FLORIDA WORKERS COMPENSATION HEALTH CARE PROVIDER REIMBURSEMENT MANUAL Edition

Transcription

1 FLORIDA WORKERS COMPENSATION HEALTH CARE PROVIDER REIMBURSEMENT MANUAL 2008 Edition Department of Financial Services Florida Department of Financial Services Division of Workers Compensation for incorporation by reference into Rule 69L-7.020, Florida Administrative Code

2 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition CONTENTS SECTION I: ADMINISTRATIVE PURPOSE OF MANUAL... 8 SECTION II: SECTION III: BASIC PROGRAM REQUIREMENTS Provider Eligibility... 8 Authorization... 8 Billing...8 Materials Adopted for Reference... 9 Medical Records Reimbursement Information CLASSIFICATION OF INJURED EMPLOYEE S STATUS General Guidelines Patient Classification Levels SECTION IV: DENTAL SERVICES SECTION V: DISPENSING OF MEDICATION Medicinal Drugs Patent, Proprietary or Over-the-Counter Drugs SECTION VI: MEDICAL SUPPLIER SERVICES SECTION VII: MEDICAL SERVICES Biofeedback Services Electrodiagnostic Medicine Evaluation and Management Services Home Health Services Impairment Rating Independent Medical Examination Independent Medical Examination, Consensus Injectable Medications Medical and Surgical Supplies Ophthalmological Services Psychiatric and Psychological Services Radiology Thermography Transcutaneous Neurostimulator

3 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition SECTION VIII: PHYSICAL MEDICINE AND REHABILITATION SERVICES General Information...25 Physical Medicine Services...26 Manipulative Treatment...27 Physical Reconditioning Services...29 Interdisciplinary Rehabilitation Programs...31 Functional Capacity Evaluation...32 SECTION IX: SURGICAL SERVICES General Reimbursement...33 Surgical Assistants...34 Multiple Procedures...35 Bilateral Procedures...35 SECTION X: SECTION XI: ANESTHESIA SERVICES Reimbursement Methodology...37 Medical Direction of CRNA/AA Anesthesia Services for Which Time Units Not Allowed...39 SCHEDULE OF MAXIMUM REIMBURSEMENT ALLOWANCES General Instructions for Use of Schedule...41 PART A: Anesthesia Surgery Radiology Pathology Medicine Evaluation and Management Dental Injections PART B: Surgery PART C: Radiology Pathology Medicine Evaluation and Management

4 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition APPENDICES APPENDIX A. DEFINITIONS APPENDIX B. OFFICIAL SOURCE OF REFERENCES APPENDIX C. MODIFIERS APPENDIX D. WORKERS COMPENSATION UNIQUE CODES APPENDIX E. MEDICARE LOCALITY MAP INDEX

5 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition 69L Florida Workers Compensation Health Care Provider Reimbursement Manual. (1) The Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition, is adopted by reference as part of this rule. The manual contains the Maximum Reimbursement Allowances determined by the Three-Member Panel, pursuant to section (12), Florida Statutes and establishes reimbursement policies, guidelines, codes and maximum reimbursement allowances for services and supplies provided by health care providers. Also, the manual includes reimbursement policies and payment methodologies for pharmacists and medical suppliers. (2) The CPT 2009 Current Procedural Terminology Professional Edition, Copyright 2008, American Medical Association; the Current Dental Terminology, CDT-2009/2010, Copyright 2008, American Dental Association; and in part for D codes and for injectable J codes, and for other medical services and supply codes, the Healthcare Common Procedure Coding System, Medicare s National Level II Codes, HCPCS 2009, American Medical Association, Twenty-first Edition, Copyright 2008, Ingenix Publishing Group, are adopted by reference as part of this rule. When a health care provider performs a procedure or service which is not listed in the Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition incorporated above, the provider must use a code contained in the CPT -2009, CDT-2009/2010 or HCPCS-2009 as specified in this section. (3) The Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition incorporated above, is available for inspection during normal business hours at the Florida Department of Financial Services, Document Processing Section, 200 East Gaines Street, Tallahassee, Florida , or via the Department s web site at Specific Authority (14)(b), FS. Law Implemented (7), (12), (14) FS. History New , Amended , , , Formerly 38F-7.20, Amended , , , , , , , , , , Formerly 38F-7.020, 4L-7.020, Amended , , , , , , ,

6 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition FLORIDA WORKERS COMPENSATION HEALTH CARE PROVIDER REIMBURSEMENT MANUAL 2008 EDITION Rule Chapter 69L-7.020, Florida Administrative Code In accordance with section , Florida Statutes (F.S.), this manual provides reimbursement policies and a schedule of maximum reimbursement allowances, as applicable, for licensed physicians, licensed health care providers, licensed pharmacists and medical suppliers rendering medical services and supplies to Florida s injured workers. The maximum reimbursement allowances and procedure codes are listed in Section XI. NOTICES AND DISCLAIMERS The Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition, provides five-digit codes and two-digit modifiers for reporting medical services and procedures that were selected from the following references by the State of Florida for inclusion in this publication. When a service or procedure is performed that does not have a code listed in the Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition, the physician or health care provider must use a code listed in the following materials: CPT 2009 Current Procedural Terminology Professional Edition, Copyright 2008, American Medical Association. Current Dental Terminology, CDT-2009/2010, Copyright 2008, American Dental Association. Healthcare Common Procedure Coding System, Medicare s National Level II Codes, HCPCS 2009, American Medical Association, Twenty-first Edition, Copyright 2008, Ingenix Publishing Group. The CPT and CDT-2009/2010 contain listings of descriptive terms and identifying codes used by physicians and dentists for reporting medical and dental services and procedures. HCPCS-2009 is used in part for the listing of descriptive terms and codes for dental services and procedures performed by dentists. HCPCS-2009 also contains a listing of injectable medications and codes used to report injections administered by physicians as well as other codes used to report medical services and supplies. It is expressly understood and agreed that the American Medical Association s rights include, but not limited to, common law and statutory rights of literary property in the CPT and in any update thereto, including all descriptive terms and identifying codes and modifiers for reporting procedures and medical services and/or any other information or materials contained in the CPT and in any update thereto are not assigned or released as a result of the agreement between the American Medical Association and the State of Florida, but are at all times reserved and retained by the American Medical Association. 6

7 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition The five character codes included in the Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition are obtained from Current Procedural Terminology (CPT ), copyright 2008 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. The responsibility for the content of the Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition is with the State of Florida Division of Workers Compensation and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in The Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of the Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply. This product includes CPT, which is commercial technical data and/or computer databases and/or commercial computer software and/or commercial software documentation, as applicable, which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS (b)(2) (June 1995) and/or subject to the restrictions of DFARS (a) (June 1995) and DFARS (a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR (June 1987) and/or subject to the restricted rights provisions of FAR (June 1987) and FAR (June 1987), as applicable, and any applicable agency FAR Supplements, for non-department of Defense Federal procurements. CPT is a registered trademark of the American Medical Association. 7

8 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition SECTION I: ADMINISTRATIVE PURPOSE OF MANUAL. The administrative purpose of the Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition, is to provide reimbursement guidelines, codes and maximum reimbursement allowances for licensed physicians and health care providers rendering medically necessary services to Florida s injured employees. This manual also contains reimbursement policies and payment methodologies for pharmacists and medical suppliers. SECTION II: BASIC PROGRAM REQUIREMENTS. A. Provider Eligibility. 1. Florida health care providers must comply with provider certification and eligibility requirements in section , Florida Statutes (F.S.), in order to qualify for reimbursement for rendering medical services to injured employees. 2. Provider certification information and the required application may be obtained from the Division at the following website (listed under rules and forms): B. Authorization. 1. Florida health care providers, out-of-state providers and federal facilities must be authorized by the employer s workers compensation insurer or a self-insured employer prior to rendering initial and remedial medical services or before referring the injured employee to facilities or other certified health care providers. 2. Insurers must comply with the statutory requirements in section , F.S., in responding to authorization requests timely and to ensure that providers are eligible to receive reimbursement for the treatment being requested. 3. Neither emergency services and care, defined in section , F.S., or a provider referral for emergency treatment resulting from emergency care requires authorization by an insurer. These are the only exceptions to the requirements of prior authorization for medical care and treatment. C. Billing. Health care providers, including pharmacists, medical suppliers, out-of-state providers and federal facilities, must report medical services rendered and must bill in accordance with rule 69L-7.602, Florida Administrative Code (F.A.C.) available at the following website: (listed under rules and forms). 8

9 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition D. Materials Adopted for Reference. 1. The following publications are adopted for reference to the listings of descriptive terms and identifying codes for reporting medical services and procedures provided to injured employees by physicians and other health care providers: a. CPT 2009 Current Procedural Terminology Professional Edition, Copyright 2008, American Medical Association. b. Current Dental Terminology, CDT-2009/2010, Copyright 2008, American Dental Association. c. Healthcare Common Procedure Coding System, Medicare s National Level II Codes, HCPCS 2009, American Medical Association, Twenty-first Edition, Copyright 2008, Ingenix Publishing Group, for dental D codes, injectable J codes, and the other medical services or supply codes as specified in this manual. 2. Physicians and providers shall use the codes and descriptions, modifiers, guidelines, definitions and instructions of the referenced CPT -2009, CDT-2009/2010 and HCPCS-2009 in part for dental codes, injection codes, specific modifiers, and the other medical services or supply codes as specified in this manual. The code descriptors, guidelines, definitions, and instructions of the aforementioned references are not provided in this manual. 3. Any modification to a code descriptor by the workers compensation program shall be specified and shall take precedence over any descriptor contained in the referenced CPT , CDT-2009/2010 or HCPCS The use of HCPCS Level II codes is only allowed when there is not a more specific CPT code. E. Maintenance and Release of Medical Records. 1. Health Insurance Portability and Accountability Act (HIPAA) and Applicable Licensure Requirements. Health care providers shall create and maintain medical records of workers compensation claimants in accordance and compliance with HIPAA, Chapter 456, F.S., and the applicable licensing statute(s) and administrative rules adopted thereunder, including the requirement to provide notice of privacy practices in a manner and form that meets the requirements of 45 C.F.R advising the claimant that Protected Health Information (PHI) may be used and disclosed without prior authorization as necessary to comply with workers compensation laws. Every health care provider shall, except in an emergency treatment situation, make a good faith effort to obtain a written acknowledgement of receipt of notice of privacy practices no later than the first day of providing medical services to a workers compensation insured patient, and if not obtained, document its good faith efforts to obtain such acknowledgment and the reason why the acknowledgement was not obtained. In the event a patient, guardian, 9

10 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition curator, or personal representative requests restriction(s) of the use or disclosure of identifiable health information that would prevent disclosure as necessary for treatment or payment for health care services, the hospital shall notify the insurer immediately, if possible, or by close of business on the next regular business day. 2. Carrier Disclosure. Unless instructed otherwise, it is the responsibility of all health care providers to furnish, without charge, the following documentation to the insurer: a. A complete report of the patient s symptoms, findings and plan of treatment pursuant to reporting requirements in section , F.S. b. An operative report when a surgical procedure is performed. c. A narrative report when a consultation or an independent medical examination is rendered. d. Any additional written documentation when requested by the employer/carrier or designated claims handling entity in order to determine compensability of the injury or when medical necessity of services must be substantiated in more detail then previously disclosed. Failure of the provider to forward information when requested by the insurer may result in the billed service being disallowed or denied for payment until sufficient documentation is provided to render the necessary determination. 3. Special insurer requests (Code 99080). Insurers may request physicians to prepare special narrative reports. Prior to a provider s provision of a special report, the insurer and provider shall agree upon reimbursement for completion of the special report. Reimbursement for special requests shall be made by the insurer at the agreed upon reimbursement amount. 4. Copies of medical records. a. Injured Employee. (1) A health care provider, upon request, shall furnish an injured employee or the employee s attorney a copy of the employee s office chart, records and reports. Reimbursement for medical records shall be made to a health care provider by the employee or employee s representative at $.50 per page. (2) A health care provider, upon request, shall furnish the injured employee or the employee s representative non-written medical records. Reimbursement shall be made to a health care provider by the requesting party at the provider s actual cost for x-rays, microfilm, or other non-written records. 10

11 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition b. Employer/Insurer. (1) A health care provider shall also furnish to the employer or insurer or its attorney, on demand, a copy of his or her office chart, records and reports. (2) A health care provider, upon request, shall furnish the employer or insurer or its attorney non-written medical records. Reimbursement shall be made to a health care provider by the requesting party at the provider s actual direct cost for x-rays, microfilm or other non-written records. (3) Reimbursement for copying charges incurred shall be as specified pursuant to Rule Chapter 64B, F.A.C., and section , F.S. or , F.S. c. Division. A health care provider, upon request, shall provide medical records to the Division without charge. Failure to forward the requested information shall result in administrative action pursuant to the provisions in section , F.S. F. Reimbursement Information. All health care providers are subject to the reimbursement guidelines contained in this manual. 1. Provider payment. a. Federal facilities. Federal facilities are exempt from the reimbursement provisions and allowances in this reimbursement manual. An insurer shall reimburse a federal facility its usual charges. b. Florida health care providers. (1) Reimbursement shall be made to a certified Florida health care provider after applying the appropriate reimbursement guidelines contained in this manual. An insurer shall reimburse a provider either the agreed upon contract price (whether agreed upon prior to rendering service(s) or upon submission of bill) or the maximum reimbursement allowance (MRA) in the appropriate schedule pursuant to section (12) (a), F.S. Reimbursement shall be based on the geographic location and whether the services were rendered in a facility or a non-facility designation. (See Section XI, Maximum Reimbursement Allowances, General Instructions.) (2) Physicians shall be reimbursed the MRAs from Section XI, Part B for surgical procedures or services and from Part C for non-surgical procedures or services. (3) All anesthesia service codes, whether provided by a physician or non-physician, and those services or procedures delineated in the CDT-2009/2010 or D codes in the HCPCS-2009 shall be reimbursed according to Section XI, Part A. 11

12 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition (4) Physical therapists, occupational therapists, audiologists including special otorhinolaryngologic services uniquely provided by qualified speech pathologists and psychologists shall be reimbursed the MRAs from Section XI, Part C. (5) Physician assistants (PAs), and advanced registered nurse practitioners (ARNPs) shall be reimbursed at eighty-five percent (85%) of the MRA in Section XI, Part B for surgical procedures or services and eighty-five percent (85%) of the MRA in Section XI, Part C for non-surgical procedures or services. (6) Licensed Clinical Social Workers shall be reimbursed at seventy-five percent (75%) of the MRA in Section XI, Part C. (7) Dietitians, Nutritionists, or Nutrition Counselors shall be reimbursed at eighty-five percent (85%) of the MRA in Section XI, Part C. (8) Independent clinical laboratories and freestanding imaging/x-ray centers shall be reimbursed at the technical non-facility MRA from Section XI, Part C. (9) All other workers compensation certified providers shall be reimbursed the MRA from Section XI, Part A. c. Out-of-state providers. (1) Prior to the delivery of medical services, an insurer and provider may mutually agree upon the amounts of reimbursement for the services; or a. When a reimbursement agreement is not made, the insurer shall reimburse the out-ofstate provider either the greater of the MRA for the services in Part A, Section XI in this manual or the maximum reimbursement allowances under the workers compensation program in the state where the services are provided. 2. Reimbursement guidelines. a. Codes paid by MRAs. Reimbursement for codes listed in this manual with MRAs shall be at the maximum reimbursement allowances after the application of any reimbursement policies contained in this manual, except when there is an agreed upon contract. b. Codes paid by report (BR). (1) Reimbursement shall be determined by the insurer for codes paid by report (BR). Payment shall be based on a provider s documentation submitted to the insurer in a special report containing information on the complete description of the services or procedures, medical necessity, pertinent clinical data, prevailing charges, fees, relative values and reimbursement for similar procedures or cost of the services or supplies. 12

13 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition (2) The provider shall submit the documentation required above when the following occurs: c. Exclusion. (a) The procedure is listed BR in this manual. (b) There is a valid code that is not listed in this manual, but contained in the materials adopted for reference in Section II D. (c) There is a valid modifier that alters the established MRA. Reimbursement shall not be made for failed appointments. This exclusion does not apply to the statutory provisions for independent medical examinations contained in section , F.S. d. Exceptions. When a provider deems it medically necessary in the treatment of a particular individual s injury or illness to furnish medical services that exceed the number of services in specific reimbursement policy guidelines, a provider must: (1) Submit documentation to the insurer substantiating the medical necessity for the request. (2) Receive specific written authorization from the insurer to render the requested exceptional services before they are provided. e. Co-payments. (1) A health care provider is entitled to collect a co-payment of $10.00 per visit when providing medical services and care to an injured employee who has reached maximum medical improvement. The co-payment shall not apply to emergency care or service provided to the employee. (2) The co-payment is not in addition to any applicable maximum reimbursement allowance or fee agreement. The reimbursement amount otherwise payable by the insurer shall be reduced by the amount of the co-payment. 3. Insurer reimbursement responsibilities. a. Insurers shall use the codes and descriptions, guidelines, definitions and instructions in the referenced CPT -2009, CDT-2009/2010 and HCPCS-2009, in part for dental services, injections, and other medical services and supply codes prior to making reimbursement decisions. In addition, where not inconsistent with instructions in this manual or in rule 69L-7.602, F.A.C., insurers may utilize National Correct Coding Initiative (NCCI) edits as part of the bill review process. 13

14 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition b. Insurers shall make available upon request from the state agency a methodology for determining reimbursement for codes that have no established MRAs, including Category III codes, unlisted procedure codes and codes that are paid BR. (1) Insurers shall utilize the expertise of peer review physicians for concurrent review, including the appropriateness and cost of the medical services reported; billing and coding issues; and reimbursement determinations. (2) Insurers shall make reimbursement decisions based on all of the provider s documentation; the insurer medical claims data; relative value studies; prevailing charges and reimbursement for procedures, services and supplies; and peer physician recommendations. c. Insurers shall reimburse all work-related and medically necessary services provided in a documented medical or dental emergency. 4. Reimbursement Disputes. a. A contested disallowance or adjustment of payment by an insurer may be resolved by petitioning the department pursuant to s (7), F.S. b. Where an insurer has disallowed or adjusted payment for services rendered pursuant to an authorized workers compensation managed care arrangement, a health care provider may not elect to petition the department pursuant to s (7). SECTION III: CLASSIFICATION OF AN INJURED EMPLOYEE S STATUS. A. General Guidelines Based on the Use of Patient Classification Levels. 1. Providers and insurers are to utilize the workers compensation specific patient classification levels, addressed in Part B of this Section, which are neither hierarchical nor severity indicators. (See rule 69L 7.602, F.A.C. for instructions on reporting classification levels.) 2. The classification system, which is criteria based, comprises descriptive categories that are provided as a means to promote decision-making, accountability and responsible medical claims handling practices. Additionally, the classification system enhances communication between the provider and the insurer which facilitates the authorization process and the provision of medically necessary care. Proper classification of the patient is intended to: a. Convey to insurers the complexity of services that may be required for optimal clinical management; b. Distinguish the overall critical differences among cases that influence the intensity, scope, and cost of services provided; 14

15 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition c. Facilitate recognition of three varying clinical configurations that affect the medical treatment plan and treatment progress or other available benefits for an injured employee; d. Assist the insurer in decisions related to authorization of recommended treatment plans or treatment plan revisions; e. Ensure that on-going treatment plans and authorized reimbursable services are consistent with the high intensity, short duration treatment approach which focuses on specific clinical dysfunction before authorization is made to a provider. B. Patient Classification Levels. 1. Level I: Key issue specific, well-defined medical condition, with clear correlation between objective relevant physical findings and patient s subjective complaints. Treatment correlates to specific findings. 2. Level II: Key issue regional or generalized deconditioning (i.e., deficits in strength, flexibility, endurance, and motor control). Treatment includes physical reconditioning or functional restoration. 3. Level III: Key issue poor correlation between patient s complaints and objective, relevant physical findings, indicating both somatic and non-somatic clinical factors. Treatment includes interdisciplinary rehabilitation and management. SECTION IV: DENTAL SERVICES. A. All dental services shall be authorized by an insurer before the services are initiated. An insurer shall only reimburse a dentist or an oral surgeon for authorized services. B. Dentists shall use the dental guidelines, codes and descriptors from the CDT-2009/2010 or the D codes in the HCPCS-2009 for dental procedures. C. Dentists shall use the appropriate guidelines, codes and descriptors from the CPT and CDT-2009/2010 or D codes in the HCPCS-2009 for temporomandibular joint services. 1. Dentists who provide temporomandibular joint services may use a combination of CPT codes and dental codes from the CDT-2009/2010 or HCPCS Dentists shall refer to the physical medicine section of this manual for information on physical medicine reimbursement guidelines. D. Oral surgeons shall use the CPT surgical guidelines, codes, descriptors and modifiers for oral and maxillofacial surgical services. 1. Surgeons shall refer to the surgical services section of this manual for information on reimbursement for multiple surgical procedures, as well as other surgical reimbursement guidelines. 15

16 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2. Surgeons may refer to other sections in this manual and may use CPT codes. E. Reimbursement to a provider shall be as follows: 1. Reimbursement to a dentist or oral surgeon for a dental procedure or service shall be either the agreed upon contract price or the listed MRA in the appropriate schedule. 2. Reimbursement to a surgeon for an oral and maxillofacial consultation shall be limited to one (1) consultative visit per date of accident. SECTION V: DISPENSING OF MEDICATION. A. Medicinal drugs. 1. Medicinal drugs, commonly known as legend or prescription drugs, shall be ordered for an injured employee by a licensed practitioner, authorized by the insurer to treat the employee. 2. Medicinal drugs are dispensed, stored and sold only by a pharmacist licensed under Chapter 465, F.S., or a dispensing practitioner according to the provisions in s , F.S. 3. Medicinal drugs may be compounded by a pharmacist or physician when the drug formulation prescribed is not commercially available. 4. Federal regulations. a. The Food and Drug Administration requires drug manufacturers to register and list manufactured drug products. The National Drug Code (NDC) is assigned by the manufacturer and placed on all prescription stock packages. b. The Food and Drug Administration considers the compounding of drugs to be the practice of pharmacy/medicine. A compounded drug does not have a NDC. 5. Reimbursement limitations. a. Reimbursement shall only be made to a licensed pharmacist or licensed dispensing practitioner for provision of medicinal drugs under the NDC number and reimbursement is calculated according to the formula below. (Providers should refer to rule 69L-7.602, F.A.C. for the option of using the workers compensation unique code DSPNS in addition to the NDC. See also Appendix D.) b. Reimbursement for prescription drugs shall be as follows: (1) The pharmaceutical reimbursement formula: Average Wholesale Price (AWP) + $4.18 dispensing fee = Reimbursement; or 16

17 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition (2) The contracted reimbursement amount determined in accordance with the contractual arrangement between the provider and insurer. c. A pharmacist or physician shall be reimbursed for a professional service related to compounding drugs which formulations are not commercially available. (1) The amount of reimbursement to be made by the insurer shall be mutually agreed upon by the provider and insurer prior to the compounding. (2) A physician or pharmacist shall be reimbursed under the workers compensation unique code COMPD for compounding drugs furnished to a patient. B. Patent, proprietary or over-the-counter drugs. 1. Reimbursement shall be made to a pharmacist for dispensing over-the-counter drugs at the pharmacist s usual charge for the drugs. 2. Reimbursement to a dispensing practitioner shall be as follows: a. Reimbursement shall be made to a dispensing practitioner for furnishing over-thecounter drugs. A dispensing practitioner shall use the NDC number and submit an invoice to the insurer that provides the name, dosage, package size and cost of drugs, including manufacturer s applicable shipping and handling. (Providers should refer to rule 69L-7.602, F.A.C., for the option of using the Workers Compensation Unique Code DSPNS in addition to the NDC. See Appendix D.) b. Reimbursement shall be made at the provider s charge or an amount not to exceed twenty percent (20%) above the actual cost of each drug furnished. c. Reimbursement shall not be made for oral vitamins, nutrient preparations and dietary supplements. SECTION VI: MEDICAL SUPPLIER SERVICES. A. Medical supplies and durable medical equipment (DME) shall be prescribed by a physician and may be provided to an injured employee by a medical supplier through rental or purchase. B. A medical supplier shall obtain written authorization and a payment agreement from the insurer prior to furnishing an injured employee medical supplies or equipment. C. A medical supplier shall provide the insurer with a copy of the physician s original order with the bill for reimbursement. The medical supplier is not required to provide invoices with the bill to document the actual costs of supplies and equipment. A medical supplier is required to submit HCPCS codes. Where a more specific HCPCS code is not available for medical supplies and DME, reimbursement shall be made under A

18 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition D. Reimbursement. 1. Reimbursement shall be made to a medical supplier by the insurer for rental or purchase of medical equipment and supplies. a. The insurer may rent the item from the supplier for the injured employee. The insurer may write a provision in the payment agreement that when the amount received by the supplier from the rental payments equals the purchase price, the item will become the property of the insurer or injured employee. b. The insurer may purchase the item from the supplier. 2. An insurer shall reimburse a medical supplier at the price stated in the payment agreement, upon receipt of a bill and copy of the physician s original order. SECTION VII: MEDICAL SERVICES. A. Biofeedback Services. 1. Reimbursement to a health care provider for biofeedback training shall be limited to twelve (12) visits per date of accident. This biofeedback training limitation does not include individual psychophysiological therapy incorporating biofeedback training by any modality with psychotherapy. 2. Reimbursement for the collection and interpretation of biofeedback data digitally stored and downloaded shall be included in the reimbursement to the provider for the basic biofeedback service. B. Electrodiagnostic Medicine. The referring physician shall determine the medical necessity of an electromyography (EMG) or a nerve conduction study (NCS). Only a physician shall determine the frequency of testing or the necessity of repeat testing. 1. Needle electromyography (EMG). a. Only a physician or a recognized practitioner specifically qualified by regulations in Florida shall be reimbursed for needle EMG testing. Reimbursement shall include the testing, interpretation of the studies and a report of the findings. b. A physician or a recognized practitioner specifically qualified by regulations in Florida shall determine the muscles to be tested based on specific clinical findings at the time of the study. c. When an initial evaluation and management service and needle EMG testing are performed during a visit, reimbursement shall be made to a physician for both services. 18

19 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition d. When a follow-up evaluation and management service and needle EMG testing are performed on the same day, reimbursement shall be made to a physician for both services if the physician s documentation validates the medical necessity of the follow-up evaluation and management service. e. When needle EMG testing is performed in a hospital or other facility, reimbursement shall be made to a physician for an interpretation of the testing when modifier 26 is appended to the appropriate code. 2. Nerve conduction studies (NCSs). a. Only a physician or a recognized practitioner specifically qualified by regulations in Florida shall be reimbursed for NCSs. Reimbursement shall include the testing, interpretation of the studies and report of the findings. b. A physician or a recognized practitioner specifically qualified by regulations in Florida shall determine the nerves to be tested based on specific clinical findings during examination at the time of the study. c. When an initial evaluation and management service and NCSs are performed during the same visit, reimbursement shall be made to a physician for both services. d. When a follow-up evaluation and management service and NCSs are performed on the same day, reimbursement shall be made to a physician for both services if the physician s documentation validates the medical necessity of the follow-up evaluation and management service. e. A technologist under the direct supervision of the physician may perform a NCS. C. Evaluation and Management Services. 1. Office visits. A physician shall be reimbursed by an insurer for evaluation and management services (new patient and established patient visits). Reimbursement is limited to one (1) visit a day at the highest level of care provided by the physician. 2. Consultations, confirmatory consultations and follow-up consultation services. A physician shall be reimbursed for consultations, confirmatory consultations and follow-up consultation services. Reimbursement shall include a review of all submitted medical records, paper and non-paper; an examination of the injured employee; and a written report. 3. Home Services. A physician shall be reimbursed for home visits when authorized by the insurer. A physician shall use the appropriate evaluation and management home visit code to report the service. 19

20 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition D. Home Health Services. A home health agency shall be reimbursed for insurer authorized home health services provided in a patient s residence based on a signed order from the authorized, treating physician. The insurer shall reimburse a home health agency at the reimbursement amounts agreed upon by the agency and the insurer. (See rule 69L-7.602, F.A.C. for billing instructions.) E. Impairment Rating (Code 99455). 1. A physician shall be reimbursed by the insurer for an impairment rating. 2. Reimbursement shall include an examination to evaluate an injured employee s condition on the establishment of the date of maximum medical improvement and the assignment of an impairment rating of zero (0) percent or greater; and the completion and submission of the required reporting form to the appropriate parties in accordance with s , F.S. 3. Reimbursement shall not be made for an evaluation and management code on the same date as code F. Independent Medical Examination (Code 99456). 1. A physician shall be reimbursed by the party requesting the independent medical examination (IME). 2. Reimbursement for an IME shall include the review of applicable paper and non-paper medical records; an examination of the injured employee; and a written report. G. Independent Medical Examination, Consensus (99457, Workers Compensation unique code). 1. A physician shall be reimbursed by the insurer for a consensus independent medical examination (CIME). 2. Reimbursement for a CIME shall include the review of applicable paper and non-paper medical records, an examination of the injured employee, and a written report. 3. Reimbursement for a CIME shall be negotiated between the physician and the insurer prior to rendering the service. H. Injectable Medications. 1. Providers shall refer to the CPT reference adopted as part of this manual for reporting the injection procedure, as well as an immune globulin, vaccine or toxoid product (including 90749). 2. Providers shall refer to J codes in the HCPCS-2009 reference as adopted as part of this manual for reporting other injectable medications. 20

21 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition 3. When the specific injectable medication is not listed in either of these references, providers shall identify the injectable product under the NDC number for reimbursement. (Providers may use the option of the Workers Compensation Unique Code DSPNS in addition to the NDC number. (See Appendix D.) 4. Reimbursement for injectable medications shall be made to health care providers as follows: a. Reimbursement shall be made to a health care provider using CPT or HCPCS J codes for specific injectable drugs and CPT codes for the administration of injectable drugs. b. Reimbursement shall be at either the agreed upon contract price or the listed MRA in the appropriate schedule. Note: The MRA for HCPCS J codes is listed in Part A, Section XI of this manual. c. Reimbursement for an injection shall include a local anesthetic, if necessary. d. Reimbursement for multiple medications administered from the same syringe shall be: (1) At either the agreed upon contract price or the listed MRA, in Part A, Section XI of this manual for the first reported drug; and (2) At either the agreed upon contract price or fifty percent (50%) of the listed MRA in the appropriate schedule for each additional drug. Each additional drug shall be reported by appending modifier 51 to the HCPCS or CPT code. 5. Reimbursement to a physician for codes or J3490, shall not exceed twenty percent (20%) above the actual cost of the injectable medication based on submission of: a. The name, strength and dosage of the medication, vaccine or toxoid; and b. Documentation verifying the cost of the medication, vaccine or toxoid, including applicable manufacturers shipping and handling. 6. A special provision is allowed for the identification of a loading dose of morphine sulfate administered via infusion pump. a. Providers may utilize HCPCS code S0093 if deemed by the practitioner to be the most appropriate coding option. (Note: No other S codes are acceptable for reporting injectable medications.) b. Reimbursement shall be limited to no more than twenty percent (20%) above the documented cost of the drug, including applicable manufacturer s shipping and handling. I. Medical and Surgical Supplies (not incidental to a service or procedure). 1. Reimbursement for supplies that are necessary to perform a procedure or provide a service shall be included in the reimbursement for the service and shall not be made separately. 2. Reimbursement for supplies and materials not incidental to a service or procedure shall be 21

22 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition reimbursed under the specific HCPCS Level II supply code. When a more specific HCPCS code is not available for supplies and materials, use HCPCS code A9999. Reimbursement shall be limited to an amount not to exceed twenty percent (20%) above the actual documented cost based on submission of documentation that substantiates the provider s cost, including applicable manufacturer s shipping and handling. J. Ophthalmological Services. 1. Reimbursement for ophthalmological services shall be made for all medically necessary services. 2. Reimbursement shall only be made for spectacles, contact lens or frames of comparable quality to the original when they are damaged, lost or required for treatment as a result of an injury. K. Psychiatric and Psychological Services. 1. Reimbursement for psychiatric and psychological services shall be made by the insurer to an authorized, licensed medical doctor, osteopathic physician, a psychologist, mental health practitioner or health professional providing individual psychotherapy services in compliance with state licensure. 2. Only a physician shall be reimbursed for evaluation and management services when CPT codes are billed. 3. Only a physician shall be reimbursed for individual psychotherapy in combination with evaluation and management services provided by the physician at a therapy session. Physicians shall refer to the incorporated CPT for specific psychiatric procedure codes to identify the combined services. 4. A physician shall not be reimbursed for an evaluation and management service code (CPT ) on the same day that reimbursement is made for a psychiatric procedure code that describes psychotherapy combined with evaluation and management services. 5. When multiple individual psychotherapy sessions are provided on the same day, only the session lasting the longest period of time shall be reimbursed. 6. Reimbursement shall be made for central nervous system assessments/testing authorized by the insurer. a. Reimbursement includes an assessment and administration of a test with interpretation and report. b. The amount of reimbursement for these services shall be determined from the number of hours (units of services) reported by the provider to perform the assessment/test. The procedure code s descriptor shall indicate if the service is per hour or all-inclusive. Reimbursement shall be made at the agreed upon contract price or the listed MRA in Section XI of this manual. 22

23 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition 7. Reimbursement for family psychotherapy, with or without the injured employee present, shall be made if the documentation supports that the purpose is related to the treatment of the injured employee s compensable injury. Reimbursement shall not be made for psychological services provided directly to members of the injured employee s family for support and assistance in adjusting to the injured employee s condition. 8. Reimbursement shall be made for health and behavior assessment/intervention services when authorized by the insurer. Providers shall refer to the incorporated CPT reference for specific health and behavior assessment/intervention procedure codes to identify their services. L. Radiology. 1. Reimbursement shall be made for radiology services, including diagnostic radiology (diagnostic imaging), diagnostic ultrasound and nuclear medicine. 2. Radiology procedures consist of two components: technical and professional. a. Technical Component: Modifier TC. HCPCS Level II modifier TC is used to designate the technical component for a procedure or service. (See Appendix C, Modifiers.) b. Professional Component: Modifier 26. When the professional (or physician) component is reported separately, the service may be identified by appending the modifier 26 to the procedure code. 3. Global services may be reported when one physician provides both the technical and the professional components of a procedure or service. The unmodified 5-digit code is used to identify a global service inclusive of the professional service and the technical cost of providing that service. 4. Reimbursement. a. Reimbursement shall not be made for a professional component (modifier 26) billed in the following situations: (1) A professional component billed by a physician for x-rays taken and interpreted by another physician and reviewed by the billing physician during an IME, medical visit or consultation. (2) A professional component billed by a physician for reviewing x-rays during an emergency department or hospital visit when the x-rays were interpreted by the radiologist at the hospital. 23

24 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition b. Reimbursement shall be made to an independent radiology facility for the technical component only when the service is identified by appending modifier TC to the five (5) digit code. M. Thermography. 1. Authorization. The insurer shall not authorize a physician to perform thermography any earlier than fortyfive (45) days after the date of accident unless documentation of medical necessity is submitted to the insurer along with the request for authorization. 2. Reimbursement. a. Reimbursement for thermography shall be limited to one (1) body area, either major or limited. (1) Major body areas. (The following areas include all views.) (a) Head. (b) Cervical spine and upper extremities. (c) Lumbosacral spine and lower extremities. (2) Limited body areas. (The following areas include all views.) (a) Thoracic spine. (b) Any portion of a major area. b. Reimbursement for thermography to a major body area shall be made at either the agreed upon contract price or the listed MRA in the appropriate schedule. c. Reimbursement for thermography to a limited body area, reported by appending modifier 52 to the code shall be made at either the agreed upon contract price or fifty percent (50%) of the MRA in the appropriate schedule. N. Transcutaneous Neurostimulator (TNS). 1. Reimbursement shall be made to an authorized physician or other health care provider for furnishing an injured employee with a transcutaneous (surface) neurostimulator (TNS) prescribed by a physician. a. Authorization and a reimbursement agreement shall be obtained from the insurer for rental or purchase of a TNS prior to a physician or provider furnishing a TNS to the injured employee. b. A reimbursement agreement shall not exceed twenty percent (20%) above the provider s 24

25 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition documented cost when the TNS is purchased. A copy of the provider s documentation shall be submitted with the bill substantiating the actual cost, including applicable manufacturer s shipping and handling. 2. Reimbursement shall be made to an authorized physician or provider for furnishing training to an injured employee on the application of a transcutaneous neurostimulator. Reimbursement is limited to no more than four (4) training sessions. SECTION VIII: PHYSICAL MEDICINE AND REHABILITATION SERVICES. A. General Information. 1. Physical medicine and rehabilitation services shall be considered as covered treatment only when such care is given based on a physician referral or prescription and when the medical necessity for such services is clearly supported in the provider s evaluation and the specific physical medicine plan of care. The Florida workers compensation program shall reimburse authorized providers, as specified in this section, for the following physical medicine and rehabilitation services: a. Modalities and therapeutic procedures applied to acute injuries to reduce symptoms, restore function and return the injured employee to work. b. Physical reconditioning focused on injuries requiring intensive physical reconditioning services to restore the injured employee to pre-injury level of physical health and function. The goal shall be for the employee to return to a job or become physically reconditioned. c. Interdisciplinary rehabilitation programs covering a variety of services that are coordinated, outcome focused and directed at the injured employee s needs to increase the employee s functioning or to return the employee to work. 2. Approval for the provision and payment of medically necessary physical medicine services (i.e., modalities and therapeutic procedures, physical reconditioning, or interdisciplinary rehabilitation programs) shall be supported in the evaluation and a specific physical medicine plan of care, regardless of the location of where the services are rendered or the provider type (i.e. physician or licensed therapist). a. If the insurer questions the appropriateness of the therapy listed in the plan of care, the insurer shall contact the physician to obtain the rationale for the ordered therapy, prior to authorization. b. It shall be the responsibility of the physician to provide the documentation of medical necessity for the therapy to the insurer in order to avoid unnecessary delays in obtaining authorization for treatment or in initiating therapy. 3. Approval beyond the guidelines provided in this section must be obtained from the insurer, in 25

26 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition writing, prior to a provider furnishing the service. The unusual circumstances must be documented and forwarded by the provider to the insurer for review before an exception to the guidelines can be considered and a determination made by the insurer to authorize additional services. B. Physical Medicine Services. 1. Authorization. a. Reimbursement shall only be made for insurer authorized physical medicine modalities and procedures up to six (6) months after the date of accident, based on a signed order or referral from an authorized, treating physician. All services shall be authorized prior to initiation of services. Exceptions to the preceding authorization criteria for physical medicine modalities and procedures may occur when the treating physician provides objective relevant medical findings that demonstrate the following: (1) The injured employee has a specifically defined, relevant clinical dysfunction, consistent with the patient classifications outlined in Section III of this reimbursement manual, that is reasonably expected to respond to the requested physical medicine modalities or procedures, and (2) The injured employee does not conform to either the Level II or Level III patient classifications based on specific documentation of the following: (a) No systemic musculoskeletal deficit (strength, flexibility, endurance, coordination) or substantive functional loss requiring an intensive physical reconditioning program; (b) No behavioral or psychological issues that present a substantive factor in the rehabilitation effort or outcome; (c) No significant vocational or return to work issues; and (d) No significant disparity between the injured employee s subjective complaints, response to intervention, and other relevant clinical indicators when compared with documented objective, relevant findings. b. Reimbursement for physical medicine services shall not exceed one (1) visit per day, unless specifically authorized by the insurer. 2. Initial evaluation. a. Reimbursement for an initial evaluation by a physician shall be made as an evaluation and management service. b. Reimbursement for an initial evaluation by a licensed therapist shall be made when billed by the therapist under code or c. Separate reimbursement shall not be made to a physician and to a physician-employed 26

27 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition therapist for an evaluation by each on the same date. d. Reimbursement for an initial evaluation shall include the evaluation and a plan of care or treatment. Documentation of the evaluation and plan of care shall be submitted to the insurer with the claim form. At a minimum, the documentation shall contain: (1) The evaluation findings including any functional limitations. (2) The proposed therapy specifying the frequency and duration of the services. (3) The anticipated degree of restoration of function with measurable goals. 3. Re-evaluation. Reimbursement shall be made for a re-evaluation ordered by a physician and performed by a therapist. A re-evaluation must be billed using either code or Revised plan. a. The physician or therapist shall submit to the insurer a revised plan of care or treatment, when appropriate. b. An authorized treating physician or treating therapist has the responsibility of providing documentation of medical necessity for therapy modifications if questioned by the insurer. 5. Modalities and therapeutic procedures. Reimbursement to a provider shall be made for the modalities and therapeutic procedures listed in the plan of care with the limitation that no more than four (4) units of service shall be reimbursed per visit. a. Codes shall each equal one (1) reimbursable unit of service. The performance of the supervised modality codes is not time-oriented and each code may only be reported once during the visit. b. Codes shall each equal one (1) reimbursable unit of service for each 15- minute increment of service performed. c. Code shall be restricted to one (1) reimbursable unit of service per visit. 6. Manipulative treatment. a. Reimbursement to a physician for a manipulative treatment shall be limited to one (1) visit a day. b. Reimbursement for manipulative treatment under workers compensation shall be limited to two (2) body regions per day. 27

