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
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... 10 Reimbursement Information... 11 CLASSIFICATION OF INJURED EMPLOYEE S STATUS General Guidelines... 14 Patient Classification Levels... 15 SECTION IV: DENTAL SERVICES... 15 SECTION V: DISPENSING OF MEDICATION Medicinal Drugs... 16 Patent, Proprietary or Over-the-Counter Drugs... 17 SECTION VI: MEDICAL SUPPLIER SERVICES... 17 SECTION VII: MEDICAL SERVICES Biofeedback Services... 18 Electrodiagnostic Medicine... 18 Evaluation and Management Services... 19 Home Health Services... 20 Impairment Rating... 20 Independent Medical Examination... 20 Independent Medical Examination, Consensus... 20 Injectable Medications... 20 Medical and Surgical Supplies... 21 Ophthalmological Services... 22 Psychiatric and Psychological Services... 22 Radiology... 23 Thermography... 24 Transcutaneous Neurostimulator... 24 2
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... 38 Anesthesia Services for Which Time Units Not Allowed...39 SCHEDULE OF MAXIMUM REIMBURSEMENT ALLOWANCES General Instructions for Use of Schedule...41 PART A: Anesthesia... 43 Surgery... 45 Radiology... 81 Pathology... 95 Medicine... 118 Evaluation and Management...127 Dental... 128 Injections...132 PART B: Surgery... 136 PART C: Radiology... 245 Pathology... 286 Medicine... 353 Evaluation and Management...378 3
Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition APPENDICES APPENDIX A. DEFINITIONS... 381 APPENDIX B. OFFICIAL SOURCE OF REFERENCES...384 APPENDIX C. MODIFIERS... 387 APPENDIX D. WORKERS COMPENSATION UNIQUE CODES...389 APPENDIX E. MEDICARE LOCALITY MAP... 391 INDEX... 393 4
Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition 69L-7.020 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 440.13 (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 32399-0311, or via the Department s web site at http://www.fldfs.com/wc. Specific Authority 440.13(14)(b), 440.591 FS. Law Implemented 440.13(7), (12), (14) FS. History New 10-1- 82, Amended 3-16-83, 11-6-83, 5-21-85, Formerly 38F-7.20, Amended 4-1-88, 7-20-88, 6-1-91, 4-29-92, 2-18- 96, 9-1-97, 12-15-97, 9-17-98, 9-30-01, 7-7-02, Formerly 38F-7.020, 4L-7.020, Amended 12-4-03, 1-1-04, 7-4-04, 5-9-05, 9-4-05, 11-16-06, 10-18-07, 02-09-09. 5
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 440.13, 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 -2009 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
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 60610. 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 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (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
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 440.13, 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 http://www.myfloridacfo.com/wc/forms.html (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 440.13, 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 395.002, 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: http://www.myfloridacfo.com/wc (listed under rules and forms). 8
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 - 2009, CDT-2009/2010 or HCPCS-2009. 4. 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. 164.520 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
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 440.13, 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
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 440.13, F.S. or 456.057, 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 440.13, 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 440.13(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
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
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 440.13, 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
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. 440.13(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. 440.13(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
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 -2009 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 - 2009 codes and dental codes from the CDT-2009/2010 or HCPCS-2009. 2. 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 -2009 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
Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2. Surgeons may refer to other sections in this manual and may use CPT -2009 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.465.0276, 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
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 A9999. 17
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
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
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.440.15, F.S. 3. Reimbursement shall not be made for an evaluation and management code on the same date as code 99455. 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 -2009 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
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 90749 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
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 - 2009 codes 99201-99499 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 -2009 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 99201-99499) 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
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 -2009 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
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
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
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 97001 or 97003. c. Separate reimbursement shall not be made to a physician and to a physician-employed 26
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 97002 or 97004. 4. 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 97010-97028 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 97032-97542 shall each equal one (1) reimbursable unit of service for each 15- minute increment of service performed. c. Code 97150 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
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 97260 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 98926 and 98928. (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 98941 and 98943. These manipulation codes are specifically designated for chiropractic physicians. (1) Reimbursement shall be made for code 98941 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
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 (95831-95834) and range of motion codes (95851-95852) shall not be reimbursed when reported separately with code 97752. c. Reimbursement shall be made for range of motion measurements. Code 95851 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
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 97850 and 97851, specifically designated to use in reporting a physical reconditioning assessment. (1) Reimbursement shall be made for code 97850 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 97851 only when used to bill each additional thirty (30) minutes of a physical reconditioning assessment subsequent to code 97850. 3. 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 97852 and 97853, specifically designated to use in reporting a physical reconditioning program. (1) Reimbursement shall be made for code 97852 when used to bill the initial hour per session of physical reconditioning each day. (2) Reimbursement shall be made for code 97853 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
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 97545 and 97546, specifically designated to use exclusively in reporting a work hardening program. (1) Reimbursement shall be made for code 97545 when used to bill the initial two (2) hours of a work hardening program each day. (2) Reimbursement shall be made for code 97546 when used to bill each additional hour of a work hardening program each day. 31
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
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
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
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
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
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 99100 Anesthesia for patient of extreme age, under one year and over seventy 1 99116 Anesthesia complicated by utilization of total body hypothermia 5 99135 Anesthesia complicated by utilization of controlled hypotension 5 99140 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
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
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
Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition SECTION XI SCHEDULE OF MAXIMUM REIMBURSEMENT ALLOWANCES 40
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
Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition PART A SCHEDULE OF MAXIMUM REIMBURSEMENT ALLOWANCES 42
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 00100 5 + TM 00528 8 + TM 00844 7 + TM 00102 6 + TM 00529 11 + TM 00846 8 + TM 00103 5 + TM 00530 4 + TM 00848 8 + TM 00104 4 + TM 00532 4 + TM 00851 6 + TM 00120 5 + TM 00534 7 + TM 00860 6 + TM 00124 4 + TM 00537 8 + TM 00862 7 + TM 00126 4 + TM 00539 17 + TM 00864 8 + TM 00140 5 + TM 00540 13 + TM 00865 8 + TM 00142 6 + TM 00541 15 + TM 00866 10 + TM 00144 6 + TM 00542 15 + TM 00868 10 + TM 00145 6 + TM 00546 15 + TM 00870 5 + TM 00147 6 + TM 00548 15 + TM 00872 7 + TM 00148 4 + TM 00550 10 + TM 00873 5 + TM 00160 5 + TM 00560 15 + TM 00880 15 + TM 00162 7 + TM 00562 20 + TM 00882 10 + TM 00164 4 + TM 00563 25 + TM 00902 5 + TM 00170 5 + TM 00566 25 + TM 00904 7 + TM 00172 6 + TM 00580 20 + TM 00906 4 + TM 00174 6 + TM 00600 10 + TM 00908 6 + TM 00176 7 + TM 00604 13 + TM 00910 3 + TM 00190 5 + TM 00620 10 + TM 00912 5 + TM 00192 7 + TM 00622 13 + TM 00914 5 + TM 00210 11 + TM 00630 8 + TM 00916 5 + TM 00212 5 + TM 00632 7 + TM 00918 5 + TM 00214 9 + TM 00634 10 + TM 00920 3 + TM 00215 9 + TM 00635 4 + TM 00921 3 + TM 00216 15 + TM 00640 3 + TM 00922 6 + TM 00218 13 + TM 00670 13 + TM 00924 4 + TM 00220 10 + TM 00700 3 + TM 00926 4 + TM 00222 6 + TM 00702 4 + TM 00928 6 + TM 00300 5 + TM 00730 5 + TM 00930 4 + TM 00320 6 + TM 00740 5 + TM 00932 4 + TM 00322 3 + TM 00750 4 + TM 00934 6 + TM 00350 10 + TM 00752 6 + TM 00936 8 + TM 00352 5 + TM 00754 7 + TM 00938 4 + TM 00400 3 + TM 00756 7 + TM 00940 3 + TM 00402 5 + TM 00770 15 + TM 00942 4 + TM 00404 5 + TM 00790 7 + TM 00944 6 + TM 00406 13 + TM 00792 13 + TM 00948 4 + TM 00410 4 + TM 00794 8 + TM 00950 5 + TM 00450 5 + TM 00796 30 + TM 00952 4 + TM 00452 6 + TM 00797 10 + TM 01112 5 + TM 00454 3 + TM 00800 3 + TM 01120 6 + TM 00470 6 + TM 00802 5 + TM 01130 3 + TM 00472 10 + TM 00810 5 + TM 01140 15 + TM 00474 13 + TM 00820 5 + TM 01150 8 + TM 00500 15 + TM 00830 4 + TM 01160 4 + TM 00520 6 + TM 00832 6 + TM 01170 8 + TM 00522 4 + TM 00840 6 + TM 01173 12 + TM 00524 4 + TM 00842 4 + TM 01180 3 + TM CPT only 2008 American Medical Association. All Rights Reserved. PartA, 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 01190 4 + TM 01632 6 + TM 01952 5 + TM 01200 4 + TM 01634 9 + TM 01953 1 + TM 01202 4 + TM 01636 15 + TM 01960 5 + TM 01210 6 + TM 01638 10 + TM 01961 7 + TM 01212 10 + TM 01650 6 + TM 01962 8 + TM 01214 8 + TM 01652 10 + TM 01963 10 + TM 01215 10 + TM 01654 8 + TM 01967 5 + TM 01220 4 + TM 01656 10 + TM 01968 3 + TM 01230 6 + TM 01670 4 + TM 01969 5 + TM 01232 5 + TM 01680 3 + TM 01990 0 01234 8 + TM 01682 4 + TM 01991 3 + TM 01250 4 + TM 01710 3 + TM 01992 5 + TM 01260 3 + TM 01712 5 + TM 01996 3 01270 8 + TM 01714 5 + TM 01999 BR 01272 4 + TM 01716 5 + TM 01274 6 + TM 01730 3 + TM 01320 4 + TM 01732 3 + TM 01340 4 + TM 01740 4 + TM 01360 5 + TM 01742 5 + TM 01380 3 + TM 01744 5 + TM 01382 3 + TM 01756 6 + TM 01390 3 + TM 01758 5 + TM 01392 4 + TM 01760 7 + TM 01400 4 + TM 01770 6 + TM 01402 7 + TM 01772 6 + TM 01404 5 + TM 01780 3 + TM 01420 3 + TM 01782 4 + TM 01430 3 + TM 01810 3 + TM 01432 6 + TM 01820 3 + TM 01440 5 + TM 01829 3 + TM 01442 8 + TM 01830 3 + TM 01444 8 + TM 01832 6 + TM 01462 3 + TM 01840 6 + TM 01464 3 + TM 01842 6 + TM 01470 3 + TM 01844 6 + TM 01472 5 + TM 01850 3 + TM 01474 5 + TM 01852 4 + TM 01480 3 + TM 01860 3 + TM 01482 4 + TM 01916 5 + TM 01484 4 + TM 01920 7 + TM 01486 7 + TM 01922 7 + TM 01490 3 + TM 01924 6 + TM 01500 8 + TM 01925 8 + TM 01502 6 + TM 01926 10 + TM 01520 3 + TM 01930 5 + TM 01522 5 + TM 01931 7 + TM 01610 5 + TM 01932 7 + TM 01620 4 + TM 01933 8 + TM 01622 4 + TM 01935 8 + TM 01630 5 + TM 01936 8 + TM CPT only 2008 American Medical Association. All Rights Reserved. PartA, 44
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 10021 $90.00 0 11406 $246.00 10 11771 $496.00 90 10022 $92.00 0 11420 $98.00 10 11772 $585.00 90 10040 $54.00 10 11421 $92.00 10 11900 $33.00 0 10060 $53.00 10 11422 $157.00 10 11901 $37.00 0 10061 $133.00 10 11423 $163.00 10 11920 $147.00 0 10080 $65.00 10 11424 $221.00 10 11921 $172.00 0 10081 $203.00 10 11426 $303.00 10 11922 $40.00 ZZZ 10120 $53.00 10 11440 $105.00 10 11950 $107.00 0 10121 $169.00 10 11441 $102.00 10 11951 $114.00 0 10140 $53.00 10 11442 $174.00 10 11952 $155.00 0 10160 $45.00 10 11443 $221.00 10 11954 $165.00 0 10180 $164.00 10 11444 $276.00 10 11960 $829.00 90 11000 $45.00 0 11446 $344.00 10 11970 $632.00 90 11001 $27.00 ZZZ 11450 $282.00 90 11971 $280.00 90 11004 $564.00 0 11451 $366.00 90 11976 $123.00 0 11005 $768.00 0 11462 $264.00 90 12001 $84.00 10 11006 $710.00 0 11463 $351.00 90 12002 $98.00 10 11008 $289.00 ZZZ 11470 $320.00 90 12004 $122.00 10 11010 $348.00 10 11471 $391.00 90 12005 $165.00 10 11011 $432.00 0 11600 $148.00 10 12006 $203.00 10 11012 $597.00 0 11601 $180.00 10 12007 $339.00 10 11040 $43.00 0 11602 $199.00 10 12011 $98.00 10 11041 $45.00 0 11603 $226.00 10 12013 $141.00 10 11042 $88.00 0 11604 $249.00 10 12014 $165.00 10 11043 $210.00 10 11606 $315.00 10 12015 $207.00 10 11044 $283.00 10 11620 $150.00 10 12016 $268.00 10 11055 $26.00 0 11621 $191.00 10 12017 $316.00 10 11056 $35.00 0 11622 $223.00 10 12018 $515.00 10 11057 $39.00 0 11623 $259.00 10 12020 $211.00 10 11100 $78.00 0 11624 $305.00 10 12021 $87.00 10 11101 $41.00 ZZZ 11626 $373.00 10 12031 $93.00 10 11200 $66.00 10 11640 $168.00 10 12032 $110.00 10 11201 $26.00 ZZZ 11641 $227.00 10 12034 $148.00 10 11300 $59.00 0 11642 $260.00 10 12035 $223.00 10 11301 $80.00 0 11643 $305.00 10 12036 $356.00 10 11302 $96.00 0 11644 $380.00 10 12037 $411.00 10 11303 $119.00 0 11646 $494.00 10 12041 $116.00 10 11305 $61.00 0 11719 $22.00 0 12042 $141.00 10 11306 $86.00 0 11720 $32.00 0 12044 $176.00 10 11307 $100.00 0 11721 $50.00 0 12045 $250.00 10 11308 $125.00 0 11730 $62.00 0 12046 $341.00 10 11310 $75.00 0 11732 $31.00 ZZZ 12047 $363.00 10 11311 $95.00 0 11740 $41.00 0 12051 $126.00 10 11312 $110.00 0 11750 $156.00 10 12052 $148.00 10 11313 $144.00 0 11752 $234.00 10 12053 $223.00 10 11400 $81.00 10 11755 $106.00 0 12054 $301.00 10 11401 $114.00 10 11760 $131.00 10 12055 $380.00 10 11402 $145.00 10 11762 $223.00 10 12056 $487.00 10 11403 $178.00 10 11765 $65.00 10 12057 $539.00 10 11404 $200.00 10 11770 $275.00 10 13100 $178.00 10 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 13101 $240.00 10 15221 $114.00 ZZZ 15783 $340.00 90 13102 $89.00 ZZZ 15240 $763.00 90 15786 $146.00 10 13120 $223.00 10 15241 $334.00 ZZZ 15787 $27.00 ZZZ 13121 $348.00 10 15260 $841.00 90 15788 $194.00 90 13122 $104.00 ZZZ 15261 $207.00 ZZZ 15789 $360.00 90 13131 $252.00 10 15300 $291.00 90 15792 $130.00 90 13132 $484.00 10 15301 $61.00 ZZZ 15793 $232.00 90 13133 $154.00 ZZZ 15320 $338.00 90 15819 $780.00 90 13150 $260.00 10 15321 $91.00 ZZZ 15820 $556.00 90 13151 $375.00 10 15330 $291.00 90 15821 $607.00 90 13152 $542.00 10 15331 $61.00 ZZZ 15822 $499.00 90 13153 $169.00 ZZZ 15335 $323.00 90 15823 $718.00 90 13160 $655.00 90 15336 $88.00 ZZZ 15824 BR 0 14000 $512.00 90 15340 $308.00 10 15825 BR 0 14001 $695.00 90 15341 $44.00 ZZZ 15826 BR 0 14020 $590.00 90 15360 $333.00 90 15828 BR 0 14021 $818.00 90 15361 $71.00 ZZZ 15829 BR 0 14040 $701.00 90 15365 $348.00 90 15830 $1,072.00 90 14041 $936.00 90 15366 $88.00 ZZZ 15832 $926.00 90 14060 $766.00 90 15400 $223.00 90 15833 $833.00 90 14061 $1,330.00 90 15401 $66.00 ZZZ 15834 $837.00 90 14300 $1,040.00 90 15420 $372.00 90 15835 $865.00 90 14350 $734.00 90 15421 $115.00 ZZZ 15836 $721.00 90 15040 $258.00 0 15430 $505.00 90 15837 $696.00 90 15050 $349.00 90 15570 $748.00 90 15838 $600.00 90 15100 $679.00 90 15572 $721.00 90 15839 $643.00 90 15101 $146.00 ZZZ 15574 $775.00 90 15840 $1,187.00 90 15110 $815.00 90 15576 $457.00 90 15841 $1,859.00 90 15111 $129.00 ZZZ 15600 $259.00 90 15842 $3,099.00 90 15115 $766.00 90 15610 $320.00 90 15845 $1,116.00 90 15116 $167.00 ZZZ 15620 $506.00 90 15850 $63.00 0 15120 $788.00 90 15630 $362.00 90 15851 $40.00 0 15121 $235.00 ZZZ 15650 $427.00 90 15852 $35.00 0 15130 $677.00 90 15731 $990.00 90 15860 $151.00 0 15131 $105.00 ZZZ 15732 $1,465.00 90 15876 BR 0 15135 $820.00 90 15734 $1,557.00 90 15877 BR 0 15136 $98.00 ZZZ 15736 $1,862.00 90 15878 BR 0 15150 $677.00 90 15738 $1,415.00 90 15879 BR 0 15151 $136.00 ZZZ 15740 $913.00 90 15920 $571.00 90 15152 $167.00 ZZZ 15750 $1,064.00 90 15922 $771.00 90 15155 $678.00 90 15756 $2,892.00 90 15931 $638.00 90 15156 $177.00 ZZZ 15757 $2,892.00 90 15933 $860.00 90 15157 $196.00 ZZZ 15758 $2,884.00 90 15934 $1,064.00 90 15170 $356.00 90 15760 $810.00 90 15935 $1,184.00 90 15171 $92.00 ZZZ 15770 $674.00 90 15936 $1,032.00 90 15175 $503.00 90 15775 $327.00 0 15937 $1,223.00 90 15176 $146.00 ZZZ 15776 $475.00 0 15940 $318.00 90 15200 $644.00 90 15780 $532.00 90 15941 $919.00 90 15201 $126.00 ZZZ 15781 $420.00 90 15944 $954.00 90 15220 $687.00 90 15782 $314.00 90 15945 $1,078.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 15946 $1,737.00 90 19000 $74.00 0 19380 $780.00 90 15950 $549.00 90 19001 $40.00 ZZZ 19396 $231.00 0 15951 $872.00 90 19020 $288.00 90 19499 BR YYY 15952 $876.00 90 19030 $98.00 0 20000 $45.00 10 15953 $1,013.00 90 19100 $117.00 0 20005 $267.00 10 15956 $1,382.00 90 19101 $338.00 10 20100 $727.00 10 15958 $1,379.00 90 19102 $263.00 0 20101 $261.00 10 15999 BR YYY 19103 $601.00 0 20102 $314.00 10 16000 $53.00 0 19105 $1,878.00 0 20103 $405.00 10 16020 $49.00 0 19110 $406.00 90 20150 $1,141.00 90 16025 $67.00 0 19112 $354.00 90 20200 $134.00 0 16030 $153.00 0 19120 $429.00 90 20205 $243.00 0 16035 $341.00 0 19125 $468.00 90 20206 $119.00 0 16036 $81.00 ZZZ 19126 $201.00 ZZZ 20220 $128.00 0 17000 $60.00 10 19260 $1,101.00 90 20225 $215.00 0 17003 $16.00 ZZZ 19271 $1,561.00 90 20240 $279.00 10 17004 $233.00 10 19272 $1,674.00 90 20245 $364.00 10 17106 $341.00 90 19290 $101.00 0 20250 $447.00 10 17107 $648.00 90 19291 $52.00 ZZZ 20251 $511.00 10 17108 $1,015.00 90 19295 $103.00 ZZZ 20500 $59.00 10 17110 $55.00 10 19296 $4,903.00 0 20501 $60.00 0 17111 $83.00 10 19297 $96.00 ZZZ 20520 $75.00 10 17250 $27.00 0 19298 $1,841.00 0 20525 $331.00 10 17260 $96.00 10 19300 $482.00 90 20526 $64.00 0 17261 $117.00 10 19301 $367.00 90 20550 $40.00 0 17262 $150.00 10 19302 $780.00 90 20551 $62.00 0 17263 $172.00 10 19303 $788.00 90 20552 $62.00 0 17264 $189.00 10 19304 $487.00 90 20553 $62.00 0 17266 $225.00 10 19305 $964.00 90 20555 $301.00 0 17270 $125.00 10 19306 $1,003.00 90 20600 $41.00 0 17271 $143.00 10 19307 $1,008.00 90 20605 $48.00 0 17272 $170.00 10 19316 $954.00 90 20610 $49.00 0 17273 $195.00 10 19318 $1,313.00 90 20612 $56.00 0 17274 $240.00 10 19324 $440.00 90 20615 $94.00 10 17276 $281.00 10 19325 $656.00 90 20650 $170.00 10 17280 $123.00 10 19328 $457.00 90 20660 $320.00 0 17281 $165.00 10 19330 $569.00 90 20661 $476.00 90 17282 $194.00 10 19340 $545.00 ZZZ 20662 $559.00 90 17283 $239.00 10 19342 $963.00 90 20663 $465.00 90 17284 $282.00 10 19350 $853.00 90 20665 $105.00 10 17286 $373.00 10 19355 $755.00 90 20670 $80.00 10 17311 $629.00 0 19357 $1,449.00 90 20680 $332.00 90 17312 $380.00 ZZZ 19361 $1,667.00 90 20690 $298.00 90 17313 $575.00 0 19364 $2,737.00 90 20692 $516.00 90 17314 $352.00 ZZZ 19366 $1,676.00 90 20693 $477.00 90 17315 $74.00 ZZZ 19367 $2,056.00 90 20694 $421.00 90 17340 $37.00 10 19368 $2,444.00 90 20802 $3,363.00 90 17360 $96.00 10 19369 $2,317.00 90 20805 $4,317.00 90 17380 BR 0 19370 $662.00 90 20808 $5,324.00 90 17999 BR YYY 19371 $788.00 90 20816 $3,060.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 20822 $2,511.00 90 21070 $679.00 90 21195 $1,360.00 90 20824 $3,027.00 90 21073 $337.00 90 21196 $1,764.00 90 20827 $3,920.00 90 21076 $1,192.00 10 21198 $1,268.00 90 20838 $3,484.00 90 21077 $3,002.00 90 21199 $1,018.00 90 20900 $454.00 90 21079 $2,086.00 90 21206 $1,112.00 90 20902 $658.00 90 21080 $2,346.00 90 21208 $946.00 90 20910 $338.00 90 21081 $2,138.00 90 21209 $576.00 90 20912 $549.00 90 21082 $1,855.00 90 21210 $930.00 90 20920 $460.00 90 21083 $1,802.00 90 21215 $970.00 90 20922 $634.00 90 21084 $2,105.00 90 21230 $956.00 90 20924 $583.00 90 21085 $801.00 10 21235 $707.00 90 20926 $444.00 90 21086 $2,333.00 90 21240 $1,281.00 90 20930 BR 0 21087 $2,217.00 90 21242 $1,207.00 90 20931 $156.00 ZZZ 21088 BR 90 21243 $1,501.00 90 20936 BR 0 21089 BR 90 21244 $1,062.00 90 20937 $234.00 ZZZ 21100 $297.00 90 21245 $1,038.00 90 20938 $257.00 ZZZ 21110 $371.00 90 21246 $1,010.00 90 20950 $123.00 0 21116 $207.00 0 21247 $2,003.00 90 20955 $3,332.00 90 21120 $500.00 90 21248 $1,023.00 90 20956 $3,167.00 90 21121 $651.00 90 21249 $1,525.00 90 20957 $3,074.00 90 21122 $700.00 90 21255 $1,459.00 90 20962 $3,122.00 90 21123 $903.00 90 21256 $1,470.00 90 20969 $3,716.00 90 21125 $656.00 90 21260 $1,372.00 90 20970 $3,650.00 90 21127 $909.00 90 21261 $2,347.00 90 20972 $3,420.00 90 21137 $797.00 90 21263 $2,361.00 90 20973 $3,821.00 90 21138 $960.00 90 21267 $1,539.00 90 20974 $266.00 0 21139 $1,168.00 90 21268 $1,946.00 90 20975 $334.00 0 21141 $1,438.00 90 21270 $890.00 90 20979 $19.00 0 21142 $1,527.00 90 21275 $963.00 90 20982 $4,231.00 0 21143 $1,511.00 90 21280 $571.00 90 20985 $140.00 ZZZ 21145 $1,513.00 90 21282 $360.00 90 20999 BR YYY 21146 $1,570.00 90 21295 $144.00 90 21010 $854.00 90 21147 $1,639.00 90 21296 $384.00 90 21015 $520.00 90 21150 $1,914.00 90 21299 BR YYY 21025 $546.00 90 21151 $2,264.00 90 21310 $81.00 0 21026 $413.00 90 21154 $2,364.00 90 21315 $180.00 10 21029 $700.00 90 21155 $2,640.00 90 21320 $235.00 10 21030 $496.00 90 21159 $3,302.00 90 21325 $348.00 90 21031 $310.00 90 21160 $3,500.00 90 21330 $639.00 90 21032 $315.00 90 21172 $2,111.00 90 21335 $852.00 90 21034 $1,140.00 90 21175 $2,604.00 90 21336 $478.00 90 21040 $227.00 90 21179 $1,826.00 90 21337 $300.00 90 21044 $957.00 90 21180 $2,035.00 90 21338 $550.00 90 21045 $1,313.00 90 21181 $813.00 90 21339 $689.00 90 21046 $899.00 90 21182 $2,570.00 90 21340 $907.00 90 21047 $1,109.00 90 21183 $2,770.00 90 21343 $1,043.00 90 21048 $925.00 90 21184 $3,150.00 90 21344 $1,450.00 90 21049 $1,051.00 90 21188 $1,786.00 90 21345 $738.00 90 21050 $1,026.00 90 21193 $1,331.00 90 21346 $917.00 90 21060 $972.00 90 21194 $1,540.00 90 21347 $1,048.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 21348 $1,286.00 90 21615 $938.00 90 22319 $1,983.00 90 21355 $295.00 10 21616 $1,042.00 90 22325 $1,407.00 90 21356 $372.00 10 21620 $689.00 90 22326 $1,710.00 90 21360 $590.00 90 21627 $686.00 90 22327 $1,660.00 90 21365 $1,239.00 90 21630 $1,455.00 90 22328 $391.00 ZZZ 21366 $1,386.00 90 21632 $1,514.00 90 22505 $174.00 10 21385 $810.00 90 21685 $918.00 90 22520 $509.00 10 21386 $812.00 90 21700 $576.00 90 22521 $477.00 10 21387 $958.00 90 21705 $746.00 90 22522 $231.00 ZZZ 21390 $920.00 90 21720 $523.00 90 22523 $617.00 10 21395 $1,384.00 90 21725 $588.00 90 22524 $592.00 10 21400 $143.00 90 21740 $1,387.00 90 22525 $283.00 ZZZ 21401 $313.00 90 21742 BR 90 22526 $2,013.00 10 21406 $852.00 90 21743 BR 90 22527 $1,637.00 ZZZ 21407 $736.00 90 21750 $1,009.00 90 22532 $1,618.00 90 21408 $1,007.00 90 21800 $84.00 90 22533 $1,509.00 90 21421 $528.00 90 21805 $236.00 90 22534 $381.00 ZZZ 21422 $761.00 90 21810 $540.00 90 22548 $2,271.00 90 21423 $890.00 90 21820 $143.00 90 22554 $1,727.00 90 21431 $598.00 90 21825 $810.00 90 22556 $2,054.00 90 21432 $744.00 90 21899 BR YYY 22558 $1,907.00 90 21433 $1,981.00 90 21920 $165.00 10 22585 $473.00 ZZZ 21435 $1,404.00 90 21925 $371.00 90 22590 $1,895.00 90 21436 $2,045.00 90 21930 $403.00 90 22595 $1,960.00 90 21440 $308.00 90 21935 $1,280.00 90 22600 $1,567.00 90 21445 $533.00 90 22010 $822.00 90 22610 $1,494.00 90 21450 $325.00 90 22015 $815.00 90 22612 $1,861.00 90 21451 $498.00 90 22100 $850.00 90 22614 $530.00 ZZZ 21452 $195.00 90 22101 $862.00 90 22630 $1,201.00 90 21453 $902.00 90 22102 $781.00 90 22632 $442.00 ZZZ 21454 $905.00 90 22103 $198.00 ZZZ 22800 $1,960.00 90 21461 $769.00 90 22110 $889.00 90 22802 $2,633.00 90 21462 $1,012.00 90 22112 $1,090.00 90 22804 $2,951.00 90 21465 $923.00 90 22114 $1,062.00 90 22808 $2,157.00 90 21470 $1,331.00 90 22116 $195.00 ZZZ 22810 $2,356.00 90 21480 $82.00 0 22206 $2,153.00 90 22812 $2,675.00 90 21485 $318.00 90 22207 $2,126.00 90 22818 $2,701.00 90 21490 $865.00 90 22208 $545.00 ZZZ 22819 $2,968.00 90 21495 $500.00 90 22210 $1,892.00 90 22830 $1,176.00 90 21497 $372.00 90 22212 $1,668.00 90 22840 $943.00 ZZZ 21499 BR YYY 22214 $819.00 90 22841 BR 0 21501 $315.00 90 22216 $492.00 ZZZ 22842 $2,352.00 ZZZ 21502 $612.00 90 22220 $1,801.00 90 22843 $1,028.00 ZZZ 21510 $534.00 90 22222 $1,604.00 90 22844 $1,277.00 ZZZ 21550 $165.00 10 22224 $1,731.00 90 22845 $1,853.00 ZZZ 21555 $337.00 90 22226 $488.00 ZZZ 22846 $999.00 ZZZ 21556 $431.00 90 22305 $213.00 90 22847 $1,077.00 ZZZ 21557 $794.00 90 22310 $272.00 90 22848 $529.00 ZZZ 21600 $631.00 90 22315 $711.00 90 22849 $2,235.00 90 21610 $828.00 90 22318 $1,755.00 90 22850 $872.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 22851 $600.00 ZZZ 23332 $1,029.00 90 23670 $759.00 90 22852 $854.00 90 23350 $74.00 0 23675 $550.00 90 22855 $1,193.00 90 23395 $1,366.00 90 23680 $1,064.00 90 22857 $1,386.00 90 23397 $1,403.00 90 23700 $237.00 10 22862 $1,690.00 90 23400 $1,196.00 90 23800 $1,346.00 90 22865 $1,646.00 90 23405 $799.00 90 23802 $1,368.00 90 22899 BR YYY 23406 $977.00 90 23900 $1,561.00 90 22900 $446.00 90 23410 $1,119.00 90 23920 $1,300.00 90 22999 BR YYY 23412 $1,229.00 90 23921 $497.00 90 23000 $447.00 90 23415 $622.00 90 23929 BR YYY 23020 $807.00 90 23420 $1,276.00 90 23930 $71.00 10 23030 $323.00 10 23430 $884.00 90 23931 $62.00 10 23031 $185.00 10 23440 $906.00 90 23935 $630.00 90 23035 $861.00 90 23450 $1,210.00 90 24000 $550.00 90 23040 $898.00 90 23455 $1,340.00 90 24006 $793.00 90 23044 $708.00 90 23460 $1,364.00 90 24065 $166.00 10 23065 $171.00 10 23462 $1,383.00 90 24066 $461.00 90 23066 $302.00 90 23465 $1,398.00 90 24075 $349.00 90 23075 $247.00 10 23466 $1,332.00 90 24076 $529.00 90 23076 $613.00 90 23470 $1,540.00 90 24077 $1,058.00 90 23077 $1,228.00 90 23472 $1,570.00 90 24100 $467.00 90 23100 $616.00 90 23480 $926.00 90 24101 $591.00 90 23101 $583.00 90 23485 $1,181.00 90 24102 $755.00 90 23105 $814.00 90 23490 $1,038.00 90 24105 $360.00 90 23106 $581.00 90 23491 $1,251.00 90 24110 $724.00 90 23107 $851.00 90 23500 $148.00 90 24115 $898.00 90 23120 $645.00 90 23505 $293.00 90 24116 $1,037.00 90 23125 $865.00 90 23515 $688.00 90 24120 $595.00 90 23130 $722.00 90 23520 $205.00 90 24125 $663.00 90 23140 $597.00 90 23525 $320.00 90 24126 $731.00 90 23145 $889.00 90 23530 $659.00 90 24130 $595.00 90 23146 $704.00 90 23532 $713.00 90 24134 $966.00 90 23150 $755.00 90 23540 $148.00 90 24136 $720.00 90 23155 $945.00 90 23545 $148.00 90 24138 $697.00 90 23156 $794.00 90 23550 $701.00 90 24140 $963.00 90 23170 $645.00 90 23552 $753.00 90 24145 $592.00 90 23172 $638.00 90 23570 $88.00 90 24147 $703.00 90 23174 $882.00 90 23575 $306.00 90 24149 $1,224.00 90 23180 $566.00 90 23585 $809.00 90 24150 $1,265.00 90 23182 $865.00 90 23600 $318.00 90 24151 $1,383.00 90 23184 $962.00 90 23605 $511.00 90 24152 $829.00 90 23190 $656.00 90 23615 $900.00 90 24153 $936.00 90 23195 $902.00 90 23616 $1,895.00 90 24155 $1,019.00 90 23200 $1,095.00 90 23620 $286.00 90 24160 $533.00 90 23210 $1,095.00 90 23625 $422.00 90 24164 $564.00 90 23220 $1,307.00 90 23630 $712.00 90 24200 $58.00 10 23221 $1,559.00 90 23650 $296.00 90 24201 $444.00 90 23222 $1,921.00 90 23655 $374.00 90 24220 $89.00 0 23330 $59.00 10 23660 $712.00 90 24300 $352.00 90 23331 $520.00 90 23665 $440.00 90 24301 $869.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 24305 $579.00 90 24605 $371.00 90 25125 $803.00 90 24310 $511.00 90 24615 $836.00 90 25126 $781.00 90 24320 $944.00 90 24620 $560.00 90 25130 $502.00 90 24330 $845.00 90 24635 $1,329.00 90 25135 $631.00 90 24331 $927.00 90 24650 $262.00 90 25136 $546.00 90 24332 $487.00 90 24655 $436.00 90 25145 $713.00 90 24340 $697.00 90 24665 $749.00 90 25150 $720.00 90 24341 $702.00 90 24666 $905.00 90 25151 $771.00 90 24342 $950.00 90 24670 $263.00 90 25170 $1,085.00 90 24343 $643.00 90 24675 $490.00 90 25210 $561.00 90 24344 $971.00 90 24685 $819.00 90 25215 $817.00 90 24345 $643.00 90 24800 $984.00 90 25230 $531.00 90 24346 $971.00 90 24802 $1,181.00 90 25240 $567.00 90 24357 $408.00 90 24900 $858.00 90 25246 $72.00 0 24358 $478.00 90 24920 $851.00 90 25248 $236.00 90 24359 $587.00 90 24925 $661.00 90 25250 $616.00 90 24360 $1,125.00 90 24930 $928.00 90 25251 $933.00 90 24361 $1,215.00 90 24931 $1,063.00 90 25259 $348.00 90 24362 $1,269.00 90 24935 $1,327.00 90 25260 $728.00 90 24363 $1,663.00 90 24940 BR 90 25263 $809.00 90 24365 $747.00 90 24999 BR YYY 25265 $998.00 90 24366 $850.00 90 25000 $381.00 90 25270 $549.00 90 24400 $991.00 90 25001 $294.00 90 25272 $613.00 90 24410 $1,319.00 90 25020 $594.00 90 25274 $887.00 90 24420 $1,265.00 90 25023 $1,040.00 90 25275 $620.00 90 24430 $1,209.00 90 25024 $683.00 90 25280 $670.00 90 24435 $1,260.00 90 25025 $1,104.00 90 25290 $436.00 90 24470 $774.00 90 25028 $417.00 90 25295 $562.00 90 24495 $742.00 90 25031 $266.00 90 25300 $592.00 90 24498 $1,076.00 90 25035 $794.00 90 25301 $757.00 90 24500 $288.00 90 25040 $654.00 90 25310 $865.00 90 24505 $574.00 90 25065 $164.00 10 25312 $968.00 90 24515 $1,018.00 90 25066 $322.00 90 25315 $1,004.00 90 24516 $1,029.00 90 25075 $352.00 90 25316 $1,203.00 90 24530 $88.00 90 25076 $544.00 90 25320 $834.00 90 24535 $671.00 90 25077 $957.00 90 25332 $1,022.00 90 24538 $850.00 90 25085 $562.00 90 25335 $1,166.00 90 24545 $946.00 90 25100 $420.00 90 25337 $946.00 90 24546 $1,273.00 90 25101 $492.00 90 25350 $913.00 90 24560 $266.00 90 25105 $635.00 90 25355 $1,014.00 90 24565 $526.00 90 25107 $600.00 90 25360 $468.00 90 24566 $705.00 90 25109 $470.00 90 25365 $1,216.00 90 24575 $872.00 90 25110 $403.00 90 25370 $1,214.00 90 24576 $295.00 90 25111 $356.00 90 25375 $1,280.00 90 24577 $575.00 90 25112 $441.00 90 25390 $1,043.00 90 24579 $964.00 90 25115 $837.00 90 25391 $1,349.00 90 24582 $773.00 90 25116 $807.00 90 25392 $1,294.00 90 24586 $1,314.00 90 25118 $466.00 90 25393 $1,473.00 90 24587 $1,278.00 90 25119 $653.00 90 25394 $723.00 90 24600 $360.00 90 25120 $712.00 90 25400 $1,112.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 25405 $1,388.00 90 25670 $731.00 90 26130 $629.00 90 25415 $1,343.00 90 25671 $462.00 90 26135 $668.00 90 25420 $1,554.00 90 25675 $404.00 90 26140 $678.00 90 25425 $1,403.00 90 25676 $741.00 90 26145 $660.00 90 25426 $1,401.00 90 25680 $471.00 90 26160 $319.00 90 25430 $638.00 90 25685 $887.00 90 26170 $452.00 90 25431 $631.00 90 25690 $518.00 90 26180 $444.00 90 25440 $931.00 90 25695 $520.00 90 26185 $511.00 90 25441 $1,147.00 90 25800 $703.00 90 26200 $598.00 90 25442 $936.00 90 25805 $1,078.00 90 26205 $788.00 90 25443 $970.00 90 25810 $1,008.00 90 26210 $543.00 90 25444 $1,031.00 90 25820 $2,276.00 90 26215 $731.00 90 25445 $959.00 90 25825 $895.00 90 26230 $624.00 90 25446 $1,542.00 90 25830 $991.00 90 26235 $612.00 90 25447 $952.00 90 25900 $871.00 90 26236 $444.00 90 25449 $395.00 90 25905 $900.00 90 26250 $814.00 90 25450 $805.00 90 25907 $799.00 90 26255 $1,184.00 90 25455 $899.00 90 25909 $849.00 90 26260 $758.00 90 25490 $955.00 90 25915 $1,523.00 90 26261 $949.00 90 25491 $1,006.00 90 25920 $771.00 90 26262 $624.00 90 25492 $1,170.00 90 25922 $670.00 90 26320 $414.00 90 25500 $200.00 90 25924 $768.00 90 26340 $266.00 90 25505 $517.00 90 25927 $830.00 90 26350 $715.00 90 25515 $800.00 90 25929 $645.00 90 26352 $855.00 90 25520 $644.00 90 25931 $731.00 90 26356 $886.00 90 25525 $1,097.00 90 25999 BR YYY 26357 $932.00 90 25526 $1,293.00 90 26010 $59.00 10 26358 $979.00 90 25530 $270.00 90 26011 $223.00 10 26370 $832.00 90 25535 $516.00 90 26020 $484.00 90 26372 $945.00 90 25545 $803.00 90 26025 $548.00 90 26373 $904.00 90 25560 $276.00 90 26030 $655.00 90 26390 $889.00 90 25565 $590.00 90 26034 $601.00 90 26392 $1,123.00 90 25574 $804.00 90 26035 $741.00 90 26410 $371.00 90 25575 $974.00 90 26037 $730.00 90 26412 $737.00 90 25600 $312.00 90 26040 $367.00 90 26415 $846.00 90 25605 $540.00 90 26045 $621.00 90 26416 $1,093.00 90 25606 $643.00 90 26055 $343.00 90 26418 $444.00 90 25607 $645.00 90 26060 $293.00 90 26420 $741.00 90 25608 $739.00 90 26070 $440.00 90 26426 $733.00 90 25609 $942.00 90 26075 $400.00 90 26428 $790.00 90 25622 $148.00 90 26080 $382.00 90 26432 $430.00 90 25624 $482.00 90 26100 $398.00 90 26433 $371.00 90 25628 $716.00 90 26105 $481.00 90 26434 $656.00 90 25630 $148.00 90 26110 $282.00 90 26437 $491.00 90 25635 $458.00 90 26115 $344.00 90 26440 $458.00 90 25645 $668.00 90 26116 $544.00 90 26442 $548.00 90 25650 $185.00 90 26117 $806.00 90 26445 $455.00 90 25651 $379.00 90 26121 $833.00 90 26449 $738.00 90 25652 $560.00 90 26123 $959.00 90 26450 $353.00 90 25660 $378.00 90 26125 $342.00 ZZZ 26455 $364.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 26460 $346.00 90 26587 $792.00 90 26951 $444.00 90 26471 $592.00 90 26590 $1,609.00 90 26952 $608.00 90 26474 $586.00 90 26591 $431.00 90 26989 BR YYY 26476 $543.00 90 26593 $587.00 90 26990 $592.00 90 26477 $553.00 90 26596 $809.00 90 26991 $466.00 90 26478 $608.00 90 26600 $133.00 90 26992 $1,146.00 90 26479 $653.00 90 26605 $296.00 90 27000 $421.00 90 26480 $808.00 90 26607 $334.00 90 27001 $550.00 90 26483 $986.00 90 26608 $497.00 90 27003 $698.00 90 26485 $891.00 90 26615 $521.00 90 27005 $738.00 90 26489 $738.00 90 26641 $71.00 90 27006 $788.00 90 26490 $496.00 90 26645 $371.00 90 27025 $896.00 90 26492 $971.00 90 26650 $533.00 90 27030 $1,148.00 90 26494 $946.00 90 26665 $693.00 90 27033 $1,173.00 90 26496 $949.00 90 26670 $148.00 90 27035 $1,413.00 90 26497 $946.00 90 26675 $501.00 90 27036 $1,176.00 90 26498 $1,317.00 90 26676 $527.00 90 27040 $196.00 10 26499 $934.00 90 26685 $592.00 90 27041 $699.00 90 26500 $557.00 90 26686 $710.00 90 27047 $535.00 90 26502 $715.00 90 26700 $88.00 90 27048 $588.00 90 26508 $334.00 90 26705 $296.00 90 27049 $1,162.00 90 26510 $564.00 90 26706 $469.00 90 27050 $449.00 90 26516 $630.00 90 26715 $526.00 90 27052 $624.00 90 26517 $890.00 90 26720 $96.00 90 27054 $843.00 90 26518 $877.00 90 26725 $187.00 90 27060 $491.00 90 26520 $583.00 90 26727 $187.00 90 27062 $499.00 90 26525 $531.00 90 26735 $532.00 90 27065 $583.00 90 26530 $708.00 90 26740 $148.00 90 27066 $931.00 90 26531 $877.00 90 26742 $148.00 90 27067 $1,234.00 90 26535 $546.00 90 26746 $548.00 90 27070 $1,040.00 90 26536 $770.00 90 26750 $96.00 90 27071 $1,112.00 90 26540 $726.00 90 26755 $133.00 90 27075 $1,485.00 90 26541 $926.00 90 26756 $366.00 90 27076 $1,859.00 90 26542 $716.00 90 26765 $398.00 90 27077 $1,976.00 90 26545 $722.00 90 26770 $79.00 90 27078 $1,164.00 90 26546 $918.00 90 26775 $275.00 90 27079 $1,170.00 90 26548 $665.00 90 26776 $401.00 90 27080 $568.00 90 26550 $1,861.00 90 26785 $408.00 90 27086 $57.00 10 26551 $3,901.00 90 26820 $854.00 90 27087 $555.00 90 26553 $3,868.00 90 26841 $756.00 90 27090 $981.00 90 26554 $4,551.00 90 26842 $901.00 90 27091 $1,482.00 90 26555 $1,567.00 90 26843 $800.00 90 27093 $62.00 0 26556 $4,005.00 90 26844 $875.00 90 27095 $121.00 0 26560 $576.00 90 26850 $704.00 90 27096 $491.00 0 26561 $1,067.00 90 26852 $829.00 90 27097 $795.00 90 26562 $1,017.00 90 26860 $542.00 90 27098 $799.00 90 26565 $730.00 90 26861 $151.00 ZZZ 27100 $987.00 90 26567 $622.00 90 26862 $747.00 90 27105 $946.00 90 26568 $1,003.00 90 26863 $317.00 ZZZ 27110 $1,174.00 90 26580 $1,585.00 90 26910 $747.00 90 27111 $1,099.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 27120 $1,603.00 90 27253 $1,162.00 90 27380 $698.00 90 27122 $1,406.00 90 27254 $1,478.00 90 27381 $1,118.00 90 27125 $1,371.00 90 27256 $338.00 10 27385 $753.00 90 27130 $1,853.00 90 27257 $455.00 10 27386 $1,064.00 90 27132 $2,128.00 90 27258 $1,355.00 90 27390 $506.00 90 27134 $2,576.00 90 27259 $1,803.00 90 27391 $647.00 90 27137 $2,190.00 90 27265 $442.00 90 27392 $834.00 90 27138 $2,025.00 90 27266 $614.00 90 27393 $608.00 90 27140 $1,092.00 90 27267 $382.00 90 27394 $748.00 90 27146 $1,432.00 90 27268 $470.00 90 27395 $1,093.00 90 27147 $1,744.00 90 27269 $1,117.00 90 27396 $742.00 90 27151 $1,732.00 90 27275 $220.00 10 27397 $989.00 90 27156 $2,017.00 90 27280 $1,179.00 90 27400 $832.00 90 27158 $1,588.00 90 27282 $990.00 90 27403 $792.00 90 27161 $1,443.00 90 27284 $1,435.00 90 27405 $842.00 90 27165 $1,572.00 90 27286 $1,503.00 90 27407 $918.00 90 27170 $1,453.00 90 27290 $2,073.00 90 27409 $1,212.00 90 27175 $491.00 90 27295 $1,594.00 90 27412 $1,605.00 90 27176 $1,024.00 90 27299 BR YYY 27415 $1,340.00 90 27177 $1,257.00 90 27301 $193.00 90 27416 $878.00 90 27178 $1,020.00 90 27303 $520.00 90 27418 $1,596.00 90 27179 $1,107.00 90 27305 $555.00 90 27420 $927.00 90 27181 $1,206.00 90 27306 $377.00 90 27422 $930.00 90 27185 $676.00 90 27307 $503.00 90 27424 $927.00 90 27187 $1,280.00 90 27310 $877.00 90 27425 $639.00 90 27193 $425.00 90 27323 $211.00 10 27427 $1,118.00 90 27194 $740.00 90 27324 $433.00 90 27428 $1,266.00 90 27200 $180.00 90 27325 $476.00 90 27429 $2,333.00 90 27202 $776.00 90 27326 $451.00 90 27430 $884.00 90 27215 $954.00 90 27327 $400.00 90 27435 $501.00 90 27216 $1,085.00 90 27328 $503.00 90 27437 $819.00 90 27217 $1,285.00 90 27329 $1,249.00 90 27438 $1,065.00 90 27218 $1,570.00 90 27330 $492.00 90 27440 $1,064.00 90 27220 $444.00 90 27331 $585.00 90 27441 $1,006.00 90 27222 $973.00 90 27332 $786.00 90 27442 $1,117.00 90 27226 $1,350.00 90 27333 $719.00 90 27443 $1,037.00 90 27227 $1,967.00 90 27334 $840.00 90 27445 $1,618.00 90 27228 $2,195.00 90 27335 $959.00 90 27446 $1,764.00 90 27230 $491.00 90 27340 $405.00 90 27447 $1,960.00 90 27232 $916.00 90 27345 $565.00 90 27448 $1,060.00 90 27235 $1,128.00 90 27347 $394.00 90 27450 $1,311.00 90 27236 $1,421.00 90 27350 $786.00 90 27454 $1,524.00 90 27238 $504.00 90 27355 $763.00 90 27455 $1,157.00 90 27240 $1,043.00 90 27356 $882.00 90 27457 $1,209.00 90 27244 $1,426.00 90 27357 $950.00 90 27465 $1,253.00 90 27245 $1,691.00 90 27358 $394.00 ZZZ 27466 $1,441.00 90 27246 $459.00 90 27360 $977.00 90 27468 $1,613.00 90 27248 $980.00 90 27365 $1,421.00 90 27470 $1,501.00 90 27250 $535.00 90 27370 $75.00 0 27472 $1,665.00 90 27252 $520.00 90 27372 $371.00 90 27475 $782.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 27477 $938.00 90 27599 BR YYY 27700 $835.00 90 27479 $1,123.00 90 27600 $517.00 90 27702 $1,278.00 90 27485 $797.00 90 27601 $516.00 90 27703 $1,337.00 90 27486 $1,771.00 90 27602 $621.00 90 27704 $683.00 90 27487 $2,352.00 90 27603 $412.00 90 27705 $985.00 90 27488 $1,438.00 90 27604 $308.00 90 27707 $484.00 90 27495 $1,477.00 90 27605 $236.00 10 27709 $1,118.00 90 27496 $563.00 90 27606 $362.00 10 27712 $1,227.00 90 27497 $652.00 90 27607 $608.00 90 27715 $1,285.00 90 27498 $701.00 90 27610 $777.00 90 27720 $1,147.00 90 27499 $782.00 90 27612 $701.00 90 27722 $1,076.00 90 27500 $520.00 90 27613 $165.00 10 27724 $1,402.00 90 27501 $659.00 90 27614 $327.00 90 27725 $1,312.00 90 27502 $909.00 90 27615 $1,106.00 90 27726 $823.00 90 27503 $911.00 90 27618 $421.00 90 27727 $1,175.00 90 27506 $1,522.00 90 27619 $730.00 90 27730 $647.00 90 27507 $1,297.00 90 27620 $587.00 90 27732 $611.00 90 27508 $400.00 90 27625 $796.00 90 27734 $766.00 90 27509 $649.00 90 27626 $863.00 90 27740 $1,044.00 90 27510 $755.00 90 27630 $430.00 90 27742 $1,045.00 90 27511 $1,281.00 90 27635 $781.00 90 27745 $940.00 90 27513 $1,562.00 90 27637 $921.00 90 27750 $319.00 90 27514 $1,508.00 90 27638 $978.00 90 27752 $614.00 90 27516 $579.00 90 27640 $1,122.00 90 27756 $708.00 90 27517 $820.00 90 27641 $922.00 90 27758 $1,115.00 90 27519 $1,311.00 90 27645 $1,302.00 90 27759 $1,262.00 90 27520 $266.00 90 27646 $1,212.00 90 27760 $223.00 90 27524 $910.00 90 27647 $1,044.00 90 27762 $495.00 90 27530 $408.00 90 27648 $72.00 0 27766 $759.00 90 27532 $641.00 90 27650 $869.00 90 27767 $233.00 90 27535 $1,075.00 90 27652 $935.00 90 27768 $361.00 90 27536 $1,282.00 90 27654 $937.00 90 27769 $622.00 90 27538 $487.00 90 27656 $458.00 90 27780 $244.00 90 27540 $1,106.00 90 27658 $527.00 90 27781 $296.00 90 27550 $296.00 90 27659 $725.00 90 27784 $643.00 90 27552 $619.00 90 27664 $504.00 90 27786 $223.00 90 27556 $832.00 90 27665 $618.00 90 27788 $422.00 90 27557 $1,479.00 90 27675 $656.00 90 27792 $706.00 90 27558 $1,529.00 90 27676 $762.00 90 27808 $332.00 90 27560 $88.00 90 27680 $523.00 90 27810 $567.00 90 27562 $514.00 90 27681 $634.00 90 27814 $972.00 90 27566 $1,047.00 90 27685 $565.00 90 27816 $386.00 90 27570 $184.00 10 27686 $706.00 90 27818 $613.00 90 27580 $1,644.00 90 27687 $589.00 90 27822 $1,201.00 90 27590 $1,059.00 90 27690 $757.00 90 27823 $1,472.00 90 27591 $1,182.00 90 27691 $889.00 90 27824 $384.00 90 27592 $911.00 90 27692 $159.00 ZZZ 27825 $670.00 90 27594 $600.00 90 27695 $658.00 90 27826 $1,080.00 90 27596 $931.00 90 27696 $758.00 90 27827 $1,310.00 90 27598 $976.00 90 27698 $881.00 90 27828 $1,823.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 27829 $742.00 90 28102 $700.00 90 28285 $463.00 90 27830 $412.00 90 28103 $709.00 90 28286 $441.00 90 27831 $415.00 90 28104 $491.00 90 28288 $452.00 90 27832 $617.00 90 28106 $632.00 90 28289 $458.00 90 27840 $334.00 90 28107 $517.00 90 28290 $557.00 90 27842 $373.00 90 28108 $418.00 90 28292 $666.00 90 27846 $877.00 90 28110 $421.00 90 28293 $845.00 90 27848 $1,224.00 90 28111 $537.00 90 28294 $797.00 90 27860 $211.00 10 28112 $457.00 90 28296 $832.00 90 27870 $1,269.00 90 28113 $481.00 90 28297 $838.00 90 27871 $843.00 90 28114 $890.00 90 28298 $755.00 90 27880 $1,015.00 90 28116 $648.00 90 28299 $829.00 90 27881 $1,120.00 90 28118 $568.00 90 28300 $845.00 90 27882 $854.00 90 28119 $524.00 90 28302 $930.00 90 27884 $579.00 90 28120 $601.00 90 28304 $776.00 90 27886 $835.00 90 28122 $622.00 90 28305 $1,030.00 90 27888 $911.00 90 28124 $480.00 90 28306 $530.00 90 27889 $879.00 90 28126 $393.00 90 28307 $614.00 90 27892 $575.00 90 28130 $727.00 90 28308 $516.00 90 27893 $574.00 90 28140 $533.00 90 28309 $955.00 90 27894 $712.00 90 28150 $416.00 90 28310 $505.00 90 27899 BR YYY 28153 $400.00 90 28312 $469.00 90 28001 $185.00 10 28160 $412.00 90 28313 $436.00 90 28002 $362.00 10 28171 $789.00 90 28315 $462.00 90 28003 $520.00 90 28173 $747.00 90 28320 $833.00 90 28005 $520.00 90 28175 $571.00 90 28322 $667.00 90 28008 $296.00 90 28190 $75.00 10 28340 $649.00 90 28010 $235.00 90 28192 $326.00 90 28341 $753.00 90 28011 $340.00 90 28193 $341.00 90 28344 $414.00 90 28020 $509.00 90 28200 $478.00 90 28345 $557.00 90 28022 $422.00 90 28202 $613.00 90 28360 $1,197.00 90 28024 $371.00 90 28208 $406.00 90 28400 $266.00 90 28035 $532.00 90 28210 $609.00 90 28405 $473.00 90 28043 $305.00 90 28220 $435.00 90 28406 $616.00 90 28045 $456.00 90 28222 $555.00 90 28415 $1,354.00 90 28046 $814.00 90 28225 $345.00 90 28420 $1,619.00 90 28050 $414.00 90 28226 $334.00 90 28430 $110.00 90 28052 $402.00 90 28230 $380.00 90 28435 $371.00 90 28054 $236.00 90 28232 $286.00 90 28436 $463.00 90 28055 $377.00 90 28234 $178.00 90 28445 $874.00 90 28060 $495.00 90 28238 $695.00 90 28446 $1,075.00 90 28062 $657.00 90 28240 $370.00 90 28450 $148.00 90 28070 $476.00 90 28250 $535.00 90 28455 $321.00 90 28072 $445.00 90 28260 $641.00 90 28456 $288.00 90 28080 $392.00 90 28261 $881.00 90 28465 $533.00 90 28086 $462.00 90 28262 $1,363.00 90 28470 $178.00 90 28088 $414.00 90 28264 $912.00 90 28475 $296.00 90 28090 $414.00 90 28270 $266.00 90 28476 $364.00 90 28092 $330.00 90 28272 $336.00 90 28485 $521.00 90 28100 $571.00 90 28280 $426.00 90 28490 $80.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 28495 $133.00 90 29035 $213.00 0 29800 $557.00 90 28496 $261.00 90 29040 $260.00 0 29804 $902.00 90 28505 $399.00 90 29044 $260.00 0 29805 $360.00 90 28510 $75.00 90 29046 $286.00 0 29806 $1,003.00 90 28515 $115.00 90 29049 $45.00 0 29807 $976.00 90 28525 $345.00 90 29055 $180.00 0 29819 $756.00 90 28530 $120.00 90 29058 $110.00 0 29820 $718.00 90 28531 $243.00 90 29065 $88.00 0 29821 $863.00 90 28540 $145.00 90 29075 $72.00 0 29822 $749.00 90 28545 $208.00 90 29085 $59.00 0 29823 $1,330.00 90 28546 $325.00 90 29086 $54.00 0 29824 $611.00 90 28555 $592.00 90 29105 $59.00 0 29825 $941.00 90 28570 $189.00 90 29125 $45.00 0 29826 $980.00 90 28575 $308.00 90 29126 $53.00 0 29827 $1,058.00 90 28576 $382.00 90 29130 $26.00 0 29828 $830.00 90 28585 $742.00 90 29131 $53.00 0 29830 $524.00 90 28600 $144.00 90 29200 $29.00 0 29834 $635.00 90 28605 $287.00 90 29220 $37.00 0 29835 $612.00 90 28606 $487.00 90 29240 $45.00 0 29836 $680.00 90 28615 $621.00 90 29260 $26.00 0 29837 $830.00 90 28630 $145.00 10 29280 $29.00 0 29838 $931.00 90 28635 $189.00 10 29305 $223.00 0 29840 $501.00 90 28636 $318.00 10 29325 $260.00 0 29843 $580.00 90 28645 $434.00 90 29345 $126.00 0 29844 $612.00 90 28660 $106.00 10 29355 $133.00 0 29845 $931.00 90 28665 $172.00 10 29358 $241.00 0 29846 $976.00 90 28666 $309.00 10 29365 $101.00 0 29847 $1,277.00 90 28675 $348.00 90 29405 $96.00 0 29848 $608.00 90 28705 $1,353.00 90 29425 $101.00 0 29850 $752.00 90 28715 $1,179.00 90 29435 $133.00 0 29851 $1,137.00 90 28725 $1,015.00 90 29440 $22.00 0 29855 $1,007.00 90 28730 $945.00 90 29445 $214.00 0 29856 $1,231.00 90 28735 $961.00 90 29450 $84.00 0 29860 $658.00 90 28737 $873.00 90 29505 $75.00 0 29861 $845.00 90 28740 $690.00 90 29515 $59.00 0 29862 $907.00 90 28750 $690.00 90 29520 $22.00 0 29863 $880.00 90 28755 $466.00 90 29530 $55.00 0 29866 $1,046.00 90 28760 $654.00 90 29540 $41.00 0 29867 $1,250.00 90 28800 $731.00 90 29550 $37.00 0 29868 $1,694.00 90 28805 $731.00 90 29580 $39.00 0 29870 $460.00 90 28810 $543.00 90 29590 $32.00 0 29871 $631.00 90 28820 $377.00 90 29700 $29.00 0 29873 $489.00 90 28825 $339.00 90 29705 $26.00 0 29874 $676.00 90 28890 $358.00 90 29710 $29.00 0 29875 $639.00 90 28899 BR YYY 29715 $109.00 0 29876 $809.00 90 29000 $247.00 0 29720 $29.00 0 29877 $852.00 90 29010 $271.00 0 29730 $29.00 0 29879 $1,064.00 90 29015 $289.00 0 29740 $37.00 0 29880 $1,169.00 90 29020 $237.00 0 29750 $105.00 0 29881 $745.00 90 29025 $188.00 0 29799 BR YYY 29882 $819.