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2018 Workers' Compensation Part B Fee Schedule

66155-67880

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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
66155   1 90 2 0 1,901.71 0
66155   2 90 2 0 1,893.81 0
66155   3 90 2 0 1,860.65 0
66155   4 90 2 0 1,852.88 0
66160   1 90 2 0 1,842.45 0
66160   2 90 2 0 1,833.39 0
66160   3 90 2 0 1,795.49 0
66160   4 90 2 0 1,651.10 0
66170   1 90 2 0 2,188.69 0
66170   2 90 2 0 1,987.26 0
66170   3 90 2 0 1,915.87 0
66170   4 90 2 0 1,924.73 0
66172   1 90 2 0 2,254.38 0
66172   2 90 2 0 2,052.59 0
66172   3 90 2 0 1,979.65 0
66172   4 90 2 0 1,987.92 0
66174   1 90 2 0 1,451.96 0
66174   2 90 2 0 1,309.55 0
66174   3 90 2 0 1,309.55 0
66174   4 90 2 0 1,309.55 0
66175   1 90 2 0 1,705.73 0
66175   2 90 2 0 1,498.04 0
66175   3 90 2 0 1,498.04 0
66175   4 90 2 0 1,498.04 0
66179   1 90 2 0 1,175.10 1416.84
66179   2 90 2 0 1,077.79 1284.41
66179   3 90 2 0 1,077.79 1284.41
66179   4 90 2 0 1,077.79 1284.41
66180   1 90 2 0 2,634.96 0
66180   2 90 2 0 2,600.67 0
66180   3 90 2 0 2,457.29 0
66180   4 90 2 0 2,425.15 0
66183   1 90 2 0 1,456.85 0
66183   2 90 2 0 1,306.49 0
66183   3 90 2 0 1,306.49 0
66183   4 90 2 0 1,306.49 0
66184   1 90 2 0 820.03 1034.76
66184   2 90 2 0 751.03 934.53
66184   3 90 2 0 751.03 934.53
66184   4 90 2 0 751.03 934.53
66185   1 90 2 0 1,567.43 0
66185   2 90 2 0 1,547.36 0
66185   3 90 2 0 1,463.38 0
66185   4 90 2 0 1,444.32 0
66220   1 90 2 0 1,874.61 0
66220   2 90 2 0 1,153.17 0
66220   3 90 2 0 1,097.96 0
66220   4 90 2 0 1,084.51 0
66225   1 90 2 0 2,635.41 0
66225   2 90 2 0 2,259.58 0
66225   3 90 2 0 2,476.26 0
66225   4 90 2 0 2,106.69 0
66250   1 90 2 0 1,133.92 0
66250   2 90 2 0 1,119.74 0
66250   3 90 2 0 1,060.55 0
66250   4 90 2 0 1,046.78 0
66500   1 90 2 0 729.00 0
66500   2 90 2 0 899.99 0
66500   3 90 2 0 680.81 0
66500   4 90 2 0 671.98 0
66505   1 90 2 0 630.90 0
66505   2 90 2 0 623.81 0
66505   3 90 2 0 594.30 0
66505   4 90 2 0 586.96 0
66600   1 90 2 0 1,722.18 0
66600   2 90 2 0 1,721.65 0
66600   3 90 2 0 1,736.67 0
66600   4 90 2 0 1,436.90 0
66605   1 90 2 0 2,381.08 0
66605   2 90 2 0 2,110.02 0
66605   3 90 2 0 2,004.37 0
66605   4 90 2 0 1,979.23 0
66625   1 90 2 0 1,571.27 0
66625   2 90 2 0 1,351.21 0
66625   3 90 2 0 1,419.48 0
66625   4 90 2 0 1,416.39 0
66630   1 90 2 0 1,612.32 0
66630   2 90 2 0 1,366.40 0
66630   3 90 2 0 1,395.30 0
66630   4 90 2 0 1,126.00 0
