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Health Care Services Review
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Medical Fee Review
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Fee Schedule
>
Fee Schedule 53515-55520
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
53515-55520
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
53515
004
90
2
X
2,334.99
X
53515
003
90
2
X
2,362.88
X
53515
002
90
2
X
2,493.46
X
53515
001
90
2
X
2,524.92
X
53520
001
90
2
X
989.38
X
53520
004
90
2
X
1,406.01
X
53520
003
90
2
X
1,358.71
X
53520
002
90
2
X
1,479.38
X
53600
001
0
2
X
149.06
133.73
53600
003
0
2
X
129.36
116.28
53600
002
0
2
X
145.46
130.96
53600
004
0
2
X
129.95
116.71
53601
001
0
2
X
135.13
120.48
53601
002
0
2
X
133.29
118.70
53601
003
0
2
X
113.03
101.05
53601
004
0
2
X
115.69
103.14
53605
004
0
2
X
185.99
X
53605
001
0
2
X
167.27
X
53605
003
0
2
X
143.42
X
53605
002
0
2
X
161.01
X
53620
001
0
2
X
179.81
159.63
53620
003
0
2
X
175.72
157.29
53620
002
0
2
X
187.98
167.86
53620
004
0
2
X
163.95
146.50
53621
003
0
2
X
139.87
125.29
53621
002
0
2
X
162.26
145.41
53621
004
0
2
X
140.40
125.77
53621
001
0
2
X
164.82
147.58
53660
004
0
2
X
97.17
84.45
53660
003
0
2
X
97.88
84.71
53660
002
0
2
X
112.24
97.50
53660
001
0
2
X
113.63
98.51
53661
004
0
2
X
95.41
83.96
53661
002
0
2
X
109.76
96.45
53661
003
0
2
X
95.30
83.89
53661
001
0
2
X
110.92
97.47
53665
004
0
2
X
119.96
X
53665
001
0
2
X
125.14
X
53665
002
0
2
X
126.05
X
53665
003
0
2
X
104.78
X
53850
004
90
2
X
1,494.65
X
53850
001
90
2
X
1,667.97
X
53850
003
90
2
X
1,494.65
X
53850
002
90
2
X
1,494.65
X
53852
001
90
2
X
1,743.24
X
53852
003
90
2
X
1,562.15
X
53852
002
90
2
X
1,562.15
X
53852
004
90
2
X
1,562.15
X
53854
004
90
2
X
2,454.17
531.10
53854
002
90
2
X
2,454.17
531.10
53854
003
90
2
X
2,454.17
531.10
53854
001
90
2
X
2,785.58
578.95
53855
003
0
2
X
1,075.74
143.56
53855
001
0
2
X
1,261.16
155.68
53855
002
0
2
X
1,075.74
143.56
53855
004
0
2
X
1,075.74
143.56
53860
001
90
2
X
2,766.48
447.44
53860
004
90
2
X
2,455.86
406.37
53860
003
90
2
X
2,455.86
406.37
53860
002
90
2
X
2,455.86
406.37
53899
YYY
2
X
#
X
54000
10
2
X
*
X
54001
001
10
2
X
338.41
X
54001
003
10
2
X
317.68
X
54001
002
10
2
X
328.45
X
54001
004
10
2
X
311.76
X
54015
003
10
2
X
642.02
X
54015
002
10
2
X
507.20
X
54015
004
10
2
X
635.63
X
54015
001
10
2
X
517.63
X
54050
004
10
2
X
143.74
X
54050
003
10
2
X
142.17
X
54050
002
10
2
X
138.28
X
54050
001
10
2
X
