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Health Care Services Review
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Medical Fee Review
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Fee Schedule
>
Fee Schedule 28270-29358
Begin Main Content Area
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Content Editor
2024 Workers' Compensation Part B Fee Schedule
28270-29358
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
28270
004
90
2
X
769.35
637.56
28270
003
90
2
X
778.36
644.28
28270
002
90
2
X
817.19
675.22
28270
001
90
2
X
826.64
682.75
28272
004
90
2
X
608.96
506.89
28272
002
90
2
X
745.67
618.38
28272
003
90
2
X
737.30
614.05
28272
001
90
2
X
703.03
583.27
28280
003
90
2
X
890.03
X
28280
002
90
2
X
903.66
X
28280
004
90
2
X
823.62
X
28280
001
90
2
X
830.68
X
28285
004
90
2
X
926.52
X
28285
001
90
2
X
1,025.14
X
28285
003
90
2
X
930.40
X
28285
002
90
2
X
1,011.50
X
28286
003
90
2
X
795.48
X
28286
002
90
2
X
989.96
X
28286
004
90
2
X
862.60
X
28286
001
90
2
X
936.92
X
28288
001
90
2
X
888.95
X
28288
003
90
2
X
823.00
X
28288
002
90
2
X
876.18
X
28288
004
90
2
X
812.97
X
28289
003
90
2
X
868.74
896.76
28289
002
90
2
X
868.74
896.76
28289
004
90
2
X
868.74
896.76
28289
001
90
2
X
950.58
983.33
28291
002
90
2
X
1,097.28
729.52
28291
003
90
2
X
1,097.28
729.52
28291
004
90
2
X
1,097.28
729.52
28291
001
90
2
X
1,218.55
792.42
28292
004
90
2
X
1,441.77
X
28292
002
90
2
X
1,555.11
X
28292
003
90
2
X
1,460.04
X
28292
001
90
2
X
1,578.00
X
28295
003
90
2
X
1,399.43
810.94
28295
002
90
2
X
1,399.43
810.94
28295
001
90
2
X
1,564.18
882.35
28295
004
90
2
X
1,399.43
810.94
28296
001
90
2
X
2,078.53
X
28296
004
90
2
X
1,901.39
X
28296
003
90
2
X
1,925.04
X
28296
002
90
2
X
2,048.73
X
28297
003
90
2
X
1,953.58
X
28297
002
90
2
X
2,081.97
X
28297
001
90
2
X
1,960.44
X
28297
004
90
2
X
1,929.55
X
28298
002
90
2
X
1,900.10
X
28298
003
90
2
X
1,788.21
X
28298
001
90
2
X
1,926.95
X
28298
004
90
2
X
1,765.51
X
28299
002
90
2
X
2,128.79
X
28299
003
90
2
X
2,045.48
X
28299
004
90
2
X
2,019.70
X
28299
001
90
2
X
1,958.74
X
28300
004
90
2
X
1,805.99
X
28300
001
90
2
X
1,842.61
X
28300
003
90
2
X
1,716.31
X
28300
002
90
2
X
1,818.01
X
28302
002
90
2
X
2,126.06
X
28302
003
90
2
X
1,993.96
X
28302
004
90
2
X
1,969.80
X
28302
001
90
2
X
2,158.02
X
28304
003
90
2
X
1,651.55
X
28304
002
90
2
X
1,747.27
X
28304
001
90
2
X
1,770.41
X
28304
004
90
2
X
1,632.01
X
28305
002
90
2
X
2,309.36
X
28305
003
90
2
X
2,173.65
X
28305
001
90
2
X
2,342.08
X
28305
004
90
2
X
2,146.97
X
28306
001
90
2
X
1,345.00
X
28306
004
90
2
X
1,245.89
X
28306
002
90
2
X
1,240.43
X
28306
003
90
2
X
1,355.60
X
28307
001
90
2
X
1,430.90
X
28307
003
90
2
X
1,321.12
X
28307
002
90
2
X
1,738.60
X
28307
004
90
2
X
1,305.17
X
28308
001
90
2
X
1,344.96
X
28308
004
90
2
X
1,183.31
X
28308
003
90
2
X
1,175.90