66635   1 90 2 0 1,643.63 0
66635   2 90 2 0 1,363.07 0
66635   3 90 2 0 1,469.56 0
66635   4 90 2 0 1,462.78 0
66680   1 90 2 0 1,118.62 0
66680   2 90 2 0 1,104.49 0
66680   3 90 2 0 1,065.95 0
66680   4 90 2 0 1,077.83 0
66682   1 90 2 0 1,857.85 0
66682   2 90 2 0 1,839.85 0
66682   3 90 2 0 1,789.72 0
66682   4 90 2 0 1,820.54 0
66700   1 90 2 0 992.37 0
66700   2 90 2 0 924.76 0
66700   3 90 2 0 922.81 0
66700   4 90 2 0 928.74 0
66710   1 90 2 0 1,016.42 0
66710   2 90 2 0 1,002.90 0
66710   3 90 2 0 946.44 0
66710   4 90 2 0 933.93 0
66711   1 90 3 0 873.72 0
66711   2 90 3 0 782.80 0
66711   3 90 3 0 782.80 0
66711   4 90 3 0 782.80 0
66720   1 90 2 0 979.96 0
66720   2 90 2 0 967.15 0
66720   3 90 2 0 913.71 0
66720   4 90 2 0 901.58 0
66740   1 90 2 0 1,006.28 0
66740   2 90 2 0 993.11 0
66740   3 90 2 0 937.80 0
66740   4 90 2 0 925.40 0
66761   1 90 2 0 1,155.61 774.46
66761   2 90 2 0 1,121.96 751.32
66761   3 90 2 0 1,076.69 719.25
66761   4 90 2 0 1,089.19 728.30
66762   1 90 2 0 1,210.53 0
66762   2 90 2 0 1,193.22 0
66762   3 90 2 0 1,120.93 0
66762   4 90 2 0 1,105.45 0
66770   1 90 2 0 1,220.29 0
66770   2 90 2 0 1,213.82 0
66770   3 90 2 0 1,049.07 0
66770   4 90 2 0 1,180.93 0
66820   1 90 2 0 780.12 0
66820   2 90 2 0 967.49 0
66820   3 90 2 0 728.29 0
66820   4 90 2 0 718.74 0
66821   1 90 2 0 776.99 0
66821   2 90 2 0 967.41 0
66821   3 90 2 0 719.10 0
66821   4 90 2 0 709.22 0
66825   1 90 2 0 1,936.38 0
66825   2 90 2 0 1,917.91 0
66825   3 90 2 0 1,865.93 0
66825   4 90 2 0 1,896.04 0
66830   1 90 2 0 1,360.68 0
66830   2 90 2 0 1,344.76 0
66830   3 90 2 0 1,278.28 0
66830   4 90 2 0 1,262.17 0
66840   1 90 2 0 1,775.62 0
66840   2 90 2 0 1,747.37 0
66840   3 90 2 0 1,682.96 0
66840   4 90 2 0 1,471.47 0
66850   1 90 2 0 1,985.12 0
66850   2 90 2 0 1,884.40 0
66850   3 90 2 0 1,834.51 0
66850   4 90 2 0 1,828.35 0
66852   1 90 2 0 2,199.12 0
66852   2 90 2 0 2,169.58 0
66852   3 90 2 0 2,045.89 0
66852   4 90 2 0 2,018.60 0
66920   1 90 2 0 1,900.81 0
66920   2 90 2 0 1,861.50 0
66920   3 90 2 0 1,768.50 0
66920   4 90 2 0 1,738.42 0
66930   1 90 2 0 1,960.55 0
66930   2 90 2 0 1,856.32 0
66930   3 90 2 0 1,776.57 0
66930   4 90 2 0 1,809.48 0
66940   1 90 2 0 1,958.30 0
66940   2 90 2 0 1,871.47 0
66940   3 90 2 0 1,815.52 0
66940   4 90 2 0 1,808.89 0
66982   1 90 2 0 1,682.46 0
66982   2 90 2 0 1,527.84 0
66982   3 90 2 0 1,527.84 0
66982   4 90 2 0 1,527.84 0
66983   1 90 2 0 2,762.25 0
66983   2 90 2 0 2,703.17 0