150.27
X
54055
004
10
2
X
192.61
X
54055
001
10
2
X
206.82
X
54055
003
10
2
X
195.70
X
54055
002
10
2
X
198.37
X
54056
001
10
2
X
181.84
X
54056
003
10
2
X
165.62
X
54056
002
10
2
X
185.78
X
54056
004
10
2
X
182.53
X
54057
001
10
2
X
303.75
X
54057
002
10
2
X
295.19
X
54057
003
10
2
X
285.13
X
54057
004
10
2
X
329.23
X
54060
001
10
2
X
322.02
X
54060
004
10
2
X
300.60
X
54060
003
10
2
X
307.58
X
54060
002
10
2
X
318.10
X
54065
004
10
2
X
523.66
X
54065
002
10
2
X
819.47
X
54065
003
10
2
X
643.55
X
54065
001
10
2
X
571.41
X
54100
002
0
2
X
242.04
X
54100
003
0
2
X
235.32
X
54100
001
0
2
X
244.08
X
54100
004
0
2
X
272.49
X
54105
002
10
2
X
449.90
X
54105
003
10
2
X
432.76
X
54105
004
10
2
X
435.34
X
54105
001
10
2
X
452.77
X
54110
002
90
2
X
1,797.22
X
54110
003
90
2
X
1,705.69
X
54110
004
90
2
X
1,685.94
X
54110
001
90
2
X
1,819.33
X
54111
004
90
2
X
2,392.60
X
54111
002
90
2
X
2,557.68
X
54111
003
90
2
X
2,421.09
X
54111
001
90
2
X
2,590.67
X
54112
004
90
2
X
2,799.51
X
54112
002
90
2
X
3,554.39
X
54112
001
90
2
X
3,570.60
X
54112
003
90
2
X
2,832.91
X
54115
004
90
2
X
1,062.47
X
54115
003
90
2
X
1,563.82
X
54115
002
90
2
X
1,757.23
X
54115
001
90
2
X
1,151.30
X
54120
003
90
2
X
1,706.02
X
54120
002
90
2
X
1,799.52
X
54120
004
90
2
X
1,685.86
X
54120
001
90
2
X
1,822.07
X
54125
001
90
2
X
2,859.60
X
54125
002
90
2
X
2,820.99
X
54125
003
90
2
X
2,660.84
X
54125
004
90
2
X
2,763.52
X
54130
003
90
2
X
3,641.98
X
54130
002
90
2
X
3,843.93
X
54130
001
90
2
X
3,892.62
X
54130
004
90
2
X
3,668.08
X
54135
002
90
2
X
4,906.52
X
54135
003
90
2
X
4,649.33
X
54135
001
90
2
X
4,968.64
X
54135
004
90
2
X
4,594.46
X
54150
0
2
X
*
X
54160
10
2
X
*
X
54161
004
10
2
X
578.69
X
54161
002
10
2
X
619.76
X
54161
003
10
2
X
587.22
X
54161
001
10
2
X
627.58
X
54162
001
10
2
X
532.50
X
54162
004
10
2
X
475.89
X
54162
002
10
2
X
475.89
X
54162
003
10
2
X
475.89
X
54163
001
10
2
X
499.45
X
54163
004
10
2
X
447.77
X
54163
003
10
2
X
447.77
X
54163
002
10
2
X
447.77
X
54164
003
10
2
X
392.44
X
54164
002
10
2
X
392.44
X
54164
004
10
2
X
392.44
X
54164
001
10
2
X
438.89
X
54200
001
10
2
X
117.31
X
54200
004
10
2
X
141.00
X
54200
002
10
2
X
116.16
X
54200
003
10
2
X
142.53
X
54205
001
90
2
X
1,431.16
X
54205
004
90
2
X
1,323.22
X
54205
003
90
2
X
1,339.02
X
54205
002
90
2
X
1,413.26
X
54220
001
0
2
X
782.68
X
54220
004
0
2
X
431.28
X
54220
002
0
2
X
756.38
X
54220
003
0
2
X
671.86
X
54230
002
0
2
X
208.80
X
54230
004
0
2
X
287.94
X
54230
