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Health Care Services Review
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Fee Schedule
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Fee Schedule J1930-L1660
Begin Main Content Area
Page Content
Content Editor
2017 Workers' Compensation Part B Fee Schedule
J1930-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
Implied Decimal 2 (in dollars)
J1930
XXX
9
0
3609
0
J1931
XXX
9
0
3573
0
J1940
XXX
9
0
311
0
J1942
0
0
0
J1945
XXX
9
0
22073
0
J1950
XXX
9
0
81835
0
J1953
XXX
9
0
60
0
J1955
XXX
9
0
7678
0
J1956
XXX
9
0
0
0
J1960
XXX
9
0
466
0
J1980
XXX
9
0
665
0
J1990
XXX
9
0
1620
0
J2001
XXX
9
0
28
0
J2010
XXX
9
0
369
0
J2020
XXX
9
0
6151
0
J2060
XXX
9
0
2623
0
J2150
XXX
9
0
721
0
J2170
XXX
9
0
0
0
J2175
XXX
9
0
226
0
J2180
XXX
9
0
756
0
J2182
0
0
0
J2185
XXX
9
0
718
0
J2210
XXX
9
0
522
0
J2212
XXX
9
0
0
0
J2248
XXX
9
0
256
0
J2250
XXX
9
0
386
0
J2260
XXX
9
0
6756
0
J2265
XXX
9
0
0
0
J2270
XXX
9
0
243
0
J2274
XXX
9
0
1097
0
J2278
XXX
9
0
931
0
J2280
XXX
9
0
1515
0
J2300
XXX
9
0
572
0
J2310
XXX
9
0
687
0
J2315
XXX
9
0
276
0
J2320
XXX
9
0
962
0
J2323
XXX
9
0
1048
0
J2325
XXX
9
0
4542
0
J2353
XXX
9
0
11589
0
J2354
XXX
9
0
642
0
J2355
XXX
9
0
0
0
J2357
XXX
9
0
2407
0
J2358
XXX
9
0
361
0
J2360
XXX
9
0
382
0
J2370
XXX
9
0
738
0
J2400
XXX
9
0
226
0
J2405
XXX
9
0
1185
0
J2407
XXX
9
0
0
0
J2410
XXX
9
0
755
0
J2425
XXX
9
0
1732
0
J2426
XXX
9
0
852
0
J2430
XXX
9
0
37627
0
J2440
XXX
9
0
342
0
J2460
XXX
9
0
226
0
J2469
XXX
9
0
2861
0
J2501
XXX
9
0
836
0
J2502
XXX
9
0
0
0
J2503
XXX
9
0
159202
0
J2504
XXX
9
0
25069
0
J2505
XXX
9
0
408788
0
J2507
XXX
9
0
38248
0
J2510
XXX
9
0
837
0
J2513
XXX
9
0
1919
0
J2515
XXX
9
0
459
0
J2540
XXX
9
0
226
0
J2543
XXX
9
0
0
0
J2545
XXX
9
0
21067
0
J2547
XXX
9
0
0
0
J2550
XXX
9
0
226
0
J2560
XXX
9
0
631
0
J2562
XXX
9
0
35736
0
J2590
XXX
9
0
226
0
J2597
XXX
9
0
5069
0
J2650
XXX
9
0
226
0
J2670
XXX
9
0
0
0
J2675
XXX
9
0
420
0
J2680
XXX
9
0
2165
0
J2690
XXX
9
0
2720
0
J2700
XXX
9
0
725
0
J2704
XXX
9
0
15
0
J2710
XXX
9
0
226
0
J2720
XXX
9
0
1069
0
J2724
XXX
9
0
1698
0
J2725
XXX
9
0
2408
0
J2730
XXX
9
0
6031
0
J2760
XXX
9
0
5873
0
J2765
XXX
9
0
510
0
J2770
XXX
9
0
17828
0
J2778
XXX
9
0
56538
0
J2780
XXX
9
0
0
0
J2783
XXX
9
0
17204
0
J2785
XXX
9
0
6373
0
J2786
0
0
0
