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2024 Workers' Compensation Part B Fee Schedule

61521-62161

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CPT/HCPC Code Modifier Medicare Location Global Surgery Indicator Multiple Surgery Indicator Prevailing Charge Amount Fee Schedule Amount Site of Service Amount
61521   003 90 2 X 8,174.07 X
61521   002 90 2 X 8,762.17 X
61521   004 90 2 X 8,752.82 X
61521   001 90 2 X 9,099.43 X
61522   004 90 2 X 5,300.47 X
61522   001 90 2 X 5,830.59 X
61522   003 90 2 X 5,361.68 X
61522   002 90 2 X 5,739.06 X
61524   003 90 2 X 6,108.25 X
61524   002 90 2 X 6,593.76 X
61524   004 90 2 X 6,035.63 X
61524   001 90 2 X 6,711.36 X
61526   002 90 2 X 8,788.29 X
61526   003 90 2 X 7,129.26 X
61526   004 90 2 X 7,041.65 X
61526   001 90 2 X 8,840.69 X
61530   001 90 2 X 7,770.79 X
61530   003 90 2 X 7,129.26 X
61530   002 90 2 X 7,646.00 X
61530   004 90 2 X 7,041.65 X
61531   001 90 2 X 4,174.16 X
61531   004 90 2 X 3,843.70 X
61531   003 90 2 X 3,889.48 X
61531   002 90 2 X 4,118.83 X
61533   001 90 2 X 4,980.01 X
61533   003 90 2 X 4,574.03 X
61533   002 90 2 X 4,900.67 X
61533   004 90 2 X 4,521.98 X
61534   001 90 2 X 3,125.81 X
61534   004 90 2 X 2,864.35 X
61534   003 90 2 X 2,893.86 X
61534   002 90 2 X 4,138.00 X
61535   001 90 2 X 2,165.39 X
61535   004 90 2 X 1,975.99 X
61535   003 90 2 X 1,999.17 X
61535   002 90 2 X 2,133.01 X
61536   001 90 2 X 6,287.73 X
61536   004 90 2 X 5,719.32 X
61536   002 90 2 X 6,189.80 X
61536   003 90 2 X 5,785.76 X
61537   001 90 2 X 4,085.02 X
61537   002 90 2 X 3,526.71 X
61537   003 90 2 X 3,526.71 X
61537   004 90 2 X 3,526.71 X
61538   001 90 2 X 7,081.35 X
61538   004 90 2 X 6,392.45 X
61538   003 90 2 X 6,469.83 X
61538   002 90 2 X 6,961.69 X
61539   002 90 2 X 6,379.16 X
61539   003 90 2 X 5,963.16 X
61539   001 90 2 X 6,480.13 X
61539   004 90 2 X 5,894.40 X
61540   001 90 2 X 4,936.85 X
61540   004 90 2 X 4,255.53 X
61540   003 90 2 X 4,255.53 X
61540   002 90 2 X 4,255.53 X
61541   002 90 2 X 5,654.76 X
61541   003 90 2 X 5,280.44 X
61541   001 90 2 X 5,945.89 X
61541   004 90 2 X 5,220.11 X
61543   001 90 2 X 4,558.00 X
61543   004 90 2 X 4,161.07 X
61543   003 90 2 X 4,210.75 X
61543   002 90 2 X 4,490.35 X
61544   004 90 2 X 5,541.59 X
61544   003 90 2 X 5,613.26 X
61544   002 90 2 X 5,948.01 X
61544   001 90 2 X 6,028.35 X
61545   003 90 2 X 6,787.56 X
61545   002 90 2 X 7,266.75 X
61545   001 90 2 X 7,382.97 X
61545   004 90 2 X 6,709.73 X
61546   001 90 2 X 7,296.82 X
61546   004 90 2 X 6,299.48 X
61546   003 90 2 X 7,023.39 X
61546   002 90 2 X 7,221.92 X
61548   003 90 2 X 7,462.52 X
61548   002 90 2 X 7,568.57 X