28 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition The entire spine is one (1) region. (2) Each of the following is one (1) region: head; two (2) upper extremities; two (2) lower extremities; one (1) upper and one (1) lower extremity; rib cage; and abdomen. c. Reimbursement for manipulative treatment to the two (2) regions listed in Section VIII.B.6.b. shall be made for workers compensation unique codes and 97261, specifically designated for physicians other than osteopaths and chiropractors. (1) Reimbursement shall be made for code 97260, when used to bill for a spinal manipulation. The spine shall be reimbursed as one (1) entity for workers compensation, although there are five (5) spinal regions (cervical; thoracic; lumbar; sacral; and pelvic). (2) Reimbursement shall be made for code 97261, when used to bill for a manipulation of the temporomandibular joint; the upper extremities, including the hand and wrist; the lower extremities; and other regions. d. Reimbursement for osteopathic manipulative treatment (OMT) to the two (2) regions listed in Section VIII.B.6.b. shall be made for codes and (1) Reimbursement shall be made for code 98926, when used to bill for a spinal manipulation. The spine shall be reimbursed as one (1) entity for workers compensation, although there are five (5) spinal regions (cervical; thoracic; lumbar; sacral; and pelvic). (2) Reimbursement shall be made for code 98928, when used to bill for a manipulation to the head region; lower extremities; upper extremities; rib cage region; and abdomen and viscera region. e. Reimbursement for chiropractic manipulative treatment (CMT) to the two (2) regions listed in Section VIII.B.6.b., shall be made for codes and These manipulation codes are specifically designated for chiropractic physicians. (1) Reimbursement shall be made for code when used to bill for a spinal manipulation. The spine shall be reimbursed as one (1) entity for workers compensation, although there are five (5) spinal regions: cervical region (includes atlanto-occipital joint); thoracic region (includes costovertebral and costo-transverse joints); lumbar region; sacral region; and pelvic (sacroiliac joint) region. (2) Reimbursement shall be made for code 98943, when used to bill for a manipulation to an extraspinal region: head (including temporomandibular joint, excluding atlantooccipital); lower extremities; upper extremities; rib cage (excluding costotransverse and costovertebral joints); and abdomen. 7. Acupuncture. a. Reimbursement for acupuncture and/or electro-acupuncture service is based on 15-minute 28

29 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition increments of face-to-face contact with the patient during a session. b. Reimbursement for acupuncture with one (1) or more needles, with or without electrical stimulation, shall be made to a physician or a recognized practitioner specifically licensed by the Florida Department of Health to diagnose and treat. c. Each treatment session consists of only one initial 15-minute increment, either for electrical stimulation or non-electrical stimulation; however, both electrical and nonelectrical codes can be reported during a single session, provided they are performed during separate 15-minute increments and reported using the appropriate add-on code(s). d. Reinsertion of the acupuncture needle(s) is required for the use of acupuncture add-on codes. 8. Fabrication of orthotic or prosthetic devices by a licensed therapist. a. Reimbursement shall only be made to certified licensed occupational and physical therapists for an insurer authorized custom fabricated orthotic or prosthetic device when reported using appropriate Level II HCPCS codes that specifically describe the device, when it is ordered by a physician. b. Reimbursement shall be by report (BR). 9. Tests and measurements. a. Reimbursement to a provider shall be limited to one (1) visit by an injured employee per thirty (30) days for tests and measurements to a selected body area or number of areas unless a different interval is outlined in the patient s plan of care. A variation to the standard limitation for tests and measurements must be ordered by the treating physician and authorized by the insurer. b. Reimbursement shall be made for the workers compensation unique code 97752, specifically designated for both manual and automated testing. Reimbursement shall include a report of the testing results. Manual muscle testing ( ) and range of motion codes ( ) shall not be reimbursed when reported separately with code c. Reimbursement shall be made for range of motion measurements. Code may be reported and paid for either manual or computerized range of motion measurements and report. C. Physical Reconditioning Services. 1. Authorization. a. Reimbursement shall only be made for insurer authorized physical reconditioning based on a signed order from the authorized treating physician. Physical reconditioning services shall be authorized prior to initiation and shall not begin any earlier than thirty (30) days 29

30 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition following the employee s date of accident. b. Reimbursement for physical reconditioning services shall only be made to an authorized occupational or physical therapist. 2. Physical reconditioning assessment. a. Reimbursement for a physical reconditioning assessment and written report shall be determined from the number of hours reported by the provider to perform the assessment and the listed MRA. Reimbursement shall be limited to eight (8) hours. b. Reimbursement shall be made for workers compensation unique codes and 97851, specifically designated to use in reporting a physical reconditioning assessment. (1) Reimbursement shall be made for code only when used to bill for the initial hour of a physical reconditioning assessment, whether the assessment is performed during a single session or multiple sessions. (2) Reimbursement shall be made for code only when used to bill each additional thirty (30) minutes of a physical reconditioning assessment subsequent to code Physical reconditioning program. a. Reimbursement for a physical reconditioning program shall be paid based on the number of hours billed by the provider and the listed MRA. Reimbursement shall be limited to a program lasting no longer than sixty (60) hours during a six (6) week period, including a physical reconditioning assessment. b. Reimbursement shall be made for workers compensation unique codes and 97853, specifically designated to use in reporting a physical reconditioning program. (1) Reimbursement shall be made for code when used to bill the initial hour per session of physical reconditioning each day. (2) Reimbursement shall be made for code when used to bill each additional thirty (30) minutes per session of physical reconditioning each day. c. Reimbursement shall be made for a physical reconditioning program when the services are provided alone, concurrently with or subsequent to modalities and procedures by the same authorized occupational or physical therapist. d. Reimbursement shall be made to a therapist for only one (1) physical reconditioning program for an injured employee per date of accident, unless authorized by the insurer for an exacerbation of the injury or surgical intervention, documented by the treating physician. e. Reimbursement for an extension of the program shall be limited to reimbursement for an 30

31 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition additional twenty (20) hours during a two (2) week period. An extension shall be ordered by the physician and authorized by the insurer. 4. Discharge from the physical reconditioning program. a. The treating physician shall determine if the injured employee shall be discharged from the physical reconditioning program before completion. If the injured employee has not completed the program and the treating physician recommends discontinuance of the program, the physician shall provide discharge information to the injured employee, the insurer and the therapist without charge. b. Upon program completion, a report of the following shall be sent by the therapist without charge to the treating physician and the insurer with the final bill: (1) The injured employee s current clinical status and degree of reconditioning/restoration; and (2) Return to work recommendations. D. Interdisciplinary Rehabilitation Programs. 1. Authorization. a. Reimbursement shall only be made to a facility for insurer authorized interdisciplinary services based on a signed order from the authorized treating physician. All services shall be authorized prior to initiation of services. b. Reimbursement for Interdisciplinary Rehabilitation Programs shall only be made to rehabilitation programs accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), except for a facility operating pursuant to Chapter 395, F.S., as part of a hospital. Rehabilitation Program services must be provided through a CARF accredited Outpatient Medical Rehabilitation Program, Occupational Rehabilitation Program or Interdisciplinary Pain Rehabilitation Program. 2. Work hardening program. a. Reimbursement for a work hardening program shall be made to a facility for the duration of the recommended individualized program. b. Reimbursement shall be made for codes and 97546, specifically designated to use exclusively in reporting a work hardening program. (1) Reimbursement shall be made for code when used to bill the initial two (2) hours of a work hardening program each day. (2) Reimbursement shall be made for code when used to bill each additional hour of a work hardening program each day. 31

32 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition 3. Pain program. a. Reimbursement for an interdisciplinary pain management program shall be made to a facility for the recommended time indicated in the injured employee s individual program plan. b. Reimbursement shall be made for codes submitted with documentation of the services rendered. The services provided must relate to the physical, psychological, social, functional and vocational goals of the employee s program plan. c. Reimbursement shall be made for biofeedback; physical and rehabilitation medicine services; pharmacy services; psychological and psychiatric services and testing; musculoskeletal services tests and measurements; neuromuscular services tests and studies and other medically necessary services during the course of the program. 4. Discharge from a CARF accredited program. a. The facility s program director shall determine if the injured employee shall be discharged from the work hardening or pain program before completion. If the injured employee has not completed the program and the program director recommends discontinuance of the program, the director shall provide discharge information to the injured employee, the insurer and the treating physician without charge. b. Upon program completion, a report shall be sent by the facility s program director without charge to the treating physician and to the insurer with the final bill. The report shall include: (1) The injured employee s current clinical status and plan for transition from the program; and (2) Return to work recommendations. E. Functional Capacity Evaluation (FCE). 1. Reimbursement for an authorized FCE shall be made at any time in the clinical continuum (see patient classification system in Section III of this manual), as long as the evaluation protocol matches the scope and specificity of the clinical situation and referral question(s). 2. Reimbursement shall be made for the workers compensation unique code 97750, specifically designated for use solely in reporting a FCE. The reimbursement for a FCE includes a written program plan and a written report. The provider shall provide the results of the evaluation and recommendations to the injured employee, the insurer and the treating physician without additional charge. 3. All FCE protocols must be evidence based. Test design and written interpretation must, at a minimum, focus on identifying associated functional loss, limitations or restrictions and the correlation to work-related clinical dysfunction (i.e. correlate impairment with disability). 32

33 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition 4. Reimbursement for an FCE shall be made only when a licensed physical therapist or occupational therapist is directly and actively involved with the testing protocol, although additional professional personnel may be involved as well. SECTION IX: SURGICAL SERVICES. A. General reimbursement information. 1. Reimbursement for a surgical package (global reimbursement) shall include the provisions of certain services before and after surgery. The maximum reimbursement allowance to physicians for surgical procedures shall be based on Part B, Section XI in this manual. (See Section XI for complete instructions.) Payment for these services includes: a. The immediate preoperative visit. b. Local infiltration, metacarpal/metatarsal/digital block or topical anesthesia. c. The surgical procedure and operative report. d. The time period for follow-up care listed in the follow-up days (FUD) column in Section XI. (1) Reimbursement for a procedure code with a YYY designation for the global period shall be set by the insurer. (2) Reimbursement for a procedure code with a ZZZ designation for the global period shall be the same as the other procedure code that is billed in conjunction with this add-on procedure code. 2. Reimbursement shall be made for other services in addition to the surgical package in the following situations when: a. A preoperative visit is the initial visit, when prolonged detention or evaluation is necessary to prepare an injured employee and when there is a need to establish the reason for a particular type of surgery. b. The preoperative visit is a consultation. c. The preoperative services are not part of the usual preparation for the particular surgical procedure. d. The services are to treat complications, exacerbations, recurrences, or other diseases and injuries. Documentation substantiating the medical necessity of the additional services rendered shall be submitted with the claim form. 33

34 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition 3. Reimbursement shall be made for additional surgery performed during the follow-up period. a. Reimbursement for surgical services shall be made when an additional surgery is performed during the postoperative period of another surgical procedure. b. Reimbursement for normal postoperative care shall run concurrently and shall be made according to the separate FUD periods listed in Section XI unless it is a procedure code with a YYY designation. For these codes the FUD period shall be set by the insurer. B. Reimbursement for surgical assistants, two (2) surgeons and surgical team. 1. Surgical assistants. a. Reimbursement for an assistant surgeon shall be twenty-five percent (25%) of the listed MRA, in Part B, Section XI in this manual. The services provided shall be identified by the modifier 80 added to the specific code. b. Reimbursement shall be made to a non-physician surgical assistant for surgical services. Reimbursement by the insurer shall not exceed seventy-five percent (75%) of twenty-five percent (25%) of the MRA listed in Part B when the insurer has: (1) Determined the non-physician surgical assistant meets state licensure requirements and holds current certification, as applicable; and (2) Provided written authorization to the non-physician surgical assistant prior to the surgery; or (3) Verified that during a medical emergency a physician was not available to assist at surgery. c. Non-physician surgical assistants (including physician assistant, nurse practitioner, or registered nurse first assistant) shall append HCPCS Level II modifier AS to the appropriate code to identify services rendered as an assistant at surgery. 2. Two surgeons. a. Reimbursement shall be made to two (2) surgeons at the same operative session for performing distinct parts of a surgical procedure. The services provided shall be identified by the same code with modifier 62 added. Reimbursement to each surgeon shall be made at sixty-two and one-half percent (62.5%) of the listed MRA in Part B, Section XI in this manual or the agreed upon contract price. b. Reimbursement shall be made to two (2) surgeons at the same operative session for rendering separate surgical procedures identified by different, unmodified codes. Reimbursement to each surgeon shall be made at the listed MRA, in Part B, Section XI or the agreed upon contract price. c. Reimbursement shall not be made to either surgeon until the insurer has received and reviewed each surgeon s bill and individual operative report. 34

35 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition 3. Surgical team. Reimbursement for a surgical team shall be made BR to each team member for each surgeon s surgical service. Each team member shall identify the specific procedure with modifier 66 added to the code. C. Reimbursement for multiple procedures. 1. Reimbursement shall be made for all medically necessary procedures when more than one (1) procedure is performed during a single operative session. 2. Reimbursement for the primary surgical procedure shall be the MRA in Part B, Section XI in this manual or the agreed upon contract price. 3. Reimbursement for an additional procedure shall be made at fifty percent (50%) of the listed MRA in Part B, Section XI in this manual or the agreed upon contract price. The additional procedure shall be identified when modifier 51 is added to the code to indicate the performance of multiple procedures. D. Reimbursement for bilateral procedures. 1. Reimbursement shall be made for bilateral procedures that are performed during the same operative session. 2. Reimbursement for a bilateral procedure that contains the word bilateral in the descriptor shall be made at the listed MRA in Part B, Section XI in this manual or the agreed upon contract price. 3. Reimbursement for a bilateral procedure that does not indicate that it is bilateral shall be made when the procedure is billed twice as follows: a. Reimbursement for the first procedure shall be made at the listed MRA, in Part B, Section XI in this manual or the agreed upon contract price. b. Reimbursement for the second procedure identified by adding modifier 50 to the procedure code, shall be made at fifty percent (50%) of the listed MRA in Part B, Section XI in this manual or the agreed upon contract price. SECTION X: ANESTHESIA SERVICES. A. Reimbursement for anesthesia services shall be made to a physician or to non-physician anesthesia providers limited to certified registered nurse anesthetists (CRNAs) and anesthesia assistants (AAs) rendering services within scope of state licensure. 1. Reimbursement shall be based on application of the following values, physical status modifiers and certain qualifying circumstances. 35

36 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition a. Basic value (BV) or base unit. (1) The usual preoperative and postoperative visits, the anesthesia care during the procedure, the administration of fluids and/or blood and the usual monitoring services (ECG, temperature, blood pressure, oximetry, capnography and mass spectrometry) are included in the BV. (2) When multiple surgical procedures are performed during an operative session, the BV for the anesthesia procedure with the highest value is billed and reimbursed. (3) The BV units, listed in Part A, Section XI under Anesthesia, for each anesthesia procedure code are used in calculating reimbursement. (4) When a surgeon provides regional or general anesthesia for a surgical procedure that he or she actually performs, modifier 47 is appended to the surgical code to indicate that the operating surgeon performed the anesthesia. Reimbursement shall be at the BV for the anesthesia service rendered. b. Time (TM) units. (1) Anesthesia time begins when the provider starts to prepare the injured employee for anesthesia care in the operating room or in an equivalent area and stops when the provider is no longer in personal attendance. (2) Anesthesia time shall be billed as the total number of minutes of anesthesia. For example, one (1) hour and fifteen (15) minutes of anesthesia must be billed as seventy-five (75) minutes of anesthesia. (3) The minutes of anesthesia must be converted into TM units as follows: (a) For anesthesiologists, each ten (10) minutes of anesthesia time equals one (1) unit of anesthesia and each minute over a unit has a value of one-tenth (1/10) unit. (b) For CRNAs/AAs, each fifteen (15) minutes of anesthesia time equals one (1) unit and each minute over a unit has a value of one-fifteenth (1/15) unit. (c) For codes providing BV + TM, time units shall be calculated and added to the listed BV to determine the reimbursement for the anesthesia services. (d) Only the BV units apply for codes without a TM unit after the base unit. For some anesthesia services, time is not reported additionally. Therefore, additional units of time are not calculated for these codes when determining reimbursement. c. Physical status modifiers. (1) Anesthesia services shall warrant additional reimbursement for units based upon the injured employee s condition and the complexity of the anesthesia service provided. 36

37 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition (2) A physical status modifier shall be determined to rank the injured employee s condition. Additional reimbursement shall be based on the unit value for the specific physical status modifier. Physical Status Modifiers Unit Values P1 A normal healthy patient 0 P2 A patient with mild systemic disease 0 P3 A patient with severe systemic disease 1 P4 A patient with severe systemic disease that is a constant threat to life 2 P5 A moribund patient who is not expected to survive without the operation 3 P6 A declared brain-dead patient whose organs are being removed for donor purposes 0 d. Qualifying circumstances. Anesthesia services, which are provided under particularly difficult circumstances, may warrant additional reimbursement for unit values based on unusual events. This subsection includes a list of important qualifying circumstances that impact the anesthesia service provided. These procedures are not reported alone but are reported as additional procedure numbers qualifying an anesthesia procedure for additional reimbursement. The listed unit value must be added to the basic unit values to obtain the reimbursement. List each of the following codes separately in addition to the procedure code for the primary anesthesia procedure. Qualifying Circumstances Unit Values Anesthesia for patient of extreme age, under one year and over seventy Anesthesia complicated by utilization of total body hypothermia Anesthesia complicated by utilization of controlled hypotension Anesthesia complicated by emergency conditions (specify) 2 2. Reimbursement for anesthesia services shall be made at the anesthesia reimbursement allowance (ARA) calculated using the BV and TM values listed in Part A, Section XI in this manual or the agreed upon contract price. a. Methodology for calculating the ARA for procedures that are listed basic value (BV) + time (TM). (1) Select the applicable anesthesia procedure code and basic value from the schedule in Section XI. 37

38 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition (2) Determine the time units according to Section X.A.1.b.(3) (ten [10] minutes = one [1] time unit for an anesthesiologist and fifteen [15] minutes = one [1] time unit for a CRNA/AA). (3) Any minutes that exceed a whole unit are counted as partial units (fractions of units), such as one (1) minute is one-tenth (1/10) unit for an anesthesiologist and onefifteenth (1/15) unit for a CRNA/AA. (4) Determine any additional units that are justified by the physical status modifiers or qualifying circumstances addressed above in Section X.A.1.c. and X.A.1.d. (5) Add the basic value, time units, physical status modifier and any applicable qualifying circumstances to determine the total anesthesia value. (6) Multiply the total anesthesia value by the conversion factor of $29.49 to obtain the anesthesia reimbursement allowance. b. Methodology for calculating the ARA for procedures that are listed only basic value (BV) and no time. Multiply the basic value by the conversion factor of $29.49 to obtain the anesthesia reimbursement allowance. c. Methodology for calculating the ARA for monitored anesthesia care. (1) Follow the guidelines, as applicable, in Section X.A.2.a. as though anesthesia was administered (basic value + time). (2) Multiply the total anesthesia value by the conversion factor of $29.49 to obtain the ARA. B. Reimbursement for medical direction of CRNAs/AAs by an anesthesiologist. 1. Reimbursement shall be made to the anesthesiologist only for direct supervision of anesthesia services which are provided by the anesthesiologist and billed under the name and license number of the physician-employer. a. Reimbursement shall be made to an anesthesiologist for providing medical direction, including preoperative and postoperative evaluations or specific consultation to a CRNA/AA when necessitated by a specific procedure or condition(s) previously identified by the parties to the protocol, as required. (1) When medical direction by an anesthesiologist is required, the CRNA/AA shall bill by appending the HCPCS Level II Modifier QX to the anesthesia procedure code. (2) Reimbursement for a CRNA/AA requiring medical direction by an anesthesiologist shall be fifty percent (50%) of the anesthesia reimbursement allowance listed in Part A, Section XI in this manual or the agreed upon contract price. 38

39 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition (3) Medical direction shall be billed by the anesthesiologist by appending the HCPCS Level II modifier QY to the anesthesia procedure code. (4) Reimbursement for medical direction by anesthesiologists shall be fifty percent (50%) of the anesthesia reimbursement allowance listed in Part A, Section XI in this manual or the agreed upon contract price. b. Reimbursement shall not be made to either the anesthesiologist or the anesthetist/anesthesia assistant until the insurer has received and reviewed the bill and anesthesia report from both providers. 2. No additional reimbursement shall be made for general supervisory services rendered by the anesthesiologist or other physician. C. Anesthesia services for which time units are not allowed. CRNAs and AAs who provide anesthesia for which no time units are used to determine the ARA shall be limited to eighty-five percent (85%) of the ARA allowed for an anesthesiologist. 39

40 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition SECTION XI SCHEDULE OF MAXIMUM REIMBURSEMENT ALLOWANCES 40

41 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition General Instructions: MAXIMUM REIMBURSEMENT ALLOWANCES I. Part A of Section XI establishes the Maximum Reimbursement Allowances (MRAs) for services and procedures performed by workers compensation certified providers not specifically addressed in Section II F of this manual and for out-of-state providers who have not contracted with the insurer for an alternate reimbursement. Part A also includes the basic value (or base unit) on which reimbursement shall be calculated for all anesthesia services according to Section X of this manual. II. Part B of Section XI establishes the MRAs for Florida physician providers of surgical procedures and services. Physician assistants and advanced registered nurse practitioners shall be paid eightyfive percent (85%) of the physician s MRA when these non-physician providers directly perform a surgical procedure or service. III. Part C of Section XI establishes the MRAs for Florida physicians, physical and occupational therapists, audiologists and speech pathologists and psychologist providers of non-surgical procedures and services. Physician assistants and advanced registered nurse practitioners shall be paid eighty-five percent (85%) of the physician s MRA when these non-physician providers directly perform a non-surgical procedure or service. Part C also establishes the MRAs for independent clinical laboratories, freestanding imaging/x-ray centers, dietitians, nutritionists, nutrition counselors and licensed clinical social workers. (Refer to Section II F for reimbursement percentages.) IV. To determine the MRA to which a provider is entitled under Part B or Part C: A. Determine the county location of the provider according to the Medicare locality map in Appendix E. B. Determine whether the procedure should be paid according to the non-facility MRA (services rendered in a provider s office, urgent care center or diagnostic facility) or the facility MRA (services rendered in a hospital setting, ambulatory surgical center, skilled nursing facility, inpatient psychiatric facility, and comprehensive [Level III] outpatient rehabilitation facility). C. Identify the specific CPT code in the far-left column of the matrix and the correct locality/non-facility or facility column across the top row. D. Locate the point of intersection for the procedure code row and the appropriate nonfacility or facility locality column on the reimbursement matrix. E. Compare the amount allowed at the point of intersection on the matrix to the amount listed in the 2003 MRA column. F. Reimburse the provider the greater of the amount in the 2003 MRA column or the amount in the column at the point of intersection. 41

42 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition PART A SCHEDULE OF MAXIMUM REIMBURSEMENT ALLOWANCES 42

43 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Anesthesia Anesthesia Anesthesia CPT Code BV + TM CPT Code BV + TM CPT Code BV + TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM CPT only 2008 American Medical Association. All Rights Reserved. PartA, 43

44 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Anesthesia Anesthesia Anesthesia CPT Code BV + TM CPT Code BV + TM CPT Code BV + TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM BR TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM TM CPT only 2008 American Medical Association. All Rights Reserved. PartA, 44

45 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $40.00 ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $27.00 ZZZ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $41.00 ZZZ $ $ $ $ $ $26.00 ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $31.00 ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 45

46 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $ ZZZ $ $89.00 ZZZ $ $ $ $ ZZZ $27.00 ZZZ $ $ $ $ ZZZ $ ZZZ $ $ $ $ $ $61.00 ZZZ $ $ ZZZ $ $ $ $91.00 ZZZ $ $ $ $ $ $61.00 ZZZ $ $ ZZZ $ $ $ $88.00 ZZZ BR $ $ BR $ $44.00 ZZZ BR $ $ BR $ $71.00 ZZZ BR $ $ $1, $ $88.00 ZZZ $ $ $ $ $1, $66.00 ZZZ $ $1, $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $1, $ $ $1, $ ZZZ $ $3, $ $ $1, $ ZZZ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ ZZZ $1, BR $ $1, BR $98.00 ZZZ $1, BR $ $1, BR $ ZZZ $ $ $ ZZZ $1, $ $ $2, $ $ ZZZ $2, $ $ ZZZ $2, $1, $ $ $1, $92.00 ZZZ $ $1, $ $ $1, $ ZZZ $ $ $ $ $ $ ZZZ $ $ $ $ $1, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 46

47 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $1, $ $ $ $40.00 ZZZ $ $ $ BR YYY $ $ $ $1, $ $ $1, $ $ $1, $ $ BR YYY $ $ $ $1, $ $ $ $1, $ $ $ $ $ $ $ $ $ $81.00 ZZZ $ ZZZ $ $ $1, $ $16.00 ZZZ $1, $ $ $1, $ $ $ $ $ $52.00 ZZZ $ $1, $ ZZZ $ $ $4, $ $ $96.00 ZZZ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ ZZZ $1, $ $ $2, $ $ ZZZ $1, $ $74.00 ZZZ $2, $ $ $2, $3, $ $2, $4, BR $ $5, BR YYY $ $3, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 47

48 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $2, $ $1, $3, $ $1, $3, $1, $1, $3, $3, $1, $ $2, $1, $ $2, $ $ $2, $ $ $1, $ $ $1, $ $ $2, $ $ $ $ $ $2, $1, BR $2, $1, $ ZZZ BR $1, BR BR $1, $ ZZZ $ $1, $ ZZZ $ $1, $ $ $2, $3, $ $1, $3, $ $1, $3, $ $1, $3, $ $1, $3, $ $1, $3, $ $2, $3, $ $2, $3, $ $1, $ $1, $1, $ $1, $ $ $1, $ $4, $1, $ $ ZZZ $1, $ BR YYY $1, $ $ $1, $ $ $1, BR YYY $ $2, $ $ $2, $ $ $2, $ $ $3, $ $ $3, $ $ $2, $ $1, $2, $ $ $1, $ $ $2, $ $1, $ $ $ $2, $ $1, $2, $1, $ $3, $1, $1, $1, $ $1, $1, $ $ $1, $1, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 48

49 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $1, $ $1, $ $1, $1, $ $ $1, $ $ $1, $1, $1, $ ZZZ $1, $1, $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $1, $ $ $ $1, $ ZZZ $ BR $2, $ BR $1, ZZZ $ $1, $1, $1, $ $1, $ $ $ ZZZ $ $ $2, $ $ $1, $ $ $2, $ BR YYY $1, $1, $ $ ZZZ $1, $ $1, $2, $ $1, $ $1, $1, $ $ $1, $ $ $1, $ $ $ ZZZ $ $ $1, $ $ $ ZZZ $ $ ZZZ $1, $ $ $2, $1, $1, $2, $ $1, $2, $1, $ ZZZ $2, $ $2, $2, $ $2, $2, $ $ ZZZ $2, $ $1, $1, $ $1, $ ZZZ BR YYY $ BR $ $ ZZZ $2, ZZZ $ $1, $1, ZZZ $ $1, $1, ZZZ $ $1, $1, ZZZ $ $ ZZZ $ ZZZ $ $ $1, ZZZ $ $ $ ZZZ $ $ $2, $ $1, $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 49

50 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ ZZZ $1, $ $ $ $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $ $1, BR YYY $ $1, $ $1, $1, BR YYY $1, $ $ $ BR YYY $ $1, $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $1, $1, $1, $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $ $ $ $ $ $1, $1, $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 50

51 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $ $1, $1, $ $1, BR $ $ BR YYY $ $ $ $ $ $ $ $1, $ $ $1, $1, $ $1, $ $ $1, $1, $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $1, $ $1, $1, $ $1, $ $ $ $ $ $1, $ $ $1, $ $ $ $1, $ $ $ $ $1, $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $ $ $ $1, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 51

52 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $ $1, $ $1, $2, $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $1, $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, BR YYY $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 52

53 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $ $ $ $1, $ $ $ BR YYY $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $ $1, $ $ $3, $ $ $3, $ $ $4, $ $1, $1, $ $ $4, $ $ $ $ $ $1, $ $ $1, $ $ $ $ ZZZ $ $ $ $ $1, $ ZZZ $1, $1, $ $1, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 53

54 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $1, $1, $ $1, $1, $1, $1, $ $ $1, $ $1, $2, $1, $ $2, $1, $ $2, $ $ $2, $ $ $1, $ $ $1, $ $1, $1, $1, $ $1, $ $ $2, $1, $ $1, $ $ $1, $1, $ $1, $1, $ $1, $2, $1, $ $1, $1, $1, BR YYY $1, $1, $ $ $1, $ $1, $1, $ $ $1, $ $ $ $ $ $1, $ $ $ $ $1, $ $ $1, $ $ $2, $ $ $ $ $ $ $1, $ $ $1, $1, $1, $1, $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $1, $2, $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $ ZZZ $1, $ $ $1, $ $1, $1, $ $ $1, $ $ $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 54

55 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ BR YYY $ $1, $ $1, $ $ $1, $1, $ $ $2, $ $ $1, $ $ $1, $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $1, $ $ $ $1, $1, $ $ $1, $ $ $ $ $ $ $ $1, $ $ $1, $1, $ $ $1, $ $ $1, $ $ $ $1, $ $ $ $1, $1, $1, $1, $ $1, $ $ $1, $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $1, $1, $ $1, $1, $ $ $ $ ZZZ $ $ $ $1, $ $ $1, $ $ $1, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 55

56 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ BR YYY $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 56

57 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $ $1, $ $1, $1, $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ BR YYY $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ BR YYY $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 57

58 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ BR YYY $ $ $1, $ $ $ $ $ $1, $ $ $2, $ $ $1, $ $ $2, $ $ $1, $ BR YYY $1, $ $ $1, $ $ $1, BR YYY $ $2, $ $ $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 58

59 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $1, $ ZZZ $ $1, $1, $ $2, $2, $ $1, $1, $ $1, $ $ $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $ $ $ BR YYY $ $ $ BR YYY $1, $ $ $1, $ $ $1, $ $ $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ ZZZ $1, $1, $ $1, $1, $ $1, $1, $ $ $1, $ $1, $1, $ $ $1, $ $1, $1, $ $1, $1, $ $1, $1, $73.00 ZZZ $1, $1, $90.00 ZZZ $1, $3, $ $ $3, $ $ $3, $86.00 ZZZ $ $4, $ $ $1, $ $ $1, $ $ $2, $ $1, $1, $ $2, $ $ $2, $ $ $1, $2, $ $1, BR YYY $ $1, $ $ $1, $ $ $2, $ $ $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 59

60 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $1, $ $2, $1, $1, $1, $1, $1, $17.00 ZZZ $2, $1, $2, $1, $1, $2, $1, $1, $2, $ ZZZ $1, $2, $ $1, $3, $ $1, $3, $ $1, $ ZZZ $ $2, $ ZZZ $ $2, $ ZZZ $ $2, $ ZZZ $ $2, $ ZZZ $ $2, $1, ZZZ $ $2, $ ZZZ $ $2, $2, $ $2, $2, $ $2, $2, $ $3, $3, $ $3, $2, $ $2, $3, $ $2, $2, $ $2, $ ZZZ $ $2, $2, $ ZZZ $1, $2, $ $2, $2, $ $2, $2, $ $2, $2, $ $3, $2, $ $2, $3, $1, $2, $3, $1, $2, $3, $ $2, $3, $ $2, $1, $1, $2, $2, $1, $1, $2, $1, $1, $2, $1, $2, $2, $2, $2, $2, $1, $2, $2, $1, $2, $2, $1, $2, $2, $ ZZZ $2, $2, $ ZZZ $2, $2, $ ZZZ $1, $2, $1, $1, $1, $1, $1, $2, $1, $2, $2, $ $2, $3, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 60

61 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $2, $1, $1, $2, $1, $1, $2, $1, $1, $2, $ ZZZ $1, $1, $1, $1, $1, $ $ ZZZ $2, $1, $ ZZZ $2, $1, $ $2, $1, $ ZZZ $2, $2, $ $1, $2, $ $1, $2, $ ZZZ $1, $2, $1, $1, $ ZZZ $1, $1, $1, $1, $2, $2, $ $2, $5, $ $ ZZZ $3, $ $2, $1, $1, $2, $ ZZZ $1, $2, $ $1, $2, $ $1, $2, $ $1, $2, $ $1, $3, $ $1, $3, $1, $ $3, $1, $2, $3, $2, $2, $2, $1, $2, $2, $1, $2, $1, $2, $2, $1, $3, $2, $1, BR YYY $1, $1, $1, $1, $2, $1, $2, $1, $ $2, $1, $ $1, $1, $1, $1, $2, $ $1, $2, $ $1, $2, $ $1, $2, $ $1, $3, $1, $ $3, $ $1, $3, $ $ $3, $ $1, $3, $2, $1, $3, $1, $1, $2, $1, $ $3, $1, $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 61

62 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $ $ $1, $1, $ $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ ZZZ $1, $ $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ ZZZ $1, $1, $1, $1, $ ZZZ $1, $1, $ ZZZ $1, $1, $ ZZZ $1, $1, $ ZZZ $1, $2, $ ZZZ $1, $1, $1, $1, $1, $1, $2, $2, $1, $1, $2, $1, $1, $2, $ ZZZ $ ZZZ $2, $ ZZZ $ ZZZ $1, $ $ $1, $ $ $2, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $2, $1, $ $1, $ $ $ ZZZ $1, $ $1, $1, $ $2, $1, $ $1, $1, $ $ ZZZ $1, $ $1, $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 62

63 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $ $1, $1, $ $ $1, $ $ $ $ $1, $ $ $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $ $ $ $1, $ $ $ $3, $ $ $1, ZZZ $ $ $2, ZZZ $ $ $2, $ $ $2, $ $1, $ $ $ $ $ $ $ $ $1, $ $ $ $ $79.00 ZZZ $ $ $ $ $ $ $ $ ZZZ $ $ $ $53.00 ZZZ $ $ ZZZ $ $ $ $ $ $2, $ $ $1, BR YYY $ $1, $ $ $ ZZZ BR $ $85.00 ZZZ BR $ $ $ $ BR YYY $ $ $ $ $ $ BR $ $ BR $ $ $ $ $ $ $ $ $2, $ $ $ ZZZ $ $1, $2, $1, $1, $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 63

64 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $ ZZZ $ $ $ ZZZ $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $1, $ $ $ $ $ BR YYY $ $ $ BR YYY $ $ $ $ $ ZZZ $1, $ $1, $1, $1, $1, $1, $1, BR YYY $ BR YYY $ BR YYY $ $ $1, $ $ $1, $ $ $2, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $ $ $ $1, $ $ BR YYY $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $1, $2, $ $1, $2, $ $1, $1, $ $1, $2, $1, BR YYY $2, BR YYY $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 64

65 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD BR YYY $ $ $ $ $ $ $ $ $ $ $ BR $1, $ BR $1, BR YYY $ $1, $ $ $1, $ $ $ $1, $ $ $ $ $ $1, $ $ $2, $ $ $2, BR $ $2, BR $ $2, $ $ $2, $ $ $2, BR YYY $ $2, $ $ $2, $ $ $2, $ $ $2, $ BR YYY $2, $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ BR YYY $ $ $ $1, $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 65

66 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $1, $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ BR $1, $ BR YYY $1, $ $ $1, $ $1, $ $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ BR YYY $ $ $1, $ $1, $ $ $1, $1, ZZZ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $1, $1, $ BR YYY $ ZZZ $ $ $1, $ $1, $1, $1, $2, $1, $ ZZZ $2, $1, $1, $2, $ $1, $2, $ $2, $1, $ $ ZZZ $1, BR YYY $ $1, $ BR $1, $ BR $1, $ $ ZZZ $1, $1, $1, $1, $1, $1, $1, $ $1, $ $1, $1, $1, $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $1, $1, $1, $1, $ $1, $1, $ $1, $ $ $1, $1, $ $2, $ $1, $1, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 66

67 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $ $1, $ $ $1, $ $ $1, $1, $ $ $1, $ $ $ ZZZ $ $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $ $ ZZZ $1, $ $1, $1, $ BR YYY $1, $ $ $1, $ $ $1, $ $ $ ZZZ $ $ $ $ $1, $ $ $1, BR YYY $ $1, $ $ $ $ $ $ $ $ $ BR YYY $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ BR YYY $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $ $ $2, $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 67

68 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $1, $ $ $2, $1, $ $ $1, $ $ $1, $1, $ $1, $ BR YYY $1, $ $1, $ $1, $1, $ $1, $ $ $1, BR YYY $ $2, $1, $ $2, $1, BR YYY $2, $1, $ $2, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ BR YYY $ $ $ BR YYY $ $ ZZZ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $1, $ $ $2, $1, $ $2, $1, $ $2, $1, $ $6, $1, $ $4, $1, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 68

69 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $ $ $1, $ ZZZ $1, $1, $ $1, $ $ BR YYY $ $ $1, $ $ $1, $ $ $ $ $ $ $ $1, $ $ $1, $2, $ $ $1, $ ZZZ $ $1, BR YYY $ $1, $ $ $1, $ BR YYY $1, $ $ $3, $ $1, $2, $ $ ZZZ $3, $ BR $2, $ BR YYY $1, $ $ BR $ $1, $ ZZZ $ $ $1, $ $ $ $ $1, $ $ $1, $1, $ ZZZ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $2, $ $1, $1, $ $1, BR YYY $ $1, $ $ $1, $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $1, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 69

70 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $1, $ BR YYY $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $ $ $ $ $5, $ $ $4, $ $1, $1, $ $2, $1, $ $2, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $ $1, $ $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $2, $1, $1, $2, $1, $1, $2, $1, $1, $3, $1, $1, $2, $1, $2, $ $1, $2, $ $1, $1, $ $1, $1, $ $1, $1, $ BR YYY $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 70

71 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $1, $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $1, TC $ $ $1, $ ZZZ $ $1, $84.00 ZZZ $ $1, TC $ ZZZ $ $1, $ $ $1, $1, $ $1, $1, $ $1, $ $ $ $1, $ $ $ $ $1, $ $ $ $1, $ $ $ $ $1, $1, $ $ $ $ $ $1, $ $ $2, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 71

72 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $1, $ $ $1, $ $ $ $1, $ $1, $ $ $1, $ $ $1, $ $ $ $ BR YYY $1, $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $1, $ $ $1, BR $ $1, $ BR YYY $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, TC $ $ $2, $ $ $1, $ $ $1, TC $ $ $1, $ $ $1, $ $ $2, $ $ $1, $1, BR YYY $1, $1, $ $1, $ $ $1, $ $ $ $1, $ $1, $1, $ $ $1, $ $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 72

73 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD BR YYY $ $ $ $ $ $ $ $ $ $ $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $49.00 ZZZ $ $ $ $1, $ $ $ $ $1, $ $ $1, $ $53.00 ZZZ $1, $ $ $1, $ $1, $1, $1, $ $1, $ $1, $1, $ $1, $ $ $1, $ $ $1, $ $ $1, $1, $ $2, $ $ $2, $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $ $1, $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 73

74 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $ $ $ $ $ $ $ $ $ $ $ $ $ $2, $ $ $1, $ $ $1, $ $1, $ ZZZ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $2, $1, $1, $1, $1, $1, $1, $ $1, $ $ $1, $ $ $1, $ $ BR YYY $ $ $ $ $ $ $ $ $ $ $2, $ $ $ $ $ $ $ $ $1, TC $ $ $1, $ $ BR YYY $ $ BR YYY TC $ $ $ $ $ $ $ BR YYY $47.00 ZZZ $ BR YYY $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $ $ $ $ $1, $ $ $1, BR YYY $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $ $ $ $ $ $1, $ $ $1, $1, $ $1, $1, $ $ $1, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 74

75 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ ZZZ $2, $2, $1, $1, $2, $1, $1, $2, $1, $1, $2, $1, $1, $3, $1, $1, $2, $1, $2, $3, $1, $2, $3, $1, $2, $3, BR YYY $2, $2, BR YYY $74.00 ZZZ $2, $ $3, $3, $ $3, $2, $ $4, $2, $ $3, $2, $ $2, $2, $ $2, $3, $ $3, $2, $ $3, $3, $ $1, $ ZZZ $1, $1, $2, ZZZ $1, $1, $ ZZZ $ $ $2, ZZZ $1, $2, $3, $1, $1, $2, $ $2, $3, $ $2, $1, $ $2, $1, $1, $2, $ $2, $2, $1, $2, $2, $ $2, $2, $1, $2, $3, $1, $2, $2, $ $2, $1, $ ZZZ $88.00 ZZZ $1, $ ZZZ $2, $1, $2, $2, $1, $4, $1, $1, $3, $1, $2, $5, $1, $2, $2, $2, $2, $4, $2, $2, $3, $1, $2, $3, $1, $2, $4, $2, $1, $4, $2, $2, $1, $2, $2, $3, $2, $3, $2, $2, $2, $2, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 75

76 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $3, $1, $1, $1, $1, $1, $1, $1, BR ZZZ $1, $ BR ZZZ $1, $ $1, $1, $ $2, $1, $ $1, $ TC $ $ ZZZ $1, $ $1, $ ZZZ $1, $1, $1, $ $2, $1, $ $1, $1, $ $ ZZZ $ ZZZ $ $2, $1, $ $ ZZZ $ ZZZ $ $1, $ $ $ ZZZ $ $ $1, $ $ $ ZZZ $ $ $2, $ $ $ ZZZ $ $ $2, $ $ $ ZZZ $1, $ $2, $1, $1, $ ZZZ $1, $ $2, $1, $ $ ZZZ $1, $ $2, $2, $ $2, $1, $ $ ZZZ $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $ ZZZ $ $1, $ ZZZ $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $2, $1, $1, $1, $1, $1, $3, $1, $1, $3, $1, $1, $3, $ $1, $1, $1, $ ZZZ $2, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 76

77 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $1, $ $ $1, $ $ $2, $ $ $2, $ $ $2, $ $ $2, $ $ ZZZ $2, $ $ $2, $ $ ZZZ $1, $ $ $1, $ $ $2, $ $ $2, $ $ $2, $ $ $2, $ $ $2, $ $ $3, $ $ $3, $ $ $3, $ $ $ ZZZ $ $ $2, $ $ $2, $ ZZZ $ $2, $ $ $2, $ ZZZ $ $2, $ $ $2, $ ZZZ $ $2, $ $ $2, $ ZZZ $ ZZZ $ ZZZ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $1, $ $1, $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ ZZZ $ $ $ $ $ $1, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 77

