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 D7282 NRC 0.00 0.00 D7283 NRC 0.00 0.00 D7285 NRC 0.00 0.00 D7286 NRC 225.46 225.46 D7287 NRC 129.29 129.29 D7288 NRC 133.90 133.90 D7290 500.00 500.00 D7291 NRC 0.00 0.00 D7292 1,000.00 1,000.00 D7293 1,000.00 1,000.00 D7294 575.00 575.00 D7295 BR 0.00 0.00 D7310 208.29 208.29 D7311 248.76 248.76 D7320 328.10 328.10 D7321 328.10 328.10 D7340 1,178.00 1,178.00 D7350 2,847.50 2,847.50 D7410 NRC 271.82 271.82 D7411 NRC 0.00 0.00 D7412 NRC 0.00 0.00 D7413 NRC 0.00 0.00 D7414 NRC 0.00 0.00 D7415 NRC 0.00 0.00 D7440 NRC 744.28 744.28 D7441 NRC 0.00 0.00 D7450 NRC 607.59 607.59 D7451 NRC 0.00 0.00 D7460 NRC 0.00 0.00 D7461 NRC 0.00 0.00 D7465 NRC 0.00 0.00 D7471 NRC 0.00 0.00 D7472 NRC 0.00 0.00 D7473 NRC 0.00 0.00 D7485 NRC 0.00 0.00 D7490 NRC 0.00 0.00 D7510 NRC 0.00 0.00 D7511 NRC 0.00 0.00 D7520 NRC 0.00 0.00 D7521 NRC 0.00 0.00 D7530 186.30 186.30 D7540 230.00 230.00 D7550 421.62 421.62 D7560 642.85 642.85 D7610 1,400.00 1,400.00 D7620 1,016.60 1,016.60 D7630 2,500.00 2,500.00 D7640 2,207.00 2,207.00 D7650 857.90 857.90 D7660 812.00 812.00 D7670 720.00 720.00 D7671 750.00 750.00 D7680 2,910.65 2,910.65 CPT only © 2010 Americal Medical Association. All rights reserved. 2010 Professional Provider Medical Services Fee Schedule Effective 1-01-2011 Fees - Page 222 of 280
Ohio Bureau of Workers Compensation 2010 Professional Provider Medical Services Fee Schedule CPT MOD DESCRIPTION COVERAGE FLAG NON-FAC FEE FACILITY FEE D7710 1,797.45 1,797.45 D7720 1,440.95 1,440.95 D7730 3,126.00 3,126.00 D7740 2,842.80 2,842.80 D7750 1,252.35 1,252.35 D7760 1,000.00 1,000.00 D7770 1,652.55 1,652.55 D7771 1,000.00 1,000.00 D7780 2,765.75 2,765.75 D7810 1,588.15 1,588.15 D7820 226.00 226.00 D7830 500.00 500.00 D7840 NRC 0.00 0.00 D7850 NRC 0.00 0.00 D7852 NRC 0.00 0.00 D7854 NRC 0.00 0.00 D7856 NRC 0.00 0.00 D7858 NRC 0.00 0.00 D7860 NRC 0.00 0.00 D7865 NRC 0.00 0.00 D7870 NRC 0.00 0.00 D7871 NRC 0.00 0.00 D7872 NRC 0.00 0.00 D7873 NRC 0.00 0.00 D7874 NRC 0.00 0.00 D7875 NRC 0.00 0.00 D7876 NRC 0.00 0.00 D7877 NRC 0.00 0.00 D7880 632.18 632.18 D7899 BR 0.00 0.00 D7910 164.90 164.90 D7911 313.95 313.95 D7912 413.50 413.50 D7920 1,367.35 1,367.35 D7940 NRC 0.00 0.00 D7941 NRC 0.00 0.00 D7943 NRC 0.00 0.00 D7944 NRC 0.00 0.00 D7945 NRC 0.00 0.00 D7946 NRC 0.00 0.00 D7947 NRC 0.00 0.00 D7948 NRC 0.00 0.00 D7949 NRC 0.00 0.00 D7950 NRC 0.00 0.00 D7951 NRC 0.00 0.00 D7953 2,000.00 2,000.00 D7955 NRC 0.00 0.00 D7960 NRC 312.32 312.32 D7963 NRC 0.00 0.00 D7970 NRC 357.24 357.24 D7971 NRC 0.00 0.00 D7972 NRC 0.00 0.00 D7980 NRC 0.00 0.00 CPT only © 2010 Americal Medical Association. All rights reserved. 2010 Professional Provider Medical Services Fee Schedule Effective 1-01-2011 Fees - Page 223 of 280
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