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 29883 $1,235.00 90 30462 $1,633.00 90 31255 $601.00 0 29884 $721.00 90 30465 $803.00 90 31256 $292.00 0 29885 $832.00 90 30520 $533.00 90 31267 $453.00 0 29886 $697.00 90 30540 $643.00 90 31276 $690.00 0 29887 $949.00 90 30545 $981.00 90 31287 $339.00 0 29888 $1,296.00 90 30560 $104.00 10 31288 $396.00 0 29889 $1,255.00 90 30580 $566.00 90 31290 $1,462.00 10 29891 $796.00 90 30600 $466.00 90 31291 $1,551.00 10 29892 $835.00 90 30620 $564.00 90 31292 $1,235.00 10 29893 $472.00 90 30630 $624.00 90 31293 $1,346.00 10 29894 $690.00 90 30801 $88.00 10 31294 $1,587.00 10 29895 $679.00 90 30802 $172.00 10 31299 BR YYY 29897 $704.00 90 30901 $75.00 0 31300 $1,295.00 90 29898 $863.00 90 30903 $110.00 0 31320 $508.00 90 29899 $973.00 90 30905 $224.00 0 31360 $1,630.00 90 29900 $434.00 90 30906 $208.00 0 31365 $2,238.00 90 29901 $479.00 90 30915 $596.00 90 31367 $1,913.00 90 29902 $514.00 90 30920 $862.00 90 31368 $2,478.00 90 29904 $557.00 90 30930 $213.00 10 31370 $1,891.00 90 29905 $601.00 90 30999 BR YYY 31375 $1,720.00 90 29906 $633.00 90 31000 $81.00 10 31380 $1,782.00 90 29907 $775.00 90 31002 $135.00 10 31382 $1,822.00 90 29999 BR YYY 31020 $281.00 90 31390 $2,513.00 90 30000 $96.00 10 31030 $531.00 90 31395 $2,937.00 90 30020 $117.00 10 31032 $604.00 90 31400 $969.00 90 30100 $86.00 0 31040 $772.00 90 31420 $969.00 90 30110 $157.00 10 31050 $489.00 90 31500 $116.00 0 30115 $360.00 90 31051 $654.00 90 31502 $74.00 0 30117 $301.00 90 31070 $410.00 90 31505 $62.00 0 30118 $819.00 90 31075 $839.00 90 31510 $145.00 0 30120 $500.00 90 31080 $942.00 90 31511 $88.00 0 30124 $243.00 90 31081 $1,089.00 90 31512 $197.00 0 30125 $599.00 90 31084 $1,210.00 90 31513 $182.00 0 30130 $275.00 90 31085 $1,281.00 90 31515 $160.00 0 30140 $320.00 90 31086 $1,081.00 90 31525 $234.00 0 30150 $790.00 90 31087 $1,075.00 90 31526 $222.00 0 30160 $875.00 90 31090 $877.00 90 31527 $262.00 0 30200 $68.00 0 31200 $463.00 90 31528 $202.00 0 30210 $75.00 10 31201 $716.00 90 31529 $217.00 0 30220 $154.00 10 31205 $851.00 90 31530 $284.00 0 30300 $45.00 10 31225 $1,683.00 90 31531 $311.00 0 30310 $170.00 10 31230 $1,908.00 90 31535 $272.00 0 30320 $419.00 90 31231 $122.00 0 31536 $308.00 0 30400 $741.00 90 31233 $221.00 0 31540 $357.00 0 30410 $1,173.00 90 31235 $217.00 0 31541 $453.00 0 30420 $1,424.00 90 31237 $266.00 0 31545 $384.00 0 30430 $626.00 90 31238 $311.00 0 31546 $587.00 0 30435 $1,005.00 90 31239 $775.00 10 31560 $446.00 0 30450 $1,445.00 90 31240 $224.00 0 31561 $509.00 0 30460 $857.00 90 31254 $588.00 0 31570 $369.00 0 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 31571 $363.00 0 31755 $1,448.00 90 32501 $374.00 ZZZ 31575 $128.00 0 31760 $1,648.00 90 32503 $1,875.00 90 31576 $186.00 0 31766 $2,315.00 90 32504 $2,145.00 90 31577 $230.00 0 31770 $1,815.00 90 32540 $1,308.00 90 31578 $264.00 0 31775 $1,973.00 90 32550 $821.00 0 31579 $219.00 0 31780 $1,577.00 90 32551 $171.00 0 31580 $1,213.00 90 31781 $1,936.00 90 32560 $302.00 0 31582 $1,881.00 90 31785 $1,320.00 90 32601 $456.00 0 31584 $1,616.00 90 31786 $1,866.00 90 32602 $494.00 0 31587 $913.00 90 31800 $628.00 90 32603 $585.00 0 31588 $1,206.00 90 31805 $1,175.00 90 32604 $663.00 0 31590 $691.00 90 31820 $458.00 90 32605 $550.00 0 31595 $773.00 90 31825 $659.00 90 32606 $637.00 0 31599 BR YYY 31830 $460.00 90 32650 $957.00 90 31600 $306.00 0 31899 BR YYY 32651 $1,166.00 90 31603 $343.00 0 32035 $821.00 90 32652 $1,615.00 90 31605 $297.00 0 32036 $908.00 90 32653 $1,144.00 90 31610 $794.00 90 32095 $848.00 90 32654 $1,096.00 90 31611 $614.00 90 32100 $1,120.00 90 32655 $1,213.00 90 31612 $99.00 0 32110 $1,223.00 90 32656 $1,222.00 90 31613 $384.00 90 32120 $1,077.00 90 32657 $1,261.00 90 31614 $736.00 90 32124 $1,144.00 90 32658 $1,142.00 90 31615 $213.00 0 32140 $1,284.00 90 32659 $1,141.00 90 31620 $271.00 ZZZ 32141 $1,267.00 90 32660 $1,691.00 90 31622 $230.00 0 32150 $1,226.00 90 32661 $1,165.00 90 31623 $225.00 0 32151 $1,231.00 90 32662 $1,459.00 90 31624 $217.00 0 32160 $842.00 90 32663 $1,636.00 90 31625 $235.00 0 32200 $1,132.00 90 32664 $1,197.00 90 31628 $269.00 0 32201 $387.00 0 32665 $1,360.00 90 31629 $198.00 0 32215 $1,024.00 90 32800 $1,166.00 90 31630 $308.00 0 32220 $1,680.00 90 32810 $1,085.00 90 31631 $252.00 0 32225 $1,268.00 90 32815 $1,917.00 90 31632 $73.00 ZZZ 32310 $1,221.00 90 32820 $1,848.00 90 31633 $90.00 ZZZ 32320 $1,787.00 90 32851 $3,100.00 90 31635 $298.00 0 32400 $129.00 0 32852 $3,339.00 90 31636 $241.00 0 32402 $798.00 90 32853 $3,787.00 90 31637 $86.00 ZZZ 32405 $159.00 0 32854 $4,038.00 90 31638 $268.00 0 32420 $116.00 0 32900 $1,532.00 90 31640 $399.00 0 32421 $159.00 0 32905 $1,661.00 90 31641 $304.00 0 32422 $194.00 0 32906 $2,100.00 90 31643 $208.00 0 32440 $1,837.00 90 32940 $1,555.00 90 31645 $208.00 0 32442 $2,093.00 90 32960 $126.00 0 31646 $161.00 0 32445 $2,093.00 90 32997 $312.00 0 31656 $127.00 0 32480 $1,622.00 90 32998 $2,809.00 0 31715 $57.00 0 32482 $1,714.00 90 32999 BR YYY 31717 $138.00 0 32484 $1,771.00 90 33010 $124.00 0 31720 $89.00 0 32486 $1,974.00 90 33011 $125.00 0 31725 $103.00 0 32488 $2,094.00 90 33015 $555.00 90 31730 $199.00 0 32491 $1,784.00 90 33020 $1,178.00 90 31750 $1,088.00 90 32500 $1,331.00 90 33025 $1,165.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 33030 $1,786.00 90 33284 $365.00 90 33506 $2,448.00 90 33031 $1,816.00 90 33300 $1,576.00 90 33507 $1,809.00 90 33050 $1,224.00 90 33305 $1,889.00 90 33508 $17.00 ZZZ 33120 $2,358.00 90 33310 $1,577.00 90 33510 $2,354.00 90 33130 $1,734.00 90 33315 $1,875.00 90 33511 $2,546.00 90 33140 $1,571.00 90 33320 $1,485.00 90 33512 $2,732.00 90 33141 $254.00 ZZZ 33321 $1,890.00 90 33513 $2,933.00 90 33202 $749.00 90 33322 $1,935.00 90 33514 $3,197.00 90 33203 $766.00 90 33330 $1,726.00 90 33516 $3,404.00 90 33206 $642.00 90 33332 $1,915.00 90 33517 $219.00 ZZZ 33207 $753.00 90 33335 $2,336.00 90 33518 $414.00 ZZZ 33208 $573.00 90 33400 $2,401.00 90 33519 $607.00 ZZZ 33210 $204.00 0 33401 $2,228.00 90 33521 $801.00 ZZZ 33211 $210.00 0 33403 $2,369.00 90 33522 $994.00 ZZZ 33212 $511.00 90 33404 $2,698.00 90 33523 $1,189.00 ZZZ 33213 $437.00 90 33405 $2,745.00 90 33530 $521.00 ZZZ 33214 $532.00 90 33406 $2,962.00 90 33533 $2,415.00 90 33215 $304.00 90 33410 $2,637.00 90 33534 $2,654.00 90 33216 $402.00 90 33411 $2,981.00 90 33535 $2,899.00 90 33217 $428.00 90 33412 $3,213.00 90 33536 $3,143.00 90 33218 $488.00 90 33413 $3,282.00 90 33542 $2,693.00 90 33220 $390.00 90 33414 $2,904.00 90 33545 $3,250.00 90 33222 $471.00 90 33415 $2,563.00 90 33548 $2,381.00 90 33223 $585.00 90 33416 $2,684.00 90 33572 $340.00 ZZZ 33224 $490.00 0 33417 $2,756.00 90 33600 $2,644.00 90 33225 $434.00 ZZZ 33420 $1,796.00 90 33602 $2,556.00 90 33226 $472.00 0 33422 $2,431.00 90 33606 $2,831.00 90 33233 $270.00 90 33425 $2,509.00 90 33608 $2,940.00 90 33234 $598.00 90 33426 $2,806.00 90 33610 $2,871.00 90 33235 $587.00 90 33427 $3,026.00 90 33611 $2,985.00 90 33236 $933.00 90 33430 $2,891.00 90 33612 $3,152.00 90 33237 $1,184.00 90 33460 $2,215.00 90 33615 $3,051.00 90 33238 $1,235.00 90 33463 $2,396.00 90 33617 $3,272.00 90 33240 $648.00 90 33464 $2,547.00 90 33619 $3,678.00 90 33241 $301.00 90 33465 $2,665.00 90 33641 $1,981.00 90 33243 $1,650.00 90 33468 $2,952.00 90 33645 $2,352.00 90 33244 $1,081.00 90 33470 $1,749.00 90 33647 $2,732.00 90 33249 $1,271.00 90 33471 $1,929.00 90 33660 $2,444.00 90 33250 $1,687.00 90 33472 $2,001.00 90 33665 $2,700.00 90 33251 $2,071.00 90 33474 $2,173.00 90 33670 $2,820.00 90 33254 $1,307.00 90 33475 $2,666.00 90 33675 $2,085.00 90 33255 $1,573.00 90 33476 $2,270.00 90 33676 $2,151.00 90 33256 $1,879.00 90 33478 $2,544.00 90 33677 $2,236.00 90 33257 $565.00 ZZZ 33496 $2,595.00 90 33681 $2,657.00 90 33258 $639.00 ZZZ 33500 $2,370.00 90 33684 $2,740.00 90 33259 $839.00 ZZZ 33501 $1,546.00 90 33688 $2,602.00 90 33261 $1,993.00 90 33502 $1,938.00 90 33690 $1,884.00 90 33265 $1,307.00 90 33503 $1,983.00 90 33692 $2,816.00 90 33266 $1,789.00 90 33504 $2,416.00 90 33694 $2,856.00 90 33282 $470.00 90 33505 $2,423.00 90 33697 $3,064.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 33702 $2,549.00 90 33880 $1,866.00 90 34800 $1,159.00 90 33710 $2,731.00 90 33881 $1,603.00 90 34802 $1,279.00 90 33720 $2,508.00 90 33883 $1,187.00 90 34803 $1,372.00 90 33722 $2,704.00 90 33884 $441.00 ZZZ 34804 $1,279.00 90 33724 $1,491.00 90 33886 $1,025.00 90 34805 $1,243.00 90 33726 $1,963.00 90 33889 $882.00 0 34806 $100.00 ZZZ 33730 $2,785.00 90 33891 $1,126.00 0 34808 $220.00 ZZZ 33732 $2,622.00 90 33910 $1,987.00 90 34812 $359.00 0 33735 $2,036.00 90 33915 $1,588.00 90 34813 $256.00 ZZZ 33736 $2,288.00 90 33916 $2,096.00 90 34820 $519.00 0 33737 $1,977.00 90 33917 $2,345.00 90 34825 $694.00 90 33750 $1,877.00 90 33920 $2,981.00 90 34826 $220.00 ZZZ 33755 $1,831.00 90 33922 $2,227.00 90 34830 $1,803.00 90 33762 $1,900.00 90 33924 $421.00 ZZZ 34831 $1,950.00 90 33764 $1,895.00 90 33925 $1,849.00 90 34832 $1,950.00 90 33766 $2,119.00 90 33926 $2,499.00 90 34833 $650.00 0 33767 $2,173.00 90 33935 $5,415.00 90 34834 $306.00 0 33768 $449.00 ZZZ 33945 $3,813.00 90 34900 $960.00 90 33770 $2,954.00 90 33960 $1,221.00 0 35001 $1,564.00 90 33771 $2,924.00 90 33961 $800.00 ZZZ 35002 $1,547.00 90 33774 $2,681.00 90 33967 $258.00 0 35005 $1,268.00 90 33775 $2,654.00 90 33968 $51.00 0 35011 $1,007.00 90 33776 $2,844.00 90 33970 $576.00 0 35013 $1,376.00 90 33777 $2,724.00 90 33971 $578.00 90 35021 $1,635.00 90 33778 $3,199.00 90 33973 $756.00 0 35022 $1,686.00 90 33779 $3,121.00 90 33974 $1,095.00 90 35045 $995.00 90 33780 $3,232.00 90 33975 $1,758.00 0 35081 $2,175.00 90 33781 $3,057.00 90 33976 $2,056.00 0 35082 $2,661.00 90 33786 $2,970.00 90 33977 $1,561.00 90 35091 $2,634.00 90 33788 $2,288.00 90 33978 $1,754.00 90 35092 $2,872.00 90 33800 $1,546.00 90 33979 $2,496.00 0 35102 $2,346.00 90 33802 $1,752.00 90 33980 $3,212.00 90 35103 $2,587.00 90 33803 $1,746.00 90 33999 BR YYY 35111 $1,398.00 90 33813 $1,935.00 90 34001 $1,012.00 90 35112 $1,351.00 90 33814 $2,464.00 90 34051 $1,134.00 90 35121 $2,000.00 90 33820 $1,619.00 90 34101 $800.00 90 35122 $2,382.00 90 33822 $1,559.00 90 34111 $669.00 90 35131 $1,495.00 90 33824 $1,884.00 90 34151 $1,288.00 90 35132 $1,742.00 90 33840 $2,029.00 90 34201 $777.00 90 35141 $1,231.00 90 33845 $2,129.00 90 34203 $949.00 90 35142 $1,339.00 90 33851 $2,129.00 90 34401 $953.00 90 35151 $1,390.00 90 33852 $2,311.00 90 34421 $779.00 90 35152 $1,229.00 90 33853 $3,057.00 90 34451 $1,117.00 90 35180 $997.00 90 33860 $3,044.00 90 34471 $685.00 90 35182 $1,345.00 90 33861 $3,069.00 90 34490 $660.00 90 35184 $976.00 90 33863 $3,183.00 90 34501 $910.00 90 35188 $1,048.00 90 33864 $3,035.00 90 34502 $2,044.00 90 35189 $1,380.00 90 33870 $3,638.00 90 34510 $1,108.00 90 35190 $1,018.00 90 33875 $2,876.00 90 34520 $1,077.00 90 35201 $852.00 90 33877 $3,767.00 90 34530 $1,368.00 90 35206 $835.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 35207 $935.00 90 35481 $565.00 0 35606 $1,539.00 90 35211 $1,833.00 90 35482 $577.00 0 35612 $1,349.00 90 35216 $1,494.00 90 35483 $696.00 0 35616 $1,346.00 90 35221 $1,243.00 90 35484 $853.00 0 35621 $1,265.00 90 35226 $841.00 90 35485 $670.00 0 35623 $1,193.00 90 35231 $1,053.00 90 35490 $691.00 0 35626 $1,921.00 90 35236 $947.00 90 35491 $423.00 0 35631 $1,891.00 90 35241 $1,926.00 90 35492 $423.00 0 35636 $1,656.00 90 35246 $1,701.00 90 35493 $523.00 0 35637 $1,704.00 90 35251 $1,260.00 90 35494 $605.00 0 35638 $1,731.00 90 35256 $1,568.00 90 35495 $532.00 0 35642 $1,298.00 90 35261 $1,008.00 90 35500 $423.00 ZZZ 35645 $1,304.00 90 35266 $921.00 90 35501 $1,569.00 90 35646 $2,105.00 90 35271 $1,814.00 90 35506 $1,641.00 90 35647 $1,555.00 90 35276 $1,541.00 90 35508 $1,564.00 90 35650 $1,236.00 90 35281 $1,396.00 90 35509 $1,529.00 90 35651 $2,055.00 90 35286 $1,036.00 90 35510 $1,316.00 90 35654 $1,603.00 90 35301 $1,486.00 90 35511 $1,256.00 90 35656 $1,589.00 90 35302 $1,109.00 90 35512 $1,291.00 90 35661 $1,145.00 90 35303 $1,218.00 90 35515 $1,387.00 90 35663 $1,237.00 90 35304 $1,267.00 90 35516 $1,391.00 90 35665 $1,333.00 90 35305 $1,218.00 90 35518 $1,313.00 90 35666 $1,686.00 90 35306 $456.00 ZZZ 35521 $1,393.00 90 35671 $1,315.00 90 35311 $1,999.00 90 35522 $1,253.00 90 35681 $751.00 ZZZ 35321 $1,031.00 90 35523 $1,237.00 90 35682 $627.00 ZZZ 35331 $1,724.00 90 35525 $1,197.00 90 35683 $702.00 ZZZ 35341 $1,908.00 90 35526 $1,527.00 90 35685 $216.00 ZZZ 35351 $1,555.00 90 35531 $2,000.00 90 35686 $178.00 ZZZ 35355 $1,336.00 90 35533 $1,716.00 90 35691 $1,546.00 90 35361 $1,859.00 90 35536 $1,888.00 90 35693 $1,140.00 90 35363 $2,006.00 90 35537 $2,141.00 90 35694 $1,353.00 90 35371 $1,006.00 90 35538 $2,391.00 90 35695 $1,351.00 90 35372 $1,085.00 90 35539 $2,248.00 90 35697 $166.00 ZZZ 35390 $225.00 ZZZ 35540 $2,505.00 90 35700 $264.00 ZZZ 35400 $224.00 ZZZ 35548 $1,751.00 90 35701 $494.00 90 35450 $643.00 0 35549 $1,902.00 90 35721 $500.00 90 35452 $518.00 0 35551 $2,036.00 90 35741 $499.00 90 35454 $520.00 0 35556 $1,745.00 90 35761 $532.00 90 35456 $631.00 0 35558 $1,219.00 90 35800 $567.00 90 35458 $804.00 0 35560 $1,899.00 90 35820 $951.00 90 35459 $736.00 0 35563 $1,115.00 90 35840 $771.00 90 35460 $430.00 0 35565 $1,312.00 90 35860 $496.00 90 35470 $537.00 0 35566 $2,161.00 90 35870 $1,583.00 90 35471 $626.00 0 35571 $1,612.00 90 35875 $827.00 90 35472 $388.00 0 35572 $369.00 ZZZ 35876 $1,232.00 90 35473 $375.00 0 35583 $1,843.00 90 35879 $1,163.00 90 35474 $456.00 0 35585 $2,277.00 90 35881 $1,275.00 90 35475 $569.00 0 35587 $1,698.00 90 35883 $1,247.00 90 35476 $338.00 0 35600 $273.00 ZZZ 35884 $1,324.00 90 35480 $935.00 0 35601 $1,495.00 90 35901 $709.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 35903 $818.00 90 36515 $92.00 0 36838 $1,230.00 90 35905 $1,343.00 90 36516 $92.00 0 36860 $166.00 0 35907 $1,335.00 90 36522 $305.00 0 36861 $224.00 0 36000 $46.00 0 36556 $316.00 0 36870 $1,755.00 90 36002 $181.00 0 36558 $703.00 10 37140 $1,666.00 90 36005 $68.00 0 36561 $1,333.00 10 37145 $1,741.00 90 36010 $136.00 0 36563 $1,679.00 10 37160 $1,681.00 90 36011 $194.00 0 36565 $1,073.00 10 37180 $1,769.00 90 36012 $186.00 0 36566 $1,121.00 10 37181 $1,923.00 90 36013 $141.00 0 36569 $350.00 0 37182 $914.00 0 36014 $159.00 0 36571 $1,550.00 10 37183 $425.00 0 36015 $186.00 0 36575 $172.00 0 37184 $3,074.00 0 36100 $176.00 0 36576 $429.00 10 37185 $1,002.00 ZZZ 36120 $120.00 0 36578 $546.00 10 37186 $2,076.00 ZZZ 36140 $106.00 0 36580 $307.00 0 37187 $2,991.00 0 36145 $10.00 0 36581 $646.00 10 37188 $2,586.00 0 36160 $196.00 0 36582 $1,210.00 10 37195 $302.00 0 36200 $240.00 0 36583 $708.00 10 37200 $232.00 0 36215 $240.00 0 36584 $321.00 0 37201 $408.00 0 36216 $270.00 0 36585 $1,525.00 10 37202 $340.00 0 36217 $325.00 0 36589 $176.00 10 37203 $287.00 0 36218 $79.00 ZZZ 36590 $378.00 10 37204 $957.00 0 36245 $249.00 0 36591 $21.00 0 37205 $589.00 0 36246 $272.00 0 36592 $26.00 0 37206 $288.00 ZZZ 36247 $323.00 0 36593 $37.00 0 37207 $613.00 0 36248 $53.00 ZZZ 36595 $880.00 0 37208 $299.00 ZZZ 36260 $749.00 90 36596 $194.00 0 37209 $116.00 0 36261 $388.00 90 36597 $167.00 0 37210 $2,128.00 0 36262 $297.00 90 36598 $130.00 0 37215 $1,095.00 90 36299 BR YYY 36600 $24.00 0 37216 $1,055.00 90 36410 $18.00 0 36620 $64.00 0 37250 $112.00 ZZZ 36415 BR 0 36625 $133.00 0 37251 $85.00 ZZZ 36416 BR 0 36640 $130.00 0 37500 $739.00 90 36425 $86.00 0 36680 $72.00 0 37501 BR YYY 36430 $37.00 0 36800 $159.00 0 37565 $364.00 90 36455 $141.00 0 36810 $345.00 0 37600 $414.00 90 36468 BR 0 36815 $236.00 0 37605 $521.00 90 36469 BR 0 36818 $736.00 90 37606 $563.00 90 36470 $76.00 10 36819 $977.00 90 37607 $456.00 90 36471 $96.00 10 36820 $800.00 90 37609 $278.00 10 36475 $2,216.00 0 36821 $721.00 90 37615 $495.00 90 36476 $434.00 ZZZ 36822 $630.00 90 37616 $1,128.00 90 36478 $2,041.00 0 36823 $1,461.00 90 37617 $1,132.00 90 36479 $438.00 ZZZ 36825 $867.00 90 37618 $514.00 90 36481 $499.00 0 36830 $967.00 90 37620 $818.00 90 36500 $159.00 0 36831 $488.00 90 37650 $430.00 90 36511 $92.00 0 36832 $810.00 90 37660 $789.00 90 36512 $92.00 0 36833 $780.00 90 37700 $336.00 90 36513 $92.00 0 36834 $761.00 90 37718 $416.00 90 36514 $92.00 0 36835 $542.00 90 37722 $495.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 37735 $847.00 90 38746 $312.00 ZZZ 40810 $141.00 10 37760 $813.00 90 38747 $337.00 ZZZ 40812 $202.00 10 37765 $462.00 90 38760 $699.00 90 40814 $319.00 90 37766 $561.00 90 38765 $1,283.00 90 40816 $336.00 90 37780 $301.00 90 38770 $1,111.00 90 40818 $249.00 90 37785 $270.00 90 38780 $1,357.00 90 40819 $208.00 90 37788 $1,654.00 90 38790 $158.00 0 40820 $104.00 10 37790 $690.00 90 38792 $26.00 0 40830 $140.00 10 37799 BR YYY 38794 $298.00 90 40831 $213.00 10 38100 $974.00 90 38999 BR YYY 40840 $687.00 90 38101 $982.00 90 39000 $664.00 90 40842 $684.00 90 38102 $332.00 ZZZ 39010 $1,148.00 90 40843 $947.00 90 38115 $1,020.00 90 39200 $1,249.00 90 40844 $1,232.00 90 38120 $1,138.00 90 39220 $1,542.00 90 40845 $1,593.00 90 38129 BR YYY 39400 $614.00 10 40899 BR YYY 38200 $180.00 0 39499 BR YYY 41000 $119.00 10 38205 $79.00 0 39501 $1,083.00 90 41005 $109.00 10 38206 $79.00 0 39502 $1,268.00 90 41006 $237.00 90 38220 $212.00 0 39503 $2,726.00 90 41007 $283.00 90 38221 $228.00 0 39520 $1,345.00 90 41008 $248.00 90 38230 $265.00 10 39530 $1,295.00 90 41009 $319.00 90 38240 $128.00 0 39531 $1,243.00 90 41010 $91.00 10 38241 $128.00 0 39540 $1,133.00 90 41015 $267.00 90 38242 $90.00 0 39541 $1,179.00 90 41016 $357.00 90 38300 $104.00 10 39545 $1,102.00 90 41017 $300.00 90 38305 $375.00 90 39560 $968.00 90 41018 $424.00 90 38308 $425.00 90 39561 $1,328.00 90 41019 $444.00 0 38380 $628.00 90 39599 BR YYY 41100 $140.00 10 38381 $1,087.00 90 40490 $108.00 0 41105 $136.00 10 38382 $798.00 90 40500 $422.00 90 41108 $110.00 10 38500 $234.00 10 40510 $469.00 90 41110 $159.00 10 38505 $139.00 0 40520 $467.00 90 41112 $255.00 90 38510 $349.00 10 40525 $714.00 90 41113 $301.00 90 38520 $431.00 90 40527 $851.00 90 41114 $682.00 90 38525 $369.00 90 40530 $501.00 90 41115 $176.00 10 38530 $517.00 90 40650 $368.00 90 41116 $242.00 90 38542 $507.00 90 40652 $436.00 90 41120 $813.00 90 38550 $519.00 90 40654 $529.00 90 41130 $937.00 90 38555 $1,115.00 90 40700 $1,009.00 90 41135 $1,869.00 90 38562 $799.00 90 40701 $1,452.00 90 41140 $2,005.00 90 38564 $831.00 90 40702 $1,030.00 90 41145 $2,406.00 90 38570 $695.00 10 40720 $1,107.00 90 41150 $1,897.00 90 38571 $902.00 10 40761 $1,202.00 90 41153 $2,091.00 90 38572 $1,049.00 10 40799 BR YYY 41155 $2,448.00 90 38589 BR YYY 40800 $110.00 10 41250 $168.00 10 38700 $863.00 90 40801 $208.00 10 41251 $203.00 10 38720 $1,328.00 90 40804 $105.00 10 41252 $294.00 10 38724 $1,366.00 90 40805 $245.00 10 41500 $334.00 90 38740 $539.00 90 40806 $38.00 0 41510 $313.00 90 38745 $770.00 90 40808 $100.00 10 41520 $255.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 41599 BR YYY 42405 $258.00 10 42961 $406.00 90 41800 $107.00 10 42408 $377.00 90 42962 $602.00 90 41805 $115.00 10 42409 $266.00 90 42970 $284.00 90 41806 $217.00 10 42410 $746.00 90 42971 $472.00 90 41820 BR 0 42415 $1,364.00 90 42972 $562.00 90 41821 BR 0 42420 $1,577.00 90 42999 BR YYY 41822 $237.00 10 42425 $1,097.00 90 43020 $696.00 90 41823 $312.00 90 42426 $1,882.00 90 43030 $712.00 90 41825 $144.00 10 42440 $634.00 90 43045 $1,574.00 90 41826 $211.00 10 42450 $395.00 90 43100 $744.00 90 41827 $322.00 90 42500 $407.00 90 43101 $1,248.00 90 41828 $176.00 10 42505 $559.00 90 43107 $2,325.00 90 41830 $156.00 10 42507 $522.00 90 43108 $2,664.00 90 41850 BR 0 42508 $767.00 90 43112 $2,471.00 90 41870 BR 0 42509 $915.00 90 43113 $2,755.00 90 41872 $249.00 90 42510 $711.00 90 43116 $2,509.00 90 41874 $193.00 90 42550 $82.00 0 43117 $2,469.00 90 41899 BR YYY 42600 $445.00 90 43118 $2,607.00 90 42000 $106.00 10 42650 $67.00 0 43121 $2,350.00 90 42100 $122.00 10 42660 $89.00 0 43122 $2,287.00 90 42104 $161.00 10 42665 $238.00 90 43123 $2,661.00 90 42106 $204.00 10 42699 BR YYY 43124 $2,242.00 90 42107 $409.00 90 42700 $144.00 10 43130 $1,020.00 90 42120 $573.00 90 42720 $270.00 10 43135 $1,332.00 90 42140 $174.00 90 42725 $720.00 90 43200 $266.00 0 42145 $741.00 90 42800 $123.00 10 43201 $245.00 0 42160 $176.00 10 42802 $150.00 10 43202 $205.00 0 42180 $222.00 10 42804 $136.00 10 43204 $228.00 0 42182 $324.00 10 42806 $167.00 10 43205 $207.00 0 42200 $946.00 90 42808 $250.00 10 43215 $160.00 0 42205 $863.00 90 42809 $152.00 10 43216 $149.00 0 42210 $1,174.00 90 42810 $335.00 90 43217 $176.00 0 42215 $766.00 90 42815 $659.00 90 43219 $171.00 0 42220 $586.00 90 42821 $378.00 90 43220 $128.00 0 42225 $803.00 90 42826 $320.00 90 43226 $142.00 0 42226 $848.00 90 42831 $235.00 90 43227 $218.00 0 42227 $762.00 90 42836 $286.00 90 43228 $230.00 0 42235 $631.00 90 42842 $729.00 90 43231 $182.00 0 42260 $491.00 90 42844 $1,173.00 90 43232 $252.00 0 42280 $148.00 10 42845 $1,958.00 90 43234 $193.00 0 42281 $160.00 10 42860 $207.00 90 43235 $239.00 0 42299 BR YYY 42870 $427.00 90 43236 $285.00 0 42300 $165.00 10 42890 $1,047.00 90 43237 $219.00 0 42305 $448.00 90 42892 $1,262.00 90 43238 $271.00 0 42310 $145.00 10 42894 $1,825.00 90 43239 $246.00 0 42320 $208.00 10 42900 $429.00 10 43240 $369.00 0 42330 $184.00 10 42950 $745.00 90 43241 $157.00 0 42335 $287.00 90 42953 $752.00 90 43242 $384.00 0 42340 $411.00 90 42955 $561.00 90 43243 $276.00 0 42400 $94.00 0 42960 $178.00 10 43244 $268.00 0 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 43245 $214.00 0 43425 $1,338.00 90 43843 $1,249.00 90 43246 $485.00 0 43450 $91.00 0 43845 $1,738.00 90 43247 $229.00 0 43453 $102.00 0 43846 $1,528.00 90 43248 $191.00 0 43456 $149.00 0 43847 $1,678.00 90 43249 $175.00 0 43458 $164.00 0 43848 $1,795.00 90 43250 $194.00 0 43460 $203.00 0 43850 $1,425.00 90 43251 $224.00 0 43496 BR 90 43855 $1,454.00 90 43255 $343.00 0 43499 BR YYY 43860 $1,435.00 90 43256 $235.00 0 43500 $649.00 90 43865 $1,549.00 90 43257 $305.00 0 43501 $1,105.00 90 43870 $590.00 90 43258 $276.00 0 43502 $1,247.00 90 43880 $1,352.00 90 43259 $271.00 0 43510 $680.00 90 43886 $280.00 90 43260 $349.00 0 43520 $599.00 90 43887 $274.00 90 43261 $362.00 0 43600 $96.00 0 43888 $389.00 90 43262 $447.00 0 43605 $686.00 90 43999 BR YYY 43263 $386.00 0 43610 $861.00 90 44005 $1,171.00 90 43264 $522.00 0 43611 $1,001.00 90 44010 $809.00 90 43265 $527.00 0 43620 $1,691.00 90 44015 $1,171.00 ZZZ 43267 $434.00 0 43621 $1,718.00 90 44020 $891.00 90 43268 $446.00 0 43622 $1,798.00 90 44021 $888.00 90 43269 $410.00 0 43631 $1,445.00 90 44025 $905.00 90 43271 $437.00 0 43632 $1,443.00 90 44050 $862.00 90 43272 $401.00 0 43633 $1,467.00 90 44055 $957.00 90 43280 $1,314.00 90 43634 $1,786.00 90 44100 $117.00 0 43289 BR YYY 43635 $143.00 ZZZ 44110 $784.00 90 43300 $837.00 90 43640 $1,119.00 90 44111 $963.00 90 43305 $1,428.00 90 43641 $1,138.00 90 44120 $1,078.00 90 43310 $2,138.00 90 43644 $1,598.00 90 44121 $308.00 ZZZ 43312 $2,331.00 90 43645 $1,724.00 90 44125 $1,135.00 90 43313 $2,632.00 90 43651 $716.00 90 44126 $1,951.00 90 43314 $2,891.00 90 43652 $856.00 90 44127 $2,243.00 90 43320 $1,299.00 90 43653 $617.00 90 44128 $242.00 ZZZ 43324 $1,280.00 90 43659 BR YYY 44130 $938.00 90 43325 $1,261.00 90 43752 $36.00 0 44133 BR 0 43326 $1,198.00 90 43760 $81.00 0 44136 BR 0 43330 $1,236.00 90 43761 $107.00 0 44139 $154.00 ZZZ 43331 $1,378.00 90 43770 $1,009.00 90 44140 $1,350.00 90 43340 $1,292.00 90 43771 $1,162.00 90 44141 $1,488.00 90 43341 $1,351.00 90 43772 $885.00 90 44143 $1,536.00 90 43350 $986.00 90 43773 $1,162.00 90 44144 $1,442.00 90 43351 $1,180.00 90 43774 $888.00 90 44145 $1,678.00 90 43352 $1,028.00 90 43800 $793.00 90 44146 $1,840.00 90 43360 $2,277.00 90 43810 $846.00 90 44147 $1,452.00 90 43361 $2,596.00 90 43820 $896.00 90 44150 $1,661.00 90 43400 $1,261.00 90 43825 $1,128.00 90 44151 $1,499.00 90 43401 $1,299.00 90 43830 $592.00 90 44155 $1,892.00 90 43405 $1,330.00 90 43831 $593.00 90 44156 $1,709.00 90 43410 $946.00 90 43832 $904.00 90 44157 $1,952.00 90 43415 $1,382.00 90 43840 $893.00 90 44158 $2,003.00 90 43420 $854.00 90 43842 $1,260.00 90 44160 $1,236.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 44180 $853.00 90 44392 $359.00 0 45130 $1,041.00 90 44186 $600.00 90 44393 $413.00 0 45135 $1,354.00 90 44187 $992.00 90 44394 $395.00 0 45136 $1,526.00 90 44188 $1,088.00 90 44397 $259.00 0 45150 $475.00 90 44202 $1,603.00 90 44500 $28.00 0 45160 $949.00 90 44203 $235.00 ZZZ 44602 $815.00 90 45170 $697.00 90 44204 $1,353.00 90 44603 $1,041.00 90 45190 $623.00 90 44205 $1,198.00 90 44604 $1,027.00 90 45300 $75.00 0 44206 $1,480.00 90 44605 $1,132.00 90 45303 $72.00 0 44207 $1,620.00 90 44615 $994.00 90 45305 $102.00 0 44208 $1,752.00 90 44620 $741.00 90 45307 $172.00 0 44210 $1,551.00 90 44625 $1,277.00 90 45308 $137.00 0 44211 $1,926.00 90 44626 $1,581.00 90 45309 $174.00 0 44212 $1,800.00 90 44640 $1,036.00 90 45315 $211.00 0 44213 $196.00 ZZZ 44650 $1,076.00 90 45317 $209.00 0 44227 $1,536.00 90 44660 $1,050.00 90 45320 $230.00 0 44238 BR YYY 44661 $1,326.00 90 45321 $154.00 0 44300 $697.00 90 44680 $1,049.00 90 45327 $96.00 0 44310 $950.00 90 44700 $1,115.00 90 45330 $87.00 0 44312 $453.00 90 44701 $161.00 ZZZ 45331 $120.00 0 44314 $892.00 90 44720 $268.00 0 45332 $174.00 0 44316 $1,229.00 90 44721 $393.00 0 45333 $176.00 0 44320 $1,029.00 90 44799 BR YYY 45334 $171.00 0 44322 $1,015.00 90 44800 $791.00 90 45335 $144.00 0 44340 $397.00 90 44820 $755.00 90 45337 $144.00 0 44345 $816.00 90 44850 $708.00 90 45338 $212.00 0 44346 $923.00 90 44899 BR YYY 45339 $237.00 0 44360 $177.00 0 44900 $644.00 90 45340 $328.00 0 44361 $195.00 0 44901 $310.00 0 45341 $153.00 0 44363 $213.00 0 44950 $643.00 90 45342 $224.00 0 44364 $255.00 0 44955 $136.00 ZZZ 45345 $164.00 0 44365 $226.00 0 44960 $790.00 90 45355 $185.00 0 44366 $300.00 0 44970 $631.00 90 45378 $341.00 0 44369 $308.00 0 44979 BR YYY 45379 $415.00 0 44370 $253.00 0 45000 $329.00 90 45380 $369.00 0 44372 $301.00 0 45005 $197.00 10 45381 $388.00 0 44373 $238.00 0 45020 $364.00 90 45382 $481.00 0 44376 $305.00 0 45100 $321.00 90 45383 $482.00 0 44377 $320.00 0 45108 $419.00 90 45384 $415.00 0 44378 $410.00 0 45110 $1,801.00 90 45385 $479.00 0 44379 $396.00 0 45111 $1,270.00 90 45386 $739.00 0 44380 $91.00 0 45112 $1,904.00 90 45387 $322.00 0 44382 $110.00 0 45113 $1,885.00 90 45391 $283.00 0 44383 $165.00 0 45114 $1,732.00 90 45392 $358.00 0 44385 $219.00 0 45116 $1,485.00 90 45395 $1,813.00 90 44386 $183.00 0 45119 $1,911.00 90 45397 $1,969.00 90 44388 $326.00 0 45120 $1,845.00 90 45400 $1,058.00 90 44389 $301.00 0 45121 $1,870.00 90 45402 $1,435.00 90 44390 $319.00 0 45123 $1,126.00 90 45500 $584.00 90 44391 $376.00 0 45126 $2,444.00 90 45505 $510.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 45520 $46.00 0 46610 $114.00 0 47146 $337.00 0 45540 $1,009.00 90 46611 $149.00 0 47147 $393.00 0 45541 $888.00 90 46612 $196.00 0 47300 $778.00 90 45550 $1,350.00 90 46614 $169.00 0 47350 $942.00 90 45560 $618.00 90 46615 $202.00 0 47360 $1,305.00 90 45562 $915.00 90 46700 $585.00 90 47361 $2,129.00 90 45563 $1,412.00 90 46706 $140.00 10 47362 $849.00 90 45800 $1,050.00 90 46710 $953.00 90 47370 $943.00 90 45805 $1,273.00 90 46712 $1,999.00 90 47371 $889.00 90 45820 $1,066.00 90 46715 $545.00 90 47379 BR YYY 45825 $1,241.00 90 46716 $906.00 90 47380 $1,107.00 90 45900 $120.00 10 46730 $1,584.00 90 47381 $1,094.00 90 45905 $133.00 10 46735 $1,881.00 90 47382 $660.00 10 45910 $163.00 10 46740 $1,671.00 90 47399 BR YYY 45915 $142.00 10 46742 $2,236.00 90 47400 $1,435.00 90 45990 $105.00 0 46744 $2,412.00 90 47420 $1,222.00 90 45999 BR YYY 46746 $2,725.00 90 47425 $1,275.00 90 46020 $230.00 10 46748 $2,933.00 90 47460 $1,039.00 90 46030 $94.00 10 46750 $636.00 90 47480 $755.00 90 46040 $393.00 90 46753 $511.00 90 47490 $467.00 90 46045 $312.00 90 46754 $188.00 10 47500 $103.00 0 46050 $105.00 10 46760 $846.00 90 47505 $96.00 0 46060 $482.00 90 46761 $813.00 90 47510 $487.00 90 46080 $246.00 10 46762 $731.00 90 47511 $627.00 90 46083 $98.00 10 46900 $128.00 10 47525 $295.00 10 46200 $323.00 90 46910 $144.00 10 47530 $35.00 90 46210 $196.00 90 46916 $145.00 10 47550 $209.00 ZZZ 46211 $353.00 90 46917 $228.00 10 47552 $364.00 0 46220 $118.00 10 46922 $189.00 10 47553 $342.00 0 46221 $124.00 10 46924 $297.00 10 47554 $594.00 0 46230 $198.00 10 46937 $268.00 10 47555 $383.00 0 46250 $400.00 90 46938 $405.00 90 47556 $425.00 0 46255 $501.00 90 46940 $165.00 10 47560 $345.00 0 46257 $504.00 90 46942 $145.00 10 47561 $388.00 0 46258 $539.00 90 46945 $199.00 90 47562 $837.00 90 46260 $598.00 90 46946 $270.00 90 47563 $900.00 90 46261 $655.00 90 46947 $328.00 90 47564 $1,069.00 90 46262 $686.00 90 46999 BR YYY 47570 $961.00 90 46270 $328.00 90 47000 $218.00 0 47579 BR YYY 46275 $442.00 90 47001 $141.00 ZZZ 47600 $868.00 90 46280 $514.00 90 47010 $788.00 90 47605 $935.00 90 46285 $335.00 90 47011 $347.00 0 47610 $1,164.00 90 46288 $521.00 90 47015 $755.00 90 47612 $1,276.00 90 46320 $126.00 10 47100 $550.00 90 47620 $1,295.00 90 46500 $109.00 10 47120 $1,663.00 90 47630 $465.00 90 46505 $229.00 10 47122 $2,512.00 90 47700 $1,111.00 90 46600 $38.00 0 47125 $2,293.00 90 47701 $1,913.00 90 46604 $92.00 0 47130 $2,482.00 90 47711 $1,442.00 90 46606 $66.00 0 47135 $6,164.00 90 47712 $1,793.00 90 46608 $115.00 0 47136 $4,985.00 90 47715 $1,157.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 47720 $1,040.00 90 49060 $827.00 90 49540 $668.00 90 47721 $1,248.00 90 49061 $288.00 0 49550 $557.00 90 47740 $1,188.00 90 49062 $892.00 90 49553 $598.00 90 47741 $1,425.00 90 49080 $123.00 0 49555 $621.00 90 47760 $1,568.00 90 49081 $98.00 0 49557 $715.00 90 47765 $1,624.00 90 49180 $212.00 0 49560 $734.00 90 47780 $1,635.00 90 49203 $1,049.00 90 49561 $856.00 90 47785 $1,871.00 90 49204 $1,337.00 90 49565 $754.00 90 47800 $1,485.00 90 49205 $1,530.00 90 49566 $881.00 90 47801 $906.00 90 49215 $1,551.00 90 49568 $339.00 ZZZ 47802 $1,352.00 90 49220 $1,182.00 90 49570 $411.00 90 47900 $1,331.00 90 49250 $622.00 90 49572 $491.00 90 47999 BR YYY 49255 $591.00 90 49585 $444.00 90 48000 $1,053.00 90 49320 $415.00 10 49587 $501.00 90 48001 $1,305.00 90 49321 $443.00 10 49590 $585.00 90 48020 $983.00 90 49322 $460.00 10 49600 $774.00 90 48100 $779.00 90 49323 $712.00 90 49605 $1,648.00 90 48102 $341.00 10 49324 $348.00 10 49606 $1,416.00 90 48105 $2,505.00 90 49325 $374.00 10 49610 $784.00 90 48120 $1,083.00 90 49326 $171.00 ZZZ 49611 $770.00 90 48140 $1,546.00 90 49329 BR YYY 49650 $484.00 90 48145 $1,661.00 90 49400 $127.00 0 49651 $621.00 90 48146 $1,830.00 90 49402 $748.00 90 49659 BR YYY 48148 $1,149.00 90 49419 $405.00 90 49900 $512.00 90 48150 $3,101.00 90 49420 $162.00 0 49904 $1,394.00 90 48152 $2,888.00 90 49421 $452.00 90 49905 $454.00 ZZZ 48153 $3,099.00 90 49422 $468.00 10 49906 BR 90 48154 $2,893.00 90 49423 $106.00 0 49999 BR YYY 48155 $1,855.00 90 49424 $54.00 0 50010 $886.00 90 48160 BR 0 49425 $914.00 90 50020 $1,084.00 90 48400 $100.00 ZZZ 49426 $725.00 90 50021 $335.00 0 48500 $1,012.00 90 49427 $48.00 0 50040 $910.00 90 48510 $938.00 90 49428 $184.00 10 50045 $1,137.00 90 48511 $286.00 0 49429 $522.00 10 50060 $1,394.00 90 48520 $1,103.00 90 49435 $110.00 ZZZ 50065 $1,514.00 90 48540 $1,350.00 90 49436 $164.00 10 50070 $1,476.00 90 48545 $1,170.00 90 49440 $1,113.00 10 50075 $1,839.00 90 48547 $1,630.00 90 49441 $1,319.00 10 50080 $1,186.00 90 48548 $1,460.00 90 49442 $1,075.00 10 50081 $1,635.00 90 48552 $230.00 0 49446 $1,100.00 0 50100 $1,250.00 90 48554 $2,365.00 90 49450 $771.00 0 50120 $1,180.00 90 48556 $1,117.00 90 49451 $817.00 0 50125 $1,228.00 90 48999 BR YYY 49452 $998.00 0 50130 $1,301.00 90 49000 $862.00 90 49460 $818.00 0 50135 $1,506.00 90 49002 $784.00 90 49465 $170.00 0 50200 $151.00 0 49010 $915.00 90 49505 $510.00 90 50205 $807.00 90 49020 $910.00 90 49507 $636.00 90 50220 $1,316.00 90 49021 $290.00 0 49520 $631.00 90 50225 $1,554.00 90 49040 $763.00 90 49521 $730.00 90 50230 $1,695.00 90 49041 $305.00 0 49525 $584.00 90 50234 $1,671.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 50236 $1,873.00 90 50570 $549.00 0 50949 BR YYY 50240 $1,679.00 90 50572 $728.00 0 50951 $414.00 0 50250 $1,157.00 90 50574 $762.00 0 50953 $461.00 0 50280 $1,170.00 90 50575 $991.00 0 50955 $546.00 0 50290 $1,080.00 90 50576 $801.00 0 50957 $546.00 0 50320 $1,680.00 90 50580 $726.00 0 50961 $510.00 0 50327 $214.00 0 50590 $980.00 90 50970 $510.00 0 50328 $187.00 0 50592 $5,936.00 10 50972 $408.00 0 50329 $179.00 0 50593 $4,692.00 10 50974 $661.00 0 50340 $1,083.00 90 50600 $1,150.00 90 50976 $641.00 0 50360 $2,475.00 90 50605 $1,054.00 90 50980 $443.00 0 50365 $2,941.00 90 50610 $1,209.00 90 51020 $587.00 90 50370 $1,128.00 90 50620 $1,152.00 90 51030 $538.00 90 50380 $1,507.00 90 50630 $1,170.00 90 51040 $439.00 90 50382 $1,594.00 0 50650 $1,297.00 90 51045 $548.00 90 50384 $1,540.00 0 50660 $1,426.00 90 51050 $596.00 90 50385 $1,326.00 0 50684 $74.00 0 51060 $768.00 90 50386 $857.00 0 50686 $109.00 0 51065 $704.00 90 50387 $772.00 0 50688 $89.00 10 51080 $510.00 90 50389 $529.00 0 50690 $85.00 0 51100 $63.00 0 50390 $118.00 0 50700 $1,192.00 90 51101 $130.00 0 50391 $139.00 0 50715 $1,397.00 90 51102 $335.00 10 50392 $189.00 0 50722 $1,211.00 90 51500 $775.00 90 50393 $235.00 0 50725 $1,371.00 90 51520 $764.00 90 50394 $64.00 0 50727 $640.00 90 51525 $1,069.00 90 50395 $203.00 0 50728 $924.00 90 51530 $957.00 90 50396 $101.00 0 50740 $1,386.00 90 51535 $932.00 90 50398 $99.00 0 50750 $1,457.00 90 51550 $1,171.00 90 50400 $1,441.00 90 50760 $1,389.00 90 51555 $1,514.00 90 50405 $1,802.00 90 50770 $1,485.00 90 51565 $1,624.00 90 50500 $1,471.00 90 50780 $1,391.00 90 51570 $1,762.00 90 50520 $1,281.00 90 50782 $1,465.00 90 51575 $2,284.00 90 50525 $1,644.00 90 50783 $1,515.00 90 51580 $2,252.00 90 50526 $1,639.00 90 50785 $1,548.00 90 51585 $2,601.00 90 50540 $1,468.00 90 50800 $1,226.00 90 51590 $2,441.00 90 50541 $1,037.00 90 50810 $1,527.00 90 51595 $2,900.00 90 50542 $1,093.00 90 50815 $1,643.00 90 51596 $3,063.00 90 50543 $1,374.00 90 50820 $1,729.00 90 51597 $2,914.00 90 50544 $1,428.00 90 50825 $2,351.00 90 51600 $54.00 0 50545 $1,273.00 90 50830 $2,292.00 90 51605 $83.00 0 50546 $1,325.00 90 50840 $1,493.00 90 51610 $45.00 0 50547 $1,702.00 90 50845 $1,513.00 90 51700 $29.00 0 50548 $1,555.00 90 50860 $1,163.00 90 51701 $58.00 0 50549 BR YYY 50900 $1,043.00 90 51702 $92.00 0 50551 $411.00 0 50920 $1,075.00 90 51703 $128.00 0 50553 $447.00 0 50930 $1,380.00 90 51705 $37.00 10 50555 $668.00 0 50940 $1,107.00 90 51710 $119.00 10 50557 $676.00 0 50945 $1,096.00 90 51715 $322.00 0 50561 $755.00 0 50947 $1,384.00 90 51720 $140.00 0 50562 $580.00 90 50948 $1,265.00 90 51725 $116.00 0 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 51725-26 $79.00 0 52010 $292.00 0 52647 $858.00 90 51725-TC $199.00 0 52204 $286.00 0 52648 $957.00 90 51726 $136.00 0 52214 $367.00 0 52649 $973.00 90 51726-26 $90.00 0 52224 $339.00 0 52700 $517.00 90 51726-TC $274.00 0 52234 $471.00 0 53000 $224.00 10 51736 $47.00 0 52235 $546.00 0 53010 $336.00 90 51736-26 $32.00 0 52240 $887.00 0 53020 $153.00 0 51736-TC $15.00 0 52250 $311.00 0 53040 $460.00 90 51741 $81.00 0 52260 $262.00 0 53060 $180.00 10 51741-26 $59.00 0 52265 $243.00 0 53080 $567.00 90 51741-TC $17.00 0 52270 $374.00 0 53085 $836.00 90 51772 $96.00 0 52275 $446.00 0 53200 $218.00 0 51772-26 $86.00 0 52276 $490.00 0 53210 $904.00 90 51772-TC $197.00 0 52277 $448.00 0 53215 $1,142.00 90 51784 $119.00 0 52281 $259.00 0 53220 $546.00 90 51784-26 $80.00 0 52282 $560.00 0 53230 $760.00 90 51784-TC $136.00 0 52283 $309.00 0 53235 $607.00 90 51785 $52.00 0 52285 $375.00 0 53240 $506.00 90 51785-26 $80.00 0 52290 $304.00 0 53250 $464.00 90 51785-TC $155.00 0 52300 $370.00 0 53260 $240.00 10 51792 $143.00 0 52301 $382.00 0 53265 $295.00 10 51792-26 $60.00 0 52305 $370.00 0 53270 $226.00 10 51792-TC $213.00 0 52310 $348.00 0 53275 $332.00 10 51795 $132.00 0 52315 $553.00 0 53400 $929.00 90 51795-26 $80.00 0 52317 $772.00 0 53405 $1,088.00 90 51795-TC $270.00 0 52318 $684.00 0 53410 $1,151.00 90 51797 $109.00 ZZZ 52320 $369.00 0 53415 $1,381.00 90 51797-26 $84.00 ZZZ 52325 $494.00 0 53420 $1,088.00 90 51797-TC $205.00 ZZZ 52327 $369.00 0 53425 $1,150.00 90 51798 $20.00 0 52330 $507.00 0 53430 $1,116.00 90 51800 $1,294.00 90 52332 $451.00 0 53431 $1,053.00 90 51820 $1,236.00 90 52334 $340.00 0 53440 $1,057.00 90 51840 $858.00 90 52341 $317.00 0 53442 $639.00 90 51841 $1,040.00 90 52342 $344.00 0 53444 $755.00 90 51845 $843.00 90 52343 $380.00 0 53445 $1,197.00 90 51860 $912.00 90 52344 $407.00 0 53446 $699.00 90 51865 $1,150.00 90 52345 $433.00 0 53447 $991.00 90 51880 $590.00 90 52346 $488.00 0 53448 $1,259.00 90 51900 $1,050.00 90 52351 $297.00 0 53449 $784.00 90 51920 $881.00 90 52352 $349.00 0 53450 $447.00 90 51925 $1,167.00 90 52353 $404.00 0 53460 $494.00 90 51940 $2,082.00 90 52354 $372.00 0 53500 $719.00 90 51960 $1,848.00 90 52355 $447.00 0 53502 $590.00 90 51980 $858.00 90 52400 $580.00 90 53505 $586.00 90 51990 $850.00 90 52402 $279.00 0 53510 $777.00 90 51992 $925.00 90 52450 $602.00 90 53515 $987.00 90 52000 $190.00 0 52500 $705.00 90 53520 $661.00 90 52001 $133.00 0 52601 $1,021.00 90 53600 $37.00 0 52005 $265.00 0 52630 $653.00 90 53601 $37.00 0 52007 $230.00 0 52640 $573.00 90 53605 $81.00 0 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 53620 $59.00 0 54332 $1,327.00 90 54865 $333.00 90 53621 $45.00 0 54336 $1,672.00 90 54900 $969.00 90 53660 $49.00 0 54340 $727.00 90 54901 $1,340.00 90 53661 $50.00 0 54344 $1,360.00 90 55000 $109.00 0 53665 $50.00 0 54348 $1,318.00 90 55040 $439.00 90 53850 $741.00 90 54352 $1,820.00 90 55041 $634.00 90 53852 $728.00 90 54360 $898.00 90 55060 $430.00 90 53899 BR YYY 54380 $1,054.00 90 55100 $156.00 10 54015 $348.00 10 54385 $1,217.00 90 55110 $223.00 90 54050 $91.00 10 54390 $1,635.00 90 55120 $350.00 90 54055 $106.00 10 54400 $784.00 90 55150 $562.00 90 54056 $100.00 10 54401 $892.00 90 55175 $426.00 90 54057 $149.00 10 54405 $1,294.00 90 55180 $796.00 90 54060 $180.00 10 54406 $687.00 90 55200 $310.00 90 54065 $281.00 10 54408 $724.00 90 55250 $349.00 90 54100 $149.00 0 54410 $856.00 90 55300 $167.00 0 54105 $261.00 10 54411 $933.00 90 55400 $660.00 90 54110 $775.00 90 54415 $510.00 90 55450 $391.00 10 54111 $1,035.00 90 54416 $665.00 90 55500 $445.00 90 54112 $1,210.00 90 54417 $819.00 90 55520 $446.00 90 54115 $588.00 90 54420 $899.00 90 55530 $467.00 90 54120 $777.00 90 54430 $799.00 90 55535 $496.00 90 54125 $1,092.00 90 54435 $503.00 90 55540 $572.00 90 54130 $1,532.00 90 54440 BR 90 55550 $486.00 90 54135 $1,945.00 90 54450 $88.00 0 55559 BR YYY 54162 $220.00 10 54500 $102.00 0 55600 $486.00 90 54163 $207.00 10 54505 $259.00 10 55605 $609.00 90 54164 $182.00 10 54512 $519.00 90 55650 $853.00 90 54200 $78.00 10 54520 $445.00 90 55680 $426.00 90 54205 $633.00 90 54522 $589.00 90 55700 $183.00 0 54220 $189.00 0 54530 $683.00 90 55705 $368.00 10 54230 $104.00 0 54535 $922.00 90 55720 $555.00 90 54231 $172.00 0 54550 $588.00 90 55725 $670.00 90 54235 $81.00 0 54560 $842.00 90 55801 $1,331.00 90 54240 $109.00 0 54600 $524.00 90 55810 $1,711.00 90 54240-26 $68.00 0 54620 $373.00 10 55812 $1,989.00 90 54240-TC $24.00 0 54640 $594.00 90 55815 $2,328.00 90 54250 $104.00 0 54650 $861.00 90 55821 $1,153.00 90 54250-26 $116.00 0 54660 $401.00 90 55831 $1,252.00 90 54250-TC $9.00 0 54670 $485.00 90 55840 $1,705.00 90 54300 $830.00 90 54680 $948.00 90 55842 $1,859.00 90 54304 $988.00 90 54690 $825.00 90 55845 $2,222.00 90 54308 $881.00 90 54692 $850.00 90 55860 $1,012.00 90 54312 $1,067.00 90 54699 BR YYY 55862 $1,351.00 90 54316 $1,316.00 90 54700 $133.00 10 55865 $1,890.00 90 54318 $900.00 90 54800 $257.00 0 55866 $1,615.00 90 54322 $974.00 90 54830 $411.00 90 55870 $166.00 0 54324 $1,260.00 90 54840 $432.00 90 55873 $1,127.00 90 54326 $1,212.00 90 54860 $503.00 90 55875 $729.00 90 54328 $1,201.00 90 54861 $696.00 90 55876 $147.00 0 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 55899 BR YYY 57200 $313.00 90 57520 $359.00 90 55920 $420.00 0 57210 $395.00 90 57522 $319.00 90 56405 $131.00 10 57220 $378.00 90 57530 $386.00 90 56420 $130.00 10 57230 $442.00 90 57531 $2,036.00 90 56440 $271.00 10 57240 $536.00 90 57540 $815.00 90 56441 $183.00 10 57250 $485.00 90 57545 $700.00 90 56442 $45.00 0 57260 $700.00 90 57550 $486.00 90 56501 $122.00 10 57265 $902.00 90 57555 $774.00 90 56515 $200.00 10 57267 $284.00 ZZZ 57556 $718.00 90 56605 $96.00 0 57268 $577.00 90 57558 $120.00 10 56606 $49.00 ZZZ 57270 $867.00 90 57700 $279.00 90 56620 $607.00 90 57280 $1,071.00 90 57720 $328.00 90 56625 $735.00 90 57282 $734.00 90 57800 $71.00 0 56630 $1,061.00 90 57283 $673.00 90 58100 $74.00 0 56631 $1,400.00 90 57284 $950.00 90 58110 $53.00 ZZZ 56632 $1,636.00 90 57285 $607.00 90 58120 $297.00 10 56633 $1,350.00 90 57287 $685.00 90 58140 $1,010.00 90 56634 $1,537.00 90 57288 $1,009.00 90 58145 $677.00 90 56637 $1,806.00 90 57289 $879.00 90 58146 $1,089.00 90 56640 $1,777.00 90 57291 $622.00 90 58150 $1,110.00 90 56700 $227.00 10 57292 $925.00 90 58152 $1,159.00 90 56740 $321.00 10 57295 $485.00 90 58180 $1,118.00 90 56800 $310.00 10 57296 $880.00 90 58200 $1,562.00 90 56805 $1,349.00 90 57300 $653.00 90 58210 $2,080.00 90 56810 $316.00 10 57305 $995.00 90 58240 $2,898.00 90 56820 $119.00 0 57307 $997.00 90 58260 $926.00 90 56821 $154.00 0 57308 $769.00 90 58262 $1,026.00 90 57000 $237.00 10 57310 $517.00 90 58263 $1,120.00 90 57010 $429.00 90 57311 $612.00 90 58267 $1,133.00 90 57020 $118.00 0 57320 $693.00 90 58270 $1,019.00 90 57022 $179.00 10 57330 $916.00 90 58275 $1,121.00 90 57023 $290.00 10 57335 $963.00 90 58280 $1,132.00 90 57061 $124.00 10 57400 $70.00 0 58285 $1,360.00 90 57065 $251.00 10 57410 $57.00 0 58290 $1,089.00 90 57100 $90.00 0 57415 $75.00 10 58291 $1,197.00 90 57105 $132.00 10 57420 $124.00 0 58292 $1,268.00 90 57106 $409.00 90 57421 $162.00 0 58293 $1,318.00 90 57107 $1,467.00 90 57423 $848.00 90 58294 $1,168.00 90 57109 $1,787.00 90 57425 $902.00 90 58300 $96.00 0 57110 $1,015.00 90 57452 $96.00 0 58301 $71.00 0 57111 $1,793.00 90 57454 $125.00 0 58321 $81.00 0 57112 $1,907.00 90 57455 $149.00 0 58322 $90.00 0 57120 $612.00 90 57456 $141.00 0 58323 $24.00 0 57130 $220.00 10 57460 $223.00 0 58340 $87.00 0 57135 $231.00 10 57461 $333.00 0 58345 $335.00 10 57150 $50.00 0 57500 $89.00 0 58346 $408.00 90 57155 $383.00 90 57505 $105.00 10 58350 $103.00 10 57160 $67.00 0 57510 $140.00 10 58353 $225.00 10 57170 $74.00 0 57511 $159.00 10 58356 $531.00 10 57180 $124.00 10 57513 $191.00 10 58400 $519.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 58410 $752.00 90 58822 $603.00 90 59414 $134.00 0 58520 $663.00 90 58823 $216.00 0 59425 $414.00 0 58540 $923.00 90 58825 $469.00 90 59426 $708.00 0 58541 $793.00 90 58900 $489.00 90 59430 $140.00 0 58542 $877.00 90 58920 $571.00 90 59510 $2,064.00 0 58543 $891.00 90 58925 $820.00 90 59514 $1,199.00 0 58544 $965.00 90 58940 $592.00 90 59515 $1,324.00 0 58545 $876.00 90 58943 $1,368.00 90 59525 $591.00 ZZZ 58546 $1,104.00 90 58950 $1,170.00 90 59610 $1,805.00 0 58548 $1,688.00 90 58951 $1,703.00 90 59612 $1,113.00 0 58550 $1,038.00 90 58952 $1,876.00 90 59614 $1,208.00 0 58552 $853.00 90 58953 $1,839.00 90 59618 $2,035.00 0 58553 $1,096.00 90 58954 $1,999.00 90 59620 $1,293.00 0 58554 $1,085.00 90 58956 $1,329.00 90 59622 $1,397.00 0 58555 $261.00 0 58957 $1,365.00 90 59812 $343.00 90 58558 $340.00 0 58958 $1,511.00 90 59820 $389.00 90 58559 $436.00 0 58960 $1,174.00 90 59821 $398.00 90 58560 $482.00 0 58999 BR YYY 59830 $496.00 90 58561 $677.00 0 59000 $123.00 0 59840 $331.00 10 58562 $339.00 0 59001 $167.00 0 59841 $443.00 10 58563 $450.00 0 59012 $267.00 0 59850 $449.00 90 58565 $2,189.00 90 59015 $168.00 0 59851 $464.00 90 58570 $844.00 90 59020 $85.00 0 59852 $642.00 90 58571 $922.00 90 59020-26 $40.00 0 59855 $477.00 90 58572 $1,047.00 90 59020-TC $23.00 0 59856 $577.00 90 58573 $1,178.00 90 59025 $54.00 0 59857 $711.00 90 58578 BR YYY 59025-26 $32.00 0 59866 $304.00 0 58579 BR YYY 59025-TC $10.00 0 59870 $348.00 90 58600 $337.00 90 59030 $155.00 0 59871 $192.00 0 58605 $298.00 90 59050 $71.00 0 59898 BR YYY 58611 $47.00 ZZZ 59051 $47.00 0 59899 BR YYY 58615 $319.00 10 59100 $633.00 90 60000 $114.00 10 58660 $793.00 90 59120 $893.00 90 60100 $96.00 0 58661 $804.00 10 59121 $768.00 90 60200 $744.00 90 58662 $807.00 90 59130 $832.00 90 60210 $872.00 90 58670 $450.00 90 59135 $1,083.00 90 60212 $1,170.00 90 58671 $463.00 90 59136 $934.00 90 60220 $851.00 90 58672 $872.00 90 59140 $461.00 90 60225 $1,107.00 90 58673 $928.00 90 59150 $543.00 90 60240 $1,228.00 90 58679 BR YYY 59151 $690.00 90 60252 $1,427.00 90 58700 $544.00 90 59160 $279.00 10 60254 $1,911.00 90 58720 $844.00 90 59200 $79.00 0 60260 $1,022.00 90 58740 $508.00 90 59300 $179.00 0 60270 $1,468.00 90 58750 $949.00 90 59320 $196.00 0 60271 $1,210.00 90 58752 $893.00 90 59325 $316.00 0 60280 $546.00 90 58760 $769.00 90 59350 $375.00 0 60281 $670.00 90 58770 $763.00 90 59400 $1,816.00 0 60300 $99.00 0 58800 $343.00 90 59409 $1,019.00 0 60500 $1,232.00 90 58805 $509.00 90 59410 $1,123.00 0 60502 $1,475.00 90 58820 $326.00 90 59412 $141.00 0 60505 $1,631.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 60512 $310.00 ZZZ 61460 $2,426.00 90 61581 $2,674.00 90 60520 $1,405.00 90 61470 $1,982.00 90 61582 $2,557.00 90 60521 $1,591.00 90 61480 $1,922.00 90 61583 $2,972.00 90 60522 $1,820.00 90 61490 $1,687.00 90 61584 $2,830.00 90 60540 $1,272.00 90 61500 $1,637.00 90 61585 $3,142.00 90 60545 $1,505.00 90 61501 $1,353.00 90 61586 $2,097.00 90 60600 $1,477.00 90 61510 $2,506.00 90 61590 $3,299.00 90 60605 $1,624.00 90 61512 $2,981.00 90 61591 $3,491.00 90 60650 $1,340.00 90 61514 $2,262.00 90 61592 $3,245.00 90 60659 BR YYY 61516 $2,253.00 90 61595 $2,350.00 90 60699 BR YYY 61517 $74.00 ZZZ 61596 $2,827.00 90 61020 $150.00 0 61518 $3,163.00 90 61597 $3,046.00 90 61026 $138.00 0 61519 $3,450.00 90 61598 $2,693.00 90 61050 $106.00 0 61520 $4,349.00 90 61600 $2,039.00 90 61055 $143.00 0 61521 $3,667.00 90 61601 $2,279.00 90 61070 $67.00 0 61522 $2,415.00 90 61605 $2,299.00 90 61105 $503.00 90 61524 $2,484.00 90 61606 $3,178.00 90 61107 $863.00 0 61526 $3,918.00 90 61607 $2,961.00 90 61108 $959.00 90 61530 $3,611.00 90 61608 $3,458.00 90 61120 $733.00 90 61531 $1,344.00 90 61609 $798.00 ZZZ 61140 $1,389.00 90 61533 $1,712.00 90 61610 $2,354.00 ZZZ 61150 $1,503.00 90 61534 $1,535.00 90 61611 $584.00 ZZZ 61151 $795.00 90 61535 $958.00 90 61612 $2,219.00 ZZZ 61154 $1,393.00 90 61536 $2,862.00 90 61613 $3,375.00 90 61156 $1,473.00 90 61537 $1,714.00 90 61615 $2,576.00 90 61210 $527.00 0 61538 $2,466.00 90 61616 $3,535.00 90 61215 $637.00 90 61539 $2,660.00 90 61618 $1,389.00 90 61250 $888.00 90 61540 $2,069.00 90 61619 $1,682.00 90 61253 $1,042.00 90 61541 $2,363.00 90 61623 $540.00 0 61304 $2,005.00 90 61542 $2,533.00 90 61624 $1,073.00 0 61305 $2,419.00 90 61543 $2,307.00 90 61626 $877.00 0 61312 $2,187.00 90 61544 $2,271.00 90 61630 $1,245.00 90 61313 $2,207.00 90 61545 $3,474.00 90 61635 $1,362.00 90 61314 $2,200.00 90 61546 $2,695.00 90 61640 $555.00 0 61315 $2,393.00 90 61548 $1,964.00 90 61641 $195.00 ZZZ 61316 $88.00 ZZZ 61550 $1,141.00 90 61642 $390.00 ZZZ 61320 $2,118.00 90 61552 $1,463.00 90 61680 $2,758.00 90 61321 $2,310.00 90 61556 $1,760.00 90 61682 $4,798.00 90 61322 $1,779.00 90 61557 $1,807.00 90 61684 $3,341.00 90 61323 $1,842.00 90 61558 $2,085.00 90 61686 $5,012.00 90 61330 $1,706.00 90 61559 $2,700.00 90 61690 $2,556.00 90 61332 $2,307.00 90 61563 $2,175.00 90 61692 $4,007.00 90 61333 $2,231.00 90 61564 $2,597.00 90 61697 $3,231.00 90 61334 $1,525.00 90 61566 $2,048.00 90 61698 $3,103.00 90 61340 $1,584.00 90 61567 $2,340.00 90 61700 $4,037.00 90 61343 $2,673.00 90 61570 $1,975.00 90 61702 $4,019.00 90 61345 $2,259.00 90 61571 $2,140.00 90 61703 $1,444.00 90 61440 $2,110.00 90 61575 $2,992.00 90 61705 $3,043.00 90 61450 $2,173.00 90 61576 $3,772.00 90 61708 $2,546.00 90 61458 $2,433.00 90 61580 $2,383.00 90 61710 $2,129.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 61711 $3,150.00 90 62201 $1,200.00 90 63040 $1,764.00 90 61720 $1,558.00 90 62220 $1,215.00 90 63042 $1,620.00 90 61735 $1,664.00 90 62223 $1,199.00 90 63043 BR ZZZ 61750 $1,521.00 90 62225 $488.00 90 63044 BR ZZZ 61751 $1,628.00 90 62230 $935.00 90 63045 $1,647.00 90 61760 $1,670.00 90 62252 $85.00 0 63046 $2,117.00 90 61770 $1,867.00 90 62252-26 $49.00 0 63047 $1,907.00 90 61790 $952.00 90 62252-TC $42.00 0 63048 $367.00 ZZZ 61791 $1,205.00 90 62256 $616.00 90 63050 $1,411.00 90 61795 $371.00 ZZZ 62258 $1,308.00 90 63051 $1,605.00 90 61850 $1,090.00 90 62263 $426.00 10 63055 $2,029.00 90 61860 $1,197.00 90 62264 $593.00 10 63056 $1,960.00 90 61863 $1,231.00 90 62268 $285.00 0 63057 $421.00 ZZZ 61864 $295.00 ZZZ 62269 $271.00 0 63064 $2,200.00 90 61867 $1,863.00 90 62270 $109.00 0 63066 $263.00 ZZZ 61868 $491.00 ZZZ 62272 $137.00 0 63075 $1,720.00 90 61870 $616.00 90 62273 $130.00 0 63076 $383.00 ZZZ 61875 $984.00 90 62280 $199.00 10 63077 $1,828.00 90 61880 $559.00 90 62281 $186.00 10 63078 $261.00 ZZZ 61885 $262.00 90 62282 $211.00 10 63081 $2,203.00 90 61886 $678.00 90 62284 $196.00 0 63082 $391.00 ZZZ 61888 $331.00 10 62287 $784.00 90 63085 $2,416.00 90 62000 $848.00 90 62290 $235.00 0 63086 $282.00 ZZZ 62005 $1,282.00 90 62291 $232.00 0 63087 $2,930.00 90 62010 $1,754.00 90 62292 $1,064.00 90 63088 $381.00 ZZZ 62100 $1,962.00 90 62294 $821.00 90 63090 $2,490.00 90 62115 $1,686.00 90 62310 $200.00 0 63091 $249.00 ZZZ 62116 $1,928.00 90 62311 $201.00 0 63101 $2,127.00 90 62117 $2,211.00 90 62318 $208.00 0 63102 $2,127.00 90 62120 $1,898.00 90 62319 $203.00 0 63103 $249.00 ZZZ 62121 $1,822.00 90 62350 $488.00 90 63170 $1,788.00 90 62140 $1,221.00 90 62351 $782.00 90 63172 $1,672.00 90 62141 $1,955.00 90 62355 $402.00 90 63173 $1,851.00 90 62142 $1,011.00 90 62360 $195.00 90 63180 $1,486.00 90 62143 $1,096.00 90 62361 $390.00 90 63182 $1,711.00 90 62145 $1,566.00 90 62362 $517.00 90 63185 $1,347.00 90 62146 $1,327.00 90 62365 $418.00 90 63190 $1,610.00 90 62147 $1,566.00 90 62367 $39.00 0 63191 $1,444.00 90 62148 $120.00 ZZZ 62368 $53.00 0 63194 $1,593.00 90 62160 $172.00 ZZZ 63001 $1,882.00 90 63195 $1,603.00 90 62161 $1,229.00 90 63003 $1,591.00 90 63196 $1,810.00 90 62162 $1,578.00 90 63005 $1,390.00 90 63197 $1,725.00 90 62163 $999.00 90 63011 $1,151.00 90 63198 $1,956.00 90 62164 $1,706.00 90 63012 $1,568.00 90 63199 $2,258.00 90 62165 $1,336.00 90 63015 $1,862.00 90 63200 $1,569.00 90 62180 $1,695.00 90 63016 $1,788.00 90 63250 $3,182.00 90 62190 $1,034.00 90 63017 $1,489.00 90 63251 $3,207.00 90 62192 $1,146.00 90 63020 $1,395.00 90 63252 $3,319.00 90 62194 $239.00 10 63030 $1,145.00 90 63265 $1,940.00 90 62200 $1,625.00 90 63035 $280.00 ZZZ 63266 $2,053.