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Individuals
Individuals
Unemployment Benefits
Disability Services
Find A Job
Workers' Compensation Services
Workforce Development
PennSERVE
Individual Services
Uniform Construction Code
Labor Management Relations
Misclassified Workers
Businesses
Businesses
Employer UC Info
Finding Skilled Workers
Disability Services
Workforce Development
Workers' Compensation Services
Labor-Management Relations
Pennsylvania Business One-Stop
State Workers' Insurance Fund
Employer Services
About L&I
About L&I
Equal Opportunity
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Councils and Committees
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Health Care Services Review
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Medical Fee Review
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Fee Schedule
>
Fee Schedule 70460-71111
Begin Main Content Area
Page Content
2021 Workers' Compensation Part B Fee Schedule
70460-71111
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
70460
26
4
XXX
0
X
156.19
X
70460
26
3
XXX
0
X
159.77
X
70460
26
2
XXX
0
X
166.92
X
70460
26
1
XXX
0
X
167.49
X
70460
TC
4
XXX
0
X
460.75
X
70460
TC
3
XXX
0
X
468.21
X
70460
TC
2
XXX
0
X
507.78
X
70460
TC
1
XXX
0
X
517.13
X
70460
4
XXX
0
X
602.54
X
70460
3
XXX
0
X
611.56
X
70460
2
XXX
0
X
658.97
X
70460
1
XXX
0
X
670.29
X
70470
26
4
XXX
0
X
175.58
X
70470
26
3
XXX
0
X
180.00
X
70470
26
2
XXX
0
X
188.18
X
70470
26
1
XXX
0
X
188.76
X
70470
TC
4
XXX
0
X
575.15
X
70470
TC
3
XXX
0
X
584.40
X
70470
TC
2
XXX
0
X
633.57
X
70470
TC
1
XXX
0
X
645.15
X
70470
4
XXX
0
X
734.10
X
70470
3
XXX
0
X
745.21
X
70470
2
XXX
0
X
803.14
X
70470
1
XXX
0
X
816.95
X
70480
26
4
XXX
0
X
177.29
X
70480
26
3
XXX
0
X
181.96
X
70480
26
2
XXX
0
X
189.83
X
70480
26
1
XXX
0
X
190.43
X
70480
TC
4
XXX
0
X
384.51
X
70480
TC
3
XXX
0
X
390.70
X
70480
TC
2
XXX
0
X
423.65
X
70480
TC
1
XXX
0
X
431.41
X
70480
4
XXX
0
X
545.10
X
70480
3
XXX
0
X
563.43
X
70480
2
XXX
0
X
594.90
X
70480
1
XXX
0
X
604.90
X
70481
26
4
XXX
0
X
190.60
X
70481
26
3
XXX
0
X
195.66
X
70481
26
2
XXX
0
X
204.24
X
70481
26
1
XXX
0
X
204.89
X
70481
TC
4
XXX
0
X
460.75
X
70481
TC
3
XXX
0
X
468.21
X
70481
TC
2
XXX
0
X
507.78
X
70481
TC
1
XXX
0
X
517.13
X
70481
4
XXX
0
X
633.76
X
70481
3
XXX
0
X
653.54
X
70481
2
XXX
0
X
691.93
X
70481
1
XXX
0
X
703.52
X
70482
26
4
XXX
0
X
200.25
X
70482
26
3
XXX
0
X
205.81
X
70482
26
2
XXX
0
X
214.80
X
70482
26
1
XXX
0
X
215.42
X
70482
TC
4
XXX
0
X
575.15
X
70482
TC
3
XXX
0
X
584.40
X
70482
TC
2
XXX
