Content Editor

2024 Workers' Compensation Part B Fee Schedule

25922-26565

View the PDF

CPT/HCPC Code	Medicare Location	Global Surgery Indicator	Multiple Surgery Indicator	Prevailing Charge Amount	Fee Schedule Amount	Site of Service Amount
25922	002	90	2	X	1,514.30	X
25922	003	90	2	X	1,412.89	X
25922	004	90	2	X	1,396.51	X
25922	001	90	2	X	1,538.85	X
25924	002	90	2	X	1,854.34	X
25924	003	90	2	X	1,729.12	X
25924	001	90	2	X	1,884.63	X
25924	004	90	2	X	1,708.46	X
25927	003	90	2	X	1,787.73	X
25927	002	90	2	X	1,767.03	X
25927	004	90	2	X	1,629.22	X
25927	001	90	2	X	1,866.49	X
25929	004	90	2	X	1,326.68	X
25929	002	90	2	X	1,283.89	X
25929	003	90	2	X	1,341.72	X
25929	001	90	2	X	1,458.62	X
25931	001	90	2	X	1,450.89	X
25931	004	90	2	X	1,323.44	X
25931	003	90	2	X	1,338.37	X
25931	002	90	2	X	1,748.59	X
25999		YYY	2	X	#	X
26010	001	10	2	X	185.58	163.54
26010	004	10	2	X	165.31	146.05
26010	002	10	2	X	184.60	162.90
26010	003	10	2	X	177.59	157.41
26011	003	10	2	X	336.02	X
26011	002	10	2	X	365.30	X
26011	004	10	2	X	346.37	X
26011	001	10	2	X	403.76	X
26020	002	90	2	X	910.55	X
26020	003	90	2	X	842.86	X
26020	004	90	2	X	861.14	X
26020	001	90	2	X	939.24	X
26025	003	90	2	X	1,011.14	X
26025	002	90	2	X	1,068.09	X
26025	001	90	2	X	1,093.47	X
26025	004	90	2	X	987.43	X
26030	001	90	2	X	1,376.50	X
26030	004	90	2	X	1,273.50	X
26030	002	90	2	X	1,353.13	X
26030	003	90	2	X	1,256.77	X
26034	004	90	2	X	1,210.22	X
26034	002	90	2	X	1,239.38	X
26034	003	90	2	X	1,215.60	X
26034	001	90	2	X	1,254.60	X
26035	002	90	2	X	1,564.17	X
26035	003	90	2	X	1,440.00	X
26035	004	90	2	X	1,490.78	X
26035	001	90	2	X	1,625.96	X
26037	003	90	2	X	1,469.22	X
26037	002	90	2	X	1,576.30	X
26037	004	90	2	X	1,451.82	X
26037	001	90	2	X	1,602.24	X
26040	003	90	2	X	889.69	X
26040	002	90	2	X	895.85	X
26040	001	90	2	X	915.96	X
26040	004	90	2	X	897.15	X
26045	001	90	2	X	1,240.14	X
26045	003	90	2	X	1,507.77	X
26045	002	90	2	X	1,505.88	X
26045	004	90	2	X	1,504.10	X
26055	004	90	2	X	842.72	X
26055	001	90	2	X	881.09	X
26055	003	90	2	X	800.60	X
26055	002	90	2	X	866.43	X
26060	003	90	2	X	394.67	X
26060	001	90	2	X	447.86	X
26060	002	90	2	X	397.50	X
26060	004	90	2	X	415.85	X
26070	004	90	2	X	831.22	X
26070	001	90	2	X	853.91	X
26070	003	90	2	X	793.48	X
26070	002	90	2	X	845.55	X
26075	001	90	2	X	719.49	X
26075	004	90	2	X	651.91	X
26075	002	90	2	X	802.98	X
26075	003	90	2	X	657.62	X
26080	001	90	2	X	842.18	X
26080	004	90	2	X	846.52	X