X
28308
002
90
2
X
1,248.32
X
28309
002
90
2
X
1,857.59
X
28309
003
90
2
X
1,744.27
X
28309
004
90
2
X
1,723.81
X
28309
001
90
2
X
1,884.93
X
28310
001
90
2
X
1,231.85
X
28310
004
90
2
X
1,174.15
X
28310
003
90
2
X
1,007.07
X
28310
002
90
2
X
1,114.35
X
28312
001
90
2
X
1,044.31
X
28312
003
90
2
X
968.65
X
28312
002
90
2
X
1,029.66
X
28312
004
90
2
X
925.74
X
28313
004
90
2
X
814.63
X
28313
003
90
2
X
798.55
X
28313
002
90
2
X
841.38
X
28313
001
90
2
X
851.74
X
28315
004
90
2
X
889.49
X
28315
001
90
2
X
1,034.92
X
28315
002
90
2
X
1,021.12
X
28315
003
90
2
X
963.70
X
28320
001
90
2
X
2,081.38
X
28320
003
90
2
X
1,925.54
X
28320
002
90
2
X
1,972.87
X
28320
004
90
2
X
1,902.07
X
28322
004
90
2
X
1,368.04
X
28322
001
90
2
X
1,476.66
X
28322
003
90
2
X
1,383.91
X
28322
002
90
2
X
1,458.58
X
28340
002
90
2
X
1,540.91
X
28340
003
90
2
X
1,523.91
X
28340
004
90
2
X
1,423.66
X
28340
001
90
2
X
1,565.01
X
28341
004
90
2
X
1,696.99
X
28341
003
90
2
X
1,717.83
X
28341
002
90
2
X
1,831.47
X
28341
001
90
2
X
1,858.85
X
28344
003
90
2
X
853.73
X
28344
002
90
2
X
915.66
X
28344
001
90
2
X
930.69
X
28344
004
90
2
X
843.58
X
28345
004
90
2
X
1,193.29
X
28345
001
90
2
X
1,310.24
X
28345
003
90
2
X
1,207.91
X
28345
002
90
2
X
1,290.34
X
28360
001
90
2
X
1,310.24
X
28360
002
90
2
X
1,290.34
X
28360
003
90
2
X
1,207.91
X
28360
004
90
2
X
1,193.29
X
28400
004
90
2
X
682.02
X
28400
002
90
2
X
611.31
X
28400
003
90
2
X
733.36
X
28400
001
90
2
X
681.43
X
28405
001
90
2
X
1,101.21
X
28405
004
90
2
X
902.87
X
28405
002
90
2
X
1,246.35
X
28405
003
90
2
X
1,002.07
X
28406
004
90
2
X
1,320.89
X
28406
002
90
2
X
1,464.65
X
28406
003
90
2
X
1,342.33
X
28406
001
90
2
X
1,458.04
X
28415
001
90
2
X
2,672.68
X
28415
003
90
2
X
2,308.82
X
28415
002
90
2
X
2,634.56
X
28415
004
90
2
X
2,296.56
X
28420
002
90
2
X
3,147.48
X
28420
003
90
2
X
3,109.28
X
28420
001
90
2
X
3,295.34
X
28420
004
90
2
X
2,926.80
X
28430
004
90
2
X
624.75
X
28430
001
90
2
X
649.17
X
28430
003
90
2
X
633.95
X
28430
002
90
2
X
531.52
X
28435
001
90
2
X
808.13
X
28435
004
90
2
X
732.82
X
28435
003
90
2
X
881.49
X
28435
002
90
2
X
898.78
X
28436
004
90
2
X
955.59
X
28436
002
90
2
X
1,037.25
X
28436
003
90
2
X
967.13
X
28436
001
90
2
X
1,054.20
X
28445
002
90
2
X
2,123.38
X
28445
003
90
2
X
1,978.72
X
28445
004
90
2
X
1,955.01
X
28445
001
90
2
X
2,158.37
X
28446
001
90
2
X
2,170.79
X
28446
003
90
2
X
1,919.88
X
28446
002
90
2
X
1,919.88
X
28446
004
90
2
X
1,919.88
X
28450
004
90
2
X
426.91
X
28450
002
90
2
X
446.97
X
28450
003
90
2
X
424.01
X
28450
001
90
2
X
450.52
X
28455
001
90
2
X
672.72
X
28455
003
90
2
X
620.35
X
28455
002
90
2
X
646.06
X
28455
004
90
2
X
669.83
X
28456
002
90
2
X
348.41
X
28456
003
90
2
X
525.86
X
28456
001
90
2
X
573.47
X
28456
004
90
2
X
519.62
X
28465
004
90
2
X
1,335.84
X
28465
001
90
2
X
1,451.43
X
28465
