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Fee Schedules

Effective July 1, 2014.

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 2014 Quick Reference Fee Schedule

Professional and Facility Services Fee Schedules (July 2014)
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. 1.87 MB
Item
PDF graphic of PDF icon
Anesthesia - CPT ™ 00100 - 01999 499 KB
Evaluation and Management - CPT ™ 99201 - 99499 512 KB
Surgery - CPT ™ 10021 - 69990 3.28 MB
Radiology - CPT ™ 70010 - 79999 2.82 MB
Pathology and Laboratory - CPT ™ 80047 - 89356 2.20 MB
Medicine - CPT ™ 90281 - 99607 1.17 MB
CPT ™ Category II and III - CPT ™ 0001F - 0192T 641 KB
HCPCS - HCPCS A0021 - V5364 3.85 MB
Medical and Surgical Supplies Codes - HCPCS A4206-A9999
(For DME Providers)
578 KB
Facility Only Codes - C1300 - S0093 347 KB
Local Codes by Code - 0401A - 5093V, R0310 - R0392, & V0028 143 KB
Local Codes by Specialty - 0401A - 5093V, R0310 - R0392, & V0028 179 KB
ASC Fee Schedules - All approved codes 815 KB
APR-DRG Assignment - Version 31 559 KB
Hospital Rates 150 KB
Residential Facility Rates 41 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. 1.41 MB 10 KB
Anesthesia 26 KB 12 KB
Ambulatory Surgery Center 101 KB 75 KB
APR-DRG 91 KB 101 KB
Hospital 14 KB 185 KB

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