2018 Workers' Compensation Part B Fee Schedule

D5226-E0660

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CPT/HCPC Code	Modifier	Global Surgery Indicator	Multiple Surgery Indicator	Fee Schedule Amount
D5226		XXX	9	*
D5281				*
D5410				*
D5411				*
D5421				*
D5422				*
D5511				*
D5512				*
D5520				*
D5611				*
D5612				*
D5621				*
D5622				*
D5630				*
D5640				*
D5650		XXX	9	*
D5660				*
D5670		XXX	9	*
D5671		XXX	9	*
D5710				*
D5711				*
D5720				*
D5721				*
D5730		XXX	9	*
D5731				*
D5740				*
D5741				*
D5750				*
D5751				*
D5760				*
D5761				*
D5810				*
D5811				*
D5820				*
D5821				*
D5850		XXX	9	*
D5851				*
D5862				*
D5863		XXX	9	*
D5864		XXX	9	*
D5865		XXX	9	*
D5866		XXX	9	*
D5867		XXX	9	*
D5875		XXX	9	*
D5899				*
D5911		YYY		*
D5912		YYY		*
D5913				*
D5914				*
D5915				*
D5916				*
D5919				*
D5922				*
D5923				*
D5924				*
D5925				*
D5926				*
D5927				*
D5928				*
D5929				*
D5931				*
D5932				*
D5933				*
D5934				*
D5935				*
D5936				*
D5937				*
D5951		YYY		*
D5952				*
D5953				*
D5954				*
D5955				*
D5958				*
D5959				*
D5960				*
D5982				*
D5983		YYY		*
D5984		YYY		*
D5985		YYY		*
D5987		YYY		*
D5988				*
D5991		XXX	9	*
D5992		XXX	9	*
D5993		XXX	9	*
D5994		XXX	9	*
D5999				*
D6010				*
D6011		XXX	9	*
D6012		XXX	9	*
D6013		XXX	9	*
D6040				*
D6050				*
D6051		XXX	9	*
D6052		XXX	9	*
D6055				*
D6056		XXX	9	*
D6057		XXX	9	*
D6058		XXX	9	*
D6059		XXX	9	*
D6060		XXX	9	*
D6061		XXX	9	*
D6062		XXX	9	*
D6063		XXX	9	*
D6064		XXX	9	*
D6065		XXX	9	*
D6066		XXX	9	*
D6067		XXX	9	*
D6068		XXX	9	*
D6069		XXX	9	*
D6070		XXX	9	*
D6071		XXX	9	*
D6072		XXX	9	*
D6073		XXX	9	*
D6074		XXX	9	*
D6075		XXX	9	*
D6076		XXX	9	*
D6077		XXX	9	*
D6080				*
D6081				*
D6085				*
D6090				*
D6091		XXX	9	*
D6092		XXX	9	*
D6093		XXX	9	*
D6094		XXX	9	*
D6095				*
D6096				*
D6100				*
D6101		XXX	9	*
D6102		XXX	9	*
D6103		XXX	9	*
D6104		XXX	9	*
D6110		XXX	9	*
D6111		XXX	9	*
D6112		XXX	9	*
D6113		XXX	9	*
D6114		XXX	9	*
D6115		XXX	9	*
D6116		XXX	9	*
D6117		XXX	9	*
D6118				*
D6119				*
D6190		XXX	9	*
D6194		XXX	9	*
D6199				*
D6205		XXX	9	*
D6210				*
D6211				*
D6212				*
D6214		XXX	9	*
D6240				*
D6241				*
D6242				*
D6245		XXX	9	*
D6250				*
D6251				*
D6252				*
D6253		XXX	9	*
D6545				*
D6548		XXX	9	*
D6549		XXX	9	*
D6600		XXX	9	*
D6601		XXX	9	*
D6602		XXX	9	*
D6603		XXX	9	*
D6604		XXX	9	*
D6605		XXX	9	*
D6606		XXX	9	*
D6607		XXX	9	*
D6608		XXX	9	*
D6609		XXX	9	*
D6610		XXX	9	*
D6611		XXX	9	*
D6612		XXX	9	*
D6613		XXX	9	*
D6614		XXX	9	*
D6615		XXX	9	*
D6624		XXX	9	*
D6634		XXX	9	*
D6710		XXX	9	*
D6720				*
D6721				*
D6722				*
D6740		XXX	9	*
D6750				*
D6751				*
D6752				*
D6780				*
D6781		XXX	9	*
D6782		XXX	9	*
D6783		XXX	9	*
D6790				*
D6791				*
D6792				*
D6793		XXX	9	*
D6794		XXX	9	*
D6920		YYY		*
D6930				*
D6940				*
D6950				*
D6980				*
D6985		XXX	9	*