26080	002	90	2	X	870.33	X
26080	003	90	2	X	866.13	X
26100	001	90	2	X	790.11	X
26100	004	90	2	X	840.25	X
26100	003	90	2	X	792.41	X
26100	002	90	2	X	778.11	X
26105	004	90	2	X	866.28	X
26105	001	90	2	X	960.62	X
26105	003	90	2	X	876.96	X
26105	002	90	2	X	944.29	X
26110	001	90	2	X	776.73	X
26110	003	90	2	X	758.69	X
26110	002	90	2	X	816.59	X
26110	004	90	2	X	768.96	X
26111	001	90	2	X	774.39	X
26111	003	90	2	X	687.70	X
26111	002	90	2	X	687.70	X
26111	004	90	2	X	687.70	X
26113	001	90	2	X	1,018.23	X
26113	004	90	2	X	904.62	X
26113	003	90	2	X	904.62	X
26113	002	90	2	X	904.62	X
26115	001	90	2	X	658.06	X
26115	003	90	2	X	614.63	X
26115	002	90	2	X	650.70	X
26115	004	90	2	X	602.23	X
26116	004	90	2	X	779.07	X
26116	001	90	2	X	839.35	X
26116	002	90	2	X	983.33	X
26116	003	90	2	X	821.87	X
26117	004	90	2	X	1,471.60	X
26117	001	90	2	X	1,288.55	X
26117	002	90	2	X	1,283.78	X
26117	003	90	2	X	1,488.32	X
26118	003	90	2	X	1,781.29	X
26118	002	90	2	X	1,781.29	X
26118	001	90	2	X	2,003.63	X
26118	004	90	2	X	1,781.29	X
26121	001	90	2	X	2,457.84	X
26121	004	90	2	X	2,265.98	X
26121	003	90	2	X	2,017.50	X
26121	002	90	2	X	2,382.67	X
26123	004	90	2	X	2,060.84	X
26123	002	90	2	X	2,160.34	X
26123	003	90	2	X	2,036.62	X
26123	001	90	2	X	2,228.50	X
26125	004	ZZZ	0	X	1,644.12	X
26125	002	ZZZ	0	X	1,710.62	X
26125	003	ZZZ	0	X	1,616.92	X
26125	001	ZZZ	0	X	1,771.76	X
26130	001	90	2	X	1,253.88	X
26130	002	90	2	X	1,233.13	X
26130	003	90	2	X	1,147.41	X
26130	004	90	2	X	1,133.76	X
26135	002	90	2	X	1,376.59	X
26135	003	90	2	X	1,289.75	X
26135	001	90	2	X	1,397.60	X
26135	004	90	2	X	1,274.88	X
26140	003	90	2	X	1,153.15	X
26140	002	90	2	X	1,231.68	X
26140	004	90	2	X	1,139.75	X
26140	001	90	2	X	1,250.79	X
26145	002	90	2	X	1,178.15	X
26145	003	90	2	X	1,119.86	X
26145	001	90	2	X	1,193.80	X
26145	004	90	2	X	1,116.34	X
26160	003	90	2	X	687.22	X
26160	002	90	2	X	715.04	X
26160	004	90	2	X	640.14	X
26160	001	90	2	X	810.70	X
26170	003	90	2	X	825.83	X
26170	002	90	2	X	876.65	X
26170	004	90	2	X	816.54	X
26170	001	90	2	X	888.99	X
26180	004	90	2	X	1,003.41	X
26180	001	90	2	X	1,104.66	X
26180	002	90	2	X	1,111.27	X
26180	003	90	2	X	1,015.19	X
26185	004	90	2	X	975.24	X
26185	001	90	2	X	1,099.07	X
26185	002	90	2	X	1,002.20	X
26185	003	90	2	X	975.24	X
26200	004	90	2	X	1,078.03	X
26200	001	90	2	X	1,185.26	X
26200	002	90	2	X	1,166.86	X
26200	003	90	2	X	1,090.82	X
26205	004	90	2	X	1,511.98	X
26205	001	90	2	X	1,663.83	X
26205	003	90	2	X	1,529.99	X
