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Individuals
Unemployment Benefits
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Workforce Development
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Individual Services
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Misclassified Workers
Businesses
Businesses
Employer UC Info
Finding Skilled Workers
Disability Services
Workforce Development
Workers' Compensation Services
Labor-Management Relations
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Fee Schedule
>
Fee Schedule L6000-V5364
Begin Main Content Area
Page Content
2021 Workers' Compensation Part B Fee Schedule
L6000-V5364
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
L6000
X
2,388.47
X
L6010
X
2,657.96
X
L6020
X
2,478.10
X
L6026
X
5,418.28
X
L6050
X
3,414.71
X
L6055
X
5,427.88
X
L6100
X
3,459.73
X
L6110
X
3,669.60
X
L6120
X
4,276.34
X
L6130
X
4,653.46
X
L6200
X
4,903.99
X
L6205
X
8,172.03
X
L6250
X
4,827.15
X
L6300
X
6,697.15
X
L6310
X
5,507.56
X
L6320
X
3,071.96
X
L6350
X
7,041.03
X
L6360
X
5,780.32
X
L6370
X
4,351.69
X
L6380
X
2,350.29
X
L6382
X
2,812.40
X
L6384
X
3,431.99
X
L6386
X
822.98
X
L6388
X
790.29
X
L6400
X
4,179.93
X
L6450
X
5,542.16
X
L6500
X
5,546.65
X
L6550
X
6,854.73
X
L6570
X
8,317.12
X
L6580
X
2,903.19
X
L6582
X
2,474.04
X
L6584
X
4,007.48
X
L6586
X
3,505.73
X
L6588
X
5,787.19
X
L6590
X
5,293.60
X
L6600
X
357.18
X
L6605
X
333.40
X
L6610
X
299.33
X
L6611
X
*
X
L6615
X
369.01
X
L6616
X
155.46
X
L6620
X
579.14
X
L6621
XXX
9
X
*
X
L6623
X
1,325.71
X
L6624
X
*
X
L6625
X
964.73
X
L6628
X
985.80
X
L6629
X
262.97
X
L6630
X
387.46
X
L6632
X
129.22
X
L6635
X
358.81
X
L6637
X
744.83
X
L6638
X
3,727.48
X
L6640
X
508.30
X
L6641
X
337.84
X
L6642
X
481.02
X
L6645
X
584.07
X
L6646
X
4,701.21
X
L6647
X
773.92
X
L6648
X
4,848.62
X
L6650
X
608.42
X
L6655
X
135.01
X
L6660
X
164.98
X
L6665
X
94.35
X
L6670
X
89.42
X
L6672
X
303.11
X
L6675
X
215.87
X
L6676
X
218.05
X
L6677
XXX
9
X
*
X
L6680
X
417.04
X
L6682
X
467.45
X
L6684
X
626.59
X
L6686
X