78 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ ZZZ BR YYY $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $1, $ $ $1, $ $ $1, $ $ $1, $1, $1, $ ZZZ $ $1, $1, $ $1, $1, $ $ $ $ $ $1, $ $1, $1, $1, $ $1, $ $ $1, $ $ $ ZZZ $ $ $ ZZZ $ $1, $ ZZZ $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $ ZZZ $1, $ $ ZZZ $ $ $1, $ $ $1, $ $ $ $1, $ $ $1, $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 78

79 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ BR YYY $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ ZZZ $ $ $ ZZZ $ $ $ ZZZ $ $1, $ ZZZ $ $84.00 ZZZ $ ZZZ $ BR YYY $ $ $ $ $ $ $ $ $ BR YYY $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $1, $ $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $1, $ $ $1, $ $ $ $1, $ BR YYY $1, $ $ $1, $ $ $1, $1, $ $1, BR YYY $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $44.00 ZZZ $ $ $ $ $ $1, $ $ $ $ $ $ $ BR YYY $ $ $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 79

80 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Surgery Surgery Surgery CPT Code MRA FUD CPT Code MRA FUD CPT Code MRA FUD $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $ BR YYY $ $ $ $ $ $1, $ $1, $1, $ $1, $1, $1, $1, $ $ $1, $ $ $2, $1, $ $ $1, $ $ $1, $ $1, $1, $ $2, BR YYY $ $1, $2, $ $1, $2, $ $1, $2, $ $1, $2, $ $1, BR YYY $ $ $ ZZZ $ $ G0127 $ $ $ G0168 $ $ $1, G0247 $38.00 ZZZ BR YYY $1, G0289 $82.00 ZZZ $ $1, G0341 $ $ $1, G0342 $ $ $1, G0343 $1, $ $1, G0364 $12.00 ZZZ $ $1, G0392 $2, $ $1, G0393 $1, $ $1, $ $1, $ $1, $1, $ $1, $1, $ $1, $ $1, $ $ $ $ $ $ $ YYY $ $ $ $1, BR BR YYY $ $ $ $ $1, $ $ $ $1, CPT only 2008 American Medical Association. All Rights Reserved. Part A, 80

81 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 81

82 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA $1, TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $1, $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $1, TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ BR TC $ $ $ $ TC $ TC BR $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $34.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 82

83 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $1, TC $ TC $ $ $ $ TC $ $ $ $1, TC $ TC $ $ $ $ TC $ $ $ $1, TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ BR $ TC $ $ $ $ TC BR TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $1, TC $17.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 83

84 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $1, TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 84

85 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $1, TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $1, TC $ $ $ $ TC $63.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 85

86 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 86

87 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ BR $ TC $ $ $ $ TC BR TC $ $ BR $ TC $ $ $ $ TC BR TC $ $ BR $ TC $ $ $ $ TC BR TC $ $ BR $ TC $ $ $ $ TC BR TC $ $ BR $ TC $ $ $ $ TC BR TC $ $ BR $ TC $ $ $ $ TC BR TC $ $ BR $ TC $ $ $ $ TC BR TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 87

88 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ BR $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ BR TC $ TC $ BR $ $ TC $ $ $ BR TC $ TC $ BR $ $ TC $ $ $ BR TC $ TC $ BR $ $ TC $ $ $ BR TC $ TC $ BR $ $ TC BR $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 88

89 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ BR $ TC $ $ $ $ TC $ TC $ $ BR $ TC $ BR $ $ TC BR TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ BR TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $70.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 89

90 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ $1, $ $ $ $ TC $ $1, TC $ $1, BR $ $ BR $ TC $1, TC BR $ BR $ TC $ BR $ $ TC BR $ $ $ $ TC $ $ $ $ TC $ $ $ $1, $ TC $ $ $ $ TC $1, $ $ $ $ TC $ $ $ $ TC $ $ $ $ $ TC $ $ $ $ TC $ $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $70.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 90

91 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ BR $ $ TC BR $ $ $ $ TC $ $ $ $ TC $ $ $ $ $ TC $ $ TC $ BR TC $ BR BR $ BR TC BR $ TC BR $ TC $ BR $ $ BR TC $ $ BR $ TC $ BR $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ BR $ TC $ BR $ BR TC BR CPT only 2008 American Medical Association. All Rights Reserved. Part A, 91

92 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA $ $ $ $ $ TC $ TC $ TC $ $ $ $ $ $ $ TC $ TC $ TC $ $ $ $ $ $ $ TC $ TC $ TC $ $ $ $ $ $ $ TC $ TC $ TC $ $ $ $ $ $ $ TC $ TC $ TC $ $ $ $ $ $ $ TC $ TC $ TC $ $ $ BR $ $ BR TC $ TC $ TC BR $ $ $ $ $ $ TC $ TC $ TC $ $ $ $ $ $ $ TC $ TC $ TC $ $ $ $ $ $ $ TC $ TC $ TC $ $ $ $ $ $ $ TC $ TC $ TC $ $ $ $ $ $ $ TC $ TC $ TC $ $ $ $ $ $ $ TC $ TC $ TC $ $ $ $ $ $ BR TC $ TC $ BR $ $ TC BR $ $ BR TC $ TC $ $ $ BR TC BR $ BR $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 92

93 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA $ TC BR $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ BR TC $ $ BR $ TC $ TC BR $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC BR $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ BR $ TC $ BR $ $ TC BR TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ BR TC $ TC $ BR $ $ TC BR $ $ $ TC $ TC $ $ $ BR TC $ $ BR $ TC $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 93

94 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology CPT Code MRA CPT Code MRA $ G0130-TC G0130-TC $57.00 G0202 G TC $ G G $ G0202-TC G0202-TC $83.00 G0204 G TC $ G G $ G0204-TC G0204-TC $ G0206 G TC $ G G $ G0206-TC G0206-TC $ G0275 G TC $ G0278 G $ G0288 G $ G0365 G TC $ G G $ G0365-TC G0365-TC $ G0389 G TC $ G G $ G0389-TC G0389-TC $ Q0092 Q TC $ BR BR TC BR $ $ TC $ $ $ TC $ $ $ TC $ BR $ TC BR $ $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR G0130 $34.00 G $10.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 94

95 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ BR $ TC $ BR $ $ TC BR TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 95

96 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC BR $ $ $ TC $ TC $ $ $ $ TC BR $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ BR TC $ TC $ BR $ $ TC BR $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $15.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 96

97 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ BR TC $ TC $ BR $ $ TC BR $ $ $ TC $7.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 97

98 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $12.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 98

99 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $32.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 99

100 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $33.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 100

101 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ BR $ TC $ BR $ $ TC BR TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $41.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 101

102 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ BR TC $ TC $ BR $ $ TC BR $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $7.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 102

103 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ BR $ TC $ BR $ $ TC BR TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ BR TC $ $ $ $ TC $ TC BR $ $ $ TC $ $ $ $ TC $49.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 103

104 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ BR $ TC $ BR $ $ TC BR CPT only 2008 American Medical Association. All Rights Reserved. Part A, 104

105 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ TC BR $ $ $ TC $ TC $ $ $ BR TC $ $ BR $ TC $ TC BR $ $ $ TC BR $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ BR TC $ $ BR $ TC $ TC BR $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ BR TC $ $ BR $ TC $6.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 105

106 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ BR $ $ BR TC $ $ TC BR $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ BR $ TC $ BR $ $ TC BR TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $4.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 106

107 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ BR TC $ $ BR $ TC $ TC BR $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ BR TC $ TC $ BR BR $ TC BR $20.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 107

108 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA TC BR $ TC $ BR TC $ $ BR $ $ TC BR $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $21.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 108

109 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $21.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 109

110 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ BR TC $ TC $ BR $ $ TC BR $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $25.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 110

111 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ BR TC $ $ BR $ TC $ TC BR $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $11.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 111

112 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ BR TC $ TC $ BR $ $ TC BR $ $ $ TC $ TC $ $ $ $ TC $ $ $ BR TC $ TC $ BR $ $ TC BR $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ BR TC $ $ BR $ TC $ TC BR $ $20.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 112

113 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $73.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 113

114 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ $ TC $ TC $ $ BR $ TC $ BR $ $ TC BR TC $ $ BR $ TC $ BR $ $ TC BR TC $ $ BR $ TC $ BR $ $ TC BR TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ BR $ TC $ BR $ $ TC BR TC $ $ $1, $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ BR $ TC $ BR $ $ TC BR TC $ $ $ $ TC $ $ $ $ TC BR TC $ $ $ $ TC $ $ $ $ TC BR TC $ $ $ $ TC $ $ $ $ TC BR TC $ $ $ $ TC $ $ $ $ TC BR TC $ $ $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 114

115 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA $ $ TC $ TC BR $ BR $ TC $ BR $ $ TC BR TC BR BR BR $ TC $ BR $ $ TC BR TC BR $ $ $ TC $ $ $ $ TC $ TC BR $ $ $1, TC $ $ $1, $ $ TC BR $ $ BR TC $ $ BR $ BR TC BR $ BR BR TC $ TC BR BR $ $ TC BR $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ BR $ $ TC BR $ $ $ TC $ TC $ $ $ $ TC $ $ $19.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 115

116 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory Pathology & Laboratory Pathology & Laboratory CPT Code MRA CPT Code MRA CPT Code MRA TC $ $ BR $ TC $ BR $ $ TC BR TC $ $ $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ BR $ $ BR TC $ $ TC BR $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC BR $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC BR $ TC $ $ TC $ $ $ $ $ TC BR $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $17.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 116

117 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code MRA $5.00 G0124 $24.00 G0141 $24.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 117

118 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA $ $ $ $ $ TC $ $ BR $ $ BR $ BR $ TC $ BR $ $ BR $ $ BR $ TC $ BR BR $ BR $ $ BR $ $ $ $ TC $ $ BR $ $ $ $ $ $ TC $ $ TC $ $ $ $ $ $ $ TC $ $ TC $ $ $ $ $ $ $ TC $ $ TC $ BR $ $ BR $ $ $ $ TC $ TC BR $ $ BR $ $ $ $ TC $ TC BR $ $ BR $ $ BR $ TC $ TC BR $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ TC $ $ TC $ $ $ $ $ $ $ TC $ $ TC $ $ $ $ $ $ $ TC $ $ TC $ $ $ $ $32.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 118

119 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA $ $ $ TC $ TC $ TC $ $ $ $ $ $ $ TC $ $ TC $ $ $ $ $ $ $ TC $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ BR $ $ BR $ $ TC BR $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ TC $ TC $ BR $ $ $ $ $ $ $ TC $ TC $ TC $ $ $ $ $ $ $ TC $ TC $ TC $ $ $ $ $ $ BR TC $ TC $ BR $ $ BR CPT only 2008 American Medical Association. All Rights Reserved. Part A, 119

120 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA BR BR $ BR $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ BR $ $ BR $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ TC $ TC $ $ $ $ $ $ $ $ TC $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ BR $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ TC $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $1, $ TC $ $ $ $ TC $1, $ $ $1, $1, TC $ $ $1, $ TC $1, $ $ $2, BR TC $ $ CPT only 2008 American Medical Association. All Rights Reserved. Part A, 120

121 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA TC $1, $ TC $ $2, $ $ $ TC $ $ TC $1, $ TC $ $2, $1, $ $ $ $ TC $1, $ TC $ $2, TC $ $ $ $ $ TC $1, $ TC $ $2, TC $ $ $ $ $ TC $1, $ TC $ $2, TC $ $ $ $ $ TC $1, $ $1, $ TC $ $ $ $ $ TC $ $ TC $ $2, TC $ BR $ $ $ TC $1, $ TC BR $2, TC $ $ $ $ $ TC $1, $ $ $2, $ TC $ $ TC $ $ TC $1, $ $ $ $ $ $ TC $ $ $ $ $ $ $ TC $ $ TC $ $ $ $ $ $ $ TC $ $ TC $ NC $ $ NC TC $ $ TC NC $ TC $ NC $ BR NC TC $ $ NC $ TC BR NC $ BR $ TC $ $ $ $ TC BR BR $ BR BR TC $ $ TC BR $ TC BR $ $ $ $ TC $ $ TC $42.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 121

122 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ $ TC $ $ TC $ $ TC $ $ $ $ $ TC $ $ $ $ TC $ $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ $ $ $ TC $ TC $ $ $ $ $ $ $ $ TC $ TC $ TC $ $ $ $ BR $ $ $ TC $ TC $ $ $ $ $ $ $ $ TC $ TC $ $ $ $ $ $ $ $ TC $ TC $ $ $ $ $ $ $ TC $ TC $ TC $ $ $ $ $ $ $ TC $43.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 122

123 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA $ $ $ $ $ $ TC $ $ $ $ $ $ $ BR $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ $ TC $ TC $ $ $ $ $ $ $ $ TC $ TC $ $ $ $ TC $ $ $ BR TC $ TC $ BR $ $ TC BR $ $ $ TC $ TC $ $ $ $ $ $ $ $ TC $ TC $ $ $ $ $ $ $ $ TC $ TC $ $ $ $ $ $ $ $ TC $ TC $ $ $ $ $ $ $ $ TC $ TC $ $ $ $ $ $ $ $ TC $ TC $ $ $ $ BR $ $ BR TC $ TC $ BR $ $ BR $ $ BR TC $ TC $ BR $ $ BR $ $ $ TC $ TC $ $ $ $ $ $ $ $ TC $ TC $ $ $ $37.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 123

124 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA $ $ $ TC $ $ $ $ TC $ BR $ $ $ TC $ $ $ $ TC $ $ $ $ $ TC $ $ $ $ TC $ BR $ $ $ TC $ $ TC BR $ TC $ $ $ $ $ TC $ $ $ $ TC $ $ $ $ $ TC $ $ $ $ TC $ $ $ $ $ TC $ $ $ $ TC $ $ $ $ $ TC $ $ $ $ TC $ $ $ $ $ TC $ $ $ $ TC $ $ $ $ $ TC $ $ $ $ TC $48.00 DSPNS see Appx D $ BR $ TC $ $ $ $ TC BR $ $ BR $ TC $ $ $ $ TC BR $ $ BR $ TC $ $ $ $ TC BR $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $28.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 124

125 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA $ $ NC BR $ BR $ $ BR $ $ BR $ $ $ $ $ BR $ BR $ $ $ $ $ $ $ $ BR $ $ $ $ $ $ BR $ $ BR $ $ BR BR $ $ $ BR NC $ $26.00 G0101 $ $ $17.00 G0102 $ $ $7.00 G0104 $ BR $35.00 G0105 $ BR $27.00 G $ $ $37.00 G0106 $ $ $30.00 G $ $ $54.00 G0106-TC $ $ $26.00 G0108 $ $ $54.00 G0109 $ $ $26.00 G0117 $ $ NC G0118 $ $ $32.00 G0120 $ $ NC G $ $ $23.00 G0120-TC $ $ NC G0121 $ $ NC G $ $ $32.00 G0122 $ $ NC G $ $ $23.00 G0122-TC $ $ $19.00 G0128 $ $ $9.00 G0166 $ $ $7.00 G0179 $ $ $8.00 G0180 $ $ $17.00 G0181 $ $ $25.00 G0182 $ $ $6.00 G0237 $ $ $4.00 G0238 $ $ $35.00 G0239 $ $ BR G0248 $ $ BR G0249 $ $ BR G0250 $ $ NC G0268 $ $ See G0270 $22.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 125

126 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine CPT Code MRA G0271 $22.00 G0281 $13.00 G0283 $10.00 G0308 $10.00 G0309 $ G0310 $ G0311 $ G0312 $ G0313 $ G0314 $ G0315 $ G0316 $ G0317 $ G0318 $ G0319 $ G0320 $ G0321 $ G0322 $ G0323 $ G0324 $ G0325 $19.00 G0326 $11.00 G0327 $13.00 G0329 $7.00 G0332 $7.00 G0366 $66.00 G0367 $21.00 G9041 $13.00 G9042 $22.00 G9043 $9.00 G9044 $9.00 P3001 $8.00 Q0035 $24.00 Q $19.00 Q0035-TC $8.00 Q0091 $11.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 126

127 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Evaluation & Management Evaluation & Management Evaluation & Management CPT Code MRA CPT Code MRA CPT Code MRA $ $ BR $ $ BR $ $ BR $ $ BR $ $86.00 G0245 $ $ $ G0246 $ $ $ G0337 $ $ $ G0344 $ $ $45.00 G0368 $ $ $72.00 G0372 $ $ $ G0396 $ $ $ G0397 $ $ $67.00 M0064 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ NC $ $90.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 127

128 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Dental Dental Dental D-Code MRA D-Code MRA D-Code MRA D0120 $17.00 D2330 $40.00 D2932 $77.00 D0140 $13.00 D2331 $61.00 D2933 $91.00 D0150 $20.00 D2332 $66.00 D2940 $29.00 D0160 $36.00 D2335 $81.00 D2950 $81.00 D0170 $18.00 D2390 $57.00 D2951 $20.00 D0180 $20.00 D2391 $43.00 D2952 $79.00 D0210 $40.00 D2392 $55.00 D2953 $ D0220 $10.00 D2393 $63.00 D2954 $ D0230 $5.00 D2394 $69.00 D2955 $81.00 D0240 $12.00 D2410 $ D2957 $71.00 D0250 $20.00 D2420 $ D2960 $ D0260 $14.00 D2430 $ D2961 $ D0270 $7.00 D2510 $ D2962 $ D0272 $12.00 D2520 $ D2980 $83.00 D0274 $20.00 D2530 $ D2999 BR D0277 $18.00 D2542 $ D3110 $25.00 D0290 $36.00 D2543 $ D3120 $20.00 D0310 $50.00 D2544 $ D3220 $61.00 D0320 $ D2610 $ D3221 $81.00 D0321 $64.00 D2620 $ D3230 $70.00 D0322 $ D2630 $ D3240 $75.00 D0330 $29.00 D2642 $ D3310 $ D0340 $40.00 D2643 $ D3320 $ D0350 $10.00 D2644 $ D3330 $ D0415 $34.00 D2650 $ D3331 $ D0425 $25.00 D2651 $ D3332 $ D0460 $13.00 D2652 $ D3333 $53.00 D0470 $24.00 D2662 $ D3346 $ D0472 $30.00 D2663 $ D3347 $ D0473 BR D2664 $ D3348 $ D0474 BR D2710 $ D3351 $ D0480 BR D2720 $ D3352 $81.00 D0502 $54.00 D2721 $ D3353 $ D0999 BR D2722 $ D3410 $ D1110 $29.00 D2740 $ D3421 $ D1204 $10.00 D2750 $ D3425 $ D1205 $40.00 D2751 $ D3426 $77.00 D1310 $23.00 D2752 $ D3430 $55.00 D1320 $48.00 D2780 $ D3450 $ D1330 $13.00 D2781 $ D3460 $ D1351 $21.00 D2782 $ D3470 $ D1510 $81.00 D2783 $ D3910 $50.00 D1515 $ D2790 $ D3920 $ D1520 $ D2791 $ D3950 $61.00 D1525 $ D2792 $ D3999 BR D1550 $14.00 D2799 $ D4210 $ D2140 $38.00 D2910 $29.00 D4211 $50.00 D2150 $44.00 D2920 $29.00 D4240 $ D2160 $54.00 D2930 $81.00 D4241 $63.00 D2161 $67.00 D2931 $ D4245 $ HCPCS 2008 Part A, 128

129 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Dental Dental Dental D-Code MRA D-Code MRA D-Code MRA D4249 $ D5721 $ D5982 $ D4260 $ D5730 $ D5983 BR D4261 $ D5731 $ D5984 BR D4263 $ D5740 $ D5985 $ D4264 $ D5741 $ D5986 $61.00 D4265 $96.00 D5750 $ D5987 BR D4266 $ D5751 $ D5988 $ D4267 $ D5760 $ D5999 BR D4268 $ D5761 $ D6010 $ D4270 $ D5810 $ D6040 $3, D4271 $ D5811 $ D6050 $1, D4273 $ D5820 $ D6053 $82.00 D4274 $ D5821 $ D6054 $61.00 D4275 $ D5850 $46.00 D6055 $ D4276 $ D5851 $50.00 D6056 $ D4320 $77.00 D5860 $ D6057 $ D4321 $55.00 D5861 $ D6058 $ D4341 $79.00 D5862 $ D6059 $ D4342 $55.00 D5867 $36.00 D6060 $ D4355 $50.00 D5875 $ D6061 $ D4381 $69.00 D5899 BR D6062 $ D4910 $40.00 D5911 $81.00 D6063 $ D4920 $27.00 D5912 $ D6064 $ D4999 BR D5913 $2, D6065 $ D5110 $ D5914 $2, D6066 $ D5120 $ D5915 $2, D6067 $ D5130 $ D5916 $2, D6068 $ D5140 $ D5919 BR D6069 $ D5211 $ D5922 $1, D6070 $ D5212 $ D5923 $1, D6071 $ D5213 $ D5924 BR D6072 $ D5214 $ D5925 BR D6073 $ D5281 $ D5926 $1, D6074 $ D5410 $27.00 D5927 $1, D6075 $ D5411 $27.00 D5928 $1, D6076 $ D5421 $27.00 D5929 BR D6077 $ D5422 $27.00 D5931 $ D6078 $1, D5510 $61.00 D5932 $1, D6079 $ D5520 $40.00 D5933 $ D6080 $71.00 D5610 $61.00 D5934 $1, D6090 $ D5620 $83.00 D5935 $1, D6095 $ D5630 $22.00 D5936 $ D6100 $ D5640 $53.00 D5937 BR D6199 BR D5650 $61.00 D5951 $ D6210 $ D5660 $ D5953 $ D6211 $ D5670 $ D5954 BR D6212 $ D5671 $ D5955 $1, D6240 $ D5710 $ D5958 $ D6241 $ D5711 $ D5959 $ D6242 $ D5720 $ D5960 $ D6245 $ HCPCS 2008 Part A, 129

130 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Dental Dental Dental D-Code MRA D-Code MRA D-Code MRA D6250 $ D7140 $45.00 D7650 $1, D6251 $ D7210 $70.00 D7660 $ D6252 $ D7220 $ D7670 $ D6253 $51.00 D7230 $ D7671 $ D6545 $ D7240 $ D7680 $1, D6548 $ D7241 $ D7710 $1, D6600 $ D7250 $81.00 D7720 $ D6601 $ D7260 $ D7730 $1, D6602 $ D7261 BR D7740 $ D6603 $ D7270 $ D7750 $1, D6604 $ D7272 $ D7760 $1, D6605 $ D7280 $ D7770 $ D6606 $ D7282 $41.00 D7771 $73.00 D6607 $ D7285 $ D7780 $2, D6608 $ D7286 $81.00 D7810 $1, D6609 $ D7287 BR D7820 $ D6610 $ D7290 $ D7830 $ D6611 $ D7291 $77.00 D7840 $1, D6612 $ D7310 $85.00 D7850 $1, D6613 $ D7320 $ D7852 $2, D6614 $ D7340 $ D7854 $2, D6615 $ D7350 $ D7856 BR D6720 $ D7410 $ D7858 $2, D6721 $ D7411 $ D7860 $ D6722 $ D7412 $ D7865 $1, D6740 $ D7413 $ D7870 $81.00 D6750 $ D7414 $ D7871 BR D6751 $ D7415 $ D7872 $ D6752 $ D7440 $ D7873 $ D6780 $ D7441 $ D7874 $ D6781 $ D7450 $ D7875 $ D6782 $ D7451 $ D7876 $ D6783 $ D7460 $ D7877 $ D6790 $ D7461 $ D7880 $ D6791 $ D7465 $71.00 D7899 BR D6792 $ D7471 $ D7910 $73.00 D6793 $30.00 D7472 $ D7911 $ D6920 $ D7473 $ D7912 $ D6930 $40.00 D7485 $ D7920 $ D6940 $ D7490 $2, D7940 $ D6950 $ D7510 $54.00 D7941 $2, D6970 $ D7520 $ D7943 $2, D6971 $ D7530 $85.00 D7944 $2, D6972 $ D7540 $ D7945 $2, D6973 $ D7550 $ D7946 $2, D6975 $ D7560 $ D7947 $2, D6976 $88.00 D7610 $1, D7948 $2, D6977 $46.00 D7620 $ D7949 $4, D6980 $ D7630 $1, D7950 $ D6999 BR D7640 $ D7955 $ HCPCS 2008 Part A, 130

131 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Dental Dental D-Code MRA D-Code MRA D7960 $ D9630 $10.00 D7970 $ D9910 $21.00 D7971 $67.00 D9911 $21.00 D7972 BR D9920 $32.00 D7980 $ D9930 $34.00 D7981 $ D9940 $ D7982 $ D9941 $58.00 D7983 $ D9950 $ D7990 $ D9951 $46.00 D7991 $ D9952 $ D7995 BR D9970 $83.00 D7996 BR D9971 $55.00 D7997 BR D9972 $ D7999 BR D9973 $40.00 D8010 $ D9974 $50.00 D8020 $ D9999 BR D8030 $ D8040 $ D8050 $ D8060 $ D8070 $1, D8080 $1, D8090 $1, D8210 $ D8220 $ D8660 $73.00 D8670 $54.00 D8680 $ D8690 $71.00 D8691 $67.00 D8692 $ D8999 BR D9110 $40.00 D9210 $14.00 D9211 $14.00 D9212 $13.00 D9215 $7.00 D9220 $ D9221 $40.00 D9230 $18.00 D9241 $ D9242 $45.00 D9248 $91.00 D9310 $41.00 D9410 $61.00 D9420 $46.00 D9430 $23.00 D9440 $41.00 D9450 BR D9610 $20.00 HCPCS 2008 Part A, 131

132 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Injections Injections Injections J-Code MRA J-Code MRA J-Code MRA J0120 $12.00 J0636 BR J1205 $9.00 J0130 BR J0637 BR J1212 $36.00 J0150 $27.00 J0640 $22.00 J1230 $1.00 J0152 BR J0670 BR J1240 $1.00 J0170 $1.00 J0690 $3.00 J1245 $31.00 J0190 $3.00 J0692 BR J1250 $49.00 J0200 BR J0694 $10.00 J1260 BR J0205 $38.00 J0696 $11.00 J1270 BR J0207 BR J0697 $6.00 J1320 $1.00 J0210 $7.00 J0698 $11.00 J1325 BR J0215 BR J0702 $4.00 J1327 BR J0256 $ J0704 $2.00 J1330 $2.00 J0280 $1.00 J0710 $3.00 J1335 BR J0282 BR J0713 $8.00 J1364 $6.00 J0285 BR J0715 $6.00 J1380 $1.00 J0287 BR J0720 $6.00 J1390 $1.00 J0288 BR J0725 $3.00 J1410 $33.00 J0289 BR J0735 BR J1435 $1.00 J0290 $2.00 J0740 BR J1436 $68.00 J0295 $7.00 J0743 $14.00 J1438 BR J0300 $2.00 J0744 BR J1440 $ J0330 $1.00 J0745 $1.00 J1441 $ J0350 $2, J0760 $3.00 J1450 BR J0360 $6.00 J0770 $32.00 J1455 $12.00 J0380 $1.00 J0780 $3.00 J1460 $2.00 J0390 $3.00 J0800 $18.00 J1470 $4.00 J0395 BR J0835 $12.00 J1480 $7.00 J0456 BR J0850 $ J1490 $9.00 J0460 $1.00 J0895 $10.00 J1500 $11.00 J0470 $11.00 J0900 $1.00 J1510 $13.00 J0475 $ J0945 $1.00 J1520 $15.00 J0476 BR J0970 $1.00 J1530 $17.00 J0500 $3.00 J1000 $3.00 J1540 $20.00 J0515 $3.00 J1020 $1.00 J1550 $22.00 J0520 $5.00 J1030 $2.00 J1560 BR J0530 $4.00 J1040 $3.00 J1565 BR J0540 $8.00 J1055 BR J1570 $36.00 J0550 $21.00 J1060 $1.00 J1580 $3.00 J0560 $6.00 J1070 $1.00 J1590 BR J0570 $9.00 J1080 $2.00 J1595 BR J0580 $26.00 J1094 BR J1600 $10.00 J0583 BR J1100 $1.00 J1610 $27.00 J0585 $ J1110 $10.00 J1620 $69.00 J0587 BR J1120 $35.00 J1626 BR J0592 BR J1160 $2.00 J1630 $4.00 J0595 BR J1165 $1.00 J1631 $28.00 J0600 $6.00 J1170 $1.00 J1642 $1.00 J0610 $1.00 J1180 $1.00 J1644 $1.00 J0620 $3.00 J1190 BR J1645 BR J0630 $21.00 J1200 $1.00 J1650 $16.00 HCPCS 2008 Part A, 132

133 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Injections Injections Injections J-Code MRA J-Code MRA J-Code MRA J1652 BR J2353 BR J2993 BR J1655 BR J2354 BR J2995 BR J1670 $23.00 J2355 BR J2997 BR J1700 $1.00 J2360 $2.00 J3000 $2.00 J1710 $5.00 J2370 $3.00 J3010 $2.00 J1720 $4.00 J2400 BR J3030 $34.00 J1730 $94.00 J2405 $6.00 J3070 $4.00 J1742 BR J2410 $3.00 J3100 BR J1745 BR J2430 $ J3105 $2.00 J1756 BR J2440 $2.00 J3120 $1.00 J1785 $4.00 J2460 $1.00 J3130 $1.00 J1790 $4.00 J2501 BR J3140 $1.00 J1800 $10.00 J2505 BR J3150 $1.00 J1810 $6.00 J2510 $1.00 J3230 $2.00 J1815 BR J2515 $1.00 J3240 $ J1817 BR J2540 $1.00 J3250 $1.00 J1825 BR J2543 BR J3260 $7.00 J1830 $76.00 J2545 $ J3265 $2.00 J1835 BR J2550 $1.00 J3280 $5.00 J1840 $7.00 J2560 $5.00 J3301 $1.00 J1850 $4.00 J2590 $1.00 J3302 $1.00 J1885 $7.00 J2597 $20.00 J3303 $1.00 J1890 $11.00 J2650 $1.00 J3305 $55.00 J1940 $1.00 J2670 BR J3310 $5.00 J1950 $ J2680 $16.00 J3320 $16.00 J1955 $37.00 J2690 $7.00 J3350 $72.00 J1956 BR J2700 $2.00 J3360 $1.00 J1960 $2.00 J2710 $1.00 J3364 $52.00 J1980 $3.00 J2720 $1.00 J3365 $ J1990 $8.00 J2725 $11.00 J3370 $9.00 J2001 BR J2730 $29.00 J3400 $12.00 J2010 $2.00 J2760 $29.00 J3410 $1.00 J2020 BR J2765 $2.00 J3411 BR J2060 $12.00 J2770 BR J3415 BR J2150 $3.00 J2780 BR J3420 $1.00 J2175 $1.00 J2783 BR J3430 $2.00 J2180 $3.00 J2790 $36.00 J3465 BR J2185 BR J2792 BR J3470 $7.00 J2210 $3.00 J2795 BR J3475 $1.00 J2250 $2.00 J2800 $3.00 J3480 $1.00 J2260 $32.00 J2810 $3.00 J3485 BR J2270 $1.00 J2820 $ J3486 BR J2271 BR J2910 $11.00 J3490 BR J2275 $13.00 J2912 $1.00 J3590 BR J2280 BR J2916 BR J7030 $11.00 J2300 $2.00 J2920 $5.00 J7040 $10.00 J2310 $3.00 J2930 $13.00 J7042 $10.00 J2320 $5.00 J2940 BR J7050 $10.00 J2321 $6.00 J2941 BR J7060 $10.00 J2322 $8.00 J2950 $1.00 J7070 $11.00 HCPCS 2008 Part A, 133

134 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Injections J-Code MRA J7100 $ J7110 $93.00 J7120 $12.00 J7130 $6.00 J7190 $ J7191 BR J7192 $ J7193 BR J7194 $ J7195 BR J7197 $ J7198 BR J7199 BR J7317 BR J7350 BR J7501 $98.00 J7504 $ J7505 $ J7513 BR J7516 BR J7599 BR HCPCS 2008 Part A, 134

135 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition PART B SCHEDULE OF MAXIMUM REIMBURSEMENT ALLOWANCES 135

136 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $90.00 $ $ $ $91.00 $95.00 $ $92.00 $ $ $ $87.00 $90.00 $ $54.00 $ $ $ $ $ $ $53.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $65.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $53.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $53.00 $ $ $ $ $ $ $45.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $45.00 $66.00 $70.00 $75.00 $43.00 $46.00 $ ZZZ $27.00 $29.00 $30.00 $33.00 $22.00 $23.00 $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $1, $ $ $1, ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $ $ $43.00 $58.00 $62.00 $66.00 $37.00 $39.00 $ $45.00 $71.00 $76.00 $82.00 $49.00 $53.00 $ $88.00 $96.00 $ $ $65.00 $69.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $26.00 $58.00 $62.00 $66.00 $31.00 $33.00 $ $35.00 $72.00 $77.00 $82.00 $44.00 $46.00 $ $39.00 $88.00 $94.00 $ $58.00 $61.00 $ $78.00 $ $ $ $59.00 $61.00 $ ZZZ $41.00 $39.00 $41.00 $43.00 $30.00 $31.00 $ $66.00 $97.00 $ $ $82.00 $86.00 $ ZZZ $26.00 $23.00 $25.00 $26.00 $21.00 $22.00 $ $59.00 $81.00 $85.00 $90.00 $37.00 $38.00 $ $80.00 $ $ $ $62.00 $65.00 $ $96.00 $ $ $ $77.00 $79.00 $ $ $ $ $ $91.00 $94.00 $ $61.00 $85.00 $90.00 $96.00 $49.00 $52.00 $ $86.00 $ $ $ $72.00 $75.00 $ $ $ $ $ $83.00 $86.00 $ $ $ $ $ $ $ $ $75.00 $ $ $ $53.00 $55.00 $ $95.00 $ $ $ $77.00 $80.00 $ $ $ $ $ $89.00 $92.00 $ $ $ $ $ $ $ $ $81.00 $ $ $ $91.00 $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 136

137 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $98.00 $ $ $ $ $ $ $92.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $22.00 $25.00 $27.00 $28.00 $13.00 $13.00 $ $32.00 $38.00 $41.00 $43.00 $23.00 $24.00 $ $50.00 $56.00 $59.00 $63.00 $40.00 $42.00 $ $62.00 $ $ $ $81.00 $86.00 $ ZZZ $31.00 $57.00 $60.00 $64.00 $41.00 $44.00 $ $41.00 $54.00 $58.00 $61.00 $40.00 $43.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $65.00 $ $ $ $84.00 $89.00 $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 137

138 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $33.00 $65.00 $68.00 $71.00 $38.00 $39.00 $ $37.00 $81.00 $85.00 $89.00 $58.00 $60.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $40.00 $80.00 $85.00 $91.00 $40.00 $43.00 $ $ $95.00 $ $ $63.00 $66.00 $ $ $ $ $ $86.00 $91.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $84.00 $ $ $ $ $ $ $98.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $98.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $87.00 $ $ $ $ $ $ $93.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 138

139 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ ZZZ $89.00 $ $ $ $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $1, ZZZ $ $ $ $ $ $ $ $1, $1, $1, $ $1, $1, ZZZ $ $ $ $ $ $ $1, $1, $1, $ $1, $1, ZZZ $ $ $ $ $ $ $ $1, $1, $1, $ $1, $1, ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $1, $1, $1, $ $1, $1, ZZZ $ $ $ $ $ $ $ $ $1, $ $ $ ZZZ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $1, $ $ $ ZZZ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $1, $1, $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 139

140 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition ZZZ $ $ $ $ $95.00 $ $ $ $1, $1, $1, $ $1, $1, ZZZ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $81.00 $86.00 $93.00 $76.00 $81.00 $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $82.00 $87.00 $94.00 $77.00 $82.00 $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $59.00 $63.00 $67.00 $37.00 $39.00 $ $ $ $ $ $ $ ZZZ $92.00 $97.00 $ $84.00 $89.00 $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $66.00 $ $ $ $78.00 $82.00 $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $1, $ $1, $1, $1, $ $ $1, $ $1, $1, $1, $ $1, $1, $ $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $1, $1, $1, $1, $2, $2, $1, $1, $1, $1, $1, $1, $2, $1, $1, $1, $1, $1, $2, $2, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $3, $3, $3, $3, $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 140

141 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $27.00 $67.00 $71.00 $75.00 $25.00 $26.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ NC BR BR BR BR BR BR NC BR BR BR BR BR BR NC BR BR BR BR BR BR NC BR BR BR BR BR BR NC BR BR BR BR BR BR $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $3, $1, $1, $1, $1, $1, $1, $1, $63.00 $ $ $ $53.00 $55.00 $ $40.00 $ $ $ $59.00 $61.00 $ $35.00 $62.00 $65.00 $70.00 $62.00 $65.00 $ $ $ $ $ $ $ $ NC BR BR BR BR BR BR NC BR BR BR BR BR BR NC BR BR BR BR BR BR NC BR BR BR BR BR BR $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 141

142 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, YYY BR $53.00 $87.00 $92.00 $98.00 $60.00 $63.00 $ $49.00 $ $ $ $72.00 $76.00 $ $67.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $81.00 $ $ $ $ $ $ $60.00 $91.00 $96.00 $ $64.00 $67.00 $ ZZZ $16.00 $9.00 $10.00 $11.00 $6.00 $7.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $55.00 $ $ $ $75.00 $79.00 $ $83.00 $ $ $ $96.00 $ $ $27.00 $92.00 $98.00 $ $46.00 $49.00 $ $96.00 $ $ $ $81.00 $85.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ ZZZ $ $ $ $65.00 $67.00 $ $37.00 $58.00 $60.00 $63.00 $58.00 $61.00 $ $96.00 $ $ $ $ $ $ NC BR BR BR BR BR BR YYY BR CPT only 2008 American Medical Association. All rights reserved. Part B, 142

143 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $74.00 $ $ $ $60.00 $63.00 $ ZZZ $40.00 $35.00 $37.00 $40.00 $30.00 $31.00 $ $ $ $ $ $ $ $ $98.00 $ $ $ $ $ $ $ $ $ $ $91.00 $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $2, $2, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $ $ $ $ $87.00 $90.00 $ ZZZ $52.00 $91.00 $96.00 $ $43.00 $45.00 $ ZZZ $ $ $ $ $ $ $ $5, $5, $6, $ $ $ ZZZ $ $ $ $ $ $ $1, $2, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $ $ $1, $ $ $ $1, $ $ $ $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $3, $3, $4, $3, $3, $4, $1, $1, $1, $2, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $2, $3, $3, $2, $2, $2, $3, $2, $2, $3, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 143

144 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ YYY BR $45.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $82.00 $86.00 $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $59.00 $ $ $ $ $ $ $60.00 $ $ $ $52.00 $54.00 $ $75.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $64.00 $99.00 $ $ $78.00 $83.00 $ $40.00 $76.00 $80.00 $86.00 $55.00 $59.00 $ $62.00 $75.00 $79.00 $84.00 $57.00 $60.00 $ $62.00 $67.00 $71.00 $75.00 $46.00 $48.00 $ $62.00 $75.00 $78.00 $82.00 $50.00 $52.00 $ $ $ $ $ $ $ $41.00 $70.00 $75.00 $80.00 $54.00 $57.00 $ $48.00 $76.00 $81.00 $86.00 $55.00 $59.00 $ $49.00 $97.00 $ $ $67.00 $71.00 $ $56.00 $76.00 $81.00 $87.00 $58.00 $62.00 $ $94.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $80.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $3, $3, $3, $3, $3, $3, $3, $4, $4, $4, $4, $4, $4, $4, $5, $5, $5, $5, $5, $5, $5, $3, $3, $3, $3, $3, $3, $3, CPT only 2008 American Medical Association. All rights reserved. Part B, 144

145 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $2, $2, $3, $3, $2, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $2, $3, $3, $2, $3, $3, $3, $2, $3, $3, $2, $3, $3, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ BR ZZZ $ $ $ $ $ $ $ BR ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $4, $3, $3, $4, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $4, $3, $3, $4, $3, $3, $3, $4, $3, $3, $4, $3, $3, $4, $4, $3, $4, $4, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $4, $3, $3, $4, $ $80.00 $85.00 $92.00 $64.00 $68.00 $ $ $ $ $ $ $ $ $19.00 $72.00 $77.00 $82.00 $50.00 $53.00 $ $5, $5, $5, $ $ $ ZZZ $ $ $ $ $ $ YYY BR $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 145

146 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $3, $3, $3, $3, $2, $3, $3, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $2, $2, $1, $2, $2, $2, $1, $1, $2, $1, $1, $2, $2, $1, $1, $1, $2, $2, $2, $2, $1, $1, $2, $ $ $ $1, $ $ $ $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, BR BR $ $ $ $1, $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $57.00 $59.00 $ $ $ $ $ $ $ $ $ $ $1, $1, $ $ $ $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $3, $3, $3, $ $ $1, $ $3, $4, $4, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $3, $3, $4, $4, $3, $4, $4, $3, $3, $3, $4, $3, $3, $4, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, $1, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $ $ $ $1, $ $ $1, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, CPT only 2008 American Medical Association. All rights reserved. Part B, 146

147 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $2, $2, $1, $1, $1, $ $1, $1, $1, $ $ $ $ $2, $2, $2, $1, $1, $1, $ $3, $4, $4, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $2, $2, $2, $2, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $ $1, $1, $1, $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $81.00 $ $ $ $38.00 $39.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $ $ $1, $1, $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 147

148 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $ $1, $ $ $ $ $ $ $ $ $2, $2, $2, $1, $1, $1, $1, $2, $2, $2, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $82.00 $ $ $ $43.00 $45.00 $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 148

149 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, BR BR $1, $ $1, $1, $ $1, $1, $84.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, ZZZ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, $1, $1, $2, $2, $1, $2, $2, $ $1, $2, $2, $1, $2, $2, ZZZ $ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $1, $1, $1, $2, $2, $2, $2, $2, $2, CPT only 2008 American Medical Association. All rights reserved. Part B, 149