61548   004 90 2 X 7,198.79 X
61548   001 90 2 X 6,013.56 X
61550   001 90 2 X 3,034.63 X
61550   004 90 2 X 2,798.89 X
61550   002 90 2 X 2,995.44 X
61550   003 90 2 X 2,832.98 X
61552   004 90 2 X 3,672.70 X
61552   002 90 2 X 4,844.56 X
61552   003 90 2 X 3,715.03 X
61552   001 90 2 X 4,044.36 X
61556   001 90 2 X 6,240.04 X
61556   004 90 2 X 6,240.04 X
61556   002 90 2 X 6,240.04 X
61556   003 90 2 X 6,240.04 X
61557   003 90 2 X 9,360.10 X
61557   002 90 2 X 9,360.10 X
61557   004 90 2 X 9,360.10 X
61557   001 90 2 X 9,360.10 X
61558   001 90 2 X 5,556.90 X
61558   004 90 2 X 4,980.86 X
61558   002 90 2 X 5,390.59 X
61558   003 90 2 X 5,047.76 X
61559   004 90 2 X 6,459.18 X
61559   001 90 2 X 7,206.19 X
61559   003 90 2 X 6,545.95 X
61559   002 90 2 X 6,990.46 X
61563   004 90 2 X 9,031.65 X
61563   001 90 2 X 9,031.65 X
61563   002 90 2 X 9,031.65 X
61563   003 90 2 X 9,031.65 X
61564   002 90 2 X 11,494.80 X
61564   003 90 2 X 11,494.80 X
61564   004 90 2 X 11,494.80 X
61564   001 90 2 X 11,494.80 X
61566   002 90 2 X 4,235.82 X
61566   003 90 2 X 4,235.82 X
61566   004 90 2 X 4,235.82 X
61566   001 90 2 X 4,844.60 X
61567   002 90 2 X 4,849.81 X
61567   003 90 2 X 4,849.81 X
61567   001 90 2 X 5,510.67 X
61567   004 90 2 X 4,849.81 X
61570   002 90 2 X 4,743.02 X
61570   003 90 2 X 4,733.67 X
61570   004 90 2 X 4,383.86 X
61570   001 90 2 X 5,056.30 X
61571   004 90 2 X 4,758.75 X
61571   001 90 2 X 5,226.15 X
61571   003 90 2 X 4,814.18 X
61571   002 90 2 X 5,145.80 X
61575   001 90 2 X 7,990.66 X
61575   004 90 2 X 7,243.65 X
61575   002 90 2 X 7,862.42 X
61575   003 90 2 X 7,673.22 X
61576   001 90 2 X 7,440.58 X
61576   004 90 2 X 6,801.07 X
61576   003 90 2 X 6,882.56 X
61576   002 90 2 X 7,331.89 X
61580   004 90 2 X 5,580.64 X
61580   001 90 2 X 6,145.41 X
61580   003 90 2 X 5,644.92 X
61580   002 90 2 X 6,047.66 X
61581   004 90 2 X 6,333.70 X
61581   001 90 2 X 6,974.70 X
61581   002 90 2 X 6,863.79 X
61581   003 90 2 X 6,406.76 X
61582   004 90 2 X 5,749.22 X
61582   001 90 2 X 6,330.73 X
61582   002 90 2 X 6,230.14 X
61582   003 90 2 X 5,815.47 X
61583   004 90 2 X 6,560.64 X
61583   002 90 2 X 7,109.69 X
61583   003 90 2 X 6,636.25 X
61583   001 90 2 X 7,224.62 X
61584   003 90 2 X 6,426.47 X
61584   002 90 2 X 6,885.10 X
61584   001 90 2 X 6,996.45 X
61584   004 90 2 X 6,353.21 X
61585   002 90 2 X 7,702.33 X
61585   003 90 2 X 7,189.26 X
61585   001 90 2 X 7,826.92 X
61585   004 90 2 X 7,107.41 X
61586   001 90 2 X 5,410.08 X
61586   002 90 2 X 4,907.31 X
61586   003 90 2 X 4,775.40 X
61586   004 90 2 X 4,775.40 X
61590   002 90 2 X 8,375.08 X
61590   003 90 2 X 7,817.70 X
