Compensation 2010 Professional Provider Medical Services Fee ...

Ohio Bureau of Workers Compensation
2010 Professional Provider Medical Services Fee Schedule
CPT MOD DESCRIPTION
COVERAGE
FLAG
NON-FAC
FEE
FACILITY
FEE
28476 680.39 680.39
28485 1,096.70 1,096.70
28490 269.71 236.92
28495 337.37 297.72
28496 805.60 457.89
28505 1,318.17 1,026.12
28510 232.68 228.11
28515 305.34 280.18
28525 1,107.52 815.48
28530 220.65 203.11
28531 767.77 428.45
28540 393.94 366.49
28545 515.46 473.52
28546 961.02 630.85
28555 1,737.67 1,385.39
28570 328.70 294.39
28575 675.55 629.79
28576 750.73 750.73
28585 1,858.43 1,544.27
28600 415.87 373.17
28605 568.23 528.57
28606 799.31 799.31
28615 1,621.20 1,621.20
28630 296.82 229.72
28635 344.48 278.14
28636 574.49 413.60
28645 1,250.68 991.42
28660 220.33 179.92
28665 311.39 280.12
28666 413.67 413.67
28675 1,138.66 840.51
28705 2,758.46 2,758.46
28715 2,047.47 2,047.47
28725 1,669.05 1,669.05
28730 1,759.59 1,759.59
28735 1,673.05 1,673.05
28737 1,457.43 1,457.43
28740 1,695.47 1,321.07
28750 1,646.82 1,258.69
28755 974.34 692.97
28760 1,556.72 1,225.79
28800 1,199.84 1,199.84
28805 1,631.12 1,631.12
28810 942.47 942.47
28820 1,044.42 732.55
28825 1,151.93 853.02
28890 BR 0.00 0.00
28899 BR 0.00 0.00
29000 490.32 326.37
29010 442.84 299.49
29015 473.79 329.67
29020 422.09 274.93
29025 521.33 365.78
CPT only © 2010 Americal Medical
Association. All rights reserved.
2010 Professional Provider Medical Services Fee Schedule
Effective 1-01-2011 Fees - Page 38 of 280