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 63267 $1,651.00 90 64408 $120.00 0 64612 $188.00 10 63268 $1,469.00 90 64410 $109.00 0 64613 $168.00 10 63270 $2,197.00 90 64412 $89.00 0 64614 $200.00 10 63271 $2,401.00 90 64413 $128.00 0 64620 $185.00 10 63272 $2,206.00 90 64415 $109.00 0 64622 $333.00 10 63273 $2,012.00 90 64416 $159.00 10 64623 $113.00 ZZZ 63275 $2,166.00 90 64417 $105.00 0 64626 $262.00 10 63276 $2,135.00 90 64418 $108.00 0 64627 $151.00 ZZZ 63277 $1,905.00 90 64420 $89.00 0 64630 $202.00 10 63278 $1,877.00 90 64421 $128.00 0 64640 $208.00 10 63280 $2,529.00 90 64425 $116.00 0 64650 $62.00 0 63281 $2,496.00 90 64430 $130.00 0 64653 $71.00 0 63282 $2,305.00 90 64435 $114.00 0 64680 $180.00 10 63283 $2,041.00 90 64445 $68.00 0 64681 $464.00 10 63285 $2,934.00 90 64446 $165.00 10 64702 $383.00 90 63286 $3,003.00 90 64447 $77.00 0 64704 $402.00 90 63287 $3,012.00 90 64448 $152.00 10 64708 $562.00 90 63290 $3,073.00 90 64449 $152.00 10 64712 $678.00 90 63295 $319.00 ZZZ 64450 $53.00 0 64713 $867.00 90 63300 $2,006.00 90 64470 $206.00 0 64714 $715.00 90 63301 $2,209.00 90 64472 $166.00 ZZZ 64716 $523.00 90 63302 $2,290.00 90 64475 $183.00 0 64718 $558.00 90 63303 $2,357.00 90 64476 $166.00 ZZZ 64719 $446.00 90 63304 $2,513.00 90 64479 $224.00 0 64721 $439.00 90 63305 $2,574.00 90 64480 $194.00 ZZZ 64722 $411.00 90 63306 $2,596.00 90 64483 $206.00 0 64726 $271.00 90 63307 $2,522.00 90 64484 $183.00 ZZZ 64727 $261.00 ZZZ 63308 $425.00 ZZZ 64505 $104.00 0 64732 $405.00 90 63600 $797.00 90 64508 $99.00 0 64734 $432.00 90 63610 $476.00 0 64510 $103.00 0 64736 $388.00 90 63615 $1,348.00 90 64517 $188.00 0 64738 $475.00 90 63650 $819.00 90 64520 $131.00 0 64740 $461.00 90 63655 $1,064.00 90 64530 $135.00 0 64742 $517.00 90 63660 $707.00 90 64550 $23.00 0 64744 $798.00 90 63685 $615.00 90 64553 $137.00 10 64746 $494.00 90 63688 $707.00 90 64555 $131.00 10 64752 $560.00 90 63700 $1,340.00 90 64560 $197.00 10 64755 $1,042.00 90 63702 $1,512.00 90 64561 $801.00 10 64760 $578.00 90 63704 $1,708.00 90 64565 $121.00 10 64761 $495.00 90 63706 $1,873.00 90 64573 $464.00 90 64763 $561.00 90 63707 $1,041.00 90 64575 $367.00 90 64766 $713.00 90 63709 $1,310.00 90 64577 $381.00 90 64771 $632.00 90 63710 $1,165.00 90 64580 $343.00 90 64772 $636.00 90 63740 $1,062.00 90 64581 $745.00 90 64774 $392.00 90 63741 $741.00 90 64585 $37.00 10 64776 $390.00 90 63744 $738.00 90 64590 $217.00 10 64778 $249.00 ZZZ 63746 $529.00 90 64595 $153.00 10 64782 $482.00 90 64400 $78.00 0 64600 $228.00 10 64783 $298.00 ZZZ 64402 $75.00 0 64605 $319.00 10 64784 $751.00 90 64405 $103.00 0 64610 $307.00 10 64786 $1,281.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 64787 $458.00 ZZZ 64999 BR YYY 65800 $88.00 0 64788 $381.00 90 65091 $678.00 90 65805 $178.00 0 64790 $884.00 90 65093 $712.00 90 65810 $516.00 90 64792 $1,148.00 90 65101 $726.00 90 65815 $327.00 90 64795 $247.00 0 65103 $769.00 90 65820 $813.00 90 64802 $711.00 90 65105 $846.00 90 65850 $968.00 90 64804 $1,202.00 90 65110 $1,305.00 90 65855 $441.00 10 64809 $1,080.00 90 65112 $1,386.00 90 65860 $339.00 90 64818 $845.00 90 65114 $1,456.00 90 65865 $540.00 90 64820 $838.00 90 65125 $312.00 90 65870 $572.00 90 64821 $609.00 90 65130 $730.00 90 65875 $597.00 90 64822 $609.00 90 65135 $678.00 90 65880 $641.00 90 64823 $703.00 90 65140 $738.00 90 65900 $945.00 90 64831 $592.00 90 65150 $652.00 90 65920 $752.00 90 64832 $171.00 ZZZ 65155 $862.00 90 65930 $700.00 90 64834 $711.00 90 65175 $654.00 90 66020 $164.00 10 64835 $834.00 90 65205 $45.00 0 66030 $160.00 10 64836 $856.00 90 65210 $53.00 0 66130 $631.00 90 64837 $480.00 ZZZ 65220 $58.00 0 66150 $798.00 90 64840 $1,058.00 90 65222 $62.00 0 66155 $795.00 90 64856 $1,063.00 90 65235 $627.00 90 66160 $942.00 90 64857 $1,137.00 90 65260 $956.00 90 66165 $769.00 90 64858 $1,313.00 90 65265 $1,104.00 90 66170 $1,089.00 90 64859 $341.00 ZZZ 65270 $88.00 10 66172 $1,264.00 90 64861 $1,524.00 90 65272 $223.00 90 66180 $1,313.00 90 64862 $1,798.00 90 65273 $376.00 90 66185 $769.00 90 64864 $970.00 90 65275 $75.00 90 66220 $711.00 90 64865 $1,250.00 90 65280 $711.00 90 66225 $1,006.00 90 64866 $1,238.00 90 65285 $1,177.00 90 66250 $602.00 90 64868 $1,162.00 90 65286 $692.00 90 66500 $359.00 90 64870 $1,313.00 90 65290 $519.00 90 66505 $359.00 90 64872 $155.00 ZZZ 65400 $603.00 90 66600 $825.00 90 64874 $230.00 ZZZ 65410 $142.00 0 66605 $1,136.00 90 64876 $189.00 ZZZ 65420 $448.00 90 66625 $543.00 90 64885 $1,382.00 90 65426 $534.00 90 66630 $623.00 90 64886 $1,636.00 90 65430 $81.00 0 66635 $595.00 90 64890 $1,112.00 90 65435 $88.00 0 66680 $526.00 90 64891 $1,243.00 90 65436 $319.00 90 66682 $627.00 90 64892 $1,177.00 90 65450 $52.00 90 66700 $506.00 90 64893 $1,321.00 90 65600 $325.00 90 66710 $513.00 90 64895 $1,500.00 90 65710 $1,124.00 90 66711 $507.00 90 64896 $1,185.00 90 65730 $1,314.00 90 66720 $506.00 90 64897 $1,419.00 90 65750 $1,381.00 90 66740 $473.00 90 64898 $1,549.00 90 65755 $1,373.00 90 66761 $506.00 90 64901 $865.00 ZZZ 65770 $1,461.00 90 66762 $433.00 90 64902 $982.00 ZZZ 65772 $449.00 90 66770 $483.00 90 64905 $1,059.00 90 65775 $595.00 90 66820 $433.00 90 64907 $1,472.00 90 65780 $766.00 90 66821 $275.00 90 64910 $645.00 90 65781 $1,169.00 90 66825 $753.00 90 64911 $783.00 90 65782 $1,008.00 90 66830 $651.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 66840 $707.00 90 67299 BR YYY 67882 $643.00 90 66850 $805.00 90 67311 $616.00 90 67900 $487.00 90 66852 $878.00 90 67312 $773.00 90 67901 $646.00 90 66920 $785.00 90 67314 $688.00 90 67902 $650.00 90 66930 $906.00 90 67316 $857.00 90 67903 $657.00 90 66940 $819.00 90 67318 $663.00 90 67904 $720.00 90 66982 $846.00 90 67320 $602.00 ZZZ 67906 $633.00 90 66983 $763.00 90 67331 $560.00 ZZZ 67908 $550.00 90 66984 $898.00 90 67332 $621.00 ZZZ 67909 $577.00 90 66985 $744.00 90 67334 $447.00 ZZZ 67911 $517.00 90 66986 $1,038.00 90 67335 $253.00 ZZZ 67912 $983.00 90 66990 $84.00 ZZZ 67340 $559.00 ZZZ 67914 $487.00 90 66999 BR YYY 67343 $628.00 90 67915 $252.00 90 67005 $639.00 90 67345 $275.00 10 67916 $675.00 90 67010 $647.00 90 67346 $173.00 0 67917 $631.00 90 67015 $637.00 90 67399 BR YYY 67921 $419.00 90 67025 $774.00 90 67400 $960.00 90 67922 $243.00 90 67027 $1,089.00 90 67405 $799.00 90 67923 $718.00 90 67028 $338.00 0 67412 $976.00 90 67924 $605.00 90 67030 $485.00 90 67413 $909.00 90 67930 $280.00 10 67031 $402.00 90 67414 $1,023.00 90 67935 $520.00 90 67036 $1,384.00 90 67415 $146.00 0 67938 $67.00 10 67039 $1,490.00 90 67420 $1,729.00 90 67950 $584.00 90 67040 $1,960.00 90 67430 $1,203.00 90 67961 $571.00 90 67041 $1,065.00 90 67440 $1,257.00 90 67966 $645.00 90 67042 $1,218.00 90 67445 $1,269.00 90 67971 $875.00 90 67043 $1,279.00 90 67450 $1,300.00 90 67973 $1,126.00 90 67101 $767.00 90 67500 $75.00 0 67974 $1,140.00 90 67105 $941.00 90 67505 $109.00 0 67975 $681.00 90 67107 $1,350.00 90 67515 $53.00 0 67999 BR YYY 67108 $1,878.00 90 67550 $946.00 90 68020 $106.00 10 67110 $1,040.00 90 67560 $936.00 90 68040 $75.00 0 67112 $1,500.00 90 67570 $1,148.00 90 68100 $137.00 0 67113 $1,405.00 90 67599 BR YYY 68110 $172.00 10 67115 $496.00 90 67700 $87.00 10 68115 $248.00 10 67120 $751.00 90 67710 $117.00 10 68130 $378.00 90 67121 $962.00 90 67715 $102.00 10 68135 $146.00 10 67141 $536.00 90 67800 $119.00 10 68200 $59.00 0 67145 $514.00 90 67801 $189.00 10 68320 $502.00 90 67208 $655.00 90 67805 $208.00 10 68325 $672.00 90 67210 $779.00 90 67808 $308.00 90 68326 $654.00 90 67218 $1,217.00 90 67810 $133.00 0 68328 $741.00 90 67220 $894.00 90 67820 $36.00 0 68330 $488.00 90 67221 $325.00 0 67825 $130.00 10 68335 $636.00 90 67225 $44.00 ZZZ 67830 $239.00 10 68340 $413.00 90 67227 $652.00 90 67835 $500.00 90 68360 $449.00 90 67228 $1,025.00 90 67840 $187.00 10 68362 $691.00 90 67229 $926.00 90 67850 $143.00 10 68371 $363.00 10 67250 $793.00 90 67875 $163.00 0 68399 BR YYY 67255 $872.00 90 67880 $442.00 90 68400 $154.00 10 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 68420 $191.00 10 69421 $155.00 10 69720 $1,307.00 90 68440 $96.00 10 69424 $84.00 0 69725 $1,922.00 90 68500 $882.00 90 69433 $145.00 10 69740 $1,274.00 90 68505 $921.00 90 69436 $182.00 10 69745 $1,447.00 90 68510 $491.00 0 69440 $699.00 90 69799 BR YYY 68520 $687.00 90 69450 $525.00 90 69801 $785.00 90 68525 $340.00 0 69501 $829.00 90 69802 $1,115.00 90 68530 $379.00 10 69502 $1,118.00 90 69805 $1,187.00 90 68540 $875.00 90 69505 $1,176.00 90 69806 $1,123.00 90 68550 $1,107.00 90 69511 $1,221.00 90 69820 $876.00 90 68700 $628.00 90 69530 $1,616.00 90 69840 $869.00 90 68705 $176.00 10 69535 $2,824.00 90 69905 $1,013.00 90 68720 $807.00 90 69540 $126.00 10 69910 $1,228.00 90 68745 $704.00 90 69550 $998.00 90 69915 $1,754.00 90 68750 $792.00 90 69552 $1,621.00 90 69930 $1,498.00 90 68760 $109.00 10 69554 $2,600.00 90 69949 BR YYY 68761 $130.00 10 69601 $1,195.00 90 69950 $2,017.00 90 68770 $634.00 90 69602 $1,225.00 90 69955 $2,185.00 90 68801 $202.00 10 69603 $1,264.00 90 69960 $2,116.00 90 68810 $290.00 10 69604 $1,263.00 90 69970 $2,306.00 90 68811 $191.00 10 69605 $1,526.00 90 69979 BR YYY 68815 $399.00 10 69610 $41.00 10 69990 $262.00 ZZZ 68816 $592.00 10 69620 $651.00 90 G0127 $17.00 0 68840 $100.00 10 69631 $985.00 90 G0168 $75.00 0 68850 $76.00 0 69632 $1,166.00 90 G0247 $38.00 ZZZ 68899 BR YYY 69633 $1,110.00 90 G0289 $82.00 ZZZ 69000 $52.00 10 69635 $1,207.00 90 G0341 $333.00 0 69005 $175.00 10 69636 $1,381.00 90 G0342 $622.00 90 69020 $109.00 10 69637 $1,370.00 90 G0343 $1,026.00 90 69100 $85.00 0 69641 $1,154.00 90 G0364 $12.00 ZZZ 69105 $87.00 0 69642 $1,519.00 90 G0392 $2,097.00 0 69110 $294.00 90 69643 $1,389.00 90 G0393 $1,587.00 0 69120 $274.00 90 69644 $1,529.00 90 69140 $722.00 90 69645 $1,479.00 90 69145 $248.00 90 69646 $1,620.00 90 69150 $1,111.00 90 69650 $879.00 90 69155 $1,680.00 90 69660 $1,072.00 90 69200 $53.00 0 69661 $1,412.00 90 69205 $110.00 10 69662 $1,386.00 90 69210 $39.00 0 69666 $887.00 90 69220 $78.00 0 69667 $887.00 90 69222 $123.00 10 69670 $988.00 90 69300 $522.00 YYY 69676 $828.00 90 69310 $937.00 90 69700 $702.00 90 69320 $1,434.00 90 69710 BR 0 69399 BR YYY 69711 $878.00 90 69400 $76.00 0 69714 $961.00 90 69401 $52.00 0 69715 $1,217.00 90 69405 $176.00 10 69717 $996.00 90 69420 $117.00 10 69718 $1,232.00 90 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 80
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA 70010 $70.00 70240-TC $15.00 70390-26 $19.00 70010-26 $19.00 70250 $35.00 70390-TC $68.00 70010-TC $51.00 70250-26 $12.00 70450 $221.00 70015 $58.00 70250-TC $22.00 70450-26 $43.00 70015-26 $31.00 70260 $50.00 70450-TC $176.00 70015-TC $27.00 70260-26 $17.00 70460 $271.00 70030 $24.00 70260-TC $33.00 70460-26 $58.00 70030-26 $10.00 70300 $15.00 70460-TC $211.00 70030-TC $15.00 70300-26 $5.00 70470 $332.00 70100 $29.00 70300-TC $10.00 70470-26 $65.00 70100-26 $9.00 70310 $24.00 70470-TC $264.00 70100-TC $19.00 70310-26 $8.00 70480 $244.00 70110 $36.00 70310-TC $15.00 70480-26 $65.00 70110-26 $12.00 70320 $40.00 70480-TC $176.00 70110-TC $22.00 70320-26 $11.00 70481 $284.00 70120 $32.00 70320-TC $29.00 70481-26 $70.00 70120-26 $9.00 70328 $28.00 70481-TC $211.00 70120-TC $22.00 70328-26 $10.00 70482 $340.00 70130 $46.00 70328-TC $18.00 70482-26 $74.00 70130-26 $17.00 70330 $43.00 70482-TC $264.00 70130-TC $29.00 70330-26 $12.00 70486 $236.00 70134 $45.00 70330-TC $31.00 70486-26 $58.00 70134-26 $17.00 70332 $107.00 70486-TC $176.00 70134-TC $28.00 70332-26 $27.00 70487 $279.00 70140 $33.00 70332-TC $80.00 70487-26 $66.00 70140-26 $9.00 70336 $497.00 70487-TC $211.00 70140-TC $22.00 70336-26 $72.00 70488 $339.00 70150 $42.00 70336-TC $419.00 70488-26 $72.00 70150-26 $12.00 70350 $24.00 70488-TC $264.00 70150-TC $29.00 70350-26 $10.00 70490 $244.00 70160 $29.00 70350-TC $14.00 70490-26 $65.00 70160-26 $8.00 70355 $32.00 70490-TC $176.00 70160-TC $19.00 70355-26 $10.00 70491 $284.00 70170 $52.00 70355-TC $21.00 70491-26 $70.00 70170-26 $15.00 70360 $24.00 70491-TC $211.00 70170-TC $37.00 70360-26 $8.00 70492 $340.00 70190 $34.00 70360-TC $15.00 70492-26 $74.00 70190-26 $10.00 70370 $65.00 70492-TC $264.00 70190-TC $22.00 70370-26 $16.00 70496 $366.00 70200 $43.00 70370-TC $48.00 70496-26 $92.00 70200-26 $14.00 70371 $122.00 70496-TC $270.00 70200-TC $29.00 70371-26 $43.00 70498 $366.00 70210 $32.00 70371-TC $79.00 70498-26 $92.00 70210-26 $8.00 70373 $90.00 70498-TC $270.00 70210-TC $22.00 70373-26 $22.00 70540 $482.00 70220 $42.00 70373-TC $68.00 70540-26 $70.00 70220-26 $12.00 70380 $34.00 70540-TC $413.00 70220-TC $29.00 70380-26 $8.00 70542 $579.00 70240 $26.00 70380-TC $24.00 70542-26 $82.00 70240-26 $9.00 70390 $87.00 70542-TC $495.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 81
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA 70543 $1,029.00 71015-TC $19.00 71250-26 $59.00 70543-26 $109.00 71020 $35.00 71250-TC $220.00 70543-TC $916.00 71020-26 $11.00 71260 $328.00 70544 $481.00 71020-TC $22.00 71260-26 $63.00 70544-26 $61.00 71021 $41.00 71260-TC $264.00 70544-TC $419.00 71021-26 $13.00 71270 $402.00 70545 $481.00 71021-TC $28.00 71270-26 $70.00 70545-26 $61.00 71022 $44.00 71270-TC $330.00 70545-TC $419.00 71022-26 $16.00 71275 $431.00 70546 $914.00 71022-TC $28.00 71275-26 $100.00 70546-26 $92.00 71023 $49.00 71275-TC $328.00 70546-TC $820.00 71023-26 $19.00 71550 $490.00 70547 $481.00 71023-TC $29.00 71550-26 $75.00 70547-26 $61.00 71030 $45.00 71550-TC $415.00 70547-TC $419.00 71030-26 $16.00 71551 $587.00 70548 $481.00 71030-TC $29.00 71551-26 $88.00 70548-26 $61.00 71034 $79.00 71551-TC $496.00 70548-TC $419.00 71034-26 $23.00 71552 $1,029.00 70549 $914.00 71034-TC $54.00 71552-26 $114.00 70549-26 $92.00 71035 $56.00 71552-TC $911.00 70549-TC $820.00 71035-26 $19.00 71555 $514.00 70551 $497.00 71035-TC $38.00 71555-26 $92.00 70551-26 $76.00 71040 $34.00 71555-TC $419.00 70551-TC $419.00 71040-26 $12.00 72010 $62.00 70552 $596.00 71040-TC $22.00 72010-26 $22.00 70552-26 $91.00 71060 $108.00 72010-TC $38.00 70552-TC $502.00 71060-26 $33.00 72020 $22.00 70553 $1,055.00 71060-TC $75.00 72020-26 $7.00 70553-26 $120.00 71090 $92.00 72020-TC $15.00 70553-TC $931.00 71090-26 $28.00 72040 $34.00 70554 $618.00 71090-TC $64.00 72040-26 $11.00 70554-26 $99.00 71100 $33.00 72040-TC $22.00 70554-TC $520.00 71100-26 $11.00 72050 $49.00 70555 BR 71100-TC $21.00 72050-26 $16.00 70555-26 $118.00 71101 $38.00 72050-TC $33.00 70555-TC BR 71101-26 $13.00 72052 $61.00 70557 $392.00 71101-TC $24.00 72052-26 $18.00 70557-26 $148.00 71110 $43.00 72052-TC $42.00 70557-TC $349.00 71110-26 $13.00 72069 $40.00 70558 $425.00 71110-TC $29.00 72069-26 $17.00 70558-26 $164.00 71111 $49.00 72069-TC $24.00 70558-TC $376.00 71111-26 $16.00 72070 $36.00 70559 $548.00 71111-TC $33.00 72070-26 $11.00 70559-26 $164.00 71120 $35.00 72070-TC $24.00 70559-TC $499.00 71120-26 $10.00 72072 $39.00 71010 $27.00 71120-TC $24.00 72072-26 $11.00 71010-26 $9.00 71130 $38.00 72072-TC $28.00 71010-TC $17.00 71130-26 $11.00 72074 $45.00 71015 $30.00 71130-TC $26.00 72074-26 $11.00 71015-26 $10.00 71250 $282.00 72074-TC $34.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 82
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA 72080 $36.00 72142-TC $502.00 72197-26 $114.00 72080-26 $11.00 72146 $549.00 72197-TC $919.00 72080-TC $24.00 72146-26 $82.00 72198 $517.00 72090 $39.00 72146-TC $465.00 72198-26 $95.00 72090-26 $14.00 72147 $603.00 72198-TC $419.00 72090-TC $24.00 72147-26 $98.00 72200 $29.00 72100 $36.00 72147-TC $502.00 72200-26 $9.00 72100-26 $11.00 72148 $543.00 72200-TC $19.00 72100-TC $24.00 72148-26 $76.00 72202 $33.00 72110 $50.00 72148-TC $465.00 72202-26 $9.00 72110-26 $16.00 72149 $597.00 72202-TC $22.00 72110-TC $34.00 72149-26 $92.00 72220 $30.00 72114 $64.00 72149-TC $502.00 72220-26 $8.00 72114-26 $18.00 72156 $1,066.00 72220-TC $21.00 72114-TC $44.00 72156-26 $131.00 72240 $132.00 72120 $45.00 72156-TC $931.00 72240-26 $26.00 72120-26 $11.00 72157 $1,066.00 72240-TC $106.00 72120-TC $33.00 72157-26 $131.00 72255 $129.00 72125 $282.00 72157-TC $931.00 72255-26 $28.00 72125-26 $59.00 72158 $1,056.00 72255-TC $101.00 72125-TC $220.00 72158-26 $121.00 72265 $132.00 72126 $328.00 72158-TC $931.00 72265-26 $28.00 72126-26 $62.00 72159 $563.00 72265-TC $104.00 72126-TC $264.00 72159-26 $94.00 72270 $176.00 72127 $397.00 72159-TC $465.00 72270-26 $39.00 72127-26 $65.00 72170 $29.00 72270-TC $137.00 72127-TC $330.00 72170-26 $8.00 72275 $112.00 72128 $282.00 72170-TC $19.00 72275-26 $34.00 72128-26 $59.00 72190 $35.00 72275-TC $78.00 72128-TC $220.00 72190-26 $10.00 72285 $101.00 72129 $328.00 72190-TC $24.00 72285-26 $15.00 72129-26 $62.00 72191 $413.00 72285-TC $86.00 72129-TC $264.00 72191-26 $94.00 72291 $178.00 72130 $397.00 72191-TC $315.00 72291-26 $66.00 72130-26 $65.00 72192 $278.00 72291-TC $157.00 72130-TC $330.00 72192-26 $56.00 72292 BR 72131 $282.00 72192-TC $220.00 72292-26 $67.00 72131-26 $59.00 72193 $317.00 72292-TC BR 72131-TC $220.00 72193-26 $59.00 72295 $107.00 72132 $328.00 72193-TC $256.00 72295-26 $13.00 72132-26 $62.00 72194 $380.00 72295-TC $94.00 72132-TC $264.00 72194-26 $62.00 73000 $28.00 72133 $391.00 72194-TC $317.00 73000-26 $8.00 72133-26 $65.00 72195 $491.00 73000-TC $19.00 72133-TC $323.00 72195-26 $74.00 73010 $29.00 72141 $503.00 72195-TC $415.00 73010-26 $8.00 72141-26 $82.00 72196 $526.00 73010-TC $19.00 72141-TC $419.00 72196-26 $84.00 73020 $26.00 72142 $604.00 72196-TC $442.00 73020-26 $7.00 72142-26 $99.00 72197 $1,037.00 73020-TC $17.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 83
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA 73030 $31.00 73202-TC $277.00 73562-26 $9.00 73030-26 $9.00 73206 $375.00 73562-TC $21.00 73030-TC $21.00 73206-26 $94.00 73564 $35.00 73040 $68.00 73206-TC $277.00 73564-26 $11.00 73040-26 $17.00 73218 $482.00 73564-TC $22.00 73040-TC $51.00 73218-26 $68.00 73565 $28.00 73050 $35.00 73218-TC $413.00 73565-26 $8.00 73050-26 $10.00 73219 $579.00 73565-TC $18.00 73050-TC $24.00 73219-26 $82.00 73580 $84.00 73060 $30.00 73219-TC $495.00 73580-26 $18.00 73060-26 $8.00 73220 $520.00 73580-TC $66.00 73060-TC $21.00 73220-26 $78.00 73590 $29.00 73070 $27.00 73220-TC $442.00 73590-26 $8.00 73070-26 $7.00 73221 $482.00 73590-TC $19.00 73070-TC $19.00 73221-26 $68.00 73600 $27.00 73080 $30.00 73221-TC $413.00 73600-26 $8.00 73080-26 $8.00 73222 $579.00 73600-TC $18.00 73080-TC $21.00 73222-26 $82.00 73610 $29.00 73085 $74.00 73222-TC $495.00 73610-26 $8.00 73085-26 $19.00 73223 $1,029.00 73610-TC $19.00 73085-TC $55.00 73223-26 $109.00 73615 $72.00 73090 $28.00 73223-TC $916.00 73615-26 $19.00 73090-26 $8.00 73225 $513.00 73615-TC $53.00 73090-TC $19.00 73225-26 $92.00 73620 $27.00 73100 $27.00 73225-TC $419.00 73620-26 $8.00 73100-26 $8.00 73500 $27.00 73620-TC $18.00 73100-TC $18.00 73500-26 $8.00 73630 $29.00 73110 $29.00 73500-TC $17.00 73630-26 $8.00 73110-26 $8.00 73510 $32.00 73630-TC $19.00 73110-TC $19.00 73510-26 $10.00 73650 $26.00 73115 $54.00 73510-TC $21.00 73650-26 $8.00 73115-26 $17.00 73520 $38.00 73650-TC $17.00 73115-TC $37.00 73520-26 $12.00 73660 $22.00 73120 $27.00 73520-TC $24.00 73660-26 $7.00 73120-26 $8.00 73525 $84.00 73660-TC $15.00 73120-TC $18.00 73525-26 $21.00 73700 $242.00 73130 $29.00 73525-TC $63.00 73700-26 $56.00 73130-26 $8.00 73530 $34.00 73700-TC $185.00 73130-TC $19.00 73530-26 $14.00 73701 $282.00 73140 $22.00 73530-TC $19.00 73701-26 $61.00 73140-26 $7.00 73542 $108.00 73701-TC $220.00 73140-TC $15.00 73542-26 $28.00 73702 $341.00 73200 $242.00 73542-TC $80.00 73702-26 $62.00 73200-26 $56.00 73550 $30.00 73702-TC $277.00 73200-TC $185.00 73550-26 $8.00 73706 $379.00 73201 $282.00 73550-TC $21.00 73706-26 $98.00 73201-26 $59.00 73560 $29.00 73706-TC $277.00 73201-TC $220.00 73560-26 $8.00 73718 $482.00 73202 $342.00 73560-TC $19.00 73718-26 $68.00 73202-26 $63.00 73562 $31.00 73718-TC $413.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 84
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA 73719 $579.00 74183-TC $919.00 74280-26 $50.00 73719-26 $82.00 74185 $514.00 74280-TC $84.00 73719-TC $495.00 74185-26 $92.00 74283 $201.00 73720 $520.00 74185-TC $419.00 74283-26 $103.00 73720-26 $78.00 74190 $73.00 74283-TC $95.00 73720-TC $442.00 74190-26 $24.00 74290 $44.00 73721 $482.00 74190-TC $49.00 74290-26 $16.00 73721-26 $68.00 74210 $63.00 74290-TC $28.00 73721-TC $413.00 74210-26 $18.00 74291 $26.00 73722 $579.00 74210-TC $44.00 74291-26 $10.00 73722-26 $82.00 74220 $68.00 74291-TC $15.00 73722-TC $495.00 74220-26 $23.00 74300 $31.00 73723 $1,029.00 74220-TC $44.00 74300-26 $19.00 73723-26 $109.00 74230 $77.00 74300-TC $104.00 73723-TC $916.00 74230-26 $27.00 74301 $107.00 73725 $515.00 74230-TC $48.00 74301-26 $11.00 73725-26 $92.00 74235 $160.00 74301-TC $104.00 73725-TC $419.00 74235-26 $60.00 74305 $51.00 74000 $29.00 74235-TC $100.00 74305-26 $21.00 74000-26 $9.00 74240 $91.00 74305-TC $30.00 74000-TC $19.00 74240-26 $35.00 74320 $145.00 74010 $33.00 74240-TC $55.00 74320-26 $26.00 74010-26 $11.00 74241 $91.00 74320-TC $119.00 74010-TC $21.00 74241-26 $35.00 74327 $103.00 74020 $37.00 74241-TC $56.00 74327-26 $35.00 74020-26 $13.00 74245 $137.00 74327-TC $68.00 74020-TC $22.00 74245-26 $46.00 74328 $155.00 74022 $44.00 74245-TC $89.00 74328-26 $35.00 74022-26 $16.00 74246 $97.00 74328-TC $120.00 74022-TC $28.00 74246-26 $35.00 74329 $155.00 74150 $274.00 74246-TC $61.00 74329-26 $35.00 74150-26 $60.00 74247 $99.00 74329-TC $120.00 74150-TC $211.00 74247-26 $35.00 74330 $165.00 74160 $322.00 74247-TC $63.00 74330-26 $45.00 74160-26 $65.00 74249 $144.00 74330-TC $120.00 74160-TC $256.00 74249-26 $46.00 74340 $121.00 74170 $390.00 74249-TC $96.00 74340-26 $26.00 74170-26 $71.00 74250 $73.00 74340-TC $95.00 74170-TC $317.00 74250-26 $23.00 74355 $137.00 74175 $418.00 74250-TC $48.00 74355-26 $38.00 74175-26 $98.00 74251 $85.00 74355-TC $99.00 74175-TC $315.00 74251-26 $34.00 74360 $145.00 74181 $498.00 74251-TC $48.00 74360-26 $27.00 74181-26 $85.00 74260 $82.00 74360-TC $118.00 74181-TC $415.00 74260-26 $25.00 74363 $274.00 74182 $587.00 74260-TC $56.00 74363-26 $44.00 74182-26 $88.00 74270 $100.00 74363-TC $230.00 74182-TC $496.00 74270-26 $35.00 74400 $89.00 74183 $1,037.00 74270-TC $64.00 74400-26 $24.00 74183-26 $114.00 74280 $136.00 74400-TC $63.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 85
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA 74410 $98.00 74775-TC $55.00 75662-26 $84.00 74410-26 $24.00 75557 $462.00 75662-TC $476.00 74410-TC $72.00 75557-26 $79.00 75665 $540.00 74415 $105.00 75557-TC $344.00 75665-26 $65.00 74415-26 $24.00 75558 $87.00 75665-TC $475.00 74415-TC $79.00 75558-26 $87.00 75671 $219.00 74420 $117.00 75558-TC $486.00 75671-26 $32.00 74420-26 $18.00 75559 $495.00 75671-TC $187.00 74420-TC $97.00 75559-26 $99.00 75676 $540.00 74425 $68.00 75559-TC $344.00 75676-26 $65.00 74425-26 $18.00 75560 $101.00 75676-TC $475.00 74425-TC $50.00 75560-26 $101.00 75680 $207.00 74430 $48.00 75560-TC $649.00 75680-26 $31.00 74430-26 $14.00 75561 $656.00 75680-TC $176.00 74430-TC $34.00 75561-26 $87.00 75685 $160.00 74440 $62.00 75561-TC $525.00 75685-26 $19.00 74440-26 $19.00 75562 $96.00 75685-TC $141.00 74440-TC $43.00 75562-26 $96.00 75705 $587.00 74445 $101.00 75562-TC $649.00 75705-26 $109.00 74445-26 $57.00 75563 $683.00 75705-TC $478.00 74445-TC $44.00 75563-26 $101.00 75710 $194.00 74450 $60.00 75563-TC $526.00 75710-26 $21.00 74450-26 $14.00 75564 $112.00 75710-TC $173.00 74450-TC $46.00 75564-26 $112.00 75716 $293.00 74455 $75.00 75564-TC $763.00 75716-26 $35.00 74455-26 $16.00 75600 $497.00 75716-TC $258.00 74455-TC $59.00 75600-26 $25.00 75722 $206.00 74470 $74.00 75600-TC $472.00 75722-26 $22.00 74470-26 $27.00 75605 $183.00 75722-TC $184.00 74470-TC $47.00 75605-26 $20.00 75724 $214.00 74475 $181.00 75605-TC $163.00 75724-26 $29.00 74475-26 $27.00 75625 $143.00 75724-TC $185.00 74475-TC $154.00 75625-26 $15.00 75726 $530.00 74480 $181.00 75625-TC $128.00 75726-26 $56.00 74480-26 $27.00 75630 $239.00 75726-TC $474.00 74480-TC $154.00 75630-26 $37.00 75731 $530.00 74485 $146.00 75630-TC $202.00 75731-26 $56.00 74485-26 $27.00 75635 $445.00 75731-TC $474.00 74485-TC $119.00 75635-26 $75.00 75733 $540.00 74710 $57.00 75635-TC $370.00 75733-26 $65.00 74710-26 $17.00 75650 $218.00 75733-TC $475.00 74710-TC $39.00 75650-26 $29.00 75736 $530.00 74740 $68.00 75650-TC $189.00 75736-26 $56.00 74740-26 $19.00 75658 $540.00 75736-TC $474.00 74740-TC $49.00 75658-26 $66.00 75741 $540.00 74742 $150.00 75658-TC $474.00 75741-26 $65.00 74742-26 $30.00 75660 $540.00 75741-TC $475.00 74742-TC $120.00 75660-26 $65.00 75743 $253.00 74775 $88.00 75660-TC $475.00 75743-26 $37.00 74775-26 $32.00 75662 $560.00 75743-TC $216.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 86
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA 75746 $530.00 75840-TC $474.00 75940-26 $8.00 75746-26 $56.00 75842 $549.00 75940-TC $143.00 75746-TC $474.00 75842-26 $73.00 75945 $192.00 75756 $183.00 75842-TC $476.00 75945-26 $21.00 75756-26 $20.00 75860 $531.00 75945-TC $171.00 75756-TC $163.00 75860-26 $57.00 75946 $108.00 75774 $80.00 75860-TC $474.00 75946-26 $21.00 75774-26 $3.00 75870 $531.00 75946-TC $87.00 75774-TC $77.00 75870-26 $57.00 75952 BR 75790 $146.00 75870-TC $474.00 75952-26 $254.00 75790-26 $93.00 75872 $530.00 75952-TC BR 75790-TC $53.00 75872-26 $56.00 75953 BR 75801 $245.00 75872-TC $474.00 75953-26 $98.00 75801-26 $41.00 75880 $72.00 75953-TC BR 75801-TC $204.00 75880-26 $35.00 75954 BR 75803 $264.00 75880-TC $37.00 75954-26 $132.00 75803-26 $58.00 75885 $546.00 75954-TC BR 75803-TC $206.00 75885-26 $71.00 75956 BR 75805 $271.00 75885-TC $475.00 75956-26 $394.00 75805-26 $40.00 75887 $546.00 75956-TC BR 75805-TC $231.00 75887-26 $71.00 75957 BR 75807 $289.00 75887-TC $475.00 75957-26 $338.00 75807-26 $58.00 75889 $530.00 75957-TC BR 75807-TC $231.00 75889-26 $56.00 75958 BR 75809 $54.00 75889-TC $474.00 75958-26 $225.00 75809-26 $24.00 75891 $530.00 75958-TC BR 75809-TC $30.00 75891-26 $56.00 75959 BR 75810 $530.00 75891-TC $474.00 75959-26 $197.00 75810-26 $56.00 75893 $499.00 75959-TC BR 75810-TC $474.00 75893-26 $26.00 75960 $600.00 75820 $72.00 75893-TC $473.00 75960-26 $41.00 75820-26 $35.00 75894 $972.00 75960-TC $559.00 75820-TC $37.00 75894-26 $65.00 75961 $616.00 75822 $111.00 75894-TC $907.00 75961-26 $213.00 75822-26 $54.00 75896 $241.00 75961-TC $403.00 75822-TC $57.00 75896-26 $18.00 75962 $618.00 75825 $194.00 75896-TC $223.00 75962-26 $27.00 75825-26 $21.00 75898 $124.00 75962-TC $591.00 75825-TC $173.00 75898-26 $84.00 75964 $333.00 75827 $530.00 75898-TC $39.00 75964-26 $18.00 75827-26 $56.00 75900 $810.00 75964-TC $315.00 75827-TC $474.00 75900-26 $24.00 75966 $659.00 75831 $54.00 75900-TC $786.00 75966-26 $66.00 75831-26 $6.00 75901 $98.00 75966-TC $593.00 75831-TC $48.00 75901-26 $23.00 75968 $333.00 75833 $549.00 75901-TC $75.00 75968-26 $18.00 75833-26 $74.00 75902 $93.00 75968-TC $315.00 75833-TC $475.00 75902-26 $19.00 75970 $475.00 75840 $531.00 75902-TC $74.00 75970-26 $42.00 75840-26 $57.00 75940 $151.00 75970-TC $433.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 87
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA 75978 $617.00 76102-TC $65.00 76514-26 $10.00 75978-26 $26.00 76120 $157.00 76514-TC $3.00 75978-TC $591.00 76120-26 $56.00 76516 $99.00 75980 $277.00 76120-TC $102.00 76516-26 $37.00 75980-26 $71.00 76125 $49.00 76516-TC $63.00 75980-TC $206.00 76125-26 $17.00 76519 $88.00 75982 $303.00 76125-TC $33.00 76519-26 $31.00 75982-26 $71.00 76140 $31.00 76519-TC $53.00 75982-TC $232.00 76150 $15.00 76529 $86.00 75984 $110.00 76350 BR 76529-26 $31.00 75984-26 $36.00 76376 $144.00 76529-TC $53.00 75984-TC $74.00 76376-26 $11.00 76536 $83.00 75989 $180.00 76376-TC $133.00 76536-26 $31.00 75989-26 $59.00 76377 $185.00 76536-TC $54.00 75989-TC $121.00 76377-26 $43.00 76604 $78.00 75992 $618.00 76377-TC $142.00 76604-26 $28.00 75992-26 $27.00 76380 $182.00 76604-TC $48.00 75992-TC $591.00 76380-26 $50.00 76645 $69.00 75993 $333.00 76380-TC $131.00 76645-26 $31.00 75993-26 $18.00 76390 $493.00 76645-TC $40.00 75993-TC $315.00 76390-26 $71.00 76700 $116.00 75994 $659.00 76390-TC $419.00 76700-26 $42.00 75994-26 $66.00 76496 BR 76700-TC $73.00 75994-TC $593.00 76496-26 BR 76705 $84.00 75995 $658.00 76496-TC $79.00 76705-26 $30.00 75995-26 $66.00 76497 BR 76705-TC $53.00 75995-TC $592.00 76497-26 BR 76770 $112.00 75996 $332.00 76497-TC $94.00 76770-26 $38.00 75996-26 $17.00 76498 BR 76770-TC $73.00 75996-TC $315.00 76498-26 BR 76775 $84.00 76000 $58.00 76498-TC $280.00 76775-26 $30.00 76000-26 $8.00 76499 BR 76775-TC $53.00 76000-TC $48.00 76499-26 BR 76776 $124.00 76001 $134.00 76499-TC BR 76776-26 $36.00 76001-26 $34.00 76506 $88.00 76776-TC $88.00 76001-TC $97.00 76506-26 $33.00 76800 $112.00 76080 $67.00 76506-TC $53.00 76800-26 $61.00 76080-26 $27.00 76510 $171.00 76800-TC $54.00 76080-TC $40.00 76510-26 $86.00 76801 $93.00 76098 $23.00 76510-TC $85.00 76801-26 $51.00 76098-26 $8.00 76511 $96.00 76801-TC $42.00 76098-TC $15.00 76511-26 $48.00 76802 $73.00 76100 $77.00 76511-TC $48.00 76802-26 $43.00 76100-26 $30.00 76512 $96.00 76802-TC $30.00 76100-TC $46.00 76512-26 $36.00 76805 $131.00 76101 $94.00 76512-TC $60.00 76805-26 $51.00 76101-26 $36.00 76513 $96.00 76805-TC $79.00 76101-TC $59.00 76513-26 $36.00 76810 $252.00 76102 $95.00 76513-TC $60.00 76810-26 $100.00 76102-26 $30.00 76514 $12.00 76810-TC $151.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 88
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA 76811 $243.00 76831-TC $57.00 76950-26 $30.00 76811-26 $100.00 76856 $93.00 76950-TC $48.00 76811-TC $142.00 76856-26 $35.00 76965 $281.00 76812 $145.00 76856-TC $57.00 76965-26 $84.00 76812-26 $94.00 76857 $59.00 76965-TC $208.00 76812-TC $51.00 76857-26 $19.00 76970 $60.00 76813 $125.00 76857-TC $39.00 76970-26 $20.00 76813-26 $55.00 76870 $90.00 76970-TC $39.00 76813-TC $71.00 76870-26 $33.00 76975 $99.00 76814 $83.00 76870-TC $57.00 76975-26 $41.00 76814-26 $46.00 76872 $93.00 76975-TC $58.00 76814-TC $37.00 76872-26 $36.00 76977 $34.00 76815 $88.00 76872-TC $57.00 76977-26 $3.00 76815-26 $33.00 76873 $151.00 76977-TC $31.00 76815-TC $53.00 76873-26 $68.00 76998 BR 76816 $72.00 76873-TC $80.00 76998-26 $61.00 76816-26 $30.00 76880 $85.00 76998-TC $96.00 76816-TC $41.00 76880-26 $32.00 76999 BR 76817 $96.00 76880-TC $54.00 76999-26 BR 76817-26 $39.00 76930 $93.00 76999-TC BR 76817-TC $57.00 76930-26 $34.00 77001 $83.00 76818 $105.00 76930-TC $59.00 77001-26 $18.00 76818-26 $40.00 76932 $93.00 77001-TC $64.00 76818-TC $60.00 76932-26 $34.00 77002 $75.00 76819 $101.00 76932-TC $59.00 77002-26 $25.00 76819-26 $40.00 76936 $341.00 77002-TC $50.00 76819-TC $60.00 76936-26 $102.00 77003 $73.00 76820 $93.00 76936-TC $236.00 77003-26 $27.00 76820-26 $27.00 76937 $34.00 77003-TC $45.00 76820-TC $66.00 76937-26 $17.00 77011 $309.00 76821 $103.00 76937-TC $18.00 77011-26 $58.00 76821-26 $38.00 76940 $171.00 77011-TC $251.00 76821-TC $66.00 76940-26 $104.00 77012 $306.00 76825 $160.00 76940-TC $68.00 77012-26 $55.00 76825-26 $65.00 76941 $128.00 77012-TC $251.00 76825-TC $73.00 76941-26 $69.00 77013-26 $191.00 76826 $71.00 76941-TC $59.00 77013-TC $297.00 76826-26 $46.00 76942 $92.00 77014 $135.00 76826-TC $27.00 76942-26 $24.00 77014-26 $41.00 76827 $97.00 76942-TC $68.00 77014-TC $94.00 76827-26 $35.00 76945 $93.00 77021 $353.00 76827-TC $65.00 76945-26 $34.00 77021-26 $73.00 76828 $72.00 76945-TC $59.00 77021-TC $280.00 76828-26 $29.00 76946 $78.00 77022 BR 76828-TC $42.00 76946-26 $19.00 77022-26 $204.00 76830 $93.00 76946-TC $59.00 77022-TC $280.00 76830-26 $35.00 76948 $77.00 77031 $258.00 76830-TC $57.00 76948-26 $19.00 77031-26 $77.00 76831 $95.00 76948-TC $58.00 77031-TC $182.00 76831-26 $37.00 76950 $80.00 77032 $70.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 89
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA 77032-26 $27.00 77079-TC $92.00 77321-26 $48.00 77032-TC $44.00 77080 $83.00 77321-TC $150.00 77051 $17.00 77080-26 $11.00 77326 $137.00 77051-26 $3.00 77080-TC $72.00 77326-26 $47.00 77051-TC $14.00 77081 $40.00 77326-TC $88.00 77052 $17.00 77081-26 $11.00 77327 $202.00 77052-26 $3.00 77081-TC $29.00 77327-26 $71.00 77052-TC $14.00 77082 $35.00 77327-TC $130.00 77053 $102.00 77082-26 $8.00 77328 $295.00 77053-26 $17.00 77082-TC $27.00 77328-26 $106.00 77053-TC $85.00 77083 $36.00 77328-TC $185.00 77054 $126.00 77083-26 $10.00 77331 $64.00 77054-26 $22.00 77083-TC $26.00 77331-26 $45.00 77054-TC $104.00 77084 $356.00 77331-TC $18.00 77055 $78.00 77084-26 $77.00 77332 $78.00 77055-26 $33.00 77084-TC $280.00 77332-26 $27.00 77055-TC $45.00 77261 $73.00 77332-TC $50.00 77056 $97.00 77262 $110.00 77333 $115.00 77056-26 $41.00 77263 $163.00 77333-26 $43.00 77056-TC $56.00 77280 $166.00 77333-TC $70.00 77057 $82.00 77280-26 $36.00 77334 $187.00 77057-26 $33.00 77280-TC $130.00 77334-26 $63.00 77057-TC $49.00 77285 $264.00 77334-TC $121.00 77058 $804.00 77285-26 $53.00 77336 $111.00 77058-26 $78.00 77285-TC $209.00 77370 $130.00 77058-TC $726.00 77290 $325.00 77371 $1,151.00 77059 $994.00 77290-26 $79.00 77372 $874.00 77059-26 $78.00 77290-TC $243.00 77373 $1,630.00 77059-TC $917.00 77295 $1,287.00 77399 BR 77071 $29.00 77295-26 $232.00 77399-26 BR 77072 $22.00 77295-TC $1,046.00 77399-TC BR 77072-26 $9.00 77299 BR 77401 $66.00 77072-TC $14.00 77299-26 BR 77402 $66.00 77073 $42.00 77299-TC BR 77403 $66.00 77073-26 $13.00 77300 $87.00 77404 $66.00 77073-TC $29.00 77300-26 $36.00 77406 $66.00 77074 $64.00 77300-TC $52.00 77407 $78.00 77074-26 $22.00 77301 $1,473.00 77408 $78.00 77074-TC $42.00 77301-26 $415.00 77409 $78.00 77075 $89.00 77301-TC $1,046.00 77411 $78.00 77075-26 $26.00 77305 $106.00 77412 $87.00 77075-TC $63.00 77305-26 $36.00 77413 $87.00 77077 $54.00 77305-TC $69.00 77414 $87.00 77077-26 $15.00 77310 $142.00 77416 $87.00 77077-TC $39.00 77310-26 $53.00 77417 $21.00 77078 $84.00 77310-TC $87.00 77418 $609.00 77078-26 $12.00 77315 $181.00 77421 $152.00 77078-TC $72.00 77315-26 $79.00 77421-26 $20.00 77079 $103.00 77315-TC $99.00 77421-TC $131.00 77079-26 $11.00 77321 $200.00 77422 $70.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 90
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA 77423 $91.00 77778-TC $192.00 78099-26 BR 77427 $166.00 77789 $74.00 78099-TC BR 77431 $95.00 77789-26 $57.00 78102 $106.00 77432 $417.00 77789-TC $16.00 78102-26 $28.00 77435 $644.00 77790 $72.00 78102-TC $77.00 77470 $527.00 77790-26 $53.00 78103 $158.00 77470-26 $106.00 77790-TC $18.00 78103-26 $39.00 77470-TC $417.00 77799 BR 78103-TC $118.00 77499 BR 77799-26 BR 78104 $194.00 77499-26 BR 77799-TC BR 78104-26 $41.00 77499-TC BR 78000 $46.00 78104-TC $152.00 77520 BR 78000-26 $9.00 78110 $45.00 77522 BR 78000-TC $36.00 78110-26 $9.00 77523 BR 78001 $62.00 78110-TC $35.00 77525 BR 78001-26 $12.00 78111 $108.00 77600 $196.00 78001-TC $48.00 78111-26 $11.00 77600-26 $80.00 78003 $54.00 78111-TC $96.00 77600-TC $113.00 78003-26 $17.00 78120 $78.00 77605 $263.00 78003-TC $36.00 78120-26 $11.00 77605-26 $108.00 78006 $115.00 78120-TC $65.00 77605-TC $151.00 78006-26 $24.00 78121 $125.00 77610 $195.00 78006-TC $89.00 78121-26 $16.00 77610-26 $79.00 78007 $122.00 78121-TC $108.00 77610-TC $113.00 78007-26 $25.00 78122 $196.00 77615 $262.00 78007-TC $96.00 78122-26 $22.00 77615-26 $106.00 78010 $89.00 78122-TC $171.00 77615-TC $151.00 78010-26 $19.00 78130 $139.00 77620 $196.00 78010-TC $68.00 78130-26 $32.00 77620-26 $80.00 78011 $114.00 78130-TC $106.00 77620-TC $113.00 78011-26 $22.00 78135 $216.00 77750 $299.00 78011-TC $90.00 78135-26 $33.00 77750-26 $248.00 78015 $132.00 78135-TC $182.00 77750-TC $49.00 78015-26 $34.00 78140 $179.00 77761 $284.00 78015-TC $96.00 78140-26 $31.00 77761-26 $188.00 78016 $173.00 78140-TC $147.00 77761-TC $93.00 78016-26 $42.00 78185 $110.00 77762 $427.00 78016-TC $130.00 78185-26 $20.00 77762-26 $289.00 78018 $248.00 78185-TC $88.00 77762-TC $135.00 78018-26 $44.00 78190 $272.00 77763 $605.00 78018-TC $202.00 78190-26 $57.00 77763-26 $435.00 78020 $35.00 78190-TC $214.00 77763-TC $167.00 78020-26 $30.00 78191 $307.00 77776 $316.00 78020-TC $5.00 78191-26 $31.00 77776-26 $233.00 78070 $112.00 78191-TC $274.00 77776-TC $82.00 78070-26 $36.00 78195 $216.00 77777 $540.00 78070-TC $68.00 78195-26 $49.00 77777-26 $378.00 78075 $242.00 78195-TC $152.00 77777-TC $158.00 78075-26 $38.00 78199 BR 77778 $764.00 78075-TC $202.00 78199-26 BR 77778-26 $568.00 78099 BR 78199-TC BR CPT only 2008 American Medical Association. All Rights Reserved. Part A, 91
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA 78201 $112.00 78271 $72.00 78445-26 $28.00 78201-26 $22.00 78271-26 $10.00 78445-TC $69.00 78201-TC $88.00 78271-TC $61.00 78456 $205.00 78202 $135.00 78272 $100.00 78456-26 $49.00 78202-26 $26.00 78272-26 $14.00 78456-TC $151.00 78202-TC $108.00 78272-TC $87.00 78457 $140.00 78205 $259.00 78278 $234.00 78457-26 $39.00 78205-26 $36.00 78278-26 $50.00 78457-TC $99.00 78205-TC $220.00 78278-TC $182.00 78458 $198.00 78206 $265.00 78282 $230.00 78458-26 $46.00 78206-26 $46.00 78282-26 $19.00 78458-TC $149.00 78206-TC $214.00 78282-TC $224.00 78459 $755.00 78215 $135.00 78290 $149.00 78459-26 $100.00 78215-26 $24.00 78290-26 $35.00 78459-TC $731.00 78215-TC $109.00 78290-TC $113.00 78460 $134.00 78216 $160.00 78291 $161.00 78460-26 $44.00 78216-26 $29.00 78291-26 $45.00 78460-TC $88.00 78216-TC $130.00 78291-TC $114.00 78461 $294.00 78220 $165.00 78299 BR 78461-26 $82.00 78220-26 $24.00 78299-26 BR 78461-TC $213.00 78220-TC $139.00 78299-TC BR 78464 $322.00 78223 $181.00 78300 $125.00 78464-26 $56.00 78223-26 $43.00 78300-26 $32.00 78464-TC $264.00 78223-TC $137.00 78300-TC $93.00 78465 $519.00 78230 $106.00 78305 $181.00 78465-26 $75.00 78230-26 $23.00 78305-26 $42.00 78465-TC $441.00 78230-TC $82.00 78305-TC $137.00 78466 $135.00 78231 $146.00 78306 $205.00 78466-26 $36.00 78231-26 $27.00 78306-26 $44.00 78466-TC $97.00 78231-TC $118.00 78306-TC $159.00 78468 $180.00 78232 $157.00 78315 $233.00 78468-26 $41.00 78232-26 $23.00 78315-26 $52.00 78468-TC $137.00 78232-TC $132.00 78315-TC $179.00 78469 $244.00 78258 $146.00 78320 $276.00 78469-26 $47.00 78258-26 $38.00 78320-26 $53.00 78469-TC $195.00 78258-TC $108.00 78320-TC $220.00 78472 $259.00 78261 $190.00 78350 $40.00 78472-26 $50.00 78261-26 $36.00 78350-26 $11.00 78472-TC $206.00 78261-TC $152.00 78350-TC $29.00 78473 $387.00 78262 $195.00 78351 $23.00 78473-26 $75.00 78262-26 $35.00 78399 BR 78473-TC $308.00 78262-TC $159.00 78399-26 BR 78478 $91.00 78264 $195.00 78399-TC BR 78478-26 $32.00 78264-26 $40.00 78414 BR 78478-TC $58.00 78264-TC $154.00 78414-26 $23.00 78480 $91.00 78267 BR 78414-TC BR 78480-26 $32.00 78268 BR 78428 $126.00 78480-TC $58.00 78270 $68.00 78428-26 $41.00 78481 $248.00 78270-26 $10.00 78428-TC $84.00 78481-26 $51.00 78270-TC $58.00 78445 $97.00 78481-TC $195.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 92
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology Radiology CPT Code MRA CPT Code MRA CPT Code MRA 78483 $373.00 78599-TC BR 78701-26 $24.00 78483-26 $77.00 78600 $131.00 78701-TC $133.00 78483-TC $294.00 78600-26 $22.00 78707 $217.00 78491 $756.00 78600-TC $108.00 78707-26 $49.00 78491-26 $85.00 78601 $154.00 78707-TC $166.00 78491-TC $731.00 78601-26 $26.00 78708 $231.00 78492 $764.00 78601-TC $126.00 78708-26 $61.00 78492-26 $100.00 78605 $155.00 78708-TC $166.00 78492-TC $731.00 78605-26 $27.00 78709 $241.00 78494 $324.00 78605-TC $126.00 78709-26 $68.00 78494-26 $59.00 78606 $221.00 78709-TC $166.00 78494-TC $262.00 78606-26 $45.00 78710 $256.00 78496 $92.00 78606-TC $177.00 78710-26 $34.00 78496-26 $24.00 78607 $311.00 78710-TC $220.00 78496-TC $66.00 78607-26 $64.00 78725 $87.00 78499 BR 78607-TC $245.00 78725-26 $19.00 78499-26 BR 78608 $876.00 78725-TC $66.00 78499-TC BR 78608-26 $78.00 78730 $73.00 78580 $167.00 78608-TC $855.00 78730-26 $18.00 78580-26 $38.00 78609 $51.00 78730-TC $55.00 78580-TC $128.00 78609-26 $78.00 78740 $109.00 78584 $171.00 78609-TC BR 78740-26 $29.00 78584-26 $50.00 78610 $74.00 78740-TC $79.00 78584-TC $119.00 78610-26 $15.00 78761 $157.00 78585 $171.00 78610-TC $59.00 78761-26 $36.00 78585-26 $36.00 78630 $223.00 78761-TC $119.00 78585-TC $133.00 78630-26 $35.00 78799 BR 78586 $118.00 78630-TC $188.00 78799-26 BR 78586-26 $20.00 78635 $129.00 78799-TC BR 78586-TC $96.00 78635-26 $32.00 78800 $162.00 78587 $131.00 78635-TC $95.00 78800-26 $34.00 78587-26 $24.00 78645 $158.00 78800-TC $126.00 78587-TC $105.00 78645-26 $29.00 78801 $199.00 78588 $239.00 78645-TC $128.00 78801-26 $40.00 78588-26 $53.00 78647 $268.00 78801-TC $158.00 78588-TC $192.00 78647-26 $46.00 78802 $252.00 78591 $128.00 78647-TC $220.00 78802-26 $44.00 78591-26 $20.00 78650 $206.00 78802-TC $207.00 78591-TC $106.00 78650-26 $31.00 78803 $303.00 78593 $151.00 78650-TC $173.00 78803-26 $56.00 78593-26 $24.00 78660 $107.00 78803-TC $245.00 78593-TC $126.00 78660-26 $27.00 78804 $227.00 78594 $214.00 78660-TC $79.00 78804-26 $55.00 78594-26 $27.00 78699 BR 78804-TC $171.00 78594-TC $186.00 78699-26 BR 78805 $166.00 78596 $332.00 78699-TC BR 78805-26 $38.00 78596-26 $65.00 78700 $137.00 78805-TC $126.00 78596-TC $264.00 78700-26 $22.00 78806 $286.00 78599 BR 78700-TC $113.00 78806-26 $44.00 78599-26 BR 78701 $158.00 78806-TC $241.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 93
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Radiology Radiology CPT Code MRA CPT Code MRA 78807 $303.00 G0130-TC G0130-TC 78807-26 $57.00 G0202 G0202 78807-TC $245.00 G0202-26 G0202-26 78811 $879.00 G0202-TC G0202-TC 78811-26 $83.00 G0204 G0204 78811-TC $855.00 G0204-26 G0204-26 78812 $884.00 G0204-TC G0204-TC 78812-26 $102.00 G0206 G0206 78812-TC $855.00 G0206-26 G0206-26 78813 $885.00 G0206-TC G0206-TC 78813-26 $106.00 G0275 G0275 78813-TC $855.00 G0278 G0278 78814 $982.00 G0288 G0288 78814-26 $116.00 G0365 G0365 78814-TC $950.00 G0365-26 G0365-26 78815 $985.00 G0365-TC G0365-TC 78815-26 $128.00 G0389 G0389 78815-TC $950.00 G0389-26 G0389-26 78816 $986.00 G0389-TC G0389-TC 78816-26 $132.00 Q0092 Q0092 78816-TC $950.00 78999 BR 78999-26 BR 78999-TC BR 79005 $199.00 79005-26 $94.00 79005-TC $105.00 79101 $207.00 79101-26 $103.00 79101-TC $105.00 79200 $203.00 79200-26 $102.00 79200-TC $97.00 79300 BR 79300-26 $83.00 79300-TC BR 79403 $287.00 79403-26 $121.00 79403-TC $165.00 79440 $204.00 79440-26 $104.00 79440-TC $97.00 79445 $232.00 79445-26 $127.00 79445-TC $105.00 79999 BR 79999-26 BR 79999-TC BR G0130 $34.00 G0130-26 $10.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 94
