86
X
61705
003
90
2
X
7,446.57
X
61705
001
90
2
X
7,977.24
X
61705
004
90
2
X
7,232.82
X
61708
004
90
2
X
6,304.48
X
61708
002
90
2
X
6,712.60
X
61708
003
90
2
X
6,380.60
X
61708
001
90
2
X
6,818.75
X
61710
002
90
2
X
5,127.25
X
61710
003
90
2
X
4,868.23
X
61710
004
90
2
X
4,812.16
X
61710
001
90
2
X
5,591.20
X
61711
003
90
2
X
7,702.51
X
61711
002
90
2
X
7,609.22
X
61711
004
90
2
X
7,611.88
X
61711
001
90
2
X
7,861.33
X
61720
001
90
2
X
6,253.71
X
61720
003
90
2
X
4,418.41
X
61720
002
90
2
X
6,365.26
X
61720
004
90
2
X
4,363.99
X
61735
001
90
2
X
3,538.44
X
61735
004
90
2
X
3,255.46
X
61735
003
90
2
X
3,294.38
X
61735
002
90
2
X
4,391.13
X
61736
002
0
0
X
1,091.04
X
61736
003
0
0
X
1,091.04
X
61736
001
0
0
X
1,169.70
X
61736
004
0
0
X
1,091.04
X
61737
004
0
0
X
1,299.34
X
61737
001
0
0
X
1,394.11
X
61737
002
0
0
X
1,299.34
X
61737
003
0
0
X
1,299.34
X
61750
001
90
2
X
5,617.32
X
61750
003
90
2
X
5,426.76
X
61750
002
90
2
X
5,580.20
X
61750
004
90
2
X
5,407.25
X
61751
004
90
2
X
5,873.64
X
61751
001
90
2
X
6,087.49
X
61751
002
90
2
X
6,064.96
X
61751
003
90
2
X
5,897.10
X
61760
003
90
2
X
4,349.24
X
61760
002
90
2
X
4,589.78
X
61760
004
90
2
X
4,299.24
X
61760
001
90
2
X
4,647.99
X
61770
004
90
2
X
3,899.89
X
61770
002
90
2
X
4,831.23
X
61770
003
90
2
X
3,947.94
X
61770
001
90
2
X
5,044.98
X
61781
001
ZZZ
0
X
482.48
X
61781
004
ZZZ
0
X
424.83
X
61781
003
ZZZ
0
X
424.83
X
61781
002
ZZZ
0
X
424.83
X
61782
003
ZZZ
0
X
347.50
X
61782
002
ZZZ
0
X
347.50
X
61782
001
ZZZ
0
X
390.51
X
61782
004
ZZZ
0
X
347.50
X
61783
002
ZZZ
0
X
424.83
X
61783
003
ZZZ
0
X
424.83
X
61783
001
ZZZ
0
X
482.48
X
61783
004
ZZZ
0
X
424.83
X
61790
004
90
2
X
4,445.00
X
61790
001
90
2
X
4,601.80
X
61790
003
90
2
X
4,460.67
X
61790
002
90
2
X
4,310.19
X
61791
004
90
2
X
4,170.07
X
61791
002
90
2
X
4,295.84
X
61791
003
90
2
X
2,614.33
X
61791
001
90
2
X
4,322.85
X
61796
004
90
0
X
1,290.15
X
61796
002
90
0
X
1,290.15
X
61796
003
90
0
X
1,290.15
X
61796
001
90
0
X
1,468.75
X
61797
001
ZZZ
0
X
398.40
X
61797
003
ZZZ
0
X
355.02
X
61797
002
ZZZ
0
X
355.02
X
61797
004
ZZZ
0
X
355.02
X
61798
004
90
0
X
1,290.15
X
61798
001
90
0
X
1,468.75
X
61798
003
90
0
X
1,290.15
X
61798
002
90
0
X
1,290.15
X
61799
001
ZZZ
0
X
551.00
X
61799
004
ZZZ
0
X
490.89
X
61799
003
ZZZ
0
X
490.89
X
61799
002
ZZZ
0
X
490.89
X
61800
001
ZZZ
0
X
285.76
X
61800
004
ZZZ
0
X
251.38
X
61800
003
ZZZ
0
X
251.38
X
61800
002
ZZZ
0
X
251.38
X
61850
002
90
2
X
2,987.33
X
61850
003
90
2
X
3,122.72
X
61850
004
90
2
X
3,087.13
X
61850
001
90
2
X
3,399.27
X
61860
004
90
2
X
2,162.42
X
61860
003
90
2
X
2,187.32
X
61860
002
90
2
X
2,343.37
X
61860
001
90
2
X
2,381.27
X
61863
001
90
2
X
2,931.65
X
61863
004
90
2
X
2,537.80
X
61863
003
90
2
X
2,537.80
X
61863
002
90
2
X
2,537.80
X
61864
002
ZZZ
0
X
608.71
X
61864
003
ZZZ
0
X
608.71
X
61864
001
ZZZ
0
X
703.22
X
61864
004
ZZZ
0
X
608.71
X
61867
001
90
2
X
4,360.34
X
61867
003
90
2
X
3,882.75
X
61867
002
90
2
X
3,882.75
X
61867
004
90
