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Fee Schedules

Effective July 1, 2012.

This site contains the policies, payment methods, billing codes, and maximum fees used to pay health care and vocational providers who treat injured workers.

Go Back Return to Fee Schedule Lookup

Make sure to check the Updates & Corrections tab for any changes to the Fee schedules. Read about the highlights of changes in the last year. These changes are also included in the payment policies.

graphic of PDF icon 2012 Quick Reference Fee Schedule

Professional and Facility Services Fee Schedules (July 2012)
Item
Excel
Professional Services Fee Schedule – Excel spreadsheet of the complete fee schedule excluding the ASC Fees, AP-DRGs, Hospital Rates and Residential Facility Rates. 5,341 KB
Item
PDF graphic of PDF icon
Anesthesia - CPT ™ 00100 - 01999 195 KB
Evaluation and Management - CPT ™ 99201 - 99499 222 KB
Surgery - CPT ™ 10021 - 69990 3566 KB
Radiology - CPT ™ 70010 - 79999 1337 KB
Pathology and Laboratory - CPT ™ 80047 - 89356 1034 KB
Medicine - CPT ™ 90281 - 99607 1028 KB
CPT ™ Category II and III - CPT ™ 0001F - 0192T 530 KB
HCPCS - HCPCS A0021 - V5364 4158 KB
Medical and Surgical Supplies Codes - HCPCS A4206-A9999
(For DME Providers)
430 KB
Facility Only Codes - C1300 - S0093 241 KB
Local Codes by Code - 0401A - 5093V, R0310 - R0392, & V0028 266 KB
Local Codes by Specialty - 0401A - 5093V, R0310 - R0392, & V0028 165 KB
ASC Fee Schedules - All approved codes 745 KB
AP-DRG Assignment - Version 23 358 KB
Hospital Rates 232 KB
Residential Facility Rates 69 KB

Fee Schedules - Comma delimited version graphic of CSV icon Field Key graphic of PDF icon
Complete fee schedule excluding the ASC Fees, AP-DRGs, Hospital Rates and Residential Facility Rates. 1372 KB 10 KB
Anesthesia 13 KB 7 KB
Ambulatory Surgery Center 99 KB (Waiting on file) 66 KB
AP-DRG 48 KB 38 KB
Hospital 13 KB 41 KB

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