150 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $2, $1, $1, $2, $1, $1, $2, $2, $1, $2, $2, $1, $1, $2, $2, $1, $2, $2, ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $3, $3, $3, $ $ $ $ $3, $3, $3, $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $2, $2, $3, $ $ $ ZZZ $2, $2, $2, $ $ $ $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, ZZZ $ $ $ $ $ $ $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $2, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $2, $2, $1, $2, $2, ZZZ $ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, ZZZ $ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, ZZZ $ $ $ $ $ $ $ $1, $1, $1, $2, $1, $1, $2, $2, $2, $3, $3, $2, $3, $3, $2, $3, $3, $3, $3, $3, $3, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, $2, $2, $3, $3, $2, $3, $3, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $4, $3, $3, $4, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $1, $1, $1, $1, $1, $1, BR ZZZ $2, $1, $1, $1, $1, $1, $1, ZZZ $1, $1, $1, $1, $1, $1, $1, ZZZ $1, $1, $1, $1, $1, $1, $1, ZZZ $1, $1, $1, $1, $1, $1, $1, ZZZ $ $1, $1, $1, $1, $1, $1, ZZZ $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $2, $1, $1, $2, $1, $1, $2, $ $ $1, $1, $ $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 150

151 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition ZZZ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, $2, $2, $3, $2, $2, $3, YYY BR $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $1, $ $ $1, $ $ $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $59.00 $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 151

152 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $74.00 $ $ $ $69.00 $71.00 $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $88.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 152

153 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ YYY BR $71.00 $ $ $ $ $ $ $62.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $58.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $89.00 $ $ $ $90.00 $94.00 $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 153

154 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $88.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 154

155 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, BR YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 155

156 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $1, $ $ $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $72.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 156

157 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 157

158 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, YYY BR $59.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 158

159 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 159

160 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $3, $4, $4, $4, $4, $4, $4, $3, $3, $3, $4, $3, $3, $4, $4, $5, $5, $6, $5, $5, $6, $1, $1, $1, $2, $1, $1, $2, $4, $3, $3, $4, $3, $3, $4, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 160

161 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $71.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $88.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $79.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, ZZZ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 161

162 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $3, $3, $3, $3, $3, $3, $1, $2, $2, $2, $2, $2, $2, $1, $3, $3, $4, $3, $3, $4, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $57.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $62.00 $ $ $ $95.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $88.00 $92.00 $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 162

163 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 163

164 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $75.00 $ $ $ $69.00 $72.00 $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 164

165 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $ $1, $1, $ $1, $1, $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 165

166 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $1, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $88.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $1, $1, $ $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 166

167 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $72.00 $ $ $ $69.00 $72.00 $ $ $ $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 167

168 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $1, $1, $ $1, $1, $1, $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 168

169 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 169

170 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $75.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 170

171 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $1, $1, $1, $ $ $1, $ $ $ $1, $ $ $ $ $ $1, $1, $ $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $1, $ $ $ $1, $ $ $1, $ $ $ $1, $ $ $1, $ $ $1, $1, $ $ $ $1, $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $80.00 $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 171

172 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $75.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $ $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 172

173 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $45.00 $ $ $ $80.00 $85.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $88.00 $ $ $ $89.00 $96.00 $ $72.00 $ $ $ $80.00 $86.00 $ $59.00 $ $ $ $85.00 $91.00 $ $54.00 $86.00 $91.00 $97.00 $61.00 $64.00 $ $59.00 $ $ $ $77.00 $81.00 $ $45.00 $83.00 $88.00 $94.00 $54.00 $57.00 $ $53.00 $97.00 $ $ $65.00 $69.00 $ $26.00 $51.00 $54.00 $58.00 $37.00 $39.00 $ $53.00 $61.00 $64.00 $67.00 $40.00 $42.00 $ $29.00 $67.00 $70.00 $73.00 $51.00 $53.00 $ $37.00 $68.00 $71.00 $75.00 $52.00 $54.00 $ $45.00 $76.00 $81.00 $85.00 $57.00 $60.00 $ $26.00 $65.00 $69.00 $73.00 $47.00 $50.00 $ $29.00 $63.00 $66.00 $70.00 $44.00 $46.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $96.00 $ $ $ $86.00 $92.00 $ $ $ $ $ $94.00 $ $ $ $ $ $ $ $ $ $22.00 $66.00 $71.00 $76.00 $46.00 $49.00 $ $ $ $ $ $ $ $ $84.00 $ $ $ $ $ $ $75.00 $95.00 $ $ $61.00 $65.00 $ $59.00 $87.00 $92.00 $98.00 $64.00 $68.00 $ $22.00 $65.00 $69.00 $72.00 $49.00 $51.00 $ $55.00 $67.00 $70.00 $75.00 $48.00 $51.00 $ $41.00 $53.00 $56.00 $60.00 $44.00 $47.00 $ $37.00 $51.00 $54.00 $58.00 $41.00 $44.00 $ $39.00 $65.00 $69.00 $74.00 $48.00 $51.00 $ $32.00 $70.00 $75.00 $80.00 $56.00 $60.00 $ $29.00 $79.00 $84.00 $90.00 $46.00 $49.00 $ $26.00 $86.00 $92.00 $99.00 $65.00 $69.00 $ $29.00 $ $ $ $ $ $ $ $ $ $ $72.00 $76.00 $ $29.00 $99.00 $ $ $60.00 $64.00 $ $29.00 $83.00 $89.00 $96.00 $62.00 $66.00 $ $37.00 $ $ $ $91.00 $97.00 $ $ $ $ $ $ $ $ YYY BR CPT only 2008 American Medical Association. All rights reserved. Part B, 173

174 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 174

175 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, YYY BR $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $86.00 $ $ $ $89.00 $93.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $68.00 $ $ $ $77.00 $81.00 $ $75.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $45.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $ $ $1, $1, $ $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 175

176 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $2, $2, $2, $2, $2, $2, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $88.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $75.00 $ $ $ $81.00 $85.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ YYY BR $81.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 176

177 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, YYY BR $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $1, $2, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $4, $3, $3, $4, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $74.00 $47.00 $49.00 $52.00 $47.00 $49.00 $ $62.00 $ $ $ $63.00 $66.00 $ $ $ $ $ $ $ $ $88.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 177

178 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $2, $2, $1, $2, $2, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $99.00 $ $ $ $64.00 $67.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $76.00 $82.00 $ ZZZ $ $ $ $92.00 $97.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $57.00 $73.00 $76.00 $79.00 $73.00 $76.00 $ $ $ $ $ $ $ $ $89.00 $70.00 $73.00 $77.00 $70.00 $73.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 178

179 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $2, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $2, $1, $1, $2, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, $2, $3, $3, $4, $3, $3, $4, $2, $4, $4, $4, $4, $4, $4, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $2, $2, $1, $2, $2, $1, $2, $3, $3, $2, $3, $3, $2, $3, $3, $3, $3, $3, $3, $1, $1, $2, $2, $1, $2, $2, $1, $1, $2, $2, $1, $2, $2, CPT only 2008 American Medical Association. All rights reserved. Part B, 179

180 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition ZZZ $ $ $ $ $ $ $ $2, $2, $2, $2, $2, $2, $2, $3, $3, $2, $3, $3, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $3, $3, $3, $3, $3, $3, $1, $1, $1, $2, $1, $1, $2, $3, $3, $3, $4, $3, $3, $4, $3, $3, $4, $4, $3, $4, $4, $3, $4, $4, $4, $4, $4, $4, $4, $4, $4, $5, $4, $4, $5, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $2, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $3, $4, $4, $ $ $ YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 180

181 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $2, $1, $1, $2, $1, $2, $2, $2, $2, $2, $2, ZZZ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $2, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, ZZZ $ $ $ $ $ $ ZZZ $ $ $1, $ $ $1, ZZZ $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $2, $1, $1, $2, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 181

182 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $1, $2, $3, $3, $2, $3, $3, $1, $4, $4, $5, $4, $4, $5, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $2, $2, $1, $2, $2, $1, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $2, $3, $4, $4, $3, $4, $4, $2, $3, $3, $3, $3, $3, $3, $2, $4, $4, $4, $4, $4, $4, $3, $3, $3, $4, $3, $3, $4, $3, $4, $4, $4, $4, $4, $4, $2, $2, $3, $3, $2, $3, $3, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $2, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $2, $3, $3, $4, $3, $3, $4, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $4, $3, $3, $4, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $3, $3, $3, $3, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, CPT only 2008 American Medical Association. All rights reserved. Part B, 182

183 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $2, $2, $2, ZZZ $17.00 $23.00 $24.00 $26.00 $23.00 $24.00 $ $2, $2, $2, $3, $2, $2, $3, $2, $2, $3, $3, $2, $3, $3, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $4, $3, $3, $4, ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ ZZZ $ $1, $1, $1, $1, $1, $1, ZZZ $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $2, $2, $2, $3, $2, $2, $3, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $3, $3, $3, $3, $3, $3, $3, $4, $3, $3, $4, $2, $3, $3, $3, $3, $3, $3, $3, $3, $4, $4, $3, $4, $4, $3, $4, $4, $3, $4, $4, ZZZ $ $ $ $ $ $ $ $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, $3, $2, $3, $3, $2, $3, $3, $3, $2, $2, $3, $2, $2, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $4, $3, $3, $4, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, $2, $3, $3, $2, $3, $3, $2, $3, $3, $2, $3, $3, $3, $3, $3, $3, $3, $3, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $3, $2, $2, $3, $3, $2, $3, $3, $2, $3, $3, CPT only 2008 American Medical Association. All rights reserved. Part B, 183

184 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $2, $1, $2, $2, $1, $2, $2, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $2, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $1, $2, $2, $1, $2, $2, ZZZ $ $ $ $ $ $ $2, $2, $3, $3, $2, $3, $3, $2, $2, $3, $3, $2, $3, $3, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $3, $2, $2, $3, $3, $3, $3, $3, $3, $3, $3, $3, $2, $3, $3, $2, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $2, $3, $3, $3, $3, $3, $3, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $2, $2, $1, $1, $2, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $3, $2, $2, $2, $2, $2, $2, $3, $4, $4, $4, $4, $4, $4, $3, $3, $3, $3, $3, $3, $3, $3, $4, $4, $4, $4, $4, $4, $4, $4, $4, $4, $4, $4, $3, $3, $3, $4, $3, $3, $4, $2, $2, $2, $3, $2, $2, $3, $3, $4, $4, $5, $4, $4, $5, CPT only 2008 American Medical Association. All rights reserved. Part B, 184

185 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $2, $2, $1, $2, $2, ZZZ $ $ $ $ $ $ $ $2, $2, $3, $2, $2, $3, $3, $3, $3, $3, $3, $3, $5, $4, $5, $5, $4, $5, $5, $3, $5, $6, $6, $5, $6, $6, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $51.00 $47.00 $50.00 $54.00 $47.00 $50.00 $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $2, $3, $3, $3, $3, $3, $3, $3, $4, $5, $5, $4, $5, $5, YYY BR $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $2, $2, $1, $2, $2, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $2, $2, $1, $2, $2, $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 185

186 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, ZZZ $ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $3, $2, $2, $3, $1, $2, $2, $3, $2, $2, $3, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $ $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $2, $2, $2, $3, $2, $2, $3, $2, $3, $3, $4, $3, $3, $4, $2, $2, $2, $3, $2, $2, $3, $2, $3, $3, $3, $3, $3, $3, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $2, $1, $1, $2, $1, $2, $2, $2, $2, $2, $2, $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 186

187 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $1, $1, $ $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $2, $2, $1, $2, $2, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $4, $4, $4, $ $ $ $ $4, $4, $5, $ $ $ $ $3, $3, $3, $ $ $ $ $2, $3, $3, $ $ $ $ $4, $4, $4, $ $ $ $ $3, $3, $3, $ $ $ $ $2, $2, $2, $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 187

188 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $2, $1, $1, $2, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $2, $3, $3, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $3, $4, $3, $3, $4, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $2, $1, $1, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $2, $2, $1, $2, $2, $1, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $2, $2, $1, $2, $2, ZZZ $ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, ZZZ $ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, CPT only 2008 American Medical Association. All rights reserved. Part B, 188

189 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $3, $2, $2, $3, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $2, $1, $2, $2, $1, $2, $2, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $2, $1, $1, $2, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $2, $1, $1, $2, $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 189

190 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $3, $2, $2, $3, $46.00 $35.00 $37.00 $39.00 $12.00 $13.00 $ $ $ $ $ $ $ $ $68.00 $ $ $ $66.00 $69.00 $ $ $ $ $1, $ $ $ $ $1, $1, $1, $ $ $ $ $1, $1, $1, $ $ $ $ $1, $1, $1, $ $ $ $ $1, $1, $1, $ $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $10.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $1, $1, $1, $ $ $ $ $1, $1, $1, $ $ $ $ $2, $3, $3, $ $ $ ZZZ $79.00 $ $ $ $71.00 $74.00 $ $ $1, $1, $1, $ $ $ $ $1, $1, $1, $ $ $ $ $2, $2, $3, $ $ $ ZZZ $53.00 $ $ $ $71.00 $74.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $18.00 $24.00 $26.00 $27.00 $12.00 $12.00 $ BR BR $86.00 $51.00 $53.00 $56.00 $51.00 $53.00 $ $37.00 $53.00 $58.00 $63.00 $53.00 $58.00 $ $ $ $ $ $ $ $ NC BR BR BR BR BR BR NC BR BR BR BR BR BR $76.00 $ $ $ $95.00 $ $ $96.00 $ $ $ $ $ $ $2, $2, $2, $ $ $ ZZZ $ $ $ $ $ $ $2, $2, $2, $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $92.00 $ $ $ $ $ $ $92.00 $ $ $ $ $ $ $92.00 $ $ $ $ $ $ $92.00 $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 190

191 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $92.00 $2, $3, $3, $ $ $ $92.00 $3, $3, $3, $85.00 $88.00 $ $ $1, $1, $2, $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $1, $1, $1, $ $ $ $1, $1, $1, $ $ $ $1, $1, $1, $ $ $ $3, $4, $4, $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $ $ $ $60.00 $66.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $97.00 $ $ $1, $1, $1, $ $ $ $1, $1, $1, $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $28.00 $30.00 $32.00 $28.00 $30.00 $ $34.00 $37.00 $39.00 $34.00 $37.00 $ $59.00 $71.00 $87.00 $59.00 $71.00 $ $ $ $ $ $ $ $ $ $ $63.00 $66.00 $ $ $ $ $85.00 $88.00 $ $ $ $ $ $ $ $24.00 $41.00 $43.00 $45.00 $21.00 $21.00 $ $64.00 $69.00 $71.00 $75.00 $69.00 $71.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $72.00 $85.00 $89.00 $94.00 $85.00 $89.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 191

192 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $2, $2, $2, $ $ $ $1, $1, $1, $2, $1, $1, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $3, $3, $3, $ $ $ ZZZ $1, $1, $1, $ $ $ ZZZ $2, $2, $2, $ $ $ $3, $3, $3, $ $ $ $2, $3, $3, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $2, $ $ $ $ $1, $1, $1, $1, $1, $1, $ $3, $3, $3, $ $ $ ZZZ $ $1, $2, $2, $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $4, $5, $5, $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ ZZZ $85.00 $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, YYY BR $ $ $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 192

193 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $2, $1, $1, $2, $ $ $ $ $ $ $ YYY BR $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, YYY BR $ $ $ $ $ $ $ $79.00 $ $ $ $ $ $ $79.00 $ $ $ $ $ $ $ $ $ $ $79.00 $82.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $90.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $98.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, YYY BR $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 193

194 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $26.00 $52.00 $55.00 $59.00 $52.00 $55.00 $ $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ YYY BR $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $7, $7, $8, $7, $7, $8, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, YYY BR $ $ $ $ $90.00 $94.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $38.00 $ $ $ $43.00 $45.00 $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 194

195 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $ $1, $1, $1, $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $1, YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $91.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, $2, $3, $3, $3, $3, $3, $3, $1, $2, $2, $3, $2, $2, $3, $2, $2, $3, $3, $2, $3, $3, $2, $3, $3, $3, $3, $3, $3, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 195

196 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ NC BR BR BR BR BR BR NC BR BR BR BR BR BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ NC BR BR BR BR BR BR NC BR BR BR BR BR BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $94.00 $ $ $ $76.00 $79.00 $84.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 196

197 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $82.00 $ $ $ $86.00 $89.00 $ $ $ $ $ $ $ $ $67.00 $ $ $ $76.00 $80.00 $ $89.00 $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $3, $2, $2, $3, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $3, $2, $2, $3, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 197

198 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $2, $3, $3, $3, $3, $3, $3, $2, $5, $5, $5, $5, $5, $5, $2, $3, $3, $4, $3, $3, $4, $2, $5, $5, $5, $5, $5, $5, $2, $5, $5, $6, $5, $5, $6, $2, $3, $3, $3, $3, $3, $3, $2, $4, $4, $4, $4, $4, $4, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $3, $3, $3, $3, $2, $5, $5, $5, $5, $5, $5, $2, $4, $4, $4, $4, $4, $4, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 198

199 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, YYY BR $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $4, $3, $3, $4, $2, $3, $4, $4, $3, $4, $4, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $3, $3, $3, $3, $1, $1, $2, $2, $1, $2, $2, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $2, $1, $1, $2, $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $ $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 199

200 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $2, $2, $1, $2, $2, $91.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ BR YYY BR $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $96.00 $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $3, $2, $2, $3, $1, $2, $2, $3, $2, $2, $3, $1, $1, $1, $2, $1, $1, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, ZZZ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ YYY BR BR $52.00 $54.00 $55.00 $52.00 $54.00 $ $81.00 $ $ $ $69.00 $72.00 $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 200

201 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, ZZZ $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $2, $1, $1, $2, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $3, $3, $3, $3, $3, $3, $2, $3, $3, $4, $3, $3, $4, ZZZ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, BR BR ZZZ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $3, $2, $2, $3, $2, $2, $3, $2, $2, $3, $2, $3, $3, $2, $3, $3, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 201

202 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $3, $2, $2, $3, $1, $2, $2, $2, $2, $2, $2, ZZZ $ $ $ $ $ $ $2, $2, $2, $2, $2, $2, YYY BR $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $91.00 $88.00 $92.00 $97.00 $88.00 $92.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 202

203 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $28.00 $34.00 $35.00 $37.00 $34.00 $35.00 $ $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, YYY BR $ $ $ $1, $ $ $1, $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $2, $3, $3, $3, $3, $3, $3, CPT only 2008 American Medical Association. All rights reserved. Part B, 203

204 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $75.00 $ $ $ $59.00 $61.00 $ $72.00 $1, $1, $1, $99.00 $ $ $ $ $ $ $95.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $99.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $96.00 $ $ $ $ $ $ $87.00 $ $ $ $80.00 $84.00 $ $ $ $ $ $95.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 204

205 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $46.00 $ $ $ $49.00 $51.00 $ $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $94.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $98.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $38.00 $ $ $ $48.00 $50.00 $ $92.00 $ $ $ $86.00 $91.00 $ $66.00 $ $ $ $89.00 $93.00 $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 205

206 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $97.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $2, $2, $3, $2, $2, $3, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $2, $3, $3, $2, $4, $4, $4, $4, $4, $4, $2, $4, $5, $5, $4, $5, $5, $2, $4, $4, $5, $4, $4, $5, $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $2, $3, $3, $2, $3, $3, $2, $4, $4, $4, $4, $4, $4, $2, $3, $4, $4, $3, $4, $4, $2, $4, $4, $4, $4, $4, $4, $6, $6, $6, $7, $6, $6, $7, $4, $5, $5, $5, $5, $5, $5, CPT only 2008 American Medical Association. All rights reserved. Part B, 206

207 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $3, $4, $4, $3, $4, $4, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, YYY BR $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $2, $1, $1, $2, $ $1, $1, $1, $1, $1, $1, YYY BR $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $96.00 $52.00 $54.00 $56.00 $52.00 $54.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $35.00 $1, $2, $2, $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, YYY BR $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 207

208 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $2, $2, $2, $2, $2, $2, $1, $3, $3, $3, $3, $3, $3, $1, $2, $3, $3, $2, $3, $3, $1, $3, $3, $4, $3, $3, $4, $1, $1, $2, $2, $1, $2, $2, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, YYY BR $1, $2, $2, $2, $2, $2, $2, $1, $2, $3, $3, $2, $3, $3, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $3, $3, $4, $3, $3, $4, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $3, $3, $4, $4, $3, $4, $4, $2, $3, $3, $4, $3, $3, $4, $3, $3, $4, $4, $3, $4, $4, $2, $3, $3, $4, $3, $3, $4, $1, $2, $2, $2, $2, $2, $2, BR ZZZ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $2, $3, $3, $3, $3, $3, $3, $1, $1, $1, $1, $1, $1, $1, YYY BR $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $2, $2, $1, $2, $2, $ $1, $1, $1, $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 208

209 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $93.00 $97.00 $ $98.00 $ $ $ $89.00 $93.00 $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $1, $2, $2, $3, $2, $2, $3, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $54.00 $ $ $ $54.00 $56.00 $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $48.00 $63.00 $66.00 $69.00 $63.00 $66.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $1, $1, $1, $ $ $ $1, $1, $1, $ $ $ $1, $1, $1, $ $ $ $1, $1, $1, $92.00 $96.00 $ $1, $1, $1, $ $ $ $1, $1, $1, $ $ $ $1, $1, $1, $65.00 $67.00 $ $ $ $ $43.00 $44.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 209

210 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $6, $6, $7, $6, $6, $7, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, ZZZ $ $ $ $ $ $ $ BR YYY BR $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 210

211 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $3, $3, $3, $3, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $2, $ $ $ $1, $1, $1, $ $ $ $1, $1, $1, $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $77.00 $80.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $64.00 $ $ $ $71.00 $74.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $99.00 $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $2, $1, $1, $2, YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 211

212 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $5, $6, $6, $ $ $ $6, $6, $6, $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $74.00 $ $ $ $67.00 $70.00 $ $ $ $ $ $ $ $ $89.00 $ $ $ $ $ $ $85.00 $ $ $ $96.00 $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 212

213 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $87.00 $91.00 $96.00 $54.00 $56.00 $ $ $ $ $73.00 $77.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $2, $3, $3, $3, $3, $3, $3, $3, $3, $3, $2, $3, $3, $3, $3, $3, $3, $54.00 $ $ $ $61.00 $64.00 $ $83.00 $53.00 $55.00 $58.00 $53.00 $55.00 $ $45.00 $ $ $ $87.00 $91.00 $ $29.00 $ $ $ $61.00 $64.00 $ $58.00 $92.00 $98.00 $ $38.00 $39.00 $ $92.00 $ $ $ $41.00 $43.00 $ $ $ $ $ $ $ $ $37.00 $ $ $ $91.00 $95.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 213

214 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $47.00 $72.00 $76.00 $80.00 $72.00 $76.00 $ $44.00 $46.00 $48.00 $44.00 $46.00 $ TC $28.00 $30.00 $32.00 $28.00 $30.00 $ $81.00 $ $ $ $ $ $ $81.00 $85.00 $89.00 $81.00 $85.00 $ TC $33.00 $35.00 $38.00 $33.00 $35.00 $ $96.00 $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $52.00 $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $77.00 $80.00 $84.00 $77.00 $80.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ ZZZ $67.00 $72.00 $78.00 $67.00 $72.00 $ TC ZZZ $ $ $ $ $ $ $20.00 $30.00 $34.00 $38.00 $30.00 $34.00 $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $2, $1, $1, $2, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 214

215 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 215

216 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $3, $3, $3, $ $ $ $ $3, $3, $3, $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $37.00 $ $ $ $89.00 $93.00 $ $37.00 $ $ $ $73.00 $77.00 $ $81.00 $90.00 $94.00 $99.00 $90.00 $94.00 $99.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 216

217 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $59.00 $ $ $ $ $ $ $45.00 $ $ $ $ $ $ $49.00 $ $ $ $57.00 $59.00 $ $50.00 $ $ $ $55.00 $58.00 $ $50.00 $53.00 $56.00 $59.00 $53.00 $56.00 $ $ $4, $4, $4, $ $ $ $ $3, $4, $4, $ $ $ YYY BR $ $ $ $ $ $ $ $91.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $78.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $81.00 $ $ $ $99.00 $ $ $ $ $ $ $ $ $ $93.00 $97.00 $ $93.00 $97.00 $ TC $45.00 $50.00 $54.00 $45.00 $50.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $16.00 $17.00 $19.00 $16.00 $17.00 $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 217

218 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ BR $88.00 $ $ $ $82.00 $86.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 218

219 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 219

220 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $64.00 $68.00 $72.00 $64.00 $68.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $96.00 $ $ $ $82.00 $87.00 $ ZZZ $49.00 $53.00 $56.00 $60.00 $41.00 $43.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $2, $1, $1, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $90.00 $ $ $ $89.00 $94.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $2, $1, $1, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $50.00 $73.00 $78.00 $83.00 $40.00 $43.00 $ $ $ $ $ $ $ $ $67.00 $ $ $ $65.00 $68.00 $ $74.00 $ $ $ $66.00 $70.00 $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 220

221 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $70.00 $ $ $ $ $ $ $57.00 $ $ $ $ $ $ $75.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $89.00 $ $ $ $98.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 221

222 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $2, $2, $2, $2, $2, $2, $2, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $71.00 $80.00 $85.00 $91.00 $65.00 $69.00 $ $74.00 $ $ $ $ $ $ ZZZ $67.00 $71.00 $76.00 $56.00 $60.00 $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $96.00 $ $ $ $72.00 $77.00 $ $71.00 $ $ $ $92.00 $97.00 $ $81.00 $ $ $ $66.00 $70.00 $ $90.00 $ $ $ $80.00 $85.00 $ $24.00 $30.00 $32.00 $34.00 $17.00 $18.00 $ $87.00 $ $ $ $79.00 $83.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $2, $3, $3, $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 222

223 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $2, $2, $3, $ $ $ $2, $2, $3, $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, YYY BR YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $47.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, YYY BR $ $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 223

224 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $1, $ $ $1, $ $1, $1, $1, $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $3, $2, $2, $3, $1, $1, $2, $1, $1, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $85.00 $98.00 $ $ $98.00 $ $ $55.00 $59.00 $66.00 $55.00 $59.00 $ TC $43.00 $48.00 $54.00 $43.00 $48.00 $ $54.00 $64.00 $70.00 $77.00 $64.00 $70.00 $ $44.00 $48.00 $54.00 $44.00 $48.00 $ TC $20.00 $21.00 $23.00 $20.00 $21.00 $ $ $ $ $ $ $ $ $71.00 $74.00 $80.00 $89.00 $74.00 $80.00 $ $47.00 $61.00 $66.00 $73.00 $61.00 $66.00 $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $79.00 $ $ $ $65.00 $71.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 224

225 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $2, $2, $2, $3, $2, $2, $3, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $1, $2, $2, $3, $2, $2, $3, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $3, $3, $2, $3, $3, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR YYY BR $ $ $ $ $ $ $ $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $67.00 $70.00 $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, CPT only 2008 American Medical Association. All rights reserved. Part B, 225

226 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition ZZZ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, YYY BR YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $67.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, ZZZ $88.00 $ $ $ $ $ $ $2, $2, $2, $3, $2, $2, $3, $2, $2, $3, $3, $2, $3, $3, $1, $3, $3, $3, $3, $3, $3, $1, $3, $3, $3, $3, $3, $3, $1, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $2, $2, $3, $3, $2, $3, $3, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, CPT only 2008 American Medical Association. All rights reserved. Part B, 226

227 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $2, $2, $2, $3, $2, $2, $3, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $3, $2, $2, $3, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $2, $2, $3, $3, $2, $3, $3, $2, $3, $3, $4, $3, $3, $4, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $2, $2, $2, $2, ZZZ $74.00 $ $ $ $ $ $ $3, $3, $3, $4, $3, $3, $4, $3, $3, $4, $4, $3, $4, $4, $4, $4, $5, $5, $4, $5, $5, $3, $4, $4, $5, $4, $4, $5, $2, $2, $3, $3, $2, $3, $3, $2, $2, $2, $3, $2, $2, $3, $3, $4, $4, $5, $4, $4, $5, $3, $3, $3, $4, $3, $3, $4, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $ $1, $1, $1, $1, $1, $1, $2, $3, $3, $4, $3, $3, $4, $3, $3, $3, $3, $3, $3, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $2, $3, $3, $2, $2, $3, $3, $2, $3, $3, $2, $3, $3, $3, $3, $3, $3, $2, $2, $3, $3, $2, $3, $3, $2, $2, $2, $2, $2, $2, $2, $3, $4, $4, $5, $4, $4, $5, $2, $3, $3, $3, $3, $3, $3, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $2, $3, $3, $3, $3, $3, $3, $3, $3, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, $2, $3, $3, $3, $3, $3, $3, $3, $4, $4, $5, $4, $4, $5, $2, $3, $3, $3, $3, $3, $3, CPT only 2008 American Medical Association. All rights reserved. Part B, 227

228 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $4, $3, $3, $4, $2, $3, $4, $4, $3, $4, $4, $2, $3, $3, $4, $3, $3, $4, $3, $3, $4, $4, $3, $4, $4, $2, $2, $2, $3, $2, $2, $3, $3, $3, $4, $4, $3, $4, $4, $3, $4, $4, $4, $4, $4, $4, $3, $4, $4, $4, $4, $4, $4, $2, $2, $3, $3, $2, $3, $3, $2, $3, $3, $3, $3, $3, $3, $3, $3, $4, $4, $3, $4, $4, $2, $3, $3, $3, $3, $3, $3, $2, $2, $2, $3, $2, $2, $3, $2, $3, $3, $3, $3, $3, $3, $2, $2, $2, $3, $2, $2, $3, $3, $3, $4, $4, $3, $4, $4, $2, $3, $3, $4, $3, $3, $4, $3, $4, $4, $5, $4, $4, $5, ZZZ $ $ $ $1, $ $ $1, ZZZ $2, $2, $2, $3, $2, $2, $3, ZZZ $ $ $ $ $ $ $ ZZZ $2, $2, $2, $2, $2, $2, $2, $3, $4, $4, $4, $4, $4, $4, $2, $3, $3, $3, $3, $3, $3, $3, $4, $4, $4, $4, $4, $4, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $ $ $ $ $ $ ZZZ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $2, $3, $3, $3, $3, $3, $3, $4, $5, $6, $6, $5, $6, $6, $3, $3, $4, $4, $3, $4, $4, $5, $6, $6, $7, $6, $6, $7, $2, $2, $3, $3, $2, $3, $3, $4, $4, $5, $5, $4, $5, $5, $3, $5, $5, $6, $5, $5, $6, $3, $5, $6, $6, $5, $6, $6, $4, $4, $5, $5, $4, $5, $5, $4, $5, $5, $5, $5, $5, $5, $1, $1, $1, $2, $1, $1, $2, $3, $3, $3, $4, $3, $3, $4, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, CPT only 2008 American Medical Association. All rights reserved. Part B, 228

229 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $3, $3, $3, $4, $3, $3, $4, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $2, $1, $1, $2, $1, $1, $2, $2, $1, $2, $2, $1, $1, $2, $2, $1, $2, $2, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, ZZZ $ $ $1, $ $ $1, $2, $3, $3, $2, $3, $3, ZZZ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $3, $2, $2, $3, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $2, $1, $1, $2, CPT only 2008 American Medical Association. All rights reserved. Part B, 229

230 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $85.00 $ $ $ $ $ $ $66.00 $72.00 $80.00 $66.00 $72.00 $ TC $67.00 $72.00 $76.00 $67.00 $72.00 $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $99.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ BR $51.00 $53.00 $56.00 $30.00 $31.00 $ BR $71.00 $75.00 $79.00 $48.00 $51.00 $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 230

231 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $2, $1, $1, $2, ZZZ BR ZZZ BR $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $2, $2, $1, $2, $2, ZZZ $ $ $ $ $ $ $ $2, $2, $2, $2, $2, $2, $2, ZZZ $ $ $ $ $ $ $ $1, $1, $2, $2, $1, $2, $2, ZZZ $ $ $ $ $ $ $ $1, $1, $2, $2, $1, $2, $2, ZZZ $ $ $ $ $ $ $ $2, $2, $2, $2, $2, $2, $2, ZZZ $ $ $ $ $ $ $ $2, $2, $2, $2, $2, $2, $2, ZZZ $ $ $ $ $ $ $ $2, $3, $3, $3, $3, $3, $3, ZZZ $ $ $ $ $ $ $ $2, $2, $2, $2, $2, $2, $2, ZZZ $ $ $ $ $ $ $ $2, $3, $3, $2, $3, $3, $2, $3, $3, $2, $3, $3, ZZZ $ $ $ $ $ $ $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $2, $1, $1, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $2, $1, $1, $2, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $2, $1, $1, $2, $1, $1, $2, $2, $1, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $1, $2, $2, $1, $2, $2, $3, $3, $4, $4, $3, $4, $4, $3, $4, $4, $4, $4, $4, $4, $3, $4, $4, $4, $4, $4, $4, $1, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, CPT only 2008 American Medical Association. All rights reserved. Part B, 231

232 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $2, $1, $1, $2, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $2, $3, $3, $2, $2, $3, $3, $2, $3, $3, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $2, $2, $2, $2, $2, $3, $3, $4, $3, $3, $4, $3, $3, $3, $4, $3, $3, $4, $3, $3, $3, $4, $3, $3, $4, $3, $3, $3, $4, $3, $3, $4, ZZZ $ $ $ $ $ $ $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $3, $2, $2, $3, $2, $2, $2, $3, $2, $2, $3, $2, $2, $3, $3, $2, $3, $3, $2, $3, $3, $3, $3, $3, $3, $2, $3, $3, $3, $3, $3, $3, $2, $2, $2, $3, $2, $2, $3, ZZZ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $2, $2, $2, $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $2, $2, $2, $2, $2, $2, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $78.00 $ $ $ $80.00 $83.00 $ $75.00 $ $ $ $93.00 $98.00 $ $ $ $ $ $92.00 $96.00 $ CPT only 2008 American Medical Association. All rights reserved. Part B, 232

233 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $89.00 $ $ $ $87.00 $91.00 $ $ $ $ $ $96.00 $ $ $ $ $ $ $95.00 $99.00 $ $ $ $ $ $ $ $ $ $ $ $ $96.00 $ $ $ $ $ $ $91.00 $95.00 $ $89.00 $ $ $ $83.00 $87.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $68.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $77.00 $93.00 $96.00 $ $93.00 $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $53.00 $ $ $ $94.00 $99.00 $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $84.00 $87.00 $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $63.00 $66.00 $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $86.00 $90.00 $ $ $ $ $ $ $ $ $99.00 $ $ $ $91.00 $95.00 $ $ $ $ $ $86.00 $90.00 $ $ $ $ $ $ $ $ $ $ $ $96.00 $ $ $ $ $ $ $ $ $ $23.00 $21.00 $22.00 $24.00 $12.00 $12.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $37.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 233

234 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $62.00 $64.00 $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $73.00 $76.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $77.00 $82.00 $86.00 $49.00 $52.00 $ $89.00 $94.00 $99.00 $62.00 $65.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 234

235 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $1, $ $ $1, $ $ $ $1, $ $ $1, $ $ $1, $1, $ $1, $1, $ $ $ $1, $ $ $1, ZZZ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ $1, $1, $1, $2, $1, $1, $2, $1, $1, $2, $2, $1, $2, $2, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, ZZZ $ $ $ $ $ $ $ ZZZ $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 235

236 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $45.00 $66.00 $69.00 $72.00 $51.00 $53.00 $ $53.00 $81.00 $84.00 $88.00 $62.00 $64.00 $ $58.00 $69.00 $72.00 $76.00 $52.00 $54.00 $ $62.00 $88.00 $92.00 $96.00 $67.00 $69.00 $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $88.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $75.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $81.00 $ $ $ $ $ $ $88.00 $93.00 $97.00 $ $80.00 $84.00 $ $ $ $ $ $ $ $ $52.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 236

237 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $88.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 237

238 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, ZZZ $84.00 $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ ZZZ $44.00 $35.00 $37.00 $38.00 $33.00 $34.00 $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, CPT only 2008 American Medical Association. All rights reserved. Part B, 238

239 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition YYY BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ ZZZ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $75.00 $ $ $ $90.00 $93.00 $ $ $97.00 $ $ $84.00 $87.00 $ $53.00 $ $ $ $93.00 $95.00 $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, YYY BR $87.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $36.00 $63.00 $66.00 $69.00 $63.00 $66.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 239

240 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $67.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ $75.00 $76.00 $80.00 $83.00 $63.00 $65.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $59.00 $49.00 $51.00 $53.00 $40.00 $42.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ YYY BR $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 240

241 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $96.00 $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $76.00 $80.00 $84.00 $88.00 $72.00 $76.00 $ YYY BR $52.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $85.00 $ $ $ $60.00 $62.00 $ $87.00 $ $ $ $83.00 $87.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $53.00 $ $ $ $70.00 $74.00 $ $ $ $ $ $ $ $ $39.00 $63.00 $66.00 $70.00 $43.00 $45.00 $ $78.00 $ $ $ $79.00 $84.00 $ $ $ $ $ $ $ $ YYY $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, YYY BR $76.00 $ $ $ $78.00 $82.00 $ $52.00 $ $ $ $64.00 $68.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 241

242 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $ $ $ $ $ $ $ $84.00 $ $ $ $80.00 $84.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $2, $3, $3, $3, $3, $3, $3, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $41.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $1, $1, $2, $1, $1, $1, $2, $1, $1, $2, $1, $1, $2, $2, $1, $2, $2, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ BR $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, CPT only 2008 American Medical Association. All rights reserved. Part B, 242

243 Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, $2, $2, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, YYY BR $ $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $1, $2, $2, $1, $1, $1, $1, $1, $1, $1, YYY BR $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $2, $3, $2, $2, $3, YYY BR ZZZ $ $ $ $ $ $ $ G $25.00 $26.00 $28.00 $12.00 $12.00 $13.00 G $ $ $ $34.00 $36.00 $38.00 G0247 ZZZ $55.00 $58.00 $60.00 $34.00 $35.00 $37.00 G0289 ZZZ $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $1, $ $ $1, G $1, $1, $1, $1, $1, $1, G0364 ZZZ $18.00 $20.00 $22.00 $14.00 $15.00 $17.00 G $3, $3, $3, $ $ $ G $2, $2, $2, $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part B, 243

244 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition PART C SCHEDULE OF MAXIMUM REIMBURSEMENT ALLOWANCES 244

245 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $70.00 $ $ $ $ $ $ NC $63.00 $65.00 $67.00 $63.00 $65.00 $ TC NC $ $ $ $ $ $ $58.00 $ $ $ $ $ $ NC $65.00 $68.00 $71.00 $65.00 $68.00 $ TC NC $80.00 $87.00 $94.00 $80.00 $87.00 $ $24.00 $29.00 $31.00 $34.00 $29.00 $31.00 $ $10.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $15.00 $20.00 $22.00 $24.00 $20.00 $22.00 $ $29.00 $33.00 $35.00 $37.00 $33.00 $35.00 $ $9.00 $10.00 $10.00 $10.00 $10.00 $10.00 $ TC $19.00 $23.00 $25.00 $27.00 $23.00 $25.00 $ $36.00 $42.00 $45.00 $48.00 $42.00 $45.00 $ $12.00 $13.00 $13.00 $14.00 $13.00 $13.00 $ TC $22.00 $29.00 $31.00 $34.00 $29.00 $31.00 $ $32.00 $37.00 $40.00 $43.00 $37.00 $40.00 $ $9.00 $10.00 $10.00 $10.00 $10.00 $10.00 $ TC $22.00 $27.00 $30.00 $32.00 $27.00 $30.00 $ $46.00 $57.00 $61.00 $66.00 $57.00 $61.00 $ $17.00 $18.00 $19.00 $20.00 $18.00 $19.00 $ TC $29.00 $39.00 $42.00 $46.00 $39.00 $42.00 $ $45.00 $51.00 $55.00 $59.00 $51.00 $55.00 $ $17.00 $18.00 $19.00 $20.00 $18.00 $19.00 $ TC $28.00 $33.00 $36.00 $39.00 $33.00 $36.00 $ $33.00 $35.00 $37.00 $40.00 $35.00 $37.00 $ $9.00 $10.00 $10.00 $11.00 $10.00 $10.00 $ TC $22.00 $24.00 $27.00 $29.00 $24.00 $27.00 $ $42.00 $47.00 $50.00 $54.00 $47.00 $50.00 $ $12.00 $13.00 $14.00 $14.00 $13.00 $14.00 $ TC $29.00 $33.00 $37.00 $40.00 $33.00 $37.00 $ $29.00 $33.00 $36.00 $38.00 $33.00 $36.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $19.00 $24.00 $26.00 $28.00 $24.00 $26.00 $ $52.00 $ $ $ $ $ $ NC $15.00 $16.00 $16.00 $15.00 $16.00 $ TC NC $ $ $ $ $ $ $34.00 $39.00 $42.00 $45.00 $39.00 $42.00 $ $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $ TC $22.00 $28.00 $30.00 $33.00 $28.00 $30.00 $ $43.00 $48.00 $52.00 $56.00 $48.00 $52.00 $ $14.00 $15.00 $15.00 $16.00 $15.00 $15.00 $ TC $29.00 $34.00 $37.00 $40.00 $34.00 $37.00 $ $32.00 $34.00 $36.00 $39.00 $34.00 $36.00 $ $8.00 $9.00 $9.00 $10.00 $9.00 $9.00 $ TC $22.00 $25.00 $27.00 $30.00 $25.00 $27.00 $ $42.00 $44.00 $48.00 $52.00 $44.00 $48.00 $ $12.00 $13.00 $13.00 $14.00 $13.00 $13.00 $ TC $29.00 $31.00 $34.00 $38.00 $31.00 $34.00 $ $26.00 $30.00 $32.00 $34.00 $30.00 $32.00 $ $9.00 $10.00 $10.00 $11.00 $10.00 $10.00 $11.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 245