61590   004 90 2 X 7,728.69 X
61590   001 90 2 X 8,510.35 X
61591   004 90 2 X 8,106.74 X
61591   001 90 2 X 8,927.25 X
61591   002 90 2 X 8,785.30 X
61591   003 90 2 X 8,200.14 X
61592   004 90 2 X 7,352.60 X
61592   003 90 2 X 7,437.34 X
61592   002 90 2 X 7,967.98 X
61592   001 90 2 X 8,096.81 X
61595   001 90 2 X 5,980.06 X
61595   004 90 2 X 5,430.39 X
61595   002 90 2 X 5,884.94 X
61595   003 90 2 X 5,492.99 X
61596   004 90 2 X 6,599.48 X
61596   002 90 2 X 7,151.83 X
61596   003 90 2 X 6,675.51 X
61596   001 90 2 X 7,267.38 X
61597   002 90 2 X 7,559.42 X
61597   003 90 2 X 7,055.96 X
61597   001 90 2 X 7,681.52 X
61597   004 90 2 X 6,975.50 X
61598   004 90 2 X 6,145.78 X
61598   002 90 2 X 6,660.02 X
61598   003 90 2 X 6,216.58 X
61598   001 90 2 X 6,767.68 X
61600   001 90 2 X 5,189.65 X
61600   002 90 2 X 5,107.13 X
61600   003 90 2 X 4,767.29 X
61600   004 90 2 X 4,713.02 X
61601   001 90 2 X 5,564.82 X
61601   004 90 2 X 5,053.34 X
61601   002 90 2 X 5,476.30 X
61601   003 90 2 X 5,111.55 X
61605   003 90 2 X 5,396.86 X
61605   002 90 2 X 5,781.95 X
61605   001 90 2 X 5,875.43 X
61605   004 90 2 X 5,335.36 X
61606   004 90 2 X 7,145.13 X
61606   001 90 2 X 7,868.00 X
61606   002 90 2 X 7,742.94 X
61606   003 90 2 X 7,227.48 X
61607   001 90 2 X 7,349.30 X
61607   002 90 2 X 7,232.39 X
61607   003 90 2 X 6,750.95 X
61607   004 90 2 X 6,674.05 X
61608   004 90 2 X 7,766.47 X
61608   001 90 2 X 8,552.14 X
61608   003 90 2 X 7,855.96 X
61608   002 90 2 X 8,416.17 X
61611   002 ZZZ 0 X 1,224.78 X
61611   003 ZZZ 0 X 1,143.24 X
61611   001 ZZZ 0 X 1,244.56 X
61611   004 ZZZ 0 X 1,130.25 X
61613   003 90 2 X 7,704.05 X
61613   002 90 2 X 8,253.92 X
61613   004 90 2 X 7,616.27 X
61613   001 90 2 X 8,387.34 X
61615   003 90 2 X 5,931.28 X
61615   002 90 2 X 6,354.38 X
61615   004 90 2 X 5,863.66 X
61615   001 90 2 X 6,457.05 X
61616   003 90 2 X 8,066.86 X
61616   002 90 2 X 8,642.26 X
61616   004 90 2 X 7,974.94 X
61616   001 90 2 X 8,781.93 X
61618   002 90 2 X 3,267.89 X
61618   003 90 2 X 3,050.39 X
61618   004 90 2 X 3,015.62 X
61618   001 90 2 X 3,320.70 X
61619   002 90 2 X 4,085.14 X
61619   003 90 2 X 3,813.25 X
61619   004 90 2 X 3,769.84 X
61619   001 90 2 X 4,151.09 X
61623   003 0 2 X 1,156.22 X
61623   002 0 2 X 1,156.22 X
61623   001 0 2 X 1,266.23 X
61623   004 0 2 X 1,156.22 X
61624   003 0 2 X 3,637.12 X
61624   002 0 2 X 3,854.28 X
61624   001 0 2 X 3,906.87 X
61624   004 0 2 X 3,594.09 X
61626   001 0 2 X 3,221.44 X
61626   004 0 2 X 2,963.73 X
61626   002 0 2 X 3,178.22 X
61626   003 0 2 X 2,999.16 X
61630     XXX 2 X * X
61635     XXX 2 X * X
61640     0 9 X * X
61641     ZZZ 9 X * X
