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Occ. & Industrial Safety
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Labor Market & Jobs Data
Divisions
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Unemployment Tax Services
Workers' Compensation
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Vocational Rehabilitation
Work Statistics
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Health Care Services Review
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Fee Schedule
>
Fee Schedule 74415-75716
Begin Main Content Area
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Content Editor
2024 Workers' Compensation Part B Fee Schedule
74415-75716
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
74415
001
XXX
0
X
304.21
X
74415
26
001
XXX
0
X
85.47
X
74415
TC
001
XXX
0
X
226.61
X
74415
002
XXX
0
X
299.23
X
74415
26
002
XXX
0
X
85.20
X
74415
TC
002
XXX
0
X
222.55
X
74415
003
XXX
0
X
282.73
X
74415
26
003
XXX
0
X
81.70
X
74415
TC
003
XXX
0
X
205.25
X
74415
004
XXX
0
X
274.04
X
74415
26
004
XXX
0
X
79.49
X
74415
TC
004
XXX
0
X
202.01
X
74420
004
XXX
0
X
303.23
X
74420
26
004
XXX
0
X
56.53
X
74420
TC
004
XXX
0
X
251.42
X
74420
003
XXX
0
X
307.87
X
74420
26
003
XXX
0
X
57.93
X
74420
TC
003
XXX
0
X
255.47
X
74420
002
XXX
0
X
332.36
X
74420
26
002
XXX
0
X
60.38
X
74420
TC
002
XXX
0
X
277.28
X
74420
001
XXX
0
X
338.25
X
74420
26
001
XXX
0
X
60.50
X
74420
TC
001
XXX
0
X
282.51
X
74425
003
XXX
0
X
181.48
X
74425
26
003
XXX
0
X
57.98
X
74425
TC
003
XXX
0
X
125.78
X
74425
002
XXX
0
X
191.51
X
74425
26
002
XXX
0
X
60.38
X
74425
TC
002
XXX
0
X
136.46
X
74425
001
XXX
0
X
194.67
X
74425
26
001
XXX
0
X
60.50
X
74425
TC
001
XXX
0
X
138.94
X
74425
004
XXX
0
X
175.70
X
74425
26
004
XXX
0
X
57.63
X
74425
TC
004
XXX
0
X
123.86
X
74430
001
XXX
0
X
163.78
X
74430
26
001
XXX
0
X
54.66
X
74430
TC
001
XXX
0
X
113.15
X
74430
002
XXX
0
X
161.10
X
74430
26
002
XXX
0
X
54.44
X
74430
TC
002
XXX
0
X
111.00
X
74430
003
XXX
0
X
151.80
X
74430
26
003
XXX
0
X
52.26
X
74430
TC
003
XXX
0
X
102.21
X
74430
004
XXX
0
X
147.61
X
74430
26
004
XXX
0
X
51.52
X
74430
TC
004
XXX
0
X
100.56
X
74440
004
XXX
0
X
164.69
X
74440
26
004
XXX
0
X
60.30
X
74440
TC
004
XXX
0
X
108.00
X
74440
001
XXX
0
X
181.50
X
74440
26
001
XXX
0
X
65.04
X
74440
TC
001
XXX
0
X
121.18
X
74440
002
XXX
0
X
178.58
X
74440
26
002
XXX
0
X
64.76
X
74440
TC
002
XXX
0
X
119.01
X
74440
003
XXX
0
X
169.02
X
74440
26
003
XXX
0
X
61.89
X
74440
TC
003
XXX
0
X
109.73
X
74445