0
X
633.57
X
70482
TC
1
XXX
0
X
645.15
X
70482
4
XXX
0
X
757.07
X
70482
3
XXX
0
X
768.40
X
70482
2
XXX
0
X
827.50
X
70482
1
XXX
0
X
841.58
X
70486
26
4
XXX
0
X
158.76
X
70486
26
3
XXX
0
X
161.20
X
70486
26
2
XXX
0
X
168.23
X
70486
26
1
XXX
0
X
168.72
X
70486
TC
4
XXX
0
X
384.51
X
70486
TC
3
XXX
0
X
390.70
X
70486
TC
2
XXX
0
X
423.65
X
70486
TC
1
XXX
0
X
431.41
X
70486
4
XXX
0
X
527.11
X
70486
3
XXX
0
X
542.89
X
70486
2
XXX
0
X
575.68
X
70486
1
XXX
0
X
585.45
X
70487
26
4
XXX
0
X
178.88
X
70487
26
3
XXX
0
X
183.65
X
70487
26
2
XXX
0
X
191.87
X
70487
26
1
XXX
0
X
192.43
X
70487
TC
4
XXX
0
X
460.75
X
70487
TC
3
XXX
0
X
468.21
X
70487
TC
2
XXX
0
X
507.78
X
70487
TC
1
XXX
0
X
517.13
X
70487
4
XXX
0
X
623.04
X
70487
3
XXX
0
X
641.57
X
70487
2
XXX
0
X
680.78
X
70487
1
XXX
0
X
692.26
X
70488
26
4
XXX
0
X
196.74
X
70488
26
3
XXX
0
X
201.99
X
70488
26
2
XXX
0
X
211.06
X
70488
26
1
XXX
0
X
211.70
X
70488
TC
4
XXX
0
X
575.15
X
70488
TC
3
XXX
0
X
584.40
X
70488
TC
2
XXX
0
X
633.57
X
70488
TC
1
XXX
0
X
645.15
X
70488
4
XXX
0
X
753.79
X
70488
3
XXX
0
X
765.04
X
70488
2
XXX
0
X
824.05
X
70488
1
XXX
0
X
838.13
X
70490
26
4
XXX
0
X
179.44
X
70490
26
3
XXX
0
X
181.79
X
70490
26
2
XXX
0
X
189.83
X
70490
26
1
XXX
0
X
190.43
X
70490
TC
4
XXX
0
X
384.51
X
70490
TC
3
XXX
0
X
390.70
X
70490
TC
2
XXX
0
X
423.65
X
70490
TC
1
XXX
0
X
431.41
X
70490
4
XXX
0
X
545.10
X
70490
3
XXX
0
X
563.43
X
70490
2
XXX
0
X
594.90
X
70490
1
XXX
0
X
604.90
X
70491
26
4
XXX
0
X
190.82
X
70491
26
3
XXX
0
X
195.99
X
70491
26
2
XXX
0
X
204.24
X
70491
26
1
XXX
0
X
204.89
X
70491
TC
4
XXX
0
X
460.75
X
70491
TC
3
XXX
0
X
468.21
X
70491
TC
2
XXX
0
X
507.78
X
70491
TC
1
XXX
0
X
517.13
X
70491
4
XXX
0
X
633.76
X
70491
3
XXX
0
X
653.54
X
70491
2
XXX
0
X
691.93
X
70491
1
XXX
0
X
703.52
X
70492
26
4
XXX
0
X
200.25
X
70492
26
3
XXX
0
X
205.56
X
70492
26
2
XXX
0
X
214.80
X
70492
26
1
XXX
0
X
215.42
X
70492
TC
4
XXX
0
X
575.15
X
70492
TC
3
XXX
0
X
584.40
X
70492
TC
2
XXX
0
X
633.57
X
70492
TC
1
XXX
0
X
645.15
X
70492
4
XXX
0
X
757.07
X
70492
3
XXX
0
X
768.40
X
70492
2
XXX
0
X
827.50
X
70492
1
XXX
0
X
841.58
X
70496
26
2
XXX
0
X
184.12
X
70496
26
3
XXX
0
X
184.12
X
70496
26
4
XXX
0
X
184.12
X
70496
26
1
XXX
0
X
199.92
X
70496
TC
2
XXX
0
X
520.85
X
70496
TC
3
XXX
0
X
520.85
X
70496
TC
4
XXX
0
X
520.85
X
70496
TC
1
XXX
0
X
628.06
X
70496
2
XXX
0
X
704.95
X
70496
3
XXX
0
X
704.95
X
70496
4
XXX
0
X
704.95
X
70496
1
XXX
0
X
827.96
X
70498
26
2
XXX
0
X
184.12
X
70498
26
3
XXX
0
X
184.12
X
70498
26
4
XXX
0
X
184.12
X
70498
26
1
XXX
0
X
199.92