J2788
XXX
9
0
5983
0
J2790
XXX
9
0
12217
0
J2791
XXX
9
0
742
0
J2792
XXX
9
0
0
0
J2793
XXX
9
0
0
0
J2794
XXX
9
0
723
0
J2795
XXX
9
0
0
0
J2796
XXX
9
0
5800
0
J2800
XXX
9
0
672
0
J2805
XXX
9
0
6714
0
J2810
XXX
9
0
0
0
J2820
XXX
9
0
24151
0
J2840
0
0
0
J2850
XXX
9
0
3065
0
J2860
XXX
9
0
0
0
J2910
XXX
9
0
2318
0
J2916
XXX
9
0
1362
0
J2920
XXX
9
0
457
0
J2930
XXX
9
0
1211
0
J2940
XXX
9
0
0
0
J2941
XXX
9
0
0
0
J2950
XXX
9
0
226
0
J2993
XXX
9
0
228209
0
J2995
XXX
9
0
72920
0
J2997
XXX
9
0
4563
0
J3000
XXX
9
0
442
0
J3010
XXX
9
0
774
0
J3030
XXX
9
0
7870
0
J3060
XXX
9
0
3727
0
J3070
XXX
9
0
623
0
J3090
XXX
9
0
0
0
J3095
XXX
9
0
253
0
J3101
XXX
9
0
5520
0
J3105
XXX
9
0
390
0
J3110
XXX
9
0
1097
0
J3121
XXX
9
0
7
0
J3145
XXX
9
0
0
0
J3230
XXX
9
0
256
0
J3240
XXX
9
0
40408
0
J3243
XXX
9
0
131
0
J3246
XXX
9
0
1232
0
J3250
XXX
9
0
491
0
J3260
XXX
9
0
1659
0
J3262
XXX
9
0
457
0
J3265
XXX
9
0
298
0
J3280
XXX
9
0
1064
0
J3285
XXX
9
0
8153
0
J3300
XXX
9
0
436
0
J3301
XXX
9
0
385
0
J3302
XXX
9
0
226
0
J3303
XXX
9
0
543
0
J3305
XXX
9
0
10289
0
J3310
XXX
9
0
1038
0
J3315
XXX
9
0
69182
0
J3320
XXX
9
0
3379
0
J3350
XXX
9
0
0
0
J3355
XXX
9
0
7601
0
J3357
XXX
9
0
14658
0
J3360
XXX
9
0
375
0
J3364
XXX
9
0
9959
0
J3365
XXX
9
0
80800
0
J3370
XXX
9
0
4704
0
J3380
XXX
9
0
0
0
J3385
XXX
9
0
45937
0
J3396
XXX
9
0
1413
0
J3400
XXX
9
0
2843
0
J3410
XXX
9
0
226
0
J3411
XXX
9
0
140
0
J3415
XXX
9
0
75
0
J3420
XXX
9
0
226
0
J3430
XXX
9
0
960
0
J3465
XXX
9
0
734
0
J3470
XXX
9
0
1405
0
J3471
XXX
9
0
62
0
J3472
XXX
9
0
20384
0
J3473
XXX
9
0
61
0
J3475
XXX
9
0
213
0
J3480
XXX
9
0
213
0
J3485
XXX
9
0
157
0
J3486
XXX
9
0
3033
0
J3489
XXX
9
0
12715
0
J3490
XXX
9
0
0
0
J3520
XXX
9
0
0
0
J3530
XXX
9
0
0
0
J3535
XXX
9
0
0
0
J3570
XXX
9
0
0
0
J3590
XXX
9
0
0
0
J7030
XXX
9
0
2099
0
J7040
XXX
9
0
2033
0
J7042
XXX
9
0
1677
0
J7050
XXX
9
0
1957
0
J7060
XXX
9
0
3182
0
J7070
XXX
9
0
5882
0
J7100
XXX
9
0
27221
0
J7110
XXX
9
0
18265
0
J7120
XXX
9
0
2388
0
J7121
XXX
9
0
0
0
J7131
XXX
9
0
0
0
J7175
0
0
0
J7178
XXX
9
0
0
0
J7179
0
0
0
J7180
XXX
9
0
0
0
J7181
XXX
9
0
0
0
J7182
XXX
9
0
0
0
J7183
XXX
9
0
111
0
J7185
XXX
9
0
144
0
J7186
XXX
9
0
114
0
J7187
XXX
9
0
129
0
J7188
XXX
9
0
0
0
J7189
XXX
9
0
157
0
J7190
XXX
9
0
0
0
J7191
XXX
9
0
0
0
J7192
XXX
9
0
267
0
J7193
XXX
9
0
169
0
J7194
XXX
9
0
0
0
