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 85420 11.70 11.70 85421 13.68 13.68 85441 5.50 5.50 85445 NRC 12.20 12.20 85460 NRC 13.86 13.86 85461 NRC 10.81 10.81 85475 8.33 8.33 85520 23.44 23.44 85525 16.43 16.43 85530 25.39 25.39 85536 8.33 8.33 85540 15.40 15.40 85547 15.40 15.40 85549 33.59 33.59 85555 11.98 11.98 85557 20.66 20.66 85576 26 27.01 27.01 85597 32.19 32.19 85598 NRC 31.63 31.63 85610 7.03 7.03 85611 7.05 7.05 85612 NRC 10.33 10.33 85613 NRC 10.33 10.33 85635 NRC 10.33 10.33 85651 6.35 6.35 85652 4.84 4.84 85660 NRC 9.88 9.88 85670 8.33 8.33 85675 12.26 12.26 85705 17.24 17.24 85730 10.75 10.75 85732 11.59 11.59 85810 20.90 20.90 85999 BR 0.00 0.00 86000 12.50 12.50 86001 9.34 9.34 86003 9.34 9.34 86005 13.54 13.54 86021 26.95 26.95 86022 32.89 32.89 86023 22.30 22.30 86038 21.65 21.65 86039 19.99 19.99 86060 NRC 13.08 13.08 86063 NRC 10.34 10.34 86077 70.12 67.17 86078 71.10 67.17 86079 NRC 71.59 67.66 86140 9.26 9.26 86141 23.18 23.18 86146 NRC 42.68 42.68 86147 NRC 42.68 42.68 86148 NRC 28.76 28.76 CPT only © 2010 Americal Medical Association. All rights reserved. 2010 Professional Provider Medical Services Fee Schedule Effective 1-01-2011 Fees - Page 158 of 280
Ohio Bureau of Workers Compensation 2010 Professional Provider Medical Services Fee Schedule CPT MOD DESCRIPTION COVERAGE FLAG NON-FAC FEE FACILITY FEE 86155 NRC 28.61 28.61 86156 NRC 10.26 10.26 86157 NRC 14.44 14.44 86160 NRC 21.50 21.50 86161 NRC 21.50 21.50 86162 NRC 36.38 36.38 86171 NRC 17.94 17.94 86185 NRC 16.01 16.01 86200 NRC 23.18 23.18 86215 NRC 23.73 23.73 86225 NRC 24.60 24.60 86226 NRC 21.69 21.69 86235 NRC 32.11 32.11 86243 NRC 31.48 31.48 86255 26 NRC 27.01 27.01 86256 26 NRC 26.38 26.38 86277 NRC 28.18 28.18 86280 NRC 14.66 14.66 86294 NRC 25.60 25.60 86300 NRC 25.60 25.60 86301 NRC 25.60 25.60 86304 NRC 25.60 25.60 86305 NRC 25.60 25.60 86308 NRC 9.26 9.26 86309 NRC 11.59 11.59 86310 NRC 13.20 13.20 86316 NRC 25.60 25.60 86317 26.84 26.84 86318 23.18 23.18 86320 26 NRC 26.38 26.38 86325 26 NRC 25.89 25.89 86327 26 NRC 30.54 30.54 86329 NRC 25.14 25.14 86331 NRC 21.46 21.46 86332 NRC 43.64 43.64 86334 26 NRC 27.01 27.01 86335 26 NRC 26.52 26.52 86336 NRC 25.60 25.60 86337 38.34 38.34 86340 NRC 26.99 26.99 86341 32.00 32.00 86343 NRC 22.31 22.31 86344 NRC 14.30 14.30 86352 121.63 121.63 86353 NRC 87.78 87.78 86355 NRC 67.54 67.54 86356 NRC 47.94 47.94 86357 NRC 67.54 67.54 86359 NRC 67.54 67.54 86360 NRC 84.13 84.13 86361 NRC 47.94 47.94 86367 NRC 67.54 67.54 86376 26.05 26.05 CPT only © 2010 Americal Medical Association. All rights reserved. 2010 Professional Provider Medical Services Fee Schedule Effective 1-01-2011 Fees - Page 159 of 280
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