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Fee Schedules

Effective July 1, 2013.

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 2013 Quick Reference Fee Schedule (Updated 7/15/2013)

Professional and Facility Services Fee Schedules (July 2013)
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 363 KB
Evaluation and Management - CPT ™ 99201 - 99499 421 KB
Surgery - CPT ™ 10021 - 69990 4122 KB
Radiology - CPT ™ 70010 - 79999 1056 KB
Pathology and Laboratory - CPT ™ 80047 - 89356 1026 KB
Medicine - CPT ™ 90281 - 99607 1025 KB
CPT ™ Category II and III - CPT ™ 0001F - 0192T 718 KB
HCPCS - HCPCS A0021 - V5364 4188 KB
Medical and Surgical Supplies Codes - HCPCS A4206-A9999
(For DME Providers)
451 KB
Facility Only Codes - C1300 - S0093 545 KB
Local Codes by Code - 0401A - 5093V, R0310 - R0392, & V0028 242 KB
Local Codes by Specialty - 0401A - 5093V, R0310 - R0392, & V0028 305 KB
ASC Fee Schedules - All approved codes 734 KB
APR-DRG Assignment - Version 29 782 KB
Hospital Rates 232 KB
Residential Facility Rates 70 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. 1055 KB 10 KB
Anesthesia 14 KB 12 KB
Ambulatory Surgery Center 96 KB 71 KB
APR-DRG 91 KB 102 KB
Hospital 13 KB 186 KB

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