002
90
2
X
1,423.98
X
28465
003
90
2
X
1,345.71
X
28470
001
90
2
X
427.50
329.14
28470
004
90
2
X
389.70
299.51
28470
003
90
2
X
422.64
324.66
28470
002
90
2
X
429.92
330.67
28475
001
90
2
X
605.69
477.45
28475
003
90
2
X
561.24
441.76
28475
002
90
2
X
596.95
470.52
28475
004
90
2
X
554.54
437.18
28476
004
90
2
X
717.07
X
28476
002
90
2
X
776.73
X
28476
003
90
2
X
725.95
X
28476
001
90
2
X
788.98
X
28485
001
90
2
X
1,193.51
X
28485
004
90
2
X
978.95
X
28485
002
90
2
X
1,034.27
X
28485
003
90
2
X
976.09
X
28490
002
90
2
X
231.19
180.54
28490
003
90
2
X
222.45
173.40
28490
001
90
2
X
236.13
183.96
28490
004
90
2
X
217.74
169.89
28495
002
90
2
X
301.94
X
28495
003
90
2
X
301.32
X
28495
001
90
2
X
306.02
X
28495
004
90
2
X
285.36
X
28496
002
90
2
X
507.38
X
28496
003
90
2
X
474.21
X
28496
004
90
2
X
468.51
X
28496
001
90
2
X
515.33
X
28505
004
90
2
X
868.07
X
28505
002
90
2
X
774.61
X
28505
003
90
2
X
847.08
X
28505
001
90
2
X
888.85
X
28510
001
90
2
X
234.34
182.74
28510
004
90
2
X
216.63
169.16
28510
003
90
2
X
218.49
171.00
28510
002
90
2
X
226.42
176.73
28515
003
90
2
X
295.04
233.19
28515
002
90
2
X
285.97
225.66
28515
001
90
2
X
289.71
228.58
28515
004
90
2
X
271.09
214.47
28525
001
90
2
X
638.73
X
28525
004
90
2
X
618.12
X
28525
003
90
2
X
620.79
X
28525
002
90
2
X
600.97
X
28530
004
90
2
X
216.63
X
28530
001
90
2
X
236.13
X
28530
002
90
2
X
232.91
X
28530
003
90
2
X
219.33
X
28531
003
90
2
X
441.31
X
28531
002
90
2
X
473.60
X
28531
004
90
2
X
436.11
X
28531
001
90
2
X
481.34
X
28540
003
90
2
X
382.32
X
28540
002
90
2
X
392.68
X
28540
001
90
2
X
396.46
X
28540
004
90
2
X
400.48
X
28545
001
90
2
X
405.02
X
28545
002
90
2
X
400.12
X
28545
003
90
2
X
379.82
X
28545
004
90
2
X
375.41
X
28546
002
90
2
X
678.91
X
28546
003
90
2
X
633.03
X
28546
001
90
2
X
689.92
X
28546
004
90
2
X
625.57
X
28555
004
90
2
X
1,250.42
X
28555
003
90
2
X
1,250.81
X
28555
002
90
2
X
1,350.40
X
28555
001
90
2
X
1,370.79
X
28570
003
90
2
X
346.06
X
28570
002
90
2
X
409.20
X
28570
004
90
2
X
341.78
X
28570
001
90
2
X
482.65
X
28575
001
90
2
X
690.47
X
28575
004
90
2
X
627.46
X
28575
003
90
2
X
635.09
X
28575
002
90
2
X
679.68
X
28576
004
90
2
X
715.85
X
28576
001
90
2
X
782.35
X
28576
003
90
2
X
724.28
X
28576
002
90
2
X
771.06
X
28585
001
90
2
X
1,451.28
X
28585
004
90
2
X
1,619.16
X
28585
002
90
2
X
1,466.82
X
28585
003
90
2
X
877.09
X
28600
004
90
2
X
261.93
X
28600
001
90
2
X
278.26
X
28600
002
90
2
X
277.36
X
28600
003
90
2
X
264.88
X
28605
002
90
2
X
560.23
X
28605
003
90
2
X
510.88
X
28605
001
90
2
X
569.02
X
28605
004
90
2
X
517.54
X
28606
001
90
2
X
956.59
X
28606
004
90
2
X
879.94
X
28606
003
90
2
X
890.29
X
28606
002
90
2
X
954.81
X
28615
002
90
2
X
1,214.46
X
28615
003
90
2
X
1,132.90
X
28615
004
90
2
X
1,119.33
X
28615
001
90
2
X
1,234.17
X
28630
003
10
2
X
275.00
X
28630
002
10
2