X
70498
TC
2
XXX
0
X
520.85
X
70498
TC
3
XXX
0
X
520.85
X
70498
TC
4
XXX
0
X
520.85
X
70498
TC
1
XXX
0
X
628.06
X
70498
2
XXX
0
X
704.95
X
70498
3
XXX
0
X
704.95
X
70498
4
XXX
0
X
704.95
X
70498
1
XXX
0
X
827.96
X
70540
26
4
XXX
0
X
208.49
X
70540
26
3
XXX
0
X
210.47
X
70540
26
2
XXX
0
X
219.21
X
70540
26
1
XXX
0
X
219.86
X
70540
TC
4
XXX
0
X
912.01
X
70540
TC
3
XXX
0
X
926.70
X
70540
TC
2
XXX
0
X
1,004.49
X
70540
TC
1
XXX
0
X
1,022.98
X
70540
4
XXX
0
X
1,098.03
X
70540
3
XXX
0
X
1,114.81
X
70540
2
XXX
0
X
1,202.76
X
70540
1
XXX
0
X
1,223.69
X
70542
26
2
XXX
0
X
119.68
X
70542
26
3
XXX
0
X
119.68
X
70542
26
4
XXX
0
X
119.68
X
70542
26
1
XXX
0
X
129.66
X
70542
TC
2
XXX
0
X
963.15
X
70542
TC
3
XXX
0
X
963.15
X
70542
TC
4
XXX
0
X
963.15
X
70542
2
XXX
0
X
1,082.84
X
70542
3
XXX
0
X
1,082.84
X
70542
4
XXX
0
X
1,082.84
X
70542
TC
1
XXX
0
X
1,143.15
X
70542
1
XXX
0
X
1,272.84
X
70543
26
2
XXX
0
X
161.01
X
70543
26
3
XXX
0
X
161.01
X
70543
26
4
XXX
0
X
161.01
X
70543
26
1
XXX
0
X
175.50
X
70543
TC
2
XXX
0
X
1,782.84
X
70543
TC
3
XXX
0
X
1,782.84
X
70543
TC
4
XXX
0
X
1,782.84
X
70543
2
XXX
0
X
1,943.83
X
70543
3
XXX
0
X
1,943.83
X
70543
4
XXX
0
X
1,943.83
X
70543
TC
1
XXX
0
X
2,115.30
X
70543
1
XXX
0
X
2,290.79
X
70544
26
2
XXX
0
X
124.24
X
70544
26
3
XXX
0
X
124.24
X
70544
26
4
XXX
0
X
124.24
X
70544
26
1
XXX
0
X
135.79
X
70544
TC
2
XXX
0
X
812.40
X
70544
TC
3
XXX
0
X
812.40
X
70544
TC
4
XXX
0
X
812.40
X
70544
2
XXX
0
X
936.65
X
70544
3
XXX
0
X
936.65
X
70544
4
XXX
0
X
936.65
X
70544
TC
1
XXX
0
X
970.15
X
70544
1
XXX
0
X
1,105.97
X
70545
26
2
XXX
0
X
124.24
X
70545
26
3
XXX
0
X
124.24
X
70545
26
4
XXX
0
X
124.24
X
70545
26
1
XXX
0
X
135.79
X
70545
TC
2
XXX
0
X
812.40
X
70545
TC
3
XXX
0
X
812.40
X
70545
TC
4
XXX
0
X
812.40
X
70545
2
XXX
0
X
936.65
X
70545
3
XXX
0
X
936.65
X
70545
4
XXX
0
X
936.65
X
70545
TC
1
XXX
0
X
970.15
X
70545
1
XXX
0
X
1,105.97
X
70546
26
2
XXX
0
X
184.17
X
70546
26
3
XXX
0
X
184.17
X
70546
26
4
XXX
0
X
184.17
X
70546
26
1
XXX
0
X
199.77
X
70546
TC
2
XXX
0
X
1,597.83
X
70546
TC
3
XXX
0
X
1,597.83
X
70546
TC
4
XXX
0
X
1,597.83
X
70546
2
XXX
0
X
1,782.00
X
70546
3
XXX
0
X
1,782.00
X
70546
4
XXX
0
X
1,782.00
X
70546
TC
1
XXX
0
X
1,890.74
X
70546
1
XXX
0
X
2,090.53
X
70547
26
2
XXX
0
X
124.24
X
70547
26
3
XXX
0
X
124.24
X
70547
26
4
XXX
0
X
124.24
X
70547
26
1
XXX
0
X
135.79
X
70547
TC
2
XXX
0
X
812.40
X
70547
TC
3
XXX
0
X
812.40
X
70547
TC
4
XXX
0
X
812.40
X
70547
2
XXX
0
X
936.65
X
70547
3
XXX
0
X
936.65
X
70547
4
XXX
0
X
936.65
X
70547
TC
1
XXX
0
X
970.15
X