002
XXX
0
X
311.17
X
74445
26
002
XXX
0
X
197.69
X
74445
TC
002
XXX
0
X
119.01
X
74445
003
XXX
0
X
296.14
X
74445
26
003
XXX
0
X
189.11
X
74445
TC
003
XXX
0
X
109.73
X
74445
004
XXX
0
X
288.46
X
74445
26
004
XXX
0
X
184.25
X
74445
TC
004
XXX
0
X
108.00
X
74445
001
XXX
0
X
312.46
X
74445
26
001
XXX
0
X
198.36
X
74445
TC
001
XXX
0
X
121.18
X
74450
004
XXX
0
X
187.64
X
74450
26
004
XXX
0
X
52.46
X
74450
TC
004
XXX
0
X
139.66
X
74450
003
XXX
0
X
192.68
X
74450
26
003
XXX
0
X
53.81
X
74450
TC
003
XXX
0
X
141.91
X
74450
002
XXX
0
X
204.92
X
74450
26
002
XXX
0
X
56.04
X
74450
TC
002
XXX
0
X
153.83
X
74450
001
XXX
0
X
208.34
X
74450
26
001
XXX
0
X
56.16
X
74450
TC
001
XXX
0
X
156.72
X
74455
003
XXX
0
X
201.80
X
74455
26
003
XXX
0
X
53.65
X
74455
TC
003
XXX
0
X
153.24
X
74455
001
XXX
0
X
221.04
X
74455
26
001
XXX
0
X
56.16
X
74455
TC
001
XXX
0
X
169.42
X
74455
002
XXX
0
X
217.38
X
74455
26
002
XXX
0
X
56.04
X
74455
TC
002
XXX
0
X
166.29
X
74455
004
XXX
0
X
198.84
X
74455
26
004
XXX
0
X
52.26
X
74455
TC
004
XXX
0
X
150.82
X
74470
004
XXX
0
X
204.86
X
74470
26
004
XXX
0
X
89.17
X
74470
TC
004
XXX
0
X
119.18
X
74470
002
XXX
0
X
221.68
X
74470
26
002
XXX
0
X
95.70
X
74470
TC
002
XXX
0
X
131.42
X
74470
003
XXX
0
X
210.33
X
74470
26
003
XXX
0
X
91.49
X
74470
TC
003
XXX
0
X
121.10
X
74470
001
XXX
0
X
221.04
X
74470
26
001
XXX
0
X
95.91
X
74470
TC
001
XXX
0
X
133.88
X
74485
004
XXX
0
X
380.35
X
74485
26
004
XXX
0
X
89.17
X
74485
TC
004
XXX
0
X
299.73
X
74485
002
XXX
0
X
416.25
X
74485
26
002
XXX
0
X
95.70
X
74485
TC
002
XXX
0
X
330.12
X
74485
003
XXX
0
X
386.13
X
74485
26
003
XXX
0
X
91.49
X
74485
TC
003
XXX
0
X
304.55
X
74485
001
XXX
0
X
423.44
X
74485
26
001
XXX
0
X
95.91
X
74485
TC
001
XXX
0
X
336.17
X
74712
001
XXX
4
X
700.30
X
74712
26
001
XXX
4
X
246.28
X
74712
TC
001
XXX
4
X
454.02
X
74712
002
XXX
4
X
618.47
X
74712
26
002
XXX
4
X
230.57
X
74712
TC
002
XXX
4
X
387.94
X
74712
003
XXX
4
X
618.47
X
74712
26
003
XXX
4
X
230.57
X
74712
TC
003
XXX
4
X
387.94
X
74712
004
XXX
4
X
618.47
X
74712
26
004
XXX
4
X
230.57
X
74712
TC
004
XXX
4
X
387.94
X
74713
004
ZZZ
0
X
339.14
X
74713
26
004
ZZZ
0
X
137.04
X
74713
TC
004
ZZZ
0
X
202.10
X
74713
003
ZZZ
0
X
339.14
X
74713
26
003
ZZZ
0
X
137.04
X
74713
TC
003
ZZZ
0
X
202.10
X
74713
002
ZZZ
0
X
339.14
X
74713
26
002
ZZZ
0
X
137.04
X
74713
TC
002
ZZZ
0
X
202.10
X
74713
001
ZZZ
0
X
382.94
X
74713
26
001
ZZZ
0
X
146.40
X
74713
TC
001
ZZZ
0
X
236.53
X
74740
001
XXX
0
X
199.28
X
74740
26
001
XXX
0
X
