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DLI
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Health Care Services Review
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Medical Fee Review
>
Fee Schedule
>
Fee Schedule E2311-L1660
Begin Main Content Area
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2024 Workers' Compensation Part B Fee Schedule
E2311-L1660
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
E2311
NU
X
5,143.11
X
E2311
RR
X
514.33
X
E2311
UE
X
3,857.35
X
E2312
NU
X
3,596.77
X
E2312
RR
X
359.69
X
E2312
UE
X
2,697.52
X
E2313
NU
X
571.19
X
E2313
RR
X
57.15
X
E2313
UE
X
428.37
X
E2321
NU
X
3,327.65
X
E2321
RR
X
332.74
X
E2321
UE
X
2,495.77
X
E2322
NU
X
3,061.67
X
E2322
RR
X
306.14
X
E2322
UE
X
2,296.25
X
E2323
NU
X
140.30
X
E2323
RR
X
14.07
X
E2323
UE
X
105.25
X
E2324
NU
X
96.57
X
E2324
RR
X
9.65
X
E2324
UE
X
72.44
X
E2325
NU
X
2,923.73
X
E2325
RR
X
292.40
X
E2325
UE
X
2,192.84
X
E2326
NU
X
693.82
X
E2326
RR
X
69.35
X
E2326
UE
X
520.38
X
E2327
NU
X
5,006.29
X
E2327
RR
X
500.66
X
E2327
UE
X
3,754.65
X
E2328
NU
X
8,417.00
X
E2328
RR
X
841.74
X
E2328
UE
X
6,312.79
X
E2329
NU
X
3,756.21
X
E2329
RR
X
375.67
X
E2329
UE
X
2,817.12
X
E2330
NU
X
7,235.96
X
E2330
RR
X
723.56
X
E2330
UE
X
5,427.00
X
E2331
X
*
X
E2340
NU
X
682.14
X
E2340
RR
X
68.20
X
E2340
UE
X
511.63
X
E2341
NU
X
1,005.04
X
E2341
RR
X
100.50
X
E2341
UE
X
753.75
X
E2342
NU
X
972.60
X
E2342
RR
X
97.24
X
E2342
UE
X
729.42
X
E2343
NU
X
562.86
X
E2343
RR
X
56.28
X
E2343
UE
X
422.12
X
E2351
NU
X
1,516.61
X
E2351
RR
X
151.67
X
E2351
UE
X
1,137.44
X
E2358
X
#
X
E2359
NU
X
303.15
X
E2359
RR
X
30.32
X
E2359
UE
X
227.34
X
E2360
NU
X
226.30
X
E2360
RR
X
22.67
X
E2360
UE
X
169.71
X
E2361
NU
X
302.76
X
E2361
RR
X
30.28
X
E2361
UE
X
227.12
X
E2362
NU
X
199.69
X
E2362
RR
X
20.00
X
E2362
UE
X
149.72
X
E2363
NU
X
403.76
X
E2363
RR
X
40.42
X
E2363
UE
X
302.83
X
E2364
NU
X
226.30
X
E2364
RR
X
22.67
X
E2364
UE
X
169.71
X
E2365
NU
X
243.54
X
E2365
RR
X
24.35
X
E2365
UE
X
182.68
X
E2366
NU
X
486.44
X
E2366
RR
X
48.80
X
E2366
UE
X
364.82
X
E2367
NU
X
909.77
X
E2367
RR
X
90.97
X
E2367
UE
X
682.34
X
E2368
NU
X
1,080.32
X
E2368
RR
X
108.05
X
E2368
UE
X
810.30
X
E2369
NU
X
940.97
X
E2369
RR
X
94.08
X
E2369
UE
X
705.72
X
E2370
NU
X
1,679.04
