Compensation 2010 Professional Provider Medical Services Fee ...

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Ohio Bureau of Workers Compensation 2010 Professional Provider Medical Services Fee Schedule CPT MOD DESCRIPTION COVERAGE FLAG NON-FAC FEE FACILITY FEE 76828 26 NRC 38.53 38.53 76828 TC NRC 29.14 29.14 76830 NRC 160.48 160.48 76830 26 NRC 48.25 48.25 76830 TC NRC 112.23 112.23 76831 NRC 161.02 161.02 76831 26 NRC 49.78 49.78 76831 TC NRC 111.25 111.25 76856 NRC 160.97 160.97 76856 26 NRC 48.74 48.74 76856 TC NRC 112.23 112.23 76857 NRC 132.87 132.87 76857 26 NRC 28.01 28.01 76857 TC NRC 104.86 104.86 76870 159.54 159.54 76870 26 45.83 45.83 76870 TC 113.71 113.71 76872 NRC 186.18 186.18 76872 26 NRC 50.35 50.35 76872 TC NRC 135.83 135.83 76873 NRC 239.30 239.30 76873 26 NRC 111.34 111.34 76873 TC NRC 127.96 127.96 76881 NRC 168.92 168.92 76881 26 NRC 43.42 43.42 76881 TC NRC 125.50 125.50 76882 NRC 45.06 45.06 76882 26 NRC 30.17 30.17 76882 TC NRC 14.89 14.89 76885 NRC 183.81 183.81 76885 26 NRC 52.41 52.41 76885 TC NRC 131.40 131.40 76886 NRC 140.55 140.55 76886 26 NRC 43.06 43.06 76886 TC NRC 97.48 97.48 76930 NRC 124.91 124.91 76930 26 NRC 49.55 49.55 76930 TC NRC 75.36 75.36 76932 NRC 224.45 224.45 76932 26 NRC 50.80 50.80 76932 TC NRC 173.65 173.65 76936 NRC 413.19 413.19 76936 26 NRC 147.08 147.08 76936 TC NRC 266.11 266.11 76937 46.68 46.68 76937 26 21.96 21.96 76937 TC 24.72 24.72 76940 NRC 247.41 247.41 76940 26 NRC 149.12 149.12 76940 TC NRC 98.29 98.29 76941 NRC 194.76 194.76 76941 26 NRC 96.47 96.47 76941 TC NRC 98.29 98.29 CPT only © 2010 Americal Medical Association. All rights reserved. 2010 Professional Provider Medical Services Fee Schedule Effective 1-01-2011 Fees - Page 132 of 280
Ohio Bureau of Workers Compensation 2010 Professional Provider Medical Services Fee Schedule CPT MOD DESCRIPTION COVERAGE FLAG NON-FAC FEE FACILITY FEE 76942 249.07 249.07 76942 26 47.85 47.85 76942 TC 201.22 201.22 76945 NRC 146.14 146.14 76945 26 NRC 47.36 47.36 76945 TC NRC 98.78 98.78 76946 NRC 54.56 54.56 76946 26 NRC 26.40 26.40 76946 TC NRC 28.16 28.16 76948 NRC 55.68 55.68 76948 26 NRC 27.03 27.03 76948 TC NRC 28.65 28.65 76950 NRC 93.90 93.90 76950 26 NRC 41.16 41.16 76950 TC NRC 52.74 52.74 76965 NRC 176.47 176.47 76965 26 NRC 97.18 97.18 76965 TC NRC 79.29 79.29 76970 118.29 118.29 76970 26 28.68 28.68 76970 TC 89.62 89.62 76975 NRC 189.52 189.52 76975 26 NRC 60.81 60.81 76975 TC NRC 128.71 128.71 76977 NRC 16.10 16.10 76977 26 NRC 4.16 4.16 76977 TC NRC 11.94 11.94 76998 222.21 222.21 76998 26 92.80 92.80 76998 TC 129.41 129.41 76999 BR 0.00 0.00 76999 26 BR 0.00 0.00 76999 TC BR 0.00 0.00 77001 142.70 142.70 77001 26 27.52 27.52 77001 TC 115.18 115.18 77002 96.29 96.29 77002 26 38.14 38.14 77002 TC 58.15 58.15 77003 80.17 80.17 77003 26 40.21 40.21 77003 TC 39.96 39.96 77011 NRC 930.49 930.49 77011 26 NRC 85.23 85.23 77011 TC NRC 845.27 845.27 77012 234.24 234.24 77012 26 81.69 81.69 77012 TC 152.55 152.55 77013 NRC 691.86 691.86 77013 26 NRC 292.23 292.23 77013 TC NRC 399.63 399.63 77014 NRC 249.40 249.40 77014 26 NRC 60.48 60.48 CPT only © 2010 Americal Medical Association. All rights reserved. 2010 Professional Provider Medical Services Fee Schedule Effective 1-01-2011 Fees - Page 133 of 280
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