J7195
XXX
9
0
193
0
J7196
XXX
9
0
0
0
J7197
XXX
9
0
142416
0
J7198
XXX
9
0
0
0
J7199
XXX
9
0
0
0
J7200
XXX
9
0
146
0
J7201
XXX
9
0
334
0
J7202
0
0
0
J7205
XXX
9
0
0
0
J7207
0
0
0
J7209
0
0
0
J7297
XXX
9
0
0
0
J7298
XXX
9
0
0
0
J7300
XXX
9
0
0
0
J7301
XXX
9
0
0
0
J7303
XXX
9
0
0
0
J7304
XXX
9
0
0
0
J7306
XXX
9
0
0
0
J7307
XXX
9
0
0
0
J7308
XXX
9
0
17154
0
J7309
XXX
9
0
0
0
J7310
XXX
9
0
985731
0
J7311
XXX
9
0
2791608
0
J7312
XXX
9
0
25678
0
J7313
XXX
9
0
0
0
J7315
XXX
9
0
0
0
J7316
XXX
9
0
126259
0
J7320
0
904
0
J7321
XXX
9
0
14216
0
J7322
0
0
0
J7323
XXX
9
0
15443
0
J7324
XXX
9
0
23870
0
J7325
XXX
9
0
1561
0
J7326
XXX
9
0
0
0
J7327
XXX
9
0
116880
0
J7328
XXX
9
0
0
0
J7330
XXX
9
0
0
0
J7336
XXX
9
0
322
0
J7340
XXX
9
0
0
0
J7342
0
0
0
J7500
XXX
9
0
0
0
J7501
XXX
9
0
0
0
J7502
XXX
9
0
0
0
J7503
XXX
9
0
0
0
J7504
XXX
9
0
0
0
J7505
XXX
9
0
0
0
J7507
XXX
9
0
0
0
J7508
XXX
9
0
50
0
J7509
XXX
9
0
0
0
J7510
XXX
9
0
0
0
J7511
XXX
9
0
42783
0
J7512
XXX
9
0
0
0
J7513
XXX
9
0
0
0
J7515
XXX
9
0
0
0
J7516
XXX
9
0
0
0
J7517
XXX
9
0
0
0
J7518
XXX
9
0
380
0
J7520
XXX
9
0
0
0
J7525
XXX
9
0
0
0
J7527
XXX
9
0
0
0
J7599
XXX
9
0
0
0
J7604
XXX
9
0
0
0
J7605
XXX
9
0
656
0
J7606
XXX
9
0
562
0
J7607
XXX
9
0
0
0
J7608
XXX
9
0
0
0
J7609
XXX
9
0
0
0
J7610
XXX
9
0
294
0
J7611
XXX
9
0
7
0
J7612
XXX
9
0
137
0
J7613
XXX
9
0
9
0
J7614
XXX
9
0
203
0
J7615
XXX
9
0
354
0
J7620
XXX
9
0
110
0
J7622
XXX
9
0
0
0
J7624
XXX
9
0
0
0
J7626
XXX
9
0
0
0
J7627
XXX
9
0
88
0
J7628
XXX
9
0
0
0
J7629
XXX
9
0
0
0
J7631
XXX
9
0
0
0
J7632
XXX
9
0
0
0
J7633
XXX
9
0
7
0
J7634
XXX
9
0
0
0
J7635
XXX
9
0
0
0
J7636
XXX
9
0
0
0
J7637
XXX
9
0
0
0
J7638
XXX
9
0
0
0
J7639
XXX
9
0
0
0
J7640
XXX
9
0
44
0
J7641
XXX
9
0
0
0
J7642
XXX
9
0
0
0
J7643
XXX
9
0
0
0
J7644
XXX
9
0
0
0
J7645
XXX
9
0
0
0
J7647
XXX
9
0
0
0
J7648
XXX
9
0
0
0
J7649
XXX
9
0
0
0
J7650
XXX
9
0
73
0
J7657
XXX
9
0
0
0
J7658
XXX
9
0
0
0
J7659
XXX
9
0
0
0
J7660
XXX
9
0
455
0
J7665
XXX
9
0
0
0
J7667
XXX
9
0
0
0
J7668
XXX
9
0
0
0
J7669
XXX
9
0
0
0
J7670
XXX
9
0
340
0
J7674
XXX
9
0
65
0
J7676
XXX
9
0
0
0
J7680
XXX
9
0
0
0
J7681
XXX
9
0
0
0
J7682
XXX
9
0
0
0
J7683
XXX
9
0
0
0
J7684
XXX
9
0
0
0
J7685
XXX
9
0
0
0
J7686
XXX
9
0
52189
0
J7699
XXX
9
0
0
0
J7799
XXX
9
0
0
0
J7999
XXX
9
0
0
0
J8498
XXX
9
0
0
0
J8499
XXX
9
0
0
0
J8501
XXX
9
0
289
0
J8510
XXX