26205	002	90	2	X	1,637.80	X
26210	001	90	2	X	1,077.93	X
26210	004	90	2	X	1,008.51	X
26210	003	90	2	X	993.54	X
26210	002	90	2	X	1,061.43	X
26215	002	90	2	X	1,485.91	X
26215	003	90	2	X	1,388.73	X
26215	001	90	2	X	1,509.36	X
26215	004	90	2	X	1,372.54	X
26230	001	90	2	X	1,274.83	X
26230	002	90	2	X	1,312.49	X
26230	003	90	2	X	1,141.10	X
26230	004	90	2	X	1,127.93	X
26235	004	90	2	X	1,105.56	X
26235	001	90	2	X	1,381.55	X
26235	003	90	2	X	1,340.36	X
26235	002	90	2	X	1,325.72	X
26236	002	90	2	X	1,296.13	X
26236	003	90	2	X	1,298.82	X
26236	004	90	2	X	1,360.92	X
26236	001	90	2	X	1,401.40	X
26250	001	90	2	X	2,007.28	X
26250	004	90	2	X	1,478.61	X
26250	002	90	2	X	1,603.39	X
26250	003	90	2	X	1,495.97	X
26260	001	90	2	X	1,686.39	X
26260	004	90	2	X	1,386.18	X
26260	003	90	2	X	1,491.18	X
26260	002	90	2	X	1,502.16	X
26262	002	90	2	X	1,661.77	X
26262	003	90	2	X	1,139.04	X
26262	004	90	2	X	1,125.64	X
26262	001	90	2	X	1,451.70	X
26320	002	90	2	X	979.61	X
26320	003	90	2	X	818.73	X
26320	004	90	2	X	831.16	X
26320	001	90	2	X	892.13	X
26340	002	90	2	X	567.61	X
26340	003	90	2	X	567.61	X
26340	004	90	2	X	567.61	X
26340	001	90	2	X	651.77	X
26341	002	10	2	X	158.16	120.96
26341	003	10	2	X	158.16	120.96
26341	004	10	2	X	158.16	120.96
26341	001	10	2	X	178.41	135.26
26350	001	90	2	X	1,734.98	X
26350	003	90	2	X	1,505.13	X
26350	002	90	2	X	1,488.01	X
26350	004	90	2	X	1,428.28	X
26352	001	90	2	X	2,101.18	X
26352	004	90	2	X	1,541.22	X
26352	002	90	2	X	2,075.75	X
26352	003	90	2	X	1,559.66	X
26356	004	90	2	X	1,595.53	X
26356	002	90	2	X	1,737.16	X
26356	003	90	2	X	1,614.82	X
26356	001	90	2	X	1,792.74	X
26357	002	90	2	X	1,781.57	X
26357	003	90	2	X	1,714.75	X
26357	004	90	2	X	1,842.61	X
26357	001	90	2	X	1,810.44	X
26358	001	90	2	X	1,971.81	X
26358	004	90	2	X	1,790.16	X
26358	003	90	2	X	1,811.45	X
26358	002	90	2	X	1,940.47	X
26370	001	90	2	X	1,823.11	X
26370	004	90	2	X	1,781.14	X
26370	002	90	2	X	1,703.93	X
26370	003	90	2	X	1,515.09	X
26372	003	90	2	X	1,792.13	X
26372	002	90	2	X	2,115.69	X
26372	001	90	2	X	1,888.02	X
26372	004	90	2	X	1,631.74	X
26373	004	90	2	X	1,611.73	X
26373	001	90	2	X	1,774.45	X
26373	002	90	2	X	1,746.50	X
26373	003	90	2	X	1,630.99	X
26390	002	90	2	X	2,129.61	X
26390	003	90	2	X	1,867.83	X
26390	004	90	2	X	2,019.09	X
26390	001	90	2	X	2,030.12	X
26392	002	90	2	X	2,285.62	X
26392	003	90	2	X	2,048.75	X
26392	004	90	2	X	2,167.95	X
26392	001	90	2	X	2,348.87	X
26410	004	90	2	X	1,036.86	X
