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Menu
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
Guide to Services
Boards
Councils and Committees
LI Directory
Right to Know
Find a Job
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Health Care Services Review
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Medical Fee Review
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Fee Schedule
>
Fee Schedule J1930-L1660
Begin Main Content Area
Page Content
2017 Workers' Compensation Part B Fee Schedule
J1930-L1660
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
Implied Decimal 2 (in dollars)
J1930
XXX
9
0
3609
0
J1931
XXX
9
0
3573
0
J1940
XXX
9
0
311
0
J1942
0
0
0
J1945
XXX
9
0
22073
0
J1950
XXX
9
0
81835
0
J1953
XXX
9
0
60
0
J1955
XXX
9
0
7678
0
J1956
XXX
9
0
0
0
J1960
XXX
9
0
466
0
J1980
XXX
9
0
665
0
J1990
XXX
9
0
1620
0
J2001
XXX
9
0
28
0
J2010
XXX
9
0
369
0
J2020
XXX
9
0
6151
0
J2060
XXX
9
0
2623
0
J2150
XXX
9
0
721
0
J2170
XXX
9
0
0
0
J2175
XXX
9
0
226
0
J2180
XXX
9
0
756
0
J2182
0
0
0
J2185
XXX
9
0
718
0
J2210
XXX
9
0
522
0
J2212
XXX
9
0
0
0
J2248
XXX
9
0
256
0
J2250
XXX
9
0
386
0
J2260
XXX
9
0
6756
0
J2265
XXX
9
0
0
0
J2270
XXX
9
0
243
0
J2274
XXX
9
0
1097
0
J2278
XXX
9
0
931
0
J2280
XXX
9
0
1515
0
J2300
XXX
9
0
572
0
J2310
XXX
9
0
687
0
J2315
XXX
9
0
276
0
J2320
XXX
9
0
962
0
J2323
XXX
9
0
1048
0
J2325
XXX
9
0
4542
0
J2353
XXX
9
0
11589
0
J2354
XXX
9
0
642
0
J2355
XXX
9
0
0
0
J2357
XXX
9
0
2407
0
J2358
XXX
9
0
361
0
J2360
XXX
9
0
382
0
J2370
XXX
9
0
738
0
J2400
XXX
9
0
226
0
J2405
XXX
9
0
1185
0
J2407
XXX
9
0
0
0
J2410
XXX
9
0
755
0
J2425
XXX
9
0
1732
0
J2426
XXX
9
0
852
0
J2430
XXX
9
0
37627
0
J2440
XXX
9
0
342
0
J2460
XXX
9
0
226
0
J2469
XXX
9
0
2861
0
J2501
XXX
9
0
836
0
J2502
XXX
9
0
0
0
J2503
XXX
9
0
159202
0
J2504
XXX
9
0
25069
0
J2505
XXX
9
0
408788
0
J2507
XXX
9
0
38248
0
J2510
XXX
9
0
837
0
J2513
XXX
9
0
1919
0
J2515
XXX
9
0
459
0
J2540
XXX
9
0
226
0
J2543
XXX
9
0
0
0
J2545
XXX
9
0
21067
0
J2547
XXX
9
0
0
0
J2550
XXX
9
0
226
0
J2560
XXX
9
0
631
0
J2562
XXX
9
0
35736
0
J2590
XXX
9
0
226
0
J2597
XXX
9
0
5069
0
J2650
XXX
9
0
226
0
J2670
XXX
9
0
0
0
J2675
XXX
9
0
420
0
J2680
XXX
9
0
2165
0
J2690
XXX
9
0
2720
0
J2700
XXX
9
0
725
0
J2704
XXX
9
0
15
0
J2710
XXX
9
0
226
0
J2720
XXX
9
0
1069
0
J2724
XXX
9
0
1698
0
J2725
XXX
9
0
2408
0
J2730
XXX