9
0
0
0
J8515
XXX
9
0
2411
0
J8520
XXX
9
0
0
0
J8521
XXX
9
0
0
0
J8530
XXX
9
0
0
0
J8540
XXX
9
0
8
0
J8560
XXX
9
0
0
0
J8562
XXX
9
0
10421
0
J8565
XXX
9
0
0
0
J8597
XXX
9
0
0
0
J8600
XXX
9
0
0
0
J8610
XXX
9
0
0
0
J8650
XXX
9
0
0
0
J8655
XXX
9
0
0
0
J8670
0
0
0
J8700
XXX
9
0
0
0
J8705
XXX
9
0
9398
0
J8999
XXX
9
0
0
0
J9000
XXX
9
0
10275
0
J9015
XXX
9
0
82721
0
J9017
XXX
9
0
4440
0
J9019
XXX
9
0
0
0
J9020
XXX
9
0
11474
0
J9025
XXX
9
0
614
0
J9027
XXX
9
0
17619
0
J9031
XXX
9
0
33608
0
J9032
XXX
9
0
0
0
J9033
XXX
9
0
2503
0
J9034
0
2677
0
J9035
XXX
9
0
8965
0
J9039
XXX
9
0
0
0
J9040
XXX
9
0
60537
0
J9041
XXX
9
0
4460
0
J9042
XXX
9
0
0
0
J9043
XXX
9
0
17116
0
J9045
XXX
9
0
17088
0
J9047
XXX
9
0
3533
0
J9050
XXX
9
0
17422
0
J9055
XXX
9
0
7795
0
J9060
XXX
9
0
6926
0
J9065
XXX
9
0
10599
0
J9070
XXX
9
0
1120
0
J9098
XXX
9
0
54180
0
J9100
XXX
9
0
1530
0
J9120
XXX
9
0
2404
0
J9130
XXX
9
0
3001
0
J9145
0
5302
0
J9150
XXX
9
0
16200
0
J9151
XXX
9
0
0
0
J9155
XXX
9
0
303
0
J9160
XXX
9
0
164722
0
J9165
XXX
9
0
2729
0
J9171
XXX
9
0
2344
0
J9175
XXX
9
0
562
0
J9176
0
704
0
J9178
XXX
9
0
4031
0
J9179
XXX
9
0
11401
0
J9181
XXX
9
0
2996
0
J9185
XXX
9
0
38588
0
J9190
XXX
9
0
370
0
J9200
XXX
9
0
19936
0
J9201
XXX
9
0
15067
0
J9202
XXX
9
0
78558
0
J9205
0
4465
0
J9206
XXX
9
0
19467
0
J9207
XXX
9
0
8569
0
J9208
XXX
9
0
0
0
J9209
XXX
9
0
3256
0
J9211
XXX
9
0
51496
0
J9212
XXX
9
0
0
0
J9213
XXX
9
0
6540
0
J9214
XXX
9
0
2269
0
J9215
XXX
9
0
7183
0
J9216
XXX
9
0
31903
0
J9217
XXX
9
0
105673
0
J9218
XXX
9
0
0
0
J9219
XXX
9
0
0
0
J9225
XXX
9
0
381011
0
J9226
XXX
9
0
1951
0
J9228
XXX
9
0
15832
0
J9230
XXX
9
0
2209
0
J9245
XXX
9
0
57519
0
J9250
XXX
9
0
1794
0
J9260
XXX
9
0
3104
0
J9261
XXX
9
0
11971
0
J9262
XXX
9
0
0
0
J9264
XXX
9
0
1259
0
J9266
XXX
9
0
267732
0
J9267
XXX
9
0
19
0
J9268
XXX
9
0
328127
0
J9270
XXX
9
0
16508
0
J9271
XXX
9
0
0
0
J9280
XXX
9
0
28251
0
J9293
XXX
9
0
140861
0
J9295
0
594
0
J9299
XXX
9
0
0
0
J9300
XXX
9
0
327941
0
J9301
XXX
9
0
6414
0
J9302
XXX
9
0
5945
0
J9303
XXX
9
0
11542
0
J9305
XXX
9
0
6366
0
J9306
XXX
9
0
1232
0
J9307
XXX
9
0
21701
0
J9308
XXX
9
0
0
0
J9310
XXX
9
0
0
0
J9315
XXX
9
0
28732
0
J9320
XXX
9
0
13445
0
J9325
0
5213
0
J9328
XXX
9
0
0
0
J9330
XXX
9
0
6443
0
J9340
XXX
9
0
13361
0
J9351
XXX
9
0
3584
0
J9352
0
32017
0
J9354
XXX
9
0