X
E2370
RR
X
167.91
X
E2370
UE
X
1,259.27
X
E2371
NU
XXX
9
X
302.98
X
E2371
RR
XXX
9
X
30.31
X
E2371
UE
XXX
9
X
227.25
X
E2372
XXX
9
X
#
X
E2373
X
#
X
E2374
NU
X
325.46
X
E2374
RR
X
32.53
X
E2374
UE
X
244.07
X
E2375
NU
X
1,645.91
X
E2375
RR
X
164.58
X
E2375
UE
X
1,234.43
X
E2376
NU
X
2,579.28
X
E2376
RR
X
257.96
X
E2376
UE
X
1,934.46
X
E2377
NU
X
933.32
X
E2377
RR
X
93.30
X
E2377
UE
X
700.03
X
E2378
X
*
X
E2381
NU
X
146.38
X
E2381
RR
X
14.63
X
E2381
UE
X
109.79
X
E2382
NU
X
39.90
X
E2382
RR
X
3.98
X
E2382
UE
X
29.90
X
E2383
NU
X
291.84
X
E2383
RR
X
29.19
X
E2383
UE
X
218.89
X
E2384
NU
X
155.47
X
E2384
RR
X
15.57
X
E2384
UE
X
116.62
X
E2385
NU
X
95.10
X
E2385
RR
X
9.53
X
E2385
UE
X
71.32
X
E2386
NU
X
289.22
X
E2386
RR
X
28.92
X
E2386
UE
X
216.90
X
E2387
NU
X
129.68
X
E2387
RR
X
12.95
X
E2387
UE
X
97.32
X
E2388
NU
X
96.79
X
E2388
RR
X
9.69
X
E2388
UE
X
72.63
X
E2389
NU
X
52.53
X
E2389
RR
X
5.28
X
E2389
UE
X
39.40
X
E2390
NU
X
82.21
X
E2390
RR
X
8.24
X
E2390
UE
X
61.61
X
E2391
NU
X
39.38
X
E2391
RR
X
3.96
X
E2391
UE
X
29.59
X
E2392
X
#
X
E2394
X
#
X
E2395
X
#
X
E2396
NU
X
108.61
X
E2396
RR
X
11.66
X
E2396
UE
X
81.52
X
E2397
X
#
X
E2398
X
#
X
E2402
RR
X
3,726.13
X
E2500
NU
X
848.93
X
E2500
RR
X
84.90
X
E2500
UE
X
636.66
X
E2502
NU
X
2,595.88
X
E2502
RR
X
259.59
X
E2502
UE
X
1,946.94
X
E2504
NU
X
3,424.28
X
E2504
RR
X
342.47
X
E2504
UE
X
2,568.22
X
E2506
NU
X
5,021.05
X
E2506
RR
X
502.09
X
E2506
UE
X
3,765.68
X
E2508
NU
X
7,764.22
X
E2508
RR
X
776.45
X
E2508
UE
X
5,823.24
X
E2510
NU
X
14,692.75
X
E2510
RR
X
1,469.24
X
E2510
UE
X
11,019.54
X
E2511
X
#
X
E2512
X
#
X
E2599
X
#
X
E2601
NU
X
185.39
X
E2601
RR
X
18.56
X
E2601
UE
X
139.05
X
E2602
NU
X
338.55
X
E2602
RR
X
33.90
X
E2602
UE
X
253.97
X
E2603
NU
X
466.47
X
E2603
RR
X
46.66
X
E2603
UE
X
349.85
X
E2604
NU
X
660.36
X
E2604
RR
X
66.01
X
E2604
UE
X
495.32
X
E2605
NU
X
672.77
X
E2605
RR
X
67.33
X
E2605
UE
X
504.62
X
E2606
NU
X
911.97
X
E2606
RR
X
91.20
X
E2606
UE
X
684.01
X
E2607
NU
X
618.24
X
E2607
RR
X
61.83
X
E2607
UE
X
463.66
X
E2608
NU
X
740.34
X
E2608
RR
X
74.07
X
E2608
UE
X
555.30
X
E2609
X
*
X
E2610
X
#
X
E2611
NU
X
653.22
X
E2611
RR
X
65.30
X
E2611
UE
X
490.00
X
E2612
NU
X
883.68
X
E2612
RR
X
88.35
X
E2612
UE
X
662.73
X
E2613
NU
X
822.01
X
E2613
RR