9
0
6031
0
J2760
XXX
9
0
5873
0
J2765
XXX
9
0
510
0
J2770
XXX
9
0
17828
0
J2778
XXX
9
0
56538
0
J2780
XXX
9
0
0
0
J2783
XXX
9
0
17204
0
J2785
XXX
9
0
6373
0
J2786
0
0
0
J2788
XXX
9
0
5983
0
J2790
XXX
9
0
12217
0
J2791
XXX
9
0
742
0
J2792
XXX
9
0
0
0
J2793
XXX
9
0
0
0
J2794
XXX
9
0
723
0
J2795
XXX
9
0
0
0
J2796
XXX
9
0
5800
0
J2800
XXX
9
0
672
0
J2805
XXX
9
0
6714
0
J2810
XXX
9
0
0
0
J2820
XXX
9
0
24151
0
J2840
0
0
0
J2850
XXX
9
0
3065
0
J2860
XXX
9
0
0
0
J2910
XXX
9
0
2318
0
J2916
XXX
9
0
1362
0
J2920
XXX
9
0
457
0
J2930
XXX
9
0
1211
0
J2940
XXX
9
0
0
0
J2941
XXX
9
0
0
0
J2950
XXX
9
0
226
0
J2993
XXX
9
0
228209
0
J2995
XXX
9
0
72920
0
J2997
XXX
9
0
4563
0
J3000
XXX
9
0
442
0
J3010
XXX
9
0
774
0
J3030
XXX
9
0
7870
0
J3060
XXX
9
0
3727
0
J3070
XXX
9
0
623
0
J3090
XXX
9
0
0
0
J3095
XXX
9
0
253
0
J3101
XXX
9
0
5520
0
J3105
XXX
9
0
390
0
J3110
XXX
9
0
1097
0
J3121
XXX
9
0
7
0
J3145
XXX
9
0
0
0
J3230
XXX
9
0
256
0
J3240
XXX
9
0
40408
0
J3243
XXX
9
0
131
0
J3246
XXX
9
0
1232
0
J3250
XXX
9
0
491
0
J3260
XXX
9
0
1659
0
J3262
XXX
9
0
457
0
J3265
XXX
9
0
298
0
J3280
XXX
9
0
1064
0
J3285
XXX
9
0
8153
0
J3300
XXX
9
0
436
0
J3301
XXX
9
0
385
0
J3302
XXX
9
0
226
0
J3303
XXX
9
0
543
0
J3305
XXX
9
0
10289
0
J3310
XXX
9
0
1038
0
J3315
XXX
9
0
69182
0
J3320
XXX
9
0
3379
0
J3350
XXX
9
0
0
0
J3355
XXX
9
0
7601
0
J3357
XXX
9
0
14658
0
J3360
XXX
9
0
375
0
J3364
XXX
9
0
9959
0
J3365
XXX
9
0
80800
0
J3370
XXX
9
0
4704
0
J3380
XXX
9
0
0
0
J3385
XXX
9
0
45937
0
J3396
XXX
9
0
1413
0
J3400
XXX
9
0
2843
0
J3410
XXX
9
0
226
0
J3411
XXX
9
0
140
0
J3415
XXX
9
0
75
0
J3420
XXX
9
0
226
0
J3430
XXX
9
0
960
0
J3465
XXX
9
0
734
0
J3470
XXX
9
0
1405
0
J3471
XXX
9
0
62
0
J3472
XXX
9
0
20384
0
J3473
XXX
9
0
61
0
J3475
XXX
9
0
213
0
J3480
XXX
9
0
213
0
J3485
XXX
9
0
157
0
J3486
XXX
9
0
3033
0
J3489
XXX
9
0
12715
0
J3490
XXX
9
0
0
0
J3520
XXX
9
0
0
0
J3530
XXX
9
0
0
0
J3535
XXX
9
0
0
0
J3570
XXX
9
0
0
0
J3590
XXX
9
0
0
0
J7030
XXX
9
0
2099
0
J7040
XXX
9
0
2033
0
J7042
XXX
9
0
1677
0
J7050
XXX
9
0
1957
0
J7060
XXX
9
0
3182
0
J7070
XXX
9
0
5882
0
J7100
XXX
9
0
27221
0
J7110
XXX
9
0
18265
0
J7120
XXX
9
0
2388
0
J7121
XXX
9
0
0
0
J7131
XXX
9
0
0
0
J7175
0
0
0
J7178
XXX
9
0
0
0
J7179
0
0
0
J7180
XXX
9
0
0
0
J7181
XXX
9
0
0
0
J7182
XXX
9
0
0
0
J7183
XXX
9
0
111
0
J7185
XXX
9
0
144
0
J7186
XXX
9
0
114
0
J7187
XXX
9
0
129
0
J7188