26410	001	90	2	X	1,094.82	X
26410	002	90	2	X	1,089.04	X
26410	003	90	2	X	972.60	X
26412	004	90	2	X	1,327.62	X
26412	003	90	2	X	1,343.75	X
26412	002	90	2	X	1,584.50	X
26412	001	90	2	X	1,466.80	X
26415	003	90	2	X	1,879.26	X
26415	002	90	2	X	1,983.23	X
26415	001	90	2	X	1,769.92	X
26415	004	90	2	X	1,950.56	X
26416	001	90	2	X	2,173.03	X
26416	004	90	2	X	1,969.28	X
26416	003	90	2	X	1,993.02	X
26416	002	90	2	X	2,137.92	X
26418	002	90	2	X	1,088.95	X
26418	003	90	2	X	949.40	X
26418	001	90	2	X	1,097.14	X
26418	004	90	2	X	1,061.10	X
26420	003	90	2	X	1,356.72	X
26420	002	90	2	X	1,454.52	X
26420	004	90	2	X	1,340.66	X
26420	001	90	2	X	1,478.15	X
26426	003	90	2	X	1,566.99	X
26426	002	90	2	X	1,683.32	X
26426	004	90	2	X	1,362.67	X
26426	001	90	2	X	1,721.61	X
26428	003	90	2	X	1,399.48	X
26428	002	90	2	X	1,499.40	X
26428	004	90	2	X	1,383.22	X
26428	001	90	2	X	1,523.68	X
26432	003	90	2	X	1,092.63	X
26432	002	90	2	X	1,092.84	X
26432	001	90	2	X	931.53	X
26432	004	90	2	X	1,058.20	X
26433	001	90	2	X	1,218.46	X
26433	003	90	2	X	1,154.57	X
26433	002	90	2	X	1,215.26	X
26433	004	90	2	X	1,126.02	X
26434	002	90	2	X	1,527.94	X
26434	003	90	2	X	1,209.57	X
26434	001	90	2	X	1,316.57	X
26434	004	90	2	X	1,195.48	X
26437	004	90	2	X	1,060.31	X
26437	001	90	2	X	1,482.15	X
26437	002	90	2	X	1,310.68	X
26437	003	90	2	X	1,072.69	X
26440	002	90	2	X	1,037.02	X
26440	003	90	2	X	988.66	X
26440	004	90	2	X	1,006.17	X
26440	001	90	2	X	1,037.18	X
26442	004	90	2	X	1,042.80	X
26442	001	90	2	X	1,135.61	X
26442	003	90	2	X	1,202.92	X
26442	002	90	2	X	1,188.47	X
26445	003	90	2	X	831.43	X
26445	002	90	2	X	842.73	X
26445	004	90	2	X	821.76	X
26445	001	90	2	X	902.32	X
26449	004	90	2	X	1,331.82	X
26449	002	90	2	X	1,444.81	X
26449	003	90	2	X	1,347.70	X
26449	001	90	2	X	1,468.29	X
26450	001	90	2	X	696.73	X
26450	004	90	2	X	639.15	X
26450	002	90	2	X	727.23	X
26450	003	90	2	X	646.52	X
26455	004	90	2	X	593.23	X
26455	001	90	2	X	645.29	X
26455	003	90	2	X	599.91	X
26455	002	90	2	X	544.29	X
26460	001	90	2	X	1,024.13	X
26460	003	90	2	X	834.35	X
26460	002	90	2	X	920.83	X
26460	004	90	2	X	554.53	X
26471	004	90	2	X	1,071.24	X
26471	002	90	2	X	1,249.02	X
26471	003	90	2	X	1,083.83	X
26471	001	90	2	X	1,173.69	X
26474	001	90	2	X	1,192.40	X
26474	004	90	2	X	1,082.57	X
26474	003	90	2	X	1,095.61	X
26474	002	90	2	X	1,173.53	X
26476	004	90	2	X	844.10	X
26476	002	90	2	X	897.41	X
26476	001	90	2	X	907.86	X
26476	003	90	2	X	853.95	X
26477	004	90	2	X	1,000.40	X
