Begin Main Content Area

2018 Workers' Compensation Part B Fee Schedules

Please click on the CPT/HCPCS applicable code range to look up specific codes.

The material below is provided for information purposes only and is not intended as a primary source for repricing of Pennsylvania Workers’ Compensation services. Updates are made periodically by the Bureau when HCPCS or fee schedule changes are indicated. The Part B Fee Schedule web pages were last updated: April 2018. If desired, it is the user’s responsibility to retain historic records of previous fee schedules.

Generally, since January 1, 1995, medical fees for outpatient services rendered under the Act are capped at 113% of the Medicare reimbursement rate. Payment rates are then frozen and thereafter updated annually by the percentage change in the Statewide average weekly wage. 34 Pa. Code §§ 127.101(a) and 127.153.

With respect to outpatient care, the regulations provide: "If a Medicare allowance does not exist for a reported HCPCS code, or successor codes, the provider shall be paid either 80 percent of the usual and customary charge, or the actual charge, whichever is lower." 34 Pa. Code § 127.103(c).

Since November 1, 2010, when resolving applications for fee review under 34 Pa. Code § 127.256, the Department utilizes the 85th percentile of the relative value benchmark database published by FAIR Health to determine the usual and customary charge (U&C) as defined in 34 Pa. Code § 127.3.

Of note, J codes are not included on this Part B fee schedule; in accordance with 34 Pa. Code § 127.131(a), “Payments for prescription drugs and professional pharmaceutical services shall be limited to 110% of the average wholesale price (AWP) of the product.” The Bureau currently utilizes Red Book, published by Truven Health Analytics, to determine the AWP.

Part B Fee Schedule user keys:

# = no FAIR Health U&C or Medicare allowance available

* = FAIR Health U&C data may be available depending on the zip code where the service was rendered

0001U-00842 00844-01820 01829-11643 11644-15278
15570-19101 19105-21014 21015-21435 21436-22849
22850-24073 24075-25109 25110-25920 25922-26565
26567-27178 27179-27468 27470-27750 27752-28264
28270-29358 29365-30620 30630-31635 31636-33211
33212-33676 33677-35011 35013-35601 35606-36578
36580-38564 38570-42227 42235-43261 43262-44145
44146-45331 45332-47130 47135-49423 49424-50551
50553-51784 51785-53510 53515-55520 55530-57511
57513-59100 59120-61520 61521-62161 62162-63286
63287-64766 64771-66150 66155-67880 67882-69643
69644-70450 70460-71111 71120-72157 72158-73206
73218-74022 74150-74410 74415-75716 75726-75902
75956-76519 76529-76941 76942-77285 77290-77778
77789-78261 78262-78605 78606-80436 80438-84630
84681-87400 87420-88333 88334-90847 90849-92134
92136-92626 92627-93312 93313-93619 93620-94005
94010-95806 95807-95933 95937-97016 97018-99347
99348-A4708 A4709-D5225 D5226-E0660 E0665-E2310
E2311-L1660 L1680-L5999 L6000-V5364