70547
1
XXX
0
X
1,105.97
X
70548
26
2
XXX
0
X
124.24
X
70548
26
3
XXX
0
X
124.24
X
70548
26
4
XXX
0
X
124.24
X
70548
26
1
XXX
0
X
135.79
X
70548
TC
2
XXX
0
X
812.40
X
70548
TC
3
XXX
0
X
812.40
X
70548
TC
4
XXX
0
X
812.40
X
70548
2
XXX
0
X
936.65
X
70548
3
XXX
0
X
936.65
X
70548
4
XXX
0
X
936.65
X
70548
TC
1
XXX
0
X
970.15
X
70548
1
XXX
0
X
1,105.97
X
70549
26
2
XXX
0
X
184.17
X
70549
26
3
XXX
0
X
184.17
X
70549
26
4
XXX
0
X
184.17
X
70549
26
1
XXX
0
X
199.77
X
70549
TC
2
XXX
0
X
1,597.83
X
70549
TC
3
XXX
0
X
1,597.83
X
70549
TC
4
XXX
0
X
1,597.83
X
70549
2
XXX
0
X
1,782.00
X
70549
3
XXX
0
X
1,782.00
X
70549
4
XXX
0
X
1,782.00
X
70549
TC
1
XXX
0
X
1,890.74
X
70549
1
XXX
0
X
2,090.53
X
70551
26
4
XXX
0
X
206.04
X
70551
26
3
XXX
0
X
210.26
X
70551
26
2
XXX
0
X
219.21
X
70551
26
1
XXX
0
X
219.86
X
70551
TC
4
XXX
0
X
912.01
X
70551
TC
3
XXX
0
X
926.70
X
70551
TC
2
XXX
0
X
1,004.49
X
70551
TC
1
XXX
0
X
1,022.98
X
70551
4
XXX
0
X
1,098.03
X
70551
3
XXX
0
X
1,114.81
X
70551
2
XXX
0
X
1,202.76
X
70551
1
XXX
0
X
1,223.69
X
70552
26
4
XXX
0
X
228.48
X
70552
26
3
XXX
0
X
231.87
X
70552
26
1
XXX
0
X
241.34
X
70552
26
2
XXX
0
X
242.12
X
70552
TC
4
XXX
0
X
1,093.90
X
70552
TC
3
XXX
0
X
1,111.58
X
70552
TC
2
XXX
0
X
1,205.04
X
70552
TC
1
XXX
0
X
1,227.18
X
70552
4
XXX
0
X
1,317.63
X
70552
3
XXX
0
X
1,337.76
X
70552
2
XXX
0
X
1,443.42
X
70552
1
XXX
0
X
1,468.55
X
70553
26
4
XXX
0
X
326.75
X
70553
26
3
XXX
0
X
335.37
X
70553
26
2
XXX
0
X
350.57
X
70553
26
1
XXX
0
X
351.56
X
70553
TC
4
XXX
0
X
2,024.92
X
70553
TC
3
XXX
0
X
2,057.57
X
70553
TC
2
XXX
0
X
2,230.41
X
70553
TC
1
XXX
0
X
2,271.36
X
70553
4
XXX
0
X
2,322.34
X
70553
3
XXX
0
X
2,358.38
X
70553
2
XXX
0
X
2,547.43
X
70553
1
XXX
0
X
2,592.32
X
70554
26
2
XXX
0
X
147.91
X
70554
26
3
XXX
0
X
147.91
X
70554
26
4
XXX
0
X
147.91
X
70554
26
1
XXX
0
X
161.12
X
70554
TC
2
XXX
0
X
725.96
X
70554
TC
3
XXX
0
X
725.96
X
70554
TC
4
XXX
0
X
725.96
X
70554
2
XXX
0
X
873.86
X
70554
3
XXX
0
X
873.86
X
70554
4
XXX
0
X
873.86
X
70554
TC
1
XXX
0
X
907.24
X
70554
1
XXX
0
X
1,068.34
X
70555
26
2
XXX
0
X
177.01
X
70555
26
3
XXX
0
X
177.01
X
70555
26
4
XXX
0
X
177.01
X
70555
26
1
XXX
0
X
192.52
X
70557
26
2
XXX
0
X
267.94
X
70557
26
3
XXX
0
X
267.94
X
70557
26
4
XXX
0
X
267.94
X
70557
26
1
XXX
0
X
286.98
X
70558
26
2
XXX
0
X
296.23
X
70558
26
3
XXX
0
X
296.23
X
70558
26
4
XXX
0
X
296.23
X
70558
26
1
XXX
0
X
317.66
X
70559
26
2
XXX
0
X
297.28
X
70559
26
3
XXX
0
X
297.28
X
70559
26
4
XXX
0
X
297.28
X
70559
26
1
XXX
0
X
319.62
X
71045
26
2
XXX
0
X
11.49
X
71045
26
3