66983   3 90 2 0 2,552.86 0
66983   4 90 2 0 2,493.40 0
66984   1 90 2 0 2,803.96 0
66984   2 90 2 0 2,762.33 0
66984   3 90 2 0 2,598.92 0
66984   4 90 2 0 2,591.47 0
66985   1 90 2 0 2,022.76 0
66985   2 90 2 0 1,992.71 0
66985   3 90 2 0 1,879.08 0
66985   4 90 2 0 1,860.77 0
66986   1 90 2 0 2,207.66 0
66986   2 90 2 0 2,176.19 0
66986   3 90 2 0 2,056.37 0
66986   4 90 2 0 2,036.12 0
66990   1 90 2 0 151.13 0
66990   2 90 2 0 138.24 0
66990   3 90 2 0 138.24 0
66990   4 90 2 0 138.24 0
66999     YYY 2 0 * 0
67005   1 90 2 0 2,397.23 0
67005   2 90 2 0 2,341.48 0
67005   3 90 2 0 2,232.22 0
67005   4 90 2 0 1,994.03 0
67010   1 90 2 0 2,101.58 0
67010   2 90 2 0 2,276.85 0
67010   3 90 2 0 1,940.38 0
67010   4 90 2 0 1,913.23 0
67015   1 90 2 0 1,082.11 0
67015   2 90 2 0 1,061.15 0
67015   3 90 2 0 1,022.49 0
67015   4 90 2 0 1,072.16 0
67025   1 90 2 0 1,086.18 0
67025   2 90 2 0 1,154.50 0
67025   3 90 2 0 1,090.49 0
67025   4 90 2 0 1,076.62 0
67027   1 90 2 0 1,564.16 0
67027   2 90 2 0 1,406.37 0
67027   3 90 2 0 1,406.37 0
67027   4 90 2 0 1,406.37 0
67028   1 0 2 0 509.13 0
67028   2 0 2 0 502.74 0
67028   3 0 2 0 475.89 0
67028   4 0 2 0 469.71 0
67030   1 90 2 0 1,034.28 0
67030   2 90 2 0 1,005.21 0
67030   3 90 2 0 1,008.47 0
67030   4 90 2 0 1,052.02 0
67031   1 90 2 0 1,459.19 0
67031   2 90 2 0 1,446.23 0
67031   3 90 2 0 1,391.67 0
67031   4 90 2 0 1,380.41 0
67036   1 90 2 0 4,235.98 0
67036   2 90 2 0 4,121.76 0
67036   3 90 2 0 3,873.01 0
67036   4 90 2 0 3,683.52 0
67039   1 90 2 0 3,690.94 0
67039   2 90 2 0 3,638.64 0
67039   3 90 2 0 3,419.42 0
67039   4 90 2 0 3,372.56 0
67040   1 90 2 0 5,403.19 0
67040   2 90 2 0 5,379.19 0
67040   3 90 2 0 4,835.38 0
67040   4 90 2 0 5,053.34 0
67041   1 90 2 0 1,623.40 0
67041   2 90 2 0 1,476.20 0
67041   3 90 2 0 1,476.20 0
67041   4 90 2 0 1,476.20 0
67042   1 90 2 0 1,855.47 0
67042   2 90 2 0 1,690.13 0
67042   3 90 2 0 1,690.13 0
67042   4 90 2 0 1,690.13 0
67043   1 90 2 0 1,949.95 0
67043   2 90 2 0 1,773.93 0
67043   3 90 2 0 1,773.93 0
67043   4 90 2 0 1,773.93 0
67101   1 90 2 0 1,978.03 0
67101   2 90 2 0 1,609.32 0
67101   3 90 2 0 1,912.56 0
67101   4 90 2 0 1,895.96 0
67105   1 90 2 0 2,559.50 0
67105   2 90 2 0 2,130.55 0
67105   3 90 2 0 2,374.03 0
67105   4 90 2 0 2,055.12 0
67107   1 90 2 0 2,946.80 0
67107   2 90 2 0 3,200.37 0
67107   3 90 2 0 3,145.40 0
67107   4 90 2 0 3,135.76 0
67108   1 90 2 0 4,962.48 0
67108   2 90 2 0 4,912.11 0
67108   3 90 2 0 4,499.65 0