1,165.23
X
L6687
X
1,036.87
X
L6688
X
1,003.00
X
L6689
X
1,211.16
X
L6690
X
1,311.67
X
L6691
X
784.37
X
L6692
X
1,005.28
X
L6693
X
4,543.53
X
L6694
X
*
X
L6695
X
*
X
L6696
X
*
X
L6697
X
*
X
L6698
X
*
X
L6703
X
485.09
X
L6704
X
803.29
X
L6706
X
478.58
X
L6707
X
2,017.03
X
L6708
X
1,147.32
X
L6709
X
1,856.86
X
L6711
X
909.52
X
L6712
X
1,674.60
X
L6713
X
2,113.58
X
L6714
X
1,790.16
X
L6715
X
*
X
L6721
X
3,181.85
X
L6722
X
2,743.02
X
L6805
X
647.05
X
L6810
X
352.74
X
L6880
X
*
X
L6881
X
6,148.00
X
L6882
X
4,663.57
X
L6883
XXX
9
X
*
X
L6884
XXX
9
X
*
X
L6885
XXX
9
X
*
X
L6890
X
305.77
X
L6895
X
1,112.81
X
L6900
X
2,888.11
X
L6905
X
2,835.30
X
L6910
X
2,910.64
X
L6915
X
1,125.35
X
L6920
X
13,856.34
X
L6925
X
15,190.51
X
L6930
X
13,108.37
X
L6935
X
15,511.52
X
L6940
X
17,089.18
X
L6945
X
19,113.91
X
L6950
X
18,110.88
X
L6955
X
22,026.32
X
L6960
X
23,384.29
X
L6965
X
26,786.64
X
L6970
X
28,790.28
X
L6975
X
31,784.88
X
L7007
X
4,974.87
X
L7008
X
8,404.42
X
L7009
X
5,087.40
X
L7040
X
5,229.26
X
L7045
X
2,905.53
X
L7170
X
10,540.19
X
L7180
X
62,764.30
X
L7181
X
*
X
L7185
X
10,791.38
X
L7186
X
16,479.42
X
L7190
X
14,050.05
X
L7191
X
17,749.73
X
L7259
X
5,342.45
X
L7360
X
537.14
X
L7362
X
483.88
X
L7364
X
894.49
X
L7366
X
1,204.98
X
L7367
X
580.31
X
L7368
X
752.26
X
L7400
XXX
9
X
*
X
L7401
XXX
9
X
*
X
L7402
XXX
9
X
*
X
L7403
XXX
9
X
*
X
L7404
XXX
9
X
*
X
L7405
XXX
9
X
*
X
L7499
X
#
X
L7510
X
*
X
L7520
X
*
X
L7600
X
*
X
L7700
X
173.69
X
L7900
X
894.13
X
L7902
X
#
X
L8000
X
65.64
X
L8001
X
188.63
X
L8002
X
248.08
X
L8010
X
109.05
X
L8015
X
*
X
L8020
X
449.74
X
L8030
X
582.12
X
L8031
X
*
X
L8032
X
*
X
L8033
X
#
X
L8035
XXX
X
5,694.15
X
L8039
X
#
X
L8040
XXX
X
*
X
L8041
XXX
X
*
X
L8042
XXX
X
*
X
L8043
XXX
X
*
X
L8044
XXX
X
*
X
L8045
XXX
X
*
X
L8046
XXX
X
*
X
L8047
XXX
X
*
X
L8048
X
#
X
L8049
XXX
X
#
X
L8300
X
151.61
X
L8310
X
239.39
X
L8320
X
107.33
X
L8330
X
88.75
X
L8400
X
31.20
X
L8410
X
41.76
X
L8415
X
40.99
X
L8417
XXX
X
124.74
X
L8420
X
36.85
X
L8430
X
39.82
X
L8435
X
37.81
X
L8440
X
75.16
X