D6999				*
D7111		XXX	9	*
D7140		XXX	9	*
D7210		YYY	0	181.84
D7220		YYY		*
D7230		YYY		*
D7240		YYY		*
D7241		YYY		*
D7250		YYY		*
D7251		XXX	9	*
D7260		YYY		*
D7261		XXX	9	*
D7270		XXX	9	*
D7272		XXX	9	*
D7280				*
D7282		XXX	9	*
D7283		XXX	9	*
D7285				*
D7286				*
D7287		XXX	9	*
D7288		XXX	9	*
D7290		XXX	9	*
D7291		YYY		*
D7292		XXX	9	*
D7293		XXX	9	*
D7294		XXX	9	*
D7295		XXX	9	*
D7296				*
D7297				*
D7310				*
D7311		XXX	9	*
D7320				*
D7321		XXX	9	*
D7340				*
D7350				*
D7410				*
D7411		XXX	9	*
D7412		XXX	9	*
D7413		XXX	9	*
D7414		XXX	9	*
D7415		XXX	9	*
D7440				*
D7441				*
D7450				*
D7451				*
D7460				*
D7461				*
D7465				*
D7471		XXX	9	*
D7472		XXX	9	*
D7473		XXX	9	*
D7485		XXX	9	*
D7490				*
D7510				*
D7511		XXX	9	*
D7520				*
D7521		XXX	9	*
D7530				*
D7540				*
D7550				*
D7560				*
D7610				*
D7620				*
D7630				*
D7640				*
D7650				*
D7660				*
D7670				*
D7671		XXX	9	*
D7680				*
D7710				*
D7720				*
D7730				*
D7740				*
D7750				*
D7760				*
D7770				*
D7771		XXX	9	*
D7780				*
D7810		XXX	9	*
D7820				*
D7830				*
D7840				*
D7850				*
D7852				*
D7854				*
D7856				*
D7858				*
D7860				*
D7865				*
D7870				*
D7871		XXX	9	*
D7872				*
D7873				*
D7874				*
D7875				*
D7876				*
D7877				*
D7880				*
D7881		XXX	9	*
D7899				*
D7910				*
D7911				*
D7912				*
D7920				*
D7921		XXX	9	*
D7940		YYY		*
D7941				*
D7943				*
D7944				*
D7945				*
D7946				*
D7947				*
D7948				*
D7949				*
D7950				*
D7951		XXX	9	*
D7952		XXX	9	*
D7953		XXX	9	*
D7955				*
D7960				*
D7963		XXX	9	*
D7970				*
D7971				*
D7972		XXX	9	*
D7979				*
D7980				*
D7981				*
D7982				*
D7983				*
D7990				*
D7991				*
D7995				*
D7996				*
D7997		XXX	9	*
D7998		XXX	9	*
D7999		XXX	9	*
D8010				*
D8020				*
D8030				*
D8040				*
D8050				*
D8060				*
D8070				*
D8080				*
D8090				*
D8210				*
D8220				*
D8660				*
D8670				*
D8680				*
D8681				*
D8690				*
D8691		XXX	9	*
D8692		XXX	9	*
D8693		XXX	9	*
D8694		XXX	9	*
D8695				*
D8999				*
D9110		YYY		*
D9120				*
D9210				*
D9211				*
D9212				*
D9215				*
D9219		XXX	9	*
D9222				*
D9223		XXX	9	*
D9230		YYY		*
D9239				*
D9243		XXX	9	*
D9248		XXX	9	*
D9310				*
D9311				*
D9410				*
D9420				*
D9430				*
D9440		XXX	9	*
D9450		XXX	9	*
D9610		XXX	9	*
D9612		XXX	9	*
D9630		YYY		*
D9910				*
D9911		XXX	9	*
D9920				*
D9930		YYY		*
D9932		XXX	9	*
D9933		XXX	9	*
D9934		XXX	9	*
D9935		XXX	9	*
D9940		YYY		*
D9941				*
D9942		XXX	9	*
D9943		XXX	9	*
D9950		YYY		*
D9951		YYY		*
D9952		YYY		*
D9970				*
D9971		XXX	9	*
D9972		XXX	9	*
D9973		XXX	9	*
D9974		XXX	9	*
D9975		XXX	9	*
D9985		XXX	9	*
D9986		XXX	9	*
D9987		XXX	9	*
D9991				*
D9992				*
D9993				*
D9994				*
D9995				*
D9996				*
D9999				*
E0100	NU			43.46
E0100	RR			12.29
E0100	UE			34.68
E0105	NU			101.29
E0105	RR			18.30
E0105	UE			76.32
E0110	NU			136.04
E0110	RR			33.01
E0110	UE			120.01