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 80048 $23.00 80156-TC $23.00 80186-26 $11.00 80048-26 $4.00 80157 $22.00 80186-TC $26.00 80048-TC $19.00 80157-26 $8.00 80188 $35.00 80050 $45.00 80157-TC $14.00 80188-26 $11.00 80050-26 $18.00 80158 $35.00 80188-TC $23.00 80050-TC $26.00 80158-26 $12.00 80190 $41.00 80051 $16.00 80158-TC $22.00 80190-26 $13.00 80051-26 $6.00 80160 $35.00 80190-TC $28.00 80051-TC $10.00 80160-26 $12.00 80192 $44.00 80053 $29.00 80160-TC $22.00 80192-26 $17.00 80053-26 $8.00 80162 $13.00 80192-TC $26.00 80053-TC $21.00 80162-26 $3.00 80194 $33.00 80055 $67.00 80162-TC $9.00 80194-26 $10.00 80055-26 $21.00 80164 $43.00 80194-TC $22.00 80055-TC $43.00 80164-26 $14.00 80196 $13.00 80061 $31.00 80164-TC $29.00 80196-26 $3.00 80061-26 $11.00 80166 $35.00 80196-TC $9.00 80061-TC $19.00 80166-26 $10.00 80197 $34.00 80069 $26.00 80166-TC $24.00 80197-26 $11.00 80069-26 $6.00 80168 $43.00 80197-TC $22.00 80069-TC $20.00 80168-26 $17.00 80198 $20.00 80074 $107.00 80168-TC $25.00 80198-26 $5.00 80074-26 $43.00 80170 $18.00 80198-TC $15.00 80074-TC $64.00 80170-26 $6.00 80200 $24.00 80076 $18.00 80170-TC $11.00 80200-26 $7.00 80076-26 $7.00 80172 $44.00 80200-TC $16.00 80076-TC $11.00 80172-26 $13.00 80201 $33.00 80100 $38.00 80172-TC $32.00 80201-26 $11.00 80100-26 $11.00 80173 $33.00 80201-TC $21.00 80100-TC $26.00 80173-26 $11.00 80202 $42.00 80101 $13.00 80173-TC $22.00 80202-26 $14.00 80101-26 $3.00 80174 $41.00 80202-TC $28.00 80101-TC $9.00 80174-26 $12.00 80299 BR 80102 $23.00 80174-TC $29.00 80299-26 BR 80102-26 $6.00 80176 $35.00 80299-TC BR 80102-TC $16.00 80176-26 $11.00 80400 $54.00 80103 $12.00 80176-TC $23.00 80400-26 $18.00 80103-26 $4.00 80178 $17.00 80400-TC $36.00 80103-TC $7.00 80178-26 $6.00 80402 $138.00 80150 $40.00 80178-TC $11.00 80402-26 $42.00 80150-26 $13.00 80182 $43.00 80402-TC $95.00 80150-TC $26.00 80182-26 $14.00 80406 $138.00 80152 $43.00 80182-TC $29.00 80406-26 $42.00 80152-26 $14.00 80184 $34.00 80406-TC $95.00 80152-TC $29.00 80184-26 $10.00 80408 $213.00 80154 $49.00 80184-TC $23.00 80408-26 $77.00 80154-26 $15.00 80185 $36.00 80408-TC $136.00 80154-TC $34.00 80185-26 $10.00 80410 $166.00 80156 $35.00 80185-TC $25.00 80410-26 $54.00 80156-26 $11.00 80186 $38.00 80410-TC $110.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 80412 $533.00 80438-TC $56.00 82003-26 $10.00 80412-26 $176.00 80439 $176.00 82003-TC $25.00 80412-TC $355.00 80439-26 $33.00 82009 $10.00 80414 $88.00 80439-TC $144.00 82009-26 $3.00 80414-26 $26.00 80440 $188.00 82009-TC $6.00 80414-TC $59.00 80440-26 $36.00 82010 $22.00 80415 $93.00 80440-TC $151.00 82010-26 $7.00 80415-26 $28.00 80500 $34.00 82010-TC $15.00 80415-TC $64.00 80500-26 $34.00 82013 $24.00 80416 $256.00 80500-TC BR 82013-26 $7.00 80416-26 $88.00 80502 $72.00 82013-TC $17.00 80416-TC $166.00 80502-26 $72.00 82024 $26.00 80417 $256.00 80502-TC BR 82024-26 $7.00 80417-26 $88.00 81000 $7.00 82024-TC $18.00 80417-TC $166.00 81000-26 $3.00 82030 $43.00 80418 $934.00 81000-TC $4.00 82030-26 $17.00 80418-26 $266.00 81001 $7.00 82030-TC $25.00 80418-TC $666.00 81001-26 $3.00 82040 $11.00 80420 $107.00 81001-TC $4.00 82040-26 $3.00 80420-26 $33.00 81002 $5.00 82040-TC $7.00 80420-TC $74.00 81002-26 $3.00 82042 $12.00 80422 $62.00 81002-TC $3.00 82042-26 $3.00 80422-26 $18.00 81003 $5.00 82042-TC $8.00 80422-TC $43.00 81003-26 $2.00 82043 $14.00 80424 $94.00 81003-TC $3.00 82043-26 $4.00 80424-26 $26.00 81005 $3.00 82043-TC $10.00 80424-TC $67.00 81005-26 $1.00 82044 $12.00 80426 $232.00 81005-TC $3.00 82044-26 $4.00 80426-26 $54.00 81007 $5.00 82044-TC $9.00 80426-TC $176.00 81007-26 $2.00 82055 $33.00 80428 $93.00 81007-TC $4.00 82055-26 $10.00 80428-26 $19.00 81015 $5.00 82055-TC $22.00 80428-TC $73.00 81015-26 $3.00 82075 $32.00 80430 $99.00 81015-TC $3.00 82075-26 $10.00 80430-26 $24.00 81020 $8.00 82075-TC $21.00 80430-TC $74.00 81020-26 $3.00 82085 $24.00 80432 $243.00 81020-TC $5.00 82085-26 $7.00 80432-26 $56.00 81025 $7.00 82085-TC $17.00 80432-TC $186.00 81025-26 $4.00 82088 $91.00 80434 $161.00 81025-TC $4.00 82088-26 $28.00 80434-26 $49.00 81050 $33.00 82088-TC $62.00 80434-TC $110.00 81050-26 $11.00 82101 $59.00 80435 $166.00 81050-TC $21.00 82101-26 $18.00 80435-26 $49.00 81099 BR 82101-TC $41.00 80435-TC $115.00 81099-26 BR 82103 $21.00 80436 $119.00 81099-TC BR 82103-26 $7.00 80436-26 $35.00 82000 $24.00 82103-TC $14.00 80436-TC $85.00 82000-26 $7.00 82104 $22.00 80438 $82.00 82000-TC $17.00 82104-26 $7.00 80438-26 $24.00 82003 $36.00 82104-TC $15.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 82105 $26.00 82160-TC $43.00 82286-26 $3.00 82105-26 $8.00 82163 $42.00 82286-TC $8.00 82105-TC $18.00 82163-26 $12.00 82300 $48.00 82106 $26.00 82163-TC $31.00 82300-26 $15.00 82106-26 $8.00 82164 $32.00 82300-TC $33.00 82106-TC $18.00 82164-26 $10.00 82306 $79.00 82108 $45.00 82164-TC $21.00 82306-26 $25.00 82108-26 $14.00 82172 $33.00 82306-TC $52.00 82108-TC $32.00 82172-26 $10.00 82307 $57.00 82120 $9.00 82172-TC $22.00 82307-26 $19.00 82120-26 $3.00 82175 $48.00 82307-TC $38.00 82120-TC $5.00 82175-26 $15.00 82308 $62.00 82127 $33.00 82175-TC $33.00 82308-26 $18.00 82127-26 $11.00 82180 $25.00 82308-TC $43.00 82127-TC $22.00 82180-26 $8.00 82310 $11.00 82128 $26.00 82180-TC $17.00 82310-26 $3.00 82128-26 $6.00 82190 $24.00 82310-TC $7.00 82128-TC $19.00 82190-26 $8.00 82330 $37.00 82131 $57.00 82190-TC $16.00 82330-26 $11.00 82131-26 $13.00 82205 $34.00 82330-TC $25.00 82131-TC $44.00 82205-26 $10.00 82331 $14.00 82135 $41.00 82205-TC $23.00 82331-26 $4.00 82135-26 $13.00 82232 $43.00 82331-TC $10.00 82135-TC $28.00 82232-26 $14.00 82340 $13.00 82136 $38.00 82232-TC $29.00 82340-26 $4.00 82136-26 $14.00 82239 $23.00 82340-TC $8.00 82136-TC $23.00 82239-26 $8.00 82355 $31.00 82139 $38.00 82239-TC $15.00 82355-26 $10.00 82139-26 $14.00 82240 $49.00 82355-TC $20.00 82139-TC $23.00 82240-26 $15.00 82360 $31.00 82140 $40.00 82240-TC $34.00 82360-26 $10.00 82140-26 $12.00 82247 $10.00 82360-TC $20.00 82140-TC $28.00 82247-26 $3.00 82365 $31.00 82143 $28.00 82247-TC $7.00 82365-26 $8.00 82143-26 $8.00 82248 $10.00 82365-TC $21.00 82143-TC $19.00 82248-26 $3.00 82370 $22.00 82145 $35.00 82248-TC $7.00 82370-26 $7.00 82145-26 $10.00 82252 $11.00 82370-TC $15.00 82145-TC $24.00 82252-26 $3.00 82373 $16.00 82150 $16.00 82252-TC $7.00 82373-26 $5.00 82150-26 $5.00 82261 $38.00 82373-TC $11.00 82150-TC $11.00 82261-26 $13.00 82374 $10.00 82154 $34.00 82261-TC $24.00 82374-26 $3.00 82154-26 $13.00 82270 $5.00 82374-TC $6.00 82154-TC $20.00 82270-26 $2.00 82375 $26.00 82157 $57.00 82270-TC $3.00 82375-26 $7.00 82157-26 $17.00 82274 BR 82375-TC $18.00 82157-TC $40.00 82274-26 BR 82376 $11.00 82160 $67.00 82274-TC BR 82376-26 $3.00 82160-26 $21.00 82286 $12.00 82376-TC $7.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 82378 $31.00 82482-TC $15.00 82541-26 $13.00 82378-26 $8.00 82485 $37.00 82541-TC $28.00 82378-TC $21.00 82485-26 $8.00 82542 $42.00 82379 $38.00 82485-TC $28.00 82542-26 $13.00 82379-26 $13.00 82486 $42.00 82542-TC $28.00 82379-TC $24.00 82486-26 $14.00 82543 $42.00 82380 $21.00 82486-TC $27.00 82543-26 $13.00 82380-26 $6.00 82487 $43.00 82543-TC $28.00 82380-TC $15.00 82487-26 $14.00 82544 $42.00 82382 $38.00 82487-TC $29.00 82544-26 $13.00 82382-26 $12.00 82488 $57.00 82544-TC $28.00 82382-TC $25.00 82488-26 $19.00 82550 $16.00 82383 $62.00 82488-TC $38.00 82550-26 $4.00 82383-26 $18.00 82489 $47.00 82550-TC $12.00 82383-TC $43.00 82489-26 $15.00 82552 $33.00 82384 $62.00 82489-TC $32.00 82552-26 $10.00 82384-26 $18.00 82491 $58.00 82552-TC $22.00 82384-TC $43.00 82491-26 $17.00 82553 $16.00 82387 $34.00 82491-TC $41.00 82553-26 $5.00 82387-26 $10.00 82492 $42.00 82553-TC $11.00 82387-TC $23.00 82492-26 $13.00 82554 $19.00 82390 $24.00 82492-TC $28.00 82554-26 $6.00 82390-26 $7.00 82495 $48.00 82554-TC $13.00 82390-TC $17.00 82495-26 $16.00 82565 $13.00 82397 $22.00 82495-TC $32.00 82565-26 $2.00 82397-26 $7.00 82507 $55.00 82565-TC $11.00 82397-TC $15.00 82507-26 $16.00 82570 $10.00 82415 $28.00 82507-TC $39.00 82570-26 $2.00 82415-26 $8.00 82520 $26.00 82570-TC $7.00 82415-TC $19.00 82520-26 $8.00 82575 $25.00 82435 $8.00 82520-TC $18.00 82575-26 $8.00 82435-26 $2.00 82523 $43.00 82575-TC $17.00 82435-TC $6.00 82523-26 $17.00 82585 $15.00 82436 $14.00 82523-TC $25.00 82585-26 $3.00 82436-26 $4.00 82525 $34.00 82585-TC $12.00 82436-TC $10.00 82525-26 $10.00 82595 $31.00 82438 $13.00 82525-TC $23.00 82595-26 $10.00 82438-26 $4.00 82528 $40.00 82595-TC $21.00 82438-TC $8.00 82528-26 $13.00 82600 $40.00 82441 $16.00 82528-TC $26.00 82600-26 $12.00 82441-26 $5.00 82530 $38.00 82600-TC $28.00 82441-TC $11.00 82530-26 $12.00 82607 $38.00 82465 $8.00 82530-TC $25.00 82607-26 $10.00 82465-26 $2.00 82533 $35.00 82607-TC $27.00 82465-TC $6.00 82533-26 $10.00 82608 $40.00 82480 $23.00 82533-TC $24.00 82608-26 $13.00 82480-26 $6.00 82540 $10.00 82608-TC $26.00 82480-TC $17.00 82540-26 $3.00 82615 $17.00 82482 $23.00 82540-TC $6.00 82615-26 $5.00 82482-26 $7.00 82541 $42.00 82615-TC $12.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 82626 $59.00 82671-TC $43.00 82757-26 $11.00 82626-26 $19.00 82672 $57.00 82757-TC $24.00 82626-TC $40.00 82672-26 $16.00 82759 $38.00 82627 $37.00 82672-TC $41.00 82759-26 $12.00 82627-26 $12.00 82677 $52.00 82759-TC $25.00 82627-TC $24.00 82677-26 $17.00 82760 $26.00 82633 $81.00 82677-TC $35.00 82760-26 $8.00 82633-26 $23.00 82679 $70.00 82760-TC $18.00 82633-TC $56.00 82679-26 $20.00 82775 $47.00 82634 $81.00 82679-TC $48.00 82775-26 $14.00 82634-26 $23.00 82690 $53.00 82775-TC $33.00 82634-TC $56.00 82690-26 $21.00 82776 $14.00 82638 $23.00 82690-TC $32.00 82776-26 $3.00 82638-26 $7.00 82693 $23.00 82776-TC $11.00 82638-TC $16.00 82693-26 $7.00 82784 $15.00 82646 $37.00 82693-TC $16.00 82784-26 $5.00 82646-26 $11.00 82696 $57.00 82784-TC $11.00 82646-TC $25.00 82696-26 $19.00 82785 $33.00 82649 $43.00 82696-TC $38.00 82785-26 $11.00 82649-26 $17.00 82705 $14.00 82785-TC $21.00 82649-TC $25.00 82705-26 $6.00 82787 $54.00 82651 $43.00 82705-TC $9.00 82787-26 $17.00 82651-26 $17.00 82710 $42.00 82787-TC $37.00 82651-TC $25.00 82710-26 $13.00 82800 $22.00 82652 $89.00 82710-TC $29.00 82800-26 $6.00 82652-26 $25.00 82715 $33.00 82800-TC $16.00 82652-TC $62.00 82715-26 $11.00 82803 $53.00 82654 $37.00 82715-TC $21.00 82803-26 $16.00 82654-26 $11.00 82725 $28.00 82803-TC $37.00 82654-TC $25.00 82725-26 $8.00 82805 $36.00 82657 $42.00 82725-TC $19.00 82805-26 $10.00 82657-26 $13.00 82726 $42.00 82805-TC $24.00 82657-TC $28.00 82726-26 $13.00 82810 $28.00 82658 $42.00 82726-TC $28.00 82810-26 $8.00 82658-26 $13.00 82728 $24.00 82810-TC $19.00 82658-TC $28.00 82728-26 $7.00 82820 $16.00 82664 $40.00 82728-TC $17.00 82820-26 $5.00 82664-26 $13.00 82735 $36.00 82820-TC $11.00 82664-TC $26.00 82735-26 $12.00 82926 $20.00 82666 $58.00 82735-TC $23.00 82926-26 $5.00 82666-26 $17.00 82742 $42.00 82926-TC $15.00 82666-TC $41.00 82742-26 $13.00 82928 $12.00 82668 $45.00 82742-TC $29.00 82928-26 $4.00 82668-26 $14.00 82746 $39.00 82928-TC $7.00 82668-TC $32.00 82746-26 $13.00 82938 $48.00 82670 $61.00 82746-TC $25.00 82938-26 $16.00 82670-26 $18.00 82747 $29.00 82938-TC $32.00 82670-TC $42.00 82747-26 $10.00 82941 $47.00 82671 $61.00 82747-TC $19.00 82941-26 $15.00 82671-26 $17.00 82757 $36.00 82941-TC $32.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 82943 $38.00 82978-TC $18.00 83030-26 $6.00 82943-26 $12.00 82979 $18.00 83030-TC $12.00 82943-TC $25.00 82979-26 $5.00 83033 $15.00 82945 $9.00 82979-TC $13.00 83033-26 $4.00 82945-26 $3.00 82980 $15.00 83033-TC $11.00 82945-TC $5.00 82980-26 $3.00 83036 $15.00 82946 $29.00 82980-TC $11.00 83036-26 $5.00 82946-26 $7.00 82985 $41.00 83036-TC $10.00 82946-TC $21.00 82985-26 $12.00 83045 $13.00 82947 $11.00 82985-TC $29.00 83045-26 $4.00 82947-26 $3.00 83001 $40.00 83045-TC $8.00 82947-TC $7.00 83001-26 $12.00 83050 $16.00 82948 $5.00 83001-TC $28.00 83050-26 $5.00 82948-26 $3.00 83002 $42.00 83050-TC $11.00 82948-TC $3.00 83002-26 $13.00 83051 $16.00 82950 $12.00 83002-TC $29.00 83051-26 $5.00 82950-26 $4.00 83003 $36.00 83051-TC $11.00 82950-TC $7.00 83003-26 $10.00 83055 $13.00 82951 $22.00 83003-TC $25.00 83055-26 $4.00 82951-26 $7.00 83008 $34.00 83055-TC $8.00 82951-TC $15.00 83008-26 $10.00 83060 $22.00 82952 $11.00 83008-TC $23.00 83060-26 $6.00 82952-26 $3.00 83010 $26.00 83060-TC $16.00 82952-TC $7.00 83010-26 $8.00 83065 $18.00 82953 $41.00 83010-TC $18.00 83065-26 $6.00 82953-26 $14.00 83012 $36.00 83065-TC $12.00 82953-TC $26.00 83012-26 $14.00 83068 $20.00 82955 $25.00 83012-TC $21.00 83068-26 $5.00 82955-26 $7.00 83013 $133.00 83068-TC $15.00 82955-TC $18.00 83013-26 $38.00 83069 $11.00 82960 $14.00 83013-TC $94.00 83069-26 $3.00 82960-26 $4.00 83014 $19.00 83069-TC $7.00 82960-TC $10.00 83014-26 $6.00 83070 $13.00 82962 $5.00 83014-TC $13.00 83070-26 $4.00 82962-26 $1.00 83015 $51.00 83070-TC $8.00 82962-TC $4.00 83015-26 $15.00 83071 $18.00 82963 $54.00 83015-TC $36.00 83071-26 $5.00 82963-26 $17.00 83018 $56.00 83071-TC $13.00 82963-TC $37.00 83018-26 $16.00 83080 $38.00 82965 $16.00 83018-TC $40.00 83080-26 $11.00 82965-26 $5.00 83020 $24.00 83080-TC $26.00 82965-TC $11.00 83020-26 $6.00 83088 $59.00 82975 $28.00 83020-TC $18.00 83088-26 $18.00 82975-26 $8.00 83021 $39.00 83088-TC $41.00 82975-TC $19.00 83021-26 $13.00 83090 $38.00 82977 $16.00 83021-TC $25.00 83090-26 $13.00 82977-26 $4.00 83026 $8.00 83090-TC $25.00 82977-TC $12.00 83026-26 $5.00 83150 $49.00 82978 $25.00 83026-TC $3.00 83150-26 $16.00 82978-26 $7.00 83030 $18.00 83150-TC $33.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 83491 $37.00 83582-TC $24.00 83788-26 $13.00 83491-26 $11.00 83586 $38.00 83788-TC $25.00 83491-TC $25.00 83586-26 $13.00 83789 $39.00 83497 $35.00 83586-TC $24.00 83789-26 $13.00 83497-26 $11.00 83593 $59.00 83789-TC $25.00 83497-TC $23.00 83593-26 $18.00 83805 $44.00 83498 $62.00 83593-TC $41.00 83805-26 $15.00 83498-26 $20.00 83605 $19.00 83805-TC $29.00 83498-TC $41.00 83605-26 $6.00 83825 $34.00 83499 $51.00 83605-TC $13.00 83825-26 $11.00 83499-26 $15.00 83615 $16.00 83825-TC $22.00 83499-TC $36.00 83615-26 $5.00 83835 $41.00 83500 $69.00 83615-TC $11.00 83835-26 $12.00 83500-26 $21.00 83625 $23.00 83835-TC $29.00 83500-TC $45.00 83625-26 $6.00 83840 $42.00 83505 $77.00 83625-TC $17.00 83840-26 $14.00 83505-26 $21.00 83632 $42.00 83840-TC $28.00 83505-TC $54.00 83632-26 $14.00 83857 $26.00 83516 $26.00 83632-TC $28.00 83857-26 $8.00 83516-26 $8.00 83655 $31.00 83857-TC $18.00 83516-TC $18.00 83655-26 $8.00 83858 $37.00 83518 $21.00 83655-TC $21.00 83858-26 $12.00 83518-26 $7.00 83670 $18.00 83858-TC $24.00 83518-TC $14.00 83670-26 $5.00 83864 $32.00 83519 $21.00 83670-TC $13.00 83864-26 $8.00 83519-26 $7.00 83690 $18.00 83864-TC $22.00 83519-TC $14.00 83690-26 $6.00 83866 $26.00 83520 $20.00 83690-TC $12.00 83866-26 $7.00 83520-26 $6.00 83718 $16.00 83866-TC $19.00 83520-TC $14.00 83718-26 $5.00 83872 $13.00 83525 $31.00 83718-TC $11.00 83872-26 $4.00 83525-26 $8.00 83719 $42.00 83872-TC $8.00 83525-TC $21.00 83719-26 $14.00 83873 $54.00 83527 $35.00 83719-TC $28.00 83873-26 $18.00 83527-26 $11.00 83721 $16.00 83873-TC $36.00 83527-TC $23.00 83721-26 $5.00 83874 $25.00 83528 $43.00 83721-TC $11.00 83874-26 $8.00 83528-26 $14.00 83727 $43.00 83874-TC $17.00 83528-TC $29.00 83727-26 $14.00 83880 BR 83540 $16.00 83727-TC $29.00 83880-26 BR 83540-26 $3.00 83735 $15.00 83880-TC BR 83540-TC $13.00 83735-26 $5.00 83883 $11.00 83550 $20.00 83735-TC $10.00 83883-26 $3.00 83550-26 $5.00 83775 $17.00 83883-TC $7.00 83550-TC $15.00 83775-26 $5.00 83885 $45.00 83570 $23.00 83775-TC $12.00 83885-26 $14.00 83570-26 $7.00 83785 $58.00 83885-TC $32.00 83570-TC $16.00 83785-26 $17.00 83887 $58.00 83582 $34.00 83785-TC $41.00 83887-26 $17.00 83582-26 $8.00 83788 $39.00 83887-TC $41.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 83890 $7.00 83916-TC $36.00 84061-26 $4.00 83890-26 $2.00 83918 $41.00 84061-TC $10.00 83890-TC $5.00 83918-26 $12.00 84066 $18.00 83891 $7.00 83918-TC $29.00 84066-26 $6.00 83891-26 $2.00 83919 $42.00 84066-TC $12.00 83891-TC $5.00 83919-26 $12.00 84075 $12.00 83892 $7.00 83919-TC $29.00 84075-26 $3.00 83892-26 $2.00 83921 $37.00 84075-TC $8.00 83892-TC $5.00 83921-26 $12.00 84078 $19.00 83893 $7.00 83921-TC $25.00 84078-26 $5.00 83893-26 $2.00 83925 $13.00 84078-TC $14.00 83893-TC $5.00 83925-26 $3.00 84080 $36.00 83894 $7.00 83925-TC $9.00 84080-26 $11.00 83894-26 $2.00 83930 $11.00 84080-TC $24.00 83894-TC $5.00 83930-26 $3.00 84081 $45.00 83896 $7.00 83930-TC $7.00 84081-26 $15.00 83896-26 $2.00 83935 $17.00 84081-TC $31.00 83896-TC $5.00 83935-26 $5.00 84085 $15.00 83897 $9.00 83935-TC $12.00 84085-26 $5.00 83897-26 $3.00 83937 $29.00 84085-TC $10.00 83897-TC $5.00 83937-26 $10.00 84087 $25.00 83898 $43.00 83937-TC $19.00 84087-26 $7.00 83898-26 $14.00 83945 $32.00 84087-TC $18.00 83898-TC $29.00 83945-26 $11.00 84100 $11.00 83901 $44.00 83945-TC $20.00 84100-26 $3.00 83901-26 $14.00 83950 BR 84100-TC $7.00 83901-TC $29.00 83950-26 BR 84105 $11.00 83902 $38.00 83950-TC BR 84105-26 $3.00 83902-26 $13.00 83970 $94.00 84105-TC $7.00 83902-TC $24.00 83970-26 $31.00 84106 $10.00 83903 $44.00 83970-TC $62.00 84106-26 $2.00 83903-26 $14.00 83986 $8.00 84106-TC $7.00 83903-TC $29.00 83986-26 $3.00 84110 $21.00 83904 $44.00 83986-TC $5.00 84110-26 $6.00 83904-26 $14.00 83992 $40.00 84110-TC $15.00 83904-TC $29.00 83992-26 $12.00 84119 $21.00 83905 $44.00 83992-TC $28.00 84119-26 $6.00 83905-26 $14.00 84022 $41.00 84119-TC $15.00 83905-TC $29.00 84022-26 $13.00 84120 $38.00 83906 $44.00 84022-TC $28.00 84120-26 $11.00 83906-26 $14.00 84030 $11.00 84120-TC $26.00 83906-TC $29.00 84030-26 $3.00 84126 $71.00 83912 $39.00 84030-TC $7.00 84126-26 $20.00 83912-26 $11.00 84035 $12.00 84126-TC $49.00 83912-TC $28.00 84035-26 $3.00 84127 $18.00 83915 $31.00 84035-TC $8.00 84127-26 $6.00 83915-26 $10.00 84060 $20.00 84127-TC $12.00 83915-TC $20.00 84060-26 $6.00 84132 $11.00 83916 $54.00 84060-TC $14.00 84132-26 $3.00 83916-26 $18.00 84061 $14.00 84132-TC $7.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 84133 $11.00 84181-TC $19.00 84270-26 $11.00 84133-26 $3.00 84182 $33.00 84270-TC $24.00 84133-TC $7.00 84182-26 $11.00 84275 $37.00 84134 $24.00 84182-TC $21.00 84275-26 $11.00 84134-26 $7.00 84202 $39.00 84275-TC $25.00 84134-TC $17.00 84202-26 $13.00 84285 $59.00 84135 $57.00 84202-TC $25.00 84285-26 $17.00 84135-26 $19.00 84203 $16.00 84285-TC $42.00 84135-TC $38.00 84203-26 $5.00 84295 $10.00 84138 $56.00 84203-TC $11.00 84295-26 $3.00 84138-26 $18.00 84206 $32.00 84295-TC $6.00 84138-TC $38.00 84206-26 $10.00 84300 $10.00 84140 $41.00 84206-TC $21.00 84300-26 $3.00 84140-26 $8.00 84207 $54.00 84300-TC $6.00 84140-TC $33.00 84207-26 $16.00 84302 BR 84143 $62.00 84207-TC $38.00 84302-26 BR 84143-26 $20.00 84210 $24.00 84302-TC BR 84143-TC $41.00 84210-26 $10.00 84305 $34.00 84144 $38.00 84210-TC $15.00 84305-26 $11.00 84144-26 $7.00 84220 $25.00 84305-TC $22.00 84144-TC $31.00 84220-26 $8.00 84307 $26.00 84146 $53.00 84220-TC $17.00 84307-26 $8.00 84146-26 $17.00 84228 $32.00 84307-TC $18.00 84146-TC $36.00 84228-26 $10.00 84311 $11.00 84150 $69.00 84228-TC $21.00 84311-26 $3.00 84150-26 $20.00 84233 $116.00 84311-TC $7.00 84150-TC $47.00 84233-26 $35.00 84315 $5.00 84152 $42.00 84233-TC $81.00 84315-26 $2.00 84152-26 $14.00 84234 $116.00 84315-TC $3.00 84152-TC $27.00 84234-26 $35.00 84375 $37.00 84153 $33.00 84234-TC $81.00 84375-26 $11.00 84153-26 $11.00 84235 $114.00 84375-TC $25.00 84153-TC $21.00 84235-26 $34.00 84376 $10.00 84154 $33.00 84235-TC $80.00 84376-26 $3.00 84154-26 $11.00 84238 $97.00 84376-TC $7.00 84154-TC $21.00 84238-26 $32.00 84377 $10.00 84155 $12.00 84238-TC $65.00 84377-26 $3.00 84155-26 $4.00 84244 $47.00 84377-TC $7.00 84155-TC $7.00 84244-26 $15.00 84378 $25.00 84160 $5.00 84244-TC $32.00 84378-26 $8.00 84160-26 $2.00 84252 $47.00 84378-TC $17.00 84160-TC $2.00 84252-26 $14.00 84379 $25.00 84165 $24.00 84252-TC $33.00 84379-26 $8.00 84165-26 $8.00 84255 $58.00 84379-TC $17.00 84165-TC $16.00 84255-26 $17.00 84392 $8.00 84166 BR 84255-TC $41.00 84392-26 $2.00 84166-26 $20.00 84260 $54.00 84392-TC $6.00 84166-TC BR 84260-26 $16.00 84402 $72.00 84181 $29.00 84260-TC $38.00 84402-26 $21.00 84181-26 $10.00 84270 $36.00 84402-TC $49.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 84403 $67.00 84479-TC $10.00 84578-26 $2.00 84403-26 $19.00 84480 $20.00 84578-TC $5.00 84403-TC $45.00 84480-26 $6.00 84580 $17.00 84425 $54.00 84480-TC $14.00 84580-26 $5.00 84425-26 $17.00 84481 $33.00 84580-TC $12.00 84425-TC $37.00 84481-26 $10.00 84583 $11.00 84430 $31.00 84481-TC $22.00 84583-26 $3.00 84430-26 $10.00 84482 $45.00 84583-TC $7.00 84430-TC $20.00 84482-26 $15.00 84585 $36.00 84432 $28.00 84482-TC $31.00 84585-26 $11.00 84432-26 $8.00 84484 $21.00 84585-TC $24.00 84432-TC $19.00 84484-26 $6.00 84586 $42.00 84436 $14.00 84484-TC $15.00 84586-26 $14.00 84436-26 $3.00 84485 $15.00 84586-TC $27.00 84436-TC $11.00 84485-26 $4.00 84588 $73.00 84437 $13.00 84485-TC $11.00 84588-26 $23.00 84437-26 $4.00 84488 $15.00 84588-TC $47.00 84437-TC $8.00 84488-26 $4.00 84590 $33.00 84439 $16.00 84488-TC $11.00 84590-26 $11.00 84439-26 $4.00 84490 $15.00 84590-TC $21.00 84439-TC $12.00 84490-26 $4.00 84591 $26.00 84442 $25.00 84490-TC $11.00 84591-26 $9.00 84442-26 $6.00 84510 $26.00 84591-TC $18.00 84442-TC $19.00 84510-26 $8.00 84597 $37.00 84443 $32.00 84510-TC $18.00 84597-26 $11.00 84443-26 $7.00 84512 $17.00 84597-TC $25.00 84443-TC $23.00 84512-26 $5.00 84600 $43.00 84445 $98.00 84512-TC $12.00 84600-26 $13.00 84445-26 $29.00 84520 $12.00 84600-TC $31.00 84445-TC $69.00 84520-26 $3.00 84620 $29.00 84446 $35.00 84520-TC $8.00 84620-26 $8.00 84446-26 $11.00 84525 $7.00 84620-TC $20.00 84446-TC $23.00 84525-26 $2.00 84630 $26.00 84449 $38.00 84525-TC $5.00 84630-26 $8.00 84449-26 $13.00 84540 $13.00 84630-TC $18.00 84449-TC $24.00 84540-26 $4.00 84681 $52.00 84450 $11.00 84540-TC $8.00 84681-26 $17.00 84450-26 $3.00 84545 $18.00 84681-TC $35.00 84450-TC $7.00 84545-26 $5.00 84702 $38.00 84460 $13.00 84545-TC $13.00 84702-26 $11.00 84460-26 $4.00 84550 $12.00 84702-TC $26.00 84460-TC $8.00 84550-26 $4.00 84703 $22.00 84466 $22.00 84550-TC $7.00 84703-26 $6.00 84466-26 $7.00 84560 $12.00 84703-TC $15.00 84466-TC $15.00 84560-26 $3.00 84830 $17.00 84478 $12.00 84560-TC $8.00 84830-26 $5.00 84478-26 $3.00 84577 $34.00 84830-TC $12.00 84478-TC $8.00 84577-26 $11.00 84999 BR 84479 $15.00 84577-TC $22.00 84999-26 BR 84479-26 $5.00 84578 $7.00 84999-TC BR CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 85002 $10.00 85049-TC BR 85280-26 $14.00 85002-26 $3.00 85060 $25.00 85280-TC $35.00 85002-TC $6.00 85060-26 $7.00 85290 $44.00 85004 BR 85060-TC $18.00 85290-26 $13.00 85004-26 BR 85097 $59.00 85290-TC $32.00 85004-TC BR 85097-26 $59.00 85291 $20.00 85007 $6.00 85097-TC BR 85291-26 $6.00 85007-26 $3.00 85130 $19.00 85291-TC $14.00 85007-TC $4.00 85130-26 $6.00 85292 $51.00 85008 $5.00 85130-TC $13.00 85292-26 $17.00 85008-26 $2.00 85170 $7.00 85292-TC $34.00 85008-TC $3.00 85170-26 $2.00 85293 $51.00 85009 $8.00 85170-TC $5.00 85293-26 $17.00 85009-26 $3.00 85175 $10.00 85293-TC $34.00 85009-TC $5.00 85175-26 $3.00 85300 $35.00 85013 $3.00 85175-TC $6.00 85300-26 $12.00 85013-26 $1.00 85210 $31.00 85300-TC $23.00 85013-TC $2.00 85210-26 $8.00 85301 $29.00 85014 $4.00 85210-TC $21.00 85301-26 $10.00 85014-26 $1.00 85220 $47.00 85301-TC $19.00 85014-TC $3.00 85220-26 $15.00 85302 $33.00 85018 $5.00 85220-TC $32.00 85302-26 $11.00 85018-26 $2.00 85230 $47.00 85302-TC $21.00 85018-TC $3.00 85230-26 $14.00 85303 $26.00 85025 $20.00 85230-TC $33.00 85303-26 $8.00 85025-26 $6.00 85240 $48.00 85303-TC $18.00 85025-TC $14.00 85240-26 $15.00 85305 $21.00 85027 $15.00 85240-TC $33.00 85305-26 $7.00 85027-26 $5.00 85244 $49.00 85305-TC $14.00 85027-TC $10.00 85244-26 $15.00 85306 $29.00 85032 BR 85244-TC $34.00 85306-26 $10.00 85032-26 BR 85245 $54.00 85306-TC $19.00 85032-TC BR 85245-26 $18.00 85307 $35.00 85041 $7.00 85245-TC $36.00 85307-26 $12.00 85041-26 $3.00 85246 $54.00 85307-TC $23.00 85041-TC $4.00 85246-26 $18.00 85335 $21.00 85044 $10.00 85246-TC $36.00 85335-26 $7.00 85044-26 $3.00 85247 $54.00 85335-TC $14.00 85044-TC $6.00 85247-26 $18.00 85337 $19.00 85045 $6.00 85247-TC $36.00 85337-26 $6.00 85045-26 $2.00 85250 $49.00 85337-TC $13.00 85045-TC $4.00 85250-26 $14.00 85345 $10.00 85046 $13.00 85250-TC $35.00 85345-26 $2.00 85046-26 $4.00 85260 $49.00 85345-TC $7.00 85046-TC $9.00 85260-26 $14.00 85347 $8.00 85048 $7.00 85260-TC $35.00 85347-26 $2.00 85048-26 $3.00 85270 $49.00 85347-TC $6.00 85048-TC $4.00 85270-26 $14.00 85348 $10.00 85049 BR 85270-TC $35.00 85348-26 $3.00 85049-26 BR 85280 $49.00 85348-TC $6.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 85360 $16.00 85445-26 $5.00 85612 $22.00 85360-26 $4.00 85445-TC $11.00 85612-26 $6.00 85360-TC $12.00 85460 $15.00 85612-TC $16.00 85362 $18.00 85460-26 $4.00 85613 $15.00 85362-26 $7.00 85460-TC $11.00 85613-26 $4.00 85362-TC $11.00 85461 $12.00 85613-TC $11.00 85366 $13.00 85461-26 $3.00 85635 $26.00 85366-26 $3.00 85461-TC $8.00 85635-26 $8.00 85366-TC $10.00 85475 $15.00 85635-TC $18.00 85370 $20.00 85475-26 $4.00 85651 $8.00 85370-26 $5.00 85475-TC $11.00 85651-26 $2.00 85370-TC $15.00 85520 $22.00 85651-TC $6.00 85378 $13.00 85520-26 $6.00 85652 $8.00 85378-26 $4.00 85520-TC $16.00 85652-26 $2.00 85378-TC $8.00 85525 $20.00 85652-TC $6.00 85379 $18.00 85525-26 $6.00 85660 $10.00 85379-26 $6.00 85525-TC $14.00 85660-26 $3.00 85379-TC $12.00 85530 $39.00 85660-TC $6.00 85380 BR 85530-26 $12.00 85670 $13.00 85380-26 BR 85530-TC $26.00 85670-26 $3.00 85380-TC BR 85536 $14.00 85670-TC $10.00 85384 $11.00 85536-26 $4.00 85675 $13.00 85384-26 $3.00 85536-TC $10.00 85675-26 $4.00 85384-TC $7.00 85540 $24.00 85675-TC $8.00 85385 $16.00 85540-26 $7.00 85705 $13.00 85385-26 $5.00 85540-TC $17.00 85705-26 $4.00 85385-TC $11.00 85547 $23.00 85705-TC $8.00 85390 $10.00 85547-26 $6.00 85730 $11.00 85390-26 $2.00 85547-TC $17.00 85730-26 $3.00 85390-TC $7.00 85549 $45.00 85730-TC $7.00 85396 $22.00 85549-26 $15.00 85732 $17.00 85400 $12.00 85549-TC $31.00 85732-26 $5.00 85400-26 $3.00 85555 $17.00 85732-TC $12.00 85400-TC $8.00 85555-26 $5.00 85810 $19.00 85410 $12.00 85555-TC $12.00 85810-26 $4.00 85410-26 $3.00 85557 $34.00 85810-TC $15.00 85410-TC $8.00 85557-26 $10.00 85999 BR 85415 $28.00 85557-TC $23.00 85999-26 BR 85415-26 $10.00 85576 $21.00 85999-TC BR 85415-TC $18.00 85576-26 $5.00 86000 $16.00 85420 $16.00 85576-TC $16.00 86000-26 $5.00 85420-26 $3.00 85597 $32.00 86000-TC $11.00 85420-TC $13.00 85597-26 $10.00 86001 $12.00 85421 $39.00 85597-TC $21.00 86001-26 $4.00 85421-26 $12.00 85610 $6.00 86001-TC $8.00 85421-TC $26.00 85610-26 $3.00 86003 $6.00 85441 $7.00 85610-TC $4.00 86003-26 $2.00 85441-26 $2.00 85611 $6.00 86003-TC $3.00 85441-TC $5.00 85611-26 $2.00 86005 $11.00 85445 $16.00 85611-TC $4.00 86005-26 $4.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 86005-TC $6.00 86156-26 $3.00 86300 $47.00 86021 $41.00 86156-TC $7.00 86300-26 $15.00 86021-26 $12.00 86157 $13.00 86300-TC $32.00 86021-TC $29.00 86157-26 $4.00 86301 $47.00 86022 $57.00 86157-TC $8.00 86301-26 $15.00 86022-26 $18.00 86160 $21.00 86301-TC $32.00 86022-TC $39.00 86160-26 $5.00 86304 $47.00 86023 $28.00 86160-TC $16.00 86304-26 $15.00 86023-26 $10.00 86161 $21.00 86304-TC $32.00 86023-TC $18.00 86161-26 $5.00 86308 $8.00 86038 $22.00 86161-TC $16.00 86308-26 $3.00 86038-26 $7.00 86162 $54.00 86308-TC $5.00 86038-TC $15.00 86162-26 $18.00 86309 $12.00 86039 $19.00 86162-TC $36.00 86309-26 $3.00 86039-26 $6.00 86171 $25.00 86309-TC $8.00 86039-TC $13.00 86171-26 $7.00 86310 $19.00 86060 $13.00 86171-TC $18.00 86310-26 $6.00 86060-26 $3.00 86185 $19.00 86310-TC $13.00 86060-TC $10.00 86185-26 $6.00 86316 $37.00 86063 $21.00 86185-TC $13.00 86316-26 $11.00 86063-26 $6.00 86215 $36.00 86316-TC $25.00 86063-TC $15.00 86215-26 $12.00 86317 $31.00 86077 $91.00 86215-TC $23.00 86317-26 $10.00 86077-26 $26.00 86225 $36.00 86317-TC $20.00 86077-TC $64.00 86225-26 $11.00 86318 $23.00 86078 $91.00 86225-TC $24.00 86318-26 $10.00 86078-26 $26.00 86226 $24.00 86318-TC $14.00 86078-TC $64.00 86226-26 $8.00 86320 $49.00 86079 $79.00 86226-TC $16.00 86320-26 $19.00 86079-26 $25.00 86235 $33.00 86320-TC $29.00 86079-TC $52.00 86235-26 $10.00 86325 $49.00 86140 $14.00 86235-TC $22.00 86325-26 $16.00 86140-26 $4.00 86243 $50.00 86325-TC $33.00 86140-TC $10.00 86243-26 $15.00 86327 $62.00 86141 BR 86243-TC $35.00 86327-26 $19.00 86141-26 BR 86255 $25.00 86327-TC $42.00 86141-TC BR 86255-26 $8.00 86329 $37.00 86146 $58.00 86255-TC $17.00 86329-26 $12.00 86146-26 $19.00 86256 $25.00 86329-TC $24.00 86146-TC $39.00 86256-26 $8.00 86331 $22.00 86147 $53.00 86256-TC $17.00 86331-26 $6.00 86147-26 $16.00 86277 $41.00 86331-TC $15.00 86147-TC $36.00 86277-26 $14.00 86332 $54.00 86148 $59.00 86277-TC $26.00 86332-26 $18.00 86148-26 $21.00 86280 $15.00 86332-TC $36.00 86148-TC $38.00 86280-26 $3.00 86334 $65.00 86155 $26.00 86280-TC $12.00 86334-26 $18.00 86155-26 $8.00 86294 BR 86334-TC $45.00 86155-TC $18.00 86294-26 BR 86335 BR 86156 $11.00 86294-TC BR 86335-26 $20.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 86335-TC BR 86430-26 $4.00 86617-TC $19.00 86336 BR 86430-TC $8.00 86618 $26.00 86336-26 BR 86431 $17.00 86618-26 $8.00 86336-TC BR 86431-26 $6.00 86618-TC $18.00 86337 $54.00 86431-TC $11.00 86619 $21.00 86337-26 $18.00 86485 $13.00 86619-26 $6.00 86337-TC $36.00 86485-26 $4.00 86619-TC $15.00 86340 $39.00 86485-TC $8.00 86622 $16.00 86340-26 $13.00 86486 $6.00 86622-26 $5.00 86340-TC $25.00 86490 $17.00 86622-TC $11.00 86341 $38.00 86490-26 $5.00 86625 $21.00 86341-26 $13.00 86490-TC $12.00 86625-26 $6.00 86341-TC $24.00 86510 $13.00 86625-TC $15.00 86343 $33.00 86510-26 $4.00 86628 $20.00 86343-26 $11.00 86510-TC $8.00 86628-26 $6.00 86343-TC $21.00 86580 $13.00 86628-TC $14.00 86344 $21.00 86580-26 $4.00 86631 $20.00 86344-26 $7.00 86580-TC $8.00 86631-26 $6.00 86344-TC $14.00 86590 $18.00 86631-TC $14.00 86353 $102.00 86590-26 $6.00 86632 $20.00 86353-26 $31.00 86590-TC $12.00 86632-26 $6.00 86353-TC $72.00 86592 $8.00 86632-TC $14.00 86359 $61.00 86592-26 $2.00 86635 $18.00 86359-26 $19.00 86592-TC $6.00 86635-26 $5.00 86359-TC $41.00 86593 $11.00 86635-TC $13.00 86360 $99.00 86593-26 $3.00 86638 $20.00 86360-26 $33.00 86593-TC $7.00 86638-26 $6.00 86360-TC $67.00 86602 $17.00 86638-TC $14.00 86361 $66.00 86602-26 $5.00 86641 $21.00 86361-26 $21.00 86602-TC $12.00 86641-26 $7.00 86361-TC $43.00 86603 $20.00 86641-TC $14.00 86376 $35.00 86603-26 $6.00 86644 $22.00 86376-26 $11.00 86603-TC $14.00 86644-26 $7.00 86376-TC $23.00 86606 $24.00 86644-TC $15.00 86378 $45.00 86606-26 $8.00 86645 $28.00 86378-26 $15.00 86606-TC $16.00 86645-26 $10.00 86378-TC $31.00 86609 $20.00 86645-TC $18.00 86382 $45.00 86609-26 $6.00 86648 $24.00 86382-26 $14.00 86609-TC $14.00 86648-26 $8.00 86382-TC $32.00 86611 $23.00 86648-TC $16.00 86384 $24.00 86611-26 $8.00 86651 $21.00 86384-26 $8.00 86611-TC $15.00 86651-26 $7.00 86384-TC $16.00 86612 $21.00 86651-TC $14.00 86403 $18.00 86612-26 $6.00 86652 $21.00 86403-26 $3.00 86612-TC $15.00 86652-26 $7.00 86403-TC $14.00 86615 $21.00 86652-TC $14.00 86406 $21.00 86615-26 $6.00 86653 $21.00 86406-26 $5.00 86615-TC $15.00 86653-26 $7.00 86406-TC $16.00 86617 $29.00 86653-TC $14.00 86430 $13.00 86617-26 $10.00 86654 $21.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 86654-26 $7.00 86695 $21.00 86723-TC $14.00 86654-TC $14.00 86695-26 $7.00 86727 $20.00 86658 $21.00 86695-TC $14.00 86727-26 $6.00 86658-26 $7.00 86696 $44.00 86727-TC $14.00 86658-TC $14.00 86696-26 $14.00 86729 $19.00 86663 $21.00 86696-TC $30.00 86729-26 $6.00 86663-26 $7.00 86698 $20.00 86729-TC $13.00 86663-TC $14.00 86698-26 $6.00 86732 $21.00 86664 $53.00 86698-TC $14.00 86732-26 $7.00 86664-26 $17.00 86701 $21.00 86732-TC $14.00 86664-TC $36.00 86701-26 $7.00 86735 $21.00 86665 $29.00 86701-TC $15.00 86735-26 $7.00 86665-26 $10.00 86702 $21.00 86735-TC $14.00 86665-TC $19.00 86702-26 $7.00 86738 $21.00 86666 $23.00 86702-TC $14.00 86738-26 $7.00 86666-26 $8.00 86703 $22.00 86738-TC $14.00 86666-TC $15.00 86703-26 $7.00 86741 $21.00 86668 $17.00 86703-TC $15.00 86741-26 $7.00 86668-26 $5.00 86704 $33.00 86741-TC $14.00 86668-TC $12.00 86704-26 $11.00 86744 $21.00 86671 $20.00 86704-TC $21.00 86744-26 $7.00 86671-26 $6.00 86705 $35.00 86744-TC $14.00 86671-TC $14.00 86705-26 $11.00 86747 $23.00 86674 $23.00 86705-TC $23.00 86747-26 $7.00 86674-26 $7.00 86706 $24.00 86747-TC $16.00 86674-TC $16.00 86706-26 $8.00 86750 $21.00 86677 $24.00 86706-TC $16.00 86750-26 $7.00 86677-26 $8.00 86707 $26.00 86750-TC $14.00 86677-TC $16.00 86707-26 $8.00 86753 $20.00 86682 $21.00 86707-TC $18.00 86753-26 $6.00 86682-26 $7.00 86708 $32.00 86753-TC $14.00 86682-TC $14.00 86708-26 $10.00 86756 $20.00 86684 $24.00 86708-TC $21.00 86756-26 $6.00 86684-26 $8.00 86709 $29.00 86756-TC $14.00 86684-TC $16.00 86709-26 $10.00 86757 $44.00 86687 $22.00 86709-TC $19.00 86757-26 $14.00 86687-26 $7.00 86710 $22.00 86757-TC $30.00 86687-TC $16.00 86710-26 $7.00 86759 $21.00 86688 $20.00 86710-TC $15.00 86759-26 $7.00 86688-26 $7.00 86713 $23.00 86759-TC $14.00 86688-TC $14.00 86713-26 $7.00 86762 $22.00 86689 $25.00 86713-TC $16.00 86762-26 $7.00 86689-26 $8.00 86717 $20.00 86762-TC $15.00 86689-TC $17.00 86717-26 $6.00 86765 $20.00 86692 $22.00 86717-TC $14.00 86765-26 $6.00 86692-26 $7.00 86720 $21.00 86765-TC $14.00 86692-TC $15.00 86720-26 $7.00 86768 $21.00 86694 $22.00 86720-TC $14.00 86768-26 $7.00 86694-26 $7.00 86723 $21.00 86768-TC $14.00 86694-TC $15.00 86723-26 $7.00 86771 $21.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 86771-26 $7.00 86813 $101.00 86903-TC $10.00 86771-TC $14.00 86813-26 $29.00 86904 $19.00 86774 $23.00 86813-TC $71.00 86904-26 $6.00 86774-26 $7.00 86816 $64.00 86904-TC $13.00 86774-TC $16.00 86816-26 $18.00 86905 $7.00 86777 $22.00 86816-TC $44.00 86905-26 $1.00 86777-26 $7.00 86817 $134.00 86905-TC $6.00 86777-TC $15.00 86817-26 $39.00 86906 $11.00 86778 $23.00 86817-TC $94.00 86906-26 $3.00 86778-26 $7.00 86821 $123.00 86906-TC $7.00 86778-TC $16.00 86821-26 $36.00 86910 $83.00 86781 $22.00 86821-TC $86.00 86910-26 $24.00 86781-26 $7.00 86822 $96.00 86910-TC $57.00 86781-TC $15.00 86822-26 $32.00 86911 $19.00 86784 $21.00 86822-TC $64.00 86911-26 $6.00 86784-26 $7.00 86849 BR 86911-TC $13.00 86784-TC $14.00 86849-26 BR 86920 $19.00 86787 $20.00 86849-TC BR 86920-26 $3.00 86787-26 $6.00 86850 $10.00 86920-TC $15.00 86787-TC $14.00 86850-26 $3.00 86921 $23.00 86790 $21.00 86850-TC $6.00 86921-26 $7.00 86790-26 $7.00 86860 $44.00 86921-TC $16.00 86790-TC $14.00 86860-26 $15.00 86922 $20.00 86793 $21.00 86860-TC $29.00 86922-26 $6.00 86793-26 $7.00 86870 $17.00 86922-TC $14.00 86793-TC $14.00 86870-26 $6.00 86927 $21.00 86800 $26.00 86870-TC $11.00 86927-26 $5.00 86800-26 $8.00 86880 $13.00 86927-TC $16.00 86800-TC $18.00 86880-26 $4.00 86930 $155.00 86803 $24.00 86880-TC $8.00 86930-26 $45.00 86803-26 $8.00 86885 $15.00 86930-TC $108.00 86803-TC $16.00 86885-26 $4.00 86931 $155.00 86804 $26.00 86885-TC $11.00 86931-26 $45.00 86804-26 $8.00 86886 $14.00 86931-TC $108.00 86804-TC $18.00 86886-26 $4.00 86932 $161.00 86805 $97.00 86886-TC $10.00 86932-26 $48.00 86805-26 $33.00 86890 $67.00 86932-TC $111.00 86805-TC $64.00 86890-26 $11.00 86940 $18.00 86806 $87.00 86890-TC $54.00 86940-26 $5.00 86806-26 $28.00 86891 $91.00 86940-TC $13.00 86806-TC $57.00 86891-26 $26.00 86941 $31.00 86807 $74.00 86891-TC $64.00 86941-26 $8.00 86807-26 $21.00 86900 $10.00 86941-TC $21.00 86807-TC $51.00 86900-26 $3.00 86945 $35.00 86808 $52.00 86900-TC $6.00 86945-26 $11.00 86808-26 $15.00 86901 $10.00 86945-TC $23.00 86808-TC $37.00 86901-26 $3.00 86950 $99.00 86812 $108.00 86901-TC $6.00 86950-26 $29.00 86812-26 $32.00 86903 $15.00 86950-TC $70.00 86812-TC $75.00 86903-26 $5.00 86965 $25.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 86965-26 $7.00 87071 $11.00 87116-TC $11.00 86965-TC $18.00 87071-26 $3.00 87118 $28.00 86970 $41.00 87071-TC $8.00 87118-26 $9.00 86970-26 $12.00 87073 $11.00 87118-TC $20.00 86970-TC $29.00 87073-26 $3.00 87140 $24.00 86971 $20.00 87073-TC $8.00 87140-26 $7.00 86971-26 $5.00 87075 $18.00 87140-TC $17.00 86971-TC $15.00 87075-26 $6.00 87143 $34.00 86972 $20.00 87075-TC $12.00 87143-26 $11.00 86972-26 $6.00 87076 $24.00 87143-TC $22.00 86972-TC $14.00 87076-26 $8.00 87147 $26.00 86975 $53.00 87076-TC $16.00 87147-26 $8.00 86975-26 $16.00 87077 $16.00 87147-TC $18.00 86975-TC $37.00 87077-26 $5.00 87149 $46.00 86976 $53.00 87077-TC $11.00 87149-26 $15.00 86976-26 $16.00 87081 $12.00 87149-TC $31.00 86976-TC $37.00 87081-26 $3.00 87152 $12.00 86977 $53.00 87081-TC $8.00 87152-26 $4.00 86977-26 $16.00 87084 $23.00 87152-TC $8.00 86977-TC $37.00 87084-26 $7.00 87158 $5.00 86978 $65.00 87084-TC $16.00 87158-26 $1.00 86978-26 $19.00 87086 $14.00 87158-TC $3.00 86978-TC $44.00 87086-26 $3.00 87164 $24.00 86985 $35.00 87086-TC $11.00 87164-26 $8.00 86985-26 $12.00 87088 $18.00 87164-TC $16.00 86985-TC $23.00 87088-26 $6.00 87166 $24.00 86999 BR 87088-TC $12.00 87166-26 $7.00 86999-26 BR 87101 $20.00 87166-TC $17.00 86999-TC BR 87101-26 $6.00 87168 $10.00 87001 $35.00 87101-TC $14.00 87168-26 $3.00 87001-26 $11.00 87102 $20.00 87168-TC $7.00 87001-TC $23.00 87102-26 $6.00 87169 $10.00 87003 $40.00 87102-TC $14.00 87169-26 $3.00 87003-26 $13.00 87103 $32.00 87169-TC $7.00 87003-TC $26.00 87103-26 $11.00 87172 $10.00 87015 $14.00 87103-TC $20.00 87172-26 $3.00 87015-26 $5.00 87106 $25.00 87172-TC $7.00 87015-TC $9.00 87106-26 $7.00 87176 $16.00 87040 $18.00 87106-TC $18.00 87176-26 $5.00 87040-26 $6.00 87107 $23.00 87176-TC $11.00 87040-TC $12.00 87107-26 $8.00 87177 $18.00 87045 $18.00 87107-TC $15.00 87177-26 $6.00 87045-26 $6.00 87109 $26.00 87177-TC $12.00 87045-TC $11.00 87109-26 $8.00 87181 $13.00 87046 $5.00 87109-TC $18.00 87181-26 $3.00 87046-26 $2.00 87110 $23.00 87181-TC $8.00 87046-TC $3.00 87110-26 $7.00 87184 $13.00 87070 $14.00 87110-TC $15.00 87184-26 $3.00 87070-26 $4.00 87116 $15.00 87184-TC $10.00 87070-TC $10.00 87116-26 $3.00 87185 $11.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 87185-26 $3.00 87260 $26.00 87285-TC $18.00 87185-TC $8.00 87260-26 $8.00 87290 $26.00 87186 $16.00 87260-TC $18.00 87290-26 $8.00 87186-26 $4.00 87265 $26.00 87290-TC $18.00 87186-TC $12.00 87265-26 $8.00 87299 $26.00 87187 $20.00 87265-TC $18.00 87299-26 $8.00 87187-26 $3.00 87267 BR 87299-TC $18.00 87187-TC $17.00 87267-26 BR 87300 $13.00 87188 $18.00 87267-TC BR 87300-26 $4.00 87188-26 $5.00 87270 $26.00 87300-TC $9.00 87188-TC $13.00 87270-26 $8.00 87301 $26.00 87190 $7.00 87270-TC $18.00 87301-26 $8.00 87190-26 $2.00 87271 BR 87301-TC $18.00 87190-TC $5.00 87271-26 BR 87320 $26.00 87197 $29.00 87271-TC BR 87320-26 $8.00 87197-26 $10.00 87272 $26.00 87320-TC $18.00 87197-TC $19.00 87272-26 $8.00 87324 $26.00 87205 $11.00 87272-TC $18.00 87324-26 $8.00 87205-26 $3.00 87273 $27.00 87324-TC $18.00 87205-TC $7.00 87273-26 $9.00 87327 $27.00 87206 $15.00 87273-TC $19.00 87327-26 $9.00 87206-26 $3.00 87274 $26.00 87327-TC $19.00 87206-TC $12.00 87274-26 $8.00 87328 $26.00 87207 $10.00 87274-TC $18.00 87328-26 $8.00 87207-26 $3.00 87275 $27.00 87328-TC $18.00 87207-TC $6.00 87275-26 $9.00 87332 $26.00 87210 $8.00 87275-TC $19.00 87332-26 $8.00 87210-26 $2.00 87276 $26.00 87332-TC $18.00 87210-TC $6.00 87276-26 $8.00 87335 $26.00 87220 $12.00 87276-TC $18.00 87335-26 $8.00 87220-26 $4.00 87277 $27.00 87335-TC $18.00 87220-TC $7.00 87277-26 $9.00 87336 $27.00 87230 $35.00 87277-TC $19.00 87336-26 $9.00 87230-26 $11.00 87278 $26.00 87336-TC $19.00 87230-TC $23.00 87278-26 $8.00 87337 $27.00 87250 $33.00 87278-TC $18.00 87337-26 $9.00 87250-26 $13.00 87279 $27.00 87337-TC $19.00 87250-TC $19.00 87279-26 $9.00 87338 $27.00 87252 $44.00 87279-TC $19.00 87338-26 $7.00 87252-26 $14.00 87280 $26.00 87338-TC $20.00 87252-TC $31.00 87280-26 $8.00 87339 $27.00 87253 $33.00 87280-TC $18.00 87339-26 $9.00 87253-26 $10.00 87281 $27.00 87339-TC $19.00 87253-TC $22.00 87281-26 $9.00 87340 $20.00 87254 $11.00 87281-TC $19.00 87340-26 $6.00 87254-26 $3.00 87283 $27.00 87340-TC $14.00 87254-TC $8.00 87283-26 $9.00 87341 $23.00 87255 BR 87283-TC $19.00 87341-26 $8.00 87255-26 BR 87285 $26.00 87341-TC $15.00 87255-TC BR 87285-26 $8.00 87350 $20.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 87350-26 $6.00 87476 $73.00 87512-TC $56.00 87350-TC $14.00 87476-26 $23.00 87515 $42.00 87380 $35.00 87476-TC $48.00 87515-26 $13.00 87380-26 $11.00 87477 $88.00 87515-TC $28.00 87380-TC $23.00 87477-26 $28.00 87516 $73.00 87385 $26.00 87477-TC $58.00 87516-26 $23.00 87385-26 $8.00 87480 $42.00 87516-TC $48.00 87385-TC $18.00 87480-26 $13.00 87517 $88.00 87390 $38.00 87480-TC $28.00 87517-26 $28.00 87390-26 $13.00 87481 $73.00 87517-TC $58.00 87390-TC $24.00 87481-26 $23.00 87520 $42.00 87391 $38.00 87481-TC $48.00 87520-26 $13.00 87391-26 $13.00 87482 $86.00 87520-TC $28.00 87391-TC $24.00 87482-26 $28.00 87521 $73.00 87400 $13.00 87482-TC $56.00 87521-26 $23.00 87400-26 $4.00 87485 $42.00 87521-TC $48.00 87400-TC $9.00 87485-26 $13.00 87522 $88.00 87420 $26.00 87485-TC $28.00 87522-26 $28.00 87420-26 $8.00 87486 $73.00 87522-TC $58.00 87420-TC $18.00 87486-26 $23.00 87525 $42.00 87425 $26.00 87486-TC $48.00 87525-26 $13.00 87425-26 $8.00 87487 $88.00 87525-TC $28.00 87425-TC $18.00 87487-26 $28.00 87526 $73.00 87427 $27.00 87487-TC $58.00 87526-26 $23.00 87427-26 $9.00 87490 $42.00 87526-TC $48.00 87427-TC $19.00 87490-26 $13.00 87527 $86.00 87430 $26.00 87490-TC $28.00 87527-26 $28.00 87430-26 $8.00 87491 $73.00 87527-TC $56.00 87430-TC $18.00 87491-26 $23.00 87528 $42.00 87449 $26.00 87491-TC $48.00 87528-26 $13.00 87449-26 $8.00 87492 $73.00 87528-TC $28.00 87449-TC $18.00 87492-26 $23.00 87529 $73.00 87450 $21.00 87492-TC $48.00 87529-26 $23.00 87450-26 $6.00 87495 $42.00 87529-TC $48.00 87450-TC $15.00 87495-26 $13.00 87530 $88.00 87451 $19.00 87495-TC $28.00 87530-26 $28.00 87451-26 $7.00 87496 $73.00 87530-TC $58.00 87451-TC $12.00 87496-26 $23.00 87531 $42.00 87470 $42.00 87496-TC $48.00 87531-26 $13.00 87470-26 $13.00 87497 $88.00 87531-TC $28.00 87470-TC $28.00 87497-26 $28.00 87532 $73.00 87471 $73.00 87497-TC $58.00 87532-26 $23.00 87471-26 $23.00 87510 $42.00 87532-TC $48.00 87471-TC $48.00 87510-26 $13.00 87533 $86.00 87472 $88.00 87510-TC $28.00 87533-26 $28.00 87472-26 $28.00 87511 $73.00 87533-TC $56.00 87472-TC $58.00 87511-26 $23.00 87534 $42.00 87475 $40.00 87511-TC $48.00 87534-26 $13.00 87475-26 $13.00 87512 $86.00 87534-TC $28.00 87475-TC $26.00 87512-26 $28.00 87535 $73.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 87535-26 $23.00 87580 $42.00 87801-TC $54.00 87535-TC $48.00 87580-26 $13.00 87802 BR 87536 $86.00 87580-TC $28.00 87802-26 BR 87536-26 $28.00 87581 $73.00 87802-TC BR 87536-TC $56.00 87581-26 $23.00 87803 BR 87537 $42.00 87581-TC $48.00 87803-26 BR 87537-26 $13.00 87582 $86.00 87803-TC BR 87537-TC $28.00 87582-26 $28.00 87804 BR 87538 $73.00 87582-TC $56.00 87804-26 BR 87538-26 $23.00 87590 $42.00 87804-TC BR 87538-TC $48.00 87590-26 $13.00 87810 $26.00 87539 $88.00 87590-TC $28.00 87810-26 $8.00 87539-26 $28.00 87591 $73.00 87810-TC $18.00 87539-TC $58.00 87591-26 $23.00 87850 $26.00 87540 $42.00 87591-TC $48.00 87850-26 $8.00 87540-26 $13.00 87592 $88.00 87850-TC $18.00 87540-TC $28.00 87592-26 $28.00 87880 $26.00 87541 $73.00 87592-TC $58.00 87880-26 $8.00 87541-26 $23.00 87620 $42.00 87880-TC $18.00 87541-TC $48.00 87620-26 $13.00 87899 $26.00 87542 $86.00 87620-TC $28.00 87899-26 $8.00 87542-26 $28.00 87621 $73.00 87899-TC $18.00 87542-TC $56.00 87621-26 $23.00 87901 $594.00 87550 $42.00 87621-TC $48.00 87901-26 $196.00 87550-26 $13.00 87622 $86.00 87901-TC $398.00 87550-TC $28.00 87622-26 $28.00 87902 BR 87551 $73.00 87622-TC $56.00 87902-26 BR 87551-26 $23.00 87650 $42.00 87902-TC BR 87551-TC $48.00 87650-26 $13.00 87903 $1,126.00 87552 $88.00 87650-TC $28.00 87903-26 $371.00 87552-26 $28.00 87651 $73.00 87903-TC $755.00 87552-TC $58.00 87651-26 $23.00 87904 $59.00 87555 $42.00 87651-TC $48.00 87904-26 $20.00 87555-26 $13.00 87652 $86.00 87904-TC $39.00 87555-TC $28.00 87652-26 $28.00 87999 BR 87556 $73.00 87652-TC $56.00 87999-26 BR 87556-26 $23.00 87797 $42.00 87999-TC BR 87556-TC $48.00 87797-26 $13.00 88000 $445.00 87557 $88.00 87797-TC $28.00 88000-26 $445.00 87557-26 $28.00 87798 $73.00 88000-TC BR 87557-TC $58.00 87798-26 $23.00 88005 $500.00 87560 $42.00 87798-TC $48.00 88005-26 $500.00 87560-26 $13.00 87799 $88.00 88005-TC BR 87560-TC $28.00 87799-26 $28.00 88007 $556.00 87561 $73.00 87799-TC $58.00 88007-26 $556.00 87561-26 $23.00 87800 $46.00 88007-TC BR 87561-TC $48.00 87800-26 $15.00 88020 $556.00 87562 $88.00 87800-TC $31.00 88020-26 $556.00 87562-26 $28.00 87801 $81.00 88020-TC BR 87562-TC $58.00 87801-26 $26.00 88025 $610.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 88025-26 $610.00 88143 $94.00 88173-TC $26.00 88025-TC BR 88143-26 $33.00 88174 BR 88027 $666.00 88143-TC $59.00 88174-26 BR 88027-26 $666.00 88147 $82.00 88174-TC BR 88027-TC BR 88147-26 BR 88175 BR 88036 $477.00 88147-TC $82.00 88175-26 BR 88036-26 $477.00 88148 $104.00 88175-TC BR 88036-TC BR 88148-26 $21.00 88182 $88.00 88037 $389.00 88148-TC $82.00 88182-26 $33.00 88037-26 $389.00 88150 $13.00 88182-TC $54.00 88037-TC BR 88150-26 $3.00 88184 $51.00 88040 $1,445.00 88150-TC $9.00 88185 $25.00 88040-26 $1,445.00 88152 $46.00 88187 $69.00 88040-TC BR 88152-26 $8.00 88188 $86.00 88045 BR 88152-TC $38.00 88189 $113.00 88045-26 BR 88153 $82.00 88199 BR 88045-TC BR 88153-26 $21.00 88199-26 BR 88099 BR 88153-TC $59.00 88199-TC BR 88099-26 BR 88154 $104.00 88233 $243.00 88099-TC BR 88154-26 $21.00 88233-26 $73.00 88104 $49.00 88154-TC $82.00 88233-TC $170.00 88104-26 $37.00 88155 $14.00 88235 $256.00 88104-TC $10.00 88155-26 $3.00 88235-26 $76.00 88106 $54.00 88155-TC $10.00 88235-TC $177.00 88106-26 $16.00 88160 $45.00 88240 $21.00 88106-TC $38.00 88160-26 $14.00 88240-26 $6.00 88107 $74.00 88160-TC $24.00 88240-TC $15.00 88107-26 $57.00 88161 $64.00 88241 $21.00 88107-TC $15.00 88161-26 $19.00 88241-26 $6.00 88108 $59.00 88161-TC $37.00 88241-TC $15.00 88108-26 $47.00 88162 $77.00 88300 $24.00 88108-TC $11.00 88162-26 $22.00 88300-26 $19.00 88112 $121.00 88162-TC $53.00 88300-TC $5.00 88112-26 $65.00 88164 $54.00 88302 $53.00 88112-TC $56.00 88164-26 $21.00 88302-26 $42.00 88125 $70.00 88164-TC $33.00 88302-TC $11.00 88125-26 $20.00 88165 $72.00 88304 $70.00 88125-TC $48.00 88165-26 $33.00 88304-26 $54.00 88130 $25.00 88165-TC $38.00 88304-TC $14.00 88130-26 $7.00 88166 $82.00 88305 $108.00 88130-TC $18.00 88166-26 $21.00 88305-26 $86.00 88140 $18.00 88166-TC $59.00 88305-TC $21.00 88140-26 $5.00 88167 $87.00 88307 $210.00 88140-TC $13.00 88167-26 $26.00 88307-26 $168.00 88141 $33.00 88167-TC $59.00 88307-TC $41.00 88141-26 BR 88172 $70.00 88309 $322.00 88141-TC BR 88172-26 $54.00 88309-26 $258.00 88142 $82.00 88172-TC $14.00 88309-TC $64.00 88142-26 $21.00 88173 $95.00 88311 $23.00 88142-TC $59.00 88173-26 $95.00 88311-26 $19.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 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 88311-TC $4.00 88348-26 $145.00 88399 BR 88312 $23.00 88348-TC $44.00 88399-26 BR 88312-26 $7.00 88349 $191.00 88399-TC BR 88312-TC $16.00 88349-26 $145.00 89049 $190.00 88313 $23.00 88349-TC $44.00 89050 $10.00 88313-26 $7.00 88355 $108.00 89050-26 $3.00 88313-TC $16.00 88355-26 $80.00 89050-TC $6.00 88314 $21.00 88355-TC $26.00 89051 $13.00 88314-26 $6.00 88356 $108.00 89051-26 $4.00 88314-TC $15.00 88356-26 $80.00 89051-TC $8.00 88318 $33.00 88356-TC $26.00 89055 BR 88318-26 $14.00 88358 $108.00 89055-26 BR 88318-TC $18.00 88358-26 $80.00 89055-TC BR 88319 $26.00 88358-TC $26.00 89060 $13.00 88319-26 $13.00 88360 $110.00 89060-26 $5.00 88319-TC $14.00 88360-26 $62.00 89060-TC $8.00 88321 $43.00 88360-TC $49.00 89100 $51.00 88321-26 $43.00 88361 $139.00 89100-26 $15.00 88321-TC BR 88361-26 $55.00 89100-TC $36.00 88323 $61.00 88361-TC $84.00 89105 $65.00 88323-26 $61.00 88362 $251.00 89105-26 $19.00 88323-TC $32.00 88362-26 $119.00 89105-TC $44.00 88325 $54.00 88362-TC $132.00 89125 $14.00 88325-26 $54.00 88365 $24.00 89125-26 $4.00 88325-TC BR 88365-26 $24.00 89125-TC $10.00 88329 $51.00 88365-TC $68.00 89130 $44.00 88329-26 $51.00 88367 $210.00 89130-26 $13.00 88329-TC BR 88367-26 $72.00 89130-TC $32.00 88331 $102.00 88367-TC $138.00 89132 $20.00 88331-26 $70.00 88368 $190.00 89132-26 $6.00 88331-TC $33.00 88368-26 $78.00 89132-TC $14.00 88332 $53.00 88368-TC $112.00 89135 $37.00 88332-26 $36.00 88371 $34.00 89135-26 $11.00 88332-TC $17.00 88371-26 $10.00 89135-TC $25.00 88333 $89.00 88371-TC $23.00 89136 $43.00 88333-26 $67.00 88372 $38.00 89136-26 $14.00 88333-TC $22.00 88372-26 $11.00 89136-TC $29.00 88334 $47.00 88372-TC $26.00 89140 $50.00 88334-26 $33.00 88380 $159.00 89140-26 $16.00 88334-TC $14.00 88380-26 $71.00 89140-TC $34.00 88342 $53.00 88380-TC $88.00 89141 $56.00 88342-26 $36.00 88381 $213.00 89141-26 $19.00 88342-TC $17.00 88381-26 $54.00 89141-TC $37.00 88346 $96.00 88381-TC $159.00 89160 $6.00 88346-26 $66.00 88385 $330.00 89160-26 $2.00 88346-TC $28.00 88385-26 $84.00 89160-TC $4.00 88347 $133.00 88385-TC $247.00 89190 $10.00 88347-26 $99.00 88386 $344.00 89190-26 $3.00 88347-TC $33.00 88386-26 $105.00 89190-TC $6.00 88348 $191.00 88386-TC $239.00 89220 $17.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 116
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code MRA 89230 $5.00 G0124 $24.00 G0141 $24.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 117
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA 90471 $4.00 90885 $49.00 91052-26 $52.00 90472 $4.00 90887 $77.00 91052-TC $12.00 90473 $13.00 90889 BR 91055 $63.00 90474 $9.00 90899 BR 91055-26 $46.00 90632 BR 90901 $46.00 91055-TC $11.00 90636 BR 90911 $82.00 91065 $34.00 90675 BR 90935 $76.00 91065-26 $23.00 90703 BR 90937 $226.00 91065-TC $14.00 90718 BR 90940 BR 91105 $35.00 90746 BR 90945 $80.00 91110 $928.00 90749 BR 90947 $125.00 91110-26 $185.00 90801 $140.00 90997 $115.00 91110-TC $743.00 90802 $143.00 90999 BR 91111 $743.00 90804 $62.00 91000 $43.00 91111-26 $53.00 90805 $68.00 91000-26 $40.00 91111-TC $690.00 90806 $94.00 91000-TC $2.00 91120 $457.00 90807 $101.00 91010 $116.00 91120-26 $52.00 90808 $144.00 91010-26 $76.00 91120-TC $405.00 90809 $149.00 91010-TC $32.00 91122 $169.00 90810 $69.00 91011 $141.00 91122-26 $122.00 90811 $77.00 91011-26 $89.00 91122-TC $37.00 90812 $101.00 91011-TC $39.00 91123 BR 90813 $107.00 91012 $143.00 91132 BR 90814 $143.00 91012-26 $95.00 91132-26 $28.00 90815 $149.00 91012-TC $45.00 91132-TC BR 90816 $64.00 91020 $60.00 91133 BR 90817 $70.00 91020-26 $49.00 91133-26 $34.00 90818 $96.00 91020-TC $9.00 91133-TC BR 90819 $102.00 91022 $227.00 91299 BR 90821 $144.00 91022-26 $77.00 91299-26 BR 90822 $149.00 91022-TC $150.00 91299-TC BR 90823 $73.00 91030 $57.00 92002 $63.00 90824 $78.00 91030-26 $47.00 92004 $98.00 90826 $103.00 91030-TC $8.00 92012 $53.00 90827 $107.00 91034 $240.00 92014 $75.00 90828 $146.00 91034-26 $52.00 92015 $34.00 90829 $150.00 91034-TC $188.00 92018 $80.00 90845 $85.00 91035 $474.00 92019 $70.00 90846 $93.00 91035-26 $84.00 92020 $31.00 90847 $110.00 91035-TC $390.00 92025 $29.00 90849 $32.00 91037 $152.00 92025-26 $17.00 90853 $32.00 91037-26 $52.00 92025-TC $13.00 90857 $31.00 91037-TC $100.00 92060 $40.00 90862 $50.00 91038 $130.00 92060-26 $32.00 90865 $143.00 91038-26 $59.00 92060-TC $7.00 90870 $94.00 91038-TC $72.00 92065 $34.00 90875 $74.00 91040 $463.00 92065-26 $19.00 90876 $112.00 91040-26 $52.00 92065-TC $6.00 90880 $112.00 91040-TC $411.00 92070 $66.00 90882 $104.00 91052 $67.00 92081 $32.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 118