61642     ZZZ 9 X * X
61645   003 0 0 X 1,217.85 X
61645   002 0 0 X 1,217.85 X
61645   001 0 0 X 1,320.64 X
61645   004 0 0 X 1,217.85 X
61650   001 0 2 X 878.90 X
61650   003 0 2 X 811.72 X
61650   002 0 2 X 811.72 X
61650   004 0 2 X 811.72 X
61651   004 ZZZ 0 X 344.76 X
61651   003 ZZZ 0 X 344.76 X
61651   002 ZZZ 0 X 344.76 X
61651   001 ZZZ 0 X 373.27 X
61680   002 90 2 X 8,216.26 X
61680   003 90 2 X 7,650.94 X
61680   004 90 2 X 7,561.94 X
61680   001 90 2 X 8,353.36 X
61682   003 90 2 X 8,755.41 X
61682   001 90 2 X 9,542.95 X
61682   004 90 2 X 8,653.44 X
61682   002 90 2 X 9,389.34 X
61684   002 90 2 X 8,020.20 X
61684   003 90 2 X 7,568.81 X
61684   004 90 2 X 7,479.39 X
61684   001 90 2 X 8,129.27 X
61686   001 90 2 X 9,828.97 X
61686   004 90 2 X 9,042.79 X
61686   003 90 2 X 9,150.97 X
61686   002 90 2 X 9,696.99 X
61690   002 90 2 X 7,278.85 X
61690   003 90 2 X 6,824.96 X
61690   004 90 2 X 6,744.68 X
61690   001 90 2 X 7,388.72 X
61692   002 90 2 X 7,757.79 X
61692   003 90 2 X 7,320.96 X
61692   004 90 2 X 7,234.45 X
61692   001 90 2 X 7,863.30 X
61697   001 90 2 X 8,408.49 X
61697   003 90 2 X 7,345.03 X
61697   002 90 2 X 7,345.03 X
61697   004 90 2 X 7,345.03 X
61698   001 90 2 X 8,096.28 X
61698   003 90 2 X 7,067.47 X
61698   002 90 2 X 7,067.47 X
61698   004 90 2 X 7,067.47 X
61700   003 90 2 X 7,529.70 X
61700   002 90 2 X 8,088.81 X
61700   001 90 2 X 8,252.16 X
61700   004 90 2 X 7,438.09 X
61702   004 90 2 X 8,463.64 X
61702   001 90 2 X 9,364.79 X
61702   003 90 2 X 8,564.42 X
61702   002 90 2 X 9,208.69 X
61703   004 90 2 X 3,172.64 X
61703   001 90 2 X 3,489.46 X
61703   002 90 2 X 3,434.81 X
61703   003 90 2 X 3,209.45 X
61705   002 90 2 X 7,848.86 X
61705   003 90 2 X 7,446.57 X
61705   001 90 2 X 7,977.24 X
61705   004 90 2 X 7,232.82 X
61708   004 90 2 X 6,304.48 X
61708   002 90 2 X 6,712.60 X
61708   003 90 2 X 6,380.60 X
61708   001 90 2 X 6,818.75 X
61710   002 90 2 X 5,127.25 X
61710   003 90 2 X 4,868.23 X
61710   004 90 2 X 4,812.16 X
61710   001 90 2 X 5,591.20 X
61711   003 90 2 X 7,702.51 X
61711   002 90 2 X 7,609.22 X
61711   004 90 2 X 7,611.88 X
61711   001 90 2 X 7,861.33 X
61720   001 90 2 X 6,253.71 X
61720   003 90 2 X 4,418.41 X
61720   002 90 2 X 6,365.26 X
61720   004 90 2 X 4,363.99 X
61735   001 90 2 X 3,538.44 X
61735   004 90 2 X 3,255.46 X
61735   003 90 2 X 3,294.38 X
61735   002 90 2 X 4,391.13 X
61736   002 0 0 X 1,091.04 X
61736   003 0 0 X 1,091.04 X
61736   001 0 0 X 1,169.70 X
61736   004 0 0 X 1,091.04 X
61737   004 0 0 X 1,299.34 X
61737   001 0 0 X 1,394.11 X
61737   002 0 0 X 1,299.34 X
61737   003 0 0 X 1,299.34 X
61750   001 90 2 X 5,617.32 X