3518
0
J9355
XXX
9
0
0
0
J9357
XXX
9
0
0
0
J9360
XXX
9
0
854
0
J9370
XXX
9
0
7888
0
J9371
XXX
9
0
0
0
J9390
XXX
9
0
9999
0
J9395
XXX
9
0
12774
0
J9400
XXX
9
0
1130
0
J9600
XXX
9
0
490103
0
J9999
XXX
9
0
0
0
L0112
0
179289
0
L0113
0
0
0
L0120
0
4148
0
L0130
0
29351
0
L0140
0
9702
0
L0150
0
17813
0
L0160
0
23256
0
L0170
0
95762
0
L0172
0
20766
0
L0174
0
40790
0
L0180
0
56559
0
L0190
0
73550
0
L0200
0
76681
0
L0220
0
20940
0
L0450
0
22207
0
L0452
0
41345
0
L0454
0
45839
0
L0455
0
38504
0
L0456
0
45839
0
L0457
0
110417
0
L0458
0
97740
0
L0460
0
97740
0
L0462
0
97740
0
L0464
0
97740
0
L0466
0
47300
0
L0467
0
40110
0
L0468
0
62660
0
L0469
0
53138
0
L0470
0
79961
0
L0472
0
50713
0
L0480
0
178589
0
L0482
0
207437
0
L0484
0
222888
0
L0486
0
236470
0
L0488
0
180532
0
L0490
0
166621
0
L0491
XXX
9
0
91092
0
L0492
XXX
9
0
59840
0
L0621
XXX
9
0
10994
0
L0622
XXX
9
0
29353
0
L0623
XXX
9
0
0
0
L0624
XXX
9
0
0
0
L0625
XXX
9
0
6530
0
L0626
XXX
9
0
9244
0
L0627
XXX
9
0
48752
0
L0628
XXX
9
0
9951
0
L0629
XXX
9
0
0
0
L0630
XXX
9
0
19208
0
L0631
XXX
9
0
121757
0
L0632
XXX
9
0
0
0
L0633
XXX
9
0
34008
0
L0634
XXX
9
0
0
0
L0635
XXX
9
0
115622
0
L0636
XXX
9
0
171475
0
L0637
XXX
9
0
127417
0
L0638
XXX
9
0
156433
0
L0639
XXX
9
0
127417
0
L0640
XXX
9
0
124109
0
L0641
0
8652
0
L0642
0
45635
0
L0643
0
17981
0
L0648
0
113968
0
L0649
0
31834
0
L0650
0
119266
0
L0651
0
119266
0
L0700
0
303544
0
L0710
0
310110
0
L0810
0
387840
0
L0820
0
348106
0
L0830
0
490590
0
L0859
XXX
9
0
138421
0
L0861
0
27608
0
L0970
0
19967
0
L0972
0
17937
0
L0974
0
26628
0
L0976
0
23740
0
L0978
0
31337
0
L0980
0
3419
0
L0982
0
2417
0
L0984
XXX
0
0
0
L0999
0
0
0
L1000
0
304551
0
L1001
0
0
0
L1005
0
422749
0
L1010
0
9962
0
L1020
0
12837
0
L1025
0
24504
0
L1030
0
9445
0
L1040
0
12359
0
L1050
0
14897
0
L1060
0
17877
0
L1070
0
17453
0
L1080
0
9821
0
L1085
0
26557
0
L1090
0
17572
0
L1100
0
28056
0
L1110
0
37926
0
L1120
0
6413
0
L1200
0
232651
0
L1210
0
38854
0
L1220
0
37112
0
L1230
0
95142
0
L1240
0
12862
0
L1250
0
12862
0
L1260
0
13129
0
L1270
0
13341
0
L1280
0
15340
0
L1290
0
12151
0
L1300
0
273497
0
L1310
0
281029
0
L1499
0
0
0
L1600
0
19140
0
L1610
0
8443
0
L1620
0
23919
0
L1630
0
25160
0
L1640
0
76598
0
L1650
0
38757
0
L1652
0
46668
0
L1660
0
25408
0
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