246 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC $15.00 $20.00 $22.00 $24.00 $20.00 $22.00 $ $35.00 $39.00 $42.00 $45.00 $39.00 $42.00 $ $12.00 $12.00 $13.00 $13.00 $12.00 $13.00 $ TC $22.00 $27.00 $29.00 $32.00 $27.00 $29.00 $ $50.00 $54.00 $59.00 $63.00 $54.00 $59.00 $ $17.00 $18.00 $19.00 $20.00 $18.00 $19.00 $ TC $33.00 $36.00 $40.00 $44.00 $36.00 $40.00 $ $15.00 $16.00 $18.00 $19.00 $16.00 $18.00 $ $5.00 $6.00 $6.00 $7.00 $6.00 $6.00 $ TC $10.00 $10.00 $11.00 $12.00 $10.00 $11.00 $ $24.00 $33.00 $36.00 $38.00 $33.00 $36.00 $ $8.00 $9.00 $9.00 $10.00 $9.00 $9.00 $ TC $15.00 $24.00 $26.00 $28.00 $24.00 $26.00 $ $40.00 $50.00 $54.00 $58.00 $50.00 $54.00 $ $11.00 $12.00 $12.00 $13.00 $12.00 $12.00 $ TC $29.00 $38.00 $42.00 $45.00 $38.00 $42.00 $ $28.00 $32.00 $34.00 $36.00 $32.00 $34.00 $ $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $ TC $18.00 $22.00 $24.00 $26.00 $22.00 $24.00 $ $43.00 $50.00 $54.00 $58.00 $50.00 $54.00 $ $12.00 $13.00 $13.00 $13.00 $13.00 $13.00 $ TC $31.00 $38.00 $41.00 $45.00 $38.00 $41.00 $ $ $ $ $ $ $ $ NC $28.00 $29.00 $30.00 $28.00 $29.00 $ TC NC $74.00 $81.00 $89.00 $74.00 $81.00 $ $ $ $ $ $ $ $ $72.00 $78.00 $81.00 $85.00 $78.00 $81.00 $ TC $ $ $ $ $ $ $ $24.00 $23.00 $25.00 $27.00 $23.00 $25.00 $ $10.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $14.00 $14.00 $16.00 $17.00 $14.00 $16.00 $ $32.00 $29.00 $31.00 $34.00 $29.00 $31.00 $ $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $ TC $21.00 $18.00 $20.00 $22.00 $18.00 $20.00 $ $24.00 $29.00 $31.00 $33.00 $29.00 $31.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $15.00 $19.00 $21.00 $23.00 $19.00 $21.00 $ $65.00 $77.00 $83.00 $89.00 $77.00 $83.00 $ $16.00 $16.00 $17.00 $17.00 $16.00 $17.00 $ TC $48.00 $61.00 $66.00 $71.00 $61.00 $66.00 $ $ $ $ $ $ $ $ $43.00 $44.00 $46.00 $48.00 $44.00 $46.00 $ TC $79.00 $73.00 $80.00 $87.00 $73.00 $80.00 $ $90.00 $94.00 $ $ $94.00 $ $ NC $23.00 $23.00 $24.00 $23.00 $23.00 $ TC NC $71.00 $78.00 $85.00 $71.00 $78.00 $ $34.00 $40.00 $43.00 $47.00 $40.00 $43.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $24.00 $31.00 $34.00 $36.00 $31.00 $34.00 $ $87.00 $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 246

247 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA NC $20.00 $21.00 $22.00 $20.00 $21.00 $ TC NC $85.00 $93.00 $ $85.00 $93.00 $ $ $ $ $ $ $ $ $43.00 $45.00 $47.00 $49.00 $45.00 $47.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $58.00 $60.00 $62.00 $65.00 $60.00 $62.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $65.00 $68.00 $70.00 $73.00 $68.00 $70.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $65.00 $68.00 $70.00 $73.00 $68.00 $70.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $70.00 $73.00 $76.00 $79.00 $73.00 $76.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $74.00 $77.00 $79.00 $82.00 $77.00 $79.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $58.00 $60.00 $62.00 $64.00 $60.00 $62.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $66.00 $69.00 $72.00 $75.00 $69.00 $72.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $72.00 $75.00 $77.00 $80.00 $75.00 $77.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $65.00 $68.00 $71.00 $74.00 $68.00 $71.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $70.00 $73.00 $76.00 $79.00 $73.00 $76.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $74.00 $77.00 $79.00 $82.00 $77.00 $79.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $92.00 $93.00 $96.00 $ $93.00 $96.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $92.00 $93.00 $97.00 $ $93.00 $97.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $70.00 $71.00 $74.00 $77.00 $71.00 $74.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $82.00 $86.00 $89.00 $92.00 $86.00 $89.00 $ TC $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 247

248 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $1, $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $61.00 $64.00 $66.00 $68.00 $64.00 $66.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $61.00 $64.00 $66.00 $68.00 $64.00 $66.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $92.00 $96.00 $99.00 $ $96.00 $99.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $61.00 $63.00 $65.00 $68.00 $63.00 $65.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $61.00 $64.00 $66.00 $68.00 $64.00 $66.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $92.00 $96.00 $99.00 $ $96.00 $99.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $76.00 $78.00 $81.00 $85.00 $78.00 $81.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $91.00 $95.00 $98.00 $ $95.00 $98.00 $ TC $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ BR BR BR BR BR BR $ $ $ $ $ $ TC BR BR BR BR BR BR $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $27.00 $27.00 $29.00 $31.00 $27.00 $29.00 $ $9.00 $10.00 $10.00 $10.00 $10.00 $10.00 $ TC $17.00 $18.00 $19.00 $21.00 $18.00 $19.00 $ $30.00 $32.00 $34.00 $37.00 $32.00 $34.00 $ $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 248

249 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC $19.00 $21.00 $23.00 $25.00 $21.00 $23.00 $ $35.00 $36.00 $39.00 $42.00 $36.00 $39.00 $ $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $22.00 $24.00 $27.00 $29.00 $24.00 $27.00 $ $41.00 $44.00 $47.00 $51.00 $44.00 $47.00 $ $13.00 $14.00 $15.00 $15.00 $14.00 $15.00 $ TC $28.00 $30.00 $33.00 $36.00 $30.00 $33.00 $ $44.00 $49.00 $52.00 $56.00 $49.00 $52.00 $ $16.00 $16.00 $16.00 $17.00 $16.00 $16.00 $ TC $28.00 $33.00 $36.00 $39.00 $33.00 $36.00 $ $49.00 $66.00 $70.00 $75.00 $66.00 $70.00 $ $19.00 $20.00 $21.00 $21.00 $20.00 $21.00 $ TC $29.00 $46.00 $50.00 $54.00 $46.00 $50.00 $ $45.00 $50.00 $54.00 $58.00 $50.00 $54.00 $ $16.00 $16.00 $16.00 $17.00 $16.00 $16.00 $ TC $29.00 $35.00 $38.00 $41.00 $35.00 $38.00 $ $79.00 $96.00 $ $ $96.00 $ $ $23.00 $25.00 $26.00 $27.00 $25.00 $26.00 $ TC $54.00 $71.00 $77.00 $83.00 $71.00 $77.00 $ $56.00 $35.00 $38.00 $40.00 $35.00 $38.00 $ $19.00 $10.00 $10.00 $10.00 $10.00 $10.00 $ TC $38.00 $26.00 $28.00 $30.00 $26.00 $28.00 $ $34.00 $ $ $ $ $ $ NC $30.00 $31.00 $33.00 $30.00 $31.00 $ TC NC $71.00 $77.00 $83.00 $71.00 $77.00 $ $ $ $ $ $ $ $ NC $39.00 $40.00 $42.00 $39.00 $40.00 $ TC NC $ $ $ $ $ $ $ NC $31.00 $32.00 $33.00 $31.00 $32.00 $ TC NC BR BR BR BR BR BR $33.00 $36.00 $39.00 $42.00 $36.00 $39.00 $ $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $21.00 $24.00 $27.00 $29.00 $24.00 $27.00 $ $38.00 $43.00 $46.00 $49.00 $43.00 $46.00 $ $13.00 $14.00 $15.00 $15.00 $14.00 $15.00 $ TC $24.00 $29.00 $31.00 $34.00 $29.00 $31.00 $ $43.00 $46.00 $49.00 $53.00 $46.00 $49.00 $ $13.00 $14.00 $15.00 $15.00 $14.00 $15.00 $ TC $29.00 $32.00 $35.00 $38.00 $32.00 $35.00 $ $49.00 $57.00 $61.00 $65.00 $57.00 $61.00 $ $16.00 $16.00 $17.00 $17.00 $16.00 $17.00 $ TC $33.00 $40.00 $44.00 $48.00 $40.00 $44.00 $ $35.00 $37.00 $40.00 $43.00 $37.00 $40.00 $ $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $ TC $24.00 $26.00 $29.00 $32.00 $26.00 $29.00 $ $38.00 $41.00 $44.00 $47.00 $41.00 $44.00 $ $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $26.00 $30.00 $32.00 $35.00 $30.00 $32.00 $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 249

250 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $59.00 $61.00 $63.00 $66.00 $61.00 $63.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $63.00 $65.00 $67.00 $70.00 $65.00 $67.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $70.00 $73.00 $76.00 $79.00 $73.00 $76.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $75.00 $77.00 $80.00 $83.00 $77.00 $80.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $88.00 $91.00 $95.00 $98.00 $91.00 $95.00 $ TC $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $92.00 $96.00 $ $ $96.00 $ $ TC $ $ $ $ $ $ $ $62.00 $71.00 $76.00 $81.00 $71.00 $76.00 $ $22.00 $24.00 $24.00 $25.00 $24.00 $24.00 $ TC $38.00 $47.00 $52.00 $56.00 $47.00 $52.00 $ $22.00 $26.00 $28.00 $30.00 $26.00 $28.00 $ $7.00 $8.00 $8.00 $9.00 $8.00 $8.00 $ TC $15.00 $18.00 $19.00 $21.00 $18.00 $19.00 $ $34.00 $39.00 $42.00 $46.00 $39.00 $42.00 $ $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $22.00 $28.00 $31.00 $33.00 $28.00 $31.00 $ $49.00 $56.00 $60.00 $65.00 $56.00 $60.00 $ $16.00 $16.00 $16.00 $17.00 $16.00 $16.00 $ TC $33.00 $40.00 $44.00 $48.00 $40.00 $44.00 $ $61.00 $70.00 $76.00 $81.00 $70.00 $76.00 $ $18.00 $19.00 $20.00 $21.00 $19.00 $20.00 $ TC $42.00 $51.00 $55.00 $60.00 $51.00 $55.00 $ $40.00 $36.00 $38.00 $41.00 $36.00 $38.00 $ $17.00 $12.00 $12.00 $13.00 $12.00 $12.00 $ TC $24.00 $24.00 $26.00 $28.00 $24.00 $26.00 $ $36.00 $38.00 $41.00 $44.00 $38.00 $41.00 $ $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $24.00 $26.00 $29.00 $32.00 $26.00 $29.00 $ $39.00 $42.00 $46.00 $49.00 $42.00 $46.00 $ $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $28.00 $31.00 $34.00 $37.00 $31.00 $34.00 $ $45.00 $50.00 $54.00 $58.00 $50.00 $54.00 $ $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $34.00 $39.00 $42.00 $46.00 $39.00 $42.00 $46.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 250

251 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $36.00 $39.00 $42.00 $45.00 $39.00 $42.00 $ $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $24.00 $28.00 $30.00 $33.00 $28.00 $30.00 $ $39.00 $49.00 $52.00 $56.00 $49.00 $52.00 $ $14.00 $15.00 $15.00 $16.00 $15.00 $15.00 $ TC $24.00 $34.00 $37.00 $40.00 $34.00 $37.00 $ $36.00 $41.00 $44.00 $48.00 $41.00 $44.00 $ $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $24.00 $30.00 $33.00 $36.00 $30.00 $33.00 $ $50.00 $58.00 $62.00 $67.00 $58.00 $62.00 $ $16.00 $16.00 $16.00 $17.00 $16.00 $16.00 $ TC $34.00 $42.00 $46.00 $50.00 $42.00 $46.00 $ $64.00 $75.00 $80.00 $86.00 $75.00 $80.00 $ $18.00 $19.00 $20.00 $21.00 $19.00 $20.00 $ TC $44.00 $55.00 $60.00 $65.00 $55.00 $60.00 $ $45.00 $52.00 $56.00 $61.00 $52.00 $56.00 $ $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $33.00 $41.00 $44.00 $48.00 $41.00 $44.00 $ $ $ $ $ $ $ $ $59.00 $61.00 $63.00 $66.00 $61.00 $63.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $62.00 $64.00 $66.00 $69.00 $64.00 $66.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $65.00 $68.00 $70.00 $73.00 $68.00 $70.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $59.00 $61.00 $63.00 $66.00 $61.00 $63.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $62.00 $64.00 $67.00 $69.00 $64.00 $67.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $65.00 $68.00 $70.00 $73.00 $68.00 $70.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $59.00 $61.00 $63.00 $66.00 $61.00 $63.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $62.00 $64.00 $66.00 $69.00 $64.00 $66.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $65.00 $68.00 $70.00 $73.00 $68.00 $70.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $82.00 $85.00 $88.00 $91.00 $85.00 $88.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $99.00 $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 251

252 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $82.00 $85.00 $88.00 $91.00 $85.00 $88.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $98.00 $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $76.00 $78.00 $81.00 $85.00 $78.00 $81.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $92.00 $95.00 $98.00 $ $95.00 $98.00 $ TC $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $94.00 $94.00 $98.00 $ $94.00 $98.00 $ TC $ $ $ $ $ $ $ $29.00 $29.00 $31.00 $34.00 $29.00 $31.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $19.00 $20.00 $22.00 $24.00 $20.00 $22.00 $ $35.00 $42.00 $45.00 $48.00 $42.00 $45.00 $ $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $ TC $24.00 $31.00 $34.00 $36.00 $31.00 $34.00 $ $ $ $ $ $ $ $ $94.00 $96.00 $ $ $96.00 $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $56.00 $58.00 $60.00 $62.00 $58.00 $60.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $59.00 $62.00 $64.00 $66.00 $62.00 $64.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $62.00 $64.00 $66.00 $69.00 $64.00 $66.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $74.00 $77.00 $80.00 $83.00 $77.00 $80.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $84.00 $92.00 $95.00 $99.00 $92.00 $95.00 $ TC $ $ $ $ $ $ $ $1, $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 252

253 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $95.00 $96.00 $99.00 $ $96.00 $99.00 $ TC $ $ $ $ $ $ $ $29.00 $31.00 $34.00 $36.00 $31.00 $34.00 $ $9.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $19.00 $22.00 $24.00 $26.00 $22.00 $24.00 $ $33.00 $38.00 $41.00 $44.00 $38.00 $41.00 $ $9.00 $10.00 $10.00 $11.00 $10.00 $10.00 $ TC $22.00 $28.00 $31.00 $33.00 $28.00 $31.00 $ $30.00 $33.00 $36.00 $39.00 $33.00 $36.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $21.00 $24.00 $26.00 $29.00 $24.00 $26.00 $ $ $ $ $ $ $ $ NC $48.00 $49.00 $51.00 $48.00 $49.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $47.00 $49.00 $50.00 $47.00 $49.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $44.00 $45.00 $47.00 $44.00 $45.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $70.00 $73.00 $76.00 $70.00 $73.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $38.00 $40.00 $41.00 $38.00 $40.00 $ TC NC $85.00 $95.00 $ $85.00 $95.00 $ $ $ $ $ $ $ $ NC $60.00 $62.00 $65.00 $60.00 $62.00 $ TC NC $ $ $ $ $ $ BR BR BR BR BR BR $73.00 $76.00 $80.00 $73.00 $76.00 $ TC BR BR BR BR BR BR BR BR BR BR BR BR $75.00 $77.00 $81.00 $75.00 $77.00 $ TC BR BR BR BR BR BR $ $ $ $ $ $ $ NC $45.00 $46.00 $49.00 $45.00 $46.00 $ TC NC $ $ $ $ $ $ $28.00 $30.00 $32.00 $34.00 $30.00 $32.00 $ $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $ TC $19.00 $21.00 $23.00 $25.00 $21.00 $23.00 $ $29.00 $31.00 $33.00 $35.00 $31.00 $33.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $19.00 $22.00 $24.00 $25.00 $22.00 $24.00 $ $26.00 $26.00 $28.00 $30.00 $26.00 $28.00 $ $7.00 $8.00 $8.00 $9.00 $8.00 $8.00 $ TC $17.00 $18.00 $20.00 $21.00 $18.00 $20.00 $21.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 253

254 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $31.00 $33.00 $36.00 $39.00 $33.00 $36.00 $ $9.00 $10.00 $10.00 $10.00 $10.00 $10.00 $ TC $21.00 $24.00 $26.00 $28.00 $24.00 $26.00 $ $68.00 $ $ $ $ $ $ NC $29.00 $30.00 $31.00 $29.00 $30.00 $ TC NC $89.00 $97.00 $ $89.00 $97.00 $ $35.00 $39.00 $42.00 $46.00 $39.00 $42.00 $ $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $ TC $24.00 $28.00 $31.00 $34.00 $28.00 $31.00 $ $30.00 $33.00 $36.00 $39.00 $33.00 $36.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $21.00 $24.00 $26.00 $28.00 $24.00 $26.00 $ $27.00 $29.00 $31.00 $34.00 $29.00 $31.00 $ $7.00 $8.00 $8.00 $9.00 $8.00 $8.00 $ TC $19.00 $21.00 $23.00 $25.00 $21.00 $23.00 $ $30.00 $36.00 $39.00 $43.00 $36.00 $39.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $21.00 $27.00 $30.00 $32.00 $27.00 $30.00 $ $74.00 $ $ $ $ $ $ NC $29.00 $30.00 $31.00 $29.00 $30.00 $ TC NC $81.00 $89.00 $97.00 $81.00 $89.00 $ $28.00 $30.00 $32.00 $34.00 $30.00 $32.00 $ $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $ TC $19.00 $21.00 $23.00 $25.00 $21.00 $23.00 $ $27.00 $30.00 $32.00 $35.00 $30.00 $32.00 $ $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $ TC $18.00 $22.00 $24.00 $25.00 $22.00 $24.00 $ $29.00 $35.00 $37.00 $40.00 $35.00 $37.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $19.00 $26.00 $28.00 $30.00 $26.00 $28.00 $ $54.00 $ $ $ $ $ $ NC $28.00 $29.00 $30.00 $28.00 $29.00 $ TC NC $79.00 $86.00 $94.00 $79.00 $86.00 $ $27.00 $29.00 $31.00 $34.00 $29.00 $31.00 $ $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $ TC $18.00 $21.00 $23.00 $24.00 $21.00 $23.00 $ $29.00 $33.00 $35.00 $38.00 $33.00 $35.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $19.00 $24.00 $26.00 $28.00 $24.00 $26.00 $ $22.00 $29.00 $31.00 $33.00 $29.00 $31.00 $ $7.00 $7.00 $7.00 $8.00 $7.00 $7.00 $ TC $15.00 $22.00 $24.00 $26.00 $22.00 $24.00 $ $ $ $ $ $ $ $ $56.00 $58.00 $60.00 $62.00 $58.00 $60.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $59.00 $61.00 $63.00 $66.00 $61.00 $63.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $63.00 $64.00 $66.00 $69.00 $64.00 $66.00 $69.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 254

255 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $94.00 $96.00 $ $ $96.00 $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $68.00 $71.00 $74.00 $77.00 $71.00 $74.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $82.00 $86.00 $89.00 $92.00 $86.00 $89.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $78.00 $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $68.00 $71.00 $74.00 $77.00 $71.00 $74.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $82.00 $86.00 $89.00 $92.00 $86.00 $89.00 $ TC $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $92.00 $91.00 $94.00 $99.00 $91.00 $94.00 $ TC $ $ $ $ $ $ $ $27.00 $28.00 $30.00 $32.00 $28.00 $30.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $17.00 $19.00 $21.00 $22.00 $19.00 $21.00 $ $32.00 $39.00 $42.00 $45.00 $39.00 $42.00 $ $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $ TC $21.00 $28.00 $30.00 $33.00 $28.00 $30.00 $ $38.00 $43.00 $46.00 $49.00 $43.00 $46.00 $ $12.00 $14.00 $14.00 $15.00 $14.00 $14.00 $ TC $24.00 $29.00 $32.00 $35.00 $29.00 $32.00 $ $84.00 $ $ $ $ $ $ NC $29.00 $30.00 $31.00 $29.00 $30.00 $ TC NC $81.00 $89.00 $97.00 $81.00 $89.00 $ $ $14.00 $15.00 $16.00 $16.00 $15.00 $16.00 $ TC $ $ $98.00 $ $ $98.00 $ $ NC $30.00 $31.00 $32.00 $30.00 $31.00 $ TC NC $68.00 $75.00 $82.00 $68.00 $75.00 $ $30.00 $33.00 $35.00 $38.00 $33.00 $35.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $21.00 $23.00 $26.00 $28.00 $23.00 $26.00 $ $29.00 $31.00 $33.00 $35.00 $31.00 $33.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $19.00 $22.00 $24.00 $25.00 $22.00 $24.00 $ $31.00 $37.00 $39.00 $43.00 $37.00 $39.00 $43.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 255

256 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $9.00 $10.00 $10.00 $10.00 $10.00 $10.00 $ TC $21.00 $27.00 $29.00 $32.00 $27.00 $29.00 $ $35.00 $41.00 $44.00 $48.00 $41.00 $44.00 $ $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $22.00 $30.00 $33.00 $36.00 $30.00 $33.00 $ $28.00 $32.00 $34.00 $36.00 $32.00 $34.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $18.00 $22.00 $24.00 $26.00 $22.00 $24.00 $ $84.00 $ $ $ $ $ $ NC $29.00 $30.00 $31.00 $29.00 $30.00 $ TC NC $ $ $ $ $ $ $29.00 $30.00 $32.00 $35.00 $30.00 $32.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $19.00 $21.00 $23.00 $24.00 $21.00 $23.00 $ $27.00 $29.00 $31.00 $34.00 $29.00 $31.00 $ $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $ TC $18.00 $21.00 $23.00 $24.00 $21.00 $23.00 $ $29.00 $33.00 $35.00 $38.00 $33.00 $35.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $19.00 $24.00 $26.00 $28.00 $24.00 $26.00 $ $72.00 $ $ $ $ $ $ NC $29.00 $30.00 $31.00 $29.00 $30.00 $ TC NC $84.00 $92.00 $ $84.00 $92.00 $ $27.00 $29.00 $31.00 $33.00 $29.00 $31.00 $ $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $ TC $18.00 $20.00 $22.00 $24.00 $20.00 $22.00 $ $29.00 $33.00 $35.00 $38.00 $33.00 $35.00 $ $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $19.00 $24.00 $26.00 $28.00 $24.00 $26.00 $ $26.00 $29.00 $31.00 $33.00 $29.00 $31.00 $ $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $ TC $17.00 $20.00 $22.00 $24.00 $20.00 $22.00 $ $22.00 $28.00 $30.00 $32.00 $28.00 $30.00 $ $7.00 $7.00 $7.00 $8.00 $7.00 $7.00 $ TC $15.00 $21.00 $23.00 $25.00 $21.00 $23.00 $ $ $ $ $ $ $ $ $56.00 $58.00 $60.00 $62.00 $58.00 $60.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $61.00 $62.00 $64.00 $66.00 $62.00 $64.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $62.00 $64.00 $67.00 $69.00 $64.00 $67.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $98.00 $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $68.00 $71.00 $74.00 $77.00 $71.00 $74.00 $ TC $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 256

257 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $ $ $ $ $ $ $ $82.00 $86.00 $89.00 $92.00 $86.00 $89.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $78.00 $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $68.00 $71.00 $74.00 $77.00 $71.00 $74.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $82.00 $86.00 $89.00 $92.00 $86.00 $89.00 $ TC $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $92.00 $96.00 $ $ $96.00 $ $ TC $ $ $ $ $ $ $ $29.00 $29.00 $31.00 $33.00 $29.00 $31.00 $ $9.00 $10.00 $10.00 $10.00 $10.00 $10.00 $ TC $19.00 $19.00 $21.00 $23.00 $19.00 $21.00 $ $33.00 $40.00 $43.00 $46.00 $40.00 $43.00 $ $11.00 $12.00 $13.00 $13.00 $12.00 $13.00 $ TC $21.00 $28.00 $30.00 $33.00 $28.00 $30.00 $ $37.00 $43.00 $46.00 $49.00 $43.00 $46.00 $ $13.00 $14.00 $15.00 $15.00 $14.00 $15.00 $ TC $22.00 $29.00 $31.00 $34.00 $29.00 $31.00 $ $44.00 $51.00 $55.00 $59.00 $51.00 $55.00 $ $16.00 $17.00 $17.00 $18.00 $17.00 $17.00 $ TC $28.00 $35.00 $38.00 $41.00 $35.00 $38.00 $ $ $ $ $ $ $ $ $60.00 $63.00 $65.00 $68.00 $63.00 $65.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $65.00 $68.00 $70.00 $73.00 $68.00 $70.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $71.00 $74.00 $77.00 $80.00 $74.00 $77.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $98.00 $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $85.00 $77.00 $80.00 $83.00 $77.00 $80.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $88.00 $92.00 $95.00 $99.00 $92.00 $95.00 $ TC $ $ $ $ $ $ $ $1, $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 257

258 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $92.00 $96.00 $99.00 $ $96.00 $99.00 $ TC $ $ $ $ $ $ $ $73.00 $ $ $ $ $ $ NC $25.00 $26.00 $27.00 $25.00 $26.00 $ TC NC $ $ $ $ $ $ $63.00 $79.00 $85.00 $91.00 $79.00 $85.00 $ $18.00 $19.00 $20.00 $21.00 $19.00 $20.00 $ TC $44.00 $59.00 $65.00 $70.00 $59.00 $65.00 $ $68.00 $88.00 $94.00 $ $88.00 $94.00 $ $23.00 $25.00 $26.00 $27.00 $25.00 $26.00 $ TC $44.00 $63.00 $69.00 $74.00 $63.00 $69.00 $ $77.00 $93.00 $99.00 $ $93.00 $99.00 $ $27.00 $28.00 $29.00 $30.00 $28.00 $29.00 $ TC $48.00 $65.00 $71.00 $76.00 $65.00 $71.00 $ $ NC $64.00 $66.00 $69.00 $64.00 $66.00 $ TC NC BR BR BR BR BR BR $91.00 $ $ $ $ $ $ $35.00 $37.00 $38.00 $40.00 $37.00 $38.00 $ TC $55.00 $74.00 $81.00 $87.00 $74.00 $81.00 $ $91.00 $ $ $ $ $ $ $35.00 $36.00 $38.00 $39.00 $36.00 $38.00 $ TC $56.00 $80.00 $87.00 $94.00 $80.00 $87.00 $ $ $ $ $ $ $ $ $46.00 $48.00 $50.00 $52.00 $48.00 $50.00 $ TC $89.00 $ $ $ $ $ $ $97.00 $ $ $ $ $ $ $35.00 $37.00 $38.00 $40.00 $37.00 $38.00 $ TC $61.00 $89.00 $97.00 $ $89.00 $97.00 $ $99.00 $ $ $ $ $ $ $35.00 $37.00 $38.00 $40.00 $37.00 $38.00 $ TC $63.00 $93.00 $ $ $93.00 $ $ $ $ $ $ $ $ $ $46.00 $48.00 $50.00 $52.00 $48.00 $50.00 $ TC $96.00 $ $ $ $ $ $ $73.00 $ $ $ $ $ $ $23.00 $25.00 $26.00 $27.00 $25.00 $26.00 $ TC $48.00 $75.00 $82.00 $88.00 $75.00 $82.00 $ $85.00 $ $ $ $ $ $ $34.00 $37.00 $38.00 $40.00 $37.00 $38.00 $ TC $48.00 $ $ $ $ $ $ $82.00 $ $ $ $ $ $ $25.00 $26.00 $27.00 $28.00 $26.00 $27.00 $ TC $56.00 $92.00 $99.00 $ $92.00 $99.00 $ $ $ $ $ $ $ $ $35.00 $37.00 $38.00 $40.00 $37.00 $38.00 $ TC $64.00 $93.00 $ $ $93.00 $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 258

259 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $50.00 $52.00 $54.00 $56.00 $52.00 $54.00 $ TC $84.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $95.00 $93.00 $ $ $93.00 $ $ $44.00 $63.00 $68.00 $72.00 $63.00 $68.00 $ $16.00 $17.00 $17.00 $18.00 $17.00 $17.00 $ TC $28.00 $46.00 $50.00 $54.00 $46.00 $50.00 $ $26.00 $49.00 $53.00 $56.00 $49.00 $53.00 $ $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $ TC $15.00 $39.00 $42.00 $44.00 $39.00 $42.00 $ $ NC $19.00 $20.00 $21.00 $19.00 $20.00 $ TC NC BR BR BR BR BR BR BR NC $11.00 $11.00 $12.00 $11.00 $11.00 $ TC NC BR BR BR BR BR BR $ NC $23.00 $23.00 $24.00 $23.00 $23.00 $ TC NC BR BR BR BR BR BR $ $ $ $ $ $ $ NC $29.00 $30.00 $31.00 $29.00 $30.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $37.00 $39.00 $40.00 $37.00 $39.00 $ TC NC $95.00 $ $ $95.00 $ $ $ NC $38.00 $39.00 $40.00 $38.00 $39.00 $ TC NC BR BR BR BR BR BR $ NC $38.00 $39.00 $40.00 $38.00 $39.00 $ TC NC BR BR BR BR BR BR $ NC $48.00 $49.00 $51.00 $48.00 $49.00 $ TC NC BR BR BR BR BR BR $ NC $29.00 $30.00 $31.00 $29.00 $30.00 $ TC NC BR BR BR BR BR BR $ NC $40.00 $41.00 $43.00 $40.00 $41.00 $ TC NC BR BR BR BR BR BR $ NC $30.00 $31.00 $32.00 $30.00 $31.00 $ TC NC BR BR BR BR BR BR $ NC $47.00 $48.00 $50.00 $47.00 $48.00 $ TC NC BR BR BR BR BR BR $89.00 $ $ $ $ $ $ $24.00 $26.00 $27.00 $28.00 $26.00 $27.00 $ TC $63.00 $87.00 $95.00 $ $87.00 $95.00 $ CPT only 2008 American Medical Association. All rights reserved. Part C, 259

260 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $98.00 $ $ $ $ $ $ $24.00 $26.00 $27.00 $28.00 $26.00 $27.00 $ TC $72.00 $94.00 $ $ $94.00 $ $ $ $ $ $ $ $ $ $24.00 $26.00 $27.00 $28.00 $26.00 $27.00 $ TC $79.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $18.00 $20.00 $21.00 $21.00 $20.00 $21.00 $ TC $97.00 $ $ $ $ $ $ $68.00 $ $ $ $ $ $ NC $20.00 $21.00 $21.00 $20.00 $21.00 $ TC NC $ $ $ $ $ $ $48.00 $78.00 $84.00 $90.00 $78.00 $84.00 $ NC $17.00 $18.00 $19.00 $17.00 $18.00 $ TC NC $61.00 $66.00 $71.00 $61.00 $66.00 $ $62.00 $85.00 $91.00 $97.00 $85.00 $91.00 $ NC $20.00 $21.00 $22.00 $20.00 $21.00 $ TC NC $65.00 $70.00 $76.00 $65.00 $70.00 $ $ $ $ $ $ $ $ NC $62.00 $65.00 $68.00 $62.00 $65.00 $ TC NC $ $ $ $ $ $ $60.00 $ $ $ $ $ $ NC $18.00 $19.00 $20.00 $18.00 $19.00 $ TC NC $ $ $ $ $ $ $75.00 $96.00 $ $ $96.00 $ $ NC $18.00 $19.00 $20.00 $18.00 $19.00 $ TC NC $78.00 $85.00 $92.00 $78.00 $85.00 $ $74.00 $ $ $ $ $ $ NC $28.00 $29.00 $30.00 $28.00 $29.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $29.00 $30.00 $31.00 $29.00 $30.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $29.00 $30.00 $31.00 $29.00 $30.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $29.00 $31.00 $32.00 $29.00 $31.00 $ TC NC $ $ $ $ $ $ $57.00 $53.00 $57.00 $62.00 $53.00 $57.00 $ $17.00 $18.00 $19.00 $20.00 $18.00 $19.00 $ TC $39.00 $35.00 $38.00 $42.00 $35.00 $38.00 $ $68.00 $82.00 $89.00 $95.00 $82.00 $89.00 $ NC $20.00 $21.00 $22.00 $20.00 $21.00 $ TC NC $62.00 $68.00 $73.00 $62.00 $68.00 $ $ NC $32.00 $34.00 $35.00 $32.00 $34.00 $ TC NC BR BR BR BR BR BR $88.00 $ $ $ $ $ $ $32.00 $33.00 $34.00 $36.00 $33.00 $34.00 $36.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 260

261 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC $55.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $28.00 $29.00 $30.00 $28.00 $29.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $62.00 $65.00 $67.00 $62.00 $65.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $61.00 $64.00 $66.00 $61.00 $64.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $99.00 $ $ $99.00 $ $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $ $ $ $ $ $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $80.00 $83.00 $86.00 $80.00 $83.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $71.00 $73.00 $77.00 $71.00 $73.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $70.00 $73.00 $76.00 $70.00 $73.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 261

262 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA NC $90.00 $93.00 $97.00 $90.00 $93.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $72.00 $75.00 $79.00 $72.00 $75.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $89.00 $92.00 $95.00 $89.00 $92.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $71.00 $73.00 $77.00 $71.00 $73.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $89.00 $92.00 $96.00 $89.00 $92.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $70.00 $73.00 $76.00 $70.00 $73.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $ $ $ $ $ $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $62.00 $65.00 $68.00 $62.00 $65.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $71.00 $73.00 $77.00 $71.00 $73.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $62.00 $65.00 $67.00 $62.00 $65.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $84.00 $86.00 $89.00 $84.00 $86.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $60.00 $62.00 $65.00 $60.00 $62.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $63.00 $65.00 $68.00 $63.00 $65.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $74.00 $76.00 $79.00 $74.00 $76.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $62.00 $64.00 $67.00 $62.00 $64.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $70.00 $72.00 $75.00 $70.00 $72.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $88.00 $91.00 $95.00 $88.00 $91.00 $ TC NC $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 262

263 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $ $ $ $ $ $ $ NC $60.00 $62.00 $65.00 $60.00 $62.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $64.00 $67.00 $69.00 $64.00 $67.00 $ TC NC $ $ $ $ $ $ $80.00 $ $ $ $ $ $ NC $20.00 $21.00 $21.00 $20.00 $21.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $97.00 $ $ $97.00 $ $ TC NC $81.00 $88.00 $95.00 $81.00 $88.00 $ $ $ $ $ $ $ $ NC $45.00 $47.00 $50.00 $45.00 $47.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $62.00 $64.00 $66.00 $62.00 $64.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $43.00 $45.00 $47.00 $43.00 $45.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $62.00 $64.00 $66.00 $62.00 $64.00 $ TC NC $ $ $ $ $ $ $54.00 $82.00 $88.00 $93.00 $82.00 $88.00 $ NC $24.00 $25.00 $26.00 $24.00 $25.00 $ TC NC $58.00 $63.00 $67.00 $58.00 $63.00 $ $ $2, $2, $2, $2, $2, $2, NC $60.00 $62.00 $64.00 $60.00 $62.00 $ TC NC $1, $2, $2, $1, $2, $2, $72.00 $ $ $ $ $ $ NC $38.00 $39.00 $41.00 $38.00 $39.00 $ TC NC $76.00 $82.00 $88.00 $76.00 $82.00 $ $ $ $ $ $ $ $ NC $56.00 $58.00 $61.00 $56.00 $58.00 $ TC NC $89.00 $97.00 $ $89.00 $97.00 $ $ $ $ $ $ $ $ NC $61.00 $64.00 $67.00 $61.00 $64.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $60.00 $62.00 $64.00 $60.00 $62.00 $ TC NC $ $ $ $ $ $ $54.00 $ $ $ $ $ $ NC $60.00 $62.00 $65.00 $60.00 $62.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $80.00 $83.00 $87.00 $80.00 $83.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $61.00 $63.00 $66.00 $61.00 $63.00 $66.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 263

264 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $79.00 $82.00 $85.00 $79.00 $82.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $62.00 $64.00 $66.00 $62.00 $64.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $61.00 $63.00 $65.00 $61.00 $63.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $67.00 $71.00 $76.00 $67.00 $71.00 $ TC NC $ $ $ $ $ $ $72.00 $ $ $ $ $ $ NC $38.00 $39.00 $40.00 $38.00 $39.00 $ TC NC $80.00 $87.00 $93.00 $80.00 $87.00 $ $ $ $ $ $ $ $ NC $76.00 $79.00 $82.00 $76.00 $79.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $77.00 $80.00 $83.00 $77.00 $80.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $60.00 $62.00 $65.00 $60.00 $62.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $60.00 $62.00 $65.00 $60.00 $62.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $29.00 $30.00 $31.00 $29.00 $30.00 $ TC NC $ $ $ $ $ $ $ NC $70.00 $73.00 $77.00 $70.00 $73.00 $ TC NC BR BR BR BR BR BR $ NC $70.00 $72.00 $75.00 $70.00 $72.00 $ TC NC BR BR BR BR BR BR $ $ $ $ $ $ $ $84.00 $88.00 $91.00 $95.00 $88.00 $91.00 $ TC $39.00 $ $ $ $ $ $ $ NC $26.00 $27.00 $29.00 $26.00 $27.00 $ TC NC BR BR BR BR BR BR $98.00 $ $ $ $ $ $ NC $26.00 $27.00 $28.00 $26.00 $27.00 $ TC NC $ $ $ $ $ $ $93.00 $ $ $ $ $ $ NC $21.00 $21.00 $22.00 $21.00 $21.00 $ TC NC $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 264

265 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA NC $30.00 $31.00 $33.00 $30.00 $31.00 $ TC NC BR BR BR BR BR BR $ $ $ $ $ $ $ NC $23.00 $24.00 $25.00 $23.00 $24.00 $ TC NC $ $ $ $ $ $ $ NC $23.00 $24.00 $26.00 $23.00 $24.00 $ TC NC BR BR BR BR BR BR BR NC $ $ $ $ $ $ TC NC BR BR BR BR BR BR BR NC $75.00 $79.00 $84.00 $75.00 $79.00 $ TC NC BR BR BR BR BR BR BR NC $ $ $ $ $ $ TC NC BR BR BR BR BR BR BR BR BR BR BR BR $ $ $ $ $ $ TC BR BR BR BR BR BR BR BR BR BR BR BR $ $ $ $ $ $ TC BR BR BR BR BR BR BR BR BR BR BR BR $ $ $ $ $ $ TC BR BR BR BR BR BR BR BR BR BR BR BR $ $ $ $ $ $ TC BR BR BR BR BR BR $ $ $ $ $ $ $ NC $45.00 $47.00 $49.00 $45.00 $47.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $ $ $ $ $ $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $29.00 $31.00 $32.00 $29.00 $31.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $20.00 $21.00 $22.00 $20.00 $21.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $72.00 $75.00 $78.00 $72.00 $75.00 $ TC NC $ $ $ $ $ $ $ $ $ $ $ $ $ NC $20.00 $21.00 $22.00 $20.00 $21.00 $ TC NC $ $ $ $ $ $ $ NC $44.00 $46.00 $48.00 $44.00 $46.00 $ TC NC BR BR BR BR BR BR CPT only 2008 American Medical Association. All rights reserved. Part C, 265

266 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $ $ $ $ $ $ $ NC $28.00 $29.00 $30.00 $28.00 $29.00 $ TC NC $ $ $ $ $ $ $ NC $77.00 $79.00 $82.00 $77.00 $79.00 $ TC NC BR BR BR BR BR BR $ NC $77.00 $79.00 $82.00 $77.00 $79.00 $ TC NC BR BR BR BR BR BR $ $ $ $ $ $ $ NC $38.00 $39.00 $40.00 $38.00 $39.00 $ TC NC $85.00 $93.00 $ $85.00 $93.00 $ $ $ $ $ $ $ $ NC $63.00 $65.00 $68.00 $63.00 $65.00 $ TC NC $ $ $ $ $ $ $ NC $30.00 $31.00 $33.00 $30.00 $31.00 $ TC NC BR BR BR BR BR BR $ NC $20.00 $21.00 $21.00 $20.00 $21.00 $ TC NC BR BR BR BR BR BR $ NC $72.00 $75.00 $78.00 $72.00 $75.00 $ TC NC BR BR BR BR BR BR $ NC $70.00 $72.00 $75.00 $70.00 $72.00 $ TC NC BR BR BR BR BR BR $ NC $19.00 $20.00 $21.00 $19.00 $20.00 $ TC NC BR BR BR BR BR BR $58.00 $92.00 $ $ $92.00 $ $ $8.00 $9.00 $9.00 $10.00 $9.00 $9.00 $ TC $48.00 $83.00 $90.00 $97.00 $83.00 $90.00 $ $ $34.00 $37.00 $39.00 $41.00 $37.00 $39.00 $ TC $ $67.00 $71.00 $75.00 $81.00 $71.00 $75.00 $ NC $29.00 $30.00 $31.00 $29.00 $30.00 $ TC NC $42.00 $46.00 $50.00 $42.00 $46.00 $ $23.00 $23.00 $25.00 $27.00 $23.00 $25.00 $ $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $ TC $15.00 $15.00 $16.00 $17.00 $15.00 $16.00 $ $77.00 $ $ $ $ $ $ $30.00 $31.00 $32.00 $34.00 $31.00 $32.00 $ TC $46.00 $78.00 $84.00 $90.00 $78.00 $84.00 $ $94.00 $ $ $ $ $ $ $36.00 $31.00 $32.00 $33.00 $31.00 $32.00 $ TC $59.00 $ $ $ $ $ $ $95.00 $ $ $ $ $ $ $30.00 $30.00 $31.00 $33.00 $30.00 $31.00 $33.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 266