XXX
9
0
0
0
J7189
XXX
9
0
157
0
J7190
XXX
9
0
0
0
J7191
XXX
9
0
0
0
J7192
XXX
9
0
267
0
J7193
XXX
9
0
169
0
J7194
XXX
9
0
0
0
J7195
XXX
9
0
193
0
J7196
XXX
9
0
0
0
J7197
XXX
9
0
142416
0
J7198
XXX
9
0
0
0
J7199
XXX
9
0
0
0
J7200
XXX
9
0
146
0
J7201
XXX
9
0
334
0
J7202
0
0
0
J7205
XXX
9
0
0
0
J7207
0
0
0
J7209
0
0
0
J7297
XXX
9
0
0
0
J7298
XXX
9
0
0
0
J7300
XXX
9
0
0
0
J7301
XXX
9
0
0
0
J7303
XXX
9
0
0
0
J7304
XXX
9
0
0
0
J7306
XXX
9
0
0
0
J7307
XXX
9
0
0
0
J7308
XXX
9
0
17154
0
J7309
XXX
9
0
0
0
J7310
XXX
9
0
985731
0
J7311
XXX
9
0
2791608
0
J7312
XXX
9
0
25678
0
J7313
XXX
9
0
0
0
J7315
XXX
9
0
0
0
J7316
XXX
9
0
126259
0
J7320
0
904
0
J7321
XXX
9
0
14216
0
J7322
0
0
0
J7323
XXX
9
0
15443
0
J7324
XXX
9
0
23870
0
J7325
XXX
9
0
1561
0
J7326
XXX
9
0
0
0
J7327
XXX
9
0
116880
0
J7328
XXX
9
0
0
0
J7330
XXX
9
0
0
0
J7336
XXX
9
0
322
0
J7340
XXX
9
0
0
0
J7342
0
0
0
J7500
XXX
9
0
0
0
J7501
XXX
9
0
0
0
J7502
XXX
9
0
0
0
J7503
XXX
9
0
0
0
J7504
XXX
9
0
0
0
J7505
XXX
9
0
0
0
J7507
XXX
9
0
0
0
J7508
XXX
9
0
50
0
J7509
XXX
9
0
0
0
J7510
XXX
9
0
0
0
J7511
XXX
9
0
42783
0
J7512
XXX
9
0
0
0
J7513
XXX
9
0
0
0
J7515
XXX
9
0
0
0
J7516
XXX
9
0
0
0
J7517
XXX
9
0
0
0
J7518
XXX
9
0
380
0
J7520
XXX
9
0
0
0
J7525
XXX
9
0
0
0
J7527
XXX
9
0
0
0
J7599
XXX
9
0
0
0
J7604
XXX
9
0
0
0
J7605
XXX
9
0
656
0
J7606
XXX
9
0
562
0
J7607
XXX
9
0
0
0
J7608
XXX
9
0
0
0
J7609
XXX
9
0
0
0
J7610
XXX
9
0
294
0
J7611
XXX
9
0
7
0
J7612
XXX
9
0
137
0
J7613
XXX
9
0
9
0
J7614
XXX
9
0
203
0
J7615
XXX
9
0
354
0
J7620
XXX
9
0
110
0
J7622
XXX
9
0
0
0
J7624
XXX
9
0
0
0
J7626
XXX
9
0
0
0
J7627
XXX
9
0
88
0
J7628
XXX
9
0
0
0
J7629
XXX
9
0
0
0
J7631
XXX
9
0
0
0
J7632
XXX
9
0
0
0
J7633
XXX
9
0
7
0
J7634
XXX
9
0
0
0
J7635
XXX
9
0
0
0
J7636
XXX
9
0
0
0
J7637
XXX
9
0
0
0
J7638
XXX
9
0
0
0
J7639
XXX
9
0
0
0
J7640
XXX
9
0
44
0
J7641
XXX
9
0
0
0
J7642
XXX
9
0
0
0
J7643
XXX
9
0
0
0
J7644
XXX
9
0
0
0
J7645
XXX
9
0
0
0
J7647
XXX
9
0
0
0
J7648
XXX
9
0
0
0
J7649
XXX
9
0
0
0
J7650
XXX
9
0
73
0
J7657
XXX
9
0
0
0
J7658
XXX
9
0
0
0
J7659
XXX
9
0
0
0
J7660
XXX
9
0
455
0
J7665
XXX
9
0
0
0
J7667
XXX
9
0
0
0
J7668
XXX
9
0
0
0
J7669
XXX
9
0
0
0
J7670
XXX
9
0
340
0
J7674
XXX
9
0
65
0
J7676
XXX
9
0
0
0
J7680
XXX
9
0
0
0
J7681
XXX
9
0
0
0
J7682
XXX
9
0
0
0
J7683
XXX
9
0
0
0
J7684
XXX
9
0
0
0
J7685
XXX
9
0
0
0
J7686
XXX
9
0
52189
0
J7699
XXX
9
0
0
0
J7799
XXX
9
0
0
0