67108   4 90 2 0 4,808.59 0
67110   1 90 2 0 2,127.74 0
67110   2 90 2 0 2,097.85 0
67110   3 90 2 0 1,972.22 0
67110   4 90 2 0 1,945.38 0
67113   1 90 2 0 2,142.62 0
67113   2 90 2 0 1,947.89 0
67113   3 90 2 0 1,947.89 0
67113   4 90 2 0 1,947.89 0
67115   1 90 2 0 1,059.58 0
67115   2 90 2 0 1,045.38 0
67115   3 90 2 0 985.82 0
67115   4 90 2 0 972.75 0
67120   1 90 2 0 1,129.71 0
67120   2 90 2 0 1,115.56 0
67120   3 90 2 0 1,056.70 0
67120   4 90 2 0 1,042.97 0
67121   1 90 2 0 1,720.74 0
67121   2 90 2 0 1,547.37 0
67121   3 90 2 0 1,617.73 0
67121   4 90 2 0 1,597.52 0
67141   1 90 2 0 1,319.57 0
67141   2 90 2 0 1,153.89 0
67141   3 90 2 0 1,087.43 0
67141   4 90 2 0 1,072.84 0
67145   1 90 2 0 1,327.95 924.09
67145   2 90 2 0 1,180.73 833.39
67145   3 90 2 0 1,113.00 785.15
67145   4 90 2 0 1,098.11 775.75
67208   1 90 2 0 1,921.37 0
67208   2 90 2 0 1,827.37 0
67208   3 90 2 0 1,881.47 0
67208   4 90 2 0 1,874.19 0
67210   1 90 2 0 1,637.23 1217.84
67210   2 90 2 0 1,739.53 1288.39
67210   3 90 2 0 1,710.38 1270.93
67210   4 90 2 0 1,553.76 1157.84
67218   1 90 2 0 2,413.27 0
67218   2 90 2 0 2,266.60 0
67218   3 90 2 0 2,152.36 0
67218   4 90 2 0 2,125.01 0
67220   1 90 2 0 1,443.47 1438.23
67220   2 90 2 0 1,326.07 1321.62
67220   3 90 2 0 1,326.07 1321.62
67220   4 90 2 0 1,326.07 1321.62
67221   1 0 2 0 657.67 477.60
67221   2 0 2 0 579.04 425.32
67221   3 0 2 0 579.04 425.32
67221   4 0 2 0 579.04 425.32
67225   1 ZZZ 0 0 91.85 88.37
67225   2 ZZZ 0 0 68.12 65.16
67225   3 ZZZ 0 0 68.12 65.16
67225   4 ZZZ 0 0 68.12 65.16
67227   1 90 2 0 1,906.77 0
67227   2 90 2 0 1,470.88 0
67227   3 90 2 0 1,474.96 0
67227   4 90 2 0 1,582.04 0
67228   1 90 2 0 2,186.54 1640.97
67228   2 90 2 0 2,154.05 1616.63
67228   3 90 2 0 2,100.22 1576.55
67228   4 90 2 0 1,652.65 1255.23
67229   1 90 2 0 1,413.42 0
67229   2 90 2 0 1,281.78 0
67229   3 90 2 0 1,281.78 0
67229   4 90 2 0 1,281.78 0
67250   1 90 2 0 1,349.82 0
67250   2 90 2 0 1,334.37 0
67250   3 90 2 0 1,269.99 0
67250   4 90 2 0 1,254.38 0
67255   1 90 2 0 2,067.28 0
67255   2 90 2 0 2,440.85 0
67255   3 90 2 0 1,920.45 0
67255   4 90 2 0 1,894.51 0
67299     YYY 2 0 * 0
67311   1 90 2 0 1,507.64 0
67311   2 90 2 0 1,498.53 0
67311   3 90 2 0 1,386.97 0
67311   4 90 2 0 1,197.74 0
67312   1 90 2 0 1,601.29 0
67312   2 90 2 0 1,577.72 0
67312   3 90 2 0 1,425.29 0
67312   4 90 2 0 1,406.74 0
67314   1 90 2 0 1,656.44 0
67314   2 90 2 0 1,645.15 0
67314   3 90 2 0 1,524.26 0