267 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC $65.00 $ $ $ $ $ $ $ $79.00 $85.00 $91.00 $79.00 $85.00 $ $56.00 $20.00 $21.00 $22.00 $20.00 $21.00 $ TC $ $59.00 $64.00 $69.00 $59.00 $64.00 $ $ $17.00 $15.00 $16.00 $16.00 $15.00 $16.00 $ TC $ $ $15.00 $23.00 $25.00 $27.00 $23.00 $25.00 $ BR $ $ $ $ $ $ $12.00 $12.00 $13.00 $12.00 $12.00 $ TC $98.00 $ $ $98.00 $ $ $ $ $ $ $ $ $45.00 $47.00 $50.00 $45.00 $47.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $50.00 $51.00 $53.00 $55.00 $51.00 $53.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $71.00 $72.00 $74.00 $77.00 $72.00 $74.00 $ TC $ $ $ $ $ $ $ BR BR TC BR $91.00 $ $ $91.00 $ $ BR BR TC BR $ $ $ $ $ $ BR BR TC BR $ $ $ $ $ $ BR BR TC BR $88.00 $ $ $ $ $ $ $33.00 $35.00 $37.00 $40.00 $35.00 $37.00 $ TC $53.00 $64.00 $70.00 $75.00 $64.00 $70.00 $ $ $ $ $ $ $ $83.00 $85.00 $87.00 $83.00 $85.00 $ TC $81.00 $87.00 $94.00 $81.00 $87.00 $ $96.00 $ $ $ $ $ $ $48.00 $51.00 $52.00 $54.00 $51.00 $52.00 $ TC $48.00 $64.00 $70.00 $76.00 $64.00 $70.00 $ $96.00 $ $ $ $ $ $ $36.00 $51.00 $52.00 $53.00 $51.00 $52.00 $ TC $60.00 $58.00 $64.00 $70.00 $58.00 $64.00 $ $96.00 $97.00 $ $ $97.00 $ $ $36.00 $36.00 $37.00 $38.00 $36.00 $37.00 $ TC $60.00 $62.00 $68.00 $74.00 $62.00 $68.00 $ $13.00 $14.00 $15.00 $13.00 $14.00 $15.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 267

268 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $10.00 $10.00 $11.00 $10.00 $10.00 $ TC $4.00 $4.00 $5.00 $4.00 $4.00 $ $99.00 $77.00 $82.00 $87.00 $77.00 $82.00 $ $37.00 $29.00 $30.00 $31.00 $29.00 $30.00 $ TC $63.00 $48.00 $52.00 $57.00 $48.00 $52.00 $ $88.00 $81.00 $86.00 $92.00 $81.00 $86.00 $ $31.00 $29.00 $30.00 $31.00 $29.00 $30.00 $ TC $53.00 $51.00 $56.00 $61.00 $51.00 $56.00 $ $86.00 $77.00 $82.00 $88.00 $77.00 $82.00 $ $31.00 $31.00 $32.00 $33.00 $31.00 $32.00 $ TC $53.00 $46.00 $50.00 $55.00 $46.00 $50.00 $ $83.00 $ $ $ $ $ $ $31.00 $29.00 $30.00 $31.00 $29.00 $30.00 $ TC $54.00 $82.00 $89.00 $96.00 $82.00 $89.00 $ $78.00 $91.00 $97.00 $ $91.00 $97.00 $ $28.00 $29.00 $30.00 $31.00 $29.00 $30.00 $ TC $48.00 $62.00 $68.00 $73.00 $62.00 $68.00 $ $69.00 $91.00 $97.00 $ $91.00 $97.00 $ $31.00 $28.00 $29.00 $30.00 $28.00 $29.00 $ TC $40.00 $62.00 $68.00 $73.00 $62.00 $68.00 $ $ $ $ $ $ $ $ $42.00 $43.00 $44.00 $46.00 $43.00 $44.00 $ TC $73.00 $ $ $ $ $ $ $84.00 $ $ $ $ $ $ $30.00 $32.00 $33.00 $34.00 $32.00 $33.00 $ TC $53.00 $75.00 $81.00 $88.00 $75.00 $81.00 $ $ $ $ $ $ $ $ $38.00 $39.00 $40.00 $42.00 $39.00 $40.00 $ TC $73.00 $98.00 $ $ $98.00 $ $ $84.00 $ $ $ $ $ $ $30.00 $31.00 $32.00 $34.00 $31.00 $32.00 $ TC $53.00 $76.00 $83.00 $89.00 $76.00 $83.00 $ $ $ $ $ $ $ $40.00 $41.00 $43.00 $40.00 $41.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $61.00 $57.00 $59.00 $61.00 $57.00 $59.00 $ TC $54.00 $73.00 $79.00 $85.00 $73.00 $79.00 $ $93.00 $ $ $ $ $ $ $51.00 $52.00 $53.00 $55.00 $52.00 $53.00 $ TC $42.00 $91.00 $99.00 $ $91.00 $99.00 $ $73.00 $86.00 $93.00 $ $86.00 $93.00 $ $43.00 $44.00 $46.00 $48.00 $44.00 $46.00 $ TC $30.00 $42.00 $47.00 $53.00 $42.00 $47.00 $ $ $ $ $ $ $ $ $51.00 $52.00 $53.00 $55.00 $52.00 $53.00 $ TC $79.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $51.00 $53.00 $55.00 $51.00 $53.00 $ TC $ $61.00 $69.00 $78.00 $61.00 $69.00 $78.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 268

269 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $94.00 $94.00 $97.00 $ $94.00 $97.00 $ TC $51.00 $69.00 $77.00 $88.00 $69.00 $77.00 $ $ $ $ $ $ $ $62.00 $65.00 $67.00 $62.00 $65.00 $ TC $80.00 $88.00 $96.00 $80.00 $88.00 $ $93.00 $ $ $93.00 $ $ $51.00 $53.00 $55.00 $51.00 $53.00 $ TC $42.00 $48.00 $54.00 $42.00 $48.00 $ $88.00 $98.00 $ $ $98.00 $ $ $33.00 $34.00 $35.00 $37.00 $34.00 $35.00 $ TC $53.00 $64.00 $70.00 $76.00 $64.00 $70.00 $ $72.00 $ $ $ $ $ $ $30.00 $45.00 $46.00 $48.00 $45.00 $46.00 $ TC $41.00 $64.00 $70.00 $75.00 $64.00 $70.00 $ $96.00 $ $ $ $ $ $ $39.00 $39.00 $40.00 $42.00 $39.00 $40.00 $ TC $57.00 $64.00 $70.00 $75.00 $64.00 $70.00 $ $ $ $ $ $ $ $ $40.00 $55.00 $57.00 $60.00 $55.00 $57.00 $ TC $60.00 $75.00 $82.00 $89.00 $75.00 $82.00 $ $ $ $ $ $ $ $ $40.00 $41.00 $42.00 $43.00 $41.00 $42.00 $ TC $60.00 $65.00 $71.00 $78.00 $65.00 $71.00 $ $74.00 $80.00 $88.00 $74.00 $80.00 $ $27.00 $28.00 $29.00 $27.00 $28.00 $ TC $47.00 $52.00 $58.00 $47.00 $52.00 $ $ $ $ $ $ $ $37.00 $39.00 $40.00 $37.00 $39.00 $ TC $72.00 $79.00 $86.00 $72.00 $79.00 $ $ $ $ $ $ $ $ $65.00 $88.00 $90.00 $94.00 $88.00 $90.00 $ TC $73.00 $ $ $ $ $ $ $71.00 $ $ $ $ $ $ $46.00 $43.00 $44.00 $46.00 $43.00 $44.00 $ TC $27.00 $64.00 $69.00 $74.00 $64.00 $69.00 $ $97.00 $89.00 $96.00 $ $89.00 $96.00 $ $35.00 $30.00 $31.00 $32.00 $30.00 $31.00 $ TC $65.00 $59.00 $65.00 $72.00 $59.00 $65.00 $ $72.00 $66.00 $71.00 $76.00 $66.00 $71.00 $ $29.00 $30.00 $31.00 $32.00 $30.00 $31.00 $ TC $42.00 $36.00 $40.00 $44.00 $36.00 $40.00 $ $93.00 $ $ $ $ $ $ $35.00 $36.00 $38.00 $39.00 $36.00 $38.00 $ TC $57.00 $86.00 $94.00 $ $86.00 $94.00 $ $95.00 $ $ $ $ $ $ $37.00 $37.00 $39.00 $40.00 $37.00 $39.00 $40.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 269

270 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC $57.00 $86.00 $93.00 $ $86.00 $93.00 $ $93.00 $ $ $ $ $ $ $35.00 $36.00 $38.00 $39.00 $36.00 $38.00 $ TC $57.00 $86.00 $94.00 $ $86.00 $94.00 $ $59.00 $84.00 $90.00 $96.00 $84.00 $90.00 $ $19.00 $20.00 $21.00 $22.00 $20.00 $21.00 $ TC $39.00 $64.00 $69.00 $74.00 $64.00 $69.00 $ $90.00 $ $ $ $ $ $ $33.00 $34.00 $35.00 $37.00 $34.00 $35.00 $ TC $57.00 $87.00 $95.00 $ $87.00 $95.00 $ $93.00 $ $ $ $ $ $ $36.00 $37.00 $39.00 $41.00 $37.00 $39.00 $ TC $57.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $68.00 $83.00 $86.00 $90.00 $83.00 $86.00 $ TC $80.00 $ $ $ $ $ $ $85.00 $ $ $ $ $ $ $32.00 $31.00 $32.00 $34.00 $31.00 $32.00 $ TC $54.00 $92.00 $ $ $92.00 $ $ $93.00 $ $ $ $ $ $ NC $37.00 $39.00 $40.00 $37.00 $39.00 $ TC NC $70.00 $77.00 $84.00 $70.00 $77.00 $ $ NC $38.00 $39.00 $40.00 $38.00 $39.00 $ TC NC BR BR BR BR BR BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $41.00 $45.00 $50.00 $41.00 $45.00 $ $17.00 $18.00 $19.00 $17.00 $18.00 $ TC $24.00 $27.00 $31.00 $24.00 $27.00 $ BR BR BR BR BR BR $ $ $ $ $ $ TC BR BR BR BR BR BR $ NC $71.00 $73.00 $76.00 $71.00 $73.00 $ TC NC BR BR BR BR BR BR $92.00 $ $ $ $ $ $ NC $36.00 $37.00 $38.00 $36.00 $37.00 $ TC NC $ $ $ $ $ $ $ NC $35.00 $36.00 $37.00 $35.00 $36.00 $ TC NC BR BR BR BR BR BR $78.00 $63.00 $68.00 $74.00 $63.00 $68.00 $ NC $20.00 $21.00 $21.00 $20.00 $21.00 $ TC NC $43.00 $47.00 $53.00 $43.00 $47.00 $ $77.00 $62.00 $67.00 $74.00 $62.00 $67.00 $ NC $19.00 $20.00 $21.00 $19.00 $20.00 $ TC NC $43.00 $47.00 $53.00 $43.00 $47.00 $ $80.00 $81.00 $86.00 $93.00 $81.00 $86.00 $93.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 270

271 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $30.00 $31.00 $32.00 $33.00 $31.00 $32.00 $ TC $48.00 $50.00 $55.00 $59.00 $50.00 $55.00 $ $ $ $ $ $ $ $ $84.00 $72.00 $75.00 $79.00 $72.00 $75.00 $ TC $ $ $ $ $ $ $ $60.00 $82.00 $88.00 $94.00 $82.00 $88.00 $ $20.00 $21.00 $21.00 $22.00 $21.00 $21.00 $ TC $39.00 $61.00 $66.00 $72.00 $61.00 $66.00 $ $99.00 $ $ $ $ $ $ NC $44.00 $45.00 $47.00 $44.00 $45.00 $ TC NC $ $ $ $ $ $ $34.00 $24.00 $27.00 $30.00 $24.00 $27.00 $ $3.00 $3.00 $3.00 $4.00 $3.00 $3.00 $ TC $31.00 $21.00 $23.00 $26.00 $21.00 $23.00 $ BR BR BR BR BR BR $67.00 $71.00 $76.00 $67.00 $71.00 $ TC BR BR BR BR BR BR BR BR TC BR $ $ $ $ $ $ $20.00 $20.00 $21.00 $20.00 $20.00 $ TC $83.00 $90.00 $98.00 $83.00 $90.00 $ $79.00 $84.00 $90.00 $79.00 $84.00 $ $28.00 $28.00 $29.00 $28.00 $28.00 $ TC $51.00 $56.00 $61.00 $51.00 $56.00 $ $72.00 $77.00 $83.00 $72.00 $77.00 $ $30.00 $31.00 $32.00 $30.00 $31.00 $ TC $42.00 $46.00 $51.00 $42.00 $46.00 $ $ $ $ $ $ $ $64.00 $66.00 $68.00 $64.00 $66.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $62.00 $64.00 $66.00 $62.00 $64.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ TC BR BR BR BR BR BR $ $ $ $ $ $ $45.00 $46.00 $48.00 $45.00 $46.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $81.00 $84.00 $88.00 $81.00 $84.00 $ TC $ $ $ $ $ $ BR BR BR BR BR BR $ $ $ $ $ $ TC BR BR BR BR BR BR $ $ $ $ $ $ $85.00 $88.00 $92.00 $85.00 $88.00 $ TC $ $ $ $ $ $ $72.00 $77.00 $83.00 $72.00 $77.00 $83.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 271

272 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $29.00 $30.00 $31.00 $29.00 $30.00 $ TC $43.00 $47.00 $51.00 $43.00 $47.00 $ $16.00 $17.00 $19.00 $16.00 $17.00 $ $4.00 $4.00 $4.00 $4.00 $4.00 $ TC $12.00 $13.00 $14.00 $12.00 $13.00 $ $16.00 $17.00 $19.00 $16.00 $17.00 $ $4.00 $4.00 $4.00 $4.00 $4.00 $ TC $12.00 $13.00 $14.00 $12.00 $13.00 $ $ $ $ $ $ $ $19.00 $20.00 $21.00 $19.00 $20.00 $ TC $82.00 $90.00 $99.00 $82.00 $90.00 $ $ $ $ $ $ $ $24.00 $25.00 $26.00 $24.00 $25.00 $ TC $ $ $ $ $ $ $89.00 $95.00 $ $89.00 $95.00 $ $37.00 $39.00 $40.00 $37.00 $39.00 $ TC $52.00 $56.00 $61.00 $52.00 $56.00 $ $ $ $ $ $ $ $46.00 $48.00 $50.00 $46.00 $48.00 $ TC $66.00 $72.00 $78.00 $66.00 $72.00 $ $90.00 $96.00 $ $90.00 $96.00 $ $37.00 $39.00 $40.00 $37.00 $39.00 $ TC $52.00 $57.00 $62.00 $52.00 $57.00 $ $ $ $1, $ $ $1, $86.00 $89.00 $93.00 $86.00 $89.00 $ TC $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $86.00 $89.00 $93.00 $86.00 $89.00 $ TC $ $1, $1, $ $1, $1, $38.00 $40.00 $43.00 $38.00 $40.00 $ $25.00 $27.00 $29.00 $25.00 $27.00 $ $10.00 $10.00 $11.00 $10.00 $10.00 $ TC $15.00 $17.00 $18.00 $15.00 $17.00 $ $44.00 $48.00 $51.00 $44.00 $48.00 $ $15.00 $15.00 $16.00 $15.00 $15.00 $ TC $30.00 $33.00 $36.00 $30.00 $33.00 $ $73.00 $78.00 $84.00 $73.00 $78.00 $ $24.00 $25.00 $26.00 $24.00 $25.00 $ TC $48.00 $53.00 $57.00 $48.00 $53.00 $ $ $ $ $ $ $ $29.00 $30.00 $31.00 $29.00 $30.00 $ TC $74.00 $81.00 $88.00 $74.00 $81.00 $ $53.00 $57.00 $62.00 $53.00 $57.00 $ $16.00 $17.00 $18.00 $16.00 $17.00 $ TC $36.00 $40.00 $44.00 $36.00 $40.00 $ $90.00 $97.00 $ $90.00 $97.00 $ $13.00 $13.00 $14.00 $13.00 $13.00 $ TC $77.00 $84.00 $90.00 $77.00 $84.00 $ $87.00 $94.00 $ $87.00 $94.00 $ $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 272

273 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC $76.00 $82.00 $88.00 $76.00 $82.00 $ $89.00 $97.00 $ $89.00 $97.00 $ $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $78.00 $86.00 $94.00 $78.00 $86.00 $ $37.00 $40.00 $44.00 $37.00 $40.00 $ $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $26.00 $29.00 $31.00 $26.00 $29.00 $ $36.00 $39.00 $42.00 $36.00 $39.00 $ $9.00 $9.00 $10.00 $9.00 $9.00 $ TC $27.00 $30.00 $33.00 $27.00 $30.00 $ $34.00 $37.00 $41.00 $34.00 $37.00 $ $11.00 $11.00 $11.00 $11.00 $11.00 $ TC $24.00 $26.00 $29.00 $24.00 $26.00 $ $ $ $ $ $ $ $84.00 $87.00 $90.00 $84.00 $87.00 $ TC $ $ $ $ $ $ $73.00 $75.00 $77.00 $81.00 $75.00 $77.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $36.00 $37.00 $39.00 $41.00 $37.00 $39.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $53.00 $55.00 $57.00 $59.00 $55.00 $57.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $79.00 $82.00 $85.00 $89.00 $82.00 $85.00 $ TC $ $ $ $ $ $ $ $1, $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ TC $1, $ $ $ $ $ $ BR BR TC BR $87.00 $83.00 $88.00 $95.00 $83.00 $88.00 $ $36.00 $33.00 $34.00 $35.00 $33.00 $34.00 $ TC $52.00 $50.00 $55.00 $59.00 $50.00 $55.00 $ $1, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ TC $1, $1, $1, $2, $1, $1, $2, $ $94.00 $ $ $94.00 $ $ $36.00 $37.00 $39.00 $41.00 $37.00 $39.00 $ TC $69.00 $57.00 $62.00 $69.00 $57.00 $62.00 $ $ $ $ $ $ $ $ $53.00 $55.00 $57.00 $59.00 $55.00 $57.00 $ TC $87.00 $72.00 $79.00 $87.00 $72.00 $79.00 $ $ $ $ $ $ $ $ $79.00 $82.00 $85.00 $89.00 $82.00 $85.00 $ TC $99.00 $92.00 $ $ $92.00 $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 273

274 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $48.00 $50.00 $52.00 $55.00 $50.00 $52.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $47.00 $49.00 $51.00 $53.00 $49.00 $51.00 $ TC $88.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $71.00 $73.00 $76.00 $79.00 $73.00 $76.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $64.00 $67.00 $70.00 $74.00 $67.00 $70.00 $ $45.00 $46.00 $47.00 $49.00 $46.00 $47.00 $ TC $18.00 $21.00 $23.00 $25.00 $21.00 $23.00 $ $78.00 $86.00 $93.00 $99.00 $86.00 $93.00 $ $27.00 $29.00 $30.00 $31.00 $29.00 $30.00 $ TC $50.00 $58.00 $63.00 $68.00 $58.00 $63.00 $ $ $93.00 $ $ $93.00 $ $ $43.00 $44.00 $46.00 $48.00 $44.00 $46.00 $ TC $70.00 $49.00 $54.00 $60.00 $49.00 $54.00 $ $ $ $ $ $ $ $ $63.00 $65.00 $67.00 $70.00 $65.00 $67.00 $ TC $ $ $ $ $ $ $ $ $91.00 $ $ $91.00 $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $1, $ $ $1, $1, $1, $1, $1, $1, $1, BR BR TC BR $66.00 $51.00 $56.00 $62.00 $51.00 $56.00 $ $66.00 $ $ $ $ $ $ $66.00 $ $ $ $ $ $ $66.00 $ $ $ $ $ $ $66.00 $ $ $ $ $ $ $78.00 $ $ $ $ $ $ $78.00 $ $ $ $ $ $ $78.00 $ $ $ $ $ $ $78.00 $ $ $ $ $ $ $87.00 $ $ $ $ $ $ $87.00 $ $ $ $ $ $ $87.00 $ $ $ $ $ $ $87.00 $ $ $ $ $ $ $21.00 $21.00 $23.00 $26.00 $21.00 $23.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $21.00 $21.00 $22.00 $21.00 $21.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 274

275 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $ $ $ $ $ $ $ $ $ $ $ $ $ $95.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ BR BR TC BR BR BR BR BR $ $ $ $ $ $ $ $80.00 $82.00 $85.00 $89.00 $82.00 $85.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $79.00 $79.00 $82.00 $86.00 $79.00 $82.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $80.00 $88.00 $93.00 $ $88.00 $93.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $49.00 $88.00 $95.00 $ $88.00 $95.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $93.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $82.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 275

276 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC $ $ $ $ $ $ $ $74.00 $ $ $ $ $ $ $57.00 $61.00 $63.00 $66.00 $61.00 $63.00 $ TC $16.00 $42.00 $45.00 $48.00 $42.00 $45.00 $ $72.00 $88.00 $93.00 $97.00 $88.00 $93.00 $ $53.00 $55.00 $57.00 $59.00 $55.00 $57.00 $ TC $18.00 $33.00 $36.00 $38.00 $33.00 $36.00 $ BR BR TC BR $46.00 $68.00 $73.00 $79.00 $68.00 $73.00 $ $9.00 $10.00 $10.00 $11.00 $10.00 $10.00 $ TC $36.00 $58.00 $63.00 $68.00 $58.00 $63.00 $ $62.00 $87.00 $94.00 $ $87.00 $94.00 $ $12.00 $14.00 $14.00 $15.00 $14.00 $14.00 $ TC $48.00 $73.00 $80.00 $86.00 $73.00 $80.00 $ $54.00 $75.00 $81.00 $87.00 $75.00 $81.00 $ $17.00 $17.00 $18.00 $18.00 $17.00 $18.00 $ TC $36.00 $58.00 $63.00 $68.00 $58.00 $63.00 $ $ $ $ $ $ $ $ $24.00 $26.00 $26.00 $27.00 $26.00 $26.00 $ TC $89.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $25.00 $26.00 $27.00 $28.00 $26.00 $27.00 $ TC $96.00 $ $ $ $ $ $ $89.00 $ $ $ $ $ $ $19.00 $21.00 $21.00 $22.00 $21.00 $21.00 $ TC $68.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $22.00 $24.00 $25.00 $26.00 $24.00 $25.00 $ TC $90.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $34.00 $36.00 $37.00 $38.00 $36.00 $37.00 $ TC $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $42.00 $43.00 $44.00 $46.00 $43.00 $44.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $44.00 $46.00 $48.00 $50.00 $46.00 $48.00 $ TC $ $ $ $ $ $ $ $35.00 $97.00 $ $ $97.00 $ $ $30.00 $32.00 $33.00 $34.00 $32.00 $33.00 $ TC $5.00 $66.00 $73.00 $80.00 $66.00 $73.00 $ $ $ $ $ $ $ $ $36.00 $44.00 $45.00 $47.00 $44.00 $45.00 $ TC $68.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $38.00 $39.00 $40.00 $42.00 $39.00 $40.00 $ TC $ $ $ $ $ $ $ BR CPT only 2008 American Medical Association. All rights reserved. Part C, 276

277 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA BR TC BR $ $ $ $ $ $ $ $28.00 $29.00 $30.00 $31.00 $29.00 $30.00 $ TC $77.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $39.00 $40.00 $41.00 $43.00 $40.00 $41.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $41.00 $42.00 $44.00 $45.00 $42.00 $44.00 $ TC $ $ $ $ $ $ $ $45.00 $74.00 $79.00 $85.00 $74.00 $79.00 $ $9.00 $10.00 $11.00 $11.00 $10.00 $11.00 $ TC $35.00 $63.00 $68.00 $74.00 $63.00 $68.00 $ $ $ $ $ $ $ $ $11.00 $12.00 $12.00 $13.00 $12.00 $12.00 $ TC $96.00 $ $ $ $ $ $ $78.00 $93.00 $ $ $93.00 $ $ $11.00 $12.00 $13.00 $13.00 $12.00 $13.00 $ TC $65.00 $81.00 $88.00 $96.00 $81.00 $88.00 $ $ $ $ $ $ $ $ $16.00 $17.00 $17.00 $18.00 $17.00 $17.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $22.00 $24.00 $25.00 $26.00 $24.00 $25.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $32.00 $33.00 $34.00 $35.00 $33.00 $34.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $33.00 $34.00 $35.00 $37.00 $34.00 $35.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $31.00 $33.00 $34.00 $35.00 $33.00 $34.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $20.00 $21.00 $22.00 $23.00 $21.00 $22.00 $ TC $88.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $57.00 $58.00 $60.00 $63.00 $58.00 $60.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $31.00 $33.00 $34.00 $35.00 $33.00 $34.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $49.00 $64.00 $67.00 $69.00 $64.00 $67.00 $ TC $ $ $ $ $ $ $ BR BR TC BR CPT only 2008 American Medical Association. All rights reserved. Part C, 277

278 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $ $ $ $ $ $ $ $22.00 $23.00 $24.00 $25.00 $23.00 $24.00 $ TC $88.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $26.00 $27.00 $28.00 $29.00 $27.00 $28.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $36.00 $38.00 $39.00 $40.00 $38.00 $39.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $46.00 $51.00 $53.00 $55.00 $51.00 $53.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $24.00 $26.00 $27.00 $28.00 $26.00 $27.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $29.00 $30.00 $31.00 $32.00 $30.00 $31.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $24.00 $26.00 $26.00 $27.00 $26.00 $26.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $43.00 $45.00 $46.00 $48.00 $45.00 $46.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $23.00 $24.00 $25.00 $26.00 $24.00 $25.00 $ TC $82.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $27.00 $27.00 $28.00 $29.00 $27.00 $28.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $23.00 $25.00 $26.00 $27.00 $25.00 $26.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $38.00 $39.00 $41.00 $42.00 $39.00 $41.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $36.00 $37.00 $38.00 $40.00 $37.00 $38.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $35.00 $36.00 $37.00 $38.00 $36.00 $37.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $40.00 $41.00 $43.00 $44.00 $41.00 $43.00 $ TC $ $ $ $ $ $ $ BR BR $68.00 $84.00 $91.00 $99.00 $84.00 $91.00 $ $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $ TC $58.00 $73.00 $80.00 $87.00 $73.00 $80.00 $87.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 278

279 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $72.00 $85.00 $92.00 $ $85.00 $92.00 $ $10.00 $11.00 $11.00 $11.00 $11.00 $11.00 $ TC $61.00 $75.00 $81.00 $89.00 $75.00 $81.00 $ $ $ $ $ $ $ $ $14.00 $14.00 $14.00 $15.00 $14.00 $14.00 $ TC $87.00 $93.00 $ $ $93.00 $ $ $ $ $ $ $ $ $ $50.00 $52.00 $54.00 $56.00 $52.00 $54.00 $ TC $ $ $ $ $ $ $ BR $ $ $ $ $ $ $19.00 $20.00 $21.00 $22.00 $20.00 $21.00 $ TC BR $ $ $ $ $ $ $ $ $ $ $ $ $ $35.00 $36.00 $38.00 $39.00 $36.00 $38.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $45.00 $47.00 $48.00 $50.00 $47.00 $48.00 $ TC $ $ $ $ $ $ $ BR BR TC BR $ $ $ $ $ $ $ $32.00 $33.00 $34.00 $36.00 $33.00 $34.00 $ TC $93.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $42.00 $44.00 $46.00 $48.00 $44.00 $46.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $44.00 $46.00 $48.00 $50.00 $46.00 $48.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $52.00 $54.00 $56.00 $58.00 $54.00 $56.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $53.00 $55.00 $57.00 $59.00 $55.00 $57.00 $ TC $ $ $ $ $ $ $ $40.00 $38.00 $41.00 $44.00 $38.00 $41.00 $ $11.00 $11.00 $11.00 $12.00 $11.00 $11.00 $ TC $29.00 $27.00 $30.00 $33.00 $27.00 $30.00 $ $23.00 $15.00 $15.00 $16.00 $15.00 $15.00 $ BR BR TC BR BR $23.00 $25.00 $26.00 $27.00 $25.00 $26.00 $ TC BR $ $ $ $ $ $ $ $41.00 $43.00 $45.00 $47.00 $43.00 $45.00 $ TC $84.00 $ $ $ $ $ $ $97.00 $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 279

280 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $28.00 $26.00 $27.00 $28.00 $26.00 $27.00 $ TC $69.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $49.00 $53.00 $55.00 $57.00 $53.00 $55.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $39.00 $40.00 $41.00 $43.00 $40.00 $41.00 $ TC $99.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $46.00 $48.00 $49.00 $51.00 $48.00 $49.00 $ TC $ $ $ $ $ $ $ BR $1, $1, $1, $1, $1, $1, $ $82.00 $84.00 $87.00 $82.00 $84.00 $ TC BR $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $44.00 $46.00 $48.00 $50.00 $46.00 $48.00 $ TC $88.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $82.00 $66.00 $68.00 $70.00 $66.00 $68.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $56.00 $60.00 $62.00 $64.00 $60.00 $62.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $75.00 $81.00 $84.00 $87.00 $81.00 $84.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $36.00 $38.00 $39.00 $40.00 $38.00 $39.00 $ TC $97.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $41.00 $44.00 $46.00 $47.00 $44.00 $46.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $47.00 $51.00 $52.00 $54.00 $51.00 $52.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $50.00 $53.00 $55.00 $57.00 $53.00 $55.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $75.00 $81.00 $83.00 $87.00 $81.00 $83.00 $ TC $ $ $ $ $ $ $ $91.00 $77.00 $83.00 $90.00 $77.00 $83.00 $ $32.00 $29.00 $30.00 $31.00 $29.00 $30.00 $ TC $58.00 $48.00 $53.00 $58.00 $48.00 $53.00 $ $91.00 $67.00 $73.00 $79.00 $67.00 $73.00 $ $32.00 $19.00 $20.00 $21.00 $19.00 $20.00 $ TC $58.00 $48.00 $53.00 $58.00 $48.00 $53.00 $ $ $ $ $ $ $ $ $51.00 $55.00 $57.00 $59.00 $55.00 $57.00 $ TC $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 280

281 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $ $ $ $ $ $ $ $77.00 $83.00 $86.00 $89.00 $83.00 $86.00 $ TC $ $ $ $ $ $ $ BR $1, $1, $1, $1, $1, $1, $85.00 $83.00 $86.00 $89.00 $83.00 $86.00 $ TC BR $1, $1, $1, $1, $1, $1, BR $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ TC BR $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $59.00 $66.00 $68.00 $71.00 $66.00 $68.00 $ TC $ $ $ $ $ $ $ $92.00 $ $ $ $ $ $ $24.00 $28.00 $28.00 $30.00 $28.00 $28.00 $ TC $66.00 $ $ $ $ $ $ BR BR TC BR $ $ $ $ $ $ $ $38.00 $39.00 $41.00 $42.00 $39.00 $41.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $50.00 $52.00 $54.00 $56.00 $52.00 $54.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $36.00 $58.00 $60.00 $62.00 $58.00 $60.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $20.00 $21.00 $22.00 $23.00 $21.00 $22.00 $ TC $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $24.00 $26.00 $27.00 $28.00 $26.00 $27.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $53.00 $58.00 $60.00 $62.00 $58.00 $60.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $20.00 $21.00 $22.00 $23.00 $21.00 $22.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $24.00 $26.00 $26.00 $27.00 $26.00 $26.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $27.00 $28.00 $29.00 $30.00 $28.00 $29.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $65.00 $66.00 $68.00 $71.00 $66.00 $68.00 $ TC $ $ $ $ $ $ $ BR BR CPT only 2008 American Medical Association. All rights reserved. Part C, 281

282 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC BR $ $ $ $ $ $ $ $22.00 $23.00 $24.00 $25.00 $23.00 $24.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $26.00 $27.00 $28.00 $29.00 $27.00 $28.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $27.00 $28.00 $29.00 $30.00 $28.00 $29.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $45.00 $34.00 $35.00 $36.00 $34.00 $35.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $64.00 $65.00 $67.00 $70.00 $65.00 $67.00 $ TC $ $ $ $ $ $ $ BR $1, $1, $1, $1, $1, $1, $79.00 $81.00 $84.00 $79.00 $81.00 $ TC $1, $1, $1, $1, $1, $1, BR $78.00 $81.00 $84.00 $78.00 $81.00 $ $78.00 $81.00 $84.00 $78.00 $81.00 $ TC BR BR BR BR BR BR $74.00 $ $ $ $ $ $ $15.00 $17.00 $17.00 $18.00 $17.00 $17.00 $ TC $59.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $35.00 $36.00 $37.00 $39.00 $36.00 $37.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $32.00 $33.00 $34.00 $35.00 $33.00 $34.00 $ TC $95.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $29.00 $30.00 $31.00 $32.00 $30.00 $31.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $46.00 $47.00 $49.00 $51.00 $47.00 $49.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $31.00 $33.00 $34.00 $35.00 $33.00 $34.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $27.00 $28.00 $29.00 $30.00 $28.00 $29.00 $ TC $79.00 $ $ $ $ $ $ BR BR TC BR $ $ $ $ $ $ $ $22.00 $24.00 $25.00 $26.00 $24.00 $25.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 282

283 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $24.00 $26.00 $27.00 $28.00 $26.00 $27.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $49.00 $51.00 $53.00 $55.00 $51.00 $53.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $61.00 $64.00 $67.00 $69.00 $64.00 $67.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $68.00 $75.00 $77.00 $80.00 $75.00 $77.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $34.00 $35.00 $36.00 $37.00 $35.00 $36.00 $ TC $ $ $ $ $ $ $ $87.00 $ $ $ $ $ $ $19.00 $20.00 $21.00 $22.00 $20.00 $21.00 $ TC $66.00 $86.00 $94.00 $ $86.00 $94.00 $ $73.00 $82.00 $89.00 $96.00 $82.00 $89.00 $ $18.00 $10.00 $11.00 $12.00 $10.00 $11.00 $ TC $55.00 $71.00 $78.00 $84.00 $71.00 $78.00 $ $ $ $ $ $ $ $ $29.00 $30.00 $31.00 $33.00 $30.00 $31.00 $ TC $79.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $36.00 $38.00 $39.00 $40.00 $38.00 $39.00 $ TC $ $ $ $ $ $ $ BR BR TC BR $ $ $ $ $ $ $ $34.00 $35.00 $37.00 $39.00 $35.00 $37.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $40.00 $43.00 $45.00 $47.00 $43.00 $45.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $44.00 $46.00 $47.00 $49.00 $46.00 $47.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $56.00 $58.00 $60.00 $63.00 $58.00 $60.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $56.00 $58.00 $60.00 $56.00 $58.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $38.00 $39.00 $40.00 $41.00 $39.00 $40.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $44.00 $46.00 $47.00 $49.00 $46.00 $47.00 $ TC $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 283

284 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $ $ $ $ $ $ $ $57.00 $58.00 $59.00 $62.00 $58.00 $59.00 $ TC $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $85.00 $88.00 $93.00 $85.00 $88.00 $ TC $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ TC $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ TC $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ TC $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ TC $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ TC $1, $1, $1, $1, $1, $1, BR BR TC BR $ $ $ $ $ $ $95.00 $98.00 $ $95.00 $98.00 $ TC $85.00 $94.00 $ $85.00 $94.00 $ $ $ $ $ $ $ $ $ $ $ $ $ TC $88.00 $97.00 $ $88.00 $97.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $97.00 $91.00 $ $ $91.00 $ $ BR $83.00 $89.00 $93.00 $98.00 $89.00 $93.00 $ TC BR $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $97.00 $83.00 $91.00 $ $83.00 $91.00 $ BR BR BR BR BR BR $ $ $ $ $ $ TC BR BR BR BR BR BR BR BR TC BR G $40.00 $43.00 $47.00 $40.00 $43.00 $47.00 G $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 284

285 Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA G0130-TC $29.00 $31.00 $34.00 $29.00 $31.00 $34.00 G $ $ $ $ $ $ G $37.00 $38.00 $40.00 $37.00 $38.00 $40.00 G0202-TC $ $ $ $ $ $ G $ $ $ $ $ $ G $46.00 $48.00 $50.00 $46.00 $48.00 $50.00 G0204-TC $ $ $ $ $ $ G $ $ $ $ $ $ G $37.00 $38.00 $40.00 $37.00 $38.00 $40.00 G0206-TC $91.00 $99.00 $ $91.00 $99.00 $ G $15.00 $15.00 $16.00 $15.00 $15.00 $16.00 G $15.00 $15.00 $16.00 $15.00 $15.00 $16.00 G $ $ $ $ $ $ G $ $ $ $ $ $ G $14.00 $14.00 $15.00 $14.00 $14.00 $15.00 G0365-TC $ $ $ $ $ $ G $ $ $ $ $ $ G $31.00 $32.00 $34.00 $31.00 $32.00 $34.00 G0389-TC $92.00 $ $ $92.00 $ $ Q $16.00 $18.00 $19.00 $16.00 $18.00 $19.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 285

286 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 286

287 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 287

288 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 288

289 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 289

290 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $34.00 $22.00 $23.00 $24.00 $20.00 $21.00 $ $ TC BR $72.00 $68.00 $70.00 $73.00 $67.00 $69.00 $ $ TC BR $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 290

291 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 291

292 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 292

293 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR $ CPT only 2008 American Medical Association. All rights reserved. Part C, 293

294 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 294

295 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 295

296 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 296

297 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 297

298 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 298

299 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 299

300 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 300

301 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 301

302 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $6.00 $20.00 $20.00 $21.00 $20.00 $20.00 $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 302

303 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 303

304 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 304

305 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 305

306 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 306

307 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $11.00 $19.00 $20.00 $20.00 $19.00 $20.00 $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 307

308 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 308

309 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 309

310 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $8.00 $20.00 $20.00 $21.00 $20.00 $20.00 $ TC $ BR BR BR BR BR BR $20.00 $20.00 $21.00 $20.00 $20.00 $ TC BR BR BR BR BR BR $ $10.00 $20.00 $20.00 $21.00 $20.00 $20.00 $21.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 310

311 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $11.00 $21.00 $21.00 $22.00 $21.00 $21.00 $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 311

312 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 312

313 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 313

314 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 314

315 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR CPT only 2008 American Medical Association. All rights reserved. Part C, 315

316 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ BR BR TC BR $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ BR BR CPT only 2008 American Medical Association. All rights reserved. Part C, 316

317 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC BR $25.00 $24.00 $25.00 $26.00 $24.00 $25.00 $ $ TC $ $59.00 $99.00 $ $ $51.00 $52.00 $ $ TC BR $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 317

318 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 318

319 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR $ $ TC $ $ $ TC $ $ $2.00 $20.00 $20.00 $21.00 $20.00 $20.00 $ TC $ $21.00 $23.00 $24.00 $21.00 $23.00 $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 319

320 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $5.00 $20.00 $21.00 $21.00 $20.00 $21.00 $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 320

321 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 321

322 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $91.00 $52.00 $54.00 $55.00 $50.00 $52.00 $ $ TC $ $91.00 $53.00 $55.00 $57.00 $50.00 $52.00 $ $ TC $ $79.00 $53.00 $55.00 $57.00 $51.00 $52.00 $ $ TC $ $ $ TC $ BR BR TC BR $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 322

323 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $8.00 $20.00 $20.00 $21.00 $20.00 $20.00 $ TC $ $ $8.00 $20.00 $21.00 $21.00 $20.00 $21.00 $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR CPT only 2008 American Medical Association. All rights reserved. Part C, 323

324 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $19.00 $20.00 $21.00 $21.00 $20.00 $21.00 $ TC $ $ $16.00 $20.00 $20.00 $21.00 $20.00 $20.00 $ TC $ $ $19.00 $23.00 $23.00 $24.00 $23.00 $23.00 $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $18.00 $20.00 $20.00 $21.00 $20.00 $20.00 $ TC $ BR BR BR BR BR BR $20.00 $20.00 $21.00 $20.00 $20.00 $21.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 324

325 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC BR BR BR BR BR BR BR BR TC BR $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 325

326 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $6.00 $7.00 $8.00 $6.00 $7.00 $ $17.00 $9.00 $10.00 $12.00 $9.00 $10.00 $ $ TC $ $13.00 $10.00 $11.00 $12.00 $10.00 $11.00 $ $ TC $ $13.00 $9.00 $10.00 $11.00 $9.00 $10.00 $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 326

327 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 327

328 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 328

329 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 329

330 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 330

331 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 331

332 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 332

333 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 333

334 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 334

335 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 335

336 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $8.00 $19.00 $20.00 $20.00 $19.00 $20.00 $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 336

337 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $3.00 $20.00 $21.00 $21.00 $20.00 $21.00 $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR CPT only 2008 American Medical Association. All rights reserved. Part C, 337

338 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ BR BR TC BR $ $ TC $ BR BR TC BR $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 338

339 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 339

340 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 340

341 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 341

342 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 342

343 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 343

344 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 344

345 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $ BR BR TC BR BR BR TC BR BR BR TC BR $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ BR BR TC BR $1, $ TC $ $ $ TC $ BR BR TC BR $ $ TC BR $ $ TC BR $ $ TC BR $ $ TC BR $ CPT only 2008 American Medical Association. All rights reserved. Part C, 345