L8460
X
119.78
X
L8465
X
106.11
X
L8470
X
12.03
X
L8480
X
16.50
X
L8485
XXX
X
*
X
L8499
X
#
X
L8500
X
1,581.74
X
L8501
X
217.13
X
L8505
X
#
X
L8507
X
63.00
X
L8509
X
164.24
X
L8510
X
380.00
X
L8511
X
*
X
L8512
X
*
X
L8513
X
*
X
L8514
X
*
X
L8515
X
88.67
X
L8600
X
*
X
L8603
X
762.76
X
L8604
X
#
X
L8605
X
933.03
X
L8606
XXX
X
*
X
L8607
X
52.22
X
L8608
X
#
X
L8609
XXX
9
X
8,798.35
X
L8610
X
*
X
L8612
X
*
X
L8613
X
*
X
L8614
X
*
X
L8615
X
633.70
X
L8616
X
147.59
X
L8617
X
128.92
X
L8618
X
36.83
X
L8619
X
11,028.16
X
L8622
X
0.44
X
L8623
X
*
X
L8624
X
*
X
L8625
X
223.46
X
L8627
X
9,748.29
X
L8628
X
1,662.23
X
L8629
X
*
X
L8630
X
*
X
L8631
X
3,224.62
X
L8641
X
*
X
L8642
X
*
X
L8658
X
*
X
L8659
X
2,814.39
X
L8670
X
*
X
L8679
X
10,590.66
X
L8680
X
620.28
X
L8681
XXX
9
X
1,978.58
X
L8682
XXX
9
X
8,050.53
X
L8683
XXX
9
X
7,086.29
X
L8684
XXX
9
X
936.67
X
L8685
XXX
9
X
17,658.70
X
L8686
XXX
9
X
11,267.61
X
L8687
XXX
9
X
22,980.99
X
L8688
XXX
9
X
14,663.72
X
L8689
XXX
9
X
56.16
X
L8690
XXX
9
X
*
X
L8691
X
3,445.14
X
L8692
X
*
X
L8693
X
1,997.04
X
L8694
X
1,117.42
X
L8695
X
22.43
X
L8696
X
272.64
X
L8698
X
#
X
L8699
X
#
X
L8701
X
#
X
L8702
X
#
X
L9900
X
#
X
M0075
XXX
9
X
#
X
M0076
XXX
9
X
#
X
M0100
XXX
9
X
#
X
M0239
2
X
330.49
X
M0239
3
X
330.49
X
M0239
4
X
330.49
X
M0239
1
X
379.70
X
M0243
2
X
330.49
X
M0243
3
X
330.49
X
M0243
4
X
330.49
X
M0243
1
X
379.70
X
M0300
XXX
9
X
#
X
M0301
XXX
9
X
#
X
M1003
X
#
X
M1004
X
#
X
M1005
X
#
X
M1006
X
#
X
M1007
X
#
X
M1008
X
#
X
M1009
X
#
X
M1010
X
#
X
M1011
X
#
X
M1012
X
#
X
M1013
X
#
X
M1014
X
#
X
M1016
X
#
X
M1017
X
#
X
M1018
X
#
X
M1019
X
#
X
M1020
X
#
X
M1021
X
#
X
M1022
X
#
X
M1025
X
#
X
M1026
X
#
X
M1027
X
#
X
M1028
X
#
X
M1029
X
#
X
M1031
X
#
X
M1032
X
#
X
M1034
X
#
X
M1035
X
#
X
M1036
X
#
X
M1037
X
#
X
M1038
X
#
X
M1039
X
#
X
M1040
X
#
X
M1041
X
#
X
M1043
X
#
X
M1045
X
#
X
M1046
X
#
X
M1049
X
#
X
M1051
X
#
X
M1052
X
#
X
M1054
X
#
X
M1055
X
#
X
M1056
X
#
X
M1057
X
#
X
M1058
X
#
X
M1059
X
#
X
M1060
X
#
X
M1067
X
#
X
M1068
X
#
X
M1069
X
#
X
M1070
X
#
X