2
X
3,882.75
X
61868
001
ZZZ
0
X
1,149.87
X
61868
003
ZZZ
0
X
1,022.09
X
61868
002
ZZZ
0
X
1,022.09
X
61868
004
ZZZ
0
X
1,022.09
X
61880
004
90
2
X
1,151.30
X
61880
003
90
2
X
1,165.15
X
61880
002
90
2
X
1,587.33
X
61880
001
90
2
X
1,259.72
X
61885
001
90
2
X
1,347.89
X
61885
003
90
2
X
479.93
X
61885
002
90
2
X
511.90
X
61885
004
90
2
X
474.25
X
61886
002
90
2
X
1,290.63
X
61886
003
90
2
X
1,290.63
X
61886
001
90
2
X
1,473.64
X
61886
004
90
2
X
1,290.63
X
61888
003
10
2
X
603.64
X
61888
002
10
2
X
646.60
X
61888
001
10
2
X
657.00
X
61888
004
10
2
X
596.80
X
61889
004
90
2
X
1,358.55
X
61889
001
90
2
X
1,463.44
X
61889
003
90
2
X
1,358.55
X
61889
002
90
2
X
1,358.55
X
61891
004
90
2
X
642.35
X
61891
001
90
2
X
695.10
X
61891
003
90
2
X
642.35
X
61891
002
90
2
X
642.35
X
61892
004
90
2
X
885.06
X
61892
002
90
2
X
885.06
X
61892
003
90
2
X
885.06
X
61892
001
90
2
X
958.00
X
62000
002
90
2
X
2,632.55
X
62000
003
90
2
X
1,880.26
X
62000
001
90
2
X
2,017.31
X
62000
004
90
2
X
2,332.20
X
62005
001
90
2
X
3,163.53
X
62005
004
90
2
X
2,879.43
X
62005
003
90
2
X
3,788.89
X
62005
002
90
2
X
3,114.65
X
62010
003
90
2
X
4,273.08
X
62010
002
90
2
X
4,602.88
X
62010
004
90
2
X
4,464.92
X
62010
001
90
2
X
4,682.69
X
62100
004
90
2
X
4,747.12
X
62100
002
90
2
X
5,431.37
X
62100
003
90
2
X
5,271.28
X
62100
001
90
2
X
5,649.66
X
62115
003
90
2
X
9,852.77
X
62115
002
90
2
X
9,852.77
X
62115
004
90
2
X
9,852.77
X
62115
001
90
2
X
9,852.77
X
62117
002
90
2
X
11,494.80
X
62117
003
90
2
X
11,494.80
X
62117
001
90
2
X
11,494.80
X
62117
004
90
2
X
11,494.80
X
62120
002
90
2
X
4,622.26
X
62120
003
90
2
X
4,297.01
X
62120
001
90
2
X
4,701.23
X
62120
004
90
2
X
4,247.19
X
62121
004
90
2
X
4,247.19
X
62121
001
90
2
X
4,701.23
X
62121
003
90
2
X
4,297.01
X
62121
002
90
2
X
4,622.26
X
62140
002
90
2
X
3,323.76
X
62140
003
90
2
X
3,240.75
X
62140
004
90
2
X
3,257.19
X
62140
001
90
2
X
3,431.57
X
62141
003
90
2
X
3,631.59
X
62141
001
90
2
X
4,008.96
X
62141
002
90
2
X
3,781.97
X
62141
004
90
2
X
3,582.16
X
62142
004
90
2
X
2,627.22
X
62142
001
90
2
X
4,246.94
X
62142
003
90
2
X
4,124.54
X
62142
002
90
2
X
4,223.09
X
62143
001
90
2
X
2,603.24
X
62143
004
90
2
X
2,367.44
X
62143
003
90
2
X
2,395.01
X
62143
002
90
2
X
2,562.57
X
62145
002
90
2
X
5,452.73
X
62145
003
90
2
X
3,462.71
X
62145
004
90
2
X
3,422.75
X
62145
001
90
2
X
3,757.93
X
62146
002
90
2
X
3,162.78
X
62146
003
90
2
X
2,952.21
X
62146
004
90
2
X
2,918.54
X
62146
001
90
2
X
3,213.91
X
62147
001
90
2
X
3,855.14
X
62147
004
90
2
X
3,501.10
X
62147
003
90
2
X
3,541.43
X
62147
002
90
2
X
3,793.84
X
62148
004
ZZZ
0
X
250.76
X
62148
002
ZZZ
0
X
250.76
X
62148
001
ZZZ
0
X
289.66
X
62148
003
ZZZ
0
X
250.76
X
62160
003
ZZZ
0
X
362.95
X
62160
002
ZZZ
0
X
362.95
X
62160
004
ZZZ
0
X
362.95
X
62160
001
ZZZ
0
X
413.81
X
62161
002
90
2
X
2,584.21
X
62161
003
90
2
X
2,584.21
X
62161
004
90
2
X
2,584.21
X
62161
001
90
2
X
2,961.84
X
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