J7999
XXX
9
0
0
0
J8498
XXX
9
0
0
0
J8499
XXX
9
0
0
0
J8501
XXX
9
0
289
0
J8510
XXX
9
0
0
0
J8515
XXX
9
0
2411
0
J8520
XXX
9
0
0
0
J8521
XXX
9
0
0
0
J8530
XXX
9
0
0
0
J8540
XXX
9
0
8
0
J8560
XXX
9
0
0
0
J8562
XXX
9
0
10421
0
J8565
XXX
9
0
0
0
J8597
XXX
9
0
0
0
J8600
XXX
9
0
0
0
J8610
XXX
9
0
0
0
J8650
XXX
9
0
0
0
J8655
XXX
9
0
0
0
J8670
0
0
0
J8700
XXX
9
0
0
0
J8705
XXX
9
0
9398
0
J8999
XXX
9
0
0
0
J9000
XXX
9
0
10275
0
J9015
XXX
9
0
82721
0
J9017
XXX
9
0
4440
0
J9019
XXX
9
0
0
0
J9020
XXX
9
0
11474
0
J9025
XXX
9
0
614
0
J9027
XXX
9
0
17619
0
J9031
XXX
9
0
33608
0
J9032
XXX
9
0
0
0
J9033
XXX
9
0
2503
0
J9034
0
2677
0
J9035
XXX
9
0
8965
0
J9039
XXX
9
0
0
0
J9040
XXX
9
0
60537
0
J9041
XXX
9
0
4460
0
J9042
XXX
9
0
0
0
J9043
XXX
9
0
17116
0
J9045
XXX
9
0
17088
0
J9047
XXX
9
0
3533
0
J9050
XXX
9
0
17422
0
J9055
XXX
9
0
7795
0
J9060
XXX
9
0
6926
0
J9065
XXX
9
0
10599
0
J9070
XXX
9
0
1120
0
J9098
XXX
9
0
54180
0
J9100
XXX
9
0
1530
0
J9120
XXX
9
0
2404
0
J9130
XXX
9
0
3001
0
J9145
0
5302
0
J9150
XXX
9
0
16200
0
J9151
XXX
9
0
0
0
J9155
XXX
9
0
303
0
J9160
XXX
9
0
164722
0
J9165
XXX
9
0
2729
0
J9171
XXX
9
0
2344
0
J9175
XXX
9
0
562
0
J9176
0
704
0
J9178
XXX
9
0
4031
0
J9179
XXX
9
0
11401
0
J9181
XXX
9
0
2996
0
J9185
XXX
9
0
38588
0
J9190
XXX
9
0
370
0
J9200
XXX
9
0
19936
0
J9201
XXX
9
0
15067
0
J9202
XXX
9
0
78558
0
J9205
0
4465
0
J9206
XXX
9
0
19467
0
J9207
XXX
9
0
8569
0
J9208
XXX
9
0
0
0
J9209
XXX
9
0
3256
0
J9211
XXX
9
0
51496
0
J9212
XXX
9
0
0
0
J9213
XXX
9
0
6540
0
J9214
XXX
9
0
2269
0
J9215
XXX
9
0
7183
0
J9216
XXX
9
0
31903
0
J9217
XXX
9
0
105673
0
J9218
XXX
9
0
0
0
J9219
XXX
9
0
0
0
J9225
XXX
9
0
381011
0
J9226
XXX
9
0
1951
0
J9228
XXX
9
0
15832
0
J9230
XXX
9
0
2209
0
J9245
XXX
9
0
57519
0
J9250
XXX
9
0
1794
0
J9260
XXX
9
0
3104
0
J9261
XXX
9
0
11971
0
J9262
XXX
9
0
0
0
J9264
XXX
9
0
1259
0
J9266
XXX
9
0
267732
0
J9267
XXX
9
0
19
0
J9268
XXX
9
0
328127
0
J9270
XXX
9
0
16508
0
J9271
XXX
9
0
0
0
J9280
XXX
9
0
28251
0
J9293
XXX
9
0
140861
0
J9295
0
594
0
J9299
XXX
9
0
0
0
J9300
XXX
9
0
327941
0
J9301
XXX
9
0
6414
0
J9302
XXX
9
0
5945
0
J9303
XXX
9
0
11542
0
J9305
XXX
9
0
6366
0
J9306
XXX
9
0
1232
0
J9307
XXX
9
0
21701
0
J9308
XXX
9
0
0
0
J9310
XXX
9
0
0
0
J9315
XXX
9
0
28732
0
J9320
XXX
9
0
13445
0
J9325
0
5213
0
J9328
XXX
9
0
0
0
J9330
XXX
9
0
6443
0
J9340
XXX
9
0
13361
0
J9351
XXX
9