M1071
X
#
X
M1106
X
#
X
M1107
X
#
X
M1108
X
#
X
M1109
X
#
X
M1110
X
#
X
M1111
X
#
X
M1112
X
#
X
M1113
X
#
X
M1114
X
#
X
M1115
X
#
X
M1116
X
#
X
M1117
X
#
X
M1118
X
#
X
M1119
X
#
X
M1120
X
#
X
M1121
X
#
X
M1122
X
#
X
M1123
X
#
X
M1124
X
#
X
M1125
X
#
X
M1126
X
#
X
M1127
X
#
X
M1128
X
#
X
M1129
X
#
X
M1130
X
#
X
M1131
X
#
X
M1132
X
#
X
M1133
X
#
X
M1134
X
#
X
M1135
X
#
X
M1141
X
#
X
M1142
X
#
X
M1143
X
#
X
M1145
X
#
X
M1146
X
#
X
M1147
X
#
X
M1148
X
#
X
M1149
X
#
X
P2028
XXX
9
X
23.01
X
P2029
XXX
9
X
*
X
P2031
XXX
9
X
*
X
P2033
XXX
9
X
26.15
X
P2038
XXX
9
X
19.33
19.94
P3000
XXX
9
X
19.57
20.21
P3001
XXX
0
X
19.57
X
P3001
26
4
XXX
0
X
63.57
X
P3001
26
3
XXX
0
X
64.34
X
P3001
26
2
XXX
0
X
68.31
X
P3001
26
1
XXX
0
X
69.20
X
P7001
XXX
9
X
46.43
X
P9010
XXX
9
X
286.05
X
P9011
XXX
9
X
67.75
X
P9012
XXX
9
X
62.71
X
P9016
XXX
9
X
184.69
X
P9017
XXX
9
X
142.84
X
P9019
XXX
9
X
157.69
X
P9020
XXX
9
X
1,165.41
X
P9021
XXX
9
X
184.69
X
P9022
XXX
9
X
534.68
X
P9023
XXX
9
X
*
X
P9031
XXX
9
X
*
X
P9032
XXX
9
X
*
X
P9033
XXX
9
X
*
X
P9034
XXX
9
X
*
X
P9035
XXX
9
X
*
X
P9036
XXX
9
X
*
X
P9037
XXX
9
X
*
X
P9038
XXX
9
X
*
X
P9039
XXX
9
X
*
X
P9040
XXX
9
X
*
X
P9041
XXX
9
X
*
X
P9043
XXX
9
X
*
X
P9044
XXX
9
X
*
X
P9045
XXX
9
X
*
X
P9046
XXX
9
X
*
X
P9047
XXX
9
X
*
X
P9048
XXX
9
X
*
X
P9050
XXX
9
X
#
X
P9051
XXX
9
X
*
X
P9052
XXX
9
X
*
X
P9053
XXX
9
X
*
X
P9054
XXX
9
X
*
X
P9055
XXX
9
X
*
X
P9056
XXX
9
X
*
X
P9057
XXX
9
X
*
X
P9058
XXX
9
X
*
X
P9059
XXX
9
X
*
X
P9060
XXX
9
X
*
X
P9073
X
*
X
P9099
X
#
X
P9100
X
*
X
P9603
XXX
9
X
#
X
P9604
XXX
9
X
4.17
X
P9612
XXX
9
X
*
X
P9615
XXX
9
X
7.73
8.03
R0070
2
XXX
0
X
241.54
X
R0070
3
XXX
0
X
251.77
X
R0070
4
XXX
0
X
252.50
X
R0070
1
XXX
0
X
263.56
X
R0075
XXX
0
X
#
X
R0076
XXX
9
X
*
X
T5999
XXX
X
#
X
U0001
XXX
X
40.59
X
U0002
XXX
X
57.98
X
U0003
XXX
9
X
118.20
X
U0004
XXX
9
X
118.20
X
U0005
XXX
9
X
28.25
X
U224U
XXX
9
X
47.61
X
V2020
XXX
9
X
112.71
X
V2025
XXX
9
X
*
X
V2100
XXX
9
X
86.47
X
V2101
XXX
9
X
90.65
X
V2102
XXX
9
X
133.50
X
V2103
XXX
9
X
81.53
X
V2104