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA 92081-26 $19.00 92286-26 $53.00 92544-26 $16.00 92081-TC $6.00 92286-TC $29.00 92544-TC $8.00 92082 $48.00 92287 $99.00 92545 $22.00 92082-26 $24.00 92310 $86.00 92545-26 $14.00 92082-TC $9.00 92311 $78.00 92545-TC $8.00 92083 $59.00 92312 $89.00 92546 $29.00 92083-26 $31.00 92313 $70.00 92546-26 $17.00 92083-TC $14.00 92314 $54.00 92546-TC $9.00 92100 $40.00 92315 $44.00 92547 $21.00 92120 $32.00 92316 $59.00 92548 $92.00 92130 $56.00 92317 $39.00 92548-26 $30.00 92135 $69.00 92325 $14.00 92548-TC $59.00 92135-26 $18.00 92326 $44.00 92551 $17.00 92135-TC $49.00 92340 $32.00 92552 $16.00 92136 $93.00 92341 $43.00 92553 $24.00 92136-26 $29.00 92342 $43.00 92555 $14.00 92136-TC $63.00 92352 $31.00 92556 $21.00 92140 $38.00 92353 $38.00 92557 $46.00 92225 $45.00 92354 $221.00 92560 $23.00 92226 $39.00 92355 $107.00 92561 $27.00 92230 $58.00 92358 $24.00 92562 $15.00 92235 $104.00 92370 $35.00 92563 $14.00 92235-26 $46.00 92371 $18.00 92564 $17.00 92235-TC $53.00 92499 BR 92565 $15.00 92240 $132.00 92499-26 BR 92567 $20.00 92240-26 $60.00 92499-TC BR 92568 $14.00 92240-TC $67.00 92502 $101.00 92569 $15.00 92250 $40.00 92504 $24.00 92571 $14.00 92250-26 $24.00 92506 $63.00 92572 $3.00 92250-TC $7.00 92507 $40.00 92575 $11.00 92260 $20.00 92508 $42.00 92576 $17.00 92265 $53.00 92511 $81.00 92577 $28.00 92265-26 $37.00 92512 $46.00 92579 $28.00 92265-TC $10.00 92516 $36.00 92582 $28.00 92270 $64.00 92520 $47.00 92583 $34.00 92270-26 $45.00 92526 $48.00 92584 $94.00 92270-TC $19.00 92531 $10.00 92585 $114.00 92275 $80.00 92532 $14.00 92585-26 $52.00 92275-26 $56.00 92533 $41.00 92585-TC $70.00 92275-TC $17.00 92534 BR 92586 $70.00 92283 $24.00 92541 $37.00 92587 $58.00 92283-26 $10.00 92541-26 $25.00 92587-26 $8.00 92283-TC $5.00 92541-TC $9.00 92587-TC $49.00 92284 $192.00 92542 $33.00 92588 $78.00 92284-26 $151.00 92542-26 $20.00 92588-26 $20.00 92284-TC $46.00 92542-TC $10.00 92588-TC $57.00 92285 $26.00 92543 $28.00 92590 $41.00 92285-26 $12.00 92543-26 $19.00 92591 BR 92285-TC $6.00 92543-TC $10.00 92592 BR 92286 $91.00 92544 $26.00 92593 BR CPT only 2008 American Medical Association. All Rights Reserved. Part A, 119
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA 92594 BR 92993 BR 93308 $118.00 92595 BR 92995 $776.00 93308-26 $46.00 92596 $22.00 92996 $210.00 93308-TC $75.00 92597 $96.00 92997 $765.00 93312 $322.00 92603 $88.00 92998 $331.00 93312-26 $140.00 92604 $60.00 93000 $26.00 93312-TC $182.00 92605 BR 93005 $16.00 93313 $76.00 92606 BR 93010 $12.00 93314 $212.00 92607 $109.00 93012 $90.00 93314-26 $65.00 92608 $22.00 93014 $28.00 93314-TC $144.00 92609 $59.00 93015 $104.00 93315 $287.00 92610 $42.00 93016 $25.00 93315-26 $144.00 92611 $46.00 93017 $63.00 93315-TC $141.00 92612 $173.00 93018 $54.00 93316 $78.00 92613 $43.00 93024 $111.00 93317 $236.00 92614 $134.00 93024-26 $71.00 93317-26 $95.00 92615 $39.00 93024-TC $42.00 93317-TC $141.00 92616 $183.00 93025 $277.00 93318 $412.00 92617 $48.00 93025-26 $40.00 93318-26 $114.00 92620 $45.00 93025-TC $299.00 93318-TC $384.00 92621 $12.00 93040 $14.00 93320 $86.00 92625 $45.00 93041 $31.00 93320-26 $30.00 92626 $86.00 93042 $9.00 93320-TC $65.00 92627 $22.00 93224 $159.00 93321 $50.00 92640 $53.00 93225 $46.00 93321-26 $10.00 92700 BR 93226 $83.00 93321-TC $42.00 92950 $203.00 93227 $50.00 93325 $114.00 92953 $35.00 93230 $168.00 93325-26 $4.00 92960 $162.00 93231 $57.00 93325-TC $110.00 92961 $239.00 93232 $82.00 93350 $216.00 92970 $201.00 93233 $55.00 93350-26 $77.00 92971 $100.00 93235 $123.00 93350-TC $66.00 92973 $174.00 93236 $97.00 93501 $674.00 92974 $197.00 93237 $28.00 93501-26 $160.00 92975 $400.00 93268 $109.00 93501-TC $634.00 92977 $302.00 93270 $46.00 93503 $187.00 92978 $269.00 93271 $90.00 93505 $318.00 92978-26 $95.00 93272 $28.00 93505-26 $248.00 92978-TC $170.00 93278 $58.00 93505-TC $74.00 92979 $163.00 93278-26 $24.00 93508 $698.00 92979-26 $76.00 93278-TC $44.00 93508-26 $232.00 92979-TC $86.00 93303 $215.00 93508-TC $469.00 92980 $952.00 93303-26 $70.00 93510 $1,628.00 92981 $268.00 93303-TC $144.00 93510-26 $247.00 92982 $705.00 93304 $114.00 93510-TC $1,388.00 92984 $191.00 93304-26 $43.00 93511 $1,629.00 92986 $1,222.00 93304-TC $73.00 93511-26 $270.00 92987 $1,271.00 93307 $196.00 93511-TC $1,350.00 92990 $974.00 93307-26 $56.00 93514 $2,208.00 92992 BR 93307-TC $144.00 93514-26 $525.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 120
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA 93514-TC $1,683.00 93572 $222.00 93624-TC $74.00 93524 $2,150.00 93572-26 $74.00 93631 $651.00 93524-26 $392.00 93572-TC $155.00 93631-26 $420.00 93524-TC $1,766.00 93580 $974.00 93631-TC $239.00 93526 $2,147.00 93581 $1,303.00 93640 $467.00 93526-26 $363.00 93600 $198.00 93640-26 $230.00 93526-TC $1,815.00 93600-26 $129.00 93640-TC $269.00 93527 $2,186.00 93600-TC $73.00 93641 $613.00 93527-26 $451.00 93602 $159.00 93641-26 $360.00 93527-TC $1,766.00 93602-26 $119.00 93641-TC $269.00 93528 $2,266.00 93602-TC $42.00 93642 $549.00 93528-26 $482.00 93603 $187.00 93642-26 $295.00 93528-TC $1,766.00 93603-26 $127.00 93642-TC $269.00 93529 $2,032.00 93603-TC $63.00 93650 $639.00 93529-26 $262.00 93609 $578.00 93651 $985.00 93529-TC $1,766.00 93609-26 $481.00 93652 $1,044.00 93530 $872.00 93609-TC $101.00 93660 $162.00 93530-26 $250.00 93610 $214.00 93660-26 $103.00 93530-TC $634.00 93610-26 $166.00 93660-TC $61.00 93531 $2,268.00 93610-TC $52.00 93662 BR 93531-26 $467.00 93612 $224.00 93662-26 $158.00 93531-TC $1,815.00 93612-26 $167.00 93662-TC BR 93532 $2,317.00 93612-TC $61.00 93668 $16.00 93532-26 $569.00 93613 $377.00 93701 $36.00 93532-TC $1,766.00 93615 $62.00 93701-26 $9.00 93533 $2,131.00 93615-26 $49.00 93701-TC $27.00 93533-26 $352.00 93615-TC $12.00 93720 $43.00 93533-TC $1,766.00 93616 $94.00 93721 $27.00 93539 $45.00 93616-26 $82.00 93722 $24.00 93540 $49.00 93616-TC $12.00 93724 $411.00 93541 $38.00 93618 $399.00 93724-26 $259.00 93542 $38.00 93618-26 $258.00 93724-TC $148.00 93543 $213.00 93618-TC $148.00 93740 $17.00 93544 $30.00 93619 $717.00 93740-26 $12.00 93545 $240.00 93619-26 $444.00 93740-TC $5.00 93555 $278.00 93619-TC $290.00 93770 NC 93555-26 $42.00 93620 $358.00 93770-26 NC 93555-TC $234.00 93620-26 $272.00 93770-TC NC 93556 $414.00 93620-TC $91.00 93784 NC 93556-26 $44.00 93621 BR 93786 NC 93556-TC $368.00 93621-26 $769.00 93788 NC 93561 $59.00 93621-TC BR 93790 NC 93561-26 $47.00 93622 BR 93797 $17.00 93561-TC $20.00 93622-26 $771.00 93798 $38.00 93562 $46.00 93622-TC BR 93799 BR 93562-26 $33.00 93623 BR 93799-26 BR 93562-TC $13.00 93623-26 $167.00 93799-TC BR 93571 $270.00 93623-TC BR 93875 $55.00 93571-26 $93.00 93624 $333.00 93875-26 $17.00 93571-TC $170.00 93624-26 $256.00 93875-TC $42.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 121
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA 93880 $176.00 93971-TC $96.00 94250-TC $5.00 93880-26 $31.00 93975 $277.00 94260 $27.00 93880-TC $144.00 93975-26 $89.00 94260-26 $8.00 93882 $117.00 93975-TC $181.00 94260-TC $18.00 93882-26 $21.00 93976 $184.00 94350 $36.00 93882-TC $95.00 93976-26 $59.00 94350-26 $14.00 93886 $215.00 93976-TC $121.00 94350-TC $20.00 93886-26 $50.00 93978 $177.00 94360 $37.00 93886-TC $162.00 93978-26 $34.00 94360-26 $11.00 93888 $142.00 93978-TC $143.00 94360-TC $26.00 93888-26 $33.00 93979 $122.00 94370 $33.00 93888-TC $109.00 93979-26 $23.00 94370-26 $18.00 93890 $241.00 93979-TC $98.00 94370-TC $12.00 93890-26 $55.00 93980 $183.00 94375 $34.00 93890-TC $185.00 93980-26 $65.00 94375-26 $16.00 93892 $256.00 93980-TC $105.00 94375-TC $17.00 93892-26 $63.00 93981 $148.00 94400 $40.00 93892-TC $193.00 93981-26 $25.00 94400-26 $24.00 93893 $251.00 93981-TC $124.00 94400-TC $14.00 93893-26 $63.00 93982 $10.00 94450 $37.00 93893-TC $188.00 93990 $110.00 94450-26 $20.00 93922 $60.00 93990-26 $14.00 94450-TC $15.00 93922-26 $16.00 93990-TC $96.00 94452 $52.00 93922-TC $44.00 94002 $84.00 94452-26 $16.00 93923 $112.00 94003 $61.00 94452-TC $36.00 93923-26 $28.00 94004 $45.00 94453 $74.00 93923-TC $85.00 94005 $80.00 94453-26 $20.00 93924 $122.00 94010 $30.00 94453-TC $53.00 93924-26 $31.00 94010-26 $12.00 94610 $63.00 93924-TC $92.00 94010-TC $16.00 94620 $91.00 93925 $175.00 94014 $39.00 94620-26 $38.00 93925-26 $31.00 94015 $14.00 94620-TC $54.00 93925-TC $144.00 94016 $26.00 94621 $122.00 93926 $117.00 94060 $57.00 94621-26 $71.00 93926-26 $21.00 94060-26 $18.00 94621-TC $52.00 93926-TC $96.00 94060-TC $36.00 94640 $19.00 93930 $174.00 94070 $32.00 94642 BR 93930-26 $26.00 94070-26 $11.00 94644 $36.00 93930-TC $150.00 94070-TC $19.00 94645 $14.00 93931 $118.00 94150 $8.00 94660 $54.00 93931-26 $17.00 94150-26 $6.00 94662 $38.00 93931-TC $101.00 94150-TC $3.00 94664 $18.00 93965 $63.00 94200 $17.00 94667 $23.00 93965-26 $26.00 94200-26 $7.00 94668 $16.00 93965-TC $42.00 94200-TC $9.00 94680 $47.00 93970 $189.00 94240 $43.00 94680-26 $23.00 93970-26 $36.00 94240-26 $15.00 94680-TC $22.00 93970-TC $154.00 94240-TC $26.00 94681 $60.00 93971 $121.00 94250 $12.00 94681-26 $12.00 93971-26 $23.00 94250-26 $8.00 94681-TC $43.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 122
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA 94690 $24.00 95149 $36.00 95831 $26.00 94690-26 $4.00 95165 $7.00 95832 $21.00 94690-TC $20.00 95170 $13.00 95833 $34.00 94720 $49.00 95180 $103.00 95834 $44.00 94720-26 $15.00 95199 BR 95851 $18.00 94720-TC $31.00 95250 $114.00 95852 $14.00 94725 $79.00 95251 $28.00 95857 $40.00 94725-26 $14.00 95805 $334.00 95860 $73.00 94725-TC $64.00 95805-26 $94.00 95860-26 $53.00 94750 $37.00 95805-TC $237.00 95860-TC $15.00 94750-26 $14.00 95806 $232.00 95861 $113.00 94750-TC $21.00 95806-26 $109.00 95861-26 $86.00 94760 $9.00 95806-TC $137.00 95861-TC $28.00 94761 $20.00 95807 $367.00 95863 $138.00 94762 $30.00 95807-26 $98.00 95863-26 $102.00 94770 $21.00 95807-TC $256.00 95863-TC $35.00 94770-26 $9.00 95808 $456.00 95864 $177.00 94770-TC $12.00 95808-26 $149.00 95864-26 $114.00 94799 BR 95808-TC $256.00 95864-TC $67.00 94799-26 BR 95810 $521.00 95865 $119.00 94799-TC BR 95810-26 $183.00 95865-26 $92.00 95004 $3.00 95810-TC $256.00 95865-TC $27.00 95010 $11.00 95811 $644.00 95866 $80.00 95012 $19.00 95811-26 $196.00 95866-26 $71.00 95015 $11.00 95811-TC $423.00 95866-TC $9.00 95024 $3.00 95812 $137.00 95867 $66.00 95027 $5.00 95812-26 $58.00 95867-26 $43.00 95028 $8.00 95812-TC $68.00 95867-TC $21.00 95044 $7.00 95813 $177.00 95868 $96.00 95052 $9.00 95813-26 $89.00 95868-26 $71.00 95056 $6.00 95813-TC $68.00 95868-TC $26.00 95060 $13.00 95816 $133.00 95869 $29.00 95065 $7.00 95816-26 $54.00 95869-26 $21.00 95070 $82.00 95816-TC $78.00 95869-TC $8.00 95071 $105.00 95819 $115.00 95870 $29.00 95075 $82.00 95819-26 $58.00 95870-26 $21.00 95115 $10.00 95819-TC $56.00 95870-TC $8.00 95117 $9.00 95822 $120.00 95872 $104.00 95120 BR 95822-26 $58.00 95872-26 $81.00 95125 BR 95822-TC $63.00 95872-TC $22.00 95130 BR 95824 $51.00 95873 $29.00 95131 BR 95824-26 $41.00 95873-26 $21.00 95132 BR 95824-TC $10.00 95873-TC $8.00 95133 BR 95827 $145.00 95874 $30.00 95134 BR 95827-26 $59.00 95874-26 $21.00 95144 $9.00 95827-TC $86.00 95874-TC $8.00 95145 $17.00 95829 $328.00 95875 $43.00 95146 $24.00 95829-26 $291.00 95875-26 $34.00 95147 $33.00 95829-TC $6.00 95875-TC $7.00 95148 $32.00 95830 $133.00 95900 $37.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 123
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA 95900-26 $24.00 95950 $265.00 95990 $57.00 95900-TC $10.00 95950-26 $84.00 95991 $84.00 95903 $43.00 95950-TC $177.00 95999 BR 95903-26 $33.00 95951 $34.00 96000 $93.00 95903-TC $9.00 95951-26 $14.00 96001 $111.00 95904 $31.00 95951-TC $20.00 96002 $21.00 95904-26 $20.00 95953 $411.00 96003 $20.00 95904-TC $8.00 95953-26 $165.00 96004 $97.00 95920 $168.00 95953-TC $240.00 96020 BR 95920-26 $118.00 95954 $208.00 96020-26 $156.00 95920-TC $48.00 95954-26 $134.00 96020-TC BR 95921 $61.00 95954-TC $23.00 96040 $37.00 95921-26 $46.00 95955 $130.00 96101 $97.00 95921-TC $14.00 95955-26 $59.00 96102 $44.00 95922 $65.00 95955-TC $74.00 96103 $28.00 95922-26 $50.00 95956 $541.00 96105 $68.00 95922-TC $14.00 95956-26 $166.00 96110 $88.00 95923 $105.00 95956-TC $314.00 96111 $68.00 95923-26 $47.00 95957 $171.00 96116 $109.00 95923-TC $57.00 95957-26 $104.00 96118 $130.00 95925 $94.00 95957-TC $64.00 96119 $66.00 95925-26 $53.00 95958 $296.00 96120 $48.00 95925-TC $41.00 95958-26 $230.00 96125 $57.00 95926 $66.00 95958-TC $66.00 96150 $26.00 95926-26 $34.00 95961 $216.00 96151 $25.00 95926-TC $34.00 95961-26 $166.00 96152 $24.00 95927 $67.00 95961-TC $48.00 96153 $6.00 95927-26 $34.00 95962 $227.00 96154 $24.00 95927-TC $34.00 95962-26 $176.00 96155 $22.00 95928 $175.00 95962-TC $48.00 DSPNS see Appx D 95928-26 $84.00 95965 BR 96401 $53.00 95928-TC $91.00 95965-26 $420.00 96402 $46.00 95929 $182.00 95965-TC BR 96405 $57.00 95929-26 $84.00 95966 BR 96406 $86.00 95929-TC $98.00 95966-26 $210.00 96409 $122.00 95930 $44.00 95966-TC BR 96411 $71.00 95930-26 $25.00 95967 BR 96413 $173.00 95930-TC $11.00 95967-26 $184.00 96415 $39.00 95933 $62.00 95967-TC BR 96416 $186.00 95933-26 $33.00 95970 $22.00 96417 $85.00 95933-TC $30.00 95971 $39.00 96420 $46.00 95934 $36.00 95972 $78.00 96422 $46.00 95934-26 $28.00 95973 $47.00 96423 $17.00 95934-TC $8.00 95974 $155.00 96425 $54.00 95936 $39.00 95975 $88.00 96440 $156.00 95936-26 $30.00 95978 $213.00 96445 $157.00 95936-TC $8.00 95979 $98.00 96450 $134.00 95937 $40.00 95980 $27.00 96521 $153.00 95937-26 $31.00 95981 $10.00 96522 $111.00 95937-TC $9.00 95982 $22.00 96523 $28.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 124
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Medicine Medicine Medicine CPT Code MRA CPT Code MRA CPT Code MRA 96542 $126.00 97537 $23.00 99078 NC 96549 BR 97542 $17.00 99080 BR 96567 $62.00 97545 $83.00 99082 BR 96570 $69.00 97546 $41.00 99090 BR 96571 $38.00 97597 $49.00 99091 $49.00 96900 $17.00 97598 $62.00 99172 BR 96902 $24.00 97602 BR 99173 $3.00 96904 $70.00 97605 $34.00 99175 $53.00 96910 $21.00 97606 $37.00 99183 $123.00 96912 $24.00 97750 BR 99185 $23.00 96913 $53.00 97752 $48.00 99186 $78.00 96920 $152.00 97755 $35.00 99190 BR 96921 $155.00 97760 $31.00 99191 BR 96922 $214.00 97761 $28.00 99192 BR 96999 BR 97762 $26.00 99195 $16.00 97001 $62.00 97799 BR 99199 NC 97002 $29.00 97802 $26.00 G0101 $32.00 97003 $62.00 97803 $17.00 G0102 $18.00 97004 $29.00 97804 $7.00 G0104 $115.00 97005 BR 97810 $35.00 G0105 $344.00 97006 BR 97811 $27.00 G0105-53 $115.00 97010 $10.00 97813 $37.00 G0106 $165.00 97012 $16.00 97814 $30.00 G0106-26 $46.00 97014 $14.00 97850 $54.00 G0106-TC $119.00 97016 $15.00 97851 $26.00 G0108 $24.00 97018 $10.00 97852 $54.00 G0109 $14.00 97022 $15.00 97853 $26.00 G0117 $40.00 97024 $10.00 98925 NC G0118 $27.00 97026 $9.00 98926 $32.00 G0120 $179.00 97028 $10.00 98927 NC G0120-26 $46.00 97032 $16.00 98928 $23.00 G0120-TC $132.00 97033 $16.00 98929 NC G0121 $344.00 97034 $13.00 98940 NC G0121-53 $115.00 97035 $11.00 98941 $32.00 G0122 $177.00 97036 $19.00 98942 NC G0122-26 $45.00 97039 $15.00 98943 $23.00 G0122-TC $132.00 97110 $22.00 98960 $19.00 G0128 $4.00 97112 $23.00 98961 $9.00 G0166 $138.00 97113 $24.00 98962 $7.00 G0179 $41.00 97116 $21.00 98966 $8.00 G0180 $54.00 97124 $19.00 98967 $17.00 G0181 $99.00 97139 $15.00 98968 $25.00 G0182 $102.00 97140 $26.00 99000 $6.00 G0237 $12.00 97150 $18.00 99001 $4.00 G0238 $13.00 97260 $23.00 99002 $35.00 G0239 $11.00 97261 $17.00 99026 BR G0248 $168.00 97530 $22.00 99027 BR G0249 $124.00 97532 $22.00 99070 BR G0250 $9.00 97533 $24.00 99071 NC G0268 $43.00 97535 $23.00 99075 See 440.13 G0270 $22.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 125
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 $678.00 G0310 $557.00 G0311 $436.00 G0312 $476.00 G0313 $393.00 G0314 $309.00 G0315 $417.00 G0316 $344.00 G0317 $268.00 G0318 $262.00 G0319 $215.00 G0320 $168.00 G0321 $532.00 G0322 $380.00 G0323 $329.00 G0324 $206.00 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 Q0035-26 $19.00 Q0035-TC $8.00 Q0091 $11.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 126
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 99201 $35.00 99315 $60.00 99456 BR 99202 $58.00 99316 $77.00 99457 BR 99203 $58.00 99318 $66.00 99499 BR 99204 $84.00 99324 $59.00 99600 BR 99205 $84.00 99325 $86.00 G0245 $58.00 99211 $19.00 99326 $125.00 G0246 $34.00 99212 $31.00 99327 $164.00 G0337 $62.00 99213 $40.00 99328 $203.00 G0344 $86.00 99214 $40.00 99334 $45.00 G0368 $8.00 99215 $65.00 99335 $72.00 G0372 $13.00 99217 $65.00 99336 $111.00 G0396 $29.00 99218 $65.00 99337 $163.00 G0397 $56.00 99219 $109.00 99339 $67.00 M0064 $34.00 99220 $152.00 99340 $93.00 99221 $66.00 99341 $59.00 99222 $109.00 99342 $85.00 99223 $152.00 99343 $109.00 99231 $33.00 99344 $160.00 99232 $54.00 99345 $193.00 99233 $77.00 99347 $46.00 99234 $129.00 99348 $71.00 99235 $173.00 99349 $107.00 99236 $213.00 99350 $156.00 99238 $66.00 99354 $106.00 99239 $88.00 99355 $104.00 99241 $54.00 99356 $87.00 99242 $88.00 99357 $88.00 99243 $117.00 99358 $94.00 99244 $163.00 99359 $45.00 99245 $212.00 99360 $47.00 99251 $54.00 99363 $108.00 99252 $70.00 99364 $38.00 99253 $96.00 99366 $37.00 99254 $138.00 99367 $48.00 99255 $190.00 99368 $31.00 99281 $18.00 99374 $75.00 99282 $28.00 99375 $75.00 99283 $60.00 99377 $75.00 99284 $94.00 99378 $104.00 99285 $103.00 99379 $75.00 99288 BR 99380 $104.00 99291 $192.00 99406 $12.00 99292 $95.00 99407 $24.00 99304 $66.00 99408 $29.00 99305 $88.00 99409 $58.00 99306 $108.00 99441 $13.00 99307 $34.00 99442 $23.00 99308 $56.00 99443 $34.00 99309 $80.00 99450 NC 99310 $100.00 99455 $90.00 CPT only 2008 American Medical Association. All Rights Reserved. Part A, 127
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 $133.00 D0220 $10.00 D2393 $63.00 D2954 $102.00 D0230 $5.00 D2394 $69.00 D2955 $81.00 D0240 $12.00 D2410 $163.00 D2957 $71.00 D0250 $20.00 D2420 $203.00 D2960 $121.00 D0260 $14.00 D2430 $293.00 D2961 $204.00 D0270 $7.00 D2510 $155.00 D2962 $294.00 D0272 $12.00 D2520 $259.00 D2980 $83.00 D0274 $20.00 D2530 $244.00 D2999 BR D0277 $18.00 D2542 $302.00 D3110 $25.00 D0290 $36.00 D2543 $318.00 D3120 $20.00 D0310 $50.00 D2544 $348.00 D3220 $61.00 D0320 $204.00 D2610 $206.00 D3221 $81.00 D0321 $64.00 D2620 $266.00 D3230 $70.00 D0322 $105.00 D2630 $348.00 D3240 $75.00 D0330 $29.00 D2642 $287.00 D3310 $206.00 D0340 $40.00 D2643 $328.00 D3320 $204.00 D0350 $10.00 D2644 $378.00 D3330 $287.00 D0415 $34.00 D2650 $206.00 D3331 $102.00 D0425 $25.00 D2651 $266.00 D3332 $110.00 D0460 $13.00 D2652 $348.00 D3333 $53.00 D0470 $24.00 D2662 $266.00 D3346 $225.00 D0472 $30.00 D2663 $328.00 D3347 $274.00 D0473 BR D2664 $348.00 D3348 $337.00 D0474 BR D2710 $194.00 D3351 $102.00 D0480 BR D2720 $410.00 D3352 $81.00 D0502 $54.00 D2721 $306.00 D3353 $163.00 D0999 BR D2722 $348.00 D3410 $179.00 D1110 $29.00 D2740 $410.00 D3421 $194.00 D1204 $10.00 D2750 $451.00 D3425 $206.00 D1205 $40.00 D2751 $328.00 D3426 $77.00 D1310 $23.00 D2752 $368.00 D3430 $55.00 D1320 $48.00 D2780 $368.00 D3450 $102.00 D1330 $13.00 D2781 $266.00 D3460 $318.00 D1351 $21.00 D2782 $306.00 D3470 $204.00 D1510 $81.00 D2783 $389.00 D3910 $50.00 D1515 $121.00 D2790 $389.00 D3920 $102.00 D1520 $102.00 D2791 $287.00 D3950 $61.00 D1525 $143.00 D2792 $328.00 D3999 BR D1550 $14.00 D2799 $204.00 D4210 $114.00 D2140 $38.00 D2910 $29.00 D4211 $50.00 D2150 $44.00 D2920 $29.00 D4240 $223.00 D2160 $54.00 D2930 $81.00 D4241 $63.00 D2161 $67.00 D2931 $121.00 D4245 $265.00 HCPCS 2008 Part A, 128
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Dental Dental Dental D-Code MRA D-Code MRA D-Code MRA D4249 $208.00 D5721 $163.00 D5982 $167.00 D4260 $328.00 D5730 $121.00 D5983 BR D4261 $164.00 D5731 $121.00 D5984 BR D4263 $195.00 D5740 $102.00 D5985 $574.00 D4264 $159.00 D5741 $102.00 D5986 $61.00 D4265 $96.00 D5750 $132.00 D5987 BR D4266 $285.00 D5751 $163.00 D5988 $219.00 D4267 $328.00 D5760 $100.00 D5999 BR D4268 $273.00 D5761 $163.00 D6010 $649.00 D4270 $155.00 D5810 $244.00 D6040 $3,016.00 D4271 $206.00 D5811 $244.00 D6050 $1,557.00 D4273 $337.00 D5820 $194.00 D6053 $82.00 D4274 $208.00 D5821 $204.00 D6054 $61.00 D4275 $178.00 D5850 $46.00 D6055 $769.00 D4276 $194.00 D5851 $50.00 D6056 $265.00 D4320 $77.00 D5860 $543.00 D6057 $303.00 D4321 $55.00 D5861 $553.00 D6058 $392.00 D4341 $79.00 D5862 $181.00 D6059 $418.00 D4342 $55.00 D5867 $36.00 D6060 $289.00 D4355 $50.00 D5875 $100.00 D6061 $379.00 D4381 $69.00 D5899 BR D6062 $365.00 D4910 $40.00 D5911 $81.00 D6063 $359.00 D4920 $27.00 D5912 $121.00 D6064 $377.00 D4999 BR D5913 $2,052.00 D6065 $513.00 D5110 $513.00 D5914 $2,052.00 D6066 $513.00 D5120 $513.00 D5915 $2,770.00 D6067 $513.00 D5130 $563.00 D5916 $2,874.00 D6068 $365.00 D5140 $563.00 D5919 BR D6069 $359.00 D5211 $256.00 D5922 $1,334.00 D6070 $322.00 D5212 $259.00 D5923 $1,641.00 D6071 $326.00 D5213 $614.00 D5924 BR D6072 $365.00 D5214 $614.00 D5925 BR D6073 $346.00 D5281 $279.00 D5926 $1,026.00 D6074 $350.00 D5410 $27.00 D5927 $1,026.00 D6075 $414.00 D5411 $27.00 D5928 $1,384.00 D6076 $402.00 D5421 $27.00 D5929 BR D6077 $447.00 D5422 $27.00 D5931 $656.00 D6078 $1,026.00 D5510 $61.00 D5932 $1,539.00 D6079 $884.00 D5520 $40.00 D5933 $306.00 D6080 $71.00 D5610 $61.00 D5934 $1,539.00 D6090 $229.00 D5620 $83.00 D5935 $1,539.00 D6095 $247.00 D5630 $22.00 D5936 $563.00 D6100 $264.00 D5640 $53.00 D5937 BR D6199 BR D5650 $61.00 D5951 $614.00 D6210 $410.00 D5660 $102.00 D5953 $614.00 D6211 $287.00 D5670 $305.00 D5954 BR D6212 $328.00 D5671 $305.00 D5955 $1,334.00 D6240 $451.00 D5710 $204.00 D5958 $780.00 D6241 $368.00 D5711 $204.00 D5959 $244.00 D6242 $410.00 D5720 $163.00 D5960 $163.00 D6245 $309.00 HCPCS 2008 Part A, 129
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Dental Dental Dental D-Code MRA D-Code MRA D-Code MRA D6250 $410.00 D7140 $45.00 D7650 $1,292.00 D6251 $287.00 D7210 $70.00 D7660 $780.00 D6252 $368.00 D7220 $111.00 D7670 $410.00 D6253 $51.00 D7230 $139.00 D7671 $779.00 D6545 $195.00 D7240 $147.00 D7680 $1,949.00 D6548 $281.00 D7241 $204.00 D7710 $1,415.00 D6600 $155.00 D7250 $81.00 D7720 $903.00 D6601 $166.00 D7260 $244.00 D7730 $1,580.00 D6602 $172.00 D7261 BR D7740 $922.00 D6603 $203.00 D7270 $147.00 D7750 $1,334.00 D6604 $110.00 D7272 $204.00 D7760 $1,046.00 D6605 $141.00 D7280 $121.00 D7770 $533.00 D6606 $139.00 D7282 $41.00 D7771 $73.00 D6607 $151.00 D7285 $106.00 D7780 $2,504.00 D6608 $170.00 D7286 $81.00 D7810 $1,292.00 D6609 $178.00 D7287 BR D7820 $110.00 D6610 $203.00 D7290 $133.00 D7830 $186.00 D6611 $217.00 D7291 $77.00 D7840 $1,764.00 D6612 $141.00 D7310 $85.00 D7850 $1,682.00 D6613 $155.00 D7320 $108.00 D7852 $2,011.00 D6614 $151.00 D7340 $195.00 D7854 $2,052.00 D6615 $162.00 D7350 $410.00 D7856 BR D6720 $410.00 D7410 $102.00 D7858 $2,298.00 D6721 $233.00 D7411 $100.00 D7860 $614.00 D6722 $348.00 D7412 $139.00 D7865 $1,723.00 D6740 $328.00 D7413 $205.00 D7870 $81.00 D6750 $356.00 D7414 $180.00 D7871 BR D6751 $328.00 D7415 $291.00 D7872 $533.00 D6752 $410.00 D7440 $161.00 D7873 $584.00 D6780 $389.00 D7441 $247.00 D7874 $737.00 D6781 $320.00 D7450 $139.00 D7875 $789.00 D6782 $322.00 D7451 $179.00 D7876 $820.00 D6783 $324.00 D7460 $137.00 D7877 $758.00 D6790 $389.00 D7461 $195.00 D7880 $291.00 D6791 $287.00 D7465 $71.00 D7899 BR D6792 $348.00 D7471 $174.00 D7910 $73.00 D6793 $30.00 D7472 $143.00 D7911 $110.00 D6920 $279.00 D7473 $147.00 D7912 $163.00 D6930 $40.00 D7485 $162.00 D7920 $676.00 D6940 $102.00 D7490 $2,545.00 D7940 $841.00 D6950 $155.00 D7510 $54.00 D7941 $2,874.00 D6970 $163.00 D7520 $121.00 D7943 $2,914.00 D6971 $113.00 D7530 $85.00 D7944 $2,298.00 D6972 $121.00 D7540 $121.00 D7945 $2,319.00 D6973 $111.00 D7550 $143.00 D7946 $2,566.00 D6975 $214.00 D7560 $266.00 D7947 $2,566.00 D6976 $88.00 D7610 $1,189.00 D7948 $2,874.00 D6977 $46.00 D7620 $984.00 D7949 $4,186.00 D6980 $106.00 D7630 $1,354.00 D7950 $881.00 D6999 BR D7640 $820.00 D7955 $922.00 HCPCS 2008 Part A, 130
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Dental Dental D-Code MRA D-Code MRA D7960 $121.00 D9630 $10.00 D7970 $137.00 D9910 $21.00 D7971 $67.00 D9911 $21.00 D7972 BR D9920 $32.00 D7980 $169.00 D9930 $34.00 D7981 $820.00 D9940 $204.00 D7982 $306.00 D9941 $58.00 D7983 $244.00 D9950 $114.00 D7990 $340.00 D9951 $46.00 D7991 $820.00 D9952 $163.00 D7995 BR D9970 $83.00 D7996 BR D9971 $55.00 D7997 BR D9972 $113.00 D7999 BR D9973 $40.00 D8010 $451.00 D9974 $50.00 D8020 $533.00 D9999 BR D8030 $718.00 D8040 $583.00 D8050 $676.00 D8060 $758.00 D8070 $1,867.00 D8080 $1,867.00 D8090 $1,949.00 D8210 $155.00 D8220 $179.00 D8660 $73.00 D8670 $54.00 D8680 $171.00 D8690 $71.00 D8691 $67.00 D8692 $104.00 D8999 BR D9110 $40.00 D9210 $14.00 D9211 $14.00 D9212 $13.00 D9215 $7.00 D9220 $111.00 D9221 $40.00 D9230 $18.00 D9241 $122.00 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
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 $101.00 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 $158.00 J0330 $1.00 J0745 $1.00 J1441 $254.00 J0350 $2,408.00 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 $362.00 J1490 $9.00 J0460 $1.00 J0895 $10.00 J1500 $11.00 J0470 $11.00 J0900 $1.00 J1510 $13.00 J0475 $201.00 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 $393.00 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
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 $189.00 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 $214.00 J1817 BR J2540 $1.00 J3250 $1.00 J1825 BR J2543 BR J3260 $7.00 J1830 $76.00 J2545 $105.00 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 $411.00 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 $433.00 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 $115.00 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
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Injections J-Code MRA J7100 $137.00 J7110 $93.00 J7120 $12.00 J7130 $6.00 J7190 $241.00 J7191 BR J7192 $316.00 J7193 BR J7194 $120.00 J7195 BR J7197 $284.00 J7198 BR J7199 BR J7317 BR J7350 BR J7501 $98.00 J7504 $282.00 J7505 $576.00 J7513 BR J7516 BR J7599 BR HCPCS 2008 Part A, 134
Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition PART B SCHEDULE OF MAXIMUM REIMBURSEMENT ALLOWANCES 135
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 10021 0 $90.00 $176.00 $186.00 $197.00 $91.00 $95.00 $100.00 10022 0 $92.00 $183.00 $194.00 $204.00 $87.00 $90.00 $94.00 10040 10 $54.00 $118.00 $124.00 $129.00 $104.00 $108.00 $113.00 10060 10 $53.00 $133.00 $141.00 $150.00 $116.00 $123.00 $130.00 10061 10 $133.00 $232.00 $245.00 $261.00 $209.00 $221.00 $236.00 10080 10 $65.00 $209.00 $222.00 $235.00 $120.00 $127.00 $135.00 10081 10 $203.00 $324.00 $344.00 $364.00 $209.00 $220.00 $234.00 10120 10 $53.00 $170.00 $180.00 $191.00 $115.00 $122.00 $129.00 10121 10 $169.00 $329.00 $350.00 $373.00 $240.00 $254.00 $272.00 10140 10 $53.00 $189.00 $201.00 $214.00 $152.00 $161.00 $173.00 10160 10 $45.00 $154.00 $164.00 $174.00 $122.00 $130.00 $138.00 10180 10 $164.00 $290.00 $310.00 $333.00 $229.00 $244.00 $264.00 11000 0 $45.00 $66.00 $70.00 $75.00 $43.00 $46.00 $49.00 11001 ZZZ $27.00 $29.00 $30.00 $33.00 $22.00 $23.00 $25.00 11004 0 ------- $738.00 $767.00 $804.00 $738.00 $767.00 $804.00 11005 0 ------- $978.00 $1,019.00 $1,071.00 $978.00 $1,019.00 $1,071.00 11006 0 ------- $937.00 $985.00 $1,048.00 $937.00 $985.00 $1,048.00 11008 ZZZ ------- $366.00 $387.00 $416.00 $366.00 $387.00 $416.00 11010 10 $348.00 $591.00 $632.00 $678.00 $373.00 $399.00 $432.00 11011 0 $432.00 $670.00 $716.00 $768.00 $400.00 $426.00 $462.00 11012 0 $597.00 $942.00 $1,009.00 $1,086.00 $588.00 $630.00 $686.00 11040 0 $43.00 $58.00 $62.00 $66.00 $37.00 $39.00 $42.00 11041 0 $45.00 $71.00 $76.00 $82.00 $49.00 $53.00 $57.00 11042 0 $88.00 $96.00 $102.00 $110.00 $65.00 $69.00 $75.00 11043 10 $210.00 $340.00 $361.00 $383.00 $298.00 $316.00 $336.00 11044 10 $283.00 $459.00 $487.00 $518.00 $411.00 $435.00 $462.00 11055 0 $26.00 $58.00 $62.00 $66.00 $31.00 $33.00 $35.00 11056 0 $35.00 $72.00 $77.00 $82.00 $44.00 $46.00 $50.00 11057 0 $39.00 $88.00 $94.00 $100.00 $58.00 $61.00 $66.00 11100 0 $78.00 $118.00 $125.00 $130.00 $59.00 $61.00 $64.00 11101 ZZZ $41.00 $39.00 $41.00 $43.00 $30.00 $31.00 $33.00 11200 10 $66.00 $97.00 $102.00 $107.00 $82.00 $86.00 $90.00 11201 ZZZ $26.00 $23.00 $25.00 $26.00 $21.00 $22.00 $24.00 11300 0 $59.00 $81.00 $85.00 $90.00 $37.00 $38.00 $40.00 11301 0 $80.00 $109.00 $114.00 $120.00 $62.00 $65.00 $67.00 11302 0 $96.00 $129.00 $136.00 $143.00 $77.00 $79.00 $83.00 11303 0 $119.00 $154.00 $162.00 $170.00 $91.00 $94.00 $99.00 11305 0 $61.00 $85.00 $90.00 $96.00 $49.00 $52.00 $55.00 11306 0 $86.00 $115.00 $121.00 $128.00 $72.00 $75.00 $79.00 11307 0 $100.00 $133.00 $140.00 $148.00 $83.00 $86.00 $91.00 11308 0 $125.00 $155.00 $164.00 $174.00 $103.00 $109.00 $115.00 11310 0 $75.00 $100.00 $105.00 $110.00 $53.00 $55.00 $58.00 11311 0 $95.00 $124.00 $131.00 $137.00 $77.00 $80.00 $83.00 11312 0 $110.00 $145.00 $152.00 $159.00 $89.00 $92.00 $96.00 11313 0 $144.00 $184.00 $194.00 $204.00 $120.00 $125.00 $131.00 11400 10 $81.00 $143.00 $151.00 $159.00 $91.00 $96.00 $101.00 11401 10 $114.00 $173.00 $183.00 $193.00 $121.00 $127.00 $135.00 11402 10 $145.00 $192.00 $204.00 $216.00 $134.00 $141.00 $150.00 11403 10 $178.00 $222.00 $235.00 $249.00 $170.00 $180.00 $191.00 11404 10 $200.00 $253.00 $268.00 $285.00 $190.00 $200.00 $213.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 136
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 11406 10 $246.00 $353.00 $373.00 $396.00 $282.00 $297.00 $315.00 11420 10 $98.00 $144.00 $153.00 $162.00 $101.00 $106.00 $112.00 11421 10 $92.00 $185.00 $196.00 $207.00 $135.00 $142.00 $151.00 11422 10 $157.00 $207.00 $220.00 $233.00 $161.00 $171.00 $181.00 11423 10 $163.00 $243.00 $257.00 $273.00 $189.00 $199.00 $212.00 11424 10 $221.00 $279.00 $296.00 $314.00 $219.00 $232.00 $247.00 11426 10 $303.00 $402.00 $425.00 $453.00 $335.00 $354.00 $378.00 11440 10 $105.00 $159.00 $169.00 $178.00 $120.00 $127.00 $133.00 11441 10 $102.00 $199.00 $210.00 $222.00 $157.00 $165.00 $175.00 11442 10 $174.00 $224.00 $237.00 $251.00 $175.00 $185.00 $196.00 11443 10 $221.00 $271.00 $287.00 $304.00 $217.00 $229.00 $243.00 11444 10 $276.00 $342.00 $362.00 $383.00 $279.00 $294.00 $312.00 11446 10 $344.00 $460.00 $486.00 $515.00 $393.00 $414.00 $439.00 11450 90 $282.00 $429.00 $455.00 $484.00 $286.00 $302.00 $322.00 11451 90 $366.00 $571.00 $607.00 $647.00 $383.00 $406.00 $435.00 11462 90 $264.00 $423.00 $450.00 $478.00 $274.00 $290.00 $310.00 11463 90 $351.00 $581.00 $618.00 $659.00 $387.00 $411.00 $441.00 11470 90 $320.00 $467.00 $496.00 $527.00 $326.00 $345.00 $368.00 11471 90 $391.00 $602.00 $641.00 $683.00 $417.00 $442.00 $473.00 11600 10 $148.00 $216.00 $229.00 $240.00 $135.00 $141.00 $148.00 11601 10 $180.00 $258.00 $272.00 $286.00 $172.00 $180.00 $189.00 11602 10 $199.00 $280.00 $295.00 $310.00 $187.00 $195.00 $204.00 11603 10 $226.00 $321.00 $337.00 $354.00 $223.00 $233.00 $244.00 11604 10 $249.00 $355.00 $374.00 $393.00 $245.00 $256.00 $269.00 11606 10 $315.00 $501.00 $527.00 $555.00 $367.00 $384.00 $404.00 11620 10 $150.00 $218.00 $230.00 $241.00 $135.00 $141.00 $148.00 11621 10 $191.00 $260.00 $274.00 $288.00 $174.00 $182.00 $191.00 11622 10 $223.00 $293.00 $309.00 $325.00 $200.00 $210.00 $220.00 11623 10 $259.00 $346.00 $364.00 $383.00 $248.00 $259.00 $272.00 11624 10 $305.00 $393.00 $415.00 $437.00 $285.00 $299.00 $315.00 11626 10 $373.00 $490.00 $518.00 $550.00 $368.00 $388.00 $412.00 11640 10 $168.00 $228.00 $241.00 $254.00 $145.00 $152.00 $160.00 11641 10 $227.00 $279.00 $295.00 $311.00 $191.00 $201.00 $211.00 11642 10 $260.00 $321.00 $340.00 $358.00 $225.00 $236.00 $248.00 11643 10 $305.00 $381.00 $402.00 $424.00 $281.00 $295.00 $311.00 11644 10 $380.00 $475.00 $502.00 $530.00 $354.00 $372.00 $394.00 11646 10 $494.00 $631.00 $668.00 $709.00 $505.00 $532.00 $566.00 11719 0 $22.00 $25.00 $27.00 $28.00 $13.00 $13.00 $14.00 11720 0 $32.00 $38.00 $41.00 $43.00 $23.00 $24.00 $26.00 11721 0 $50.00 $56.00 $59.00 $63.00 $40.00 $42.00 $45.00 11730 0 $62.00 $122.00 $130.00 $139.00 $81.00 $86.00 $92.00 11732 ZZZ $31.00 $57.00 $60.00 $64.00 $41.00 $44.00 $47.00 11740 0 $41.00 $54.00 $58.00 $61.00 $40.00 $43.00 $45.00 11750 10 $156.00 $258.00 $273.00 $289.00 $221.00 $233.00 $247.00 11752 10 $234.00 $367.00 $389.00 $413.00 $335.00 $354.00 $376.00 11755 0 $106.00 $162.00 $172.00 $183.00 $110.00 $117.00 $124.00 11760 10 $131.00 $242.00 $258.00 $275.00 $172.00 $183.00 $196.00 11762 10 $223.00 $329.00 $350.00 $374.00 $266.00 $282.00 $302.00 11765 10 $65.00 $151.00 $161.00 $171.00 $84.00 $89.00 $95.00 11770 10 $275.00 $323.00 $344.00 $367.00 $225.00 $239.00 $257.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 137
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 11771 90 $496.00 $647.00 $687.00 $734.00 $515.00 $546.00 $585.00 11772 90 $585.00 $799.00 $849.00 $907.00 $676.00 $717.00 $768.00 11900 0 $33.00 $65.00 $68.00 $71.00 $38.00 $39.00 $40.00 11901 0 $37.00 $81.00 $85.00 $89.00 $58.00 $60.00 $63.00 11920 0 $147.00 $246.00 $263.00 $281.00 $149.00 $159.00 $172.00 11921 0 $172.00 $279.00 $298.00 $319.00 $177.00 $188.00 $204.00 11922 ZZZ $40.00 $80.00 $85.00 $91.00 $40.00 $43.00 $47.00 11950 0 $107.00 $95.00 $100.00 $105.00 $63.00 $66.00 $69.00 11951 0 $114.00 $125.00 $132.00 $140.00 $86.00 $91.00 $96.00 11952 0 $155.00 $179.00 $189.00 $201.00 $128.00 $135.00 $143.00 11954 0 $165.00 $213.00 $227.00 $243.00 $148.00 $158.00 $170.00 11960 90 $829.00 $1,145.00 $1,216.00 $1,298.00 $1,145.00 $1,216.00 $1,298.00 11970 90 $632.00 $760.00 $808.00 $868.00 $760.00 $808.00 $868.00 11971 90 $280.00 $589.00 $627.00 $663.00 $372.00 $394.00 $418.00 11976 0 $123.00 $186.00 $198.00 $211.00 $129.00 $137.00 $147.00 12001 10 $84.00 $185.00 $196.00 $207.00 $130.00 $136.00 $144.00 12002 10 $98.00 $198.00 $209.00 $221.00 $145.00 $153.00 $162.00 12004 10 $122.00 $233.00 $246.00 $261.00 $171.00 $180.00 $191.00 12005 10 $165.00 $290.00 $307.00 $325.00 $213.00 $224.00 $238.00 12006 10 $203.00 $362.00 $382.00 $406.00 $270.00 $284.00 $302.00 12007 10 $339.00 $409.00 $433.00 $462.00 $312.00 $329.00 $352.00 12011 10 $98.00 $197.00 $209.00 $221.00 $135.00 $142.00 $150.00 12013 10 $141.00 $217.00 $229.00 $243.00 $154.00 $162.00 $172.00 12014 10 $165.00 $256.00 $270.00 $287.00 $185.00 $195.00 $207.00 12015 10 $207.00 $322.00 $340.00 $360.00 $233.00 $244.00 $259.00 12016 10 $268.00 $382.00 $404.00 $428.00 $284.00 $299.00 $317.00 12017 10 $316.00 $345.00 $363.00 $386.00 $345.00 $363.00 $386.00 12018 10 $515.00 $415.00 $439.00 $470.00 $415.00 $439.00 $470.00 12020 10 $211.00 $335.00 $356.00 $379.00 $239.00 $254.00 $271.00 12021 10 $87.00 $198.00 $211.00 $226.00 $175.00 $186.00 $199.00 12031 10 $93.00 $270.00 $285.00 $301.00 $184.00 $193.00 $204.00 12032 10 $110.00 $356.00 $376.00 $396.00 $231.00 $243.00 $255.00 12034 10 $148.00 $353.00 $373.00 $394.00 $244.00 $256.00 $271.00 12035 10 $223.00 $455.00 $483.00 $514.00 $299.00 $316.00 $338.00 12036 10 $356.00 $508.00 $542.00 $580.00 $354.00 $376.00 $405.00 12037 10 $411.00 $574.00 $612.00 $656.00 $412.00 $439.00 $473.00 12041 10 $116.00 $287.00 $304.00 $321.00 $200.00 $210.00 $221.00 12042 10 $141.00 $337.00 $355.00 $373.00 $232.00 $243.00 $255.00 12044 10 $176.00 $385.00 $407.00 $431.00 $258.00 $271.00 $287.00 12045 10 $250.00 $461.00 $490.00 $521.00 $312.00 $330.00 $353.00 12046 10 $341.00 $547.00 $582.00 $621.00 $369.00 $391.00 $420.00 12047 10 $363.00 $585.00 $623.00 $665.00 $408.00 $433.00 $464.00 12051 10 $126.00 $317.00 $335.00 $354.00 $217.00 $228.00 $241.00 12052 10 $148.00 $347.00 $366.00 $384.00 $245.00 $257.00 $269.00 12053 10 $223.00 $382.00 $403.00 $425.00 $257.00 $270.00 $284.00 12054 10 $301.00 $412.00 $436.00 $461.00 $279.00 $293.00 $310.00 12055 10 $380.00 $507.00 $537.00 $570.00 $350.00 $369.00 $392.00 12056 10 $487.00 $626.00 $665.00 $707.00 $434.00 $459.00 $491.00 12057 10 $539.00 $672.00 $711.00 $754.00 $492.00 $518.00 $550.00 13100 10 $178.00 $380.00 $402.00 $425.00 $288.00 $303.00 $320.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 138
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 13101 10 $240.00 $470.00 $495.00 $521.00 $347.00 $363.00 $382.00 13102 ZZZ $89.00 $131.00 $139.00 $148.00 $96.00 $101.00 $108.00 13120 10 $223.00 $394.00 $416.00 $439.00 $299.00 $315.00 $332.00 13121 10 $348.00 $513.00 $540.00 $567.00 $385.00 $403.00 $423.00 13122 ZZZ $104.00 $152.00 $161.00 $171.00 $110.00 $116.00 $123.00 13131 10 $252.00 $434.00 $457.00 $481.00 $338.00 $355.00 $373.00 13132 10 $484.00 $675.00 $707.00 $740.00 $558.00 $582.00 $608.00 13133 ZZZ $154.00 $206.00 $217.00 $229.00 $167.00 $175.00 $185.00 13150 10 $260.00 $446.00 $472.00 $499.00 $343.00 $361.00 $383.00 13151 10 $375.00 $492.00 $518.00 $546.00 $393.00 $412.00 $434.00 13152 10 $542.00 $669.00 $703.00 $739.00 $528.00 $553.00 $580.00 13153 ZZZ $169.00 $230.00 $244.00 $259.00 $185.00 $195.00 $208.00 13160 90 $655.00 $1,033.00 $1,097.00 $1,178.00 $1,033.00 $1,097.00 $1,178.00 14000 90 $512.00 $787.00 $832.00 $880.00 $655.00 $691.00 $731.00 14001 90 $695.00 $1,026.00 $1,084.00 $1,146.00 $879.00 $926.00 $980.00 14020 90 $590.00 $876.00 $926.00 $978.00 $746.00 $786.00 $831.00 14021 90 $818.00 $1,151.00 $1,211.00 $1,276.00 $1,013.00 $1,064.00 $1,120.00 14040 90 $701.00 $920.00 $970.00 $1,022.00 $800.00 $841.00 $886.00 14041 90 $936.00 $1,257.00 $1,319.00 $1,383.00 $1,103.00 $1,154.00 $1,209.00 14060 90 $766.00 $942.00 $992.00 $1,046.00 $845.00 $889.00 $937.00 14061 90 $1,330.00 $1,363.00 $1,429.00 $1,498.00 $1,194.00 $1,248.00 $1,307.00 14300 90 $1,040.00 $1,331.00 $1,404.00 $1,486.00 $1,180.00 $1,243.00 $1,316.00 14350 90 $734.00 $965.00 $1,024.00 $1,098.00 $965.00 $1,024.00 $1,098.00 15040 0 ------- $325.00 $347.00 $368.00 $167.00 $177.00 $190.00 15050 90 $349.00 $661.00 $701.00 $745.00 $550.00 $583.00 $620.00 15100 90 $679.00 $1,118.00 $1,190.00 $1,273.00 $921.00 $980.00 $1,051.00 15101 ZZZ $146.00 $254.00 $272.00 $290.00 $150.00 $160.00 $172.00 15110 90 ------- $1,100.00 $1,168.00 $1,248.00 $949.00 $1,006.00 $1,077.00 15111 ZZZ ------- $162.00 $172.00 $185.00 $143.00 $152.00 $164.00 15115 90 ------- $1,078.00 $1,140.00 $1,212.00 $969.00 $1,023.00 $1,089.00 15116 ZZZ ------- $213.00 $226.00 $243.00 $193.00 $205.00 $221.00 15120 90 $788.00 $1,158.00 $1,227.00 $1,305.00 $987.00 $1,044.00 $1,112.00 15121 ZZZ $235.00 $352.00 $376.00 $401.00 $232.00 $247.00 $266.00 15130 90 ------- $870.00 $927.00 $991.00 $723.00 $769.00 $825.00 15131 ZZZ ------- $130.00 $138.00 $149.00 $115.00 $122.00 $132.00 15135 90 ------- $1,094.00 $1,160.00 $1,236.00 $989.00 $1,048.00 $1,118.00 15136 ZZZ ------- $125.00 $133.00 $143.00 $116.00 $123.00 $133.00 15150 90 ------- $914.00 $971.00 $1,039.00 $832.00 $883.00 $945.00 15151 ZZZ ------- $171.00 $182.00 $196.00 $154.00 $164.00 $177.00 15152 ZZZ ------- $210.00 $224.00 $241.00 $193.00 $205.00 $221.00 15155 90 ------- $942.00 $996.00 $1,060.00 $887.00 $937.00 $998.00 15156 ZZZ ------- $225.00 $239.00 $257.00 $212.00 $225.00 $242.00 15157 ZZZ ------- $250.00 $265.00 $285.00 $231.00 $245.00 $264.00 15170 90 ------- $521.00 $548.00 $582.00 $449.00 $471.00 $500.00 15171 ZZZ ------- $120.00 $127.00 $136.00 $115.00 $121.00 $130.00 15175 90 ------- $688.00 $726.00 $773.00 $619.00 $652.00 $695.00 15176 ZZZ ------- $192.00 $203.00 $217.00 $183.00 $193.00 $207.00 15200 90 $644.00 $982.00 $1,041.00 $1,108.00 $813.00 $860.00 $917.00 15201 ZZZ $126.00 $191.00 $204.00 $219.00 $104.00 $111.00 $120.00 15220 90 $687.00 $931.00 $988.00 $1,049.00 $774.00 $819.00 $872.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 139
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 15221 ZZZ $114.00 $177.00 $188.00 $201.00 $95.00 $101.00 $109.00 15240 90 $763.00 $1,105.00 $1,168.00 $1,237.00 $971.00 $1,024.00 $1,085.00 15241 ZZZ $334.00 $230.00 $245.00 $261.00 $149.00 $158.00 $169.00 15260 90 $841.00 $1,170.00 $1,229.00 $1,290.00 $1,037.00 $1,087.00 $1,140.00 15261 ZZZ $207.00 $263.00 $279.00 $295.00 $185.00 $195.00 $207.00 15300 90 ------- $423.00 $447.00 $476.00 $366.00 $387.00 $412.00 15301 ZZZ ------- $81.00 $86.00 $93.00 $76.00 $81.00 $87.00 15320 90 ------- $483.00 $511.00 $544.00 $420.00 $444.00 $474.00 15321 ZZZ ------- $122.00 $129.00 $140.00 $115.00 $122.00 $132.00 15330 90 ------- $393.00 $417.00 $446.00 $335.00 $355.00 $381.00 15331 ZZZ ------- $82.00 $87.00 $94.00 $77.00 $82.00 $89.00 15335 90 ------- $425.00 $451.00 $482.00 $366.00 $388.00 $416.00 15336 ZZZ ------- $119.00 $126.00 $136.00 $110.00 $117.00 $127.00 15340 10 ------- $401.00 $425.00 $452.00 $344.00 $364.00 $388.00 15341 ZZZ ------- $59.00 $63.00 $67.00 $37.00 $39.00 $42.00 15360 90 ------- $451.00 $479.00 $510.00 $384.00 $407.00 $433.00 15361 ZZZ ------- $92.00 $97.00 $105.00 $84.00 $89.00 $96.00 15365 90 ------- $453.00 $481.00 $511.00 $392.00 $415.00 $442.00 15366 ZZZ ------- $116.00 $122.00 $131.00 $108.00 $114.00 $123.00 15400 90 $223.00 $468.00 $496.00 $528.00 $437.00 $463.00 $493.00 15401 ZZZ $66.00 $130.00 $139.00 $149.00 $78.00 $82.00 $89.00 15420 90 ------- $526.00 $558.00 $593.00 $470.00 $497.00 $530.00 15421 ZZZ ------- $149.00 $159.00 $171.00 $115.00 $122.00 $132.00 15430 90 ------- $668.00 $709.00 $755.00 $648.00 $687.00 $731.00 15570 90 $748.00 $1,111.00 $1,183.00 $1,267.00 $902.00 $959.00 $1,031.00 15572 90 $721.00 $1,043.00 $1,108.00 $1,184.00 $890.00 $943.00 $1,010.00 15574 90 $775.00 $1,120.00 $1,188.00 $1,266.00 $960.00 $1,017.00 $1,086.00 15576 90 $457.00 $989.00 $1,046.00 $1,108.00 $838.00 $884.00 $938.00 15600 90 $259.00 $436.00 $466.00 $495.00 $259.00 $276.00 $295.00 15610 90 $320.00 $400.00 $427.00 $456.00 $305.00 $326.00 $349.00 15620 90 $506.00 $554.00 $588.00 $623.00 $392.00 $415.00 $440.00 15630 90 $362.00 $565.00 $599.00 $633.00 $424.00 $448.00 $473.00 15650 90 $427.00 $612.00 $648.00 $686.00 $466.00 $492.00 $521.00 15731 90 ------- $1,359.00 $1,434.00 $1,519.00 $1,231.00 $1,297.00 $1,375.00 15732 90 $1,465.00 $1,901.00 $2,011.00 $2,137.00 $1,666.00 $1,759.00 $1,872.00 15734 90 $1,557.00 $1,974.00 $2,101.00 $2,254.00 $1,735.00 $1,845.00 $1,983.00 15736 90 $1,862.00 $1,780.00 $1,899.00 $2,042.00 $1,510.00 $1,610.00 $1,737.00 15738 90 $1,415.00 $1,893.00 $2,017.00 $2,168.00 $1,647.00 $1,754.00 $1,891.00 15740 90 $913.00 $1,186.00 $1,244.00 $1,304.00 $1,035.00 $1,083.00 $1,133.00 15750 90 $1,064.00 $1,158.00 $1,226.00 $1,308.00 $1,158.00 $1,226.00 $1,308.00 15756 90 $2,892.00 $3,070.00 $3,257.00 $3,496.00 $3,070.00 $3,257.00 $3,496.00 15757 90 $2,892.00 $3,031.00 $3,201.00 $3,412.00 $3,031.00 $3,201.00 $3,412.00 15758 90 $2,884.00 $3,038.00 $3,216.00 $3,440.00 $3,038.00 $3,216.00 $3,440.00 15760 90 $810.00 $1,033.00 $1,091.00 $1,154.00 $880.00 $927.00 $981.00 15770 90 $674.00 $826.00 $877.00 $937.00 $826.00 $877.00 $937.00 15775 0 $327.00 $405.00 $431.00 $462.00 $290.00 $307.00 $332.00 15776 0 $475.00 $572.00 $609.00 $652.00 $440.00 $467.00 $503.00 15780 90 $532.00 $1,021.00 $1,079.00 $1,139.00 $822.00 $865.00 $913.00 15781 90 $420.00 $647.00 $684.00 $720.00 $533.00 $561.00 $590.00 15782 90 $314.00 $696.00 $738.00 $778.00 $520.00 $549.00 $579.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 140
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 15783 90 $340.00 $595.00 $629.00 $661.00 $454.00 $478.00 $502.00 15786 10 $146.00 $287.00 $302.00 $317.00 $169.00 $177.00 $185.00 15787 ZZZ $27.00 $67.00 $71.00 $75.00 $25.00 $26.00 $28.00 15788 90 $194.00 $511.00 $543.00 $571.00 $287.00 $302.00 $317.00 15789 90 $360.00 $684.00 $720.00 $754.00 $512.00 $536.00 $560.00 15792 90 $130.00 $499.00 $531.00 $560.00 $324.00 $343.00 $361.00 15793 90 $232.00 $554.00 $585.00 $613.00 $426.00 $447.00 $469.00 15819 90 $780.00 $914.00 $963.00 $1,022.00 $914.00 $963.00 $1,022.00 15820 90 $556.00 $651.00 $685.00 $721.00 $586.00 $616.00 $647.00 15821 90 $607.00 $696.00 $732.00 $770.00 $623.00 $654.00 $688.00 15822 90 $499.00 $517.00 $547.00 $577.00 $455.00 $480.00 $507.00 15823 90 $718.00 $802.00 $842.00 $884.00 $734.00 $769.00 $807.00 15824 0 NC BR BR BR BR BR BR 15825 0 NC BR BR BR BR BR BR 15826 0 NC BR BR BR BR BR BR 15828 0 NC BR BR BR BR BR BR 15829 0 NC BR BR BR BR BR BR 15830 90 ------- $1,517.00 $1,626.00 $1,770.00 $1,517.00 $1,626.00 $1,770.00 15832 90 $926.00 $1,141.00 $1,213.00 $1,303.00 $1,141.00 $1,213.00 $1,303.00 15833 90 $833.00 $1,060.00 $1,126.00 $1,208.00 $1,060.00 $1,126.00 $1,208.00 15834 90 $837.00 $1,086.00 $1,155.00 $1,242.00 $1,086.00 $1,155.00 $1,242.00 15835 90 $865.00 $1,112.00 $1,180.00 $1,266.00 $1,112.00 $1,180.00 $1,266.00 15836 90 $721.00 $936.00 $994.00 $1,067.00 $936.00 $994.00 $1,067.00 15837 90 $696.00 $964.00 $1,025.00 $1,097.00 $862.00 $916.00 $982.00 15838 90 $600.00 $713.00 $748.00 $788.00 $713.00 $748.00 $788.00 15839 90 $643.00 $1,046.00 $1,110.00 $1,186.00 $903.00 $957.00 $1,024.00 15840 90 $1,187.00 $1,270.00 $1,337.00 $1,417.00 $1,270.00 $1,337.00 $1,417.00 15841 90 $1,859.00 $2,122.00 $2,237.00 $2,379.00 $2,122.00 $2,237.00 $2,379.00 15842 90 $3,099.00 $3,397.00 $3,601.00 $3,859.00 $3,397.00 $3,601.00 $3,859.00 15845 90 $1,116.00 $1,165.00 $1,217.00 $1,275.00 $1,165.00 $1,217.00 $1,275.00 15850 0 $63.00 $110.00 $116.00 $122.00 $53.00 $55.00 $58.00 15851 0 $40.00 $121.00 $128.00 $134.00 $59.00 $61.00 $64.00 15852 0 $35.00 $62.00 $65.00 $70.00 $62.00 $65.00 $70.00 15860 0 $151.00 $149.00 $158.00 $171.00 $149.00 $158.00 $171.00 15876 0 NC BR BR BR BR BR BR 15877 0 NC BR BR BR BR BR BR 15878 0 NC BR BR BR BR BR BR 15879 0 NC BR BR BR BR BR BR 15920 90 $571.00 $738.00 $784.00 $840.00 $738.00 $784.00 $840.00 15922 90 $771.00 $952.00 $1,014.00 $1,091.00 $952.00 $1,014.00 $1,091.00 15931 90 $638.00 $848.00 $900.00 $966.00 $848.00 $900.00 $966.00 15933 90 $860.00 $1,044.00 $1,109.00 $1,192.00 $1,044.00 $1,109.00 $1,192.00 15934 90 $1,064.00 $1,171.00 $1,245.00 $1,339.00 $1,171.00 $1,245.00 $1,339.00 15935 90 $1,184.00 $1,385.00 $1,474.00 $1,585.00 $1,385.00 $1,474.00 $1,585.00 15936 90 $1,032.00 $1,143.00 $1,216.00 $1,309.00 $1,143.00 $1,216.00 $1,309.00 15937 90 $1,223.00 $1,337.00 $1,423.00 $1,532.00 $1,337.00 $1,423.00 $1,532.00 15940 90 $318.00 $878.00 $932.00 $1,002.00 $878.00 $932.00 $1,002.00 15941 90 $919.00 $1,153.00 $1,227.00 $1,319.00 $1,153.00 $1,227.00 $1,319.00 15944 90 $954.00 $1,125.00 $1,197.00 $1,286.00 $1,125.00 $1,197.00 $1,286.00 15945 90 $1,078.00 $1,245.00 $1,325.00 $1,425.00 $1,245.00 $1,325.00 $1,425.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 141
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 15946 90 $1,737.00 $2,071.00 $2,201.00 $2,367.00 $2,071.00 $2,201.00 $2,367.00 15950 90 $549.00 $725.00 $770.00 $827.00 $725.00 $770.00 $827.00 15951 90 $872.00 $1,034.00 $1,099.00 $1,180.00 $1,034.00 $1,099.00 $1,180.00 15952 90 $876.00 $1,077.00 $1,145.00 $1,230.00 $1,077.00 $1,145.00 $1,230.00 15953 90 $1,013.00 $1,202.00 $1,279.00 $1,375.00 $1,202.00 $1,279.00 $1,375.00 15956 90 $1,382.00 $1,463.00 $1,556.00 $1,673.00 $1,463.00 $1,556.00 $1,673.00 15958 90 $1,379.00 $1,493.00 $1,589.00 $1,709.00 $1,493.00 $1,589.00 $1,709.00 15999 YYY BR ------- ------- ------- ------- ------- ------- 16000 0 $53.00 $87.00 $92.00 $98.00 $60.00 $63.00 $67.00 16020 0 $49.00 $104.00 $110.00 $117.00 $72.00 $76.00 $81.00 16025 0 $67.00 $185.00 $196.00 $209.00 $147.00 $156.00 $166.00 16030 0 $153.00 $223.00 $237.00 $252.00 $170.00 $180.00 $193.00 16035 0 $341.00 $282.00 $299.00 $321.00 $282.00 $299.00 $321.00 16036 ZZZ $81.00 $113.00 $120.00 $129.00 $113.00 $120.00 $129.00 17000 10 $60.00 $91.00 $96.00 $101.00 $64.00 $67.00 $70.00 17003 ZZZ $16.00 $9.00 $10.00 $11.00 $6.00 $7.00 $7.00 17004 10 $233.00 $212.00 $224.00 $235.00 $168.00 $176.00 $185.00 17106 90 $341.00 $477.00 $503.00 $530.00 $410.00 $431.00 $454.00 17107 90 $648.00 $836.00 $877.00 $923.00 $741.00 $776.00 $816.00 17108 90 $1,015.00 $1,117.00 $1,163.00 $1,211.00 $1,015.00 $1,054.00 $1,095.00 17110 10 $55.00 $120.00 $128.00 $135.00 $75.00 $79.00 $83.00 17111 10 $83.00 $146.00 $154.00 $162.00 $96.00 $101.00 $106.00 17250 0 $27.00 $92.00 $98.00 $104.00 $46.00 $49.00 $52.00 17260 10 $96.00 $114.00 $120.00 $125.00 $81.00 $85.00 $88.00 17261 10 $117.00 $162.00 $171.00 $179.00 $107.00 $112.00 $117.00 17262 10 $150.00 $198.00 $208.00 $217.00 $137.00 $143.00 $149.00 17263 10 $172.00 $218.00 $229.00 $239.00 $152.00 $158.00 $164.00 17264 10 $189.00 $236.00 $248.00 $259.00 $163.00 $169.00 $176.00 17266 10 $225.00 $268.00 $281.00 $293.00 $188.00 $195.00 $203.00 17270 10 $125.00 $170.00 $179.00 $187.00 $116.00 $121.00 $125.00 17271 10 $143.00 $187.00 $196.00 $205.00 $131.00 $136.00 $142.00 17272 10 $170.00 $214.00 $225.00 $235.00 $152.00 $158.00 $164.00 17273 10 $195.00 $239.00 $251.00 $262.00 $171.00 $178.00 $185.00 17274 10 $240.00 $285.00 $299.00 $312.00 $210.00 $218.00 $227.00 17276 10 $281.00 $335.00 $351.00 $368.00 $255.00 $266.00 $277.00 17280 10 $123.00 $159.00 $168.00 $176.00 $106.00 $110.00 $115.00 17281 10 $165.00 $203.00 $213.00 $223.00 $148.00 $154.00 $160.00 17282 10 $194.00 $235.00 $247.00 $258.00 $171.00 $178.00 $185.00 17283 10 $239.00 $286.00 $300.00 $313.00 $215.00 $224.00 $233.00 17284 10 $282.00 $334.00 $350.00 $365.00 $256.00 $266.00 $277.00 17286 10 $373.00 $430.00 $450.00 $471.00 $351.00 $365.00 $382.00 17311 0 ------- $845.00 $890.00 $930.00 $463.00 $480.00 $498.00 17312 ZZZ ------- $510.00 $538.00 $563.00 $246.00 $256.00 $265.00 17313 0 ------- $772.00 $813.00 $851.00 $416.00 $431.00 $448.00 17314 ZZZ ------- $471.00 $497.00 $520.00 $228.00 $236.00 $245.00 17315 ZZZ ------- $100.00 $105.00 $110.00 $65.00 $67.00 $70.00 17340 10 $37.00 $58.00 $60.00 $63.00 $58.00 $61.00 $64.00 17360 10 $96.00 $155.00 $162.00 $170.00 $119.00 $124.00 $129.00 17380 0 NC BR BR BR BR BR BR 17999 YYY BR ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part B, 142