X
291.29
X
28630
001
10
2
X
296.92
X
28630
004
10
2
X
288.34
X
28635
001
10
2
X
392.15
X
28635
003
10
2
X
364.49
X
28635
002
10
2
X
353.96
X
28635
004
10
2
X
360.11
X
28636
001
10
2
X
641.83
X
28636
004
10
2
X
581.70
X
28636
002
10
2
X
631.43
X
28636
003
10
2
X
588.72
X
28645
004
90
2
X
781.09
X
28645
001
90
2
X
850.41
X
28645
003
90
2
X
790.48
X
28645
002
90
2
X
838.76
X
28660
003
10
2
X
209.83
X
28660
002
10
2
X
205.49
X
28660
004
10
2
X
225.48
X
28660
001
10
2
X
219.73
X
28665
002
10
2
X
325.82
X
28665
003
10
2
X
309.74
X
28665
001
10
2
X
329.72
X
28665
004
10
2
X
306.24
X
28666
001
10
2
X
613.58
X
28666
004
10
2
X
556.26
X
28666
003
10
2
X
562.98
X
28666
002
10
2
X
603.66
X
28675
004
90
2
X
654.47
X
28675
002
90
2
X
677.93
X
28675
003
90
2
X
633.01
X
28675
001
90
2
X
700.24
X
28705
001
90
2
X
3,603.44
X
28705
004
90
2
X
3,261.33
X
28705
002
90
2
X
2,862.45
X
28705
003
90
2
X
3,301.23
X
28715
002
90
2
X
2,949.79
X
28715
003
90
2
X
2,823.13
X
28715
001
90
2
X
2,997.79
X
28715
004
90
2
X
2,750.24
X
28725
003
90
2
X
2,267.92
X
28725
002
90
2
X
2,423.67
X
28725
004
90
2
X
2,241.04
X
28725
001
90
2
X
2,312.26
X
28730
002
90
2
X
2,255.03
X
28730
003
90
2
X
1,971.52
X
28730
001
90
2
X
2,180.67
X
28730
004
90
2
X
2,084.94
X
28735
002
90
2
X
2,249.80
X
28735
003
90
2
X
2,209.80
X
28735
004
90
2
X
2,183.18
X
28735
001
90
2
X
2,398.95
X
28737
002
90
2
X
1,997.03
X
28737
003
90
2
X
1,967.79
X
28737
004
90
2
X
1,943.88
X
28737
001
90
2
X
2,142.47
X
28740
002
90
2
X
1,341.63
X
28740
003
90
2
X
1,298.64
X
28740
004
90
2
X
1,281.86
X
28740
001
90
2
X
1,361.62
X
28750
001
90
2
X
1,451.95
X
28750
004
90
2
X
1,369.40
X
28750
003
90
2
X
1,439.08
X
28750
002
90
2
X
1,452.12
X
28755
001
90
2
X
969.65
X
28755
003
90
2
X
950.25
X
28755
002
90
2
X
956.03
X
28755
004
90
2
X
889.18
X
28760
004
90
2
X
1,464.34
X
28760
001
90
2
X
1,298.11
X
28760
003
90
2
X
1,256.88
X
28760
002
90
2
X
1,356.00
X
28800
004
90
2
X
1,809.71
X
28800
001
90
2
X
1,875.45
X
28800
002
90
2
X
1,859.29
X
28800
003
90
2
X
1,787.25
X
28805
004
90
2
X
1,661.42
X
28805
002
90
2
X
1,690.23
X
28805
003
90
2
X
1,573.41
X
28805
001
90
2
X
1,841.91
X
28810
004
90
2
X
1,052.85
X
28810
001
90
2
X
1,157.76
X
28810
002
90
2
X
1,179.15
X
28810
003
90
2
X
1,081.04
X
28820
004
0
2
X
682.51
X
28820
001
0
2
X
840.70
X
28820
003
0
2
X
690.47
X
28820
002
0
2
X
738.02
X
28825
004
0
2
X
612.62
X
28825
001
0
2
X
778.24
X
28825
002
0
2
X
676.68
X
28825
003
0
2
X
619.80
X
28890
003
90
2
X
639.77
401.07
28890
001
90
2
X
745.08
452.89
28890
002
90
2
X
639.77
401.07
28890
004
90
2
X
639.77
401.07
28899
YYY
2
X
#
X
29000
003
0
2
X
548.34
X
29000
002
0
2
X
487.20
X
29000
001
0
2
X
482.60
X
29000
004
0
2
X
295.52
X
29010
003
0
2
X
491.98
X
29010
002
0
2
X
527.91
X
29010
004
0
2
X
485.97
X
29010
001
0
2
X
689.92
X
29015
003
0
2
X
528.74
X
29015
002
0