XXX
9
X
88.35
X
V2105
XXX
9
X
98.31
X
V2106
XXX
9
X
109.12
X
V2107
XXX
9
X
101.12
X
V2108
XXX
9
X
107.35
X
V2109
XXX
9
X
118.84
X
V2110
XXX
9
X
117.29
X
V2111
XXX
9
X
120.29
X
V2112
XXX
9
X
133.34
X
V2113
XXX
9
X
138.97
X
V2114
XXX
9
X
162.97
X
V2115
XXX
9
X
144.20
X
V2118
XXX
9
X
175.71
X
V2121
XXX
9
X
*
X
V2199
XXX
9
X
#
X
V2200
XXX
9
X
119.08
X
V2201
XXX
9
X
130.47
X
V2202
XXX
9
X
157.56
X
V2203
XXX
9
X
122.96
X
V2204
XXX
9
X
129.56
X
V2205
XXX
9
X
140.14
X
V2206
XXX
9
X
150.50
X
V2207
XXX
9
X
133.04
X
V2208
XXX
9
X
142.71
X
V2209
XXX
9
X
152.60
X
V2210
XXX
9
X
170.68
X
V2211
XXX
9
X
157.91
X
V2212
XXX
9
X
164.54
X
V2213
XXX
9
X
155.54
X
V2214
XXX
9
X
200.70
X
V2215
XXX
9
X
170.84
X
V2218
XXX
9
X
242.42
X
V2219
XXX
9
X
106.74
X
V2220
XXX
9
X
86.54
X
V2221
XXX
9
X
143.65
X
V2299
XXX
9
X
#
X
V2300
XXX
9
X
142.40
X
V2301
XXX
9
X
166.89
X
V2302
XXX
9
X
196.55
X
V2303
XXX
9
X
130.47
X
V2304
XXX
9
X
152.43
X
V2305
XXX
9
X
176.61
X
V2306
XXX
9
X
187.49
X
V2307
XXX
9
X
173.08
X
V2308
XXX
9
X
179.88
X
V2309
XXX
9
X
188.00
X
V2310
XXX
9
X
199.39
X
V2311
XXX
9
X
180.15
X
V2312
XXX
9
X
181.19
X
V2313
XXX
9
X
187.93
X
V2314
XXX
9
X
241.47
X
V2315
XXX
9
X
214.53
X
V2318
XXX
9
X
335.58
X
V2319
XXX
9
X
118.97
X
V2320
XXX
9
X
125.59
X
V2321
XXX
9
X
211.30
X
V2399
XXX
9
X
#
X
V2410
XXX
9
X
187.12
X
V2430
XXX
9
X
209.14
X
V2499
XXX
9
X
#
X
V2500
XXX
9
X
194.82
X
V2501
XXX
9
X
264.78
X
V2502
XXX
9
X
348.57
X
V2503
XXX
9
X
336.05
X
V2510
XXX
9
X
263.37
X
V2511
XXX
9
X
341.51
X
V2512
XXX
9
X
420.19
X
V2513
XXX
9
X
342.46
X
V2520
XXX
9
X
244.00
X
V2521
XXX
9
X
385.07
X
V2522
XXX
9
X
343.54
X
V2523
XXX
9
X
339.53
X
V2524
X
#
X
V2530
XXX
9
X
458.69
X
V2531
XXX
X
921.44
X
V2599
XXX
9
X
#
X
V2600
XXX
9
X
*
X
V2610
XXX
9
X
*
X
V2615
XXX
9
X
#
X
V2623
XXX
9
X
1,613.60
X
V2624
XXX
9
X
145.92
X
V2625
XXX
9
X
665.29
X
V2626
XXX
9
X
358.69
X
V2627
XXX
9
X
2,229.34
X
V2628
XXX
9
X
546.92
X
V2629
XXX
9
X
#
X
V2630
XXX
9
X
*
X
V2631
XXX
9
X
*
X
V2632
XXX
9
X
*
X
V2700
XXX
9
X
96.76
X
V2702
XXX
9
X
*
X
V2710
XXX