001
0
2
X
211.57
X
54230
003
0
2
X
197.80
X
54231
001
0
2
X
493.83
X
54231
004
0
2
X
456.42
X
54231
003
0
2
X
461.82
X
54231
002
0
2
X
487.61
X
54235
001
0
2
X
163.17
142.37
54235
003
0
2
X
152.44
133.76
54235
002
0
2
X
165.01
144.24
54235
004
0
2
X
156.30
137.12
54240
001
0
0
X
264.68
X
54240
26
001
0
0
X
193.12
X
54240
TC
001
0
0
X
62.99
X
54240
004
0
0
X
240.12
X
54240
26
004
0
0
X
160.32
X
54240
TC
004
0
0
X
54.84
X
54240
003
0
0
X
251.87
X
54240
26
003
0
0
X
180.96
X
54240
TC
003
0
0
X
55.70
X
54240
002
0
0
X
264.96
X
54240
26
002
0
0
X
191.69
X
54240
TC
002
0
0
X
74.90
X
54250
004
0
0
X
242.17
X
54250
26
004
0
0
X
288.76
X
54250
TC
004
0
0
X
32.86
X
54250
002
0
0
X
251.27
X
54250
26
002
0
0
X
231.55
X
54250
TC
002
0
0
X
36.67
X
54250
003
0
0
X
243.55
X
54250
26
003
0
0
X
225.01
X
54250
TC
003
0
0
X
33.37
X
54250
001
0
0
X
254.45
X
54250
26
001
0
0
X
305.75
X
54250
TC
001
0
0
X
37.42
X
54300
002
90
2
X
1,221.59
X
54300
003
90
2
X
1,860.67
X
54300
001
90
2
X
1,235.42
X
54300
004
90
2
X
1,839.05
X
54304
003
90
2
X
2,265.74
X
54304
002
90
2
X
2,536.51
X
54304
004
90
2
X
2,239.07
X
54304
001
90
2
X
2,424.32
X
54308
002
90
2
X
2,005.49
X
54308
003
90
2
X
1,903.88
X
54308
004
90
2
X
1,882.56
X
54308
001
90
2
X
2,030.12
X
54312
001
90
2
X
2,616.44
X
54312
004
90
2
X
2,419.71
X
54312
003
90
2
X
2,448.57
X
54312
002
90
2
X
2,583.80
X
54316
004
90
2
X
2,935.29
X
54316
003
90
2
X
2,970.43
X
54316
002
90
2
X
3,135.01
X
54316
001
90
2
X
3,174.76
X
54318
001
90
2
X
2,154.14
X
54318
002
90
2
X
2,123.39
X
54318
003
90
2
X
1,996.57
X
54318
004
90
2
X
1,973.48
X
54322
001
90
2
X
2,305.95
X
54322
004
90
2
X
2,138.98
X
54322
003
90
2
X
2,164.16
X
54322
002
90
2
X
2,278.37
X
54324
004
90
2
X
2,840.33
X
54324
001
90
2
X
3,071.82
X
54324
002
90
2
X
3,111.65
X
54324
003
90
2
X
3,044.85
X
54326
004
90
2
X
2,719.86
X
54326
001
90
2
X
2,941.32
X
54326
003
90
2
X
2,752.39
X
54326
002
90
2
X
2,904.56
X
54328
002
90
2
X
2,958.13
X
54328
003
90
2
X
2,794.56
X
54328
004
90
2
X
2,761.74
X
54328
001
90
2
X
2,997.78
X
54332
004
90
2
X
3,075.10
X
54332
001
90
2
X
3,326.72
X
54332
002
90
2
X
3,285.16
X
54332
003
90
2
X
3,112.38
X
54336
001
90
2
X
4,362.86
X
54336
002
90
2
X
4,307.36
X
54336
003
90
2
X
4,076.04
X
54336
004
90
2
X
4,025.21
X
54340
001
90
2
X
1,699.19
X
54340
004
90
2
X
1,571.34
X
54340
003
90
2
X
1,590.10
X
54340
002
90
2
X
1,677.93
X
54344
002
90
2
X
3,618.30
X
54344
003
90
2
X
3,424.89
X
54344
001
90
2
X
3,664.68
X
54344