X
82.21
X
E2613
UE
X
616.48
X
E2614
NU
X
1,137.54
X
E2614
RR
X
113.78
X
E2614
UE
X
853.21
X
E2615
NU
X
945.97
X
E2615
RR
X
94.63
X
E2615
UE
X
709.44
X
E2616
NU
X
1,272.74
X
E2616
RR
X
127.29
X
E2616
UE
X
954.64
X
E2617
X
*
X
E2619
NU
X
107.32
X
E2619
RR
X
10.71
X
E2619
UE
X
80.54
X
E2620
NU
X
1,202.05
X
E2620
RR
X
120.18
X
E2620
UE
X
901.57
X
E2621
NU
X
1,145.45
X
E2621
RR
X
114.55
X
E2621
UE
X
859.06
X
E2622
NU
X
522.85
X
E2622
RR
X
52.31
X
E2622
UE
X
392.13
X
E2623
NU
X
665.31
X
E2623
RR
X
66.56
X
E2623
UE
X
498.96
X
E2624
NU
X
527.14
X
E2624
RR
X
52.73
X
E2624
UE
X
395.38
X
E2625
NU
X
667.31
X
E2625
RR
X
66.73
X
E2625
UE
X
500.49
X
E2626
NU
X
1,124.62
X
E2626
RR
X
112.43
X
E2626
UE
X
843.39
X
E2627
NU
X
1,794.55
X
E2627
RR
X
179.50
X
E2627
UE
X
1,345.91
X
E2628
NU
X
1,351.89
X
E2628
RR
X
135.19
X
E2628
UE
X
1,013.92
X
E2629
NU
X
1,710.80
X
E2629
RR
X
171.06
X
E2629
UE
X
1,283.11
X
E2630
NU
X
1,164.00
X
E2630
RR
X
116.43
X
E2630
UE
X
873.04
X
E2631
NU
X
478.55
X
E2631
RR
X
47.86
X
E2631
UE
X
358.94
X
E2632
NU
X
304.28
X
E2632
RR
X
30.42
X
E2632
UE
X
228.23
X
E2633
NU
X
258.10
X
E2633
RR
X
25.82
X
E2633
UE
X
193.56
X
E8000
X
*
X
E8001
X
*
X
E8002
X
*
X
H0031
XXX
9
X
*
X
H0032
XXX
9
X
*
X
H0033
XXX
9
X
*
X
H0034
XXX
9
X
*
X
H0035
XXX
9
X
*
X
H0036
XXX
9
X
*
X
H0037
XXX
9
X
*
X
H0038
XXX
9
X
*
X
H0039
XXX
9
X
*
X
H0040
XXX
9
X
*
X
H0041
XXX
9
X
#
X
H0042
XXX
9
X
#
X
H0043
XXX
9
X
*
X
H0044
XXX
9
X
*
X
H0045
XXX
9
X
*
X
H0046
XXX
9
X
#
X
H0047
XXX
9
X
#
X
H0048
XXX
9
X
*
X
H0049
XXX
9
X
*
X
H0050
XXX
9
X
*
X
H1000
XXX
9
X
*
X
H1001
XXX
9
X
*
X
H1002
XXX
9
X
*
X
H1003
XXX
9
X
*
X
H1004
XXX
9
X
*
X
H1005
XXX
9
X
*
X
H1010
XXX
9
X
*
X
H1011
XXX
9
X
*
X
H2000
XXX
9
X
*
X
H2001
XXX
9
X
*
X
H2010
XXX
9
X
*
X
H2011
XXX
9
X
*
X
H2012
XXX
9
X
*
X
H2013
XXX
9
X
*
X
H2014
XXX
9
X
*
X
H2015
XXX
9
X
*
X
H2016
XXX
9
X
*
X
H2017
XXX
9
X
*
X
H2018
XXX
9
X
*
X
H2019
XXX
9
X
*
X
H2020
XXX
9
X
*
X
H2021
XXX
9
X
*
X
H2022
XXX
9
X
*
X
H2023
XXX
9
X
*
X
H2024
XXX
9
X
#
X
H2025
XXX
9
X
*
X
H2026
XXX
9
X
#
X
H2027
XXX
9
X
*
X
H2028
XXX
9
X
*
X
H2029
XXX
9
X
*
X
H2030
XXX
9
X
*
X
H2031
XXX
9
X
*
X
H2032
XXX
9
X
#
X
H2033
XXX
9
X
*
X
H2034
XXX
9
X
*
X
H2035
XXX
9
X
*
X
H2036
XXX
9
X
*
X
H2037
XXX
9
X
#
X
H2040
XXX
9
X
#
X
H2041
XXX
9