346 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ TC BR $ $ TC BR $ $ TC BR $ $ TC BR $1, $1, TC BR BR BR TC BR BR BR TC BR $49.00 $63.00 $67.00 $70.00 $63.00 $67.00 $ $37.00 $30.00 $31.00 $32.00 $30.00 $31.00 $ TC $10.00 $33.00 $36.00 $39.00 $33.00 $36.00 $ $54.00 $80.00 $84.00 $89.00 $80.00 $84.00 $ $16.00 $30.00 $31.00 $32.00 $30.00 $31.00 $ TC $38.00 $50.00 $54.00 $57.00 $50.00 $54.00 $ $74.00 $ $ $ $ $ $ $57.00 $41.00 $42.00 $44.00 $41.00 $42.00 $ TC $15.00 $60.00 $64.00 $68.00 $60.00 $64.00 $ $59.00 $76.00 $80.00 $85.00 $76.00 $80.00 $ $47.00 $30.00 $31.00 $32.00 $30.00 $31.00 $ TC $11.00 $46.00 $50.00 $53.00 $46.00 $50.00 $ $ $ $ $ $ $ $61.00 $62.00 $64.00 $61.00 $62.00 $ TC $53.00 $57.00 $61.00 $53.00 $57.00 $ $70.00 $20.00 $21.00 $23.00 $20.00 $21.00 $ $20.00 $13.00 $14.00 $14.00 $13.00 $14.00 $ TC $48.00 $7.00 $8.00 $8.00 $7.00 $8.00 $ $ $ TC $ $ $ TC $ $33.00 $27.00 $28.00 $29.00 $27.00 $28.00 $ NC BR BR BR BR BR BR TC NC BR BR BR BR BR BR $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 346

347 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $ TC $ $ NC BR BR BR BR BR BR TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $45.00 $55.00 $58.00 $62.00 $55.00 $58.00 $ $14.00 $26.00 $27.00 $28.00 $26.00 $27.00 $ TC $24.00 $29.00 $31.00 $33.00 $29.00 $31.00 $ $64.00 $60.00 $64.00 $67.00 $60.00 $64.00 $ $19.00 $27.00 $28.00 $29.00 $27.00 $28.00 $ TC $37.00 $33.00 $36.00 $39.00 $33.00 $36.00 $ $77.00 $82.00 $87.00 $91.00 $82.00 $87.00 $ $22.00 $41.00 $42.00 $44.00 $41.00 $42.00 $ TC $53.00 $41.00 $45.00 $48.00 $41.00 $45.00 $ $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $70.00 $55.00 $58.00 $61.00 $55.00 $58.00 $ $54.00 $32.00 $33.00 $34.00 $32.00 $33.00 $ TC $14.00 $23.00 $25.00 $27.00 $23.00 $25.00 $ $95.00 $ $ $ $ $ $ $95.00 $73.00 $75.00 $78.00 $73.00 $75.00 $78.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 347

348 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $26.00 $67.00 $72.00 $77.00 $67.00 $72.00 $ BR BR TC BR BR BR TC BR $88.00 $ $ $ $ $ $ $33.00 $39.00 $41.00 $42.00 $39.00 $41.00 $ TC $54.00 $72.00 $77.00 $83.00 $72.00 $77.00 $ $75.00 $81.00 $86.00 $75.00 $81.00 $ $43.00 $47.00 $50.00 $43.00 $47.00 $ $67.00 $69.00 $70.00 $67.00 $69.00 $ $83.00 $85.00 $86.00 $83.00 $85.00 $ $ $ $ $ $ $ BR BR TC BR $ $ TC $ $ $ TC $ $ $ TC $ $ $ TC $ $24.00 $24.00 $26.00 $28.00 $24.00 $26.00 $ $19.00 $5.00 $5.00 $5.00 $5.00 $5.00 $ TC $5.00 $19.00 $21.00 $22.00 $19.00 $21.00 $ $53.00 $52.00 $56.00 $59.00 $52.00 $56.00 $ $42.00 $7.00 $8.00 $8.00 $7.00 $8.00 $ TC $11.00 $45.00 $48.00 $52.00 $45.00 $48.00 $ $70.00 $64.00 $69.00 $73.00 $64.00 $69.00 $ $54.00 $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $14.00 $53.00 $57.00 $61.00 $53.00 $57.00 $ $ $ $ $ $ $ $ $86.00 $40.00 $41.00 $43.00 $40.00 $41.00 $ TC $21.00 $70.00 $75.00 $80.00 $70.00 $75.00 $ $ $ $ $ $ $ $ $ $85.00 $88.00 $91.00 $85.00 $88.00 $ TC $41.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $64.00 $ $ $ $ $ $ $23.00 $19.00 $20.00 $21.00 $19.00 $20.00 $ $19.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 348

349 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA TC $4.00 $7.00 $7.00 $8.00 $7.00 $7.00 $ $23.00 $97.00 $ $ $97.00 $ $ $7.00 $28.00 $29.00 $30.00 $28.00 $29.00 $ TC $16.00 $68.00 $73.00 $77.00 $68.00 $73.00 $ $23.00 $73.00 $78.00 $82.00 $73.00 $78.00 $ $7.00 $13.00 $13.00 $13.00 $13.00 $13.00 $ TC $16.00 $60.00 $65.00 $69.00 $60.00 $65.00 $ $21.00 $98.00 $ $ $98.00 $ $ $6.00 $24.00 $25.00 $26.00 $24.00 $25.00 $ TC $15.00 $74.00 $79.00 $84.00 $74.00 $79.00 $ $33.00 $ $ $ $ $ $ $14.00 $23.00 $23.00 $24.00 $23.00 $23.00 $ TC $18.00 $85.00 $91.00 $97.00 $85.00 $91.00 $ $26.00 $ $ $ $ $ $ $13.00 $28.00 $29.00 $30.00 $28.00 $29.00 $ TC $14.00 $ $ $ $ $ $ $43.00 $93.00 $96.00 $99.00 $83.00 $86.00 $ $ TC NC BR BR BR BR BR BR $61.00 $ $ $ $ $ $ $61.00 $91.00 $93.00 $96.00 $91.00 $93.00 $ TC NC $59.00 $64.00 $68.00 $59.00 $64.00 $ $54.00 $ $ $ $ $ $ $ TC NC BR BR BR BR BR BR $51.00 $52.00 $54.00 $56.00 $35.00 $36.00 $ $ TC NC BR BR BR BR BR BR $ $95.00 $99.00 $ $95.00 $99.00 $ $70.00 $64.00 $66.00 $68.00 $64.00 $66.00 $ TC $33.00 $31.00 $34.00 $36.00 $31.00 $34.00 $ $53.00 $43.00 $45.00 $47.00 $43.00 $45.00 $ $36.00 $32.00 $33.00 $34.00 $32.00 $33.00 $ TC $17.00 $11.00 $12.00 $13.00 $11.00 $12.00 $ $97.00 $ $ $97.00 $ $ $65.00 $67.00 $69.00 $65.00 $67.00 $ TC $32.00 $35.00 $38.00 $32.00 $35.00 $ $56.00 $59.00 $62.00 $56.00 $59.00 $ $37.00 $39.00 $40.00 $37.00 $39.00 $ TC $19.00 $21.00 $22.00 $19.00 $21.00 $ $53.00 $ $ $ $ $ $ $36.00 $45.00 $46.00 $48.00 $45.00 $46.00 $ TC $17.00 $57.00 $62.00 $66.00 $57.00 $62.00 $ $96.00 $ $ $ $ $ $ $66.00 $45.00 $47.00 $48.00 $45.00 $47.00 $ TC $28.00 $58.00 $63.00 $67.00 $58.00 $63.00 $ $ $86.00 $90.00 $95.00 $86.00 $90.00 $ $99.00 $44.00 $46.00 $47.00 $44.00 $46.00 $ TC $33.00 $41.00 $45.00 $48.00 $41.00 $45.00 $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 349

350 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $ $80.00 $83.00 $86.00 $80.00 $83.00 $ TC $44.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $41.00 $42.00 $44.00 $41.00 $42.00 $ TC $44.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $80.00 $95.00 $98.00 $ $95.00 $98.00 $ TC $26.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $80.00 $ $ $ $ $ $ TC $26.00 $ $ $ $ $ $ $ $84.00 $90.00 $97.00 $84.00 $90.00 $ $80.00 $52.00 $55.00 $59.00 $52.00 $55.00 $ TC $26.00 $31.00 $35.00 $39.00 $31.00 $35.00 $ $ $ $ $ $ $ $59.00 $61.00 $64.00 $59.00 $61.00 $ TC $64.00 $69.00 $74.00 $64.00 $69.00 $ $ $ $ $ $ $ $65.00 $68.00 $72.00 $65.00 $68.00 $ TC $ $ $ $ $ $ BR $ $ $ $ $ $ BR $ $ $ $ $ $ TC BR $ $ $ $ $ $ $24.00 $ $ $ $ $ $ $24.00 $62.00 $64.00 $66.00 $62.00 $64.00 $ TC BR $93.00 $ $ $93.00 $ $ $ $ $ $ $ $ $66.00 $69.00 $71.00 $66.00 $69.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $72.00 $75.00 $77.00 $72.00 $75.00 $ TC $ $ $ $ $ $ $ $10.00 $19.00 $20.00 $20.00 $19.00 $20.00 $ TC $ $ $11.00 $20.00 $21.00 $21.00 $20.00 $21.00 $ TC $ BR $ $ $ $ $ $ BR $79.00 $81.00 $84.00 $79.00 $81.00 $ TC BR $92.00 $ $ $92.00 $ $ $ $ $ $ $ $ $60.00 $62.00 $65.00 $60.00 $62.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $77.00 $80.00 $83.00 $77.00 $80.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $97.00 $ $ $97.00 $ $ TC $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 350

351 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA BR BR TC BR $ $ $ $64.00 $66.00 $ $ $ TC $ $ $ TC $ BR BR TC BR $ $5.00 $20.00 $21.00 $21.00 $20.00 $21.00 $ TC $ $51.00 $ $ $ $39.00 $40.00 $ $ TC $ $65.00 $ $ $ $32.00 $34.00 $ $ TC $ $ $ TC $ $44.00 $ $ $ $28.00 $29.00 $ $ TC $ $20.00 $ $ $ $16.00 $17.00 $ $ TC $ $37.00 $ $ $ $50.00 $52.00 $ $ TC $ $43.00 $ $ $ $15.00 $16.00 $ $ TC $ $50.00 $ $ $ $51.00 $53.00 $ $ TC $ $56.00 $ $ $ $49.00 $51.00 $ $ TC $ $ $ TC $ $ $ TC $ $17.00 $18.00 $20.00 $17.00 $18.00 $20.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 351

352 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA $5.00 $5.00 $6.00 $5.00 $5.00 $6.00 G $27.00 $28.00 $29.00 $27.00 $28.00 $29.00 G $27.00 $28.00 $29.00 $27.00 $28.00 $29.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 352

353 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $4.00 $22.00 $23.00 $24.00 $22.00 $23.00 $ $4.00 $11.00 $12.00 $12.00 $9.00 $10.00 $ BR $14.00 $15.00 $15.00 $9.00 $10.00 $ BR $10.00 $10.00 $11.00 $8.00 $8.00 $ BR BR BR BR BR BR BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $62.00 $67.00 $69.00 $71.00 $58.00 $60.00 $ $68.00 $74.00 $76.00 $78.00 $66.00 $67.00 $ $94.00 $95.00 $98.00 $ $89.00 $91.00 $ $ $ $ $ $97.00 $99.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $69.00 $72.00 $74.00 $76.00 $64.00 $66.00 $ $77.00 $82.00 $85.00 $87.00 $71.00 $73.00 $ $ $ $ $ $94.00 $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $64.00 $63.00 $65.00 $67.00 $63.00 $65.00 $ $70.00 $70.00 $71.00 $73.00 $70.00 $71.00 $ $96.00 $94.00 $96.00 $99.00 $94.00 $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $73.00 $68.00 $70.00 $72.00 $68.00 $70.00 $ $78.00 $76.00 $78.00 $80.00 $76.00 $78.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $85.00 $88.00 $90.00 $92.00 $86.00 $88.00 $ $93.00 $93.00 $95.00 $98.00 $91.00 $93.00 $ $ $ $ $ $ $ $ $32.00 $35.00 $36.00 $37.00 $32.00 $33.00 $ $32.00 $33.00 $34.00 $34.00 $31.00 $31.00 $ $31.00 $37.00 $38.00 $39.00 $33.00 $34.00 $ $50.00 $56.00 $58.00 $60.00 $48.00 $49.00 $ $ $ $ $ $ $ $ $94.00 $ $ $ $91.00 $93.00 $ $74.00 $75.00 $78.00 $80.00 $61.00 $63.00 $ $ $ $ $ $96.00 $98.00 $ $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 353

354 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $49.00 $49.00 $50.00 $51.00 $49.00 $50.00 $ $77.00 $85.00 $88.00 $90.00 $75.00 $77.00 $ BR BR $46.00 $38.00 $40.00 $42.00 $21.00 $22.00 $ $82.00 $94.00 $99.00 $ $48.00 $50.00 $ $76.00 $71.00 $73.00 $76.00 $71.00 $73.00 $ $ $ $ $ $ $ $ BR $80.00 $74.00 $77.00 $79.00 $74.00 $77.00 $ $ $ $ $ $ $ $ $ $94.00 $97.00 $ $94.00 $97.00 $ BR $43.00 $78.00 $82.00 $86.00 $78.00 $82.00 $ $40.00 $38.00 $39.00 $41.00 $38.00 $39.00 $ TC $2.00 $39.00 $42.00 $45.00 $39.00 $42.00 $ $ $ $ $ $ $ $ $76.00 $69.00 $72.00 $75.00 $69.00 $72.00 $ TC $32.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $89.00 $84.00 $87.00 $91.00 $84.00 $87.00 $ TC $39.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $95.00 $81.00 $84.00 $87.00 $81.00 $84.00 $ TC $45.00 $ $ $ $ $ $ $60.00 $ $ $ $ $ $ $49.00 $79.00 $82.00 $86.00 $79.00 $82.00 $ TC $9.00 $ $ $ $ $ $ $ $ $ $ $ $ $80.00 $83.00 $86.00 $80.00 $83.00 $ TC $ $ $ $ $ $ $57.00 $ $ $ $ $ $ $47.00 $51.00 $52.00 $54.00 $51.00 $52.00 $ TC $8.00 $92.00 $98.00 $ $92.00 $98.00 $ $ $ $ $ $ $ $54.00 $57.00 $59.00 $54.00 $57.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $87.00 $90.00 $93.00 $87.00 $90.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $55.00 $57.00 $60.00 $55.00 $57.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $62.00 $65.00 $67.00 $62.00 $65.00 $ TC $85.00 $92.00 $99.00 $85.00 $92.00 $ $ $ $ $ $ $ $52.00 $54.00 $56.00 $52.00 $54.00 $ TC $ $ $ $ $ $ $67.00 $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 354

355 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $52.00 $44.00 $45.00 $47.00 $44.00 $45.00 $ TC $12.00 $94.00 $ $ $94.00 $ $ $63.00 $ $ $ $ $ $ $46.00 $49.00 $51.00 $53.00 $49.00 $51.00 $ TC $11.00 $99.00 $ $ $99.00 $ $ $34.00 $64.00 $69.00 $73.00 $64.00 $69.00 $ $23.00 $11.00 $11.00 $12.00 $11.00 $11.00 $ TC $14.00 $53.00 $58.00 $61.00 $53.00 $58.00 $ $35.00 $90.00 $96.00 $ $19.00 $20.00 $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $56.00 $58.00 $60.00 $56.00 $58.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $52.00 $54.00 $57.00 $52.00 $54.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $97.00 $ $ $97.00 $ $ TC $37.00 $ $ $ $ $ $ BR BR $28.00 $29.00 $30.00 $31.00 $29.00 $30.00 $ TC BR BR $34.00 $37.00 $39.00 $40.00 $37.00 $39.00 $ TC BR BR BR TC BR $63.00 $71.00 $74.00 $77.00 $45.00 $47.00 $ $98.00 $ $ $ $94.00 $96.00 $ $53.00 $75.00 $78.00 $81.00 $47.00 $48.00 $ $75.00 $ $ $ $72.00 $74.00 $ $34.00 $45.00 $48.00 $50.00 $19.00 $20.00 $ $80.00 $ $ $ $ $ $ $70.00 $68.00 $70.00 $72.00 $68.00 $70.00 $ $31.00 $26.00 $27.00 $28.00 $20.00 $21.00 $ $33.00 $35.00 $37.00 $33.00 $35.00 $ $18.00 $19.00 $19.00 $18.00 $19.00 $ TC $15.00 $16.00 $18.00 $15.00 $16.00 $ $40.00 $57.00 $60.00 $62.00 $57.00 $60.00 $ $32.00 $37.00 $38.00 $39.00 $37.00 $38.00 $ TC $7.00 $20.00 $21.00 $23.00 $20.00 $21.00 $ $34.00 $42.00 $44.00 $47.00 $42.00 $44.00 $ $19.00 $19.00 $20.00 $20.00 $19.00 $20.00 $ TC $6.00 $23.00 $25.00 $26.00 $23.00 $25.00 $ $66.00 $66.00 $69.00 $72.00 $38.00 $39.00 $ $32.00 $52.00 $55.00 $58.00 $52.00 $55.00 $58.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 355

356 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $19.00 $19.00 $20.00 $20.00 $19.00 $20.00 $ TC $6.00 $33.00 $35.00 $38.00 $33.00 $35.00 $ $48.00 $67.00 $71.00 $75.00 $67.00 $71.00 $ $24.00 $23.00 $24.00 $25.00 $23.00 $24.00 $ TC $9.00 $44.00 $48.00 $50.00 $44.00 $48.00 $ $59.00 $77.00 $82.00 $86.00 $77.00 $82.00 $ $31.00 $27.00 $27.00 $28.00 $27.00 $27.00 $ TC $14.00 $51.00 $55.00 $58.00 $51.00 $55.00 $ $40.00 $86.00 $90.00 $93.00 $48.00 $49.00 $ $32.00 $71.00 $74.00 $77.00 $42.00 $43.00 $ $56.00 $79.00 $83.00 $87.00 $44.00 $45.00 $ $69.00 $45.00 $48.00 $50.00 $45.00 $48.00 $ $18.00 $19.00 $19.00 $20.00 $19.00 $19.00 $ TC $49.00 $27.00 $29.00 $30.00 $27.00 $29.00 $ $93.00 $86.00 $91.00 $97.00 $86.00 $91.00 $ $29.00 $29.00 $30.00 $31.00 $29.00 $30.00 $ TC $63.00 $56.00 $61.00 $66.00 $56.00 $61.00 $ $38.00 $56.00 $59.00 $61.00 $26.00 $27.00 $ $45.00 $23.00 $24.00 $25.00 $20.00 $21.00 $ $39.00 $21.00 $22.00 $23.00 $18.00 $18.00 $ $58.00 $67.00 $70.00 $73.00 $31.00 $32.00 $ $ $ $ $ $ $ $ $46.00 $44.00 $45.00 $47.00 $44.00 $45.00 $ TC $53.00 $87.00 $94.00 $ $87.00 $94.00 $ $ $ $ $ $ $ $ $60.00 $60.00 $62.00 $64.00 $60.00 $62.00 $ TC $67.00 $ $ $ $ $ $ $40.00 $73.00 $77.00 $81.00 $73.00 $77.00 $ $24.00 $23.00 $24.00 $25.00 $23.00 $24.00 $ TC $7.00 $50.00 $53.00 $57.00 $50.00 $53.00 $ $20.00 $18.00 $18.00 $19.00 $11.00 $12.00 $ $53.00 $82.00 $87.00 $92.00 $82.00 $87.00 $ $37.00 $42.00 $44.00 $46.00 $42.00 $44.00 $ TC $10.00 $40.00 $43.00 $46.00 $40.00 $43.00 $ $64.00 $89.00 $94.00 $98.00 $89.00 $94.00 $ $45.00 $43.00 $44.00 $46.00 $43.00 $44.00 $ TC $19.00 $46.00 $50.00 $53.00 $46.00 $50.00 $ $80.00 $ $ $ $ $ $ $56.00 $54.00 $56.00 $58.00 $54.00 $56.00 $ TC $17.00 $72.00 $77.00 $82.00 $72.00 $77.00 $ $24.00 $43.00 $46.00 $49.00 $43.00 $46.00 $ $10.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ TC $5.00 $34.00 $37.00 $39.00 $34.00 $37.00 $ $ $69.00 $74.00 $78.00 $69.00 $74.00 $ $ $12.00 $13.00 $13.00 $12.00 $13.00 $ TC $46.00 $57.00 $61.00 $65.00 $57.00 $61.00 $ $26.00 $44.00 $47.00 $49.00 $44.00 $47.00 $ $12.00 $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $6.00 $32.00 $35.00 $37.00 $32.00 $35.00 $ $91.00 $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 356

357 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $53.00 $35.00 $36.00 $38.00 $35.00 $36.00 $ TC $29.00 $92.00 $99.00 $ $92.00 $99.00 $ $99.00 $ $ $ $42.00 $44.00 $ $86.00 $88.00 $92.00 $96.00 $60.00 $62.00 $ $78.00 $88.00 $92.00 $96.00 $55.00 $56.00 $ $89.00 $98.00 $ $ $65.00 $67.00 $ $70.00 $84.00 $88.00 $91.00 $47.00 $48.00 $ $54.00 $67.00 $70.00 $73.00 $34.00 $35.00 $ $44.00 $60.00 $63.00 $66.00 $23.00 $23.00 $ $59.00 $76.00 $80.00 $84.00 $37.00 $38.00 $ $39.00 $61.00 $65.00 $68.00 $22.00 $23.00 $ $14.00 $25.00 $27.00 $29.00 $25.00 $27.00 $ $44.00 $50.00 $55.00 $59.00 $50.00 $55.00 $ $32.00 $37.00 $39.00 $40.00 $19.00 $19.00 $ $43.00 $41.00 $43.00 $45.00 $23.00 $24.00 $ $43.00 $45.00 $47.00 $48.00 $27.00 $28.00 $ $31.00 $39.00 $41.00 $42.00 $19.00 $19.00 $ $38.00 $46.00 $48.00 $50.00 $26.00 $26.00 $ $ $ $ $ $ $ $ $ $94.00 $ $ $94.00 $ $ $24.00 $27.00 $29.00 $32.00 $27.00 $29.00 $ $35.00 $31.00 $33.00 $35.00 $17.00 $18.00 $ $18.00 $18.00 $20.00 $21.00 $18.00 $20.00 $ BR BR TC BR $ $98.00 $ $ $98.00 $ $ $24.00 $29.00 $31.00 $32.00 $10.00 $10.00 $ $63.00 $ $ $ $47.00 $49.00 $ $40.00 $66.00 $70.00 $73.00 $28.00 $29.00 $ $42.00 $31.00 $33.00 $34.00 $15.00 $15.00 $ $81.00 $ $ $ $61.00 $64.00 $ $46.00 $63.00 $67.00 $70.00 $28.00 $29.00 $ $36.00 $64.00 $68.00 $71.00 $24.00 $24.00 $ $47.00 $58.00 $60.00 $63.00 $42.00 $43.00 $ $48.00 $87.00 $92.00 $96.00 $28.00 $29.00 $ $ $ $ BR $37.00 $60.00 $64.00 $68.00 $60.00 $64.00 $ $25.00 $22.00 $23.00 $24.00 $22.00 $23.00 $ TC $9.00 $38.00 $41.00 $44.00 $38.00 $41.00 $ $33.00 $62.00 $66.00 $70.00 $62.00 $66.00 $ $20.00 $18.00 $18.00 $19.00 $18.00 $18.00 $ TC $10.00 $44.00 $47.00 $51.00 $44.00 $47.00 $ $28.00 $29.00 $31.00 $33.00 $29.00 $31.00 $ $19.00 $6.00 $6.00 $7.00 $6.00 $6.00 $ TC $10.00 $23.00 $25.00 $26.00 $23.00 $25.00 $ $26.00 $50.00 $53.00 $56.00 $50.00 $53.00 $56.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 357

358 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $16.00 $14.00 $15.00 $15.00 $14.00 $15.00 $ TC $8.00 $35.00 $38.00 $41.00 $35.00 $38.00 $ $22.00 $46.00 $49.00 $52.00 $46.00 $49.00 $ $14.00 $13.00 $13.00 $14.00 $13.00 $13.00 $ TC $8.00 $33.00 $36.00 $38.00 $33.00 $36.00 $ $29.00 $87.00 $93.00 $99.00 $87.00 $93.00 $ $17.00 $15.00 $16.00 $16.00 $15.00 $16.00 $ TC $9.00 $72.00 $77.00 $82.00 $72.00 $77.00 $ $21.00 $7.00 $9.00 $11.00 $7.00 $9.00 $ $92.00 $ $ $ $ $ $ $30.00 $28.00 $28.00 $30.00 $28.00 $28.00 $ TC $59.00 $78.00 $86.00 $94.00 $78.00 $86.00 $ $17.00 $10.00 $11.00 $12.00 $10.00 $11.00 $ $16.00 $23.00 $25.00 $28.00 $23.00 $25.00 $ $24.00 $32.00 $35.00 $38.00 $32.00 $35.00 $ $14.00 $18.00 $20.00 $22.00 $18.00 $20.00 $ $21.00 $25.00 $28.00 $31.00 $25.00 $28.00 $ $46.00 $59.00 $63.00 $69.00 $57.00 $61.00 $ $ $27.00 $32.00 $35.00 $38.00 $32.00 $35.00 $ $15.00 $23.00 $25.00 $27.00 $23.00 $25.00 $ $14.00 $21.00 $23.00 $25.00 $21.00 $23.00 $ $17.00 $22.00 $24.00 $27.00 $22.00 $24.00 $ $15.00 $15.00 $17.00 $19.00 $15.00 $17.00 $ $20.00 $24.00 $26.00 $29.00 $23.00 $25.00 $ $14.00 $23.00 $24.00 $26.00 $23.00 $24.00 $ $15.00 $19.00 $21.00 $23.00 $19.00 $21.00 $ $14.00 $19.00 $21.00 $23.00 $19.00 $21.00 $ $3.00 $14.00 $15.00 $16.00 $14.00 $15.00 $ $11.00 $30.00 $32.00 $35.00 $30.00 $32.00 $ $17.00 $23.00 $26.00 $28.00 $23.00 $26.00 $ $28.00 $24.00 $26.00 $30.00 $24.00 $26.00 $ $28.00 $51.00 $54.00 $57.00 $49.00 $51.00 $ $28.00 $41.00 $45.00 $49.00 $41.00 $45.00 $ $34.00 $37.00 $41.00 $45.00 $37.00 $41.00 $ $94.00 $88.00 $98.00 $ $88.00 $98.00 $ $ $ $ $ $ $ $ $52.00 $27.00 $28.00 $30.00 $27.00 $28.00 $ TC $70.00 $83.00 $91.00 $ $83.00 $91.00 $ $70.00 $73.00 $81.00 $89.00 $73.00 $81.00 $ $58.00 $52.00 $57.00 $63.00 $52.00 $57.00 $ $8.00 $7.00 $8.00 $8.00 $7.00 $8.00 $ TC $49.00 $45.00 $49.00 $55.00 $45.00 $49.00 $ $78.00 $76.00 $83.00 $90.00 $76.00 $83.00 $ $20.00 $20.00 $20.00 $21.00 $20.00 $20.00 $ TC $57.00 $57.00 $63.00 $70.00 $57.00 $63.00 $ $ BR BR BR CPT only 2008 American Medical Association. All rights reserved. Part C, 358

359 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA BR BR $22.00 $35.00 $39.00 $42.00 $35.00 $39.00 $ $96.00 $ $ $ $48.00 $50.00 $ $88.00 $ $ $ $ $ $ $60.00 $92.00 $96.00 $ $85.00 $89.00 $ BR BR $ $ $ $ $ $ $ $22.00 $31.00 $34.00 $38.00 $31.00 $34.00 $ $59.00 $82.00 $88.00 $94.00 $82.00 $88.00 $ $42.00 $ $ $ $ $ $ $46.00 $ $ $ $ $ $ $ $ $ $ $71.00 $73.00 $ BR $42.00 $44.00 $46.00 $42.00 $44.00 $ $ $ $ $ $71.00 $73.00 $ BR $37.00 $39.00 $41.00 $37.00 $39.00 $ $ $ $ $ $ $ $ BR $46.00 $48.00 $51.00 $46.00 $48.00 $ $64.00 $70.00 $75.00 $64.00 $70.00 $ $17.00 $19.00 $22.00 $17.00 $19.00 $ $64.00 $69.00 $75.00 $64.00 $69.00 $ $86.00 $93.00 $ $86.00 $93.00 $ $21.00 $23.00 $24.00 $21.00 $23.00 $ $53.00 $57.00 $61.00 $53.00 $57.00 $ BR $ $ $ $ $ $ $ $35.00 $12.00 $13.00 $14.00 $12.00 $13.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $95.00 $ $ $ $ $ $ TC $ $ $76.00 $83.00 $86.00 $90.00 $83.00 $86.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $1, BR CPT only 2008 American Medical Association. All rights reserved. Part C, 359

360 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA BR $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $26.00 $25.00 $26.00 $28.00 $25.00 $26.00 $ $16.00 $15.00 $17.00 $18.00 $15.00 $17.00 $ $12.00 $9.00 $10.00 $10.00 $9.00 $10.00 $ $90.00 $ $ $ $ $ $ $28.00 $29.00 $30.00 $31.00 $29.00 $30.00 $ $ $ $ $ $ $ $ $25.00 $26.00 $27.00 $28.00 $26.00 $27.00 $ $63.00 $70.00 $77.00 $84.00 $70.00 $77.00 $ $54.00 $17.00 $17.00 $18.00 $17.00 $17.00 $ $ $ $ $ $ $ $ $71.00 $66.00 $68.00 $70.00 $66.00 $68.00 $ TC $42.00 $63.00 $68.00 $74.00 $63.00 $68.00 $ $ $ $ $ $ $ $ $43.00 $44.00 $46.00 $43.00 $44.00 $ TC $ $ $ $ $ $ $14.00 $15.00 $16.00 $17.00 $15.00 $16.00 $ $31.00 $7.00 $7.00 $8.00 $7.00 $7.00 $ $9.00 $8.00 $9.00 $9.00 $8.00 $9.00 $ $ $ $ $ $ $ $ $46.00 $46.00 $51.00 $56.00 $46.00 $51.00 $ $83.00 $75.00 $83.00 $91.00 $75.00 $83.00 $ $50.00 $30.00 $31.00 $32.00 $30.00 $31.00 $ $ $ $ $ $ $ $ $57.00 $51.00 $56.00 $62.00 $51.00 $56.00 $ $82.00 $78.00 $85.00 $93.00 $78.00 $85.00 $ $55.00 $29.00 $30.00 $31.00 $29.00 $30.00 $ $ $ $28.00 $25.00 $26.00 $27.00 $25.00 $26.00 $ $ $ $ $ $ $ $ $46.00 $35.00 $39.00 $43.00 $35.00 $39.00 $ $90.00 $ $ $ $ $ $ $28.00 $28.00 $29.00 $30.00 $28.00 $29.00 $ $58.00 $53.00 $58.00 $64.00 $53.00 $58.00 $ $24.00 $14.00 $14.00 $15.00 $14.00 $14.00 $ TC $44.00 $39.00 $44.00 $49.00 $39.00 $44.00 $ $ $ $ $ $ $ $ $70.00 $70.00 $72.00 $74.00 $70.00 $72.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $43.00 $40.00 $41.00 $43.00 $40.00 $41.00 $ TC $73.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $56.00 $52.00 $53.00 $55.00 $52.00 $53.00 $ TC $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 360

361 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $ $ $ $ $ $ $ $46.00 $30.00 $31.00 $32.00 $30.00 $31.00 $ TC $75.00 $93.00 $ $ $93.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $76.00 $46.00 $47.00 $50.00 $46.00 $47.00 $ $ $ $ $ $ $ $ $65.00 $69.00 $71.00 $73.00 $69.00 $71.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $78.00 $48.00 $50.00 $52.00 $48.00 $50.00 $ $ $95.00 $96.00 $ $ $96.00 $ $ TC $ BR $ $ $ $ $ $ $ $ $ $ $ $ $ TC BR $ $ $ $ $ $ $86.00 $91.00 $99.00 $ $91.00 $99.00 $ $30.00 $21.00 $22.00 $23.00 $21.00 $22.00 $ TC $65.00 $70.00 $77.00 $85.00 $70.00 $77.00 $ $50.00 $46.00 $50.00 $55.00 $46.00 $50.00 $ $10.00 $9.00 $9.00 $10.00 $9.00 $9.00 $ TC $42.00 $37.00 $41.00 $45.00 $37.00 $41.00 $ $ $87.00 $96.00 $ $87.00 $96.00 $ $4.00 $4.00 $5.00 $5.00 $4.00 $5.00 $ TC $ $83.00 $92.00 $ $83.00 $92.00 $ $ $ $ $ $ $ $ $77.00 $83.00 $86.00 $89.00 $83.00 $86.00 $ TC $66.00 $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $74.00 $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ TC $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ TC $1, $2, $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 361

362 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC $1, $2, $ $ $ $ $ $ $ TC $1, $2, $2, $2, $2, $2, $2, $2, $ $ $ $ $ $ $ TC $1, $1, $1, $2, $1, $1, $2, $2, $ $ $ $ $ $ $ TC $1, $2, $ $ $ $ $ $ $ TC $1, $2, $ $ $ $ $ $ $ TC $1, $ $ $ $ $ $ $ $ TC $ $2, $ $ $ $ $ $ $ TC $1, $2, $ $ $ $ $ $ $ TC $1, $2, $ $ $ $ $ $ $ TC $1, $45.00 $67.00 $71.00 $74.00 $23.00 $23.00 $ $49.00 $ $ $ $24.00 $25.00 $ $38.00 $17.00 $17.00 $18.00 $17.00 $17.00 $ $38.00 $ $ $ $17.00 $17.00 $ $ $65.00 $69.00 $73.00 $17.00 $17.00 $ $30.00 $48.00 $51.00 $53.00 $15.00 $15.00 $ $ $ $ $ $23.00 $23.00 $ $ $ $ $ $ $ $ $42.00 $46.00 $48.00 $50.00 $46.00 $48.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $44.00 $47.00 $49.00 $51.00 $47.00 $49.00 $ TC $ $ $ $ $ $ $ $ $47.00 $26.00 $26.00 $27.00 $26.00 $26.00 $ TC $ $ $33.00 $8.00 $8.00 $9.00 $8.00 $8.00 $ TC $ $ $93.00 $ $ $ $ $ $ TC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 362

363 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $ $74.00 $80.00 $83.00 $85.00 $80.00 $83.00 $ TC $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $49.00 $54.00 $56.00 $58.00 $54.00 $56.00 $ TC $ $ $82.00 $74.00 $77.00 $81.00 $74.00 $77.00 $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ BR $ $ $ $ $ $ $ TC BR BR $ $ $ $ $ $ $ TC BR BR $ $ $ $ $ $ $ TC BR $ $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 363

364 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $61.00 $74.00 $80.00 $85.00 $74.00 $80.00 $ BR $ $ $ $ $ $ $ TC BR BR $17.00 $18.00 $19.00 $17.00 $18.00 $ $36.00 $41.00 $43.00 $46.00 $41.00 $43.00 $ $9.00 $10.00 $10.00 $11.00 $10.00 $10.00 $ TC $27.00 $31.00 $33.00 $35.00 $31.00 $33.00 $ $43.00 $49.00 $53.00 $57.00 $49.00 $53.00 $ $27.00 $40.00 $44.00 $48.00 $40.00 $44.00 $ $24.00 $9.00 $9.00 $10.00 $9.00 $9.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $17.00 $11.00 $12.00 $13.00 $11.00 $12.00 $ $12.00 $8.00 $8.00 $9.00 $8.00 $8.00 $ TC $5.00 $3.00 $4.00 $4.00 $3.00 $4.00 $ NC NC NC NC NC NC NC NC NC NC NC NC NC NC TC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC $17.00 $19.00 $21.00 $22.00 $10.00 $11.00 $ $38.00 $29.00 $30.00 $32.00 $16.00 $16.00 $ BR BR TC BR $55.00 $ $ $ $ $ $ $17.00 $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $42.00 $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 364

365 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $ $ $ $ $ $ $ $31.00 $33.00 $34.00 $36.00 $33.00 $34.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $21.00 $22.00 $23.00 $25.00 $22.00 $23.00 $ TC $95.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $50.00 $51.00 $53.00 $56.00 $51.00 $53.00 $ TC $ $ $ $ $ $ $ $ $99.00 $ $ $99.00 $ $ $33.00 $34.00 $36.00 $38.00 $34.00 $36.00 $ TC $ $65.00 $71.00 $77.00 $65.00 $71.00 $ $ $ $ $ $ $ $55.00 $57.00 $60.00 $55.00 $57.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $61.00 $64.00 $66.00 $61.00 $64.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $61.00 $64.00 $66.00 $61.00 $64.00 $ TC $ $ $ $ $ $ $60.00 $ $ $ $ $ $ $16.00 $14.00 $14.00 $15.00 $14.00 $14.00 $ TC $44.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $28.00 $25.00 $26.00 $28.00 $25.00 $26.00 $ TC $85.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $31.00 $28.00 $30.00 $32.00 $28.00 $30.00 $ TC $92.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $31.00 $31.00 $33.00 $34.00 $31.00 $33.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $21.00 $21.00 $23.00 $24.00 $21.00 $23.00 $ TC $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $26.00 $26.00 $27.00 $28.00 $26.00 $27.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $17.00 $17.00 $18.00 $19.00 $17.00 $18.00 $ TC $ $ $ $ $ $ $ $63.00 $ $ $ $ $ $ $26.00 $19.00 $19.00 $20.00 $19.00 $19.00 $ TC $42.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $36.00 $38.00 $39.00 $42.00 $38.00 $39.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $23.00 $25.00 $26.00 $27.00 $25.00 $26.00 $27.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 365

366 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $89.00 $99.00 $ $ $99.00 $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $59.00 $64.00 $66.00 $69.00 $64.00 $66.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $34.00 $36.00 $38.00 $40.00 $36.00 $38.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $23.00 $24.00 $25.00 $26.00 $24.00 $25.00 $ TC $98.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $65.00 $68.00 $71.00 $74.00 $68.00 $71.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $25.00 $23.00 $24.00 $25.00 $23.00 $24.00 $ TC $ $ $ $ $ $ $ $43.00 $45.00 $48.00 $43.00 $45.00 $ $ $ $ $ $ $ $ $14.00 $14.00 $15.00 $16.00 $14.00 $15.00 $ TC $96.00 $ $ $ $ $ $ $92.00 $95.00 $99.00 $92.00 $95.00 $ $67.00 $69.00 $72.00 $67.00 $69.00 $ $48.00 $50.00 $52.00 $48.00 $50.00 $ $87.00 $90.00 $93.00 $87.00 $90.00 $ $30.00 $36.00 $39.00 $41.00 $36.00 $39.00 $ $12.00 $9.00 $9.00 $10.00 $9.00 $9.00 $ TC $16.00 $27.00 $29.00 $32.00 $27.00 $29.00 $ $39.00 $52.00 $55.00 $57.00 $52.00 $55.00 $ $14.00 $25.00 $27.00 $29.00 $25.00 $27.00 $ $26.00 $26.00 $27.00 $28.00 $26.00 $27.00 $ $57.00 $62.00 $67.00 $72.00 $62.00 $67.00 $ $18.00 $15.00 $15.00 $16.00 $15.00 $15.00 $ TC $36.00 $47.00 $52.00 $56.00 $47.00 $52.00 $ $32.00 $66.00 $71.00 $77.00 $66.00 $71.00 $ $11.00 $30.00 $31.00 $33.00 $30.00 $31.00 $ TC $19.00 $35.00 $39.00 $44.00 $35.00 $39.00 $ $8.00 $22.00 $24.00 $26.00 $22.00 $24.00 $ $6.00 $4.00 $4.00 $5.00 $4.00 $4.00 $ TC $3.00 $18.00 $20.00 $21.00 $18.00 $20.00 $ $17.00 $25.00 $26.00 $28.00 $25.00 $26.00 $ $7.00 $6.00 $6.00 $7.00 $6.00 $6.00 $ TC $9.00 $19.00 $20.00 $22.00 $19.00 $20.00 $ $43.00 $42.00 $46.00 $49.00 $42.00 $46.00 $ $15.00 $13.00 $13.00 $14.00 $13.00 $13.00 $ TC $26.00 $29.00 $32.00 $35.00 $29.00 $32.00 $ $12.00 $28.00 $30.00 $32.00 $28.00 $30.00 $ $8.00 $6.00 $6.00 $7.00 $6.00 $6.00 $7.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 366

367 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA TC $5.00 $22.00 $24.00 $26.00 $22.00 $24.00 $ $27.00 $34.00 $36.00 $40.00 $34.00 $36.00 $ $8.00 $6.00 $7.00 $7.00 $6.00 $7.00 $ TC $18.00 $27.00 $30.00 $32.00 $27.00 $30.00 $ $36.00 $40.00 $43.00 $46.00 $40.00 $43.00 $ $14.00 $13.00 $13.00 $14.00 $13.00 $13.00 $ TC $20.00 $27.00 $29.00 $32.00 $27.00 $29.00 $ $37.00 $46.00 $50.00 $54.00 $46.00 $50.00 $ $11.00 $13.00 $13.00 $14.00 $13.00 $13.00 $ TC $26.00 $33.00 $36.00 $40.00 $33.00 $36.00 $ $33.00 $37.00 $40.00 $42.00 $37.00 $40.00 $ $18.00 $13.00 $13.00 $14.00 $13.00 $13.00 $ TC $12.00 $24.00 $26.00 $28.00 $24.00 $26.00 $ $34.00 $39.00 $42.00 $44.00 $39.00 $42.00 $ $16.00 $15.00 $15.00 $16.00 $15.00 $15.00 $ TC $17.00 $24.00 $26.00 $28.00 $24.00 $26.00 $ $40.00 $57.00 $62.00 $67.00 $57.00 $62.00 $ $24.00 $21.00 $22.00 $23.00 $21.00 $22.00 $ TC $14.00 $36.00 $40.00 $44.00 $36.00 $40.00 $ $37.00 $53.00 $57.00 $60.00 $53.00 $57.00 $ $20.00 $20.00 $21.00 $21.00 $20.00 $21.00 $ TC $15.00 $33.00 $36.00 $39.00 $33.00 $36.00 $ $59.00 $63.00 $66.00 $59.00 $63.00 $ $16.00 $16.00 $17.00 $16.00 $16.00 $ TC $43.00 $46.00 $49.00 $43.00 $46.00 $ $80.00 $85.00 $90.00 $80.00 $85.00 $ $20.00 $21.00 $22.00 $20.00 $21.00 $ TC $60.00 $64.00 $68.00 $60.00 $64.00 $ $72.00 $78.00 $87.00 $72.00 $78.00 $ $91.00 $96.00 $ $ $96.00 $ $ $38.00 $32.00 $34.00 $35.00 $32.00 $34.00 $ TC $54.00 $64.00 $70.00 $76.00 $64.00 $70.00 $ $ $ $ $ $ $ $ $71.00 $73.00 $76.00 $79.00 $73.00 $76.00 $ TC $52.00 $95.00 $ $ $95.00 $ $ $19.00 $15.00 $16.00 $17.00 $15.00 $16.00 $ BR $39.00 $42.00 $45.00 $39.00 $42.00 $ $15.00 $16.00 $18.00 $15.00 $16.00 $ $54.00 $59.00 $62.00 $65.00 $39.00 $40.00 $ $38.00 $38.00 $39.00 $41.00 $38.00 $39.00 $ $18.00 $17.00 $18.00 $21.00 $17.00 $18.00 $ $23.00 $24.00 $26.00 $29.00 $24.00 $26.00 $ $16.00 $20.00 $22.00 $24.00 $20.00 $22.00 $ $47.00 $71.00 $77.00 $82.00 $71.00 $77.00 $ $23.00 $13.00 $13.00 $14.00 $13.00 $13.00 $ TC $22.00 $58.00 $63.00 $68.00 $58.00 $63.00 $ $60.00 $86.00 $94.00 $ $86.00 $94.00 $ $12.00 $10.00 $10.00 $11.00 $10.00 $10.00 $ TC $43.00 $76.00 $83.00 $91.00 $76.00 $83.00 $91.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 367