004
90
2
X
3,381.39
X
54348
001
90
2
X
3,251.62
X
54348
003
90
2
X
3,042.71
X
54348
002
90
2
X
3,210.97
X
54348
004
90
2
X
3,006.75
X
54352
001
90
2
X
4,627.66
X
54352
004
90
2
X
4,287.84
X
54352
002
90
2
X
4,571.53
X
54352
003
90
2
X
4,338.91
X
54360
001
90
2
X
2,136.64
X
54360
002
90
2
X
2,110.60
X
54360
003
90
2
X
2,002.86
X
54360
004
90
2
X
1,979.66
X
54380
003
90
2
X
2,375.90
X
54380
002
90
2
X
2,502.18
X
54380
004
90
2
X
2,347.47
X
54380
001
90
2
X
2,532.65
X
54385
002
90
2
X
2,871.27
X
54385
003
90
2
X
2,726.37
X
54385
004
90
2
X
2,693.96
X
54385
001
90
2
X
2,906.27
X
54390
002
90
2
X
3,990.49
X
54390
003
90
2
X
3,776.81
X
54390
004
90
2
X
3,733.00
X
54390
001
90
2
X
4,042.22
X
54400
004
90
2
X
2,914.66
X
54400
001
90
2
X
3,009.15
X
54400
002
90
2
X
2,993.18
X
54400
003
90
2
X
2,926.91
X
54401
002
90
2
X
3,255.94
X
54401
003
90
2
X
3,168.71
X
54401
004
90
2
X
3,153.06
X
54401
001
90
2
X
3,276.94
X
54405
003
90
2
X
3,961.63
X
54405
002
90
2
X
4,068.74
X
54405
004
90
2
X
3,942.16
X
54405
001
90
2
X
4,094.42
X
54406
001
90
2
X
1,651.40
X
54406
002
90
2
X
1,494.49
X
54406
003
90
2
X
1,494.49
X
54406
004
90
2
X
1,494.49
X
54408
004
90
2
X
1,575.30
X
54408
002
90
2
X
1,575.30
X
54408
003
90
2
X
1,575.30
X
54408
001
90
2
X
1,738.96
X
54410
004
90
2
X
1,866.59
X
54410
001
90
2
X
2,049.88
X
54410
003
90
2
X
1,866.59
X
54410
002
90
2
X
1,866.59
X
54411
001
90
2
X
2,236.71
X
54411
004
90
2
X
2,030.37
X
54411
002
90
2
X
2,030.37
X
54411
003
90
2
X
2,030.37
X
54415
003
90
2
X
1,106.34
X
54415
002
90
2
X
1,106.34
X
54415
001
90
2
X
1,229.44
X
54415
004
90
2
X
1,106.34
X
54416
004
90
2
X
1,443.64
X
54416
003
90
2
X
1,443.64
X
54416
002
90
2
X
1,443.64
X
54416
001
90
2
X
1,595.39
X
54417
004
90
2
X
1,784.96
X
54417
001
90
2
X
1,958.61
X
54417
003
90
2
X
1,784.96
X
54417
002
90
2
X
1,784.96
X
54420
003
90
2
X
2,022.92
X
54420
001
90
2
X
2,168.49
X
54420
002
90
2
X
2,140.13
X
54420
004
90
2
X
1,999.12
X
54430
001
90
2
X
1,925.59
X
54430
004
90
2
X
1,778.98
X
54430
003
90
2
X
1,800.38
X
54430
002
90
2
X
1,901.31
X
54435
001
90
2
X
1,134.40
X
54435
003
90
2
X
1,061.74
X
54435
002
90
2
X
940.87
X
54435
004
90
2
X
1,049.05
X
54437
001
90
2
X
1,138.42
X
54437
002
90
2
X
1,045.91
X
54437
003
90
2
X
1,045.91
X
54437
004
90
2
X
1,045.91
X
54438
003
90
2
X
2,114.99
X
54438
001
90
2
X
2,294.60
X
54438
004
90
2
X
2,114.99
X
54438
002
90
2
X
2,114.99
X
54440
001
90
2
X
2,136.64
X
54440
003
90
2
X
2,002.86
X
54440
002
90
2
X