9
X
135.16
X
V2715
XXX
9
X
22.12
X
V2718
XXX
9
X
53.19
X
V2730
XXX
9
X
37.91
X
V2744
XXX
9
X
29.48
X
V2745
XXX
9
X
19.80
X
V2750
XXX
9
X
39.07
X
V2755
XXX
9
X
29.87
X
V2756
XXX
9
X
*
X
V2760
XXX
9
X
36.98
X
V2761
XXX
9
X
*
X
V2762
XXX
9
X
86.90
X
V2770
XXX
9
X
35.10
X
V2780
XXX
9
X
22.49
X
V2781
XXX
9
X
#
X
V2782
XXX
9
X
93.89
X
V2783
XXX
9
X
105.84
X
V2784
XXX
9
X
68.86
X
V2785
XXX
9
X
#
X
V2786
XXX
9
X
*
X
V2787
XXX
9
X
*
X
V2788
XXX
9
X
*
X
V2790
XXX
9
X
*
X
V2797
XXX
9
X
*
X
V2799
XXX
9
X
#
X
V5008
XXX
9
X
*
X
V5010
XXX
9
X
*
X
V5011
XXX
9
X
*
X
V5014
XXX
9
X
*
X
V5020
XXX
9
X
*
X
V5030
XXX
9
X
*
X
V5040
XXX
9
X
*
X
V5050
XXX
9
X
*
X
V5060
XXX
9
X
*
X
V5070
XXX
9
X
#
X
V5080
XXX
9
X
*
X
V5090
XXX
9
X
*
X
V5095
XXX
9
X
#
X
V5100
XXX
9
X
*
X
V5110
XXX
9
X
*
X
V5120
XXX
9
X
*
X
V5130
XXX
9
X
*
X
V5140
XXX
9
X
*
X
V5150
XXX
9
X
*
X
V5160
XXX
9
X
*
X
V5171
X
#
X
V5172
X
#
X
V5181
X
*
X
V5190
XXX
9
X
*
X
V5200
XXX
9
X
*
X
V5211
X
#
X
V5212
X
#
X
V5213
X
#
X
V5214
X
#
X
V5215
X
*
X
V5221
X
*
X
V5230
XXX
9
X
#
X
V5240
XXX
9
X
*
X
V5241
XXX
9
X
*
X
V5242
XXX
9
X
#
X
V5243
XXX
9
X
#
X
V5244
XXX
9
X
*
X
V5245
XXX
9
X
*
X
V5246
XXX
9
X
*
X
V5247
XXX
9
X
*
X
V5248
XXX
9
X
*
X
V5249
XXX
9
X
#
X
V5250
XXX
9
X
*
X
V5251
XXX
9
X
*
X
V5252
XXX
9
X
*
X
V5253
XXX
9
X
*
X
V5254
XXX
9
X
*
X
V5255
XXX
9
X
*
X
V5256
XXX
9
X
*
X
V5257
XXX
9
X
*
X
V5258
XXX
9
X
*
X
V5259
XXX
9
X
*
X
V5260
XXX
9
X
*
X
V5261
XXX
9
X
*
X
V5262
XXX
9
X
*
X
V5263
XXX
9
X
*
X
V5264
XXX
9
X
*
X
V5265
XXX
9
X
*
X
V5266
XXX
9
X
*
X
V5267
XXX
9
X
*
X
V5268
XXX
9
X
*
X
V5269
XXX
9
X
*
X
V5270
XXX
9
X
*
X
V5271
XXX
9
X
#
X
V5272
XXX
9
X
#
X
V5273
XXX
9
X
#
X
V5274
XXX
9
X
#
X
V5275
XXX
9
X
*
X
V5281
XXX
9
X
#
X
V5282
XXX
9
X
*
X
V5283
XXX
9
X
#
X
V5284
XXX
9
X
*
X
V5285
XXX
9
X
*
X
V5286
XXX
9
X
*
X
V5287
XXX
9
X
#
X
V5288
XXX
9
X
#
X
V5289
XXX
9
X
#
X
V5290
XXX
9
X
*
X
V5298
XXX
9
X
#
X
V5299
XXX
9
X
#
X
V5336
XXX
9
X
#
X
V5362
XXX
9
X
#
X
V5363
XXX
9
X
#
X
V5364
XXX
9
X
#
X
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