Fee Schedules

2024 Fee Schedules

Effective July 1, 2024

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

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.

2024 Quick Reference Fee Schedule (English) Español (Spanish)

Professional and Facility Services Fee Schedules (July 2024)

Note: These fee schedules have been enhanced with search features for your convenience. Enable Macros in Excel for the files below to open without errors. These files are best viewed in the desktop application and not the web browser.

  • Professional Services Fee Schedule — Excel spreadsheet of the complete fee schedule excluding the ASC Fees, AP-DRGs, Hospital Rates and Residential Facility Rates. This fee schedule has been enhanced with a search feature for your convenience.

Note: For your reference here are the code ranges you will find in the professional fee schedule.

    • Evaluation and Management — CPT™ 99202 - 99499
    • Surgery — CPT™ 10004 - 69979
    • Radiology — CPT™ 70010 - 79999
    • Pathology and Laboratory — CPT™ 80047 - 89398 and 0001U - 0222U
    • Medicine — CPT™ 90281 - 99607
    • CPT ™ Category II and III — CPT™ 0001F - 0639T
    • HCPCS — A0021 - V5364
    • Medical and Surgical Supplies Codes — HCPCS A4206 - A9999 (For DME Providers)
    • Facility Only Codes — C1300 - S0093
    • Local Codes — Local Codes Listed by Specialty                                                            

Fee Schedules - Comma delimited version with Field Key

Billing & Payment Policies

2024 Billing & Payment Policies

Effective July 1, 2024

These billing and payment policies determine under what conditions we will pay health care and vocational providers who treat injured workers and crime victims.

Note: Make sure to check the Updates & Corrections tab for any changes to the Payment policies.

Payment Policies Complete   (2024)

Professional Services

Facility Services

Unless noted, all policies in the Medical Aid Rules and Fee Schedules apply to claimants receiving benefits from either the State Fund, the Crime Victims Compensation Program or Self-Insurers.

Providers must follow the administrative rules, medical coverage decisions and payment policies applicable to L&I.

Updates & Corrections

2024 Updates and Corrections

Updates

Payment policy updates
Posting date Policy Area Description
08/01/2024 Chapter 19 Update​ The acupuncture payment policy has been updated to allow treatment for Chronic Migraine. See our Chapter 19 update for details. Effective September 1, 2024.
Fee schedule updates
Posting date Description Updated Version
10/07/2024 Services billed with modifier -74 will be reduced to 60% of the provider fee schedule or billed amount, whichever is less. Effective July 1, 2024. N/A
10/01/2024 Effective November 1, 2024, we've updated the fees for interpreter services as follows:
  • 9984M:  $1.08
  • 9990M:  $0.87
  • 9983M:  $0.70
  • 9996M:  $63.16
 N/A
09/23/2024 New HCPCS and Deleted HCPCS codes. See file for details. October 2024 PFS Updates​
08/07/2024 Effective September 1, 2024, we've created a new code for acupuncture related to chronic migraine and priced it as follows​:​
  • 1581M:  $120.70
 N/A
06/25/2024 New HCPCS and deleted HCPCs. New and deleted HCPS July 2024​
06/21/2024 Effective July 1, 2024, we are updating the coverage for PET scans. July 2024 UR for PET Codes​
06/21/2024 Effective July 1, 2024, the ASC Payment amounts for the following codes are being updated to the maximum allowable amounts and are not subject to multiple procedure discounting:
  • 78811:  $1,196.33
  • 78812:  $1,318.05
  • 78813:  $1,318.05
  • 78814:  $1,318.05
  • 78815:  $1,318.05
  • 78816:  $1,318.05
    		•  N/A

    ​Corrections

    Payment policy corrections
    Posting date Policy Area Description
    Fee schedule corrections
    Posting date Description Updated Version
    11/20/2024 We've identified two errors in the Professional Services Fee Schedule. G2082 should have appeared with a non-facility fee of $1,555.28 and a facility fee of $63.58. G2083 should have appeared with a non-facility fee of $2,201.87 and a facility fee of $63.58. This is effective July 1, 2024.​ N/A
    11/06/2024 We've identified an error in the Professional Services Fee Schedule. Code E0118 -RR should have appeared with a max fee of $78.90. This is effective July 1, 2024.​ N/A
    10/25/2024 An error has been identified in the Professional Services Fee Schedule. Code 23929 should have appeared with an FSI of N for by report, not B or bundled. This is effective July 1, 2024.​ N/A
    06/25/2024 The following codes are deleted from the ASC Fee Schedule effective July 1, 2024:
    • C9113
    • J2780
    • J9371
    		 N/A