2,110.60
X
54440
004
90
2
X
1,979.66
X
54450
002
0
2
X
205.91
X
54450
003
0
2
X
195.55
X
54450
001
0
2
X
208.42
X
54450
004
0
2
X
193.28
X
54500
004
0
2
X
186.11
X
54500
002
0
2
X
160.84
X
54500
003
0
2
X
188.19
X
54500
001
0
2
X
198.64
X
54505
002
10
2
X
605.53
X
54505
003
10
2
X
574.84
X
54505
004
10
2
X
568.29
X
54505
001
10
2
X
613.03
X
54512
002
90
2
X
1,189.49
X
54512
003
90
2
X
1,189.49
X
54512
004
90
2
X
1,189.49
X
54512
001
90
2
X
1,312.11
X
54520
001
90
2
X
1,207.36
X
54520
004
90
2
X
1,105.93
X
54520
002
90
2
X
1,190.34
X
54520
003
90
2
X
1,119.86
X
54522
004
90
2
X
1,351.21
X
54522
002
90
2
X
1,351.21
X
54522
003
90
2
X
1,351.21
X
54522
001
90
2
X
1,493.09
X
54530
002
90
2
X
1,760.63
X
54530
003
90
2
X
1,685.94
X
54530
004
90
2
X
1,661.02
X
54530
001
90
2
X
1,762.88
X
54535
004
90
2
X
2,165.91
X
54535
002
90
2
X
2,322.83
X
54535
003
90
2
X
2,191.79
X
54535
001
90
2
X
2,354.46
X
54550
001
90
2
X
1,481.79
X
54550
004
90
2
X
1,365.30
X
54550
002
90
2
X
1,462.31
X
54550
003
90
2
X
1,381.50
X
54560
001
90
2
X
2,070.95
X
54560
004
90
2
X
1,911.16
X
54560
002
90
2
X
2,044.26
X
54560
003
90
2
X
1,933.81
X
54600
003
90
2
X
1,221.42
X
54600
002
90
2
X
1,290.06
X
54600
004
90
2
X
1,207.13
X
54600
001
90
2
X
1,306.67
X
54620
002
10
2
X
919.15
X
54620
003
10
2
X
871.06
X
54620
001
10
2
X
930.78
X
54620
004
10
2
X
860.77
X
54640
002
90
2
X
1,733.67
X
54640
003
90
2
X
1,724.06
X
54640
004
90
2
X
1,715.65
X
54640
001
90
2
X
1,724.06
X
54650
002
90
2
X
1,890.94
X
54650
003
90
2
X
1,877.47
X
54650
004
90
2
X
1,867.69
X
54650
001
90
2
X
2,203.26
X
54660
001
90
2
X
952.98
X
54660
003
90
2
X
891.63
X
54660
002
90
2
X
941.12
X
54660
004
90
2
X
881.09
X
54670
004
90
2
X
300.21
X
54670
002
90
2
X
316.68
X
54670
003
90
2
X
303.47
X
54670
001
90
2
X
319.81
X
54680
001
90
2
X
2,291.03
X
54680
004
90
2
X
2,118.58
X
54680
003
90
2
X
2,143.84
X
54680
002
90
2
X
2,262.38
X
54690
001
90
2
X
1,775.71
X
54690
003
90
2
X
1,605.33
X
54690
002
90
2
X
1,605.33
X
54690
004
90
2
X
1,605.33
X
54692
002
90
2
X
1,656.45
X
54692
003
90
2
X
1,656.45
X
54692
004
90
2
X
1,656.45
X
54692
001
90
2
X
1,820.18
X
54699
YYY
2
X
#
X
54700
001
10
2
X
409.12
X
54700
004
10
2
X
395.28
X
54700
003
10
2
X
395.08
X
54700
002
10
2
X
405.23
X
54800
004
0
2
X
462.62
X
54800
002
0
2
X
495.42
X
54800
003
0
2
X
468.33
X
54800
001
0
2
X
501.97
X
54830
001
90
2
X
1,003.48
X
54830
004
90
2
X
948.02
X
54830
003
90
2
X
937.39
X
54830
002
90
2
X
990.63
X
54840
001
90