65.04
X
74740
TC
001
XXX
0
X
138.94
X
74740
002
XXX
0
X
196.05
X
74740
26
002
XXX
0
X
64.76
X
74740
TC
002
XXX
0
X
136.46
X
74740
003
XXX
0
X
185.72
X
74740
26
003
XXX
0
X
61.89
X
74740
TC
003
XXX
0
X
125.78
X
74740
004
XXX
0
X
179.55
X
74740
26
004
XXX
0
X
60.30
X
74740
TC
004
XXX
0
X
123.86
X
74742
001
XXX
0
X
430.42
X
74742
26
001
XXX
0
X
94.27
X
74742
TC
001
XXX
0
X
336.17
X
74742
002
XXX
0
X
423.26
X
74742
26
002
XXX
0
X
93.11
X
74742
TC
002
XXX
0
X
330.12
X
74742
003
XXX
0
X
393.00
X
74742
26
003
XXX
0
X
88.45
X
74742
TC
003
XXX
0
X
304.55
X
74742
004
XXX
0
X
387.23
X
74742
26
004
XXX
0
X
87.47
X
74742
TC
004
XXX
0
X
299.73
X
74775
004
XXX
0
X
236.66
X
74775
26
004
XXX
0
X
101.33
X
74775
TC
004
XXX
0
X
139.66
X
74775
003
XXX
0
X
243.06
X
74775
26
003
XXX
0
X
104.00
X
74775
TC
003
XXX
0
X
141.91
X
74775
002
XXX
0
X
255.96
X
74775
26
002
XXX
0
X
108.61
X
74775
TC
002
XXX
0
X
153.83
X
74775
001
XXX
0
X
255.99
X
74775
26
001
XXX
0
X
108.94
X
74775
TC
001
XXX
0
X
156.72
X
75557
004
XXX
4
X
797.14
X
75557
26
004
XXX
4
X
213.53
X
75557
TC
004
XXX
4
X
583.61
X
75557
003
XXX
4
X
797.14
X
75557
26
003
XXX
4
X
213.53
X
75557
TC
003
XXX
4
X
583.61
X
75557
002
XXX
4
X
797.14
X
75557
26
002
XXX
4
X
213.53
X
75557
TC
002
XXX
4
X
583.61
X
75557
001
XXX
4
X
953.78
X
75557
26
001
XXX
4
X
232.27
X
75557
TC
001
XXX
4
X
721.49
X
75559
001
XXX
4
X
1,011.16
X
75559
26
001
XXX
4
X
296.04
X
75559
TC
001
XXX
4
X
715.14
X
75559
002
XXX
4
X
855.49
X
75559
26
002
XXX
4
X
272.31
X
75559
TC
002
XXX
4
X
583.22
X
75559
003
XXX
4
X
855.49
X
75559
26
003
XXX
4
X
272.31
X
75559
TC
003
XXX
4
X
583.22
X
75559
004
XXX
4
X
855.49
X
75559
26
004
XXX
4
X
272.31
X
75559
TC
004
XXX
4
X
583.22
X
75561
004
XXX
4
X
1,127.99
X
75561
26
004
XXX
4
X
236.20
X
75561
TC
004
XXX
4
X
891.83
X
75561
001
XXX
4
X
1,353.32
X
75561
26
001
XXX
4
X
256.93
X
75561
TC
001
XXX
4
X
1,096.41
X
75561
002
XXX
4
X
1,127.99
X
75561
26
002
XXX
4
X
236.20
X
75561
TC
002
XXX
4
X
891.83
X
75561
003
XXX
4
X
1,127.99
X
75561
26
003
XXX
4
X
236.20
X
75561
TC
003
XXX
4
X
891.83
X
75563
001
XXX
4
X
1,401.55
X
75563
26
001
XXX
4
X
308.51
X
75563
TC
001
XXX
4
X
1,093.05
X
75563
003
XXX
4
X
1,175.08
X
75563
26
003
XXX
4
X
282.88
X
75563
002
XXX
4
X
1,175.08
X
75563
26
002
XXX
4
X
282.88
X
75563
004
XXX
4
X
1,175.08
X
75563
26
004
XXX
4
X
282.88
X
75563
TC
002
XXX
4
X
892.17
X
75563
TC
003
XXX
4
X
892.17
X
75563
TC
004
XXX
4
X
892.17
X
75565
001
ZZZ
0
X
177.42
X
75565
26
001
ZZZ
0
X
23.57
X
75565