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 19000 0 $74.00 $143.00 $152.00 $161.00 $60.00 $63.00 $67.00 19001 ZZZ $40.00 $35.00 $37.00 $40.00 $30.00 $31.00 $33.00 19020 90 $288.00 $535.00 $569.00 $606.00 $354.00 $376.00 $402.00 19030 0 $98.00 $218.00 $230.00 $241.00 $105.00 $109.00 $114.00 19100 0 $117.00 $176.00 $188.00 $200.00 $91.00 $96.00 $104.00 19101 10 $338.00 $403.00 $429.00 $457.00 $274.00 $290.00 $311.00 19102 0 $263.00 $287.00 $304.00 $320.00 $138.00 $144.00 $152.00 19103 0 $601.00 $737.00 $783.00 $826.00 $258.00 $270.00 $285.00 19105 0 ------- $2,521.00 $2,695.00 $2,843.00 $247.00 $258.00 $273.00 19110 90 $406.00 $546.00 $581.00 $621.00 $398.00 $423.00 $455.00 19112 90 $354.00 $520.00 $554.00 $591.00 $358.00 $381.00 $408.00 19120 90 $429.00 $572.00 $608.00 $651.00 $492.00 $522.00 $561.00 19125 90 $468.00 $631.00 $670.00 $717.00 $546.00 $579.00 $621.00 19126 ZZZ $201.00 $211.00 $224.00 $241.00 $211.00 $224.00 $241.00 19260 90 $1,101.00 $1,528.00 $1,621.00 $1,736.00 $1,528.00 $1,621.00 $1,736.00 19271 90 $1,561.00 $2,080.00 $2,207.00 $2,360.00 $2,080.00 $2,207.00 $2,360.00 19272 90 $1,674.00 $2,301.00 $2,441.00 $2,612.00 $2,301.00 $2,441.00 $2,612.00 19290 0 $101.00 $209.00 $221.00 $232.00 $87.00 $90.00 $94.00 19291 ZZZ $52.00 $91.00 $96.00 $101.00 $43.00 $45.00 $47.00 19295 ZZZ $103.00 $125.00 $134.00 $142.00 $125.00 $134.00 $142.00 19296 0 ------- $5,483.00 $5,870.00 $6,194.00 $267.00 $281.00 $299.00 19297 ZZZ ------- $121.00 $127.00 $136.00 $121.00 $127.00 $136.00 19298 0 ------- $1,919.00 $2,045.00 $2,156.00 $429.00 $448.00 $471.00 19300 90 ------- $679.00 $723.00 $773.00 $480.00 $511.00 $549.00 19301 90 ------- $733.00 $768.00 $811.00 $733.00 $768.00 $811.00 19302 90 ------- $1,106.00 $1,174.00 $1,263.00 $1,106.00 $1,174.00 $1,263.00 19303 90 ------- $1,130.00 $1,181.00 $1,245.00 $1,130.00 $1,181.00 $1,245.00 19304 90 ------- $692.00 $735.00 $791.00 $692.00 $735.00 $791.00 19305 90 ------- $1,364.00 $1,442.00 $1,541.00 $1,364.00 $1,442.00 $1,541.00 19306 90 ------- $1,427.00 $1,510.00 $1,617.00 $1,427.00 $1,510.00 $1,617.00 19307 90 ------- $1,436.00 $1,521.00 $1,629.00 $1,436.00 $1,521.00 $1,629.00 19316 90 $954.00 $1,007.00 $1,075.00 $1,160.00 $1,007.00 $1,075.00 $1,160.00 19318 90 $1,313.00 $1,506.00 $1,618.00 $1,765.00 $1,506.00 $1,618.00 $1,765.00 19324 90 $440.00 $613.00 $651.00 $698.00 $613.00 $651.00 $698.00 19325 90 $656.00 $829.00 $886.00 $957.00 $829.00 $886.00 $957.00 19328 90 $457.00 $621.00 $662.00 $712.00 $621.00 $662.00 $712.00 19330 90 $569.00 $794.00 $847.00 $914.00 $794.00 $847.00 $914.00 19340 ZZZ $545.00 $529.00 $567.00 $617.00 $529.00 $567.00 $617.00 19342 90 $963.00 $1,175.00 $1,253.00 $1,352.00 $1,175.00 $1,253.00 $1,352.00 19350 90 $853.00 $1,127.00 $1,206.00 $1,296.00 $878.00 $938.00 $1,014.00 19355 90 $755.00 $907.00 $962.00 $1,024.00 $700.00 $740.00 $790.00 19357 90 $1,449.00 $1,974.00 $2,104.00 $2,265.00 $1,974.00 $2,104.00 $2,265.00 19361 90 $1,667.00 $2,051.00 $2,177.00 $2,336.00 $2,051.00 $2,177.00 $2,336.00 19364 90 $2,737.00 $3,629.00 $3,869.00 $4,182.00 $3,629.00 $3,869.00 $4,182.00 19366 90 $1,676.00 $1,814.00 $1,935.00 $2,094.00 $1,814.00 $1,935.00 $2,094.00 19367 90 $2,056.00 $2,366.00 $2,526.00 $2,732.00 $2,366.00 $2,526.00 $2,732.00 19368 90 $2,444.00 $2,941.00 $3,148.00 $3,420.00 $2,941.00 $3,148.00 $3,420.00 19369 90 $2,317.00 $2,683.00 $2,859.00 $3,088.00 $2,683.00 $2,859.00 $3,088.00 19370 90 $662.00 $867.00 $924.00 $995.00 $867.00 $924.00 $995.00 19371 90 $788.00 $1,006.00 $1,075.00 $1,161.00 $1,006.00 $1,075.00 $1,161.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 143
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 19380 90 $780.00 $976.00 $1,040.00 $1,119.00 $976.00 $1,040.00 $1,119.00 19396 0 $231.00 $266.00 $284.00 $304.00 $183.00 $194.00 $209.00 19499 YYY BR ------- ------- ------- ------- ------- ------- 20000 10 $45.00 $257.00 $273.00 $291.00 $202.00 $214.00 $228.00 20005 10 $267.00 $382.00 $407.00 $435.00 $310.00 $329.00 $353.00 20100 10 $727.00 $782.00 $827.00 $887.00 $782.00 $827.00 $887.00 20101 10 $261.00 $499.00 $533.00 $568.00 $265.00 $282.00 $304.00 20102 10 $314.00 $585.00 $623.00 $663.00 $318.00 $337.00 $362.00 20103 10 $405.00 $719.00 $767.00 $821.00 $463.00 $494.00 $532.00 20150 90 $1,141.00 $1,214.00 $1,292.00 $1,394.00 $1,214.00 $1,292.00 $1,394.00 20200 0 $134.00 $240.00 $257.00 $275.00 $123.00 $131.00 $143.00 20205 0 $243.00 $329.00 $352.00 $376.00 $194.00 $206.00 $222.00 20206 0 $119.00 $345.00 $367.00 $387.00 $82.00 $86.00 $90.00 20220 0 $128.00 $247.00 $262.00 $276.00 $103.00 $107.00 $112.00 20225 0 $215.00 $1,016.00 $1,087.00 $1,149.00 $159.00 $169.00 $181.00 20240 10 $279.00 $302.00 $321.00 $345.00 $302.00 $321.00 $345.00 20245 10 $364.00 $823.00 $879.00 $948.00 $823.00 $879.00 $948.00 20250 10 $447.00 $501.00 $540.00 $591.00 $501.00 $540.00 $591.00 20251 10 $511.00 $558.00 $602.00 $659.00 $558.00 $602.00 $659.00 20500 10 $59.00 $158.00 $168.00 $178.00 $128.00 $135.00 $144.00 20501 0 $60.00 $171.00 $181.00 $191.00 $52.00 $54.00 $56.00 20520 10 $75.00 $243.00 $258.00 $274.00 $185.00 $196.00 $209.00 20525 10 $331.00 $611.00 $653.00 $697.00 $326.00 $348.00 $375.00 20526 0 $64.00 $99.00 $106.00 $113.00 $78.00 $83.00 $89.00 20550 0 $40.00 $76.00 $80.00 $86.00 $55.00 $59.00 $63.00 20551 0 $62.00 $75.00 $79.00 $84.00 $57.00 $60.00 $64.00 20552 0 $62.00 $67.00 $71.00 $75.00 $46.00 $48.00 $51.00 20553 0 $62.00 $75.00 $78.00 $82.00 $50.00 $52.00 $55.00 20555 0 ------- $425.00 $443.00 $467.00 $425.00 $443.00 $467.00 20600 0 $41.00 $70.00 $75.00 $80.00 $54.00 $57.00 $61.00 20605 0 $48.00 $76.00 $81.00 $86.00 $55.00 $59.00 $63.00 20610 0 $49.00 $97.00 $103.00 $110.00 $67.00 $71.00 $76.00 20612 0 $56.00 $76.00 $81.00 $87.00 $58.00 $62.00 $67.00 20615 10 $94.00 $280.00 $296.00 $313.00 $206.00 $216.00 $229.00 20650 10 $170.00 $251.00 $267.00 $286.00 $205.00 $218.00 $235.00 20660 0 $320.00 $348.00 $372.00 $401.00 $312.00 $332.00 $360.00 20661 90 $476.00 $606.00 $654.00 $715.00 $606.00 $654.00 $715.00 20662 90 $559.00 $597.00 $629.00 $666.00 $597.00 $629.00 $666.00 20663 90 $465.00 $580.00 $622.00 $673.00 $580.00 $622.00 $673.00 20665 10 $105.00 $165.00 $177.00 $189.00 $135.00 $144.00 $155.00 20670 10 $80.00 $559.00 $598.00 $636.00 $199.00 $213.00 $230.00 20680 90 $332.00 $745.00 $789.00 $836.00 $516.00 $544.00 $578.00 20690 90 $298.00 $639.00 $667.00 $701.00 $639.00 $667.00 $701.00 20692 90 $516.00 $1,174.00 $1,225.00 $1,286.00 $1,174.00 $1,225.00 $1,286.00 20693 90 $477.00 $607.00 $649.00 $702.00 $607.00 $649.00 $702.00 20694 90 $421.00 $565.00 $605.00 $651.00 $443.00 $474.00 $513.00 20802 90 $3,363.00 $3,144.00 $3,302.00 $3,502.00 $3,144.00 $3,302.00 $3,502.00 20805 90 $4,317.00 $4,093.00 $4,310.00 $4,577.00 $4,093.00 $4,310.00 $4,577.00 20808 90 $5,324.00 $5,307.00 $5,611.00 $5,988.00 $5,307.00 $5,611.00 $5,988.00 20816 90 $3,060.00 $3,203.00 $3,415.00 $3,673.00 $3,203.00 $3,415.00 $3,673.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 144
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 20822 90 $2,511.00 $2,815.00 $3,010.00 $3,247.00 $2,815.00 $3,010.00 $3,247.00 20824 90 $3,027.00 $3,176.00 $3,387.00 $3,646.00 $3,176.00 $3,387.00 $3,646.00 20827 90 $3,920.00 $2,851.00 $3,035.00 $3,255.00 $2,851.00 $3,035.00 $3,255.00 20838 90 $3,484.00 $2,995.00 $3,088.00 $3,185.00 $2,995.00 $3,088.00 $3,185.00 20900 90 $454.00 $787.00 $842.00 $905.00 $610.00 $653.00 $705.00 20902 90 $658.00 $799.00 $855.00 $925.00 $799.00 $855.00 $925.00 20910 90 $338.00 $554.00 $589.00 $632.00 $554.00 $589.00 $632.00 20912 90 $549.00 $624.00 $661.00 $704.00 $624.00 $661.00 $704.00 20920 90 $460.00 $521.00 $553.00 $591.00 $521.00 $553.00 $591.00 20922 90 $634.00 $754.00 $799.00 $848.00 $623.00 $658.00 $700.00 20924 90 $583.00 $663.00 $709.00 $766.00 $663.00 $709.00 $766.00 20926 90 $444.00 $568.00 $606.00 $654.00 $568.00 $606.00 $654.00 20930 0 BR ------- ------- ------- ------- ------- ------- 20931 ZZZ $156.00 $159.00 $173.00 $192.00 $159.00 $173.00 $192.00 20936 0 BR ------- ------- ------- ------- ------- ------- 20937 ZZZ $234.00 $237.00 $255.00 $280.00 $237.00 $255.00 $280.00 20938 ZZZ $257.00 $260.00 $281.00 $310.00 $260.00 $281.00 $310.00 20950 0 $123.00 $352.00 $377.00 $401.00 $122.00 $130.00 $141.00 20955 90 $3,332.00 $3,338.00 $3,539.00 $3,795.00 $3,338.00 $3,539.00 $3,795.00 20956 90 $3,167.00 $3,607.00 $3,866.00 $4,208.00 $3,607.00 $3,866.00 $4,208.00 20957 90 $3,074.00 $3,420.00 $3,661.00 $3,990.00 $3,420.00 $3,661.00 $3,990.00 20962 90 $3,122.00 $3,558.00 $3,811.00 $4,139.00 $3,558.00 $3,811.00 $4,139.00 20969 90 $3,716.00 $3,692.00 $3,899.00 $4,158.00 $3,692.00 $3,899.00 $4,158.00 20970 90 $3,650.00 $3,761.00 $4,012.00 $4,340.00 $3,761.00 $4,012.00 $4,340.00 20972 90 $3,420.00 $3,384.00 $3,583.00 $3,844.00 $3,384.00 $3,583.00 $3,844.00 20973 90 $3,821.00 $3,629.00 $3,840.00 $4,116.00 $3,629.00 $3,840.00 $4,116.00 20974 0 $266.00 $80.00 $85.00 $92.00 $64.00 $68.00 $74.00 20975 0 $334.00 $242.00 $260.00 $285.00 $242.00 $260.00 $285.00 20979 0 $19.00 $72.00 $77.00 $82.00 $50.00 $53.00 $58.00 20982 0 ------- $5,135.00 $5,491.00 $5,797.00 $537.00 $565.00 $601.00 20985 ZZZ ------- $205.00 $221.00 $242.00 $205.00 $221.00 $242.00 20999 YYY BR ------- ------- ------- ------- ------- ------- 21010 90 $854.00 $934.00 $986.00 $1,050.00 $934.00 $986.00 $1,050.00 21015 90 $520.00 $551.00 $585.00 $626.00 $551.00 $585.00 $626.00 21025 90 $546.00 $1,244.00 $1,322.00 $1,410.00 $1,077.00 $1,143.00 $1,221.00 21026 90 $413.00 $725.00 $770.00 $818.00 $614.00 $651.00 $693.00 21029 90 $700.00 $935.00 $993.00 $1,058.00 $801.00 $849.00 $905.00 21030 90 $496.00 $606.00 $644.00 $685.00 $511.00 $542.00 $578.00 21031 90 $310.00 $468.00 $500.00 $535.00 $369.00 $393.00 $423.00 21032 90 $315.00 $476.00 $508.00 $544.00 $363.00 $388.00 $416.00 21034 90 $1,140.00 $1,689.00 $1,786.00 $1,898.00 $1,512.00 $1,597.00 $1,698.00 21040 90 $227.00 $608.00 $646.00 $687.00 $502.00 $533.00 $568.00 21044 90 $957.00 $1,117.00 $1,177.00 $1,247.00 $1,117.00 $1,177.00 $1,247.00 21045 90 $1,313.00 $1,551.00 $1,631.00 $1,725.00 $1,551.00 $1,631.00 $1,725.00 21046 90 $899.00 $1,388.00 $1,477.00 $1,585.00 $1,388.00 $1,477.00 $1,585.00 21047 90 $1,109.00 $1,691.00 $1,787.00 $1,906.00 $1,691.00 $1,787.00 $1,906.00 21048 90 $925.00 $1,408.00 $1,495.00 $1,599.00 $1,408.00 $1,495.00 $1,599.00 21049 90 $1,051.00 $1,605.00 $1,687.00 $1,783.00 $1,605.00 $1,687.00 $1,783.00 21050 90 $1,026.00 $1,100.00 $1,168.00 $1,252.00 $1,100.00 $1,168.00 $1,252.00 21060 90 $972.00 $1,017.00 $1,080.00 $1,157.00 $1,017.00 $1,080.00 $1,157.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 145
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 21070 90 $679.00 $834.00 $891.00 $960.00 $834.00 $891.00 $960.00 21073 90 ------- $465.00 $496.00 $529.00 $306.00 $325.00 $349.00 21076 10 $1,192.00 $1,297.00 $1,384.00 $1,493.00 $1,155.00 $1,232.00 $1,332.00 21077 90 $3,002.00 $3,188.00 $3,393.00 $3,645.00 $2,890.00 $3,074.00 $3,309.00 21079 90 $2,086.00 $2,185.00 $2,329.00 $2,505.00 $1,930.00 $2,055.00 $2,216.00 21080 90 $2,346.00 $2,490.00 $2,658.00 $2,865.00 $2,184.00 $2,330.00 $2,519.00 21081 90 $2,138.00 $2,260.00 $2,409.00 $2,590.00 $1,975.00 $2,102.00 $2,267.00 21082 90 $1,855.00 $2,082.00 $2,222.00 $2,395.00 $1,826.00 $1,948.00 $2,106.00 21083 90 $1,802.00 $1,977.00 $2,110.00 $2,273.00 $1,689.00 $1,802.00 $1,949.00 21084 90 $2,105.00 $2,211.00 $2,337.00 $2,481.00 $1,896.00 $1,999.00 $2,124.00 21085 10 $801.00 $903.00 $963.00 $1,035.00 $780.00 $831.00 $896.00 21086 90 $2,333.00 $2,380.00 $2,540.00 $2,740.00 $2,161.00 $2,305.00 $2,492.00 21087 90 $2,217.00 $2,350.00 $2,503.00 $2,692.00 $2,136.00 $2,273.00 $2,449.00 21088 90 BR ------- ------- ------- ------- ------- ------- 21089 90 BR ------- ------- ------- ------- ------- ------- 21100 90 $297.00 $901.00 $957.00 $1,009.00 $498.00 $525.00 $554.00 21110 90 $371.00 $895.00 $953.00 $1,015.00 $782.00 $832.00 $887.00 21116 0 $207.00 $214.00 $227.00 $240.00 $57.00 $59.00 $62.00 21120 90 $500.00 $787.00 $839.00 $892.00 $635.00 $675.00 $720.00 21121 90 $651.00 $942.00 $1,001.00 $1,067.00 $818.00 $869.00 $927.00 21122 90 $700.00 $915.00 $972.00 $1,040.00 $915.00 $972.00 $1,040.00 21123 90 $903.00 $1,084.00 $1,151.00 $1,232.00 $1,084.00 $1,151.00 $1,232.00 21125 90 $656.00 $3,543.00 $3,776.00 $3,982.00 $933.00 $979.00 $1,032.00 21127 90 $909.00 $3,890.00 $4,157.00 $4,404.00 $1,119.00 $1,188.00 $1,273.00 21137 90 $797.00 $959.00 $1,020.00 $1,094.00 $959.00 $1,020.00 $1,094.00 21138 90 $960.00 $1,169.00 $1,245.00 $1,339.00 $1,169.00 $1,245.00 $1,339.00 21139 90 $1,168.00 $1,244.00 $1,307.00 $1,380.00 $1,244.00 $1,307.00 $1,380.00 21141 90 $1,438.00 $1,730.00 $1,835.00 $1,966.00 $1,730.00 $1,835.00 $1,966.00 21142 90 $1,527.00 $1,700.00 $1,802.00 $1,930.00 $1,700.00 $1,802.00 $1,930.00 21143 90 $1,511.00 $1,758.00 $1,847.00 $1,951.00 $1,758.00 $1,847.00 $1,951.00 21145 90 $1,513.00 $2,008.00 $2,128.00 $2,280.00 $2,008.00 $2,128.00 $2,280.00 21146 90 $1,570.00 $2,011.00 $2,133.00 $2,291.00 $2,011.00 $2,133.00 $2,291.00 21147 90 $1,639.00 $2,108.00 $2,207.00 $2,323.00 $2,108.00 $2,207.00 $2,323.00 21150 90 $1,914.00 $2,256.00 $2,381.00 $2,531.00 $2,256.00 $2,381.00 $2,531.00 21151 90 $2,264.00 $2,402.00 $2,522.00 $2,664.00 $2,402.00 $2,522.00 $2,664.00 21154 90 $2,364.00 $2,681.00 $2,817.00 $2,975.00 $2,681.00 $2,817.00 $2,975.00 21155 90 $2,640.00 $3,222.00 $3,467.00 $3,790.00 $3,222.00 $3,467.00 $3,790.00 21159 90 $3,302.00 $3,771.00 $4,058.00 $4,445.00 $3,771.00 $4,058.00 $4,445.00 21160 90 $3,500.00 $3,801.00 $3,996.00 $4,234.00 $3,801.00 $3,996.00 $4,234.00 21172 90 $2,111.00 $2,288.00 $2,427.00 $2,608.00 $2,288.00 $2,427.00 $2,608.00 21175 90 $2,604.00 $2,737.00 $2,916.00 $3,152.00 $2,737.00 $2,916.00 $3,152.00 21179 90 $1,826.00 $1,915.00 $2,031.00 $2,179.00 $1,915.00 $2,031.00 $2,179.00 21180 90 $2,035.00 $2,182.00 $2,321.00 $2,500.00 $2,182.00 $2,321.00 $2,500.00 21181 90 $813.00 $940.00 $999.00 $1,072.00 $940.00 $999.00 $1,072.00 21182 90 $2,570.00 $2,606.00 $2,739.00 $2,900.00 $2,606.00 $2,739.00 $2,900.00 21183 90 $2,770.00 $3,026.00 $3,212.00 $3,447.00 $3,026.00 $3,212.00 $3,447.00 21184 90 $3,150.00 $3,200.00 $3,412.00 $3,693.00 $3,200.00 $3,412.00 $3,693.00 21188 90 $1,786.00 $2,077.00 $2,181.00 $2,299.00 $2,077.00 $2,181.00 $2,299.00 21193 90 $1,331.00 $1,615.00 $1,712.00 $1,833.00 $1,615.00 $1,712.00 $1,833.00 21194 90 $1,540.00 $1,820.00 $1,917.00 $2,035.00 $1,820.00 $1,917.00 $2,035.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 146
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 21195 90 $1,360.00 $1,714.00 $1,805.00 $1,911.00 $1,714.00 $1,805.00 $1,911.00 21196 90 $1,764.00 $1,871.00 $1,977.00 $2,102.00 $1,871.00 $1,977.00 $2,102.00 21198 90 $1,268.00 $1,456.00 $1,536.00 $1,629.00 $1,456.00 $1,536.00 $1,629.00 21199 90 $1,018.00 $1,308.00 $1,373.00 $1,452.00 $1,308.00 $1,373.00 $1,452.00 21206 90 $1,112.00 $1,415.00 $1,491.00 $1,578.00 $1,415.00 $1,491.00 $1,578.00 21208 90 $946.00 $1,997.00 $2,124.00 $2,248.00 $1,050.00 $1,109.00 $1,178.00 21209 90 $576.00 $1,002.00 $1,066.00 $1,135.00 $813.00 $864.00 $922.00 21210 90 $930.00 $2,347.00 $2,502.00 $2,653.00 $1,063.00 $1,127.00 $1,203.00 21215 90 $970.00 $3,880.00 $4,148.00 $4,396.00 $1,115.00 $1,185.00 $1,271.00 21230 90 $956.00 $998.00 $1,058.00 $1,130.00 $998.00 $1,058.00 $1,130.00 21235 90 $707.00 $890.00 $942.00 $995.00 $707.00 $745.00 $787.00 21240 90 $1,281.00 $1,456.00 $1,552.00 $1,672.00 $1,456.00 $1,552.00 $1,672.00 21242 90 $1,207.00 $1,328.00 $1,410.00 $1,510.00 $1,328.00 $1,410.00 $1,510.00 21243 90 $1,501.00 $2,177.00 $2,316.00 $2,490.00 $2,177.00 $2,316.00 $2,490.00 21244 90 $1,062.00 $1,316.00 $1,390.00 $1,474.00 $1,316.00 $1,390.00 $1,474.00 21245 90 $1,038.00 $1,414.00 $1,495.00 $1,584.00 $1,161.00 $1,224.00 $1,298.00 21246 90 $1,010.00 $1,119.00 $1,182.00 $1,260.00 $1,119.00 $1,182.00 $1,260.00 21247 90 $2,003.00 $2,106.00 $2,232.00 $2,387.00 $2,106.00 $2,232.00 $2,387.00 21248 90 $1,023.00 $1,330.00 $1,414.00 $1,511.00 $1,134.00 $1,204.00 $1,290.00 21249 90 $1,525.00 $1,881.00 $2,002.00 $2,148.00 $1,627.00 $1,730.00 $1,861.00 21255 90 $1,459.00 $1,796.00 $1,910.00 $2,049.00 $1,796.00 $1,910.00 $2,049.00 21256 90 $1,470.00 $1,472.00 $1,548.00 $1,638.00 $1,472.00 $1,548.00 $1,638.00 21260 90 $1,372.00 $1,553.00 $1,624.00 $1,699.00 $1,553.00 $1,624.00 $1,699.00 21261 90 $2,347.00 $2,833.00 $2,990.00 $3,182.00 $2,833.00 $2,990.00 $3,182.00 21263 90 $2,361.00 $2,479.00 $2,605.00 $2,757.00 $2,479.00 $2,605.00 $2,757.00 21267 90 $1,539.00 $1,991.00 $2,099.00 $2,219.00 $1,991.00 $2,099.00 $2,219.00 21268 90 $1,946.00 $2,381.00 $2,534.00 $2,727.00 $2,381.00 $2,534.00 $2,727.00 21270 90 $890.00 $1,121.00 $1,180.00 $1,242.00 $880.00 $921.00 $969.00 21275 90 $963.00 $1,032.00 $1,092.00 $1,166.00 $1,032.00 $1,092.00 $1,166.00 21280 90 $571.00 $647.00 $679.00 $712.00 $647.00 $679.00 $712.00 21282 90 $360.00 $430.00 $452.00 $474.00 $430.00 $452.00 $474.00 21295 90 $144.00 $217.00 $229.00 $243.00 $217.00 $229.00 $243.00 21296 90 $384.00 $504.00 $532.00 $560.00 $504.00 $532.00 $560.00 21299 YYY BR ------- ------- ------- ------- ------- ------- 21310 0 $81.00 $138.00 $147.00 $155.00 $38.00 $39.00 $42.00 21315 10 $180.00 $319.00 $338.00 $357.00 $186.00 $196.00 $207.00 21320 10 $235.00 $307.00 $326.00 $345.00 $176.00 $186.00 $198.00 21325 90 $348.00 $605.00 $641.00 $676.00 $605.00 $641.00 $676.00 21330 90 $639.00 $744.00 $789.00 $837.00 $744.00 $789.00 $837.00 21335 90 $852.00 $929.00 $981.00 $1,036.00 $929.00 $981.00 $1,036.00 21336 90 $478.00 $809.00 $855.00 $904.00 $809.00 $855.00 $904.00 21337 90 $300.00 $482.00 $511.00 $540.00 $354.00 $373.00 $395.00 21338 90 $550.00 $981.00 $1,045.00 $1,112.00 $981.00 $1,045.00 $1,112.00 21339 90 $689.00 $1,063.00 $1,130.00 $1,203.00 $1,063.00 $1,130.00 $1,203.00 21340 90 $907.00 $1,015.00 $1,072.00 $1,140.00 $1,015.00 $1,072.00 $1,140.00 21343 90 $1,043.00 $1,486.00 $1,574.00 $1,673.00 $1,486.00 $1,574.00 $1,673.00 21344 90 $1,450.00 $1,936.00 $2,050.00 $2,190.00 $1,936.00 $2,050.00 $2,190.00 21345 90 $738.00 $998.00 $1,057.00 $1,123.00 $833.00 $881.00 $937.00 21346 90 $917.00 $1,202.00 $1,274.00 $1,355.00 $1,202.00 $1,274.00 $1,355.00 21347 90 $1,048.00 $1,442.00 $1,530.00 $1,628.00 $1,442.00 $1,530.00 $1,628.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 147
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 21348 90 $1,286.00 $1,566.00 $1,668.00 $1,799.00 $1,566.00 $1,668.00 $1,799.00 21355 10 $295.00 $533.00 $563.00 $594.00 $398.00 $419.00 $442.00 21356 10 $372.00 $610.00 $646.00 $685.00 $472.00 $499.00 $530.00 21360 90 $590.00 $672.00 $711.00 $757.00 $672.00 $711.00 $757.00 21365 90 $1,239.00 $1,409.00 $1,488.00 $1,584.00 $1,409.00 $1,488.00 $1,584.00 21366 90 $1,386.00 $1,610.00 $1,712.00 $1,843.00 $1,610.00 $1,712.00 $1,843.00 21385 90 $810.00 $906.00 $959.00 $1,019.00 $906.00 $959.00 $1,019.00 21386 90 $812.00 $848.00 $896.00 $953.00 $848.00 $896.00 $953.00 21387 90 $958.00 $966.00 $1,022.00 $1,089.00 $966.00 $1,022.00 $1,089.00 21390 90 $920.00 $962.00 $1,011.00 $1,068.00 $962.00 $1,011.00 $1,068.00 21395 90 $1,384.00 $1,235.00 $1,302.00 $1,385.00 $1,235.00 $1,302.00 $1,385.00 21400 90 $143.00 $213.00 $226.00 $240.00 $176.00 $186.00 $198.00 21401 90 $313.00 $573.00 $610.00 $647.00 $361.00 $382.00 $407.00 21406 90 $852.00 $686.00 $725.00 $770.00 $686.00 $725.00 $770.00 21407 90 $736.00 $812.00 $859.00 $915.00 $812.00 $859.00 $915.00 21408 90 $1,007.00 $1,118.00 $1,183.00 $1,264.00 $1,118.00 $1,183.00 $1,264.00 21421 90 $528.00 $875.00 $932.00 $993.00 $768.00 $818.00 $872.00 21422 90 $761.00 $861.00 $913.00 $974.00 $861.00 $913.00 $974.00 21423 90 $890.00 $1,022.00 $1,084.00 $1,159.00 $1,022.00 $1,084.00 $1,159.00 21431 90 $598.00 $928.00 $983.00 $1,040.00 $928.00 $983.00 $1,040.00 21432 90 $744.00 $847.00 $894.00 $948.00 $847.00 $894.00 $948.00 21433 90 $1,981.00 $2,162.00 $2,284.00 $2,435.00 $2,162.00 $2,284.00 $2,435.00 21435 90 $1,404.00 $1,693.00 $1,786.00 $1,899.00 $1,693.00 $1,786.00 $1,899.00 21436 90 $2,045.00 $2,439.00 $2,574.00 $2,742.00 $2,439.00 $2,574.00 $2,742.00 21440 90 $308.00 $613.00 $654.00 $694.00 $525.00 $558.00 $593.00 21445 90 $533.00 $896.00 $955.00 $1,018.00 $766.00 $816.00 $872.00 21450 90 $325.00 $640.00 $681.00 $720.00 $558.00 $592.00 $627.00 21451 90 $498.00 $865.00 $920.00 $978.00 $758.00 $806.00 $858.00 21452 90 $195.00 $756.00 $807.00 $855.00 $396.00 $422.00 $448.00 21453 90 $902.00 $998.00 $1,062.00 $1,129.00 $919.00 $978.00 $1,040.00 21454 90 $905.00 $701.00 $744.00 $793.00 $701.00 $744.00 $793.00 21461 90 $769.00 $2,158.00 $2,301.00 $2,436.00 $1,140.00 $1,211.00 $1,287.00 21462 90 $1,012.00 $2,371.00 $2,529.00 $2,683.00 $1,259.00 $1,338.00 $1,427.00 21465 90 $923.00 $1,172.00 $1,242.00 $1,327.00 $1,172.00 $1,242.00 $1,327.00 21470 90 $1,331.00 $1,520.00 $1,610.00 $1,720.00 $1,520.00 $1,610.00 $1,720.00 21480 0 $82.00 $116.00 $123.00 $131.00 $43.00 $45.00 $48.00 21485 90 $318.00 $763.00 $812.00 $862.00 $675.00 $717.00 $762.00 21490 90 $865.00 $1,198.00 $1,280.00 $1,384.00 $1,198.00 $1,280.00 $1,384.00 21495 90 $500.00 $816.00 $862.00 $908.00 $816.00 $862.00 $908.00 21497 90 $372.00 $765.00 $815.00 $865.00 $673.00 $716.00 $761.00 21499 YYY BR ------- ------- ------- ------- ------- ------- 21501 90 $315.00 $540.00 $574.00 $610.00 $399.00 $423.00 $451.00 21502 90 $612.00 $681.00 $723.00 $777.00 $681.00 $723.00 $777.00 21510 90 $534.00 $610.00 $649.00 $696.00 $610.00 $649.00 $696.00 21550 10 $165.00 $309.00 $327.00 $345.00 $198.00 $208.00 $219.00 21555 90 $337.00 $533.00 $568.00 $606.00 $416.00 $442.00 $474.00 21556 90 $431.00 $522.00 $553.00 $591.00 $522.00 $553.00 $591.00 21557 90 $794.00 $751.00 $796.00 $853.00 $751.00 $796.00 $853.00 21600 90 $631.00 $706.00 $752.00 $808.00 $706.00 $752.00 $808.00 21610 90 $828.00 $1,429.00 $1,539.00 $1,686.00 $1,429.00 $1,539.00 $1,686.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 148
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 21615 90 $938.00 $896.00 $954.00 $1,028.00 $896.00 $954.00 $1,028.00 21616 90 $1,042.00 $1,100.00 $1,174.00 $1,269.00 $1,100.00 $1,174.00 $1,269.00 21620 90 $689.00 $683.00 $727.00 $781.00 $683.00 $727.00 $781.00 21627 90 $686.00 $714.00 $761.00 $819.00 $714.00 $761.00 $819.00 21630 90 $1,455.00 $1,653.00 $1,758.00 $1,893.00 $1,653.00 $1,758.00 $1,893.00 21632 90 $1,514.00 $1,640.00 $1,745.00 $1,879.00 $1,640.00 $1,745.00 $1,879.00 21685 90 ------- $1,251.00 $1,312.00 $1,381.00 $1,251.00 $1,312.00 $1,381.00 21700 90 $576.00 $539.00 $563.00 $588.00 $539.00 $563.00 $588.00 21705 90 $746.00 $824.00 $878.00 $949.00 $824.00 $878.00 $949.00 21720 90 $523.00 $505.00 $540.00 $586.00 $505.00 $540.00 $586.00 21725 90 $588.00 $694.00 $744.00 $807.00 $694.00 $744.00 $807.00 21740 90 $1,387.00 $1,426.00 $1,516.00 $1,634.00 $1,426.00 $1,516.00 $1,634.00 21742 90 BR ------- ------- ------- ------- ------- ------- 21743 90 BR ------- ------- ------- ------- ------- ------- 21750 90 $1,009.00 $948.00 $1,010.00 $1,091.00 $948.00 $1,010.00 $1,091.00 21800 90 $84.00 $120.00 $128.00 $135.00 $122.00 $129.00 $137.00 21805 90 $236.00 $324.00 $345.00 $369.00 $324.00 $345.00 $369.00 21810 90 $540.00 $658.00 $700.00 $752.00 $658.00 $700.00 $752.00 21820 90 $143.00 $165.00 $176.00 $188.00 $165.00 $176.00 $188.00 21825 90 $810.00 $742.00 $791.00 $852.00 $742.00 $791.00 $852.00 21899 YYY BR ------- ------- ------- ------- ------- ------- 21920 10 $165.00 $302.00 $319.00 $336.00 $193.00 $202.00 $213.00 21925 90 $371.00 $524.00 $558.00 $597.00 $426.00 $453.00 $486.00 21930 90 $403.00 $584.00 $622.00 $665.00 $470.00 $499.00 $536.00 21935 90 $1,280.00 $1,512.00 $1,607.00 $1,731.00 $1,512.00 $1,607.00 $1,731.00 22010 90 ------- $1,159.00 $1,234.00 $1,328.00 $1,159.00 $1,234.00 $1,328.00 22015 90 ------- $1,151.00 $1,225.00 $1,318.00 $1,151.00 $1,225.00 $1,318.00 22100 90 $850.00 $1,070.00 $1,153.00 $1,260.00 $1,070.00 $1,153.00 $1,260.00 22101 90 $862.00 $1,059.00 $1,136.00 $1,234.00 $1,059.00 $1,136.00 $1,234.00 22102 90 $781.00 $1,061.00 $1,137.00 $1,235.00 $1,061.00 $1,137.00 $1,235.00 22103 ZZZ $198.00 $197.00 $212.00 $233.00 $197.00 $212.00 $233.00 22110 90 $889.00 $1,325.00 $1,428.00 $1,564.00 $1,325.00 $1,428.00 $1,564.00 22112 90 $1,090.00 $1,310.00 $1,407.00 $1,533.00 $1,310.00 $1,407.00 $1,533.00 22114 90 $1,062.00 $1,317.00 $1,417.00 $1,548.00 $1,317.00 $1,417.00 $1,548.00 22116 ZZZ $195.00 $200.00 $216.00 $239.00 $200.00 $216.00 $239.00 22206 90 ------- $3,118.00 $3,339.00 $3,636.00 $3,118.00 $3,339.00 $3,636.00 22207 90 ------- $3,076.00 $3,293.00 $3,583.00 $3,076.00 $3,293.00 $3,583.00 22208 ZZZ ------- $804.00 $870.00 $963.00 $804.00 $870.00 $963.00 22210 90 $1,892.00 $2,362.00 $2,555.00 $2,813.00 $2,362.00 $2,555.00 $2,813.00 22212 90 $1,668.00 $1,927.00 $2,072.00 $2,264.00 $1,927.00 $2,072.00 $2,264.00 22214 90 $819.00 $1,945.00 $2,092.00 $2,284.00 $1,945.00 $2,092.00 $2,284.00 22216 ZZZ $492.00 $522.00 $564.00 $623.00 $522.00 $564.00 $623.00 22220 90 $1,801.00 $2,143.00 $2,320.00 $2,560.00 $2,143.00 $2,320.00 $2,560.00 22222 90 $1,604.00 $1,940.00 $2,083.00 $2,277.00 $1,940.00 $2,083.00 $2,277.00 22224 90 $1,731.00 $2,083.00 $2,238.00 $2,442.00 $2,083.00 $2,238.00 $2,442.00 22226 ZZZ $488.00 $520.00 $562.00 $621.00 $520.00 $562.00 $621.00 22305 90 $213.00 $240.00 $258.00 $280.00 $221.00 $238.00 $259.00 22310 90 $272.00 $358.00 $381.00 $409.00 $334.00 $356.00 $383.00 22315 90 $711.00 $1,102.00 $1,184.00 $1,286.00 $982.00 $1,056.00 $1,151.00 22318 90 $1,755.00 $2,145.00 $2,327.00 $2,575.00 $2,145.00 $2,327.00 $2,575.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 149
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 22319 90 $1,983.00 $2,365.00 $2,569.00 $2,849.00 $2,365.00 $2,569.00 $2,849.00 22325 90 $1,407.00 $1,835.00 $1,977.00 $2,165.00 $1,835.00 $1,977.00 $2,165.00 22326 90 $1,710.00 $1,939.00 $2,096.00 $2,306.00 $1,939.00 $2,096.00 $2,306.00 22327 90 $1,660.00 $1,898.00 $2,043.00 $2,237.00 $1,898.00 $2,043.00 $2,237.00 22328 ZZZ $391.00 $391.00 $422.00 $465.00 $391.00 $422.00 $465.00 22505 10 $174.00 $168.00 $180.00 $197.00 $168.00 $180.00 $197.00 22520 10 $509.00 $3,204.00 $3,436.00 $3,659.00 $809.00 $870.00 $952.00 22521 10 $477.00 $3,054.00 $3,275.00 $3,486.00 $763.00 $820.00 $897.00 22522 ZZZ $231.00 $347.00 $373.00 $410.00 $347.00 $373.00 $410.00 22523 10 ------- $833.00 $896.00 $979.00 $833.00 $896.00 $979.00 22524 10 ------- $796.00 $855.00 $933.00 $796.00 $855.00 $933.00 22525 ZZZ ------- $374.00 $402.00 $440.00 $374.00 $402.00 $440.00 22526 10 ------- $2,712.00 $2,909.00 $3,091.00 $480.00 $517.00 $568.00 22527 ZZZ ------- $2,207.00 $2,366.00 $2,507.00 $223.00 $241.00 $265.00 22532 90 ------- $2,272.00 $2,434.00 $2,647.00 $2,272.00 $2,434.00 $2,647.00 22533 90 ------- $2,085.00 $2,214.00 $2,378.00 $2,085.00 $2,214.00 $2,378.00 22534 ZZZ ------- $513.00 $554.00 $611.00 $513.00 $554.00 $611.00 22548 90 $2,271.00 $2,475.00 $2,672.00 $2,938.00 $2,475.00 $2,672.00 $2,938.00 22554 90 $1,727.00 $1,752.00 $1,907.00 $2,116.00 $1,752.00 $1,907.00 $2,116.00 22556 90 $2,054.00 $2,188.00 $2,347.00 $2,559.00 $2,188.00 $2,347.00 $2,559.00 22558 90 $1,907.00 $1,964.00 $2,089.00 $2,249.00 $1,964.00 $2,089.00 $2,249.00 22585 ZZZ $473.00 $480.00 $520.00 $577.00 $480.00 $520.00 $577.00 22590 90 $1,895.00 $2,053.00 $2,222.00 $2,449.00 $2,053.00 $2,222.00 $2,449.00 22595 90 $1,960.00 $1,947.00 $2,104.00 $2,315.00 $1,947.00 $2,104.00 $2,315.00 22600 90 $1,567.00 $1,664.00 $1,798.00 $1,978.00 $1,664.00 $1,798.00 $1,978.00 22610 90 $1,494.00 $1,638.00 $1,767.00 $1,939.00 $1,638.00 $1,767.00 $1,939.00 22612 90 $1,861.00 $2,120.00 $2,281.00 $2,497.00 $2,120.00 $2,281.00 $2,497.00 22614 ZZZ $530.00 $556.00 $602.00 $664.00 $556.00 $602.00 $664.00 22630 90 $1,201.00 $2,057.00 $2,224.00 $2,448.00 $2,057.00 $2,224.00 $2,448.00 22632 ZZZ $442.00 $454.00 $492.00 $544.00 $454.00 $492.00 $544.00 22800 90 $1,960.00 $1,803.00 $1,941.00 $2,124.00 $1,803.00 $1,941.00 $2,124.00 22802 90 $2,633.00 $2,878.00 $3,098.00 $3,393.00 $2,878.00 $3,098.00 $3,393.00 22804 90 $2,951.00 $3,328.00 $3,578.00 $3,914.00 $3,328.00 $3,578.00 $3,914.00 22808 90 $2,157.00 $2,433.00 $2,612.00 $2,851.00 $2,433.00 $2,612.00 $2,851.00 22810 90 $2,356.00 $2,710.00 $2,900.00 $3,151.00 $2,710.00 $2,900.00 $3,151.00 22812 90 $2,675.00 $2,953.00 $3,154.00 $3,418.00 $2,953.00 $3,154.00 $3,418.00 22818 90 $2,701.00 $3,006.00 $3,233.00 $3,540.00 $3,006.00 $3,233.00 $3,540.00 22819 90 $2,968.00 $3,421.00 $3,686.00 $4,045.00 $3,421.00 $3,686.00 $4,045.00 22830 90 $1,176.00 $1,080.00 $1,166.00 $1,278.00 $1,080.00 $1,166.00 $1,278.00 22840 ZZZ $943.00 $1,091.00 $1,182.00 $1,309.00 $1,091.00 $1,182.00 $1,309.00 22841 0 BR ------- ------- ------- ------- ------- ------- 22842 ZZZ $2,352.00 $1,090.00 $1,180.00 $1,305.00 $1,090.00 $1,180.00 $1,305.00 22843 ZZZ $1,028.00 $1,152.00 $1,246.00 $1,376.00 $1,152.00 $1,246.00 $1,376.00 22844 ZZZ $1,277.00 $1,403.00 $1,511.00 $1,659.00 $1,403.00 $1,511.00 $1,659.00 22845 ZZZ $1,853.00 $1,051.00 $1,143.00 $1,271.00 $1,051.00 $1,143.00 $1,271.00 22846 ZZZ $999.00 $1,092.00 $1,187.00 $1,319.00 $1,092.00 $1,187.00 $1,319.00 22847 ZZZ $1,077.00 $1,190.00 $1,288.00 $1,424.00 $1,190.00 $1,288.00 $1,424.00 22848 ZZZ $529.00 $510.00 $549.00 $603.00 $510.00 $549.00 $603.00 22849 90 $2,235.00 $1,753.00 $1,891.00 $2,076.00 $1,753.00 $1,891.00 $2,076.00 22850 90 $872.00 $955.00 $1,031.00 $1,131.00 $955.00 $1,031.00 $1,131.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 150
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 22851 ZZZ $600.00 $580.00 $629.00 $696.00 $580.00 $629.00 $696.00 22852 90 $854.00 $911.00 $983.00 $1,076.00 $911.00 $983.00 $1,076.00 22855 90 $1,193.00 $1,491.00 $1,614.00 $1,780.00 $1,491.00 $1,614.00 $1,780.00 22857 90 ------- $2,287.00 $2,431.00 $2,614.00 $2,287.00 $2,431.00 $2,614.00 22862 90 ------- $2,752.00 $2,946.00 $3,204.00 $2,752.00 $2,946.00 $3,204.00 22865 90 ------- $2,679.00 $2,867.00 $3,117.00 $2,679.00 $2,867.00 $3,117.00 22899 YYY BR ------- ------- ------- ------- ------- ------- 22900 90 $446.00 $518.00 $549.00 $589.00 $518.00 $549.00 $589.00 22999 YYY BR ------- ------- ------- ------- ------- ------- 23000 90 $447.00 $671.00 $717.00 $768.00 $464.00 $496.00 $535.00 23020 90 $807.00 $907.00 $971.00 $1,052.00 $907.00 $971.00 $1,052.00 23030 10 $323.00 $549.00 $587.00 $630.00 $339.00 $363.00 $393.00 23031 10 $185.00 $525.00 $563.00 $602.00 $290.00 $310.00 $335.00 23035 90 $861.00 $909.00 $972.00 $1,052.00 $909.00 $972.00 $1,052.00 23040 90 $898.00 $944.00 $1,011.00 $1,096.00 $944.00 $1,011.00 $1,096.00 23044 90 $708.00 $749.00 $801.00 $868.00 $749.00 $801.00 $868.00 23065 10 $171.00 $259.00 $274.00 $290.00 $207.00 $218.00 $231.00 23066 90 $302.00 $634.00 $677.00 $725.00 $438.00 $467.00 $503.00 23075 10 $247.00 $324.00 $346.00 $370.00 $227.00 $242.00 $261.00 23076 90 $613.00 $726.00 $774.00 $835.00 $726.00 $774.00 $835.00 23077 90 $1,228.00 $1,530.00 $1,625.00 $1,746.00 $1,530.00 $1,625.00 $1,746.00 23100 90 $616.00 $635.00 $680.00 $737.00 $635.00 $680.00 $737.00 23101 90 $583.00 $588.00 $630.00 $682.00 $588.00 $630.00 $682.00 23105 90 $814.00 $835.00 $895.00 $970.00 $835.00 $895.00 $970.00 23106 90 $581.00 $624.00 $667.00 $722.00 $624.00 $667.00 $722.00 23107 90 $851.00 $871.00 $933.00 $1,012.00 $871.00 $933.00 $1,012.00 23120 90 $645.00 $736.00 $788.00 $854.00 $736.00 $788.00 $854.00 23125 90 $865.00 $924.00 $990.00 $1,074.00 $924.00 $990.00 $1,074.00 23130 90 $722.00 $792.00 $848.00 $919.00 $792.00 $848.00 $919.00 23140 90 $597.00 $668.00 $714.00 $771.00 $668.00 $714.00 $771.00 23145 90 $889.00 $902.00 $965.00 $1,044.00 $902.00 $965.00 $1,044.00 23146 90 $704.00 $807.00 $864.00 $937.00 $807.00 $864.00 $937.00 23150 90 $755.00 $847.00 $904.00 $975.00 $847.00 $904.00 $975.00 23155 90 $945.00 $1,036.00 $1,110.00 $1,204.00 $1,036.00 $1,110.00 $1,204.00 23156 90 $794.00 $883.00 $946.00 $1,025.00 $883.00 $946.00 $1,025.00 23170 90 $645.00 $697.00 $746.00 $806.00 $697.00 $746.00 $806.00 23172 90 $638.00 $713.00 $760.00 $817.00 $713.00 $760.00 $817.00 23174 90 $882.00 $984.00 $1,054.00 $1,142.00 $984.00 $1,054.00 $1,142.00 23180 90 $566.00 $917.00 $982.00 $1,063.00 $917.00 $982.00 $1,063.00 23182 90 $865.00 $881.00 $942.00 $1,018.00 $881.00 $942.00 $1,018.00 23184 90 $962.00 $993.00 $1,064.00 $1,151.00 $993.00 $1,064.00 $1,151.00 23190 90 $656.00 $725.00 $775.00 $838.00 $725.00 $775.00 $838.00 23195 90 $902.00 $983.00 $1,053.00 $1,141.00 $983.00 $1,053.00 $1,141.00 23200 90 $1,095.00 $1,145.00 $1,223.00 $1,322.00 $1,145.00 $1,223.00 $1,322.00 23210 90 $1,095.00 $1,199.00 $1,281.00 $1,385.00 $1,199.00 $1,281.00 $1,385.00 23220 90 $1,307.00 $1,418.00 $1,517.00 $1,644.00 $1,418.00 $1,517.00 $1,644.00 23221 90 $1,559.00 $1,665.00 $1,783.00 $1,936.00 $1,665.00 $1,783.00 $1,936.00 23222 90 $1,921.00 $2,236.00 $2,388.00 $2,586.00 $2,236.00 $2,388.00 $2,586.00 23330 10 $59.00 $283.00 $302.00 $321.00 $192.00 $204.00 $219.00 23331 90 $520.00 $769.00 $824.00 $892.00 $769.00 $824.00 $892.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 151
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 23332 90 $1,029.00 $1,168.00 $1,250.00 $1,355.00 $1,168.00 $1,250.00 $1,355.00 23350 0 $74.00 $207.00 $219.00 $231.00 $69.00 $71.00 $75.00 23395 90 $1,366.00 $1,694.00 $1,812.00 $1,963.00 $1,694.00 $1,812.00 $1,963.00 23397 90 $1,403.00 $1,521.00 $1,628.00 $1,767.00 $1,521.00 $1,628.00 $1,767.00 23400 90 $1,196.00 $1,292.00 $1,384.00 $1,502.00 $1,292.00 $1,384.00 $1,502.00 23405 90 $799.00 $832.00 $891.00 $967.00 $832.00 $891.00 $967.00 23406 90 $977.00 $1,042.00 $1,117.00 $1,214.00 $1,042.00 $1,117.00 $1,214.00 23410 90 $1,119.00 $1,195.00 $1,281.00 $1,391.00 $1,195.00 $1,281.00 $1,391.00 23412 90 $1,229.00 $1,271.00 $1,363.00 $1,480.00 $1,271.00 $1,363.00 $1,480.00 23415 90 $622.00 $976.00 $1,047.00 $1,136.00 $976.00 $1,047.00 $1,136.00 23420 90 $1,276.00 $1,390.00 $1,486.00 $1,608.00 $1,390.00 $1,486.00 $1,608.00 23430 90 $884.00 $982.00 $1,053.00 $1,143.00 $982.00 $1,053.00 $1,143.00 23440 90 $906.00 $1,015.00 $1,089.00 $1,183.00 $1,015.00 $1,089.00 $1,183.00 23450 90 $1,210.00 $1,273.00 $1,365.00 $1,483.00 $1,273.00 $1,365.00 $1,483.00 23455 90 $1,340.00 $1,356.00 $1,454.00 $1,580.00 $1,356.00 $1,454.00 $1,580.00 23460 90 $1,364.00 $1,466.00 $1,571.00 $1,707.00 $1,466.00 $1,571.00 $1,707.00 23462 90 $1,383.00 $1,435.00 $1,536.00 $1,668.00 $1,435.00 $1,536.00 $1,668.00 23465 90 $1,398.00 $1,495.00 $1,603.00 $1,742.00 $1,495.00 $1,603.00 $1,742.00 23466 90 $1,332.00 $1,460.00 $1,561.00 $1,690.00 $1,460.00 $1,561.00 $1,690.00 23470 90 $1,540.00 $1,630.00 $1,746.00 $1,896.00 $1,630.00 $1,746.00 $1,896.00 23472 90 $1,570.00 $2,010.00 $2,151.00 $2,334.00 $2,010.00 $2,151.00 $2,334.00 23480 90 $926.00 $1,093.00 $1,171.00 $1,271.00 $1,093.00 $1,171.00 $1,271.00 23485 90 $1,181.00 $1,285.00 $1,377.00 $1,496.00 $1,285.00 $1,377.00 $1,496.00 23490 90 $1,038.00 $1,068.00 $1,133.00 $1,214.00 $1,068.00 $1,133.00 $1,214.00 23491 90 $1,251.00 $1,358.00 $1,455.00 $1,581.00 $1,358.00 $1,455.00 $1,581.00 23500 90 $148.00 $262.00 $279.00 $299.00 $255.00 $272.00 $291.00 23505 90 $293.00 $434.00 $465.00 $501.00 $410.00 $439.00 $474.00 23515 90 $688.00 $888.00 $944.00 $1,015.00 $888.00 $944.00 $1,015.00 23520 90 $205.00 $271.00 $290.00 $312.00 $270.00 $289.00 $311.00 23525 90 $320.00 $426.00 $453.00 $484.00 $398.00 $423.00 $453.00 23530 90 $659.00 $722.00 $773.00 $836.00 $722.00 $773.00 $836.00 23532 90 $713.00 $814.00 $872.00 $946.00 $814.00 $872.00 $946.00 23540 90 $148.00 $269.00 $286.00 $305.00 $258.00 $274.00 $293.00 23545 90 $148.00 $382.00 $405.00 $430.00 $349.00 $370.00 $393.00 23550 90 $701.00 $748.00 $801.00 $868.00 $748.00 $801.00 $868.00 23552 90 $753.00 $864.00 $925.00 $1,002.00 $864.00 $925.00 $1,002.00 23570 90 $88.00 $281.00 $300.00 $323.00 $281.00 $301.00 $323.00 23575 90 $306.00 $477.00 $509.00 $546.00 $450.00 $480.00 $516.00 23585 90 $809.00 $1,187.00 $1,255.00 $1,339.00 $1,187.00 $1,255.00 $1,339.00 23600 90 $318.00 $394.00 $422.00 $453.00 $359.00 $384.00 $413.00 23605 90 $511.00 $587.00 $629.00 $679.00 $541.00 $580.00 $627.00 23615 90 $900.00 $1,120.00 $1,191.00 $1,280.00 $1,120.00 $1,191.00 $1,280.00 23616 90 $1,895.00 $1,763.00 $1,900.00 $2,082.00 $1,763.00 $1,900.00 $2,082.00 23620 90 $286.00 $323.00 $346.00 $372.00 $301.00 $322.00 $347.00 23625 90 $422.00 $475.00 $508.00 $549.00 $445.00 $477.00 $515.00 23630 90 $712.00 $938.00 $996.00 $1,066.00 $938.00 $996.00 $1,066.00 23650 90 $296.00 $362.00 $382.00 $404.00 $325.00 $342.00 $362.00 23655 90 $374.00 $481.00 $513.00 $552.00 $481.00 $513.00 $552.00 23660 90 $712.00 $759.00 $813.00 $882.00 $759.00 $813.00 $882.00 23665 90 $440.00 $524.00 $560.00 $603.00 $494.00 $528.00 $569.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 152
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 23670 90 $759.00 $1,046.00 $1,107.00 $1,182.00 $1,046.00 $1,107.00 $1,182.00 23675 90 $550.00 $692.00 $741.00 $799.00 $642.00 $688.00 $744.00 23680 90 $1,064.00 $1,158.00 $1,232.00 $1,325.00 $1,158.00 $1,232.00 $1,325.00 23700 10 $237.00 $256.00 $275.00 $298.00 $256.00 $275.00 $298.00 23800 90 $1,346.00 $1,354.00 $1,449.00 $1,570.00 $1,354.00 $1,449.00 $1,570.00 23802 90 $1,368.00 $1,603.00 $1,710.00 $1,848.00 $1,603.00 $1,710.00 $1,848.00 23900 90 $1,561.00 $1,772.00 $1,893.00 $2,051.00 $1,772.00 $1,893.00 $2,051.00 23920 90 $1,300.00 $1,428.00 $1,525.00 $1,650.00 $1,428.00 $1,525.00 $1,650.00 23921 90 $497.00 $574.00 $611.00 $656.00 $574.00 $611.00 $656.00 23929 YYY BR ------- ------- ------- ------- ------- ------- 23930 10 $71.00 $456.00 $487.00 $520.00 $281.00 $299.00 $323.00 23931 10 $62.00 $364.00 $389.00 $415.00 $205.00 $219.00 $236.00 23935 90 $630.00 $653.00 $699.00 $757.00 $653.00 $699.00 $757.00 24000 90 $550.00 $612.00 $655.00 $708.00 $612.00 $655.00 $708.00 24006 90 $793.00 $929.00 $993.00 $1,073.00 $929.00 $993.00 $1,073.00 24065 10 $166.00 $296.00 $313.00 $331.00 $204.00 $214.00 $226.00 24066 90 $461.00 $741.00 $792.00 $848.00 $512.00 $546.00 $590.00 24075 90 $349.00 $594.00 $634.00 $677.00 $397.00 $423.00 $455.00 24076 90 $529.00 $610.00 $651.00 $702.00 $610.00 $651.00 $702.00 24077 90 $1,058.00 $1,063.00 $1,133.00 $1,223.00 $1,063.00 $1,133.00 $1,223.00 24100 90 $467.00 $517.00 $554.00 $600.00 $517.00 $554.00 $600.00 24101 90 $591.00 $647.00 $692.00 $749.00 $647.00 $692.00 $749.00 24102 90 $755.00 $805.00 $862.00 $933.00 $805.00 $862.00 $933.00 24105 90 $360.00 $431.00 $462.00 $498.00 $431.00 $462.00 $498.00 24110 90 $724.00 $760.00 $814.00 $883.00 $760.00 $814.00 $883.00 24115 90 $898.00 $891.00 $955.00 $1,038.00 $891.00 $955.00 $1,038.00 24116 90 $1,037.00 $1,151.00 $1,233.00 $1,339.00 $1,151.00 $1,233.00 $1,339.00 24120 90 $595.00 $680.00 $728.00 $787.00 $680.00 $728.00 $787.00 24125 90 $663.00 $764.00 $813.00 $873.00 $764.00 $813.00 $873.00 24126 90 $731.00 $817.00 $870.00 $935.00 $817.00 $870.00 $935.00 24130 90 $595.00 $658.00 $704.00 $761.00 $658.00 $704.00 $761.00 24134 90 $966.00 $998.00 $1,068.00 $1,155.00 $998.00 $1,068.00 $1,155.00 24136 90 $720.00 $824.00 $882.00 $955.00 $824.00 $882.00 $955.00 24138 90 $697.00 $855.00 $914.00 $988.00 $855.00 $914.00 $988.00 24140 90 $963.00 $954.00 $1,021.00 $1,103.00 $954.00 $1,021.00 $1,103.00 24145 90 $592.00 $803.00 $859.00 $928.00 $803.00 $859.00 $928.00 24147 90 $703.00 $836.00 $895.00 $968.00 $836.00 $895.00 $968.00 24149 90 $1,224.00 $1,494.00 $1,593.00 $1,719.00 $1,494.00 $1,593.00 $1,719.00 24150 90 $1,265.00 $1,290.00 $1,382.00 $1,501.00 $1,290.00 $1,382.00 $1,501.00 24151 90 $1,383.00 $1,492.00 $1,595.00 $1,729.00 $1,492.00 $1,595.00 $1,729.00 24152 90 $829.00 $946.00 $1,008.00 $1,087.00 $946.00 $1,008.00 $1,087.00 24153 90 $936.00 $870.00 $908.00 $952.00 $870.00 $908.00 $952.00 24155 90 $1,019.00 $1,110.00 $1,188.00 $1,287.00 $1,110.00 $1,188.00 $1,287.00 24160 90 $533.00 $792.00 $847.00 $917.00 $792.00 $847.00 $917.00 24164 90 $564.00 $646.00 $691.00 $748.00 $646.00 $691.00 $748.00 24200 10 $58.00 $253.00 $270.00 $286.00 $174.00 $184.00 $197.00 24201 90 $444.00 $714.00 $764.00 $818.00 $471.00 $503.00 $543.00 24220 0 $89.00 $225.00 $238.00 $251.00 $90.00 $94.00 $98.00 24300 90 $352.00 $505.00 $541.00 $582.00 $505.00 $541.00 $582.00 24301 90 $869.00 $989.00 $1,057.00 $1,145.00 $989.00 $1,057.00 $1,145.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 153
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 24305 90 $579.00 $753.00 $804.00 $868.00 $753.00 $804.00 $868.00 24310 90 $511.00 $617.00 $660.00 $713.00 $617.00 $660.00 $713.00 24320 90 $944.00 $1,006.00 $1,076.00 $1,166.00 $1,006.00 $1,076.00 $1,166.00 24330 90 $845.00 $944.00 $1,011.00 $1,095.00 $944.00 $1,011.00 $1,095.00 24331 90 $927.00 $1,041.00 $1,114.00 $1,207.00 $1,041.00 $1,114.00 $1,207.00 24332 90 $487.00 $780.00 $834.00 $901.00 $780.00 $834.00 $901.00 24340 90 $697.00 $805.00 $863.00 $935.00 $805.00 $863.00 $935.00 24341 90 $702.00 $928.00 $990.00 $1,066.00 $928.00 $990.00 $1,066.00 24342 90 $950.00 $1,041.00 $1,116.00 $1,212.00 $1,041.00 $1,116.00 $1,212.00 24343 90 $643.00 $914.00 $977.00 $1,056.00 $914.00 $977.00 $1,056.00 24344 90 $971.00 $1,428.00 $1,526.00 $1,651.00 $1,428.00 $1,526.00 $1,651.00 24345 90 $643.00 $910.00 $974.00 $1,052.00 $910.00 $974.00 $1,052.00 24346 90 $971.00 $1,423.00 $1,520.00 $1,644.00 $1,423.00 $1,520.00 $1,644.00 24357 90 ------- $576.00 $616.00 $666.00 $576.00 $616.00 $666.00 24358 90 ------- $678.00 $726.00 $785.00 $678.00 $726.00 $785.00 24359 90 ------- $838.00 $896.00 $969.00 $838.00 $896.00 $969.00 24360 90 $1,125.00 $1,184.00 $1,268.00 $1,374.00 $1,184.00 $1,268.00 $1,374.00 24361 90 $1,215.00 $1,327.00 $1,417.00 $1,532.00 $1,327.00 $1,417.00 $1,532.00 24362 90 $1,269.00 $1,314.00 $1,409.00 $1,535.00 $1,314.00 $1,409.00 $1,535.00 24363 90 $1,663.00 $1,942.00 $2,065.00 $2,222.00 $1,942.00 $2,065.00 $2,222.00 24365 90 $747.00 $841.00 $900.00 $975.00 $841.00 $900.00 $975.00 24366 90 $850.00 $902.00 $965.00 $1,045.00 $902.00 $965.00 $1,045.00 24400 90 $991.00 $1,087.00 $1,165.00 $1,265.00 $1,087.00 $1,165.00 $1,265.00 24410 90 $1,319.00 $1,396.00 $1,496.00 $1,626.00 $1,396.00 $1,496.00 $1,626.00 24420 90 $1,265.00 $1,287.00 $1,376.00 $1,490.00 $1,287.00 $1,376.00 $1,490.00 24430 90 $1,209.00 $1,358.00 $1,448.00 $1,563.00 $1,358.00 $1,448.00 $1,563.00 24435 90 $1,260.00 $1,390.00 $1,485.00 $1,605.00 $1,390.00 $1,485.00 $1,605.00 24470 90 $774.00 $866.00 $927.00 $1,005.00 $866.00 $927.00 $1,005.00 24495 90 $742.00 $862.00 $919.00 $988.00 $862.00 $919.00 $988.00 24498 90 $1,076.00 $1,159.00 $1,241.00 $1,348.00 $1,159.00 $1,241.00 $1,348.00 24500 90 $288.00 $427.00 $456.00 $489.00 $382.00 $408.00 $438.00 24505 90 $574.00 $628.00 $673.00 $726.00 $574.00 $615.00 $665.00 24515 90 $1,018.00 $1,159.00 $1,242.00 $1,347.00 $1,159.00 $1,242.00 $1,347.00 24516 90 $1,029.00 $1,147.00 $1,228.00 $1,333.00 $1,147.00 $1,228.00 $1,333.00 24530 90 $88.00 $461.00 $493.00 $530.00 $414.00 $442.00 $477.00 24535 90 $671.00 $787.00 $843.00 $911.00 $732.00 $785.00 $849.00 24538 90 $850.00 $980.00 $1,050.00 $1,137.00 $980.00 $1,050.00 $1,137.00 24545 90 $946.00 $1,173.00 $1,250.00 $1,346.00 $1,173.00 $1,250.00 $1,346.00 24546 90 $1,273.00 $1,420.00 $1,526.00 $1,664.00 $1,420.00 $1,526.00 $1,664.00 24560 90 $266.00 $385.00 $411.00 $441.00 $335.00 $358.00 $385.00 24565 90 $526.00 $653.00 $699.00 $754.00 $603.00 $646.00 $698.00 24566 90 $705.00 $893.00 $953.00 $1,026.00 $893.00 $953.00 $1,026.00 24575 90 $872.00 $980.00 $1,055.00 $1,151.00 $980.00 $1,055.00 $1,151.00 24576 90 $295.00 $404.00 $432.00 $464.00 $360.00 $385.00 $414.00 24577 90 $575.00 $675.00 $723.00 $779.00 $624.00 $668.00 $721.00 24579 90 $964.00 $1,104.00 $1,185.00 $1,290.00 $1,104.00 $1,185.00 $1,290.00 24582 90 $773.00 $1,014.00 $1,083.00 $1,166.00 $1,014.00 $1,083.00 $1,166.00 24586 90 $1,314.00 $1,458.00 $1,562.00 $1,697.00 $1,458.00 $1,562.00 $1,697.00 24587 90 $1,278.00 $1,444.00 $1,544.00 $1,674.00 $1,444.00 $1,544.00 $1,674.00 24600 90 $360.00 $459.00 $487.00 $519.00 $410.00 $435.00 $465.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 154
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 24605 90 $371.00 $586.00 $627.00 $677.00 $586.00 $627.00 $677.00 24615 90 $836.00 $943.00 $1,009.00 $1,093.00 $943.00 $1,009.00 $1,093.00 24620 90 $560.00 $710.00 $759.00 $818.00 $710.00 $759.00 $818.00 24635 90 $1,329.00 $1,103.00 $1,198.00 $1,318.00 $1,103.00 $1,198.00 $1,318.00 24650 90 $262.00 $312.00 $333.00 $358.00 $275.00 $294.00 $316.00 24655 90 $436.00 $544.00 $582.00 $626.00 $496.00 $530.00 $571.00 24665 90 $749.00 $848.00 $909.00 $985.00 $848.00 $909.00 $985.00 24666 90 $905.00 $961.00 $1,029.00 $1,115.00 $961.00 $1,029.00 $1,115.00 24670 90 $263.00 $351.00 $375.00 $403.00 $310.00 $332.00 $357.00 24675 90 $490.00 $574.00 $615.00 $663.00 $528.00 $565.00 $611.00 24685 90 $819.00 $857.00 $921.00 $1,001.00 $857.00 $921.00 $1,001.00 24800 90 $984.00 $1,049.00 $1,118.00 $1,205.00 $1,049.00 $1,118.00 $1,205.00 24802 90 $1,181.00 $1,315.00 $1,408.00 $1,529.00 $1,315.00 $1,408.00 $1,529.00 24900 90 $858.00 $930.00 $993.00 $1,072.00 $930.00 $993.00 $1,072.00 24920 90 $851.00 $922.00 $986.00 $1,069.00 $922.00 $986.00 $1,069.00 24925 90 $661.00 $704.00 $752.00 $814.00 $704.00 $752.00 $814.00 24930 90 $928.00 $972.00 $1,039.00 $1,125.00 $972.00 $1,039.00 $1,125.00 24931 90 $1,063.00 $1,046.00 $1,114.00 $1,204.00 $1,046.00 $1,114.00 $1,204.00 24935 90 $1,327.00 $1,397.00 $1,485.00 $1,596.00 $1,397.00 $1,485.00 $1,596.00 24940 90 BR ------- ------- ------- ------- ------- ------- 24999 YYY BR ------- ------- ------- ------- ------- ------- 25000 90 $381.00 $477.00 $510.00 $547.00 $477.00 $510.00 $547.00 25001 90 $294.00 $421.00 $449.00 $483.00 $421.00 $449.00 $483.00 25020 90 $594.00 $767.00 $820.00 $881.00 $767.00 $820.00 $881.00 25023 90 $1,040.00 $1,462.00 $1,560.00 $1,679.00 $1,462.00 $1,560.00 $1,679.00 25024 90 $683.00 $970.00 $1,031.00 $1,106.00 $970.00 $1,031.00 $1,106.00 25025 90 $1,104.00 $1,471.00 $1,553.00 $1,654.00 $1,471.00 $1,553.00 $1,654.00 25028 90 $417.00 $672.00 $718.00 $771.00 $672.00 $718.00 $771.00 25031 90 $266.00 $532.00 $568.00 $609.00 $532.00 $568.00 $609.00 25035 90 $794.00 $933.00 $998.00 $1,075.00 $933.00 $998.00 $1,075.00 25040 90 $654.00 $757.00 $809.00 $873.00 $757.00 $809.00 $873.00 25065 10 $164.00 $295.00 $312.00 $329.00 $203.00 $214.00 $226.00 25066 90 $322.00 $519.00 $555.00 $596.00 $519.00 $555.00 $596.00 25075 90 $352.00 $451.00 $481.00 $517.00 $451.00 $481.00 $517.00 25076 90 $544.00 $634.00 $677.00 $726.00 $634.00 $677.00 $726.00 25077 90 $957.00 $1,034.00 $1,103.00 $1,186.00 $1,034.00 $1,103.00 $1,186.00 25085 90 $562.00 $622.00 $664.00 $715.00 $622.00 $664.00 $715.00 25100 90 $420.00 $458.00 $489.00 $526.00 $458.00 $489.00 $526.00 25101 90 $492.00 $538.00 $575.00 $620.00 $538.00 $575.00 $620.00 25105 90 $635.00 $657.00 $702.00 $757.00 $657.00 $702.00 $757.00 25107 90 $600.00 $795.00 $846.00 $906.00 $795.00 $846.00 $906.00 25109 90 ------- $658.00 $701.00 $754.00 $658.00 $701.00 $754.00 25110 90 $403.00 $502.00 $537.00 $577.00 $502.00 $537.00 $577.00 25111 90 $356.00 $411.00 $440.00 $473.00 $411.00 $440.00 $473.00 25112 90 $441.00 $504.00 $538.00 $579.00 $504.00 $538.00 $579.00 25115 90 $837.00 $1,103.00 $1,174.00 $1,257.00 $1,103.00 $1,174.00 $1,257.00 25116 90 $807.00 $918.00 $981.00 $1,053.00 $918.00 $981.00 $1,053.00 25118 90 $466.00 $509.00 $544.00 $585.00 $509.00 $544.00 $585.00 25119 90 $653.00 $679.00 $726.00 $782.00 $679.00 $726.00 $782.00 25120 90 $712.00 $798.00 $854.00 $919.00 $798.00 $854.00 $919.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 155