2
X
1,193.19
X
54840
004
90
2
X
1,082.49
X
54840
002
90
2
X
1,142.62
X
54840
003
90
2
X
1,153.19
X
54860
004
90
2
X
1,247.58
X
54860
001
90
2
X
1,351.84
X
54860
003
90
2
X
1,293.94
X
54860
002
90
2
X
1,290.60
X
54861
001
90
2
X
1,852.70
X
54861
004
90
2
X
1,705.75
X
54861
003
90
2
X
1,726.65
X
54861
002
90
2
X
1,828.23
X
54865
003
90
2
X
577.40
X
54865
002
90
2
X
577.40
X
54865
001
90
2
X
647.63
X
54865
004
90
2
X
577.40
X
54900
003
90
2
X
2,343.28
X
54900
002
90
2
X
2,472.61
X
54900
001
90
2
X
2,503.85
X
54900
004
90
2
X
2,315.57
X
54901
001
90
2
X
3,436.83
X
54901
004
90
2
X
3,178.23
X
54901
002
90
2
X
3,393.86
X
54901
003
90
2
X
3,216.23
X
55000
004
0
2
X
185.47
166.21
55000
001
0
2
X
205.91
184.48
55000
003
0
2
X
191.04
171.43
55000
002
0
2
X
206.47
184.63
55040
001
90
2
X
1,206.05
X
55040
004
90
2
X
1,089.33
X
55040
003
90
2
X
1,157.17
X
55040
002
90
2
X
1,172.67
X
55041
003
90
2
X
1,675.08
X
55041
002
90
2
X
1,759.70
X
55041
004
90
2
X
1,687.28
X
55041
001
90
2
X
1,759.42
X
55060
004
90
2
X
1,093.41
X
55060
001
90
2
X
1,136.45
X
55060
003
90
2
X
1,103.47
X
55060
002
90
2
X
1,125.49
X
55100
003
10
2
X
222.39
X
55100
002
10
2
X
228.94
X
55100
004
10
2
X
220.55
X
55100
001
10
2
X
231.19
X
55110
001
90
2
X
904.26
X
55110
004
90
2
X
943.22
X
55110
003
90
2
X
866.83
X
55110
002
90
2
X
896.98
X
55120
004
90
2
X
626.55
X
55120
001
90
2
X
753.04
X
55120
003
90
2
X
636.84
X
55120
002
90
2
X
744.88
X
55150
002
90
2
X
1,396.89
X
55150
003
90
2
X
1,318.73
X
55150
001
90
2
X
1,415.69
X
55150
004
90
2
X
1,302.90
X
55175
004
90
2
X
1,019.43
X
55175
001
90
2
X
1,110.89
X
55175
003
90
2
X
1,031.94
X
55175
002
90
2
X
1,088.94
X
55180
002
90
2
X
1,738.18
X
55180
003
90
2
X
1,852.49
X
55180
001
90
2
X
1,753.10
X
55180
004
90
2
X
1,830.95
X
55200
002
90
2
X
693.78
X
55200
003
90
2
X
661.49
X
55200
001
90
2
X
701.57
X
55200
004
90
2
X
654.05
X
55250
002
90
2
X
809.80
X
55250
003
90
2
X
759.61
X
55250
001
90
2
X
798.64
X
55250
004
90
2
X
762.14
X
55300
002
0
2
X
715.78
X
55300
003
0
2
X
677.24
X
55300
004
0
2
X
669.15
X
55300
001
0
2
X
725.08
X
55400
001
90
2
X
1,723.60
X
55400
004
90
2
X
1,590.80
X
55400
003
90
2
X
1,610.08
X
55400
002
90
2
X
1,701.52
X
55500
004
90
2
X
1,029.25
X
55500
001
90
2
X
1,099.52
X
55500
003
90
2
X
1,033.18
X
55500
002
90
2
X
1,090.48
X
55520
004
90
2
X
968.10
X
55520
001
90
2
X
1,052.04
X
55520
003
90
2
X
978.95
X
55520
002
90
2
X
1,037.74
X
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