26477	002	90	2	X	1,221.36	X
26477	003	90	2	X	1,012.10	X
26477	001	90	2	X	1,102.54	X
26478	001	90	2	X	1,205.79	X
26478	004	90	2	X	1,098.64	X
26478	003	90	2	X	1,111.57	X
26478	002	90	2	X	1,187.43	X
26479	001	90	2	X	1,330.63	X
26479	004	90	2	X	1,206.33	X
26479	003	90	2	X	1,220.76	X
26479	002	90	2	X	1,309.30	X
26480	003	90	2	X	1,521.86	X
26480	002	90	2	X	1,636.85	X
26480	004	90	2	X	1,454.13	X
26480	001	90	2	X	1,707.60	X
26483	004	90	2	X	1,828.55	X
26483	002	90	2	X	1,991.37	X
26483	003	90	2	X	1,850.86	X
26483	001	90	2	X	2,025.33	X
26485	003	90	2	X	1,592.91	X
26485	002	90	2	X	1,827.88	X
26485	001	90	2	X	1,945.21	X
26485	004	90	2	X	1,531.33	X
26489	003	90	2	X	1,238.94	X
26489	002	90	2	X	1,278.69	X
26489	001	90	2	X	1,442.58	X
26489	004	90	2	X	1,342.08	X
26490	004	90	2	X	1,758.05	X
26490	003	90	2	X	1,779.23	X
26490	002	90	2	X	1,909.54	X
26490	001	90	2	X	1,941.08	X
26492	004	90	2	X	1,969.55	X
26492	002	90	2	X	2,129.31	X
26492	003	90	2	X	1,993.53	X
26492	001	90	2	X	2,162.02	X
26494	001	90	2	X	1,881.99	X
26494	004	90	2	X	1,706.47	X
26494	002	90	2	X	1,851.72	X
26494	003	90	2	X	1,726.88	X
26496	001	90	2	X	2,214.51	X
26496	004	90	2	X	2,002.27	X
26496	002	90	2	X	2,177.81	X
26496	003	90	2	X	2,026.23	X
26497	001	90	2	X	2,109.63	X
26497	004	90	2	X	1,913.10	X
26497	002	90	2	X	1,969.71	X
26497	003	90	2	X	1,935.82	X
26498	004	90	2	X	2,622.00	X
26498	001	90	2	X	3,111.30	X
26498	002	90	2	X	3,061.38	X
26498	003	90	2	X	2,855.44	X
26499	001	90	2	X	1,993.45	X
26499	004	90	2	X	1,810.20	X
26499	002	90	2	X	1,961.93	X
26499	003	90	2	X	1,831.95	X
26500	001	90	2	X	961.47	X
26500	004	90	2	X	892.35	X
26500	002	90	2	X	1,086.77	X
26500	003	90	2	X	1,021.50	X
26502	004	90	2	X	1,337.54	X
26502	002	90	2	X	1,448.94	X
26502	003	90	2	X	1,353.11	X
26502	001	90	2	X	1,472.13	X
26508	001	90	2	X	1,188.50	X
26508	004	90	2	X	1,082.72	X
26508	003	90	2	X	1,095.34	X
26508	002	90	2	X	1,170.36	X
26510	001	90	2	X	1,119.15	X
26510	004	90	2	X	1,018.23	X
26510	002	90	2	X	1,101.82	X
26510	003	90	2	X	1,030.28	X
26516	001	90	2	X	1,306.74	X
26516	002	90	2	X	1,850.85	X
26516	003	90	2	X	1,557.11	X
26516	004	90	2	X	1,199.17	X
26517	004	90	2	X	1,715.83	X
26517	001	90	2	X	2,782.01	X
26517	003	90	2	X	2,717.16	X
26517	002	90	2	X	1,860.49	X
26518	002	90	2	X	1,818.47	X
26518	003	90	2	X	1,697.58	X
26518	001	90	2	X	3,427.56	X
26518	004	90	2	X	1,678.02	X
26520	003	90	2	X	1,064.62	X
26520	002	90	2	X	1,139.50	X
26520	001	90	2	X	1,257.29	X
