Compensation 2010 Professional Provider Medical Services Fee ...

Ohio Bureau of Workers Compensation
2010 Professional Provider Medical Services Fee Schedule
CPT MOD DESCRIPTION
COVERAGE
FLAG
NON-FAC
FEE
FACILITY
FEE
69090 NRC 0.00 0.00
69100 NRC 209.12 104.66
69105 NRC 274.60 132.77
69110 909.71 670.28
69120 815.67 815.67
69140 NRC 1,767.38 1,767.38
69145 NRC 768.86 507.32
69150 NRC 2,185.07 2,185.07
69155 NRC 3,514.20 3,514.20
69200 240.06 116.53
69205 208.82 208.82
69210 NRC 101.16 69.14
69220 NRC 269.21 128.90
69222 NRC 434.66 281.39
69300 NRC 1,326.41 992.42
69310 2,210.89 2,210.89
69320 NRC 3,153.95 3,153.95
69399 BR 0.00 0.00
69400 NRC 281.41 128.14
69401 NRC 165.27 101.98
69405 NRC 526.11 404.11
69420 NRC 378.80 247.64
69421 NRC 311.39 311.39
69424 NRC 253.25 128.96
69433 NRC 396.75 268.65
69436 NRC 336.87 336.87
69440 NRC 1,404.64 1,404.64
69450 NRC 1,101.07 1,101.07
69501 NRC 1,513.29 1,513.29
69502 NRC 2,017.16 2,017.16
69505 NRC 2,465.95 2,465.95
69511 NRC 2,535.62 2,535.62
69530 NRC 3,430.20 3,430.20
69535 NRC 5,623.23 5,623.23
69540 NRC 411.00 259.26
69550 NRC 2,130.57 2,130.57
69552 NRC 3,264.34 3,264.34
69554 NRC 5,195.51 5,195.51
69601 NRC 2,171.10 2,171.10
69602 NRC 2,255.19 2,255.19
69603 NRC 2,604.23 2,604.23
69604 NRC 2,321.34 2,321.34
69605 NRC 3,229.08 3,229.08
69610 799.62 623.48
69620 NRC 1,393.20 1,009.65
69631 NRC 1,807.14 1,807.14
69632 NRC 2,220.71 2,220.71
69633 NRC 2,141.55 2,141.55
69635 NRC 2,499.58 2,499.58
69636 NRC 2,835.01 2,835.01
69637 NRC 2,825.21 2,825.21
69641 NRC 2,153.62 2,153.62
69642 NRC 2,777.47 2,777.47
CPT only © 2010 Americal Medical
Association. All rights reserved.
2010 Professional Provider Medical Services Fee Schedule
Effective 1-01-2011 Fees - Page 107 of 280