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 25125 90 $803.00 $902.00 $962.00 $1,031.00 $902.00 $962.00 $1,031.00 25126 90 $781.00 $930.00 $996.00 $1,074.00 $930.00 $996.00 $1,074.00 25130 90 $502.00 $592.00 $632.00 $680.00 $592.00 $632.00 $680.00 25135 90 $631.00 $736.00 $785.00 $845.00 $736.00 $785.00 $845.00 25136 90 $546.00 $657.00 $704.00 $762.00 $657.00 $704.00 $762.00 25145 90 $713.00 $814.00 $870.00 $935.00 $814.00 $870.00 $935.00 25150 90 $720.00 $775.00 $828.00 $893.00 $775.00 $828.00 $893.00 25151 90 $771.00 $909.00 $971.00 $1,045.00 $909.00 $971.00 $1,045.00 25170 90 $1,085.00 $1,237.00 $1,322.00 $1,425.00 $1,237.00 $1,322.00 $1,425.00 25210 90 $561.00 $648.00 $691.00 $743.00 $648.00 $691.00 $743.00 25215 90 $817.00 $841.00 $897.00 $966.00 $841.00 $897.00 $966.00 25230 90 $531.00 $576.00 $616.00 $662.00 $576.00 $616.00 $662.00 25240 90 $567.00 $595.00 $636.00 $684.00 $595.00 $636.00 $684.00 25246 0 $72.00 $230.00 $243.00 $256.00 $100.00 $104.00 $109.00 25248 90 $236.00 $616.00 $656.00 $703.00 $616.00 $656.00 $703.00 25250 90 $616.00 $677.00 $723.00 $779.00 $677.00 $723.00 $779.00 25251 90 $933.00 $922.00 $980.00 $1,051.00 $922.00 $980.00 $1,051.00 25259 90 $348.00 $502.00 $537.00 $578.00 $502.00 $537.00 $578.00 25260 90 $728.00 $957.00 $1,023.00 $1,098.00 $957.00 $1,023.00 $1,098.00 25263 90 $809.00 $948.00 $1,013.00 $1,088.00 $948.00 $1,013.00 $1,088.00 25265 90 $998.00 $1,119.00 $1,195.00 $1,284.00 $1,119.00 $1,195.00 $1,284.00 25270 90 $549.00 $785.00 $839.00 $902.00 $785.00 $839.00 $902.00 25272 90 $613.00 $878.00 $939.00 $1,009.00 $878.00 $939.00 $1,009.00 25274 90 $887.00 $1,022.00 $1,092.00 $1,175.00 $1,022.00 $1,092.00 $1,175.00 25275 90 $620.00 $870.00 $928.00 $1,000.00 $870.00 $928.00 $1,000.00 25280 90 $670.00 $882.00 $942.00 $1,011.00 $882.00 $942.00 $1,011.00 25290 90 $436.00 $803.00 $858.00 $919.00 $803.00 $858.00 $919.00 25295 90 $562.00 $826.00 $882.00 $947.00 $826.00 $882.00 $947.00 25300 90 $592.00 $895.00 $954.00 $1,025.00 $895.00 $954.00 $1,025.00 25301 90 $757.00 $856.00 $915.00 $986.00 $856.00 $915.00 $986.00 25310 90 $865.00 $958.00 $1,022.00 $1,098.00 $958.00 $1,022.00 $1,098.00 25312 90 $968.00 $1,083.00 $1,156.00 $1,242.00 $1,083.00 $1,156.00 $1,242.00 25315 90 $1,004.00 $1,159.00 $1,237.00 $1,331.00 $1,159.00 $1,237.00 $1,331.00 25316 90 $1,203.00 $1,339.00 $1,427.00 $1,531.00 $1,339.00 $1,427.00 $1,531.00 25320 90 $834.00 $1,240.00 $1,319.00 $1,414.00 $1,240.00 $1,319.00 $1,414.00 25332 90 $1,022.00 $1,110.00 $1,187.00 $1,284.00 $1,110.00 $1,187.00 $1,284.00 25335 90 $1,166.00 $1,273.00 $1,357.00 $1,462.00 $1,273.00 $1,357.00 $1,462.00 25337 90 $946.00 $1,157.00 $1,233.00 $1,326.00 $1,157.00 $1,233.00 $1,326.00 25350 90 $913.00 $1,045.00 $1,119.00 $1,206.00 $1,045.00 $1,119.00 $1,206.00 25355 90 $1,014.00 $1,161.00 $1,243.00 $1,343.00 $1,161.00 $1,243.00 $1,343.00 25360 90 $468.00 $1,019.00 $1,091.00 $1,176.00 $1,019.00 $1,091.00 $1,176.00 25365 90 $1,216.00 $1,367.00 $1,464.00 $1,584.00 $1,367.00 $1,464.00 $1,584.00 25370 90 $1,214.00 $1,463.00 $1,566.00 $1,693.00 $1,463.00 $1,566.00 $1,693.00 25375 90 $1,280.00 $1,429.00 $1,531.00 $1,657.00 $1,429.00 $1,531.00 $1,657.00 25390 90 $1,043.00 $1,169.00 $1,250.00 $1,346.00 $1,169.00 $1,250.00 $1,346.00 25391 90 $1,349.00 $1,471.00 $1,572.00 $1,696.00 $1,471.00 $1,572.00 $1,696.00 25392 90 $1,294.00 $1,467.00 $1,565.00 $1,685.00 $1,467.00 $1,565.00 $1,685.00 25393 90 $1,473.00 $1,669.00 $1,788.00 $1,937.00 $1,669.00 $1,788.00 $1,937.00 25394 90 $723.00 $1,004.00 $1,071.00 $1,156.00 $1,004.00 $1,071.00 $1,156.00 25400 90 $1,112.00 $1,231.00 $1,317.00 $1,422.00 $1,231.00 $1,317.00 $1,422.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 156
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 25405 90 $1,388.00 $1,538.00 $1,644.00 $1,774.00 $1,538.00 $1,644.00 $1,774.00 25415 90 $1,343.00 $1,447.00 $1,548.00 $1,671.00 $1,447.00 $1,548.00 $1,671.00 25420 90 $1,554.00 $1,706.00 $1,823.00 $1,967.00 $1,706.00 $1,823.00 $1,967.00 25425 90 $1,403.00 $1,550.00 $1,657.00 $1,783.00 $1,550.00 $1,657.00 $1,783.00 25426 90 $1,401.00 $1,612.00 $1,722.00 $1,861.00 $1,612.00 $1,722.00 $1,861.00 25430 90 $638.00 $910.00 $967.00 $1,039.00 $910.00 $967.00 $1,039.00 25431 90 $631.00 $1,045.00 $1,122.00 $1,220.00 $1,045.00 $1,122.00 $1,220.00 25440 90 $931.00 $1,033.00 $1,103.00 $1,191.00 $1,033.00 $1,103.00 $1,191.00 25441 90 $1,147.00 $1,235.00 $1,320.00 $1,429.00 $1,235.00 $1,320.00 $1,429.00 25442 90 $936.00 $1,047.00 $1,115.00 $1,199.00 $1,047.00 $1,115.00 $1,199.00 25443 90 $970.00 $1,002.00 $1,066.00 $1,143.00 $1,002.00 $1,066.00 $1,143.00 25444 90 $1,031.00 $1,078.00 $1,151.00 $1,243.00 $1,078.00 $1,151.00 $1,243.00 25445 90 $959.00 $948.00 $1,014.00 $1,096.00 $948.00 $1,014.00 $1,096.00 25446 90 $1,542.00 $1,550.00 $1,652.00 $1,782.00 $1,550.00 $1,652.00 $1,782.00 25447 90 $952.00 $1,055.00 $1,125.00 $1,213.00 $1,055.00 $1,125.00 $1,213.00 25449 90 $395.00 $1,362.00 $1,453.00 $1,569.00 $1,362.00 $1,453.00 $1,569.00 25450 90 $805.00 $831.00 $891.00 $965.00 $831.00 $891.00 $965.00 25455 90 $899.00 $968.00 $1,024.00 $1,088.00 $968.00 $1,024.00 $1,088.00 25490 90 $955.00 $1,072.00 $1,145.00 $1,231.00 $1,072.00 $1,145.00 $1,231.00 25491 90 $1,006.00 $1,129.00 $1,208.00 $1,302.00 $1,129.00 $1,208.00 $1,302.00 25492 90 $1,170.00 $1,349.00 $1,446.00 $1,565.00 $1,349.00 $1,446.00 $1,565.00 25500 90 $200.00 $318.00 $339.00 $363.00 $285.00 $304.00 $326.00 25505 90 $517.00 $630.00 $675.00 $728.00 $580.00 $622.00 $672.00 25515 90 $800.00 $880.00 $946.00 $1,029.00 $880.00 $946.00 $1,029.00 25520 90 $644.00 $698.00 $747.00 $808.00 $664.00 $711.00 $770.00 25525 90 $1,097.00 $1,091.00 $1,176.00 $1,286.00 $1,091.00 $1,176.00 $1,286.00 25526 90 $1,293.00 $1,338.00 $1,433.00 $1,552.00 $1,338.00 $1,433.00 $1,552.00 25530 90 $270.00 $309.00 $330.00 $354.00 $274.00 $293.00 $315.00 25535 90 $516.00 $605.00 $648.00 $701.00 $569.00 $610.00 $660.00 25545 90 $803.00 $834.00 $898.00 $978.00 $834.00 $898.00 $978.00 25560 90 $276.00 $321.00 $343.00 $367.00 $281.00 $300.00 $322.00 25565 90 $590.00 $657.00 $703.00 $759.00 $601.00 $643.00 $695.00 25574 90 $804.00 $846.00 $901.00 $969.00 $846.00 $901.00 $969.00 25575 90 $974.00 $1,160.00 $1,238.00 $1,336.00 $1,160.00 $1,238.00 $1,336.00 25600 90 $312.00 $354.00 $379.00 $407.00 $313.00 $335.00 $360.00 25605 90 $540.00 $761.00 $812.00 $872.00 $718.00 $765.00 $823.00 25606 90 ------- $871.00 $931.00 $1,004.00 $871.00 $931.00 $1,004.00 25607 90 ------- $907.00 $967.00 $1,041.00 $907.00 $967.00 $1,041.00 25608 90 ------- $1,046.00 $1,120.00 $1,215.00 $1,046.00 $1,120.00 $1,215.00 25609 90 ------- $1,334.00 $1,429.00 $1,551.00 $1,334.00 $1,429.00 $1,551.00 25622 90 $148.00 $363.00 $388.00 $416.00 $320.00 $342.00 $367.00 25624 90 $482.00 $576.00 $616.00 $664.00 $523.00 $560.00 $604.00 25628 90 $716.00 $922.00 $983.00 $1,058.00 $922.00 $983.00 $1,058.00 25630 90 $148.00 $372.00 $398.00 $427.00 $329.00 $351.00 $378.00 25635 90 $458.00 $545.00 $584.00 $629.00 $475.00 $508.00 $549.00 25645 90 $668.00 $743.00 $796.00 $861.00 $743.00 $796.00 $861.00 25650 90 $185.00 $386.00 $412.00 $442.00 $348.00 $371.00 $398.00 25651 90 $379.00 $601.00 $642.00 $691.00 $601.00 $642.00 $691.00 25652 90 $560.00 $796.00 $851.00 $918.00 $796.00 $851.00 $918.00 25660 90 $378.00 $499.00 $530.00 $566.00 $499.00 $530.00 $566.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 157
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 25670 90 $731.00 $797.00 $852.00 $921.00 $797.00 $852.00 $921.00 25671 90 $462.00 $669.00 $715.00 $771.00 $669.00 $715.00 $771.00 25675 90 $404.00 $531.00 $566.00 $605.00 $488.00 $519.00 $556.00 25676 90 $741.00 $826.00 $884.00 $956.00 $826.00 $884.00 $956.00 25680 90 $471.00 $575.00 $611.00 $655.00 $575.00 $611.00 $655.00 25685 90 $887.00 $955.00 $1,022.00 $1,106.00 $955.00 $1,022.00 $1,106.00 25690 90 $518.00 $590.00 $631.00 $681.00 $590.00 $631.00 $681.00 25695 90 $520.00 $827.00 $884.00 $955.00 $827.00 $884.00 $955.00 25800 90 $703.00 $989.00 $1,057.00 $1,142.00 $989.00 $1,057.00 $1,142.00 25805 90 $1,078.00 $1,136.00 $1,214.00 $1,312.00 $1,136.00 $1,214.00 $1,312.00 25810 90 $1,008.00 $1,134.00 $1,209.00 $1,301.00 $1,134.00 $1,209.00 $1,301.00 25820 90 $2,276.00 $806.00 $863.00 $931.00 $806.00 $863.00 $931.00 25825 90 $895.00 $982.00 $1,048.00 $1,128.00 $982.00 $1,048.00 $1,128.00 25830 90 $991.00 $1,249.00 $1,333.00 $1,431.00 $1,249.00 $1,333.00 $1,431.00 25900 90 $871.00 $1,030.00 $1,098.00 $1,177.00 $1,030.00 $1,098.00 $1,177.00 25905 90 $900.00 $1,016.00 $1,084.00 $1,166.00 $1,016.00 $1,084.00 $1,166.00 25907 90 $799.00 $900.00 $960.00 $1,029.00 $900.00 $960.00 $1,029.00 25909 90 $849.00 $1,011.00 $1,081.00 $1,165.00 $1,011.00 $1,081.00 $1,165.00 25915 90 $1,523.00 $1,670.00 $1,789.00 $1,941.00 $1,670.00 $1,789.00 $1,941.00 25920 90 $771.00 $886.00 $947.00 $1,021.00 $886.00 $947.00 $1,021.00 25922 90 $670.00 $776.00 $828.00 $892.00 $776.00 $828.00 $892.00 25924 90 $768.00 $868.00 $927.00 $1,000.00 $868.00 $927.00 $1,000.00 25927 90 $830.00 $1,031.00 $1,099.00 $1,179.00 $1,031.00 $1,099.00 $1,179.00 25929 90 $645.00 $741.00 $790.00 $852.00 $741.00 $790.00 $852.00 25931 90 $731.00 $958.00 $1,023.00 $1,097.00 $958.00 $1,023.00 $1,097.00 25999 YYY BR ------- ------- ------- ------- ------- ------- 26010 10 $59.00 $328.00 $349.00 $371.00 $166.00 $176.00 $188.00 26011 10 $223.00 $507.00 $542.00 $577.00 $237.00 $253.00 $272.00 26020 90 $484.00 $544.00 $580.00 $624.00 $544.00 $580.00 $624.00 26025 90 $548.00 $534.00 $570.00 $614.00 $534.00 $570.00 $614.00 26030 90 $655.00 $630.00 $672.00 $724.00 $630.00 $672.00 $724.00 26034 90 $601.00 $683.00 $730.00 $788.00 $683.00 $730.00 $788.00 26035 90 $741.00 $1,040.00 $1,105.00 $1,187.00 $1,040.00 $1,105.00 $1,187.00 26037 90 $730.00 $736.00 $786.00 $848.00 $736.00 $786.00 $848.00 26040 90 $367.00 $392.00 $419.00 $452.00 $392.00 $419.00 $452.00 26045 90 $621.00 $601.00 $644.00 $696.00 $601.00 $644.00 $696.00 26055 90 $343.00 $759.00 $812.00 $863.00 $369.00 $394.00 $422.00 26060 90 $293.00 $333.00 $357.00 $384.00 $333.00 $357.00 $384.00 26070 90 $440.00 $373.00 $397.00 $425.00 $373.00 $397.00 $425.00 26075 90 $400.00 $401.00 $427.00 $458.00 $401.00 $427.00 $458.00 26080 90 $382.00 $486.00 $520.00 $559.00 $486.00 $520.00 $559.00 26100 90 $398.00 $412.00 $440.00 $472.00 $412.00 $440.00 $472.00 26105 90 $481.00 $421.00 $450.00 $485.00 $421.00 $450.00 $485.00 26110 90 $282.00 $401.00 $428.00 $460.00 $401.00 $428.00 $460.00 26115 90 $344.00 $804.00 $860.00 $917.00 $456.00 $487.00 $523.00 26116 90 $544.00 $613.00 $654.00 $704.00 $613.00 $654.00 $704.00 26117 90 $806.00 $836.00 $892.00 $961.00 $836.00 $892.00 $961.00 26121 90 $833.00 $772.00 $825.00 $890.00 $772.00 $825.00 $890.00 26123 90 $959.00 $1,039.00 $1,106.00 $1,187.00 $1,039.00 $1,106.00 $1,187.00 26125 ZZZ $342.00 $379.00 $405.00 $439.00 $379.00 $405.00 $439.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 158
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 26130 90 $629.00 $588.00 $630.00 $682.00 $588.00 $630.00 $682.00 26135 90 $668.00 $713.00 $761.00 $821.00 $713.00 $761.00 $821.00 26140 90 $678.00 $646.00 $689.00 $742.00 $646.00 $689.00 $742.00 26145 90 $660.00 $657.00 $702.00 $757.00 $657.00 $702.00 $757.00 26160 90 $319.00 $737.00 $787.00 $838.00 $403.00 $430.00 $461.00 26170 90 $452.00 $514.00 $548.00 $589.00 $514.00 $548.00 $589.00 26180 90 $444.00 $561.00 $598.00 $644.00 $561.00 $598.00 $644.00 26185 90 $511.00 $656.00 $697.00 $746.00 $656.00 $697.00 $746.00 26200 90 $598.00 $579.00 $619.00 $668.00 $579.00 $619.00 $668.00 26205 90 $788.00 $781.00 $834.00 $900.00 $781.00 $834.00 $900.00 26210 90 $543.00 $561.00 $599.00 $645.00 $561.00 $599.00 $645.00 26215 90 $731.00 $711.00 $757.00 $813.00 $711.00 $757.00 $813.00 26230 90 $624.00 $651.00 $696.00 $752.00 $651.00 $696.00 $752.00 26235 90 $612.00 $637.00 $680.00 $733.00 $637.00 $680.00 $733.00 26236 90 $444.00 $564.00 $602.00 $648.00 $564.00 $602.00 $648.00 26250 90 $814.00 $746.00 $795.00 $855.00 $746.00 $795.00 $855.00 26255 90 $1,184.00 $1,176.00 $1,251.00 $1,343.00 $1,176.00 $1,251.00 $1,343.00 26260 90 $758.00 $704.00 $751.00 $808.00 $704.00 $751.00 $808.00 26261 90 $949.00 $848.00 $900.00 $964.00 $848.00 $900.00 $964.00 26262 90 $624.00 $590.00 $631.00 $680.00 $590.00 $631.00 $680.00 26320 90 $414.00 $438.00 $467.00 $502.00 $438.00 $467.00 $502.00 26340 90 $266.00 $391.00 $418.00 $447.00 $391.00 $418.00 $447.00 26350 90 $715.00 $963.00 $1,029.00 $1,101.00 $963.00 $1,029.00 $1,101.00 26352 90 $855.00 $1,089.00 $1,163.00 $1,245.00 $1,089.00 $1,163.00 $1,245.00 26356 90 $886.00 $1,378.00 $1,466.00 $1,561.00 $1,378.00 $1,466.00 $1,561.00 26357 90 $932.00 $1,161.00 $1,242.00 $1,332.00 $1,161.00 $1,242.00 $1,332.00 26358 90 $979.00 $1,233.00 $1,317.00 $1,412.00 $1,233.00 $1,317.00 $1,412.00 26370 90 $832.00 $1,040.00 $1,113.00 $1,193.00 $1,040.00 $1,113.00 $1,193.00 26372 90 $945.00 $1,205.00 $1,289.00 $1,384.00 $1,205.00 $1,289.00 $1,384.00 26373 90 $904.00 $1,142.00 $1,220.00 $1,307.00 $1,142.00 $1,220.00 $1,307.00 26390 90 $889.00 $1,110.00 $1,186.00 $1,274.00 $1,110.00 $1,186.00 $1,274.00 26392 90 $1,123.00 $1,309.00 $1,399.00 $1,501.00 $1,309.00 $1,399.00 $1,501.00 26410 90 $371.00 $767.00 $820.00 $878.00 $767.00 $820.00 $878.00 26412 90 $737.00 $923.00 $987.00 $1,057.00 $923.00 $987.00 $1,057.00 26415 90 $846.00 $954.00 $1,013.00 $1,080.00 $954.00 $1,013.00 $1,080.00 26416 90 $1,093.00 $1,097.00 $1,159.00 $1,225.00 $1,097.00 $1,159.00 $1,225.00 26418 90 $444.00 $768.00 $822.00 $878.00 $768.00 $822.00 $878.00 26420 90 $741.00 $966.00 $1,033.00 $1,108.00 $966.00 $1,033.00 $1,108.00 26426 90 $733.00 $824.00 $881.00 $945.00 $824.00 $881.00 $945.00 26428 90 $790.00 $1,006.00 $1,075.00 $1,152.00 $1,006.00 $1,075.00 $1,152.00 26432 90 $430.00 $668.00 $715.00 $765.00 $668.00 $715.00 $765.00 26433 90 $371.00 $719.00 $769.00 $823.00 $719.00 $769.00 $823.00 26434 90 $656.00 $849.00 $908.00 $973.00 $849.00 $908.00 $973.00 26437 90 $491.00 $831.00 $888.00 $952.00 $831.00 $888.00 $952.00 26440 90 $458.00 $845.00 $904.00 $965.00 $845.00 $904.00 $965.00 26442 90 $548.00 $1,236.00 $1,316.00 $1,404.00 $1,236.00 $1,316.00 $1,404.00 26445 90 $455.00 $790.00 $845.00 $902.00 $790.00 $845.00 $902.00 26449 90 $738.00 $1,052.00 $1,120.00 $1,195.00 $1,052.00 $1,120.00 $1,195.00 26450 90 $353.00 $534.00 $571.00 $613.00 $534.00 $571.00 $613.00 26455 90 $364.00 $530.00 $567.00 $608.00 $530.00 $567.00 $608.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 159
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 26460 90 $346.00 $514.00 $550.00 $590.00 $514.00 $550.00 $590.00 26471 90 $592.00 $817.00 $874.00 $936.00 $817.00 $874.00 $936.00 26474 90 $586.00 $788.00 $841.00 $899.00 $788.00 $841.00 $899.00 26476 90 $543.00 $766.00 $818.00 $876.00 $766.00 $818.00 $876.00 26477 90 $553.00 $775.00 $829.00 $888.00 $775.00 $829.00 $888.00 26478 90 $608.00 $837.00 $895.00 $959.00 $837.00 $895.00 $959.00 26479 90 $653.00 $828.00 $885.00 $950.00 $828.00 $885.00 $950.00 26480 90 $808.00 $1,016.00 $1,086.00 $1,162.00 $1,016.00 $1,086.00 $1,162.00 26483 90 $986.00 $1,136.00 $1,213.00 $1,301.00 $1,136.00 $1,213.00 $1,301.00 26485 90 $891.00 $1,092.00 $1,167.00 $1,249.00 $1,092.00 $1,167.00 $1,249.00 26489 90 $738.00 $1,130.00 $1,203.00 $1,286.00 $1,130.00 $1,203.00 $1,286.00 26490 90 $496.00 $1,037.00 $1,106.00 $1,186.00 $1,037.00 $1,106.00 $1,186.00 26492 90 $971.00 $1,152.00 $1,229.00 $1,319.00 $1,152.00 $1,229.00 $1,319.00 26494 90 $946.00 $1,058.00 $1,130.00 $1,213.00 $1,058.00 $1,130.00 $1,213.00 26496 90 $949.00 $1,139.00 $1,217.00 $1,307.00 $1,139.00 $1,217.00 $1,307.00 26497 90 $946.00 $1,142.00 $1,219.00 $1,309.00 $1,142.00 $1,219.00 $1,309.00 26498 90 $1,317.00 $1,524.00 $1,627.00 $1,751.00 $1,524.00 $1,627.00 $1,751.00 26499 90 $934.00 $1,079.00 $1,153.00 $1,238.00 $1,079.00 $1,153.00 $1,238.00 26500 90 $557.00 $834.00 $891.00 $954.00 $834.00 $891.00 $954.00 26502 90 $715.00 $936.00 $1,001.00 $1,076.00 $936.00 $1,001.00 $1,076.00 26508 90 $334.00 $850.00 $909.00 $977.00 $850.00 $909.00 $977.00 26510 90 $564.00 $794.00 $848.00 $907.00 $794.00 $848.00 $907.00 26516 90 $630.00 $940.00 $1,004.00 $1,078.00 $940.00 $1,004.00 $1,078.00 26517 90 $890.00 $1,095.00 $1,171.00 $1,260.00 $1,095.00 $1,171.00 $1,260.00 26518 90 $877.00 $1,096.00 $1,170.00 $1,256.00 $1,096.00 $1,170.00 $1,256.00 26520 90 $583.00 $884.00 $945.00 $1,010.00 $884.00 $945.00 $1,010.00 26525 90 $531.00 $889.00 $951.00 $1,016.00 $889.00 $951.00 $1,016.00 26530 90 $708.00 $689.00 $736.00 $794.00 $689.00 $736.00 $794.00 26531 90 $877.00 $801.00 $854.00 $920.00 $801.00 $854.00 $920.00 26535 90 $546.00 $501.00 $533.00 $573.00 $501.00 $533.00 $573.00 26536 90 $770.00 $851.00 $909.00 $974.00 $851.00 $909.00 $974.00 26540 90 $726.00 $882.00 $942.00 $1,011.00 $882.00 $942.00 $1,011.00 26541 90 $926.00 $1,072.00 $1,145.00 $1,228.00 $1,072.00 $1,145.00 $1,228.00 26542 90 $716.00 $908.00 $970.00 $1,039.00 $908.00 $970.00 $1,039.00 26545 90 $722.00 $926.00 $990.00 $1,061.00 $926.00 $990.00 $1,061.00 26546 90 $918.00 $1,270.00 $1,354.00 $1,449.00 $1,270.00 $1,354.00 $1,449.00 26548 90 $665.00 $1,017.00 $1,086.00 $1,165.00 $1,017.00 $1,086.00 $1,165.00 26550 90 $1,861.00 $2,010.00 $2,130.00 $2,274.00 $2,010.00 $2,130.00 $2,274.00 26551 90 $3,901.00 $4,138.00 $4,429.00 $4,816.00 $4,138.00 $4,429.00 $4,816.00 26553 90 $3,868.00 $3,693.00 $3,844.00 $4,013.00 $3,693.00 $3,844.00 $4,013.00 26554 90 $4,551.00 $5,247.00 $5,617.00 $6,096.00 $5,247.00 $5,617.00 $6,096.00 26555 90 $1,567.00 $1,798.00 $1,918.00 $2,064.00 $1,798.00 $1,918.00 $2,064.00 26556 90 $4,005.00 $3,810.00 $3,967.00 $4,144.00 $3,810.00 $3,967.00 $4,144.00 26560 90 $576.00 $734.00 $785.00 $842.00 $734.00 $785.00 $842.00 26561 90 $1,067.00 $1,177.00 $1,253.00 $1,342.00 $1,177.00 $1,253.00 $1,342.00 26562 90 $1,017.00 $1,595.00 $1,698.00 $1,825.00 $1,595.00 $1,698.00 $1,825.00 26565 90 $730.00 $902.00 $964.00 $1,033.00 $902.00 $964.00 $1,033.00 26567 90 $622.00 $907.00 $970.00 $1,040.00 $907.00 $970.00 $1,040.00 26568 90 $1,003.00 $1,201.00 $1,286.00 $1,383.00 $1,201.00 $1,286.00 $1,383.00 26580 90 $1,585.00 $1,682.00 $1,782.00 $1,906.00 $1,682.00 $1,782.00 $1,906.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 160
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 26587 90 $792.00 $1,227.00 $1,296.00 $1,382.00 $1,227.00 $1,296.00 $1,382.00 26590 90 $1,609.00 $1,749.00 $1,867.00 $2,015.00 $1,749.00 $1,867.00 $2,015.00 26591 90 $431.00 $589.00 $629.00 $672.00 $589.00 $629.00 $672.00 26593 90 $587.00 $788.00 $841.00 $900.00 $788.00 $841.00 $900.00 26596 90 $809.00 $945.00 $1,010.00 $1,090.00 $945.00 $1,010.00 $1,090.00 26600 90 $133.00 $326.00 $347.00 $370.00 $293.00 $312.00 $333.00 26605 90 $296.00 $392.00 $420.00 $452.00 $355.00 $380.00 $410.00 26607 90 $334.00 $602.00 $644.00 $694.00 $602.00 $644.00 $694.00 26608 90 $497.00 $612.00 $654.00 $706.00 $612.00 $654.00 $706.00 26615 90 $521.00 $675.00 $717.00 $768.00 $675.00 $717.00 $768.00 26641 90 $71.00 $434.00 $459.00 $487.00 $393.00 $415.00 $440.00 26645 90 $371.00 $508.00 $542.00 $583.00 $466.00 $498.00 $536.00 26650 90 $533.00 $608.00 $652.00 $706.00 $608.00 $652.00 $706.00 26665 90 $693.00 $760.00 $806.00 $860.00 $760.00 $806.00 $860.00 26670 90 $148.00 $403.00 $427.00 $454.00 $356.00 $376.00 $400.00 26675 90 $501.00 $551.00 $589.00 $636.00 $507.00 $542.00 $586.00 26676 90 $527.00 $641.00 $686.00 $740.00 $641.00 $686.00 $740.00 26685 90 $592.00 $714.00 $763.00 $823.00 $714.00 $763.00 $823.00 26686 90 $710.00 $801.00 $856.00 $924.00 $801.00 $856.00 $924.00 26700 90 $88.00 $380.00 $401.00 $425.00 $348.00 $367.00 $390.00 26705 90 $296.00 $504.00 $539.00 $580.00 $461.00 $492.00 $531.00 26706 90 $469.00 $553.00 $591.00 $637.00 $553.00 $591.00 $637.00 26715 90 $526.00 $683.00 $726.00 $779.00 $683.00 $726.00 $779.00 26720 90 $96.00 $233.00 $249.00 $266.00 $208.00 $222.00 $238.00 26725 90 $187.00 $423.00 $452.00 $486.00 $374.00 $400.00 $431.00 26727 90 $187.00 $601.00 $643.00 $693.00 $601.00 $643.00 $693.00 26735 90 $532.00 $708.00 $753.00 $807.00 $708.00 $753.00 $807.00 26740 90 $148.00 $271.00 $290.00 $311.00 $253.00 $271.00 $291.00 26742 90 $148.00 $460.00 $492.00 $528.00 $415.00 $443.00 $477.00 26746 90 $548.00 $841.00 $887.00 $941.00 $841.00 $887.00 $941.00 26750 90 $96.00 $217.00 $232.00 $247.00 $206.00 $219.00 $234.00 26755 90 $133.00 $385.00 $410.00 $439.00 $329.00 $351.00 $376.00 26756 90 $366.00 $530.00 $567.00 $611.00 $530.00 $567.00 $611.00 26765 90 $398.00 $566.00 $601.00 $641.00 $566.00 $601.00 $641.00 26770 90 $79.00 $324.00 $342.00 $362.00 $289.00 $305.00 $323.00 26775 90 $275.00 $466.00 $497.00 $533.00 $413.00 $440.00 $473.00 26776 90 $401.00 $565.00 $604.00 $650.00 $565.00 $604.00 $650.00 26785 90 $408.00 $614.00 $649.00 $691.00 $614.00 $649.00 $691.00 26820 90 $854.00 $1,050.00 $1,122.00 $1,206.00 $1,050.00 $1,122.00 $1,206.00 26841 90 $756.00 $982.00 $1,051.00 $1,130.00 $982.00 $1,051.00 $1,130.00 26842 90 $901.00 $1,057.00 $1,131.00 $1,216.00 $1,057.00 $1,131.00 $1,216.00 26843 90 $800.00 $974.00 $1,040.00 $1,116.00 $974.00 $1,040.00 $1,116.00 26844 90 $875.00 $1,085.00 $1,159.00 $1,244.00 $1,085.00 $1,159.00 $1,244.00 26850 90 $704.00 $926.00 $989.00 $1,061.00 $926.00 $989.00 $1,061.00 26852 90 $829.00 $1,051.00 $1,121.00 $1,201.00 $1,051.00 $1,121.00 $1,201.00 26860 90 $542.00 $750.00 $802.00 $858.00 $750.00 $802.00 $858.00 26861 ZZZ $151.00 $144.00 $154.00 $167.00 $144.00 $154.00 $167.00 26862 90 $747.00 $962.00 $1,027.00 $1,101.00 $962.00 $1,027.00 $1,101.00 26863 ZZZ $317.00 $320.00 $341.00 $368.00 $320.00 $341.00 $368.00 26910 90 $747.00 $939.00 $1,003.00 $1,078.00 $939.00 $1,003.00 $1,078.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 161
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 26951 90 $444.00 $795.00 $846.00 $901.00 $795.00 $846.00 $901.00 26952 90 $608.00 $864.00 $923.00 $989.00 $864.00 $923.00 $989.00 26989 YYY BR ------- ------- ------- ------- ------- ------- 26990 90 $592.00 $800.00 $855.00 $923.00 $800.00 $855.00 $923.00 26991 90 $466.00 $910.00 $973.00 $1,046.00 $673.00 $720.00 $779.00 26992 90 $1,146.00 $1,270.00 $1,358.00 $1,471.00 $1,270.00 $1,358.00 $1,471.00 27000 90 $421.00 $588.00 $631.00 $683.00 $588.00 $631.00 $683.00 27001 90 $550.00 $712.00 $764.00 $829.00 $712.00 $764.00 $829.00 27003 90 $698.00 $756.00 $806.00 $868.00 $756.00 $806.00 $868.00 27005 90 $738.00 $962.00 $1,032.00 $1,121.00 $962.00 $1,032.00 $1,121.00 27006 90 $788.00 $972.00 $1,042.00 $1,130.00 $972.00 $1,042.00 $1,130.00 27025 90 $896.00 $1,160.00 $1,237.00 $1,334.00 $1,160.00 $1,237.00 $1,334.00 27030 90 $1,148.00 $1,257.00 $1,347.00 $1,462.00 $1,257.00 $1,347.00 $1,462.00 27033 90 $1,173.00 $1,300.00 $1,391.00 $1,510.00 $1,300.00 $1,391.00 $1,510.00 27035 90 $1,413.00 $1,474.00 $1,564.00 $1,678.00 $1,474.00 $1,564.00 $1,678.00 27036 90 $1,176.00 $1,319.00 $1,411.00 $1,528.00 $1,319.00 $1,411.00 $1,528.00 27040 10 $196.00 $418.00 $443.00 $469.00 $254.00 $268.00 $284.00 27041 90 $699.00 $889.00 $946.00 $1,017.00 $889.00 $946.00 $1,017.00 27047 90 $535.00 $787.00 $839.00 $900.00 $666.00 $708.00 $762.00 27048 90 $588.00 $610.00 $650.00 $700.00 $610.00 $650.00 $700.00 27049 90 $1,162.00 $1,293.00 $1,375.00 $1,480.00 $1,293.00 $1,375.00 $1,480.00 27050 90 $449.00 $452.00 $480.00 $515.00 $452.00 $480.00 $515.00 27052 90 $624.00 $715.00 $763.00 $823.00 $715.00 $763.00 $823.00 27054 90 $843.00 $889.00 $951.00 $1,029.00 $889.00 $951.00 $1,029.00 27060 90 $491.00 $553.00 $589.00 $633.00 $553.00 $589.00 $633.00 27062 90 $499.00 $584.00 $625.00 $676.00 $584.00 $625.00 $676.00 27065 90 $583.00 $643.00 $688.00 $743.00 $643.00 $688.00 $743.00 27066 90 $931.00 $1,059.00 $1,133.00 $1,227.00 $1,059.00 $1,133.00 $1,227.00 27067 90 $1,234.00 $1,319.00 $1,400.00 $1,502.00 $1,319.00 $1,400.00 $1,502.00 27070 90 $1,040.00 $1,105.00 $1,180.00 $1,274.00 $1,105.00 $1,180.00 $1,274.00 27071 90 $1,112.00 $1,194.00 $1,276.00 $1,379.00 $1,194.00 $1,276.00 $1,379.00 27075 90 $1,485.00 $3,059.00 $3,266.00 $3,541.00 $3,059.00 $3,266.00 $3,541.00 27076 90 $1,859.00 $2,116.00 $2,260.00 $2,446.00 $2,116.00 $2,260.00 $2,446.00 27077 90 $1,976.00 $3,550.00 $3,782.00 $4,086.00 $3,550.00 $3,782.00 $4,086.00 27078 90 $1,164.00 $1,328.00 $1,418.00 $1,534.00 $1,328.00 $1,418.00 $1,534.00 27079 90 $1,170.00 $1,294.00 $1,374.00 $1,477.00 $1,294.00 $1,374.00 $1,477.00 27080 90 $568.00 $629.00 $669.00 $719.00 $629.00 $669.00 $719.00 27086 10 $57.00 $314.00 $335.00 $357.00 $191.00 $203.00 $218.00 27087 90 $555.00 $824.00 $881.00 $952.00 $824.00 $881.00 $952.00 27090 90 $981.00 $1,103.00 $1,181.00 $1,282.00 $1,103.00 $1,181.00 $1,282.00 27091 90 $1,482.00 $2,112.00 $2,258.00 $2,449.00 $2,112.00 $2,258.00 $2,449.00 27093 0 $62.00 $261.00 $278.00 $295.00 $95.00 $100.00 $107.00 27095 0 $121.00 $317.00 $338.00 $357.00 $107.00 $112.00 $119.00 27096 0 $491.00 $244.00 $258.00 $271.00 $88.00 $92.00 $96.00 27097 90 $795.00 $874.00 $936.00 $1,017.00 $874.00 $936.00 $1,017.00 27098 90 $799.00 $806.00 $851.00 $906.00 $806.00 $851.00 $906.00 27100 90 $987.00 $1,076.00 $1,152.00 $1,248.00 $1,076.00 $1,152.00 $1,248.00 27105 90 $946.00 $1,109.00 $1,182.00 $1,275.00 $1,109.00 $1,182.00 $1,275.00 27110 90 $1,174.00 $1,248.00 $1,335.00 $1,447.00 $1,248.00 $1,335.00 $1,447.00 27111 90 $1,099.00 $1,170.00 $1,250.00 $1,352.00 $1,170.00 $1,250.00 $1,352.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 162
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 27120 90 $1,603.00 $1,708.00 $1,827.00 $1,982.00 $1,708.00 $1,827.00 $1,982.00 27122 90 $1,406.00 $1,469.00 $1,572.00 $1,705.00 $1,469.00 $1,572.00 $1,705.00 27125 90 $1,371.00 $1,480.00 $1,581.00 $1,711.00 $1,480.00 $1,581.00 $1,711.00 27130 90 $1,853.00 $1,920.00 $2,054.00 $2,229.00 $1,920.00 $2,054.00 $2,229.00 27132 90 $2,128.00 $2,245.00 $2,400.00 $2,602.00 $2,245.00 $2,400.00 $2,602.00 27134 90 $2,576.00 $2,620.00 $2,803.00 $3,046.00 $2,620.00 $2,803.00 $3,046.00 27137 90 $2,190.00 $1,993.00 $2,132.00 $2,314.00 $1,993.00 $2,132.00 $2,314.00 27138 90 $2,025.00 $2,074.00 $2,219.00 $2,410.00 $2,074.00 $2,219.00 $2,410.00 27140 90 $1,092.00 $1,195.00 $1,280.00 $1,389.00 $1,195.00 $1,280.00 $1,389.00 27146 90 $1,432.00 $1,685.00 $1,801.00 $1,952.00 $1,685.00 $1,801.00 $1,952.00 27147 90 $1,744.00 $1,943.00 $2,079.00 $2,257.00 $1,943.00 $2,079.00 $2,257.00 27151 90 $1,732.00 $1,955.00 $2,092.00 $2,276.00 $1,955.00 $2,092.00 $2,276.00 27156 90 $2,017.00 $2,302.00 $2,462.00 $2,672.00 $2,302.00 $2,462.00 $2,672.00 27158 90 $1,588.00 $1,795.00 $1,916.00 $2,073.00 $1,795.00 $1,916.00 $2,073.00 27161 90 $1,443.00 $1,629.00 $1,744.00 $1,893.00 $1,629.00 $1,744.00 $1,893.00 27165 90 $1,572.00 $1,801.00 $1,923.00 $2,082.00 $1,801.00 $1,923.00 $2,082.00 27170 90 $1,453.00 $1,570.00 $1,679.00 $1,821.00 $1,570.00 $1,679.00 $1,821.00 27175 90 $491.00 $848.00 $906.00 $981.00 $848.00 $906.00 $981.00 27176 90 $1,024.00 $1,207.00 $1,294.00 $1,407.00 $1,207.00 $1,294.00 $1,407.00 27177 90 $1,257.00 $1,470.00 $1,573.00 $1,706.00 $1,470.00 $1,573.00 $1,706.00 27178 90 $1,020.00 $1,175.00 $1,258.00 $1,364.00 $1,175.00 $1,258.00 $1,364.00 27179 90 $1,107.00 $1,293.00 $1,384.00 $1,500.00 $1,293.00 $1,384.00 $1,500.00 27181 90 $1,206.00 $1,374.00 $1,449.00 $1,540.00 $1,374.00 $1,449.00 $1,540.00 27185 90 $676.00 $999.00 $1,085.00 $1,200.00 $999.00 $1,085.00 $1,200.00 27187 90 $1,280.00 $1,326.00 $1,420.00 $1,542.00 $1,326.00 $1,420.00 $1,542.00 27193 90 $425.00 $600.00 $642.00 $694.00 $603.00 $645.00 $697.00 27194 90 $740.00 $961.00 $1,028.00 $1,114.00 $961.00 $1,028.00 $1,114.00 27200 90 $180.00 $218.00 $232.00 $250.00 $220.00 $235.00 $252.00 27202 90 $776.00 $968.00 $1,034.00 $1,108.00 $968.00 $1,034.00 $1,108.00 27215 90 $954.00 $989.00 $1,063.00 $1,161.00 $989.00 $1,063.00 $1,161.00 27216 90 $1,085.00 $1,416.00 $1,517.00 $1,648.00 $1,416.00 $1,517.00 $1,648.00 27217 90 $1,285.00 $1,349.00 $1,444.00 $1,567.00 $1,349.00 $1,444.00 $1,567.00 27218 90 $1,570.00 $1,828.00 $1,957.00 $2,128.00 $1,828.00 $1,957.00 $2,128.00 27220 90 $444.00 $675.00 $722.00 $780.00 $670.00 $716.00 $774.00 27222 90 $973.00 $1,293.00 $1,382.00 $1,495.00 $1,293.00 $1,382.00 $1,495.00 27226 90 $1,350.00 $1,342.00 $1,435.00 $1,557.00 $1,342.00 $1,435.00 $1,557.00 27227 90 $1,967.00 $2,225.00 $2,380.00 $2,581.00 $2,225.00 $2,380.00 $2,581.00 27228 90 $2,195.00 $2,550.00 $2,726.00 $2,958.00 $2,550.00 $2,726.00 $2,958.00 27230 90 $491.00 $604.00 $647.00 $699.00 $591.00 $633.00 $685.00 27232 90 $916.00 $1,027.00 $1,098.00 $1,191.00 $1,027.00 $1,098.00 $1,191.00 27235 90 $1,128.00 $1,209.00 $1,294.00 $1,403.00 $1,209.00 $1,294.00 $1,403.00 27236 90 $1,421.00 $1,564.00 $1,671.00 $1,809.00 $1,564.00 $1,671.00 $1,809.00 27238 90 $504.00 $580.00 $621.00 $670.00 $580.00 $621.00 $670.00 27240 90 $1,043.00 $1,255.00 $1,342.00 $1,453.00 $1,255.00 $1,342.00 $1,453.00 27244 90 $1,426.00 $1,545.00 $1,653.00 $1,793.00 $1,545.00 $1,653.00 $1,793.00 27245 90 $1,691.00 $1,897.00 $2,032.00 $2,208.00 $1,897.00 $2,032.00 $2,208.00 27246 90 $459.00 $496.00 $532.00 $576.00 $496.00 $532.00 $576.00 27248 90 $980.00 $1,009.00 $1,081.00 $1,174.00 $1,009.00 $1,081.00 $1,174.00 27250 90 $535.00 $611.00 $642.00 $680.00 $611.00 $642.00 $680.00 27252 90 $520.00 $992.00 $1,059.00 $1,145.00 $992.00 $1,059.00 $1,145.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 163
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 27253 90 $1,162.00 $1,259.00 $1,348.00 $1,463.00 $1,259.00 $1,348.00 $1,463.00 27254 90 $1,478.00 $1,699.00 $1,820.00 $1,978.00 $1,699.00 $1,820.00 $1,978.00 27256 10 $338.00 $387.00 $409.00 $436.00 $323.00 $341.00 $365.00 27257 10 $455.00 $440.00 $467.00 $502.00 $440.00 $467.00 $502.00 27258 90 $1,355.00 $1,472.00 $1,576.00 $1,710.00 $1,472.00 $1,576.00 $1,710.00 27259 90 $1,803.00 $2,051.00 $2,194.00 $2,381.00 $2,051.00 $2,194.00 $2,381.00 27265 90 $442.00 $509.00 $540.00 $578.00 $509.00 $540.00 $578.00 27266 90 $614.00 $759.00 $813.00 $881.00 $759.00 $813.00 $881.00 27267 90 ------- $543.00 $582.00 $629.00 $543.00 $582.00 $629.00 27268 90 ------- $671.00 $719.00 $779.00 $671.00 $719.00 $779.00 27269 90 ------- $1,607.00 $1,717.00 $1,861.00 $1,607.00 $1,717.00 $1,861.00 27275 10 $220.00 $238.00 $255.00 $276.00 $238.00 $255.00 $276.00 27280 90 $1,179.00 $1,361.00 $1,459.00 $1,587.00 $1,361.00 $1,459.00 $1,587.00 27282 90 $990.00 $1,092.00 $1,168.00 $1,265.00 $1,092.00 $1,168.00 $1,265.00 27284 90 $1,435.00 $2,151.00 $2,298.00 $2,492.00 $2,151.00 $2,298.00 $2,492.00 27286 90 $1,503.00 $2,131.00 $2,261.00 $2,426.00 $2,131.00 $2,261.00 $2,426.00 27290 90 $2,073.00 $2,072.00 $2,206.00 $2,380.00 $2,072.00 $2,206.00 $2,380.00 27295 90 $1,594.00 $1,675.00 $1,787.00 $1,934.00 $1,675.00 $1,787.00 $1,934.00 27299 YYY BR ------- ------- ------- ------- ------- ------- 27301 90 $193.00 $852.00 $911.00 $979.00 $640.00 $684.00 $739.00 27303 90 $520.00 $838.00 $897.00 $972.00 $838.00 $897.00 $972.00 27305 90 $555.00 $612.00 $656.00 $710.00 $612.00 $656.00 $710.00 27306 90 $377.00 $506.00 $543.00 $590.00 $506.00 $543.00 $590.00 27307 90 $503.00 $616.00 $660.00 $716.00 $616.00 $660.00 $716.00 27310 90 $877.00 $950.00 $1,017.00 $1,101.00 $950.00 $1,017.00 $1,101.00 27323 10 $211.00 $320.00 $340.00 $361.00 $223.00 $236.00 $251.00 27324 90 $433.00 $492.00 $525.00 $566.00 $492.00 $525.00 $566.00 27325 90 ------- $668.00 $713.00 $770.00 $668.00 $713.00 $770.00 27326 90 ------- $642.00 $687.00 $744.00 $642.00 $687.00 $744.00 27327 90 $400.00 $564.00 $602.00 $644.00 $445.00 $475.00 $511.00 27328 90 $503.00 $541.00 $578.00 $623.00 $541.00 $578.00 $623.00 27329 90 $1,249.00 $1,344.00 $1,430.00 $1,540.00 $1,344.00 $1,430.00 $1,540.00 27330 90 $492.00 $525.00 $562.00 $609.00 $525.00 $562.00 $609.00 27331 90 $585.00 $617.00 $661.00 $717.00 $617.00 $661.00 $717.00 27332 90 $786.00 $836.00 $896.00 $971.00 $836.00 $896.00 $971.00 27333 90 $719.00 $758.00 $812.00 $879.00 $758.00 $812.00 $879.00 27334 90 $840.00 $892.00 $955.00 $1,034.00 $892.00 $955.00 $1,034.00 27335 90 $959.00 $1,009.00 $1,081.00 $1,172.00 $1,009.00 $1,081.00 $1,172.00 27340 90 $405.00 $470.00 $504.00 $545.00 $470.00 $504.00 $545.00 27345 90 $565.00 $623.00 $667.00 $722.00 $623.00 $667.00 $722.00 27347 90 $394.00 $653.00 $697.00 $752.00 $653.00 $697.00 $752.00 27350 90 $786.00 $850.00 $910.00 $985.00 $850.00 $910.00 $985.00 27355 90 $763.00 $790.00 $846.00 $916.00 $790.00 $846.00 $916.00 27356 90 $882.00 $966.00 $1,034.00 $1,120.00 $966.00 $1,034.00 $1,120.00 27357 90 $950.00 $1,077.00 $1,156.00 $1,257.00 $1,077.00 $1,156.00 $1,257.00 27358 ZZZ $394.00 $396.00 $424.00 $463.00 $396.00 $424.00 $463.00 27360 90 $977.00 $1,119.00 $1,197.00 $1,295.00 $1,119.00 $1,197.00 $1,295.00 27365 90 $1,421.00 $1,616.00 $1,727.00 $1,869.00 $1,616.00 $1,727.00 $1,869.00 27370 0 $75.00 $220.00 $234.00 $247.00 $69.00 $72.00 $76.00 27372 90 $371.00 $766.00 $820.00 $880.00 $525.00 $562.00 $608.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 164
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 27380 90 $698.00 $776.00 $831.00 $900.00 $776.00 $831.00 $900.00 27381 90 $1,118.00 $1,059.00 $1,134.00 $1,229.00 $1,059.00 $1,134.00 $1,229.00 27385 90 $753.00 $832.00 $891.00 $965.00 $832.00 $891.00 $965.00 27386 90 $1,064.00 $1,100.00 $1,178.00 $1,277.00 $1,100.00 $1,178.00 $1,277.00 27390 90 $506.00 $568.00 $608.00 $658.00 $568.00 $608.00 $658.00 27391 90 $647.00 $747.00 $800.00 $866.00 $747.00 $800.00 $866.00 27392 90 $834.00 $927.00 $993.00 $1,075.00 $927.00 $993.00 $1,075.00 27393 90 $608.00 $662.00 $709.00 $768.00 $662.00 $709.00 $768.00 27394 90 $748.00 $858.00 $920.00 $997.00 $858.00 $920.00 $997.00 27395 90 $1,093.00 $1,162.00 $1,245.00 $1,351.00 $1,162.00 $1,245.00 $1,351.00 27396 90 $742.00 $805.00 $862.00 $933.00 $805.00 $862.00 $933.00 27397 90 $989.00 $1,165.00 $1,242.00 $1,340.00 $1,165.00 $1,242.00 $1,340.00 27400 90 $832.00 $880.00 $938.00 $1,010.00 $880.00 $938.00 $1,010.00 27403 90 $792.00 $844.00 $904.00 $980.00 $844.00 $904.00 $980.00 27405 90 $842.00 $887.00 $950.00 $1,030.00 $887.00 $950.00 $1,030.00 27407 90 $918.00 $1,024.00 $1,096.00 $1,189.00 $1,024.00 $1,096.00 $1,189.00 27409 90 $1,212.00 $1,271.00 $1,361.00 $1,476.00 $1,271.00 $1,361.00 $1,476.00 27412 90 ------- $2,209.00 $2,370.00 $2,584.00 $2,209.00 $2,370.00 $2,584.00 27415 90 ------- $1,884.00 $2,038.00 $2,245.00 $1,884.00 $2,038.00 $2,245.00 27416 90 ------- $1,261.00 $1,350.00 $1,466.00 $1,261.00 $1,350.00 $1,466.00 27418 90 $1,596.00 $1,100.00 $1,177.00 $1,276.00 $1,100.00 $1,177.00 $1,276.00 27420 90 $927.00 $988.00 $1,058.00 $1,148.00 $988.00 $1,058.00 $1,148.00 27422 90 $930.00 $985.00 $1,055.00 $1,144.00 $985.00 $1,055.00 $1,144.00 27424 90 $927.00 $986.00 $1,056.00 $1,145.00 $986.00 $1,056.00 $1,145.00 27425 90 $639.00 $575.00 $616.00 $667.00 $575.00 $616.00 $667.00 27427 90 $1,118.00 $946.00 $1,013.00 $1,099.00 $946.00 $1,013.00 $1,099.00 27428 90 $1,266.00 $1,445.00 $1,545.00 $1,671.00 $1,445.00 $1,545.00 $1,671.00 27429 90 $2,333.00 $1,616.00 $1,727.00 $1,869.00 $1,616.00 $1,727.00 $1,869.00 27430 90 $884.00 $977.00 $1,047.00 $1,135.00 $977.00 $1,047.00 $1,135.00 27435 90 $501.00 $1,038.00 $1,110.00 $1,200.00 $1,038.00 $1,110.00 $1,200.00 27437 90 $819.00 $868.00 $930.00 $1,009.00 $868.00 $930.00 $1,009.00 27438 90 $1,065.00 $1,109.00 $1,187.00 $1,288.00 $1,109.00 $1,187.00 $1,288.00 27440 90 $1,064.00 $984.00 $1,054.00 $1,144.00 $984.00 $1,054.00 $1,144.00 27441 90 $1,006.00 $1,038.00 $1,111.00 $1,206.00 $1,038.00 $1,111.00 $1,206.00 27442 90 $1,117.00 $1,156.00 $1,239.00 $1,346.00 $1,156.00 $1,239.00 $1,346.00 27443 90 $1,037.00 $1,083.00 $1,161.00 $1,259.00 $1,083.00 $1,161.00 $1,259.00 27445 90 $1,618.00 $1,684.00 $1,803.00 $1,958.00 $1,684.00 $1,803.00 $1,958.00 27446 90 $1,764.00 $1,500.00 $1,608.00 $1,749.00 $1,500.00 $1,608.00 $1,749.00 27447 90 $1,960.00 $2,063.00 $2,208.00 $2,397.00 $2,063.00 $2,208.00 $2,397.00 27448 90 $1,060.00 $1,092.00 $1,170.00 $1,270.00 $1,092.00 $1,170.00 $1,270.00 27450 90 $1,311.00 $1,357.00 $1,454.00 $1,578.00 $1,357.00 $1,454.00 $1,578.00 27454 90 $1,524.00 $1,720.00 $1,841.00 $1,998.00 $1,720.00 $1,841.00 $1,998.00 27455 90 $1,157.00 $1,255.00 $1,345.00 $1,460.00 $1,255.00 $1,345.00 $1,460.00 27457 90 $1,209.00 $1,294.00 $1,386.00 $1,505.00 $1,294.00 $1,386.00 $1,505.00 27465 90 $1,253.00 $1,575.00 $1,675.00 $1,803.00 $1,575.00 $1,675.00 $1,803.00 27466 90 $1,441.00 $1,572.00 $1,682.00 $1,823.00 $1,572.00 $1,682.00 $1,823.00 27468 90 $1,613.00 $1,781.00 $1,907.00 $2,072.00 $1,781.00 $1,907.00 $2,072.00 27470 90 $1,501.00 $1,568.00 $1,678.00 $1,820.00 $1,568.00 $1,678.00 $1,820.00 27472 90 $1,665.00 $1,699.00 $1,819.00 $1,975.00 $1,699.00 $1,819.00 $1,975.00 27475 90 $782.00 $858.00 $916.00 $989.00 $858.00 $916.00 $989.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 165
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 27477 90 $938.00 $967.00 $1,037.00 $1,126.00 $967.00 $1,037.00 $1,126.00 27479 90 $1,123.00 $1,296.00 $1,400.00 $1,537.00 $1,296.00 $1,400.00 $1,537.00 27485 90 $797.00 $885.00 $948.00 $1,028.00 $885.00 $948.00 $1,028.00 27486 90 $1,771.00 $1,878.00 $2,008.00 $2,178.00 $1,878.00 $2,008.00 $2,178.00 27487 90 $2,352.00 $2,376.00 $2,542.00 $2,760.00 $2,376.00 $2,542.00 $2,760.00 27488 90 $1,438.00 $1,584.00 $1,693.00 $1,833.00 $1,584.00 $1,693.00 $1,833.00 27495 90 $1,477.00 $1,511.00 $1,618.00 $1,755.00 $1,511.00 $1,618.00 $1,755.00 27496 90 $563.00 $655.00 $699.00 $754.00 $655.00 $699.00 $754.00 27497 90 $652.00 $713.00 $761.00 $821.00 $713.00 $761.00 $821.00 27498 90 $701.00 $778.00 $829.00 $894.00 $778.00 $829.00 $894.00 27499 90 $782.00 $874.00 $934.00 $1,011.00 $874.00 $934.00 $1,011.00 27500 90 $520.00 $660.00 $706.00 $763.00 $612.00 $655.00 $709.00 27501 90 $659.00 $649.00 $695.00 $751.00 $637.00 $681.00 $737.00 27502 90 $909.00 $1,044.00 $1,116.00 $1,209.00 $1,044.00 $1,116.00 $1,209.00 27503 90 $911.00 $1,057.00 $1,131.00 $1,227.00 $1,057.00 $1,131.00 $1,227.00 27506 90 $1,522.00 $1,757.00 $1,877.00 $2,032.00 $1,757.00 $1,877.00 $2,032.00 27507 90 $1,297.00 $1,318.00 $1,411.00 $1,533.00 $1,318.00 $1,411.00 $1,533.00 27508 90 $400.00 $666.00 $712.00 $768.00 $626.00 $669.00 $723.00 27509 90 $649.00 $845.00 $905.00 $979.00 $845.00 $905.00 $979.00 27510 90 $755.00 $916.00 $979.00 $1,059.00 $916.00 $979.00 $1,059.00 27511 90 $1,281.00 $1,374.00 $1,469.00 $1,591.00 $1,374.00 $1,469.00 $1,591.00 27513 90 $1,562.00 $1,736.00 $1,858.00 $2,016.00 $1,736.00 $1,858.00 $2,016.00 27514 90 $1,508.00 $1,448.00 $1,563.00 $1,712.00 $1,448.00 $1,563.00 $1,712.00 27516 90 $579.00 $622.00 $664.00 $714.00 $585.00 $625.00 $672.00 27517 90 $820.00 $865.00 $921.00 $990.00 $865.00 $921.00 $990.00 27519 90 $1,311.00 $1,293.00 $1,392.00 $1,520.00 $1,293.00 $1,392.00 $1,520.00 27520 90 $266.00 $391.00 $418.00 $449.00 $349.00 $373.00 $402.00 27524 90 $910.00 $1,000.00 $1,071.00 $1,162.00 $1,000.00 $1,071.00 $1,162.00 27530 90 $408.00 $492.00 $526.00 $567.00 $455.00 $487.00 $525.00 27532 90 $641.00 $793.00 $849.00 $919.00 $751.00 $804.00 $871.00 27535 90 $1,075.00 $1,222.00 $1,304.00 $1,409.00 $1,222.00 $1,304.00 $1,409.00 27536 90 $1,282.00 $1,570.00 $1,678.00 $1,818.00 $1,570.00 $1,678.00 $1,818.00 27538 90 $487.00 $590.00 $633.00 $683.00 $551.00 $591.00 $639.00 27540 90 $1,106.00 $1,127.00 $1,215.00 $1,330.00 $1,127.00 $1,215.00 $1,330.00 27550 90 $296.00 $615.00 $655.00 $701.00 $570.00 $606.00 $650.00 27552 90 $619.00 $811.00 $869.00 $942.00 $811.00 $869.00 $942.00 27556 90 $832.00 $1,276.00 $1,373.00 $1,500.00 $1,276.00 $1,373.00 $1,500.00 27557 90 $1,479.00 $1,516.00 $1,630.00 $1,779.00 $1,516.00 $1,630.00 $1,779.00 27558 90 $1,529.00 $1,660.00 $1,779.00 $1,933.00 $1,660.00 $1,779.00 $1,933.00 27560 90 $88.00 $441.00 $467.00 $496.00 $386.00 $409.00 $435.00 27562 90 $514.00 $584.00 $625.00 $675.00 $584.00 $625.00 $675.00 27566 90 $1,047.00 $1,191.00 $1,275.00 $1,385.00 $1,191.00 $1,275.00 $1,385.00 27570 10 $184.00 $191.00 $205.00 $222.00 $191.00 $205.00 $222.00 27580 90 $1,644.00 $1,924.00 $2,058.00 $2,231.00 $1,924.00 $2,058.00 $2,231.00 27590 90 $1,059.00 $1,083.00 $1,150.00 $1,238.00 $1,083.00 $1,150.00 $1,238.00 27591 90 $1,182.00 $1,210.00 $1,290.00 $1,393.00 $1,210.00 $1,290.00 $1,393.00 27592 90 $911.00 $915.00 $973.00 $1,047.00 $915.00 $973.00 $1,047.00 27594 90 $600.00 $665.00 $708.00 $763.00 $665.00 $708.00 $763.00 27596 90 $931.00 $968.00 $1,031.00 $1,111.00 $968.00 $1,031.00 $1,111.00 27598 90 $976.00 $982.00 $1,047.00 $1,131.00 $982.00 $1,047.00 $1,131.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 166
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 27599 YYY BR ------- ------- ------- ------- ------- ------- 27600 90 $517.00 $555.00 $592.00 $638.00 $555.00 $592.00 $638.00 27601 90 $516.00 $568.00 $604.00 $649.00 $568.00 $604.00 $649.00 27602 90 $621.00 $685.00 $729.00 $787.00 $685.00 $729.00 $787.00 27603 90 $412.00 $662.00 $707.00 $758.00 $501.00 $534.00 $575.00 27604 90 $308.00 $581.00 $621.00 $666.00 $451.00 $482.00 $519.00 27605 10 $236.00 $489.00 $522.00 $557.00 $269.00 $287.00 $309.00 27606 10 $362.00 $399.00 $427.00 $463.00 $399.00 $427.00 $463.00 27607 90 $608.00 $800.00 $855.00 $924.00 $800.00 $855.00 $924.00 27610 90 $777.00 $862.00 $921.00 $995.00 $862.00 $921.00 $995.00 27612 90 $701.00 $747.00 $796.00 $857.00 $747.00 $796.00 $857.00 27613 10 $165.00 $297.00 $315.00 $333.00 $208.00 $220.00 $233.00 27614 90 $327.00 $702.00 $749.00 $801.00 $539.00 $574.00 $617.00 27615 90 $1,106.00 $1,170.00 $1,247.00 $1,343.00 $1,170.00 $1,247.00 $1,343.00 27618 90 $421.00 $610.00 $651.00 $697.00 $494.00 $526.00 $566.00 27619 90 $730.00 $985.00 $1,051.00 $1,129.00 $778.00 $830.00 $895.00 27620 90 $587.00 $611.00 $654.00 $707.00 $611.00 $654.00 $707.00 27625 90 $796.00 $793.00 $847.00 $915.00 $793.00 $847.00 $915.00 27626 90 $863.00 $857.00 $917.00 $994.00 $857.00 $917.00 $994.00 27630 90 $430.00 $675.00 $721.00 $773.00 $491.00 $524.00 $565.00 27635 90 $781.00 $785.00 $840.00 $910.00 $785.00 $840.00 $910.00 27637 90 $921.00 $989.00 $1,059.00 $1,146.00 $989.00 $1,059.00 $1,146.00 27638 90 $978.00 $1,040.00 $1,115.00 $1,210.00 $1,040.00 $1,115.00 $1,210.00 27640 90 $1,122.00 $1,163.00 $1,242.00 $1,343.00 $1,163.00 $1,242.00 $1,343.00 27641 90 $922.00 $934.00 $996.00 $1,075.00 $934.00 $996.00 $1,075.00 27645 90 $1,302.00 $1,406.00 $1,505.00 $1,630.00 $1,406.00 $1,505.00 $1,630.00 27646 90 $1,212.00 $1,250.00 $1,336.00 $1,444.00 $1,250.00 $1,336.00 $1,444.00 27647 90 $1,044.00 $1,097.00 $1,167.00 $1,257.00 $1,097.00 $1,167.00 $1,257.00 27648 0 $72.00 $212.00 $225.00 $238.00 $69.00 $72.00 $76.00 27650 90 $869.00 $935.00 $999.00 $1,082.00 $935.00 $999.00 $1,082.00 27652 90 $935.00 $998.00 $1,067.00 $1,156.00 $998.00 $1,067.00 $1,156.00 27654 90 $937.00 $938.00 $1,002.00 $1,083.00 $938.00 $1,002.00 $1,083.00 27656 90 $458.00 $684.00 $731.00 $782.00 $456.00 $486.00 $524.00 27658 90 $527.00 $510.00 $545.00 $588.00 $510.00 $545.00 $588.00 27659 90 $725.00 $673.00 $719.00 $777.00 $673.00 $719.00 $777.00 27664 90 $504.00 $489.00 $524.00 $566.00 $489.00 $524.00 $566.00 27665 90 $618.00 $559.00 $599.00 $647.00 $559.00 $599.00 $647.00 27675 90 $656.00 $689.00 $735.00 $794.00 $689.00 $735.00 $794.00 27676 90 $762.00 $825.00 $882.00 $954.00 $825.00 $882.00 $954.00 27680 90 $523.00 $578.00 $618.00 $668.00 $578.00 $618.00 $668.00 27681 90 $634.00 $692.00 $741.00 $803.00 $692.00 $741.00 $803.00 27685 90 $565.00 $787.00 $841.00 $903.00 $637.00 $679.00 $732.00 27686 90 $706.00 $752.00 $804.00 $870.00 $752.00 $804.00 $870.00 27687 90 $589.00 $620.00 $663.00 $717.00 $620.00 $663.00 $717.00 27690 90 $757.00 $819.00 $874.00 $943.00 $819.00 $874.00 $943.00 27691 90 $889.00 $973.00 $1,040.00 $1,126.00 $973.00 $1,040.00 $1,126.00 27692 ZZZ $159.00 $154.00 $165.00 $180.00 $154.00 $165.00 $180.00 27695 90 $658.00 $661.00 $707.00 $764.00 $661.00 $707.00 $764.00 27696 90 $758.00 $791.00 $845.00 $912.00 $791.00 $845.00 $912.00 27698 90 $881.00 $883.00 $943.00 $1,020.00 $883.00 $943.00 $1,020.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 167
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 27700 90 $835.00 $823.00 $876.00 $943.00 $823.00 $876.00 $943.00 27702 90 $1,278.00 $1,337.00 $1,431.00 $1,553.00 $1,337.00 $1,431.00 $1,553.00 27703 90 $1,337.00 $1,534.00 $1,642.00 $1,781.00 $1,534.00 $1,642.00 $1,781.00 27704 90 $683.00 $742.00 $794.00 $861.00 $742.00 $794.00 $861.00 27705 90 $985.00 $1,026.00 $1,099.00 $1,193.00 $1,026.00 $1,099.00 $1,193.00 27707 90 $484.00 $515.00 $551.00 $595.00 $515.00 $551.00 $595.00 27709 90 $1,118.00 $1,403.00 $1,480.00 $1,575.00 $1,403.00 $1,480.00 $1,575.00 27712 90 $1,227.00 $1,437.00 $1,536.00 $1,664.00 $1,437.00 $1,536.00 $1,664.00 27715 90 $1,285.00 $1,415.00 $1,514.00 $1,641.00 $1,415.00 $1,514.00 $1,641.00 27720 90 $1,147.00 $1,170.00 $1,253.00 $1,359.00 $1,170.00 $1,253.00 $1,359.00 27722 90 $1,076.00 $1,167.00 $1,249.00 $1,355.00 $1,167.00 $1,249.00 $1,355.00 27724 90 $1,402.00 $1,718.00 $1,839.00 $1,997.00 $1,718.00 $1,839.00 $1,997.00 27725 90 $1,312.00 $1,583.00 $1,692.00 $1,832.00 $1,583.00 $1,692.00 $1,832.00 27726 90 ------- $1,164.00 $1,228.00 $1,306.00 $1,164.00 $1,228.00 $1,306.00 27727 90 $1,175.00 $1,369.00 $1,465.00 $1,590.00 $1,369.00 $1,465.00 $1,590.00 27730 90 $647.00 $787.00 $852.00 $937.00 $787.00 $852.00 $937.00 27732 90 $611.00 $541.00 $576.00 $620.00 $541.00 $576.00 $620.00 27734 90 $766.00 $828.00 $884.00 $956.00 $828.00 $884.00 $956.00 27740 90 $1,044.00 $939.00 $1,006.00 $1,091.00 $939.00 $1,006.00 $1,091.00 27742 90 $1,045.00 $889.00 $953.00 $1,039.00 $889.00 $953.00 $1,039.00 27745 90 $940.00 $1,005.00 $1,077.00 $1,169.00 $1,005.00 $1,077.00 $1,169.00 27750 90 $319.00 $424.00 $454.00 $489.00 $386.00 $414.00 $446.00 27752 90 $614.00 $684.00 $732.00 $790.00 $638.00 $683.00 $739.00 27756 90 $708.00 $742.00 $794.00 $858.00 $742.00 $794.00 $858.00 27758 90 $1,115.00 $1,174.00 $1,257.00 $1,362.00 $1,174.00 $1,257.00 $1,362.00 27759 90 $1,262.00 $1,336.00 $1,431.00 $1,553.00 $1,336.00 $1,431.00 $1,553.00 27760 90 $223.00 $407.00 $435.00 $467.00 $365.00 $390.00 $419.00 27762 90 $495.00 $613.00 $656.00 $706.00 $566.00 $605.00 $653.00 27766 90 $759.00 $811.00 $872.00 $948.00 $811.00 $872.00 $948.00 27767 90 ------- $322.00 $343.00 $365.00 $323.00 $344.00 $367.00 27768 90 ------- $512.00 $548.00 $591.00 $512.00 $548.00 $591.00 27769 90 ------- $889.00 $947.00 $1,022.00 $889.00 $947.00 $1,022.00 27780 90 $244.00 $361.00 $386.00 $414.00 $323.00 $345.00 $371.00 27781 90 $296.00 $527.00 $564.00 $608.00 $490.00 $525.00 $567.00 27784 90 $643.00 $877.00 $932.00 $1,000.00 $877.00 $932.00 $1,000.00 27786 90 $223.00 $386.00 $413.00 $443.00 $342.00 $366.00 $394.00 27788 90 $422.00 $536.00 $574.00 $619.00 $493.00 $527.00 $570.00 27792 90 $706.00 $897.00 $956.00 $1,028.00 $897.00 $956.00 $1,028.00 27808 90 $332.00 $403.00 $431.00 $463.00 $358.00 $383.00 $412.00 27810 90 $567.00 $601.00 $642.00 $692.00 $552.00 $590.00 $636.00 27814 90 $972.00 $1,033.00 $1,109.00 $1,205.00 $1,033.00 $1,109.00 $1,205.00 27816 90 $386.00 $383.00 $409.00 $438.00 $342.00 $365.00 $391.00 27818 90 $613.00 $621.00 $663.00 $712.00 $567.00 $605.00 $651.00 27822 90 $1,201.00 $1,141.00 $1,224.00 $1,327.00 $1,141.00 $1,224.00 $1,327.00 27823 90 $1,472.00 $1,299.00 $1,393.00 $1,512.00 $1,299.00 $1,393.00 $1,512.00 27824 90 $384.00 $379.00 $404.00 $433.00 $362.00 $386.00 $414.00 27825 90 $670.00 $700.00 $748.00 $806.00 $644.00 $688.00 $743.00 27826 90 $1,080.00 $1,055.00 $1,123.00 $1,206.00 $1,055.00 $1,123.00 $1,206.00 27827 90 $1,310.00 $1,451.00 $1,554.00 $1,684.00 $1,451.00 $1,554.00 $1,684.00 27828 90 $1,823.00 $1,716.00 $1,833.00 $1,982.00 $1,716.00 $1,833.00 $1,982.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 168