0
3584
0
J9352
0
32017
0
J9354
XXX
9
0
3518
0
J9355
XXX
9
0
0
0
J9357
XXX
9
0
0
0
J9360
XXX
9
0
854
0
J9370
XXX
9
0
7888
0
J9371
XXX
9
0
0
0
J9390
XXX
9
0
9999
0
J9395
XXX
9
0
12774
0
J9400
XXX
9
0
1130
0
J9600
XXX
9
0
490103
0
J9999
XXX
9
0
0
0
L0112
0
179289
0
L0113
0
0
0
L0120
0
4148
0
L0130
0
29351
0
L0140
0
9702
0
L0150
0
17813
0
L0160
0
23256
0
L0170
0
95762
0
L0172
0
20766
0
L0174
0
40790
0
L0180
0
56559
0
L0190
0
73550
0
L0200
0
76681
0
L0220
0
20940
0
L0450
0
22207
0
L0452
0
41345
0
L0454
0
45839
0
L0455
0
38504
0
L0456
0
45839
0
L0457
0
110417
0
L0458
0
97740
0
L0460
0
97740
0
L0462
0
97740
0
L0464
0
97740
0
L0466
0
47300
0
L0467
0
40110
0
L0468
0
62660
0
L0469
0
53138
0
L0470
0
79961
0
L0472
0
50713
0
L0480
0
178589
0
L0482
0
207437
0
L0484
0
222888
0
L0486
0
236470
0
L0488
0
180532
0
L0490
0
166621
0
L0491
XXX
9
0
91092
0
L0492
XXX
9
0
59840
0
L0621
XXX
9
0
10994
0
L0622
XXX
9
0
29353
0
L0623
XXX
9
0
0
0
L0624
XXX
9
0
0
0
L0625
XXX
9
0
6530
0
L0626
XXX
9
0
9244
0
L0627
XXX
9
0
48752
0
L0628
XXX
9
0
9951
0
L0629
XXX
9
0
0
0
L0630
XXX
9
0
19208
0
L0631
XXX
9
0
121757
0
L0632
XXX
9
0
0
0
L0633
XXX
9
0
34008
0
L0634
XXX
9
0
0
0
L0635
XXX
9
0
115622
0
L0636
XXX
9
0
171475
0
L0637
XXX
9
0
127417
0
L0638
XXX
9
0
156433
0
L0639
XXX
9
0
127417
0
L0640
XXX
9
0
124109
0
L0641
0
8652
0
L0642
0
45635
0
L0643
0
17981
0
L0648
0
113968
0
L0649
0
31834
0
L0650
0
119266
0
L0651
0
119266
0
L0700
0
303544
0
L0710
0
310110
0
L0810
0
387840
0
L0820
0
348106
0
L0830
0
490590
0
L0859
XXX
9
0
138421
0
L0861
0
27608
0
L0970
0
19967
0
L0972
0
17937
0
L0974
0
26628
0
L0976
0
23740
0
L0978
0
31337
0
L0980
0
3419
0
L0982
0
2417
0
L0984
XXX
0
0
0
L0999
0
0
0
L1000
0
304551
0
L1001
0
0
0
L1005
0
422749
0
L1010
0
9962
0
L1020
0
12837
0
L1025
0
24504
0
L1030
0
9445
0
L1040
0
12359
0
L1050
0
14897
0
L1060
0
17877
0
L1070
0
17453
0
L1080
0
9821
0
L1085
0
26557
0
L1090
0
17572
0
L1100
0
28056
0
L1110
0
37926
0
L1120
0
6413
0
L1200
0
232651
0
L1210
0
38854
0
L1220
0
37112
0
L1230
0
95142
0
L1240
0
12862
0
L1250
0
12862
0
L1260
0
13129
0
L1270
0
13341
0
L1280
0
15340
0
L1290
0
12151
0
L1300
0
273497
0
L1310
0
281029
0
L1499
0
0
0
L1600
0
19140
0
L1610
0
8443
0
L1620
0
23919
0
L1630
0
25160
0
L1640
0
76598
0
L1650
0
38757
0
L1652
0
46668
0
L1660
0
25408
0
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