67314   4 90 2 0 1,258.10 0
67316   1 90 2 0 1,736.96 0
67316   2 90 2 0 1,711.15 0
67316   3 90 2 0 1,620.73 0
67316   4 90 2 0 1,599.31 0
67318   1 90 2 0 1,459.45 0
67318   2 90 2 0 1,451.73 0
67318   3 90 2 0 1,346.02 0
67318   4 90 2 0 1,114.07 0
67320   1 90 2 0 1,756.36 0
67320   2 90 2 0 1,733.38 0
67320   3 90 2 0 1,637.12 0
67320   4 90 2 0 1,615.66 0
67331   1 90 2 0 1,613.64 0
67331   2 90 2 0 1,605.41 0
67331   3 90 2 0 1,458.66 0
67331   4 90 2 0 1,439.64 0
67332   1 90 2 0 1,913.60 0
67332   2 90 2 0 1,904.48 0
67332   3 90 2 0 1,620.73 0
67332   4 90 2 0 1,599.58 0
67334   1 90 2 0 1,214.52 0
67334   2 90 2 0 1,200.79 0
67334   3 90 2 0 1,143.88 0
67334   4 90 2 0 1,129.84 0
67335   1 ZZZ 0 0 830.71 0
67335   2 ZZZ 0 0 818.21 0
67335   3 ZZZ 0 0 765.98 0
67335   4 ZZZ 0 0 755.17 0
67340   1 90 2 0 1,519.28 0
67340   2 90 2 0 1,502.19 0
67340   3 90 2 0 1,431.12 0
67340   4 90 2 0 1,413.48 0
67343   1 90 2 0 1,124.92 0
67343   2 90 2 0 1,112.24 0
67343   3 90 2 0 1,059.37 0
67343   4 90 2 0 1,046.35 0
67345   1 10 2 0 466.77 0
67345   2 10 2 0 460.44 0
67345   3 10 2 0 434.57 0
67345   4 10 2 0 429.40 0
67346   1 0 2 0 259.42 0
67346   2 0 2 0 231.75 0
67346   3 0 2 0 231.75 0
67346   4 0 2 0 231.75 0
67399     YYY 2 0 * 0
67400   1 90 2 0 1,951.86 0
67400   2 90 2 0 1,942.58 0
67400   3 90 2 0 1,854.92 0
67400   4 90 2 0 1,864.82 0
67405   1 90 2 0 1,517.89 0
67405   2 90 2 0 1,497.56 0
67405   3 90 2 0 1,485.29 0
67405   4 90 2 0 1,394.63 0
67412   1 90 2 0 2,045.62 0
67412   2 90 2 0 2,035.69 0
67412   3 90 2 0 1,728.01 0
67412   4 90 2 0 1,984.86 0
67413   1 90 2 0 1,583.69 0
67413   2 90 2 0 1,788.75 0
67413   3 90 2 0 1,485.64 0
67413   4 90 2 0 1,725.93 0
67414   1 90 2 0 1,617.64 0
67414   2 90 2 0 1,599.46 0
67414   3 90 2 0 1,523.62 0
67414   4 90 2 0 1,504.87 0
67415   1 0 2 0 394.12 0
67415   2 0 2 0 392.34 0
67415   3 0 2 0 385.01 0
67415   4 0 2 0 383.31 0
67420   1 90 2 0 3,335.81 0
67420   2 90 2 0 3,255.70 0
67420   3 90 2 0 2,511.36 0
67420   4 90 2 0 2,478.93 0
67430   1 90 2 0 2,053.45 0
67430   2 90 2 0 2,030.41 0
67430   3 90 2 0 1,934.41 0
67430   4 90 2 0 1,910.61 0
67440   1 90 2 0 3,063.38 0
67440   2 90 2 0 3,049.69 0
67440   3 90 2 0 2,355.02 0
67440   4 90 2 0 2,324.43 0
67445   1 90 2 0 2,145.99 0
67445   2 90 2 0 2,121.87 0
67445   3 90 2 0 2,021.33 0
67445   4 90 2 0 1,996.53 0
67450   1 90 2 0 2,488.94 0
67450   2 90 2 0 2,196.09 0
67450   3 90 2 0 2,173.51 0
67450   4 90 2 0 1,984.74 0
67500   1 0 2 0 241.62 0