E0111	NU			109.87
E0111	RR			17.38
E0111	UE			84.76
E0112	NU			76.32
E0112	RR			20.46
E0112	UE			58.24
E0113	NU			43.58
E0113	RR			10.63
E0113	UE			32.73
E0114	NU			97.29
E0114	RR			17.72
E0114	UE			73.57
E0116	NU			57.23
E0116	RR			11.12
E0116	UE			43.04
E0117	NU			330.73
E0117	RR			33.08
E0117	UE			248.04
E0118				*
E0130	NU			144.86
E0130	RR			34.70
E0130	UE			111.42
E0135	NU			164.46
E0135	RR			35.60
E0135	UE			123.00
E0140	NU			605.71
E0140	RR			60.55
E0140	UE			454.27
E0141	NU			237.80
E0141	RR			39.22
E0141	UE			178.34
E0143	NU			247.99
E0143	RR			44.56
E0143	UE			177.53
E0144				*
E0147	NU			711.59
E0147	RR			72.33
E0147	UE			540.71
E0148		XXX		*
E0149		XXX		*
E0153	NU			143.12
E0153	RR			16.13
E0153	UE			107.33
E0154	NU			140.82
E0154	RR			17.69
E0154	UE			107.41
E0155	NU			63.03
E0155	RR			7.97
E0155	UE			49.62
E0156	NU			54.51
E0156	RR			6.97
E0156	UE			40.92
E0157	NU			143.62
E0157	RR			18.50
E0157	UE			107.71
E0158	NU			66.39
E0158	RR			7.31
E0158	UE			50.12
E0159	NU			35.09
E0159	RR			3.54
E0159	UE			26.36
E0160	NU			60.97
E0160	RR			8.88
E0160	UE			51.13
E0161	NU			54.06
E0161	RR			7.36
E0161	UE			40.54
E0162	NU			300.50
E0162	RR			31.50
E0162	UE			233.08
E0163	NU			219.64
E0163	RR			50.40
E0163	UE			160.14
E0165				325.81
E0167	NU			21.07
E0167	RR			2.61
E0167	UE			18.23
E0168	NU			262.87
E0168	RR			26.42
E0168	UE			197.15
E0170	RR	XXX	9	249.87
E0171	RR	XXX	9	44.96
E0172				*
E0175	NU			116.08
E0175	RR			11.61
E0175	UE			85.45
E0181				658.57
E0182				540.04
E0184	NU			401.58
E0184	RR			50.66
E0184	UE			308.01
E0185	NU			563.44
E0185	RR			92.70
E0185	UE			506.38
E0186				418.48
E0187				479.00
E0188				*
E0189				*
E0190				*
E0191	NU			20.57
E0191	RR			2.10
E0191	UE			15.42
E0193				15,638.57
E0194				66,354.87
E0196				670.08
E0197	NU			457.04
E0197	RR			63.07
E0197	UE			401.46
E0198	NU			457.04
E0198	RR			47.36
E0198	UE			346.83
E0199	NU			66.11
E0199	RR			6.61
E0199	UE			49.59
E0200	NU			163.55
E0200	RR			22.19
E0200	UE			122.66
E0202				1,291.56
E0203				*
E0205	NU			340.28
E0205	RR			43.33
E0205	UE			255.19
E0210	NU			67.29
E0210	RR			6.34
E0210	UE			50.48
E0215	NU			146.12
E0215	RR			15.30
E0215	UE			109.57
E0217	NU			860.38
E0217	RR			95.80
E0217	UE			645.21
E0218				*
E0221	NU			3,681.17
E0221	RR			368.08
E0221	UE			2,760.88
E0225	NU			681.43
E0225	RR			67.14
E0225	UE			511.07
E0231				*
E0232				*
E0235				355.80
E0236	NU			806.97
E0236	RR			80.70
E0239	NU			927.83
E0239	RR			92.77
E0239	UE			695.94
E0240				*
E0241				*
E0242				*
E0243				*
E0244				*
E0245				*
E0246				*
E0247				*
E0248				*
E0249	NU			205.41
E0249	RR			22.60
E0249	UE			154.10
E0250				2,016.55
E0251				1,528.11
E0255				2,359.22
E0256				1,610.52
E0260				3,463.71
E0261				2,653.55
E0265				4,123.22
E0266				3,663.21
E0270				*
E0271	NU			438.91
E0271	RR			47.58
