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 21242 2,090.73 2,090.73 21243 NRC 3,458.13 3,458.13 21244 2,171.93 2,171.93 21245 2,299.92 1,891.21 21246 1,756.77 1,756.77 21247 NRC 3,433.21 3,433.21 21248 2,170.86 1,817.05 21249 2,997.50 2,572.01 21255 NRC 2,889.23 2,889.23 21256 2,457.69 2,457.69 21260 NRC 2,593.88 2,593.88 21261 4,810.43 4,810.43 21263 4,032.11 4,032.11 21267 3,309.86 3,309.86 21268 4,145.13 4,145.13 21270 1,886.91 1,491.16 21275 1,725.52 1,725.52 21280 NRC 1,146.27 1,146.27 21282 NRC 748.64 748.64 21295 NRC 365.71 365.71 21296 NRC 873.37 873.37 21299 BR 0.00 0.00 21310 213.59 62.61 21315 523.60 307.81 21320 498.37 283.34 21325 950.28 950.28 21330 1,148.85 1,148.85 21335 1,508.05 1,508.05 21336 1,306.13 1,306.13 21337 790.15 593.41 21338 1,497.95 1,497.95 21339 1,686.44 1,686.44 21340 1,640.35 1,640.35 21343 2,434.97 2,434.97 21344 3,450.98 3,450.98 21345 1,615.59 1,341.85 21346 1,921.61 1,921.61 21347 2,206.41 2,206.41 21348 2,347.28 2,347.28 21355 879.20 672.56 21356 987.85 772.05 21360 1,088.49 1,088.49 21365 2,331.72 2,331.72 21366 2,615.09 2,615.09 21385 1,450.90 1,450.90 21386 1,400.07 1,400.07 21387 1,560.17 1,560.17 21390 1,636.06 1,636.06 21395 1,975.14 1,975.14 21400 360.03 299.80 21401 944.37 617.25 21406 1,098.93 1,098.93 21407 1,342.97 1,342.97 CPT only © 2010 Americal Medical Association. All rights reserved. 2010 Professional Provider Medical Services Fee Schedule Effective 1-01-2011 Fees - Page 14 of 280
Ohio Bureau of Workers Compensation 2010 Professional Provider Medical Services Fee Schedule CPT MOD DESCRIPTION COVERAGE FLAG NON-FAC FEE FACILITY FEE 21408 1,865.25 1,865.25 21421 1,498.11 1,284.60 21422 1,363.15 1,363.15 21423 1,667.77 1,667.77 21431 1,546.55 1,546.55 21432 1,397.68 1,397.68 21433 3,594.61 3,594.61 21435 2,754.82 2,754.82 21436 4,258.85 4,258.85 21440 1,073.23 897.09 21445 1,489.04 1,238.17 21450 1,118.01 936.53 21451 1,447.91 1,238.97 21452 1,148.13 670.02 21453 1,702.87 1,509.95 21454 1,137.98 1,137.98 21461 3,819.03 1,864.68 21462 4,092.49 2,049.69 21465 1,943.53 1,943.53 21470 2,500.10 2,500.10 21480 178.60 69.56 21485 1,304.93 1,117.34 21490 1,935.00 1,935.00 21495 1,398.37 1,398.37 21497 1,325.02 1,140.49 21499 BR 0.00 0.00 21501 886.93 658.18 21502 1,106.42 1,106.42 21510 969.85 969.85 21550 NRC 507.84 327.12 21552 NRC 966.40 966.40 21554 NRC 1,587.65 1,587.65 21555 NRC 823.25 640.24 21556 NRC 1,063.78 1,063.78 21557 NRC 1,835.45 1,835.45 21558 NRC 2,986.04 2,986.04 21600 NRC 1,162.91 1,162.91 21610 NRC 2,408.95 2,408.95 21615 NRC 1,440.67 1,440.67 21616 NRC 1,789.18 1,789.18 21620 NRC 1,102.82 1,102.82 21627 NRC 1,156.67 1,156.67 21630 NRC 2,688.05 2,688.05 21632 NRC 2,715.66 2,715.66 21685 NRC 2,099.24 2,099.24 21700 NRC 906.75 906.75 21705 NRC 1,350.33 1,350.33 21720 NRC 925.64 925.64 21725 NRC 1,099.38 1,099.38 21740 NRC 2,279.57 2,279.57 21742 NRC 0.00 0.00 21743 NRC 0.00 0.00 21750 1,541.74 1,541.74 CPT only © 2010 Americal Medical Association. All rights reserved. 2010 Professional Provider Medical Services Fee Schedule Effective 1-01-2011 Fees - Page 15 of 280
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