TC
001
ZZZ
0
X
153.83
X
75565
002
ZZZ
0
X
151.41
X
75565
26
002
ZZZ
0
X
21.87
X
75565
TC
002
ZZZ
0
X
129.57
X
75565
003
ZZZ
0
X
151.41
X
75565
26
003
ZZZ
0
X
21.87
X
75565
TC
003
ZZZ
0
X
129.57
X
75565
004
ZZZ
0
X
151.41
X
75565
26
004
ZZZ
0
X
21.87
X
75565
TC
004
ZZZ
0
X
129.57
X
75571
004
XXX
4
X
122.83
X
75571
26
004
XXX
4
X
48.83
X
75571
TC
004
XXX
4
X
74.02
X
75571
002
XXX
4
X
122.83
X
75571
26
002
XXX
4
X
48.83
X
75571
TC
002
XXX
4
X
74.02
X
75571
001
XXX
4
X
140.26
X
75571
26
001
XXX
4
X
52.34
X
75571
TC
001
XXX
4
X
87.94
X
75571
003
XXX
4
X
122.83
X
75571
26
003
XXX
4
X
48.83
X
75571
TC
003
XXX
4
X
74.02
X
75572
004
XXX
4
X
439.71
X
75572
26
004
XXX
4
X
148.20
X
75572
TC
004
XXX
4
X
291.52
X
75572
003
XXX
4
X
439.71
X
75572
26
003
XXX
4
X
148.20
X
75572
TC
003
XXX
4
X
291.52
X
75572
002
XXX
4
X
439.71
X
75572
26
002
XXX
4
X
148.20
X
75572
TC
002
XXX
4
X
291.52
X
75572
001
XXX
4
X
504.66
X
75572
26
001
XXX
4
X
158.72
X
75572
TC
001
XXX
4
X
345.90
X
75573
001
XXX
4
X
716.40
X
75573
26
001
XXX
4
X
226.76
X
75573
TC
001
XXX
4
X
489.62
X
75573
002
XXX
4
X
624.82
X
75573
26
002
XXX
4
X
212.13
X
75573
TC
002
XXX
4
X
412.69
X
75573
003
XXX
4
X
624.82
X
75573
26
003
XXX
4
X
212.13
X
75573
TC
003
XXX
4
X
412.69
X
75573
004
XXX
4
X
624.82
X
75573
26
004
XXX
4
X
212.13
X
75573
TC
004
XXX
4
X
412.69
X
75574
004
XXX
4
X
642.98
X
75574
26
004
XXX
4
X
201.95
X
75574
TC
004
XXX
4
X
441.07
X
75574
001
XXX
4
X
739.25
X
75574
26
001
XXX
4
X
216.02
X
75574
TC
001
XXX
4
X
523.28
X
75574
003
XXX
4
X
642.98
X
75574
26
003
XXX
4
X
201.95
X
75574
TC
003
XXX
4
X
441.07
X
75574
002
XXX
4
X
642.98
X
75574
26
002
XXX
4
X
201.95
X
75574
TC
002
XXX
4
X
441.07
X
75580
001
XXX
0
X
1,056.26
X
75580
26
001
XXX
0
X
39.86
X
75580
TC
001
XXX
0
X
1,016.40
X
75580
004
XXX
0
X
931.90
X
75580
26
004
XXX
0
X
37.36
X
75580
TC
004
XXX
0
X
894.54
X
75580
003
XXX
0
X
931.90
X
75580
26
003
XXX
0
X
37.36
X
75580
TC
003
XXX
0
X
894.54
X
75580
002
XXX
0
X
931.90
X
75580
26
002
XXX
0
X
37.36
X
75580
TC
002
XXX
0
X
894.54
X
75600
003
XXX
6
X
1,293.05
X
75600
26
003
XXX
6
X
81.62
X
75600
TC
003
XXX
6
X
773.88
X
75600
002
XXX
6
X
1,399.14
X
75600
26
002
XXX
6
X
85.20
X
75600
TC
002
XXX
6
X
835.52
X
75600
001
XXX
6
X
1,424.31
X
75600
26
001
XXX
6
X
85.47
X
75600
TC
001
XXX
6
X
849.17
X
75600
004
XXX
6
X
1,272.87
X
75600
26
004
XXX
6
X
79.49
X
75600
TC
004
XXX
6
X
760.17
X
75605
002
XXX
6
X
1,500.80
X
75605
26
002
XXX
6
X
197.69
X
75605
TC
002
XXX
6
X
935.47
X
75605
003