E0271	UE			357.76
E0272	NU			402.02
E0272	RR			43.58
E0272	UE			301.52
E0273				*
E0274				*
E0275	NU			31.54
E0275	RR			3.29
E0275	UE			23.68
E0276	NU			27.46
E0276	RR			3.22
E0276	UE			21.73
E0277				16,033.86
E0280	NU			76.32
E0280	RR			8.47
E0280	UE			57.24
E0290				1,541.77
E0291				1,119.75
E0292				1,672.25
E0293				1,475.34
E0294				2,695.57
E0295				2,626.56
E0296				3,386.76
E0297				2,902.12
E0300	NU			4,766.52
E0300	RR			476.66
E0300	UE			3,574.89
E0301	RR			792.66
E0302	RR			645.73
E0303	RR			490.19
E0304	RR			1,294.09
E0305				330.20
E0310	NU			340.38
E0310	RR			46.95
E0310	UE			257.58
E0315				*
E0316	RR			367.96
E0325	NU			20.88
E0325	RR			3.12
E0325	UE			13.79
E0326	NU			20.40
E0326	RR			2.46
E0326	UE			15.31
E0328				*
E0329				*
E0350				*
E0352				*
E0370				*
E0371				839.07
E0372				1,018.17
E0373				1,166.34
E0424				706.87
E0425				*
E0430				*
E0431				111.08
E0433	RR			70.72
E0434				111.08
E0435				*
E0439				706.87
E0440				*
E0441				499.77
E0442				499.77
E0443				66.00
E0444				66.00
E0445				*
E0446				*
E0455				4,631.08
E0457				1,033.87
E0459				1,049.56
E0462	RR			6,010.72
E0465	RR			1,249.06
E0466	RR			1,249.06
E0470	RR			366.22
E0471	RR			916.56
E0472	RR			916.56
E0480				906.18
E0481				*
E0482				717.82
E0483	RR			1,824.47
E0484	NU			63.36
E0484	RR			6.33
E0484	UE			47.56
E0485		XXX	9	*
E0486		XXX	9	*
E0487				*
E0500				1,044.88
E0550				1,033.90
E0555				272.54
E0560	NU			300.71
E0560	RR			41.48
E0560	UE			225.52
E0561	NU			179.66
E0561	RR			17.96
E0561	UE			134.74
E0562	NU			505.78
E0562	RR			50.55
E0562	UE			379.34
E0565				1,258.48
E0570				407.17
E0572		XXX		*
E0574		XXX		*
E0575				195.23
E0580				313.48
E0585				723.35
E0600				944.43
E0601				2,108.56
E0602				*
E0603				*
E0604				*
E0605	NU			54.51
E0605	RR			5.47
E0605	UE			40.92
E0606				402.02
E0607	NU			392.54
E0607	RR			56.36
E0607	UE			290.68
E0610	NU			490.63
E0610	RR			51.76
E0610	UE			367.97
E0615	NU			869.51
E0615	RR			120.65
E0615	UE			652.14
E0616				*
E0617				*
E0618	RR			429.84
E0619				*
E0620	NU			1,523.00
E0620	RR			152.30
E0620	UE			1,142.23
E0621	NU			191.40
E0621	RR			19.10
E0621	UE			149.24
E0625				*
E0627	NU			682.13
E0627	RR			68.22
E0627	UE			511.58
E0629	NU			682.13
E0629	RR			68.22
E0629	UE			511.58
E0630				2,101.27
E0635				2,145.16
E0636				*
E0637	NU			3,534.62
E0637	RR			353.45
E0637	UE			2,650.92
E0638	NU			1,433.28
E0638	RR			143.32
E0638	UE			1,074.96
E0639				*
E0640				*
E0641				*
E0642				*
E0650	NU			1,457.88
E0650	RR			183.28
E0650	UE			947.01
E0651	NU			1,894.39
E0651	RR			189.49
E0651	UE			1,420.82
E0652	NU			10,807.70
E0652	RR			1,080.74
E0652	UE			6,964.91
E0655	NU			189.22
E0655	RR			26.14
E0655	UE			142.11
E0656				*
E0657				*
E0660	NU			299.82
E0660	RR			34.28
E0660	UE			224.87

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