2
X
697.16
X
29015
001
0
2
X
573.86
X
29015
004
0
2
X
522.39
X
29035
003
0
2
X
618.12
X
29035
002
0
2
X
712.81
X
29035
004
0
2
X
415.05
X
29035
001
0
2
X
459.71
X
29040
001
0
2
X
512.64
X
29040
003
0
2
X
472.35
X
29040
002
0
2
X
504.85
X
29040
004
0
2
X
466.70
X
29044
001
0
2
X
516.07
X
29044
004
0
2
X
467.49
X
29044
003
0
2
X
473.04
X
29044
002
0
2
X
507.62
X
29046
001
0
2
X
566.94
X
29046
003
0
2
X
520.85
X
29046
002
0
2
X
557.93
X
29046
004
0
2
X
514.60
X
29049
001
0
2
X
152.71
X
29049
004
0
2
X
130.54
X
29049
002
0
2
X
150.82
X
29049
003
0
2
X
143.12
X
29055
004
0
2
X
468.98
X
29055
002
0
2
X
453.35
X
29055
003
0
2
X
328.78
X
29055
001
0
2
X
353.78
X
29058
001
0
2
X
229.08
X
29058
004
0
2
X
318.86
X
29058
003
0
2
X
214.56
X
29058
002
0
2
X
226.26
X
29065
003
0
2
X
308.15
241.19
29065
002
0
2
X
318.76
250.02
29065
004
0
2
X
291.16
228.19
29065
001
0
2
X
317.19
249.25
29075
004
0
2
X
186.47
148.72
29075
001
0
2
X
232.45
185.99
29075
003
0
2
X
224.06
178.81
29075
002
0
2
X
248.97
198.66
29085
004
0
2
X
117.10
97.70
29085
001
0
2
X
124.64
103.23
29085
003
0
2
X
118.09
98.00
29085
002
0
2
X
123.21
102.49
29086
004
0
2
X
116.30
92.71
29086
001
0
2
X
132.51
104.77
29086
003
0
2
X
116.30
92.71
29086
002
0
2
X
116.30
92.71
29105
001
0
2
X
163.23
135.70
29105
004
0
2
X
150.50
125.21
29105
002
0
2
X
161.39
134.10
29105
003
0
2
X
150.03
124.32
29125
001
0
2
X
113.21
93.16
29125
003
0
2
X
110.91
91.57
29125
002
0
2
X
111.70
91.99
29125
004
0
2
X
104.33
85.99
29126
004
0
2
X
102.97
86.92
29126
002
0
2
X
119.46
100.39
29126
003
0
2
X
132.65
111.73
29126
001
0
2
X
137.54
115.92
29130
001
0
2
X
76.87
67.65
29130
002
0
2
X
76.03
66.99
29130
003
0
2
X
93.55
82.46
29130
004
0
2
X
94.06
83.04
29131
001
0
2
X
190.31
X
29131
004
0
2
X
103.20
X
29131
003
0
2
X
187.43
X
29131
002
0
2
X
179.29
X
29200
004
0
2
X
81.28
70.42
29200
001
0
2
X
84.66
72.96
29200
002
0
2
X
85.24
73.50
29200
003
0
2
X
81.65
70.34
29240
002
0
2
X
104.55
X
29240
003
0
2
X
101.77
X
29240
004
0
2
X
97.88
X
29240
001
0
2
X
102.41
X
29260
001
0
2
X
81.07
69.88
29260
004
0
2
X
77.75
67.13
29260
002
0
2
X
80.89
69.94
29260
003
0
2
X
77.78
67.10
29280
004
0
2
X
77.00
X
29280
001
0
2
X
82.31
X
29280
002
0
2
X
81.43
X
29280
003
0
2
X
77.88
X
29305
001
0
2
X
607.05
X
29305
003
0
2
X
502.39
X
29305
002
0
2
X
607.12
X
29305
004
0
2
X
434.11
X
29325
001
0
2
X
512.58
X
29325
004
0
2
X
468.18
X
29325
002
0
2
X
505.02
X
29325
003
0
2
X
483.87
X
29345
002
0
2
X
384.76
310.68
29345
003
0
2
X
303.86
245.74
29345
001
0
2
X
378.56
305.70
29345
004
0
2
X
288.72
233.19
29355
003
0
2
X
292.51
236.55
29355
002
0
2
X
328.65
265.62
29355
001
0
2
X
315.87
255.89
29355
004
0
2
X
267.75
216.92
29358
003
0
2
X
380.46
X
29358
002
0
2
X
439.43
X
29358
004
0
2
X
375.81
X
29358
001
0
2
X
442.54
X
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