XXX
6
X
1,389.18
X
75605
26
003
XXX
6
X
189.11
X
75605
TC
003
XXX
6
X
870.11
X
75605
004
XXX
6
X
1,367.96
X
75605
26
004
XXX
6
X
184.25
X
75605
TC
004
XXX
6
X
852.99
X
75605
001
XXX
6
X
1,527.22
X
75605
26
001
XXX
6
X
198.36
X
75605
TC
001
XXX
6
X
948.86
X
75625
001
XXX
6
X
1,527.22
X
75625
26
001
XXX
6
X
198.36
X
75625
TC
001
XXX
6
X
948.86
X
75625
004
XXX
6
X
1,367.96
X
75625
26
004
XXX
6
X
184.25
X
75625
TC
004
XXX
6
X
852.99
X
75625
003
XXX
6
X
1,389.18
X
75625
26
003
XXX
6
X
189.11
X
75625
TC
003
XXX
6
X
870.11
X
75625
002
XXX
6
X
1,500.80
X
75625
26
002
XXX
6
X
197.69
X
75625
TC
002
XXX
6
X
935.47
X
75630
004
XXX
6
X
1,444.14
X
75630
26
004
XXX
6
X
211.84
X
75630
TC
004
XXX
6
X
907.03
X
75630
003
XXX
6
X
1,466.51
X
75630
26
003
XXX
6
X
217.39
X
75630
TC
003
XXX
6
X
925.59
X
75630
002
XXX
6
X
1,583.98
X
75630
26
002
XXX
6
X
227.27
X
75630
TC
002
XXX
6
X
994.71
X
75630
001
XXX
6
X
1,611.92
X
75630
26
001
XXX
6
X
227.95
X
75630
TC
001
XXX
6
X
1,008.50
X
75635
001
XXX
4
X
1,106.70
X
75635
26
001
XXX
4
X
251.65
X
75635
TC
001
XXX
4
X
855.06
X
75635
003
XXX
4
X
950.25
X
75635
26
003
XXX
4
X
232.40
X
75635
TC
003
XXX
4
X
717.81
X
75635
004
XXX
4
X
950.25
X
75635
26
004
XXX
4
X
232.40
X
75635
TC
004
XXX
4
X
717.81
X
75635
002
XXX
4
X
950.25
X
75635
26
002
XXX
4
X
232.40
X
75635
TC
002
XXX
4
X
717.81
X
75705
001
XXX
6
X
1,693.00
X
75705
26
001
XXX
6
X
379.09
X
75705
TC
001
XXX
6
X
1,346.79
X
75705
002
XXX
6
X
1,664.41
X
75705
26
002
XXX
6
X
377.81
X
75705
TC
002
XXX
6
X
1,322.54
X
75705
003
XXX
6
X
1,544.55
X
75705
26
003
XXX
6
X
361.47
X
75705
TC
003
XXX
6
X
1,220.19
X
75705
004
XXX
6
X
1,521.57
X
75705
26
004
XXX
6
X
352.27
X
75705
TC
004
XXX
6
X
1,200.80
X
75710
001
XXX
6
X
1,527.22
X
75710
26
001
XXX
6
X
198.36
X
75710
TC
001
XXX
6
X
1,346.79
X
75710
002
XXX
6
X
1,500.80
X
75710
26
002
XXX
6
X
197.69
X
75710
TC
002
XXX
6
X
1,322.54
X
75710
003
XXX
6
X
1,389.18
X
75710
26
003
XXX
6
X
189.11
X
75710
TC
003
XXX
6
X
1,220.19
X
75710
004
XXX
6
X
1,367.96
X
75710
26
004
XXX
6
X
184.25
X
75710
TC
004
XXX
6
X
1,200.80
X
75716
004
XXX
6
X
1,392.92
X
75716
26
004
XXX
6
X
211.84
X
75716
TC
004
XXX
6
X
1,200.80
X
75716
001
XXX
6
X
1,554.11
X
75716
26
001
XXX
6
X
227.95
X
75716
TC
001
XXX
6
X
1,346.79
X
75716
003
XXX
6
X
1,414.42
X
75716
26
003
XXX
6
X
217.39
X
75716
TC
003
XXX
6
X
1,220.19
X
75716
002
XXX
6
X
1,527.29
X
75716
26
002
XXX
6
X
227.27
X
75716
TC
002
XXX
6
X
1,322.54
X
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