61750   003 90 2 X 5,426.76 X
61750   002 90 2 X 5,580.20 X
61750   004 90 2 X 5,407.25 X
61751   004 90 2 X 5,873.64 X
61751   001 90 2 X 6,087.49 X
61751   002 90 2 X 6,064.96 X
61751   003 90 2 X 5,897.10 X
61760   003 90 2 X 4,349.24 X
61760   002 90 2 X 4,589.78 X
61760   004 90 2 X 4,299.24 X
61760   001 90 2 X 4,647.99 X
61770   004 90 2 X 3,899.89 X
61770   002 90 2 X 4,831.23 X
61770   003 90 2 X 3,947.94 X
61770   001 90 2 X 5,044.98 X
61781   001 ZZZ 0 X 482.48 X
61781   004 ZZZ 0 X 424.83 X
61781   003 ZZZ 0 X 424.83 X
61781   002 ZZZ 0 X 424.83 X
61782   003 ZZZ 0 X 347.50 X
61782   002 ZZZ 0 X 347.50 X
61782   001 ZZZ 0 X 390.51 X
61782   004 ZZZ 0 X 347.50 X
61783   002 ZZZ 0 X 424.83 X
61783   003 ZZZ 0 X 424.83 X
61783   001 ZZZ 0 X 482.48 X
61783   004 ZZZ 0 X 424.83 X
61790   004 90 2 X 4,445.00 X
61790   001 90 2 X 4,601.80 X
61790   003 90 2 X 4,460.67 X
61790   002 90 2 X 4,310.19 X
61791   004 90 2 X 4,170.07 X
61791   002 90 2 X 4,295.84 X
61791   003 90 2 X 2,614.33 X
61791   001 90 2 X 4,322.85 X
61796   004 90 0 X 1,290.15 X
61796   002 90 0 X 1,290.15 X
61796   003 90 0 X 1,290.15 X
61796   001 90 0 X 1,468.75 X
61797   001 ZZZ 0 X 398.40 X
61797   003 ZZZ 0 X 355.02 X
61797   002 ZZZ 0 X 355.02 X
61797   004 ZZZ 0 X 355.02 X
61798   004 90 0 X 1,290.15 X
61798   001 90 0 X 1,468.75 X
61798   003 90 0 X 1,290.15 X
61798   002 90 0 X 1,290.15 X
61799   001 ZZZ 0 X 551.00 X
61799   004 ZZZ 0 X 490.89 X
61799   003 ZZZ 0 X 490.89 X
61799   002 ZZZ 0 X 490.89 X
61800   001 ZZZ 0 X 285.76 X
61800   004 ZZZ 0 X 251.38 X
61800   003 ZZZ 0 X 251.38 X
61800   002 ZZZ 0 X 251.38 X
61850   002 90 2 X 2,987.33 X
61850   003 90 2 X 3,122.72 X
61850   004 90 2 X 3,087.13 X
61850   001 90 2 X 3,399.27 X
61860   004 90 2 X 2,162.42 X
61860   003 90 2 X 2,187.32 X
61860   002 90 2 X 2,343.37 X
61860   001 90 2 X 2,381.27 X
61863   001 90 2 X 2,931.65 X
61863   004 90 2 X 2,537.80 X
61863   003 90 2 X 2,537.80 X
61863   002 90 2 X 2,537.80 X
61864   002 ZZZ 0 X 608.71 X
61864   003 ZZZ 0 X 608.71 X
61864   001 ZZZ 0 X 703.22 X
61864   004 ZZZ 0 X 608.71 X
61867   001 90 2 X 4,360.34 X
61867   003 90 2 X 3,882.75 X
61867   002 90 2 X 3,882.75 X
61867   004 90 2 X 3,882.75 X
61868   001 ZZZ 0 X 1,149.87 X
61868   003 ZZZ 0 X 1,022.09 X
61868   002 ZZZ 0 X 1,022.09 X
61868   004 ZZZ 0 X 1,022.09 X
61880   004 90 2 X 1,151.30 X
61880   003 90 2 X 1,165.15 X
61880   002 90 2 X 1,587.33 X
61880   001 90 2 X 1,259.72 X
61885   001 90 2 X 1,347.89 X
61885   003 90 2 X 479.93 X
61885   002 90 2 X 511.90 X
61885   004 90 2 X 474.25 X
61886   002 90 2 X 1,290.63 X
61886   003 90 2 X 1,290.63 X