26520	004	90	2	X	1,079.98	X
26525	003	90	2	X	1,136.61	X
26525	002	90	2	X	1,156.74	X
26525	004	90	2	X	1,139.72	X
26525	001	90	2	X	1,134.54	X
26530	002	90	2	X	1,448.94	X
26530	003	90	2	X	1,411.45	X
26530	004	90	2	X	1,349.49	X
26530	001	90	2	X	1,458.03	X
26531	001	90	2	X	1,739.84	X
26531	003	90	2	X	1,653.83	X
26531	002	90	2	X	1,712.25	X
26531	004	90	2	X	1,645.96	X
26535	002	90	2	X	1,305.56	X
26535	003	90	2	X	1,228.95	X
26535	004	90	2	X	1,066.72	X
26535	001	90	2	X	1,333.17	X
26536	001	90	2	X	1,775.19	X
26536	004	90	2	X	1,707.00	X
26536	003	90	2	X	1,695.91	X
26536	002	90	2	X	1,763.41	X
26540	001	90	2	X	1,838.66	X
26540	004	90	2	X	1,722.05	X
26540	002	90	2	X	1,705.30	X
26540	003	90	2	X	1,700.11	X
26541	001	90	2	X	2,121.34	X
26541	004	90	2	X	1,914.87	X
26541	002	90	2	X	2,082.74	X
26541	003	90	2	X	1,938.27	X
26542	002	90	2	X	1,455.99	X
26542	003	90	2	X	1,357.74	X
26542	004	90	2	X	1,341.82	X
26542	001	90	2	X	1,479.73	X
26545	004	90	2	X	1,311.46	X
26545	001	90	2	X	1,444.52	X
26545	002	90	2	X	1,421.58	X
26545	003	90	2	X	1,326.89	X
26546	004	90	2	X	1,802.56	X
26546	001	90	2	X	2,070.72	X
26546	003	90	2	X	1,802.56	X
26546	002	90	2	X	1,852.29	X
26548	003	90	2	X	1,503.11	X
26548	001	90	2	X	1,631.87	X
26548	002	90	2	X	1,606.73	X
26548	004	90	2	X	1,485.89	X
26550	001	90	2	X	1,631.87	X
26550	004	90	2	X	1,485.89	X
26550	002	90	2	X	1,606.73	X
26550	003	90	2	X	1,503.11	X
26551	002	90	2	X	9,652.18	X
26551	003	90	2	X	9,392.73	X
26551	001	90	2	X	10,789.19	X
26551	004	90	2	X	9,392.73	X
26553	002	90	2	X	9,585.10	X
26553	003	90	2	X	9,327.44	X
26553	001	90	2	X	10,714.16	X
26553	004	90	2	X	9,327.44	X
26554	003	90	2	X	11,128.96	X
26554	002	90	2	X	11,436.34	X
26554	001	90	2	X	12,783.64	X
26554	004	90	2	X	11,128.96	X
26555	002	90	2	X	4,025.36	X
26555	003	90	2	X	3,759.82	X
26555	004	90	2	X	3,708.04	X
26555	001	90	2	X	4,151.09	X
26556	004	90	2	X	9,486.17	X
26556	002	90	2	X	9,748.13	X
26556	003	90	2	X	9,486.17	X
26556	001	90	2	X	10,896.61	X
26560	003	90	2	X	1,099.54	X
26560	002	90	2	X	1,173.58	X
26560	004	90	2	X	1,086.45	X
26560	001	90	2	X	1,823.47	X
26561	001	90	2	X	2,382.79	X
26561	004	90	2	X	2,161.70	X
26561	003	90	2	X	2,187.20	X
26561	002	90	2	X	2,344.68	X
26562	001	90	2	X	2,346.26	X
26562	003	90	2	X	2,184.64	X
26562	002	90	2	X	2,314.99	X
26562	004	90	2	X	2,156.76	X
26565	001	90	2	X	1,483.73	X
26565	004	90	2	X	1,351.30	X
26565	002	90	2	X	1,488.72	X
26565	003	90	2	X	1,367.56	X

Return to CPT/HCPC List