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 95866 TC NRC 42.91 42.91 95867 100.68 100.68 95867 26 56.30 56.30 95867 TC 44.38 44.38 95868 137.91 137.91 95868 26 83.70 83.70 95868 TC 54.22 54.22 95869 68.80 68.80 95869 26 26.38 26.38 95869 TC 42.42 42.42 95870 66.83 66.83 95870 26 26.38 26.38 95870 TC 40.45 40.45 95872 237.10 237.10 95872 26 198.12 198.12 95872 TC 38.98 38.98 95873 68.80 68.80 95873 26 27.86 27.86 95873 TC 40.94 40.94 95874 65.36 65.36 95874 26 26.87 26.87 95874 TC 38.48 38.48 95875 132.50 132.50 95875 26 77.79 77.79 95875 TC 54.71 54.71 95900 74.79 74.79 95900 26 29.91 29.91 95900 TC 44.88 44.88 95903 87.55 87.55 95903 26 42.18 42.18 95903 TC 45.37 45.37 95904 65.79 65.79 95904 26 24.36 24.36 95904 TC 41.43 41.43 95905 103.61 103.61 95905 26 4.16 4.16 95905 TC 99.45 99.45 95920 207.88 207.88 95920 26 148.25 148.25 95920 TC 59.63 59.63 95921 102.85 102.85 95921 26 62.40 62.40 95921 TC 40.45 40.45 95922 124.59 124.59 95922 26 66.44 66.44 95922 TC 58.15 58.15 95923 170.34 170.34 95923 26 63.52 63.52 95923 TC 106.82 106.82 95925 175.80 175.80 95925 26 37.51 37.51 95925 TC 138.29 138.29 95926 172.49 172.49 CPT only © 2010 Americal Medical Association. All rights reserved. 2010 Professional Provider Medical Services Fee Schedule Effective 1-01-2011 Fees - Page 192 of 280
Ohio Bureau of Workers Compensation 2010 Professional Provider Medical Services Fee Schedule CPT MOD DESCRIPTION COVERAGE FLAG NON-FAC FEE FACILITY FEE 95926 26 38.14 38.14 95926 TC 134.35 134.35 95927 167.93 167.93 95927 26 38.00 38.00 95927 TC 129.93 129.93 95928 278.54 278.54 95928 26 105.21 105.21 95928 TC 173.33 173.33 95929 294.76 294.76 95929 26 105.70 105.70 95929 TC 189.06 189.06 95930 153.32 153.32 95930 26 24.87 24.87 95930 TC 128.45 128.45 95933 90.97 90.97 95933 26 41.67 41.67 95933 TC 49.30 49.30 95934 69.55 69.55 95934 26 35.98 35.98 95934 TC 33.57 33.57 95936 59.79 59.79 95936 26 38.51 38.51 95936 TC 21.28 21.28 95937 80.40 80.40 95937 26 46.34 46.34 95937 TC 34.06 34.06 95950 337.06 337.06 95950 26 105.72 105.72 95950 TC 231.34 231.34 95951 1,252.97 1,252.97 95951 26 430.23 430.23 95951 TC 822.74 822.74 95953 573.36 573.36 95953 26 231.40 231.40 95953 TC 341.96 341.96 95954 361.46 361.46 95954 26 158.98 158.98 95954 TC 202.47 202.47 95955 196.11 196.11 95955 26 69.62 69.62 95955 TC 126.49 126.49 95956 986.53 986.53 95956 26 215.48 215.48 95956 TC 771.06 771.06 95957 390.17 390.17 95957 26 139.30 139.30 95957 TC 250.87 250.87 95958 558.07 558.07 95958 26 298.56 298.56 95958 TC 259.50 259.50 95961 318.66 318.66 95961 26 210.85 210.85 95961 TC 107.81 107.81 CPT only © 2010 Americal Medical Association. All rights reserved. 2010 Professional Provider Medical Services Fee Schedule Effective 1-01-2011 Fees - Page 193 of 280
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