X
#
X
L0112
X
2,387.37
X
L0113
X
*
X
L0120
X
55.21
X
L0130
X
390.84
X
L0140
X
129.20
X
L0150
X
237.19
X
L0160
X
309.68
X
L0170
X
1,275.15
X
L0172
X
276.52
X
L0174
X
543.14
X
L0180
X
753.13
X
L0190
X
979.37
X
L0200
X
1,021.08
X
L0220
X
278.82
X
L0450
X
295.69
X
L0452
X
550.53
X
L0454
X
610.39
X
L0455
X
512.72
X
L0456
X
610.39
X
L0457
X
1,470.31
X
L0458
X
1,301.48
X
L0460
X
1,301.48
X
L0462
X
1,301.48
X
L0464
X
1,301.48
X
L0466
X
629.84
X
L0467
X
534.08
X
L0468
X
834.36
X
L0469
X
707.57
X
L0470
X
1,064.75
X
L0472
X
675.26
X
L0480
X
2,378.08
X
L0482
X
2,762.20
X
L0484
X
2,967.94
X
L0486
X
3,148.80
X
L0488
X
2,403.95
X
L0490
X
2,218.69
X
L0491
XXX
9
X
1,212.96
X
L0492
XXX
9
X
796.83
X
L0621
XXX
9
X
146.38
X
L0622
XXX
9
X
390.86
X
L0623
XXX
9
X
*
X
L0624
XXX
9
X
#
X
L0625
XXX
9
X
86.95
X
L0626
XXX
9
X
123.08
X
L0627
XXX
9
X
649.17
X
L0628
XXX
9
X
132.51
X
L0629
XXX
9
X
*
X
L0630
XXX
9
X
255.77
X
L0631
XXX
9
X
1,621.29
X
L0632
XXX
9
X
#
X
L0633
XXX
9
X
452.85
X
L0634
XXX
9
X
*
X
L0635
XXX
9
X
1,539.61
X
L0636
XXX
9
X
2,283.33
X
L0637
XXX
9
X
1,696.68
X
L0638
XXX
9
X
2,083.04
X
L0639
XXX
9
X
1,696.68
X
L0640
XXX
9
X
1,652.61
X
L0641
X
115.21
X
L0642
X
607.66
X
L0643
X
239.44
X
L0648
X
1,517.58
X
L0649
X
423.89
X
L0650
X
1,588.13
X
L0651
X
1,588.13
X
L0700
X
4,041.94
X
L0710
X
4,129.37
X
L0810
X
5,164.42
X
L0820
X
4,635.33
X
L0830
X
6,532.62
X
L0859
XXX
9
X
1,843.18
X
L0861
X
367.63
X
L0970
X
265.88
X
L0972
X
238.84
X
L0974
X
354.59
X
L0976
X
316.10
X
L0978
X
417.28
X
L0980
X
45.53
X
L0982
X
32.19
X
L0984
XXX
X
*
X
L0999
X
#
X
L1000
X
4,055.37
X
L1001
X
#
X
L1005
X
5,629.26
X
L1010
X
132.65
X
L1020
X
170.92
X
L1025
X
326.28
X
L1030
X
125.77
X
L1040
X
164.58
X
L1050
X
198.37
X
L1060
X
238.04
X
L1070
X
232.40
X
L1080
X
130.79
X
L1085
X
353.63
X
L1090
X
233.98
X
L1100
X
373.59
X
L1110
X
505.01
X
L1120
X
85.38
X
L1200
X
3,097.95
X
L1210
X
517.38
X
L1220
X
494.17
X
L1230
X
1,266.89
X
L1240
X
171.28
X
L1250
X
171.28
X
L1260
X
174.83
X
L1270
X
177.65
X
L1280
X
204.26
X
L1290
X
161.80
X
L1300
X
3,641.85
X
L1310
X
3,742.16
X
L1499
X
#
X
L1600
X
254.84
X
L1610
X
112.42
X
L1620
X
318.51
X
L1630
X
335.03
X
L1640
X
1,019.98
X
L1650
X
516.09
X
L1652
X
621.42
X
L1660
X
338.33
X
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