61886   001 90 2 X 1,473.64 X
61886   004 90 2 X 1,290.63 X
61888   003 10 2 X 603.64 X
61888   002 10 2 X 646.60 X
61888   001 10 2 X 657.00 X
61888   004 10 2 X 596.80 X
61889   004 90 2 X 1,358.55 X
61889   001 90 2 X 1,463.44 X
61889   003 90 2 X 1,358.55 X
61889   002 90 2 X 1,358.55 X
61891   004 90 2 X 642.35 X
61891   001 90 2 X 695.10 X
61891   003 90 2 X 642.35 X
61891   002 90 2 X 642.35 X
61892   004 90 2 X 885.06 X
61892   002 90 2 X 885.06 X
61892   003 90 2 X 885.06 X
61892   001 90 2 X 958.00 X
62000   002 90 2 X 2,632.55 X
62000   003 90 2 X 1,880.26 X
62000   001 90 2 X 2,017.31 X
62000   004 90 2 X 2,332.20 X
62005   001 90 2 X 3,163.53 X
62005   004 90 2 X 2,879.43 X
62005   003 90 2 X 3,788.89 X
62005   002 90 2 X 3,114.65 X
62010   003 90 2 X 4,273.08 X
62010   002 90 2 X 4,602.88 X
62010   004 90 2 X 4,464.92 X
62010   001 90 2 X 4,682.69 X
62100   004 90 2 X 4,747.12 X
62100   002 90 2 X 5,431.37 X
62100   003 90 2 X 5,271.28 X
62100   001 90 2 X 5,649.66 X
62115   003 90 2 X 9,852.77 X
62115   002 90 2 X 9,852.77 X
62115   004 90 2 X 9,852.77 X
62115   001 90 2 X 9,852.77 X
62117   002 90 2 X 11,494.80 X
62117   003 90 2 X 11,494.80 X
62117   001 90 2 X 11,494.80 X
62117   004 90 2 X 11,494.80 X
62120   002 90 2 X 4,622.26 X
62120   003 90 2 X 4,297.01 X
62120   001 90 2 X 4,701.23 X
62120   004 90 2 X 4,247.19 X
62121   004 90 2 X 4,247.19 X
62121   001 90 2 X 4,701.23 X
62121   003 90 2 X 4,297.01 X
62121   002 90 2 X 4,622.26 X
62140   002 90 2 X 3,323.76 X
62140   003 90 2 X 3,240.75 X
62140   004 90 2 X 3,257.19 X
62140   001 90 2 X 3,431.57 X
62141   003 90 2 X 3,631.59 X
62141   001 90 2 X 4,008.96 X
62141   002 90 2 X 3,781.97 X
62141   004 90 2 X 3,582.16 X
62142   004 90 2 X 2,627.22 X
62142   001 90 2 X 4,246.94 X
62142   003 90 2 X 4,124.54 X
62142   002 90 2 X 4,223.09 X
62143   001 90 2 X 2,603.24 X
62143   004 90 2 X 2,367.44 X
62143   003 90 2 X 2,395.01 X
62143   002 90 2 X 2,562.57 X
62145   002 90 2 X 5,452.73 X
62145   003 90 2 X 3,462.71 X
62145   004 90 2 X 3,422.75 X
62145   001 90 2 X 3,757.93 X
62146   002 90 2 X 3,162.78 X
62146   003 90 2 X 2,952.21 X
62146   004 90 2 X 2,918.54 X
62146   001 90 2 X 3,213.91 X
62147   001 90 2 X 3,855.14 X
62147   004 90 2 X 3,501.10 X
62147   003 90 2 X 3,541.43 X
62147   002 90 2 X 3,793.84 X
62148   004 ZZZ 0 X 250.76 X
62148   002 ZZZ 0 X 250.76 X
62148   001 ZZZ 0 X 289.66 X
62148   003 ZZZ 0 X 250.76 X
62160   003 ZZZ 0 X 362.95 X
62160   002 ZZZ 0 X 362.95 X
62160   004 ZZZ 0 X 362.95 X
62160   001 ZZZ 0 X 413.81 X
62161   002 90 2 X 2,584.21 X
62161   003 90 2 X 2,584.21 X
62161   004 90 2 X 2,584.21 X
62161   001 90 2 X 2,961.84 X