67500   2 0 2 0 210.53 0
67500   3 0 2 0 204.58 0
67500   4 0 2 0 229.82 0
67505   1 0 2 0 271.87 199.44
67505   2 0 2 0 266.96 195.76
67505   3 0 2 0 236.83 173.86
67505   4 0 2 0 266.23 195.89
67515   1 0 2 0 108.51 83.27
67515   2 0 2 0 133.89 103.12
67515   3 0 2 0 134.79 103.76
67515   4 0 2 0 142.41 109.89
67550   1 90 2 0 1,725.02 0
67550   2 90 2 0 1,703.16 0
67550   3 90 2 0 1,612.21 0
67550   4 90 2 0 1,592.09 0
67560   1 90 2 0 1,619.03 0
67560   2 90 2 0 2,093.77 0
67560   3 90 2 0 1,523.13 0
67560   4 90 2 0 2,053.51 0
67570   1 90 2 0 1,748.50 0
67570   2 90 2 0 1,730.41 0
67570   3 90 2 0 1,655.41 0
67570   4 90 2 0 1,635.89 0
67599     YYY 2 0 * 0
67700   1 10 2 0 158.82 137.56
67700   2 10 2 0 153.84 133.19
67700   3 10 2 0 147.81 128.32
67700   4 10 2 0 146.16 127.00
67710   1 10 2 0 175.03 0
67710   2 10 2 0 172.91 0
67710   3 10 2 0 163.98 0
67710   4 10 2 0 161.92 0
67715   1 10 2 0 292.24 0
67715   2 10 2 0 284.77 0
67715   3 10 2 0 298.92 0
67715   4 10 2 0 218.03 0
67800   1 10 2 0 200.58 160.81
67800   2 10 2 0 198.36 159.09
67800   3 10 2 0 175.29 140.87
67800   4 10 2 0 163.81 132.42
67801   1 10 2 0 284.70 225.68
67801   2 10 2 0 281.49 223.24
67801   3 10 2 0 268.27 213.30
67801   4 10 2 0 265.05 210.97
67805   1 10 2 0 310.64 0
67805   2 10 2 0 307.27 0
67805   3 10 2 0 293.48 0
67805   4 10 2 0 290.02 0
67808   1 90 2 0 475.49 0
67808   2 90 2 0 472.46 0
67808   3 90 2 0 457.74 0
67808   4 90 2 0 464.16 0
67810   1 0 2 0 200.58 166.21
67810   2 0 2 0 198.41 164.59
67810   3 0 2 0 189.77 157.81
67810   4 0 2 0 187.58 156.18
67820   1 0 2 0 97.28 83.18
67820   2 0 2 0 96.49 82.47
67820   3 0 2 0 88.96 76.22
67820   4 0 2 0 90.87 78.17
67825   1 10 2 0 245.53 197.34
67825   2 10 2 0 192.60 154.94
67825   3 10 2 0 183.82 148.39
67825   4 10 2 0 205.01 165.30
67830   1 10 2 0 875.84 0
67830   2 10 2 0 845.67 0
67830   3 10 2 0 820.02 0
67830   4 10 2 0 359.78 0
67835   1 90 2 0 1,328.41 0
67835   2 90 2 0 1,154.74 0
67835   3 90 2 0 1,090.58 0
67835   4 90 2 0 1,241.72 0
67840   1 10 2 0 395.39 322.55
67840   2 10 2 0 375.12 306.45
67840   3 10 2 0 299.88 245.58
67840   4 10 2 0 261.68 214.53
67850   1 10 2 0 175.87 147.76
67850   2 10 2 0 167.69 140.83
67850   3 10 2 0 157.73 132.59
67850   4 10 2 0 158.32 132.95
67875   1 0 2 0 286.06 0
67875   2 0 2 0 282.17 0
67875   3 0 2 0 266.06 0
67875   4 0 2 0 262.61 0
67880   1 90 2 0 884.81 0
67880   2 90 2 0 698.88 0
67880   3 90 2 0 665.82 0
67880   4 90 2 0 658.56 0