368 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $24.00 $65.00 $71.00 $76.00 $65.00 $71.00 $ $4.00 $4.00 $4.00 $5.00 $4.00 $4.00 $ TC $20.00 $61.00 $66.00 $71.00 $61.00 $66.00 $ $49.00 $56.00 $61.00 $65.00 $56.00 $61.00 $ $15.00 $13.00 $13.00 $14.00 $13.00 $13.00 $ TC $31.00 $43.00 $47.00 $52.00 $43.00 $47.00 $ $79.00 $94.00 $ $ $94.00 $ $ $14.00 $13.00 $13.00 $14.00 $13.00 $13.00 $ TC $64.00 $81.00 $89.00 $97.00 $81.00 $89.00 $ $37.00 $72.00 $78.00 $83.00 $72.00 $78.00 $ $14.00 $11.00 $12.00 $12.00 $11.00 $12.00 $ TC $21.00 $61.00 $66.00 $71.00 $61.00 $66.00 $ $9.00 $3.00 $4.00 $4.00 $3.00 $4.00 $ $20.00 $7.00 $9.00 $11.00 $7.00 $9.00 $ $30.00 $32.00 $36.00 $41.00 $32.00 $36.00 $ $21.00 $41.00 $45.00 $49.00 $41.00 $45.00 $ $9.00 $8.00 $8.00 $8.00 $8.00 $8.00 $ TC $12.00 $33.00 $37.00 $41.00 $33.00 $37.00 $ BR BR TC BR $3.00 $6.00 $7.00 $7.00 $6.00 $7.00 $ $11.00 $19.00 $20.00 $21.00 $19.00 $20.00 $ $20.00 $21.00 $23.00 $20.00 $21.00 $ $11.00 $13.00 $14.00 $15.00 $13.00 $14.00 $ $3.00 $7.00 $8.00 $9.00 $7.00 $8.00 $ $5.00 $6.00 $6.00 $7.00 $6.00 $6.00 $ $8.00 $11.00 $12.00 $13.00 $11.00 $12.00 $ $7.00 $8.00 $8.00 $9.00 $8.00 $8.00 $ $9.00 $8.00 $9.00 $10.00 $8.00 $9.00 $ $6.00 $29.00 $31.00 $33.00 $29.00 $31.00 $ $13.00 $22.00 $24.00 $26.00 $22.00 $24.00 $ $7.00 $18.00 $20.00 $21.00 $18.00 $20.00 $ $82.00 $62.00 $67.00 $71.00 $62.00 $67.00 $ $ $78.00 $84.00 $89.00 $78.00 $84.00 $ $82.00 $67.00 $69.00 $72.00 $50.00 $51.00 $ $10.00 $13.00 $15.00 $16.00 $13.00 $15.00 $ $9.00 $17.00 $18.00 $20.00 $17.00 $18.00 $ BR BR BR BR BR BR BR $9.00 $12.00 $13.00 $13.00 $4.00 $4.00 $ $17.00 $16.00 $17.00 $18.00 $4.00 $4.00 $ $24.00 $25.00 $26.00 $28.00 $4.00 $4.00 $ $33.00 $24.00 $26.00 $27.00 $4.00 $4.00 $ $32.00 $33.00 $36.00 $38.00 $4.00 $4.00 $4.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 368

369 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $36.00 $44.00 $47.00 $50.00 $4.00 $4.00 $ $7.00 $12.00 $13.00 $13.00 $4.00 $4.00 $ $13.00 $9.00 $10.00 $11.00 $4.00 $4.00 $ $ $ $ $ $ $ $ BR $ $ $ $ $ $ $ $41.00 $42.00 $43.00 $41.00 $42.00 $ $ $ $ $ $ $ $ $94.00 $98.00 $ $ $98.00 $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $86.00 $89.00 $93.00 $86.00 $89.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $98.00 $85.00 $88.00 $91.00 $85.00 $88.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $1, $1, $ $1, $1, $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $58.00 $58.00 $61.00 $63.00 $58.00 $61.00 $ TC $68.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $89.00 $92.00 $96.00 $ $92.00 $96.00 $ TC $68.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $54.00 $58.00 $61.00 $63.00 $58.00 $61.00 $ TC $78.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $58.00 $58.00 $61.00 $63.00 $58.00 $61.00 $ TC $56.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $58.00 $58.00 $61.00 $63.00 $58.00 $61.00 $ TC $63.00 $ $ $ $ $ $ $ $41.00 $40.00 $41.00 $43.00 $40.00 $41.00 $ TC $ $ $ $ $ $ $ $ $59.00 $57.00 $59.00 $61.00 $57.00 $59.00 $ TC $86.00 $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ TC $6.00 $1, $1, $1, $1, $1, $1, $ $ $ $ $92.00 $96.00 $ CPT only 2008 American Medical Association. All rights reserved. Part C, 369

370 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $26.00 $28.00 $29.00 $31.00 $15.00 $16.00 $ $21.00 $26.00 $27.00 $29.00 $16.00 $17.00 $ $34.00 $40.00 $42.00 $43.00 $25.00 $26.00 $ $44.00 $47.00 $49.00 $51.00 $33.00 $34.00 $ $18.00 $19.00 $20.00 $21.00 $9.00 $9.00 $ $14.00 $15.00 $16.00 $16.00 $6.00 $7.00 $ $40.00 $44.00 $46.00 $48.00 $28.00 $29.00 $ $73.00 $91.00 $96.00 $ $91.00 $96.00 $ $53.00 $53.00 $55.00 $58.00 $53.00 $55.00 $ TC $15.00 $37.00 $40.00 $43.00 $37.00 $40.00 $ $ $ $ $ $ $ $ $86.00 $85.00 $88.00 $91.00 $85.00 $88.00 $ TC $28.00 $41.00 $44.00 $48.00 $41.00 $44.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $35.00 $48.00 $53.00 $57.00 $48.00 $53.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $67.00 $73.00 $80.00 $87.00 $73.00 $80.00 $ $ $ $ $ $ $ $88.00 $91.00 $95.00 $88.00 $91.00 $ TC $33.00 $36.00 $38.00 $33.00 $36.00 $ $93.00 $98.00 $ $93.00 $98.00 $ $69.00 $72.00 $75.00 $69.00 $72.00 $ TC $24.00 $26.00 $28.00 $24.00 $26.00 $ $66.00 $75.00 $79.00 $83.00 $75.00 $79.00 $ $43.00 $43.00 $44.00 $46.00 $43.00 $44.00 $ TC $21.00 $32.00 $35.00 $38.00 $32.00 $35.00 $ $96.00 $ $ $ $ $ $ $71.00 $64.00 $66.00 $69.00 $64.00 $66.00 $ TC $26.00 $39.00 $42.00 $46.00 $39.00 $42.00 $ $29.00 $44.00 $47.00 $49.00 $44.00 $47.00 $ $21.00 $21.00 $21.00 $22.00 $21.00 $21.00 $ TC $8.00 $23.00 $25.00 $27.00 $23.00 $25.00 $ $29.00 $43.00 $46.00 $49.00 $43.00 $46.00 $ $21.00 $21.00 $21.00 $22.00 $21.00 $21.00 $ TC $8.00 $22.00 $24.00 $26.00 $22.00 $24.00 $ $ $ $ $ $ $ $ $81.00 $ $ $ $ $ $ TC $22.00 $30.00 $33.00 $36.00 $30.00 $33.00 $ $43.00 $46.00 $49.00 $43.00 $46.00 $ $21.00 $22.00 $23.00 $21.00 $22.00 $ TC $22.00 $24.00 $26.00 $22.00 $24.00 $ $43.00 $45.00 $48.00 $43.00 $45.00 $ $21.00 $22.00 $23.00 $21.00 $22.00 $ TC $22.00 $24.00 $25.00 $22.00 $24.00 $ $43.00 $ $ $ $ $ $ $34.00 $61.00 $63.00 $65.00 $61.00 $63.00 $ TC $7.00 $44.00 $48.00 $52.00 $44.00 $48.00 $ $37.00 $61.00 $65.00 $68.00 $61.00 $65.00 $68.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 370

371 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $24.00 $23.00 $24.00 $25.00 $23.00 $24.00 $ TC $10.00 $38.00 $41.00 $44.00 $38.00 $41.00 $ $43.00 $69.00 $73.00 $77.00 $69.00 $73.00 $ $33.00 $33.00 $34.00 $35.00 $33.00 $34.00 $ TC $9.00 $36.00 $39.00 $41.00 $36.00 $39.00 $ $31.00 $53.00 $57.00 $60.00 $53.00 $57.00 $ $20.00 $19.00 $20.00 $21.00 $19.00 $20.00 $ TC $8.00 $34.00 $37.00 $40.00 $34.00 $37.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $48.00 $52.00 $57.00 $62.00 $52.00 $57.00 $ $61.00 $74.00 $78.00 $82.00 $74.00 $78.00 $ $46.00 $47.00 $49.00 $50.00 $47.00 $49.00 $ TC $14.00 $27.00 $29.00 $31.00 $27.00 $29.00 $ $65.00 $87.00 $91.00 $96.00 $87.00 $91.00 $ $50.00 $52.00 $54.00 $56.00 $52.00 $54.00 $ TC $14.00 $35.00 $38.00 $40.00 $35.00 $38.00 $ $ $ $ $ $ $ $ $47.00 $49.00 $51.00 $53.00 $49.00 $51.00 $ TC $57.00 $73.00 $78.00 $83.00 $73.00 $78.00 $ $94.00 $ $ $ $ $ $ $53.00 $30.00 $31.00 $33.00 $30.00 $31.00 $ TC $41.00 $79.00 $85.00 $92.00 $79.00 $85.00 $ $66.00 $ $ $ $ $ $ $34.00 $29.00 $31.00 $32.00 $29.00 $31.00 $ TC $34.00 $78.00 $84.00 $90.00 $78.00 $84.00 $ $67.00 $ $ $ $ $ $ $34.00 $31.00 $32.00 $34.00 $31.00 $32.00 $ TC $34.00 $80.00 $87.00 $93.00 $80.00 $87.00 $ $ $ $ $ $ $ $80.00 $83.00 $86.00 $80.00 $83.00 $ TC $ $ $ $ $ $ $ $ $ $ $ $ $81.00 $83.00 $87.00 $81.00 $83.00 $ TC $ $ $ $ $ $ $44.00 $ $ $ $ $ $ $25.00 $19.00 $20.00 $21.00 $19.00 $20.00 $ TC $11.00 $92.00 $98.00 $ $92.00 $98.00 $ $62.00 $70.00 $75.00 $81.00 $70.00 $75.00 $ $33.00 $33.00 $34.00 $36.00 $33.00 $34.00 $ TC $30.00 $37.00 $41.00 $45.00 $37.00 $41.00 $ $36.00 $46.00 $49.00 $52.00 $46.00 $49.00 $ $28.00 $28.00 $28.00 $30.00 $28.00 $28.00 $ TC $8.00 $19.00 $21.00 $22.00 $19.00 $21.00 $ $39.00 $44.00 $46.00 $49.00 $44.00 $46.00 $ $30.00 $30.00 $31.00 $32.00 $30.00 $31.00 $ TC $8.00 $14.00 $15.00 $16.00 $14.00 $15.00 $ $40.00 $60.00 $64.00 $69.00 $60.00 $64.00 $ $31.00 $38.00 $40.00 $43.00 $38.00 $40.00 $ TC $9.00 $22.00 $24.00 $26.00 $22.00 $24.00 $26.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 371

372 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $ $ $ $ $ $ $ $84.00 $82.00 $85.00 $88.00 $82.00 $85.00 $ TC $ $ $ $ $ $ $ $ $14.00 $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $23.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $59.00 $53.00 $55.00 $57.00 $53.00 $55.00 $ TC $74.00 $98.00 $ $ $98.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $64.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $66.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $48.00 $73.00 $79.00 $85.00 $73.00 $79.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TC $48.00 $55.00 $60.00 $66.00 $55.00 $60.00 $ BR $ $ $ $ $ $ $ TC BR BR $ $ $ $ $ $ $ TC BR BR $ $ $ $ $ $ $ TC BR $22.00 $53.00 $56.00 $59.00 $24.00 $25.00 $ $39.00 $58.00 $61.00 $65.00 $41.00 $43.00 $ $78.00 $ $ $ $82.00 $86.00 $ $47.00 $60.00 $63.00 $66.00 $49.00 $51.00 $ $ $ $ $ $ $ $ $88.00 $ $ $ $94.00 $98.00 $ $ $ $ $ $ $ $97.00 $ $ $88.00 $91.00 $ $44.00 $46.00 $48.00 $44.00 $46.00 $ $29.00 $31.00 $33.00 $17.00 $18.00 $ $45.00 $48.00 $50.00 $34.00 $36.00 $38.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 372

373 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $57.00 $65.00 $71.00 $76.00 $65.00 $71.00 $ $93.00 $99.00 $ $39.00 $41.00 $ BR $93.00 $92.00 $96.00 $ $92.00 $96.00 $ $ $ $ $ $ $ $ $21.00 $21.00 $22.00 $23.00 $21.00 $22.00 $ $20.00 $19.00 $20.00 $21.00 $19.00 $20.00 $ $97.00 $ $ $ $ $ $ BR BR BR BR BR BR $ $ $ $ $ $ TC BR BR BR BR BR BR $39.00 $42.00 $45.00 $39.00 $42.00 $ $91.00 $94.00 $97.00 $91.00 $93.00 $ $54.00 $56.00 $59.00 $24.00 $25.00 $ $42.00 $44.00 $46.00 $26.00 $26.00 $ $68.00 $78.00 $87.00 $96.00 $78.00 $87.00 $ $88.00 $18.00 $22.00 $28.00 $18.00 $22.00 $ $68.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $99.00 $ $ $81.00 $88.00 $97.00 $37.00 $41.00 $ $68.00 $71.00 $75.00 $25.00 $26.00 $ $ $ $ $87.00 $92.00 $ $25.00 $25.00 $26.00 $24.00 $25.00 $ $24.00 $24.00 $25.00 $23.00 $24.00 $ $23.00 $23.00 $24.00 $23.00 $23.00 $ $6.00 $6.00 $6.00 $5.00 $5.00 $ $22.00 $23.00 $24.00 $22.00 $23.00 $ $23.00 $24.00 $25.00 $23.00 $24.00 $25.00 DSPNS see formula See Appx D See Appx D See Appx D See Appx D See Appx D See Appx D $67.00 $72.00 $76.00 $67.00 $72.00 $ $43.00 $45.00 $48.00 $43.00 $45.00 $ $57.00 $ $ $ $31.00 $32.00 $ $86.00 $ $ $ $43.00 $45.00 $ $ $ $ $ $ $ $72.00 $78.00 $83.00 $72.00 $78.00 $ $ $ $ $ $ $ $39.00 $43.00 $47.00 $39.00 $43.00 $ $ $ $ $ $ $ $84.00 $91.00 $97.00 $84.00 $91.00 $ $46.00 $ $ $ $ $ $ $46.00 $ $ $ $ $ $ $17.00 $84.00 $90.00 $95.00 $84.00 $90.00 $ $54.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $29.00 $31.00 $33.00 $29.00 $31.00 $33.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 373

374 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $ $ $ $ $51.00 $54.00 $ BR $62.00 $ $ $ $ $ $ $69.00 $62.00 $66.00 $70.00 $62.00 $66.00 $ $38.00 $29.00 $31.00 $32.00 $29.00 $31.00 $ $17.00 $21.00 $23.00 $24.00 $21.00 $23.00 $ $24.00 $22.00 $22.00 $23.00 $21.00 $21.00 $ $75.00 $81.00 $85.00 $75.00 $81.00 $ $21.00 $61.00 $66.00 $71.00 $61.00 $66.00 $ $24.00 $78.00 $85.00 $91.00 $78.00 $85.00 $ $53.00 $ $ $ $ $ $ $ $ $ $ $66.00 $68.00 $ $ $ $ $ $66.00 $68.00 $ $ $ $ $ $ $ $ BR $62.00 $75.00 $78.00 $81.00 $75.00 $78.00 $ $29.00 $40.00 $42.00 $43.00 $40.00 $42.00 $ $62.00 $80.00 $84.00 $88.00 $80.00 $84.00 $ $29.00 $47.00 $50.00 $52.00 $47.00 $50.00 $ NC BR BR BR BR BR BR NC BR BR BR BR BR BR $10.00 $5.00 $5.00 $6.00 $5.00 $5.00 $ $16.00 $15.00 $16.00 $17.00 $15.00 $16.00 $ $14.00 $14.00 $15.00 $16.00 $14.00 $15.00 $ $15.00 $16.00 $16.00 $17.00 $16.00 $16.00 $ $10.00 $8.00 $8.00 $9.00 $8.00 $8.00 $ $15.00 $18.00 $18.00 $19.00 $18.00 $18.00 $ $10.00 $5.00 $6.00 $6.00 $5.00 $6.00 $ $9.00 $5.00 $5.00 $6.00 $5.00 $5.00 $ $10.00 $7.00 $7.00 $8.00 $7.00 $7.00 $ $16.00 $17.00 $18.00 $18.00 $17.00 $18.00 $ $16.00 $24.00 $26.00 $27.00 $24.00 $26.00 $ $13.00 $15.00 $16.00 $16.00 $15.00 $16.00 $ $11.00 $12.00 $13.00 $13.00 $12.00 $13.00 $ $19.00 $26.00 $27.00 $28.00 $26.00 $27.00 $ $ $22.00 $29.00 $31.00 $32.00 $29.00 $31.00 $ $23.00 $30.00 $31.00 $33.00 $30.00 $31.00 $ $24.00 $35.00 $37.00 $38.00 $35.00 $37.00 $ $21.00 $25.00 $26.00 $27.00 $25.00 $26.00 $ $19.00 $23.00 $24.00 $25.00 $23.00 $24.00 $ $ $26.00 $27.00 $28.00 $29.00 $27.00 $28.00 $ $18.00 $19.00 $19.00 $20.00 $19.00 $19.00 $ $ $ $22.00 $31.00 $32.00 $33.00 $31.00 $32.00 $ $22.00 $25.00 $26.00 $27.00 $25.00 $26.00 $ $24.00 $27.00 $28.00 $29.00 $27.00 $28.00 $ $23.00 $31.00 $32.00 $33.00 $31.00 $32.00 $33.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 374

375 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA $23.00 $28.00 $29.00 $30.00 $28.00 $29.00 $ $17.00 $28.00 $29.00 $30.00 $28.00 $29.00 $ $ $ $59.00 $63.00 $66.00 $40.00 $42.00 $ $73.00 $77.00 $81.00 $51.00 $54.00 $ BR $36.00 $37.00 $39.00 $28.00 $29.00 $ $39.00 $41.00 $42.00 $31.00 $32.00 $ BR BR BR BR BR BR BR $ $35.00 $36.00 $38.00 $35.00 $36.00 $ $34.00 $35.00 $37.00 $34.00 $35.00 $ $30.00 $31.00 $32.00 $30.00 $31.00 $ $33.00 $35.00 $37.00 $33.00 $35.00 $ BR $26.00 $29.00 $30.00 $31.00 $29.00 $30.00 $ $17.00 $26.00 $27.00 $28.00 $25.00 $26.00 $ $7.00 $15.00 $16.00 $16.00 $15.00 $15.00 $ $37.00 $38.00 $40.00 $31.00 $32.00 $ $28.00 $29.00 $31.00 $26.00 $27.00 $ $39.00 $40.00 $42.00 $34.00 $35.00 $ $31.00 $33.00 $34.00 $29.00 $30.00 $ $ $ $ $ NC NC NC NC NC NC NC $32.00 $41.00 $43.00 $45.00 $34.00 $35.00 $ NC NC NC NC NC NC NC $23.00 $62.00 $65.00 $67.00 $52.00 $54.00 $ NC NC NC NC NC NC NC NC NC NC NC NC NC NC $32.00 $36.00 $37.00 $38.00 $31.00 $32.00 $ NC NC NC NC NC NC NC $23.00 $24.00 $24.00 $25.00 $20.00 $21.00 $ $23.00 $25.00 $27.00 $23.00 $25.00 $ $12.00 $13.00 $14.00 $12.00 $13.00 $ $8.00 $9.00 $10.00 $8.00 $9.00 $ $13.00 $14.00 $14.00 $12.00 $13.00 $ $25.00 $26.00 $27.00 $24.00 $25.00 $ $37.00 $39.00 $40.00 $36.00 $37.00 $ $ $ $ BR BR BR NC NC NC NC NC NC NC See CPT only 2008 American Medical Association. All rights reserved. Part C, 375

376 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA NC NC NC NC NC NC NC BR BR BR BR $53.00 $54.00 $56.00 $53.00 $54.00 $ BR BR $3.00 $3.00 $4.00 $3.00 $3.00 $ $53.00 $40.00 $45.00 $50.00 $40.00 $45.00 $ $ $ $ $ $ $ $ $23.00 $48.00 $52.00 $56.00 $48.00 $52.00 $ $78.00 $95.00 $ $ $95.00 $ $ BR BR BR $16.00 $60.00 $65.00 $69.00 $60.00 $65.00 $ NC NC NC NC NC NC NC G $38.00 $39.00 $41.00 $38.00 $39.00 $41.00 G $21.00 $22.00 $23.00 $9.00 $10.00 $10.00 G $ $ $ $63.00 $66.00 $70.00 G $ $ $ $ $ $ G $ $ $ $63.00 $66.00 $70.00 G $ $ $ $ $ $ G $52.00 $54.00 $56.00 $52.00 $54.00 $56.00 G0106-TC $ $ $ $ $ $ G $29.00 $31.00 $33.00 $29.00 $31.00 $33.00 G $16.00 $18.00 $19.00 $16.00 $18.00 $19.00 G $46.00 $49.00 $51.00 $46.00 $49.00 $51.00 G $31.00 $33.00 $35.00 $31.00 $33.00 $35.00 G $ $ $ $ $ $ G $52.00 $54.00 $56.00 $52.00 $54.00 $56.00 G0120-TC $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $ $63.00 $66.00 $70.00 G $ $ $ $ $ $ G $51.00 $53.00 $55.00 $51.00 $53.00 $55.00 G0122-TC $ $ $ $ $ $ G $4.00 $5.00 $5.00 $4.00 $5.00 $5.00 G $ $ $ $ $ $ G $47.00 $50.00 $52.00 $47.00 $50.00 $52.00 G $62.00 $65.00 $68.00 $62.00 $65.00 $68.00 G $ $ $ $ $ $ G $ $ $ $ $ $ G $15.00 $16.00 $17.00 $15.00 $16.00 $17.00 G $15.00 $17.00 $18.00 $15.00 $17.00 $18.00 G $14.00 $15.00 $16.00 $14.00 $15.00 $16.00 G $ $ $ $ $ $ G $ $ $ $ $ $ G $10.00 $10.00 $11.00 $10.00 $10.00 $11.00 G $49.00 $52.00 $54.00 $33.00 $34.00 $35.00 G $26.00 $27.00 $28.00 $25.00 $26.00 $27.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 376

377 Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA G $15.00 $16.00 $16.00 $15.00 $15.00 $16.00 G $12.00 $13.00 $13.00 $12.00 $13.00 $13.00 G $12.00 $13.00 $13.00 $12.00 $13.00 $13.00 G $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $ $ $ $ G $ $ $ $ $ $ G $21.00 $22.00 $23.00 $21.00 $22.00 $23.00 G $13.00 $13.00 $14.00 $13.00 $13.00 $14.00 G $15.00 $16.00 $16.00 $15.00 $16.00 $16.00 G $8.00 $9.00 $9.00 $8.00 $9.00 $9.00 G $9.00 $9.00 $10.00 $9.00 $9.00 $10.00 G $77.00 $83.00 $87.00 $77.00 $83.00 $87.00 G $25.00 $26.00 $28.00 $25.00 $26.00 $28.00 G $15.00 $17.00 $18.00 $15.00 $17.00 $18.00 G $25.00 $26.00 $26.00 $25.00 $26.00 $26.00 G $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 G $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 G $9.00 $10.00 $11.00 $9.00 $10.00 $11.00 P $27.00 $28.00 $29.00 $27.00 $28.00 $29.00 Q $23.00 $24.00 $26.00 $23.00 $24.00 $26.00 Q $9.00 $9.00 $10.00 $9.00 $9.00 $10.00 Q0035-TC $14.00 $15.00 $16.00 $14.00 $15.00 $16.00 Q $43.00 $45.00 $48.00 $20.00 $21.00 $21.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 377

378 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Evaluation and Management CPT Code 2003 MRA $35.00 $39.00 $41.00 $43.00 $25.00 $26.00 $ $58.00 $67.00 $70.00 $74.00 $47.00 $49.00 $ $58.00 $99.00 $ $ $73.00 $76.00 $ $84.00 $ $ $ $ $ $ $84.00 $ $ $ $ $ $ $19.00 $21.00 $22.00 $23.00 $9.00 $10.00 $ $31.00 $40.00 $42.00 $45.00 $25.00 $26.00 $ $40.00 $64.00 $67.00 $70.00 $46.00 $47.00 $ $40.00 $97.00 $ $ $72.00 $74.00 $ $65.00 $ $ $ $ $ $ $65.00 $71.00 $74.00 $77.00 $71.00 $74.00 $ $65.00 $67.00 $70.00 $72.00 $67.00 $70.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $66.00 $94.00 $96.00 $ $94.00 $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $33.00 $39.00 $40.00 $42.00 $39.00 $40.00 $ $54.00 $69.00 $71.00 $73.00 $69.00 $71.00 $ $77.00 $99.00 $ $ $99.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $66.00 $71.00 $73.00 $76.00 $71.00 $73.00 $ $88.00 $ $ $ $ $ $ $54.00 $52.00 $55.00 $58.00 $35.00 $37.00 $ $88.00 $97.00 $ $ $74.00 $77.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $54.00 $51.00 $52.00 $55.00 $51.00 $52.00 $ $70.00 $81.00 $84.00 $88.00 $81.00 $84.00 $ $96.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $18.00 $22.00 $22.00 $23.00 $22.00 $22.00 $ $28.00 $41.00 $42.00 $43.00 $41.00 $42.00 $ $60.00 $66.00 $69.00 $72.00 $66.00 $69.00 $ $94.00 $ $ $ $ $ $ $ $ $ $ $ $ $ BR $ $ $ $ $ $ $ $95.00 $ $ $ $ $ $ $83.00 $86.00 $89.00 $83.00 $86.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $41.00 $43.00 $44.00 $41.00 $43.00 $ $63.00 $65.00 $68.00 $63.00 $65.00 $ $85.00 $88.00 $91.00 $85.00 $88.00 $ $ $ $ $ $ $ CPT only 2008 American Medical Association. All rights reserved. Part C, 378

379 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Evaluation and Management CPT Code 2003 MRA $60.00 $62.00 $64.00 $67.00 $62.00 $64.00 $ $77.00 $81.00 $83.00 $87.00 $81.00 $83.00 $ $87.00 $90.00 $92.00 $87.00 $90.00 $ $58.00 $61.00 $63.00 $58.00 $61.00 $ $85.00 $88.00 $92.00 $85.00 $88.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $58.00 $60.00 $63.00 $58.00 $60.00 $ $90.00 $93.00 $96.00 $90.00 $93.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $73.00 $75.00 $79.00 $73.00 $75.00 $ $ $ $ $ $ $ $59.00 $58.00 $60.00 $63.00 $58.00 $60.00 $ $85.00 $85.00 $88.00 $92.00 $85.00 $88.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $46.00 $55.00 $57.00 $60.00 $55.00 $57.00 $ $71.00 $84.00 $86.00 $89.00 $84.00 $86.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $98.00 $ $ $93.00 $96.00 $ $ $96.00 $ $ $91.00 $94.00 $ $87.00 $90.00 $93.00 $96.00 $90.00 $93.00 $ $88.00 $90.00 $93.00 $97.00 $90.00 $93.00 $ BR $ $ $ $ $ $ BR $50.00 $51.00 $53.00 $50.00 $51.00 $ BR $59.00 $60.00 $62.00 $59.00 $60.00 $ $ $ $ $80.00 $83.00 $ $40.00 $42.00 $44.00 $31.00 $32.00 $ $42.00 $44.00 $46.00 $41.00 $43.00 $ $54.00 $55.00 $57.00 $54.00 $55.00 $ $35.00 $36.00 $37.00 $35.00 $36.00 $ $75.00 $68.00 $71.00 $74.00 $57.00 $59.00 $ $75.00 $ $ $ $ $ $ $75.00 $68.00 $71.00 $74.00 $57.00 $59.00 $ $ $ $ $ $ $ $ $75.00 $67.00 $70.00 $73.00 $56.00 $58.00 $ $ $ $ $ $88.00 $91.00 $ $13.00 $14.00 $14.00 $13.00 $13.00 $ $26.00 $27.00 $28.00 $25.00 $26.00 $ $32.00 $33.00 $33.00 $30.00 $31.00 $ $63.00 $65.00 $66.00 $61.00 $63.00 $ $14.00 $15.00 $15.00 $13.00 $13.00 $ $25.00 $26.00 $27.00 $24.00 $25.00 $ $37.00 $39.00 $40.00 $36.00 $37.00 $ NC NC NC NC NC NC NC $ CPT only 2008 American Medical Association. All rights reserved. Part C, 379

380 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Evaluation and Management CPT Code 2003 MRA BR BR BR BR G $67.00 $70.00 $73.00 $47.00 $48.00 $50.00 G $40.00 $42.00 $43.00 $24.00 $25.00 $26.00 G $71.00 $74.00 $78.00 $71.00 $74.00 $78.00 G $ $ $ $73.00 $77.00 $81.00 G $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 G $16.00 $16.00 $17.00 $9.00 $9.00 $10.00 G $32.00 $33.00 $33.00 $30.00 $31.00 $32.00 G $63.00 $65.00 $66.00 $61.00 $62.00 $64.00 M $39.00 $41.00 $42.00 $18.00 $18.00 $19.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 380

381 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition APPENDIX A DEFINITIONS 381

382 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition APPENDIX A. DEFINITIONS. (1) AA means an anesthesiologist assistant licensed pursuant to Chapter 458, F.S. (2) Agency means the Agency for Health Care Administration as defined in s (3), F.S. (3) Anesthesia Reimbursement Allowance (ARA) means the maximum reimbursement allowance paid to a provider for an anesthesia procedure. (4) Authorization means the approval given to a health care provider by the insurer or selfinsured employer for the provision of medical services to an employee. (5) Basic Value (BV) or base unit means the value of all usual anesthesia services, except the values of time units actually spent in anesthesia care and the value of any additional modifiers. (6) Billing means the completion and submission of a form to the insurer in order to receive reimbursement for health care services provided to an injured employee. (7) Commission on Accreditation of Rehabilitation Facilities (CARF) is a not-for-profit organization whose mission is to promote the quality, value and optimal outcomes of services through a consultative accreditation process that centers on enhancing the lives of people in need of rehabilitation and served by CARF accredited organizations and rehabilitation programs. (8) CRNA means a certified registered nurse anesthetist licensed by Chapter 464, F.S. (9) Division means the Division of Workers Compensation of the Department of Financial Services as defined in s (14), F.S. (10) Durable medical equipment (DME) means articles of a permanent nature which are prescribed for prolonged or continuous use. (11) Exception means payment may be made for services or supplies exceeding reimbursement guidelines if documented and authorized by the insurer. (12) Exclusion means a procedure, service or supply that is not reimbursable under the workers compensation program. (13) Health care provider means a provider as defined in s (1), F.S. (14) Limitations means the restrictions placed on the reimbursement of medical services. (15) Maximum Reimbursement Allowance (MRA) means the specifically listed maximum dollar amount in the schedule adopted by the three-member panel for reimbursement of medical service(s) rendered to an injured employee by a health care provider. (16) Medically Necessary or Medical Necessity means any medical service or medical supply which meets the definition of the terms according to s (1) (l), F.S. 382

383 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition (17) Medical record means the medical file that contains information that identifies the patient, supports the diagnosis, justifies the treatment and documents the care provided as required under Chapter 395, F.S. (18) Medical supplier means a supplier who furnishes medical equipment, supplies, appliances, devices, transcutaneous neurostimulators, ocular and hearing aids, prosthetics or orthotics as prescribed by a physician. (19) National Correct Coding Initiative or Correct Coding Initiative refers to the Centers for Medicare and Medicaid Services (CMS) plan to promote national correct coding methodologies and to control improper coding. The CMS annually updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services (Coding Policy Manual). (20) Non-physician surgical assistant means a physician assistant licensed pursuant to s , F.S., or s , F.S., or a licensed registered nurse certified pursuant to s.464, F.S. (21) Not covered or non-covered (NC) means a service or supply that is not reimbursable under the workers compensation program. These services and supplies are identified by NC in the MRA column in the schedule of maximum reimbursement allowances. (22) Orthotics means mechanical appliances that are used to support and correct deformities. (23) Peer review means an evaluation as defined in s , F.S. (24) Physician means a physician as defined in s , F.S. (25) Professional component means that portion of a diagnostic procedure that consists of the physician s professional services. This includes examination of the patient when indicated; the performance, supervision and interpretation of the procedure; and the provision of a written report. (26) Prosthetics means artificial substitutes that are used to replace missing parts or devices to augment performance of a natural function. (27) Technical component means the portion of certain diagnostic procedures that includes the provision of personnel, materials and equipment to perform the procedures or studies. (28) Time (TM) Units means the number of units of time that a procedure requires, which is calculated by dividing the total anesthesia time (total minutes) by either ten (10) minute intervals for anesthesiologists, or fifteen (15) minute intervals for CRNAs/AAs. (29) Unlisted procedure means a procedure code that is not listed in this schedule, but is contained in the CPT 2009 Current Procedural Terminology Professional Edition, Copyright 2008, American Medical Association; the Current Dental Terminology, CDT- 2009/2010, Copyright 2008, American Dental Association; or the Healthcare Common Procedure Coding System, Medicare s National Level II Codes, HCPCS 2009, American Medical Association, Twenty-first Edition, Copyright 2008, Ingenix Publishing Group. 383

384 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition APPENDIX B OFFICIAL SOURCE OF REFERENCES DIRECTORY OFFICIAL S 384

385 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition APPENDIX B. OFFICIAL SOURCE OF REFERENCES. As medical information pertaining to coding systems and guidelines are evolving, users of this manual seeking up-to-date information should use the appropriate listed reference address, telephone/fax number or web site for specific answers to questions, inquiries and products Relative Value Guide: A Guide for Anesthesia Values American Society of Anesthesiologists 520 N. Northwest Highway Park Ridge, Il (847) Web Site: Complete Global Service Data for Orthopaedic Surgery, Vol. 1 & 2 American Academy of Orthopaedic Surgeons 6300 North River Road Rosemont, Illinois (847) (800) (847) Fax (800) Fax Web site: OU RC E OF RE FE RE NC ES Current Dental Terminology (CDT-2009/2010) American Dental Association 211 East Chicago Avenue, 6 th Floor Chicago, Illinois (312) (800) (312) Fax Web site: ADA Order Department American Dental Association Post Office Box 776 St. Charles, Illinois (800) (888) Fax Web site: Drug Topics Red Book Medical Economics Company, Inc. Five Paragon Drive Montvale, New Jersey (201) (800) (201) Fax Web site: 385

386 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition Current Procedural Terminology, (CPT ) CPT Assistant Guide To The Evaluation of Permanent Impairment, 5 th Edition HCPCS ICD-9-CM American Medical Association (AMA) MAIN OFFICE 515 North State Street Chicago, Illinois (312) (312) Fax Web site: AMA Order Department P.O. Box Atlanta, Georgia (800) (800) (312) Fax For questions regarding the use of CPT codes, please contact the American Medical Association CPT Information and Education Services at Florida Uniform Permanent Impairment Rating Schedule Florida Workers Compensation Institute P. O. Box 200 Tallahassee, Florida (850) (850) Fax Web site: National Correct Coding Initiative Coding Policy Manual for Medicare Services (Coding Policy Manual) Visit for an overview of the Coding Policy Manual and for information on how to obtain the manual. Comments or concerns about specific NCCI edits may be submitted in writing to: National Correct Coding Initiative Correct Coding Solutions LLC P.O. Box 907 Carmel, IN Attention: Niles R. Rosen, M.D., Medical Director and Linda S. Dietz, RHIA, CCS, CCS-P, Coding Specialist (317) Fax 386

387 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition APPENDIX C MODIFIERS 387

388 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition APPENDIX C. MODIFIERS. 1. Modifiers change the basic services reported and require different reimbursements from the MRAs listed for the unmodified basic services. Modifiers are two (2) characters: alpha, numeric or an alphanumeric combination. 2. The CPT has a two-digit numeric modifier series. The modifier, when appropriate, must be added to the procedure code of the basic procedure. a. Reimbursement shall be made for all of the two-digit numeric modifiers provided in the CPT , when the service is medically necessary. (1) The guidelines in the CPT must be followed for each modifier reported by the provider. (2) In some situations, it may be necessary for the provider to submit a report with the bill to explain the circumstances in order for an insurer to determine payment. 3. In addition to the CPT modifiers, there are HCPCS Level II modifiers for reporting a change to the basic service. HCPCS Level II modifiers specifically required by this manual are the following: a. Modifier TC (Technical Component) When the technical component of a procedure (personnel, materials, equipment, space and supplies) is rendered by a health care provider other than the physician performing the professional component of the procedure, the provider shall bill the technical component by adding modifier TC to the appropriate procedure code. b. Modifiers used specifically for CRNA services: Modifier QX is appended to the appropriate anesthesia CPT code by a CRNA to identify services provided with medical direction of a physician. The reimbursement for a CRNA requiring medical direction of a physician shall be fifty percent (50%) of the anesthesia reimbursement allowance listed in Part A, Section XI in this manual or the agreed upon contract price. Modifier QY is used by an anesthesiologist to report medical directions of a CRNA. When an anesthesiologist/physician is not personally administering the anesthesia but is providing medical direction for the anesthesia services provided by a nurse anesthetist, not employed by the anesthesiologist, the physician shall bill for the medical direction service by adding one of the appropriate modifiers to the anesthesia procedure code. The medical direction service includes the preoperative and postoperative anesthesia care. Reimbursement for medical direction services by an anesthesiologist shall be fifty percent (50%) of the anesthesia reimbursement allowance or the agreed-upon contracted price. c. Modifier AS is used by a physician assistant, nurse practitioner or registered nurse first assistant to report services for assistant at surgery. 388

389 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition APPENDIX D WORKERS COMPENSATION UNIQUE CODES 389

390 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition APPENDIX D. WORKERS COMPENSATION UNIQUE CODES DSPNS Legend, prescription, and over-the-counter drugs dispensed by Page 16 a licensed practitioner. (See Section V: Dispensing of Medication and rule 69L-7.602, F.A.C. for specific limitations on the use of this code.) COMPD Compounded drugs dispensed. Page Manipulation of spine by a physician other than an Page 28 osteopathic or chiropractic physician Manipulation of the temporomandibular joint; upper Page 28 extremities including the hand and wrist; the lower extremities; and other regions by a physician other than an osteopathic or chiropractic physician Functional capacity evaluation (FCE) with written report. Page Muscle testing manually or by automated equipment with Page 29 written report Physical reconditioning assessment; per hour. Page Physical reconditioning assessment; additional thirty (30) Page 23 minutes Physical reconditioning program; per hour. Page Physical reconditioning program; additional thirty (30) minutes. Page Consensus Independent Medical Examination (CIME). Page

391 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition COMPENSATION UN APPENDIX E MEDICARE LOCALITY MAP 391

392 Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicare Payment Localities (Counties) Locality 01 / Locality 02: Alachua Franklin Lake Putnam Baker Gadsden Leon Santa Rosa Bay Gilchrist Levy Sarasota Bradford Glades Liberty Seminole Brevard Gulf Madison St. Johns Calhoun Hamilton Manatee Sumter Charlotte Hardee Marion Suwannee Citrus Hendry Nassau Taylor Clay Hernando Okaloosa Union Columbia Highlands Okeechobee Volusia De Soto Hillsborough Orange Wakulla Dixie Holmes Osceola Walton Duval Jackson Pasco Washington Escambia Jefferson Pinellas Flagler Lafayette Polk : Broward Collier Martin Indian River Lee Palm Beach St. Lucie : Dade Monroe 392