XXX
0
X
11.49
X
71045
26
4
XXX
0
X
11.49
X
71045
26
1
XXX
0
X
12.26
X
71045
TC
2
XXX
0
X
12.64
X
71045
TC
3
XXX
0
X
12.64
X
71045
TC
4
XXX
0
X
12.64
X
71045
TC
1
XXX
0
X
14.59
X
71045
2
XXX
0
X
24.12
X
71045
3
XXX
0
X
24.12
X
71045
4
XXX
0
X
24.12
X
71045
1
XXX
0
X
26.84
X
71046
26
2
XXX
0
X
13.70
X
71046
26
3
XXX
0
X
13.70
X
71046
26
4
XXX
0
X
13.70
X
71046
26
1
XXX
0
X
14.56
X
71046
TC
2
XXX
0
X
23.15
X
71046
TC
3
XXX
0
X
23.15
X
71046
TC
4
XXX
0
X
23.15
X
71046
TC
1
XXX
0
X
26.65
X
71046
2
XXX
0
X
36.84
X
71046
3
XXX
0
X
36.84
X
71046
4
XXX
0
X
36.84
X
71046
1
XXX
0
X
41.21
X
71047
26
2
XXX
0
X
17.64
X
71047
26
3
XXX
0
X
17.64
X
71047
26
4
XXX
0
X
17.64
X
71047
26
1
XXX
0
X
18.79
X
71047
TC
2
XXX
0
X
29.44
X
71047
TC
3
XXX
0
X
29.44
X
71047
TC
4
XXX
0
X
29.44
X
71047
TC
1
XXX
0
X
33.87
X
71047
2
XXX
0
X
47.07
X
71047
3
XXX
0
X
47.07
X
71047
4
XXX
0
X
47.07
X
71047
1
XXX
0
X
52.66
X
71048
26
2
XXX
0
X
20.25
X
71048
26
3
XXX
0
X
20.25
X
71048
26
4
XXX
0
X
20.25
X
71048
26
1
XXX
0
X
21.58
X
71048
TC
2
XXX
0
X
30.29
X
71048
TC
3
XXX
0
X
30.29
X
71048
TC
4
XXX
0
X
30.29
X
71048
TC
1
XXX
0
X
34.84
X
71048
2
XXX
0
X
50.53
X
71048
3
XXX
0
X
50.53
X
71048
4
XXX
0
X
50.53
X
71048
1
XXX
0
X
56.42
X
71100
26
4
XXX
0
X
30.59
X
71100
26
3
XXX
0
X
31.35
X
71100
26
2
XXX
0
X
32.80
X
71100
26
1
XXX
0
X
32.92
X
71100
TC
4
XXX
0
X
46.89
X
71100
TC
3
XXX
0
X
48.98
X
71100
TC
2
XXX
0
X
55.03
X
71100
TC
1
XXX
0
X
57.06
X
71100
4
XXX
0
X
75.96
X
71100
3
XXX
0
X
78.24
X
71100
2
XXX
0
X
82.76
X
71100
1
XXX
0
X
83.08
X
71101
26
4
XXX
0
X
37.22
X
71101
26
3
XXX
0
X
38.15
X
71101
26
2
XXX
0
X
39.86
X
71101
26
1
XXX
0
X
40.02
X
71101
TC
4
XXX
0
X
54.83
X
71101
TC
3
XXX
0
X
55.70
X
71101
TC
2
XXX
0
X
62.90
X
71101
TC
1
XXX
0
X
67.28
X
71101
4
XXX
0
X
90.61
X
71101
3
XXX
0
X
93.11
X
71101
2
XXX
0
X
99.70
X
71101
1
XXX
0
X
108.52
X
71110
26
4
XXX
0
X
37.09
X
71110
26
3
XXX
0
X
38.11
X
71110
26
2
XXX
0
X
39.86
X
71110
26
1
XXX
0
X
40.02
X
71110
TC
4
XXX
0
X
64.34
X
71110
TC
3
XXX
0
X
65.38
X
71110
TC
2
XXX
0
X
70.94
X
71110
TC
1
XXX
0
X
72.27
X
71110
4
XXX
0
X
98.76
X
71110
3
XXX
0
X
101.92
X
71110
2
XXX
0
X
107.72
X
71110
1
XXX
0
X
109.54
X
71111
26
4
XXX
0
X
43.70
X
71111
26
3
XXX
0
X
44.43
X
71111
26
2
XXX
0
X
46.46
X
71111
26
1
XXX
0
X
46.65
X
71111
TC
4
XXX
0
X
73.09
X
71111
TC
3
XXX
0
X
74.27
X
71111
TC
2
XXX
0
X
82.22
X
71111
TC
1
XXX
0
X
82.24
X
71111
4
XXX
0
X
113.79
X
71111
3
XXX
0
X
116.87
X
71111
1
XXX
0
X
125.48
X
71111
2
XXX
0
X
127.54
X
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