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 27829 90 $742.00 $825.00 $874.00 $931.00 $825.00 $874.00 $931.00 27830 90 $412.00 $435.00 $464.00 $498.00 $409.00 $436.00 $468.00 27831 90 $415.00 $488.00 $522.00 $563.00 $488.00 $522.00 $563.00 27832 90 $617.00 $876.00 $926.00 $985.00 $876.00 $926.00 $985.00 27840 90 $334.00 $440.00 $465.00 $494.00 $440.00 $465.00 $494.00 27842 90 $373.00 $626.00 $669.00 $723.00 $626.00 $669.00 $723.00 27846 90 $877.00 $980.00 $1,050.00 $1,139.00 $980.00 $1,050.00 $1,139.00 27848 90 $1,224.00 $1,123.00 $1,203.00 $1,305.00 $1,123.00 $1,203.00 $1,305.00 27860 10 $211.00 $234.00 $250.00 $271.00 $234.00 $250.00 $271.00 27870 90 $1,269.00 $1,392.00 $1,487.00 $1,610.00 $1,392.00 $1,487.00 $1,610.00 27871 90 $843.00 $922.00 $987.00 $1,070.00 $922.00 $987.00 $1,070.00 27880 90 $1,015.00 $1,200.00 $1,269.00 $1,358.00 $1,200.00 $1,269.00 $1,358.00 27881 90 $1,120.00 $1,189.00 $1,269.00 $1,371.00 $1,189.00 $1,269.00 $1,371.00 27882 90 $854.00 $842.00 $895.00 $962.00 $842.00 $895.00 $962.00 27884 90 $579.00 $774.00 $824.00 $888.00 $774.00 $824.00 $888.00 27886 90 $835.00 $879.00 $936.00 $1,009.00 $879.00 $936.00 $1,009.00 27888 90 $911.00 $938.00 $1,001.00 $1,080.00 $938.00 $1,001.00 $1,080.00 27889 90 $879.00 $917.00 $975.00 $1,050.00 $917.00 $975.00 $1,050.00 27892 90 $575.00 $722.00 $769.00 $828.00 $722.00 $769.00 $828.00 27893 90 $574.00 $717.00 $764.00 $823.00 $717.00 $764.00 $823.00 27894 90 $712.00 $1,092.00 $1,161.00 $1,248.00 $1,092.00 $1,161.00 $1,248.00 27899 YYY BR ------- ------- ------- ------- ------- ------- 28001 10 $185.00 $330.00 $350.00 $374.00 $244.00 $259.00 $277.00 28002 10 $362.00 $611.00 $647.00 $689.00 $503.00 $532.00 $567.00 28003 90 $520.00 $859.00 $913.00 $977.00 $753.00 $799.00 $858.00 28005 90 $520.00 $818.00 $868.00 $931.00 $818.00 $868.00 $931.00 28008 90 $296.00 $524.00 $558.00 $596.00 $411.00 $437.00 $468.00 28010 90 $235.00 $295.00 $313.00 $335.00 $282.00 $300.00 $321.00 28011 90 $340.00 $421.00 $449.00 $482.00 $402.00 $428.00 $461.00 28020 90 $509.00 $629.00 $671.00 $719.00 $488.00 $520.00 $560.00 28022 90 $422.00 $574.00 $611.00 $653.00 $450.00 $479.00 $514.00 28024 90 $371.00 $548.00 $584.00 $624.00 $430.00 $457.00 $490.00 28035 90 $532.00 $625.00 $667.00 $713.00 $488.00 $519.00 $558.00 28043 90 $305.00 $419.00 $446.00 $477.00 $352.00 $374.00 $401.00 28045 90 $456.00 $584.00 $622.00 $665.00 $445.00 $473.00 $508.00 28046 90 $814.00 $1,081.00 $1,150.00 $1,232.00 $909.00 $965.00 $1,037.00 28050 90 $414.00 $546.00 $582.00 $623.00 $422.00 $449.00 $483.00 28052 90 $402.00 $509.00 $542.00 $580.00 $386.00 $411.00 $441.00 28054 90 $236.00 $475.00 $506.00 $540.00 $351.00 $373.00 $400.00 28055 90 ------- $527.00 $559.00 $598.00 $527.00 $559.00 $598.00 28060 90 $495.00 $618.00 $658.00 $704.00 $489.00 $520.00 $559.00 28062 90 $657.00 $733.00 $780.00 $833.00 $570.00 $606.00 $650.00 28070 90 $476.00 $614.00 $655.00 $702.00 $484.00 $516.00 $555.00 28072 90 $445.00 $599.00 $639.00 $685.00 $469.00 $500.00 $539.00 28080 90 $392.00 $575.00 $609.00 $647.00 $452.00 $478.00 $508.00 28086 90 $462.00 $683.00 $731.00 $784.00 $499.00 $534.00 $576.00 28088 90 $414.00 $550.00 $588.00 $631.00 $408.00 $436.00 $471.00 28090 90 $414.00 $554.00 $590.00 $631.00 $422.00 $449.00 $482.00 28092 90 $330.00 $504.00 $537.00 $574.00 $375.00 $399.00 $428.00 28100 90 $571.00 $735.00 $785.00 $840.00 $551.00 $587.00 $632.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 169
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 28102 90 $700.00 $727.00 $775.00 $836.00 $727.00 $775.00 $836.00 28103 90 $709.00 $596.00 $635.00 $683.00 $596.00 $635.00 $683.00 28104 90 $491.00 $616.00 $656.00 $703.00 $483.00 $514.00 $552.00 28106 90 $632.00 $633.00 $673.00 $724.00 $633.00 $673.00 $724.00 28107 90 $517.00 $678.00 $722.00 $772.00 $519.00 $552.00 $593.00 28108 90 $418.00 $513.00 $546.00 $583.00 $396.00 $420.00 $450.00 28110 90 $421.00 $540.00 $576.00 $615.00 $394.00 $419.00 $449.00 28111 90 $537.00 $625.00 $666.00 $712.00 $462.00 $492.00 $528.00 28112 90 $457.00 $586.00 $625.00 $668.00 $432.00 $460.00 $494.00 28113 90 $481.00 $686.00 $728.00 $774.00 $549.00 $581.00 $619.00 28114 90 $890.00 $1,283.00 $1,363.00 $1,456.00 $1,074.00 $1,140.00 $1,221.00 28116 90 $648.00 $907.00 $962.00 $1,027.00 $764.00 $809.00 $865.00 28118 90 $568.00 $704.00 $750.00 $804.00 $558.00 $594.00 $640.00 28119 90 $524.00 $627.00 $668.00 $714.00 $494.00 $525.00 $563.00 28120 90 $601.00 $710.00 $757.00 $810.00 $535.00 $570.00 $613.00 28122 90 $622.00 $815.00 $867.00 $928.00 $684.00 $727.00 $780.00 28124 90 $480.00 $571.00 $607.00 $648.00 $455.00 $483.00 $517.00 28126 90 $393.00 $457.00 $487.00 $519.00 $344.00 $366.00 $392.00 28130 90 $727.00 $859.00 $913.00 $982.00 $859.00 $913.00 $982.00 28140 90 $533.00 $779.00 $829.00 $887.00 $625.00 $664.00 $713.00 28150 90 $416.00 $516.00 $550.00 $587.00 $393.00 $418.00 $448.00 28153 90 $400.00 $474.00 $505.00 $539.00 $351.00 $373.00 $400.00 28160 90 $412.00 $489.00 $521.00 $556.00 $373.00 $397.00 $425.00 28171 90 $789.00 $835.00 $888.00 $956.00 $835.00 $888.00 $956.00 28173 90 $747.00 $922.00 $979.00 $1,047.00 $759.00 $805.00 $864.00 28175 90 $571.00 $669.00 $710.00 $758.00 $531.00 $562.00 $602.00 28190 10 $75.00 $295.00 $314.00 $333.00 $181.00 $191.00 $204.00 28192 90 $326.00 $573.00 $611.00 $653.00 $440.00 $467.00 $501.00 28193 90 $341.00 $653.00 $695.00 $743.00 $519.00 $551.00 $591.00 28200 90 $478.00 $566.00 $603.00 $644.00 $436.00 $463.00 $497.00 28202 90 $613.00 $773.00 $823.00 $881.00 $609.00 $648.00 $696.00 28208 90 $406.00 $541.00 $576.00 $616.00 $415.00 $442.00 $474.00 28210 90 $609.00 $711.00 $756.00 $808.00 $564.00 $599.00 $642.00 28220 90 $435.00 $537.00 $571.00 $610.00 $423.00 $449.00 $481.00 28222 90 $555.00 $625.00 $664.00 $709.00 $507.00 $538.00 $576.00 28225 90 $345.00 $468.00 $498.00 $531.00 $351.00 $372.00 $399.00 28226 90 $334.00 $553.00 $588.00 $628.00 $436.00 $463.00 $496.00 28230 90 $380.00 $518.00 $551.00 $589.00 $408.00 $434.00 $465.00 28232 90 $286.00 $457.00 $487.00 $520.00 $345.00 $367.00 $393.00 28234 90 $178.00 $470.00 $501.00 $534.00 $356.00 $379.00 $406.00 28238 90 $695.00 $843.00 $898.00 $963.00 $685.00 $728.00 $784.00 28240 90 $370.00 $527.00 $561.00 $600.00 $413.00 $440.00 $472.00 28250 90 $535.00 $675.00 $719.00 $771.00 $544.00 $579.00 $623.00 28260 90 $641.00 $839.00 $895.00 $961.00 $710.00 $756.00 $815.00 28261 90 $881.00 $1,213.00 $1,287.00 $1,377.00 $1,072.00 $1,136.00 $1,218.00 28262 90 $1,363.00 $1,732.00 $1,850.00 $1,995.00 $1,521.00 $1,624.00 $1,757.00 28264 90 $912.00 $1,068.00 $1,139.00 $1,226.00 $947.00 $1,010.00 $1,090.00 28270 90 $266.00 $570.00 $607.00 $649.00 $455.00 $483.00 $518.00 28272 90 $336.00 $467.00 $497.00 $529.00 $354.00 $376.00 $402.00 28280 90 $426.00 $642.00 $685.00 $733.00 $504.00 $537.00 $577.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 170
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 28285 90 $463.00 $554.00 $590.00 $630.00 $434.00 $461.00 $495.00 28286 90 $441.00 $545.00 $579.00 $618.00 $420.00 $445.00 $477.00 28288 90 $452.00 $688.00 $730.00 $777.00 $564.00 $598.00 $637.00 28289 90 $458.00 $897.00 $954.00 $1,020.00 $739.00 $785.00 $841.00 28290 90 $557.00 $695.00 $741.00 $795.00 $551.00 $587.00 $632.00 28292 90 $666.00 $927.00 $982.00 $1,044.00 $774.00 $818.00 $871.00 28293 90 $845.00 $1,241.00 $1,314.00 $1,396.00 $936.00 $988.00 $1,051.00 28294 90 $797.00 $914.00 $972.00 $1,040.00 $729.00 $773.00 $830.00 28296 90 $832.00 $975.00 $1,037.00 $1,110.00 $787.00 $835.00 $897.00 28297 90 $838.00 $1,027.00 $1,095.00 $1,176.00 $832.00 $886.00 $955.00 28298 90 $755.00 $872.00 $928.00 $994.00 $699.00 $742.00 $798.00 28299 90 $829.00 $1,126.00 $1,196.00 $1,278.00 $938.00 $994.00 $1,065.00 28300 90 $845.00 $900.00 $963.00 $1,042.00 $900.00 $963.00 $1,042.00 28302 90 $930.00 $892.00 $951.00 $1,026.00 $892.00 $951.00 $1,026.00 28304 90 $776.00 $974.00 $1,038.00 $1,113.00 $807.00 $859.00 $925.00 28305 90 $1,030.00 $913.00 $967.00 $1,036.00 $913.00 $967.00 $1,036.00 28306 90 $530.00 $725.00 $774.00 $829.00 $545.00 $581.00 $626.00 28307 90 $614.00 $879.00 $938.00 $1,003.00 $612.00 $652.00 $702.00 28308 90 $516.00 $648.00 $691.00 $738.00 $495.00 $526.00 $564.00 28309 90 $955.00 $1,209.00 $1,289.00 $1,392.00 $1,209.00 $1,289.00 $1,392.00 28310 90 $505.00 $645.00 $687.00 $734.00 $487.00 $518.00 $556.00 28312 90 $469.00 $586.00 $625.00 $669.00 $437.00 $466.00 $500.00 28313 90 $436.00 $610.00 $651.00 $698.00 $507.00 $540.00 $581.00 28315 90 $462.00 $570.00 $606.00 $648.00 $444.00 $472.00 $506.00 28320 90 $833.00 $858.00 $916.00 $991.00 $858.00 $916.00 $991.00 28322 90 $667.00 $969.00 $1,035.00 $1,112.00 $787.00 $840.00 $907.00 28340 90 $649.00 $761.00 $808.00 $862.00 $605.00 $641.00 $687.00 28341 90 $753.00 $872.00 $925.00 $988.00 $715.00 $757.00 $810.00 28344 90 $414.00 $547.00 $582.00 $619.00 $407.00 $432.00 $461.00 28345 90 $557.00 $690.00 $735.00 $787.00 $556.00 $591.00 $635.00 28360 90 $1,197.00 $1,291.00 $1,380.00 $1,494.00 $1,291.00 $1,380.00 $1,494.00 28400 90 $266.00 $307.00 $328.00 $352.00 $281.00 $301.00 $323.00 28405 90 $473.00 $507.00 $542.00 $584.00 $483.00 $516.00 $557.00 28406 90 $616.00 $699.00 $749.00 $811.00 $699.00 $749.00 $811.00 28415 90 $1,354.00 $1,549.00 $1,659.00 $1,799.00 $1,549.00 $1,659.00 $1,799.00 28420 90 $1,619.00 $1,615.00 $1,728.00 $1,872.00 $1,615.00 $1,728.00 $1,872.00 28430 90 $110.00 $288.00 $307.00 $329.00 $253.00 $270.00 $290.00 28435 90 $371.00 $402.00 $430.00 $463.00 $381.00 $407.00 $439.00 28436 90 $463.00 $555.00 $595.00 $642.00 $555.00 $595.00 $642.00 28445 90 $874.00 $1,448.00 $1,550.00 $1,682.00 $1,448.00 $1,550.00 $1,682.00 28446 90 ------- $1,534.00 $1,633.00 $1,760.00 $1,534.00 $1,633.00 $1,760.00 28450 90 $148.00 $265.00 $283.00 $303.00 $236.00 $252.00 $270.00 28455 90 $321.00 $362.00 $385.00 $413.00 $346.00 $368.00 $395.00 28456 90 $288.00 $361.00 $386.00 $415.00 $361.00 $386.00 $415.00 28465 90 $533.00 $802.00 $852.00 $914.00 $802.00 $852.00 $914.00 28470 90 $178.00 $265.00 $283.00 $304.00 $237.00 $253.00 $272.00 28475 90 $296.00 $336.00 $359.00 $386.00 $318.00 $339.00 $365.00 28476 90 $364.00 $438.00 $468.00 $503.00 $438.00 $468.00 $503.00 28485 90 $521.00 $683.00 $724.00 $773.00 $683.00 $724.00 $773.00 28490 90 $80.00 $166.00 $177.00 $189.00 $146.00 $156.00 $166.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 171
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 28495 90 $133.00 $208.00 $221.00 $236.00 $191.00 $203.00 $216.00 28496 90 $261.00 $532.00 $569.00 $606.00 $295.00 $315.00 $338.00 28505 90 $399.00 $800.00 $844.00 $890.00 $604.00 $634.00 $669.00 28510 90 $75.00 $144.00 $154.00 $164.00 $142.00 $152.00 $162.00 28515 90 $115.00 $188.00 $200.00 $213.00 $178.00 $189.00 $201.00 28525 90 $345.00 $686.00 $726.00 $769.00 $489.00 $516.00 $546.00 28530 90 $120.00 $138.00 $147.00 $157.00 $131.00 $140.00 $149.00 28531 90 $243.00 $490.00 $523.00 $557.00 $257.00 $274.00 $294.00 28540 90 $145.00 $248.00 $264.00 $282.00 $237.00 $252.00 $269.00 28545 90 $208.00 $292.00 $311.00 $334.00 $276.00 $295.00 $317.00 28546 90 $325.00 $570.00 $610.00 $652.00 $396.00 $423.00 $455.00 28555 90 $592.00 $1,046.00 $1,109.00 $1,181.00 $828.00 $875.00 $934.00 28570 90 $189.00 $221.00 $236.00 $252.00 $204.00 $218.00 $233.00 28575 90 $308.00 $407.00 $435.00 $469.00 $389.00 $417.00 $450.00 28576 90 $382.00 $471.00 $503.00 $543.00 $471.00 $503.00 $543.00 28585 90 $742.00 $1,084.00 $1,150.00 $1,227.00 $932.00 $987.00 $1,055.00 28600 90 $144.00 $259.00 $276.00 $295.00 $239.00 $255.00 $273.00 28605 90 $287.00 $338.00 $360.00 $386.00 $322.00 $344.00 $369.00 28606 90 $487.00 $518.00 $555.00 $600.00 $518.00 $555.00 $600.00 28615 90 $621.00 $999.00 $1,060.00 $1,135.00 $999.00 $1,060.00 $1,135.00 28630 10 $145.00 $182.00 $193.00 $206.00 $144.00 $152.00 $163.00 28635 10 $189.00 $219.00 $233.00 $250.00 $183.00 $194.00 $209.00 28636 10 $318.00 $371.00 $396.00 $425.00 $281.00 $300.00 $324.00 28645 90 $434.00 $719.00 $758.00 $799.00 $584.00 $613.00 $647.00 28660 10 $106.00 $133.00 $141.00 $150.00 $108.00 $115.00 $122.00 28665 10 $172.00 $193.00 $206.00 $221.00 $181.00 $192.00 $207.00 28666 10 $309.00 $269.00 $288.00 $312.00 $269.00 $288.00 $312.00 28675 90 $348.00 $676.00 $715.00 $756.00 $487.00 $512.00 $542.00 28705 90 $1,353.00 $1,767.00 $1,887.00 $2,042.00 $1,767.00 $1,887.00 $2,042.00 28715 90 $1,179.00 $1,304.00 $1,392.00 $1,504.00 $1,304.00 $1,392.00 $1,504.00 28725 90 $1,015.00 $1,087.00 $1,161.00 $1,257.00 $1,087.00 $1,161.00 $1,257.00 28730 90 $945.00 $1,115.00 $1,187.00 $1,278.00 $1,115.00 $1,187.00 $1,278.00 28735 90 $961.00 $1,069.00 $1,138.00 $1,226.00 $1,069.00 $1,138.00 $1,226.00 28737 90 $873.00 $947.00 $1,007.00 $1,084.00 $947.00 $1,007.00 $1,084.00 28740 90 $690.00 $1,067.00 $1,136.00 $1,216.00 $835.00 $888.00 $954.00 28750 90 $690.00 $1,049.00 $1,118.00 $1,196.00 $796.00 $847.00 $910.00 28755 90 $466.00 $610.00 $651.00 $696.00 $454.00 $483.00 $519.00 28760 90 $654.00 $949.00 $1,007.00 $1,075.00 $772.00 $818.00 $875.00 28800 90 $731.00 $767.00 $816.00 $877.00 $767.00 $816.00 $877.00 28805 90 $731.00 $971.00 $1,022.00 $1,085.00 $971.00 $1,022.00 $1,085.00 28810 90 $543.00 $588.00 $625.00 $671.00 $588.00 $625.00 $671.00 28820 90 $377.00 $658.00 $701.00 $747.00 $462.00 $490.00 $525.00 28825 90 $339.00 $567.00 $605.00 $645.00 $379.00 $403.00 $433.00 28890 90 ------- $447.00 $476.00 $507.00 $297.00 $315.00 $338.00 28899 YYY BR ------- ------- ------- ------- ------- ------- 29000 0 $247.00 $312.00 $335.00 $362.00 $223.00 $239.00 $260.00 29010 0 $271.00 $324.00 $349.00 $378.00 $217.00 $235.00 $257.00 29015 0 $289.00 $300.00 $319.00 $339.00 $214.00 $227.00 $243.00 29020 0 $237.00 $296.00 $316.00 $337.00 $192.00 $204.00 $219.00 29025 0 $188.00 $327.00 $351.00 $379.00 $238.00 $256.00 $278.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 172
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 29035 0 $213.00 $288.00 $308.00 $330.00 $182.00 $194.00 $210.00 29040 0 $260.00 $276.00 $295.00 $318.00 $204.00 $218.00 $236.00 29044 0 $260.00 $316.00 $338.00 $363.00 $212.00 $227.00 $246.00 29046 0 $286.00 $339.00 $364.00 $392.00 $246.00 $264.00 $287.00 29049 0 $45.00 $112.00 $120.00 $129.00 $80.00 $85.00 $92.00 29055 0 $180.00 $252.00 $270.00 $291.00 $175.00 $187.00 $203.00 29058 0 $110.00 $145.00 $155.00 $165.00 $110.00 $117.00 $125.00 29065 0 $88.00 $118.00 $126.00 $136.00 $89.00 $96.00 $104.00 29075 0 $72.00 $109.00 $117.00 $126.00 $80.00 $86.00 $93.00 29085 0 $59.00 $116.00 $124.00 $133.00 $85.00 $91.00 $99.00 29086 0 $54.00 $86.00 $91.00 $97.00 $61.00 $64.00 $69.00 29105 0 $59.00 $109.00 $116.00 $124.00 $77.00 $81.00 $88.00 29125 0 $45.00 $83.00 $88.00 $94.00 $54.00 $57.00 $61.00 29126 0 $53.00 $97.00 $103.00 $109.00 $65.00 $69.00 $73.00 29130 0 $26.00 $51.00 $54.00 $58.00 $37.00 $39.00 $42.00 29131 0 $53.00 $61.00 $64.00 $67.00 $40.00 $42.00 $43.00 29200 0 $29.00 $67.00 $70.00 $73.00 $51.00 $53.00 $55.00 29220 0 $37.00 $68.00 $71.00 $75.00 $52.00 $54.00 $57.00 29240 0 $45.00 $76.00 $81.00 $85.00 $57.00 $60.00 $64.00 29260 0 $26.00 $65.00 $69.00 $73.00 $47.00 $50.00 $53.00 29280 0 $29.00 $63.00 $66.00 $70.00 $44.00 $46.00 $48.00 29305 0 $223.00 $289.00 $309.00 $333.00 $206.00 $221.00 $240.00 29325 0 $260.00 $312.00 $334.00 $360.00 $229.00 $245.00 $266.00 29345 0 $126.00 $171.00 $183.00 $197.00 $135.00 $144.00 $157.00 29355 0 $133.00 $176.00 $188.00 $203.00 $144.00 $154.00 $168.00 29358 0 $241.00 $189.00 $203.00 $218.00 $137.00 $147.00 $160.00 29365 0 $101.00 $152.00 $163.00 $176.00 $116.00 $125.00 $135.00 29405 0 $96.00 $112.00 $120.00 $129.00 $86.00 $92.00 $99.00 29425 0 $101.00 $121.00 $129.00 $139.00 $94.00 $101.00 $109.00 29435 0 $133.00 $148.00 $159.00 $171.00 $115.00 $123.00 $133.00 29440 0 $22.00 $66.00 $71.00 $76.00 $46.00 $49.00 $53.00 29445 0 $214.00 $189.00 $202.00 $217.00 $151.00 $161.00 $175.00 29450 0 $84.00 $195.00 $208.00 $223.00 $168.00 $179.00 $192.00 29505 0 $75.00 $95.00 $101.00 $108.00 $61.00 $65.00 $69.00 29515 0 $59.00 $87.00 $92.00 $98.00 $64.00 $68.00 $73.00 29520 0 $22.00 $65.00 $69.00 $72.00 $49.00 $51.00 $54.00 29530 0 $55.00 $67.00 $70.00 $75.00 $48.00 $51.00 $54.00 29540 0 $41.00 $53.00 $56.00 $60.00 $44.00 $47.00 $50.00 29550 0 $37.00 $51.00 $54.00 $58.00 $41.00 $44.00 $47.00 29580 0 $39.00 $65.00 $69.00 $74.00 $48.00 $51.00 $55.00 29590 0 $32.00 $70.00 $75.00 $80.00 $56.00 $60.00 $64.00 29700 0 $29.00 $79.00 $84.00 $90.00 $46.00 $49.00 $53.00 29705 0 $26.00 $86.00 $92.00 $99.00 $65.00 $69.00 $75.00 29710 0 $29.00 $150.00 $160.00 $172.00 $110.00 $118.00 $127.00 29715 0 $109.00 $111.00 $117.00 $124.00 $72.00 $76.00 $81.00 29720 0 $29.00 $99.00 $107.00 $115.00 $60.00 $64.00 $70.00 29730 0 $29.00 $83.00 $89.00 $96.00 $62.00 $66.00 $72.00 29740 0 $37.00 $122.00 $130.00 $140.00 $91.00 $97.00 $106.00 29750 0 $105.00 $129.00 $138.00 $149.00 $103.00 $111.00 $121.00 29799 YYY BR ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part B, 173
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 29800 90 $557.00 $685.00 $730.00 $786.00 $685.00 $730.00 $786.00 29804 90 $902.00 $851.00 $910.00 $984.00 $851.00 $910.00 $984.00 29805 90 $360.00 $619.00 $664.00 $719.00 $619.00 $664.00 $719.00 29806 90 $1,003.00 $1,413.00 $1,513.00 $1,641.00 $1,413.00 $1,513.00 $1,641.00 29807 90 $976.00 $1,377.00 $1,474.00 $1,599.00 $1,377.00 $1,474.00 $1,599.00 29819 90 $756.00 $776.00 $831.00 $901.00 $776.00 $831.00 $901.00 29820 90 $718.00 $716.00 $767.00 $832.00 $716.00 $767.00 $832.00 29821 90 $863.00 $782.00 $838.00 $909.00 $782.00 $838.00 $909.00 29822 90 $749.00 $760.00 $815.00 $883.00 $760.00 $815.00 $883.00 29823 90 $1,330.00 $831.00 $890.00 $965.00 $831.00 $890.00 $965.00 29824 90 $611.00 $878.00 $939.00 $1,016.00 $878.00 $939.00 $1,016.00 29825 90 $941.00 $775.00 $831.00 $901.00 $775.00 $831.00 $901.00 29826 90 $980.00 $891.00 $955.00 $1,036.00 $891.00 $955.00 $1,036.00 29827 90 $1,058.00 $1,458.00 $1,563.00 $1,699.00 $1,458.00 $1,563.00 $1,699.00 29828 90 ------- $1,192.00 $1,276.00 $1,385.00 $1,192.00 $1,276.00 $1,385.00 29830 90 $524.00 $597.00 $640.00 $693.00 $597.00 $640.00 $693.00 29834 90 $635.00 $650.00 $697.00 $755.00 $650.00 $697.00 $755.00 29835 90 $612.00 $668.00 $716.00 $776.00 $668.00 $716.00 $776.00 29836 90 $680.00 $762.00 $815.00 $881.00 $762.00 $815.00 $881.00 29837 90 $830.00 $699.00 $749.00 $812.00 $699.00 $749.00 $812.00 29838 90 $931.00 $782.00 $837.00 $907.00 $782.00 $837.00 $907.00 29840 90 $501.00 $578.00 $617.00 $665.00 $578.00 $617.00 $665.00 29843 90 $580.00 $619.00 $661.00 $712.00 $619.00 $661.00 $712.00 29844 90 $612.00 $651.00 $697.00 $753.00 $651.00 $697.00 $753.00 29845 90 $931.00 $736.00 $783.00 $839.00 $736.00 $783.00 $839.00 29846 90 $976.00 $684.00 $731.00 $789.00 $684.00 $731.00 $789.00 29847 90 $1,277.00 $707.00 $755.00 $815.00 $707.00 $755.00 $815.00 29848 90 $608.00 $633.00 $674.00 $724.00 $633.00 $674.00 $724.00 29850 90 $752.00 $727.00 $776.00 $840.00 $727.00 $776.00 $840.00 29851 90 $1,137.00 $1,251.00 $1,343.00 $1,462.00 $1,251.00 $1,343.00 $1,462.00 29855 90 $1,007.00 $1,046.00 $1,121.00 $1,218.00 $1,046.00 $1,121.00 $1,218.00 29856 90 $1,231.00 $1,337.00 $1,433.00 $1,556.00 $1,337.00 $1,433.00 $1,556.00 29860 90 $658.00 $853.00 $911.00 $984.00 $853.00 $911.00 $984.00 29861 90 $845.00 $937.00 $1,001.00 $1,084.00 $937.00 $1,001.00 $1,084.00 29862 90 $907.00 $1,047.00 $1,117.00 $1,204.00 $1,047.00 $1,117.00 $1,204.00 29863 90 $880.00 $1,028.00 $1,092.00 $1,171.00 $1,028.00 $1,092.00 $1,171.00 29866 90 ------- $1,391.00 $1,489.00 $1,614.00 $1,391.00 $1,489.00 $1,614.00 29867 90 ------- $1,681.00 $1,795.00 $1,941.00 $1,681.00 $1,795.00 $1,941.00 29868 90 ------- $2,279.00 $2,445.00 $2,661.00 $2,279.00 $2,445.00 $2,661.00 29870 90 $460.00 $534.00 $572.00 $618.00 $534.00 $572.00 $618.00 29871 90 $631.00 $674.00 $722.00 $783.00 $674.00 $722.00 $783.00 29873 90 $489.00 $673.00 $721.00 $780.00 $673.00 $721.00 $780.00 29874 90 $676.00 $700.00 $748.00 $808.00 $700.00 $748.00 $808.00 29875 90 $639.00 $653.00 $700.00 $759.00 $653.00 $700.00 $759.00 29876 90 $809.00 $849.00 $907.00 $980.00 $849.00 $907.00 $980.00 29877 90 $852.00 $802.00 $857.00 $926.00 $802.00 $857.00 $926.00 29879 90 $1,064.00 $859.00 $918.00 $992.00 $859.00 $918.00 $992.00 29880 90 $1,169.00 $898.00 $960.00 $1,038.00 $898.00 $960.00 $1,038.00 29881 90 $745.00 $836.00 $893.00 $965.00 $836.00 $893.00 $965.00 29882 90 $819.00 $905.00 $968.00 $1,047.00 $905.00 $968.00 $1,047.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 174
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 29883 90 $1,235.00 $1,114.00 $1,193.00 $1,293.00 $1,114.00 $1,193.00 $1,293.00 29884 90 $721.00 $799.00 $854.00 $922.00 $799.00 $854.00 $922.00 29885 90 $832.00 $971.00 $1,038.00 $1,122.00 $971.00 $1,038.00 $1,122.00 29886 90 $697.00 $817.00 $873.00 $943.00 $817.00 $873.00 $943.00 29887 90 $949.00 $966.00 $1,032.00 $1,116.00 $966.00 $1,032.00 $1,116.00 29888 90 $1,296.00 $1,318.00 $1,412.00 $1,534.00 $1,318.00 $1,412.00 $1,534.00 29889 90 $1,255.00 $1,603.00 $1,715.00 $1,858.00 $1,603.00 $1,715.00 $1,858.00 29891 90 $796.00 $909.00 $969.00 $1,045.00 $909.00 $969.00 $1,045.00 29892 90 $835.00 $938.00 $999.00 $1,075.00 $938.00 $999.00 $1,075.00 29893 90 $472.00 $713.00 $756.00 $803.00 $552.00 $583.00 $621.00 29894 90 $690.00 $687.00 $734.00 $794.00 $687.00 $734.00 $794.00 29895 90 $679.00 $669.00 $715.00 $773.00 $669.00 $715.00 $773.00 29897 90 $704.00 $700.00 $749.00 $810.00 $700.00 $749.00 $810.00 29898 90 $863.00 $781.00 $834.00 $901.00 $781.00 $834.00 $901.00 29899 90 $973.00 $1,399.00 $1,495.00 $1,619.00 $1,399.00 $1,495.00 $1,619.00 29900 90 $434.00 $607.00 $650.00 $702.00 $607.00 $650.00 $702.00 29901 90 $479.00 $671.00 $718.00 $776.00 $671.00 $718.00 $776.00 29902 90 $514.00 $700.00 $748.00 $809.00 $700.00 $748.00 $809.00 29904 90 ------- $793.00 $846.00 $912.00 $793.00 $846.00 $912.00 29905 90 ------- $853.00 $910.00 $981.00 $853.00 $910.00 $981.00 29906 90 ------- $899.00 $959.00 $1,034.00 $899.00 $959.00 $1,034.00 29907 90 ------- $1,108.00 $1,184.00 $1,282.00 $1,108.00 $1,184.00 $1,282.00 29999 YYY BR ------- ------- ------- ------- ------- ------- 30000 10 $96.00 $280.00 $297.00 $314.00 $146.00 $154.00 $163.00 30020 10 $117.00 $264.00 $280.00 $296.00 $149.00 $157.00 $166.00 30100 0 $86.00 $164.00 $174.00 $183.00 $89.00 $93.00 $98.00 30110 10 $157.00 $267.00 $283.00 $299.00 $164.00 $173.00 $183.00 30115 90 $360.00 $532.00 $564.00 $597.00 $532.00 $564.00 $597.00 30117 90 $301.00 $953.00 $1,016.00 $1,072.00 $409.00 $433.00 $457.00 30118 90 $819.00 $966.00 $1,018.00 $1,075.00 $966.00 $1,018.00 $1,075.00 30120 90 $500.00 $630.00 $668.00 $708.00 $568.00 $601.00 $638.00 30124 90 $243.00 $350.00 $369.00 $390.00 $350.00 $369.00 $390.00 30125 90 $599.00 $782.00 $826.00 $874.00 $782.00 $826.00 $874.00 30130 90 $275.00 $465.00 $493.00 $522.00 $465.00 $493.00 $522.00 30140 90 $320.00 $523.00 $556.00 $589.00 $523.00 $556.00 $589.00 30150 90 $790.00 $1,018.00 $1,078.00 $1,144.00 $1,018.00 $1,078.00 $1,144.00 30160 90 $875.00 $1,011.00 $1,067.00 $1,130.00 $1,011.00 $1,067.00 $1,130.00 30200 0 $68.00 $132.00 $141.00 $148.00 $77.00 $81.00 $86.00 30210 10 $75.00 $174.00 $185.00 $195.00 $123.00 $130.00 $138.00 30220 10 $154.00 $334.00 $355.00 $374.00 $157.00 $165.00 $174.00 30300 10 $45.00 $279.00 $297.00 $313.00 $150.00 $159.00 $168.00 30310 10 $170.00 $256.00 $271.00 $286.00 $256.00 $271.00 $286.00 30320 90 $419.00 $580.00 $614.00 $649.00 $580.00 $614.00 $649.00 30400 90 $741.00 $1,314.00 $1,393.00 $1,477.00 $1,314.00 $1,393.00 $1,477.00 30410 90 $1,173.00 $1,599.00 $1,696.00 $1,801.00 $1,599.00 $1,696.00 $1,801.00 30420 90 $1,424.00 $1,740.00 $1,837.00 $1,944.00 $1,740.00 $1,837.00 $1,944.00 30430 90 $626.00 $1,166.00 $1,238.00 $1,311.00 $1,166.00 $1,238.00 $1,311.00 30435 90 $1,005.00 $1,551.00 $1,644.00 $1,743.00 $1,551.00 $1,644.00 $1,743.00 30450 90 $1,445.00 $2,036.00 $2,155.00 $2,290.00 $2,036.00 $2,155.00 $2,290.00 30460 90 $857.00 $998.00 $1,056.00 $1,122.00 $998.00 $1,056.00 $1,122.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 175
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 30462 90 $1,633.00 $2,019.00 $2,146.00 $2,297.00 $2,019.00 $2,146.00 $2,297.00 30465 90 $803.00 $1,233.00 $1,301.00 $1,377.00 $1,233.00 $1,301.00 $1,377.00 30520 90 $533.00 $726.00 $764.00 $803.00 $726.00 $764.00 $803.00 30540 90 $643.00 $866.00 $915.00 $967.00 $866.00 $915.00 $967.00 30545 90 $981.00 $1,250.00 $1,335.00 $1,436.00 $1,250.00 $1,335.00 $1,436.00 30560 10 $104.00 $320.00 $340.00 $359.00 $172.00 $182.00 $192.00 30580 90 $566.00 $786.00 $837.00 $895.00 $650.00 $691.00 $741.00 30600 90 $466.00 $721.00 $765.00 $815.00 $571.00 $605.00 $646.00 30620 90 $564.00 $767.00 $812.00 $860.00 $767.00 $812.00 $860.00 30630 90 $624.00 $777.00 $821.00 $868.00 $777.00 $821.00 $868.00 30801 10 $88.00 $270.00 $288.00 $304.00 $160.00 $170.00 $179.00 30802 10 $172.00 $349.00 $370.00 $390.00 $231.00 $244.00 $257.00 30901 0 $75.00 $132.00 $139.00 $147.00 $81.00 $85.00 $90.00 30903 0 $110.00 $233.00 $247.00 $261.00 $106.00 $111.00 $117.00 30905 0 $224.00 $292.00 $310.00 $327.00 $137.00 $144.00 $152.00 30906 0 $208.00 $335.00 $355.00 $375.00 $180.00 $189.00 $199.00 30915 90 $596.00 $720.00 $759.00 $801.00 $720.00 $759.00 $801.00 30920 90 $862.00 $1,029.00 $1,082.00 $1,140.00 $1,029.00 $1,082.00 $1,140.00 30930 10 $213.00 $151.00 $160.00 $170.00 $151.00 $160.00 $170.00 30999 YYY BR ------- ------- ------- ------- ------- ------- 31000 10 $81.00 $213.00 $227.00 $239.00 $131.00 $138.00 $145.00 31002 10 $135.00 $251.00 $265.00 $280.00 $251.00 $265.00 $280.00 31020 90 $281.00 $591.00 $629.00 $666.00 $432.00 $458.00 $485.00 31030 90 $531.00 $875.00 $929.00 $985.00 $655.00 $693.00 $736.00 31032 90 $604.00 $713.00 $753.00 $797.00 $713.00 $753.00 $797.00 31040 90 $772.00 $953.00 $1,005.00 $1,065.00 $953.00 $1,005.00 $1,065.00 31050 90 $489.00 $610.00 $645.00 $683.00 $610.00 $645.00 $683.00 31051 90 $654.00 $801.00 $846.00 $895.00 $801.00 $846.00 $895.00 31070 90 $410.00 $536.00 $567.00 $600.00 $536.00 $567.00 $600.00 31075 90 $839.00 $977.00 $1,030.00 $1,088.00 $977.00 $1,030.00 $1,088.00 31080 90 $942.00 $1,290.00 $1,364.00 $1,448.00 $1,290.00 $1,364.00 $1,448.00 31081 90 $1,089.00 $1,587.00 $1,702.00 $1,842.00 $1,587.00 $1,702.00 $1,842.00 31084 90 $1,210.00 $1,447.00 $1,524.00 $1,610.00 $1,447.00 $1,524.00 $1,610.00 31085 90 $1,281.00 $1,572.00 $1,667.00 $1,776.00 $1,572.00 $1,667.00 $1,776.00 31086 90 $1,081.00 $1,401.00 $1,475.00 $1,555.00 $1,401.00 $1,475.00 $1,555.00 31087 90 $1,075.00 $1,394.00 $1,474.00 $1,566.00 $1,394.00 $1,474.00 $1,566.00 31090 90 $877.00 $1,234.00 $1,305.00 $1,380.00 $1,234.00 $1,305.00 $1,380.00 31200 90 $463.00 $675.00 $713.00 $748.00 $675.00 $713.00 $748.00 31201 90 $716.00 $918.00 $971.00 $1,030.00 $918.00 $971.00 $1,030.00 31205 90 $851.00 $1,079.00 $1,135.00 $1,192.00 $1,079.00 $1,135.00 $1,192.00 31225 90 $1,683.00 $2,260.00 $2,365.00 $2,480.00 $2,260.00 $2,365.00 $2,480.00 31230 90 $1,908.00 $2,547.00 $2,662.00 $2,789.00 $2,547.00 $2,662.00 $2,789.00 31231 0 $122.00 $233.00 $248.00 $262.00 $100.00 $105.00 $111.00 31233 0 $221.00 $332.00 $352.00 $373.00 $183.00 $193.00 $205.00 31235 0 $217.00 $383.00 $407.00 $431.00 $219.00 $231.00 $245.00 31237 0 $266.00 $414.00 $439.00 $465.00 $244.00 $257.00 $273.00 31238 0 $311.00 $426.00 $451.00 $476.00 $264.00 $277.00 $293.00 31239 10 $775.00 $843.00 $884.00 $930.00 $843.00 $884.00 $930.00 31240 0 $224.00 $217.00 $228.00 $242.00 $217.00 $228.00 $242.00 31254 0 $588.00 $373.00 $393.00 $418.00 $373.00 $393.00 $418.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 176
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 31255 0 $601.00 $554.00 $585.00 $624.00 $554.00 $585.00 $624.00 31256 0 $292.00 $271.00 $286.00 $304.00 $271.00 $286.00 $304.00 31267 0 $453.00 $437.00 $461.00 $491.00 $437.00 $461.00 $491.00 31276 0 $690.00 $698.00 $737.00 $785.00 $698.00 $737.00 $785.00 31287 0 $339.00 $318.00 $335.00 $357.00 $318.00 $335.00 $357.00 31288 0 $396.00 $369.00 $389.00 $414.00 $369.00 $389.00 $414.00 31290 10 $1,462.00 $1,507.00 $1,580.00 $1,666.00 $1,507.00 $1,580.00 $1,666.00 31291 10 $1,551.00 $1,598.00 $1,680.00 $1,779.00 $1,598.00 $1,680.00 $1,779.00 31292 10 $1,235.00 $1,304.00 $1,368.00 $1,443.00 $1,304.00 $1,368.00 $1,443.00 31293 10 $1,346.00 $1,419.00 $1,487.00 $1,567.00 $1,419.00 $1,487.00 $1,567.00 31294 10 $1,587.00 $1,634.00 $1,713.00 $1,806.00 $1,634.00 $1,713.00 $1,806.00 31299 YYY BR ------- ------- ------- ------- ------- ------- 31300 90 $1,295.00 $1,569.00 $1,652.00 $1,741.00 $1,569.00 $1,652.00 $1,741.00 31320 90 $508.00 $812.00 $860.00 $908.00 $812.00 $860.00 $908.00 31360 90 $1,630.00 $2,418.00 $2,519.00 $2,627.00 $2,418.00 $2,519.00 $2,627.00 31365 90 $2,238.00 $3,047.00 $3,175.00 $3,317.00 $3,047.00 $3,175.00 $3,317.00 31367 90 $1,913.00 $2,671.00 $2,796.00 $2,932.00 $2,671.00 $2,796.00 $2,932.00 31368 90 $2,478.00 $3,017.00 $3,163.00 $3,323.00 $3,017.00 $3,163.00 $3,323.00 31370 90 $1,891.00 $2,528.00 $2,652.00 $2,786.00 $2,528.00 $2,652.00 $2,786.00 31375 90 $1,720.00 $2,376.00 $2,492.00 $2,617.00 $2,376.00 $2,492.00 $2,617.00 31380 90 $1,782.00 $2,355.00 $2,473.00 $2,601.00 $2,355.00 $2,473.00 $2,601.00 31382 90 $1,822.00 $2,567.00 $2,688.00 $2,820.00 $2,567.00 $2,688.00 $2,820.00 31390 90 $2,513.00 $3,416.00 $3,563.00 $3,725.00 $3,416.00 $3,563.00 $3,725.00 31395 90 $2,937.00 $3,658.00 $3,823.00 $4,004.00 $3,658.00 $3,823.00 $4,004.00 31400 90 $969.00 $1,261.00 $1,329.00 $1,401.00 $1,261.00 $1,329.00 $1,401.00 31420 90 $969.00 $1,051.00 $1,104.00 $1,163.00 $1,051.00 $1,104.00 $1,163.00 31500 0 $116.00 $147.00 $153.00 $161.00 $147.00 $153.00 $161.00 31502 0 $74.00 $47.00 $49.00 $52.00 $47.00 $49.00 $52.00 31505 0 $62.00 $105.00 $111.00 $117.00 $63.00 $66.00 $70.00 31510 0 $145.00 $266.00 $281.00 $297.00 $159.00 $167.00 $177.00 31511 0 $88.00 $268.00 $283.00 $300.00 $168.00 $177.00 $187.00 31512 0 $197.00 $266.00 $281.00 $297.00 $172.00 $181.00 $191.00 31513 0 $182.00 $176.00 $184.00 $195.00 $176.00 $184.00 $195.00 31515 0 $160.00 $264.00 $280.00 $295.00 $144.00 $151.00 $160.00 31525 0 $234.00 $318.00 $336.00 $354.00 $212.00 $223.00 $235.00 31526 0 $222.00 $211.00 $222.00 $234.00 $211.00 $222.00 $234.00 31527 0 $262.00 $256.00 $269.00 $284.00 $256.00 $269.00 $284.00 31528 0 $202.00 $190.00 $199.00 $211.00 $190.00 $199.00 $211.00 31529 0 $217.00 $217.00 $228.00 $241.00 $217.00 $228.00 $241.00 31530 0 $284.00 $267.00 $280.00 $297.00 $267.00 $280.00 $297.00 31531 0 $311.00 $287.00 $302.00 $319.00 $287.00 $302.00 $319.00 31535 0 $272.00 $255.00 $268.00 $283.00 $255.00 $268.00 $283.00 31536 0 $308.00 $285.00 $300.00 $317.00 $285.00 $300.00 $317.00 31540 0 $357.00 $327.00 $343.00 $363.00 $327.00 $343.00 $363.00 31541 0 $453.00 $359.00 $376.00 $398.00 $359.00 $376.00 $398.00 31545 0 ------- $475.00 $495.00 $518.00 $475.00 $495.00 $518.00 31546 0 ------- $729.00 $764.00 $807.00 $729.00 $764.00 $807.00 31560 0 $446.00 $422.00 $443.00 $468.00 $422.00 $443.00 $468.00 31561 0 $509.00 $462.00 $485.00 $513.00 $462.00 $485.00 $513.00 31570 0 $369.00 $454.00 $480.00 $507.00 $307.00 $322.00 $340.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 177
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 31571 0 $363.00 $338.00 $355.00 $375.00 $338.00 $355.00 $375.00 31575 0 $128.00 $149.00 $158.00 $166.00 $100.00 $106.00 $112.00 31576 0 $186.00 $283.00 $299.00 $315.00 $162.00 $170.00 $178.00 31577 0 $230.00 $311.00 $329.00 $348.00 $200.00 $211.00 $223.00 31578 0 $264.00 $358.00 $379.00 $400.00 $223.00 $234.00 $247.00 31579 0 $219.00 $286.00 $303.00 $320.00 $186.00 $195.00 $206.00 31580 90 $1,213.00 $1,502.00 $1,580.00 $1,663.00 $1,502.00 $1,580.00 $1,663.00 31582 90 $1,881.00 $2,422.00 $2,553.00 $2,694.00 $2,422.00 $2,553.00 $2,694.00 31584 90 $1,616.00 $1,927.00 $2,031.00 $2,148.00 $1,927.00 $2,031.00 $2,148.00 31587 90 $913.00 $1,234.00 $1,291.00 $1,355.00 $1,234.00 $1,291.00 $1,355.00 31588 90 $1,206.00 $1,423.00 $1,497.00 $1,577.00 $1,423.00 $1,497.00 $1,577.00 31590 90 $691.00 $1,133.00 $1,205.00 $1,280.00 $1,133.00 $1,205.00 $1,280.00 31595 90 $773.00 $970.00 $1,023.00 $1,079.00 $970.00 $1,023.00 $1,079.00 31599 YYY BR ------- ------- ------- ------- ------- ------- 31600 0 $306.00 $537.00 $567.00 $606.00 $537.00 $567.00 $606.00 31603 0 $343.00 $302.00 $318.00 $340.00 $302.00 $318.00 $340.00 31605 0 $297.00 $249.00 $263.00 $282.00 $249.00 $263.00 $282.00 31610 90 $794.00 $899.00 $947.00 $1,002.00 $899.00 $947.00 $1,002.00 31611 90 $614.00 $668.00 $704.00 $743.00 $668.00 $704.00 $743.00 31612 0 $99.00 $103.00 $109.00 $116.00 $64.00 $67.00 $71.00 31613 90 $384.00 $554.00 $587.00 $621.00 $554.00 $587.00 $621.00 31614 90 $736.00 $901.00 $948.00 $998.00 $901.00 $948.00 $998.00 31615 0 $213.00 $235.00 $248.00 $262.00 $167.00 $175.00 $184.00 31620 ZZZ ------- $366.00 $389.00 $411.00 $96.00 $101.00 $106.00 31622 0 $230.00 $417.00 $441.00 $464.00 $194.00 $202.00 $212.00 31623 0 $225.00 $456.00 $481.00 $504.00 $194.00 $201.00 $209.00 31624 0 $217.00 $424.00 $447.00 $468.00 $194.00 $201.00 $209.00 31625 0 $235.00 $454.00 $479.00 $503.00 $228.00 $236.00 $246.00 31628 0 $269.00 $542.00 $572.00 $599.00 $253.00 $262.00 $272.00 31629 0 $198.00 $861.00 $912.00 $957.00 $269.00 $277.00 $287.00 31630 0 $308.00 $279.00 $292.00 $309.00 $279.00 $292.00 $309.00 31631 0 $252.00 $311.00 $326.00 $344.00 $311.00 $326.00 $344.00 31632 ZZZ ------- $104.00 $112.00 $121.00 $76.00 $82.00 $90.00 31633 ZZZ ------- $122.00 $129.00 $139.00 $92.00 $97.00 $105.00 31635 0 $298.00 $474.00 $500.00 $526.00 $255.00 $266.00 $279.00 31636 0 ------- $304.00 $318.00 $334.00 $304.00 $318.00 $334.00 31637 ZZZ ------- $108.00 $113.00 $120.00 $108.00 $113.00 $120.00 31638 0 ------- $335.00 $347.00 $360.00 $335.00 $347.00 $360.00 31640 0 $399.00 $358.00 $376.00 $399.00 $358.00 $376.00 $399.00 31641 0 $304.00 $348.00 $363.00 $382.00 $348.00 $363.00 $382.00 31643 0 $208.00 $236.00 $245.00 $256.00 $236.00 $245.00 $256.00 31645 0 $208.00 $407.00 $429.00 $450.00 $213.00 $221.00 $230.00 31646 0 $161.00 $371.00 $391.00 $410.00 $185.00 $192.00 $200.00 31656 0 $127.00 $438.00 $465.00 $490.00 $152.00 $158.00 $166.00 31715 0 $57.00 $73.00 $76.00 $79.00 $73.00 $76.00 $79.00 31717 0 $138.00 $463.00 $492.00 $518.00 $148.00 $155.00 $162.00 31720 0 $89.00 $70.00 $73.00 $77.00 $70.00 $73.00 $77.00 31725 0 $103.00 $128.00 $133.00 $140.00 $128.00 $133.00 $140.00 31730 0 $199.00 $848.00 $904.00 $953.00 $194.00 $202.00 $213.00 31750 90 $1,088.00 $1,672.00 $1,761.00 $1,854.00 $1,672.00 $1,761.00 $1,854.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 178
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 31755 90 $1,448.00 $2,122.00 $2,242.00 $2,364.00 $2,122.00 $2,242.00 $2,364.00 31760 90 $1,648.00 $1,843.00 $1,955.00 $2,101.00 $1,843.00 $1,955.00 $2,101.00 31766 90 $2,315.00 $2,476.00 $2,636.00 $2,852.00 $2,476.00 $2,636.00 $2,852.00 31770 90 $1,815.00 $1,797.00 $1,903.00 $2,042.00 $1,797.00 $1,903.00 $2,042.00 31775 90 $1,973.00 $1,923.00 $2,038.00 $2,188.00 $1,923.00 $2,038.00 $2,188.00 31780 90 $1,577.00 $1,552.00 $1,630.00 $1,724.00 $1,552.00 $1,630.00 $1,724.00 31781 90 $1,936.00 $1,886.00 $1,982.00 $2,103.00 $1,886.00 $1,982.00 $2,103.00 31785 90 $1,320.00 $1,431.00 $1,504.00 $1,592.00 $1,431.00 $1,504.00 $1,592.00 31786 90 $1,866.00 $2,019.00 $2,144.00 $2,307.00 $2,019.00 $2,144.00 $2,307.00 31800 90 $628.00 $891.00 $943.00 $1,001.00 $891.00 $943.00 $1,001.00 31805 90 $1,175.00 $1,108.00 $1,178.00 $1,270.00 $1,108.00 $1,178.00 $1,270.00 31820 90 $458.00 $533.00 $563.00 $595.00 $418.00 $440.00 $465.00 31825 90 $659.00 $748.00 $788.00 $831.00 $616.00 $647.00 $683.00 31830 90 $460.00 $540.00 $573.00 $607.00 $437.00 $461.00 $490.00 31899 YYY BR ------- ------- ------- ------- ------- ------- 32035 90 $821.00 $924.00 $977.00 $1,044.00 $924.00 $977.00 $1,044.00 32036 90 $908.00 $1,005.00 $1,064.00 $1,139.00 $1,005.00 $1,064.00 $1,139.00 32095 90 $848.00 $831.00 $881.00 $944.00 $831.00 $881.00 $944.00 32100 90 $1,120.00 $1,304.00 $1,387.00 $1,497.00 $1,304.00 $1,387.00 $1,497.00 32110 90 $1,223.00 $1,952.00 $2,070.00 $2,227.00 $1,952.00 $2,070.00 $2,227.00 32120 90 $1,077.00 $1,146.00 $1,212.00 $1,297.00 $1,146.00 $1,212.00 $1,297.00 32124 90 $1,144.00 $1,225.00 $1,298.00 $1,394.00 $1,225.00 $1,298.00 $1,394.00 32140 90 $1,284.00 $1,310.00 $1,387.00 $1,487.00 $1,310.00 $1,387.00 $1,487.00 32141 90 $1,267.00 $1,875.00 $1,958.00 $2,063.00 $1,875.00 $1,958.00 $2,063.00 32150 90 $1,226.00 $1,322.00 $1,400.00 $1,501.00 $1,322.00 $1,400.00 $1,501.00 32151 90 $1,231.00 $1,349.00 $1,430.00 $1,533.00 $1,349.00 $1,430.00 $1,533.00 32160 90 $842.00 $993.00 $1,047.00 $1,114.00 $993.00 $1,047.00 $1,114.00 32200 90 $1,132.00 $1,472.00 $1,557.00 $1,667.00 $1,472.00 $1,557.00 $1,667.00 32201 0 $387.00 $1,220.00 $1,299.00 $1,367.00 $274.00 $285.00 $299.00 32215 90 $1,024.00 $1,070.00 $1,136.00 $1,222.00 $1,070.00 $1,136.00 $1,222.00 32220 90 $1,680.00 $2,145.00 $2,280.00 $2,457.00 $2,145.00 $2,280.00 $2,457.00 32225 90 $1,268.00 $1,323.00 $1,402.00 $1,506.00 $1,323.00 $1,402.00 $1,506.00 32310 90 $1,221.00 $1,228.00 $1,305.00 $1,404.00 $1,228.00 $1,305.00 $1,404.00 32320 90 $1,787.00 $2,139.00 $2,271.00 $2,444.00 $2,139.00 $2,271.00 $2,444.00 32400 0 $129.00 $198.00 $208.00 $218.00 $119.00 $123.00 $129.00 32402 90 $798.00 $747.00 $792.00 $848.00 $747.00 $792.00 $848.00 32405 0 $159.00 $133.00 $139.00 $145.00 $132.00 $138.00 $144.00 32420 0 $116.00 $147.00 $152.00 $159.00 $147.00 $152.00 $159.00 32421 0 ------- $215.00 $227.00 $238.00 $102.00 $106.00 $111.00 32422 0 ------- $265.00 $279.00 $292.00 $165.00 $172.00 $179.00 32440 90 $1,837.00 $2,164.00 $2,300.00 $2,480.00 $2,164.00 $2,300.00 $2,480.00 32442 90 $2,093.00 $3,789.00 $3,947.00 $4,148.00 $3,789.00 $3,947.00 $4,148.00 32445 90 $2,093.00 $4,203.00 $4,363.00 $4,563.00 $4,203.00 $4,363.00 $4,563.00 32480 90 $1,622.00 $2,041.00 $2,170.00 $2,340.00 $2,041.00 $2,170.00 $2,340.00 32482 90 $1,714.00 $2,172.00 $2,308.00 $2,488.00 $2,172.00 $2,308.00 $2,488.00 32484 90 $1,771.00 $1,953.00 $2,068.00 $2,218.00 $1,953.00 $2,068.00 $2,218.00 32486 90 $1,974.00 $2,986.00 $3,125.00 $3,304.00 $2,986.00 $3,125.00 $3,304.00 32488 90 $2,094.00 $3,047.00 $3,196.00 $3,389.00 $3,047.00 $3,196.00 $3,389.00 32491 90 $1,784.00 $1,991.00 $2,108.00 $2,260.00 $1,991.00 $2,108.00 $2,260.00 32500 90 $1,331.00 $1,974.00 $2,097.00 $2,259.00 $1,974.00 $2,097.00 $2,259.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 179
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 32501 ZZZ $374.00 $343.00 $365.00 $395.00 $343.00 $365.00 $395.00 32503 90 ------- $2,511.00 $2,670.00 $2,883.00 $2,511.00 $2,670.00 $2,883.00 32504 90 ------- $2,867.00 $3,050.00 $3,295.00 $2,867.00 $3,050.00 $3,295.00 32540 90 $1,308.00 $2,112.00 $2,202.00 $2,315.00 $2,112.00 $2,202.00 $2,315.00 32550 0 ------- $1,102.00 $1,175.00 $1,243.00 $308.00 $324.00 $345.00 32551 0 ------- $247.00 $262.00 $282.00 $247.00 $262.00 $282.00 32560 0 ------- $409.00 $435.00 $461.00 $153.00 $161.00 $172.00 32601 0 $456.00 $430.00 $458.00 $496.00 $430.00 $458.00 $496.00 32602 0 $494.00 $467.00 $497.00 $539.00 $467.00 $497.00 $539.00 32603 0 $585.00 $601.00 $640.00 $694.00 $601.00 $640.00 $694.00 32604 0 $663.00 $673.00 $717.00 $775.00 $673.00 $717.00 $775.00 32605 0 $550.00 $541.00 $576.00 $624.00 $541.00 $576.00 $624.00 32606 0 $637.00 $648.00 $691.00 $748.00 $648.00 $691.00 $748.00 32650 90 $957.00 $931.00 $992.00 $1,072.00 $931.00 $992.00 $1,072.00 32651 90 $1,166.00 $1,400.00 $1,474.00 $1,570.00 $1,400.00 $1,474.00 $1,570.00 32652 90 $1,615.00 $2,110.00 $2,217.00 $2,356.00 $2,110.00 $2,217.00 $2,356.00 32653 90 $1,144.00 $1,360.00 $1,434.00 $1,530.00 $1,360.00 $1,434.00 $1,530.00 32654 90 $1,096.00 $1,476.00 $1,545.00 $1,632.00 $1,476.00 $1,545.00 $1,632.00 32655 90 $1,213.00 $1,259.00 $1,333.00 $1,428.00 $1,259.00 $1,333.00 $1,428.00 32656 90 $1,222.00 $1,117.00 $1,190.00 $1,285.00 $1,117.00 $1,190.00 $1,285.00 32657 90 $1,261.00 $1,104.00 $1,179.00 $1,278.00 $1,104.00 $1,179.00 $1,278.00 32658 90 $1,142.00 $1,003.00 $1,069.00 $1,155.00 $1,003.00 $1,069.00 $1,155.00 32659 90 $1,141.00 $1,017.00 $1,081.00 $1,165.00 $1,017.00 $1,081.00 $1,165.00 32660 90 $1,691.00 $1,423.00 $1,507.00 $1,614.00 $1,423.00 $1,507.00 $1,614.00 32661 90 $1,165.00 $1,122.00 $1,196.00 $1,292.00 $1,122.00 $1,196.00 $1,292.00 32662 90 $1,459.00 $1,260.00 $1,343.00 $1,451.00 $1,260.00 $1,343.00 $1,451.00 32663 90 $1,636.00 $1,874.00 $1,979.00 $2,116.00 $1,874.00 $1,979.00 $2,116.00 32664 90 $1,197.00 $1,183.00 $1,266.00 $1,377.00 $1,183.00 $1,266.00 $1,377.00 32665 90 $1,360.00 $1,596.00 $1,681.00 $1,790.00 $1,596.00 $1,681.00 $1,790.00 32800 90 $1,166.00 $1,248.00 $1,324.00 $1,424.00 $1,248.00 $1,324.00 $1,424.00 32810 90 $1,085.00 $1,213.00 $1,288.00 $1,385.00 $1,213.00 $1,288.00 $1,385.00 32815 90 $1,917.00 $3,338.00 $3,474.00 $3,646.00 $3,338.00 $3,474.00 $3,646.00 32820 90 $1,848.00 $1,817.00 $1,922.00 $2,055.00 $1,817.00 $1,922.00 $2,055.00 32851 90 $3,100.00 $3,561.00 $3,789.00 $4,078.00 $3,561.00 $3,789.00 $4,078.00 32852 90 $3,339.00 $3,968.00 $4,220.00 $4,539.00 $3,968.00 $4,220.00 $4,539.00 32853 90 $3,787.00 $4,278.00 $4,555.00 $4,913.00 $4,278.00 $4,555.00 $4,913.00 32854 90 $4,038.00 $4,616.00 $4,907.00 $5,280.00 $4,616.00 $4,907.00 $5,280.00 32900 90 $1,532.00 $1,832.00 $1,941.00 $2,085.00 $1,832.00 $1,941.00 $2,085.00 32905 90 $1,661.00 $1,830.00 $1,946.00 $2,099.00 $1,830.00 $1,946.00 $2,099.00 32906 90 $2,100.00 $2,263.00 $2,406.00 $2,596.00 $2,263.00 $2,406.00 $2,596.00 32940 90 $1,555.00 $1,675.00 $1,781.00 $1,921.00 $1,675.00 $1,781.00 $1,921.00 32960 0 $126.00 $183.00 $193.00 $204.00 $130.00 $136.00 $144.00 32997 0 $312.00 $481.00 $502.00 $529.00 $481.00 $502.00 $529.00 32998 0 ------- $3,806.00 $4,066.00 $4,286.00 $395.00 $411.00 $431.00 32999 YYY BR ------- ------- ------- ------- ------- ------- 33010 0 $124.00 $162.00 $168.00 $177.00 $162.00 $168.00 $177.00 33011 0 $125.00 $165.00 $173.00 $181.00 $165.00 $173.00 $181.00 33015 90 $555.00 $700.00 $735.00 $775.00 $700.00 $735.00 $775.00 33020 90 $1,178.00 $1,170.00 $1,239.00 $1,329.00 $1,170.00 $1,239.00 $1,329.00 33025 90 $1,165.00 $1,089.00 $1,157.00 $1,246.00 $1,089.00 $1,157.00 $1,246.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 180
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 33030 90 $1,786.00 $1,737.00 $1,843.00 $1,982.00 $1,737.00 $1,843.00 $1,982.00 33031 90 $1,816.00 $1,927.00 $2,042.00 $2,195.00 $1,927.00 $2,042.00 $2,195.00 33050 90 $1,224.00 $1,342.00 $1,424.00 $1,531.00 $1,342.00 $1,424.00 $1,531.00 33120 90 $2,358.00 $2,131.00 $2,264.00 $2,442.00 $2,131.00 $2,264.00 $2,442.00 33130 90 $1,734.00 $1,855.00 $1,967.00 $2,114.00 $1,855.00 $1,967.00 $2,114.00 33140 90 $1,571.00 $2,084.00 $2,194.00 $2,338.00 $2,084.00 $2,194.00 $2,338.00 33141 ZZZ $254.00 $233.00 $255.00 $286.00 $233.00 $255.00 $286.00 33202 90 ------- $1,057.00 $1,122.00 $1,207.00 $1,057.00 $1,122.00 $1,207.00 33203 90 ------- $1,070.00 $1,128.00 $1,200.00 $1,070.00 $1,128.00 $1,200.00 33206 90 $642.00 $624.00 $654.00 $689.00 $624.00 $654.00 $689.00 33207 90 $753.00 $669.00 $702.00 $739.00 $669.00 $702.00 $739.00 33208 90 $573.00 $714.00 $747.00 $784.00 $714.00 $747.00 $784.00 33210 0 $204.00 $242.00 $252.00 $264.00 $242.00 $252.00 $264.00 33211 0 $210.00 $249.00 $259.00 $272.00 $249.00 $259.00 $272.00 33212 90 $511.00 $469.00 $493.00 $520.00 $469.00 $493.00 $520.00 33213 90 $437.00 $533.00 $558.00 $588.00 $533.00 $558.00 $588.00 33214 90 $532.00 $668.00 $701.00 $739.00 $668.00 $701.00 $739.00 33215 90 $304.00 $426.00 $447.00 $471.00 $426.00 $447.00 $471.00 33216 90 $402.00 $520.00 $545.00 $572.00 $520.00 $545.00 $572.00 33217 90 $428.00 $519.00 $544.00 $572.00 $519.00 $544.00 $572.00 33218 90 $488.00 $538.00 $563.00 $591.00 $538.00 $563.00 $591.00 33220 90 $390.00 $540.00 $565.00 $593.00 $540.00 $565.00 $593.00 33222 90 $471.00 $483.00 $509.00 $538.00 $483.00 $509.00 $538.00 33223 90 $585.00 $578.00 $606.00 $638.00 $578.00 $606.00 $638.00 33224 0 $490.00 $690.00 $719.00 $754.00 $690.00 $719.00 $754.00 33225 ZZZ $434.00 $617.00 $642.00 $671.00 $617.00 $642.00 $671.00 33226 0 $472.00 $668.00 $698.00 $734.00 $668.00 $698.00 $734.00 33233 90 $270.00 $337.00 $354.00 $373.00 $337.00 $354.00 $373.00 33234 90 $598.00 $673.00 $706.00 $743.00 $673.00 $706.00 $743.00 33235 90 $587.00 $875.00 $919.00 $968.00 $875.00 $919.00 $968.00 33236 90 $933.00 $1,073.00 $1,140.00 $1,227.00 $1,073.00 $1,140.00 $1,227.00 33237 90 $1,184.00 $1,167.00 $1,235.00 $1,321.00 $1,167.00 $1,235.00 $1,321.00 33238 90 $1,235.00 $1,285.00 $1,366.00 $1,469.00 $1,285.00 $1,366.00 $1,469.00 33240 90 $648.00 $636.00 $664.00 $694.00 $636.00 $664.00 $694.00 33241 90 $301.00 $316.00 $331.00 $347.00 $316.00 $331.00 $347.00 33243 90 $1,650.00 $1,826.00 $1,919.00 $2,035.00 $1,826.00 $1,919.00 $2,035.00 33244 90 $1,081.00 $1,187.00 $1,245.00 $1,310.00 $1,187.00 $1,245.00 $1,310.00 33249 90 $1,271.00 $1,229.00 $1,282.00 $1,339.00 $1,229.00 $1,282.00 $1,339.00 33250 90 $1,687.00 $2,011.00 $2,131.00 $2,289.00 $2,011.00 $2,131.00 $2,289.00 33251 90 $2,071.00 $2,204.00 $2,335.00 $2,510.00 $2,204.00 $2,335.00 $2,510.00 33254 90 ------- $1,861.00 $1,981.00 $2,141.00 $1,861.00 $1,981.00 $2,141.00 33255 90 ------- $2,238.00 $2,379.00 $2,567.00 $2,238.00 $2,379.00 $2,567.00 33256 90 ------- $2,681.00 $2,854.00 $3,087.00 $2,681.00 $2,854.00 $3,087.00 33257 ZZZ ------- $796.00 $838.00 $889.00 $796.00 $838.00 $889.00 33258 ZZZ ------- $903.00 $952.00 $1,012.00 $903.00 $952.00 $1,012.00 33259 ZZZ ------- $1,195.00 $1,268.00 $1,361.00 $1,195.00 $1,268.00 $1,361.00 33261 90 $1,993.00 $2,213.00 $2,343.00 $2,513.00 $2,213.00 $2,343.00 $2,513.00 33265 90 ------- $1,861.00 $1,981.00 $2,141.00 $1,861.00 $1,981.00 $2,141.00 33266 90 ------- $2,554.00 $2,721.00 $2,947.00 $2,554.00 $2,721.00 $2,947.00 33282 90 $470.00 $445.00 $466.00 $487.00 $445.00 $466.00 $487.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 181
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 33284 90 $365.00 $326.00 $342.00 $358.00 $326.00 $342.00 $358.00 33300 90 $1,576.00 $2,926.00 $3,037.00 $3,177.00 $2,926.00 $3,037.00 $3,177.00 33305 90 $1,889.00 $4,750.00 $4,893.00 $5,069.00 $4,750.00 $4,893.00 $5,069.00 33310 90 $1,577.00 $1,603.00 $1,701.00 $1,829.00 $1,603.00 $1,701.00 $1,829.00 33315 90 $1,875.00 $2,014.00 $2,135.00 $2,296.00 $2,014.00 $2,135.00 $2,296.00 33320 90 $1,485.00 $1,437.00 $1,519.00 $1,625.00 $1,437.00 $1,519.00 $1,625.00 33321 90 $1,890.00 $1,657.00 $1,764.00 $1,905.00 $1,657.00 $1,764.00 $1,905.00 33322 90 $1,935.00 $1,866.00 $1,974.00 $2,116.00 $1,866.00 $1,974.00 $2,116.00 33330 90 $1,726.00 $1,900.00 $2,007.00 $2,147.00 $1,900.00 $2,007.00 $2,147.00 33332 90 $1,915.00 $1,888.00 $2,001.00 $2,149.00 $1,888.00 $2,001.00 $2,149.00 33335 90 $2,336.00 $2,572.00 $2,727.00 $2,933.00 $2,572.00 $2,727.00 $2,933.00 33400 90 $2,401.00 $3,025.00 $3,183.00 $3,389.00 $3,025.00 $3,183.00 $3,389.00 33401 90 $2,228.00 $2,024.00 $2,157.00 $2,332.00 $2,024.00 $2,157.00 $2,332.00 33403 90 $2,369.00 $2,145.00 $2,283.00 $2,462.00 $2,145.00 $2,283.00 $2,462.00 33404 90 $2,698.00 $2,475.00 $2,632.00 $2,841.00 $2,475.00 $2,632.00 $2,841.00 33405 90 $2,745.00 $3,192.00 $3,387.00 $3,646.00 $3,192.00 $3,387.00 $3,646.00 33406 90 $2,962.00 $3,838.00 $4,043.00 $4,313.00 $3,838.00 $4,043.00 $4,313.00 33410 90 $2,637.00 $3,373.00 $3,551.00 $3,784.00 $3,373.00 $3,551.00 $3,784.00 33411 90 $2,981.00 $4,339.00 $4,549.00 $4,823.00 $4,339.00 $4,549.00 $4,823.00 33412 90 $3,213.00 $3,478.00 $3,705.00 $4,010.00 $3,478.00 $3,705.00 $4,010.00 33413 90 $3,282.00 $4,432.00 $4,677.00 $4,999.00 $4,432.00 $4,677.00 $4,999.00 33414 90 $2,904.00 $2,918.00 $3,084.00 $3,306.00 $2,918.00 $3,084.00 $3,306.00 33415 90 $2,563.00 $2,704.00 $2,854.00 $3,054.00 $2,704.00 $2,854.00 $3,054.00 33416 90 $2,684.00 $2,742.00 $2,906.00 $3,125.00 $2,742.00 $2,906.00 $3,125.00 33417 90 $2,756.00 $2,328.00 $2,477.00 $2,676.00 $2,328.00 $2,477.00 $2,676.00 33420 90 $1,796.00 $1,826.00 $1,906.00 $2,006.00 $1,826.00 $1,906.00 $2,006.00 33422 90 $2,431.00 $2,328.00 $2,473.00 $2,664.00 $2,328.00 $2,473.00 $2,664.00 33425 90 $2,509.00 $3,429.00 $3,587.00 $3,793.00 $3,429.00 $3,587.00 $3,793.00 33426 90 $2,806.00 $3,247.00 $3,434.00 $3,680.00 $3,247.00 $3,434.00 $3,680.00 33427 90 $3,026.00 $3,459.00 $3,676.00 $3,967.00 $3,459.00 $3,676.00 $3,967.00 33430 90 $2,891.00 $3,684.00 $3,877.00 $4,130.00 $3,684.00 $3,877.00 $4,130.00 33460 90 $2,215.00 $3,019.00 $3,153.00 $3,327.00 $3,019.00 $3,153.00 $3,327.00 33463 90 $2,396.00 $3,797.00 $3,954.00 $4,154.00 $3,797.00 $3,954.00 $4,154.00 33464 90 $2,547.00 $3,153.00 $3,310.00 $3,517.00 $3,153.00 $3,310.00 $3,517.00 33465 90 $2,665.00 $3,489.00 $3,655.00 $3,873.00 $3,489.00 $3,655.00 $3,873.00 33468 90 $2,952.00 $2,586.00 $2,741.00 $2,944.00 $2,586.00 $2,741.00 $2,944.00 33470 90 $1,749.00 $1,548.00 $1,607.00 $1,675.00 $1,548.00 $1,607.00 $1,675.00 33471 90 $1,929.00 $1,875.00 $1,999.00 $2,163.00 $1,875.00 $1,999.00 $2,163.00 33472 90 $2,001.00 $1,873.00 $2,000.00 $2,170.00 $1,873.00 $2,000.00 $2,170.00 33474 90 $2,173.00 $2,695.00 $2,819.00 $2,981.00 $2,695.00 $2,819.00 $2,981.00 33475 90 $2,666.00 $3,136.00 $3,316.00 $3,555.00 $3,136.00 $3,316.00 $3,555.00 33476 90 $2,270.00 $1,990.00 $2,092.00 $2,220.00 $1,990.00 $2,092.00 $2,220.00 33478 90 $2,544.00 $2,196.00 $2,338.00 $2,526.00 $2,196.00 $2,338.00 $2,526.00 33496 90 $2,595.00 $2,319.00 $2,466.00 $2,664.00 $2,319.00 $2,466.00 $2,664.00 33500 90 $2,370.00 $2,176.00 $2,314.00 $2,499.00 $2,176.00 $2,314.00 $2,499.00 33501 90 $1,546.00 $1,471.00 $1,548.00 $1,647.00 $1,471.00 $1,548.00 $1,647.00 33502 90 $1,938.00 $1,767.00 $1,879.00 $2,027.00 $1,767.00 $1,879.00 $2,027.00 33503 90 $1,983.00 $1,739.00 $1,824.00 $1,926.00 $1,739.00 $1,824.00 $1,926.00 33504 90 $2,416.00 $2,014.00 $2,140.00 $2,305.00 $2,014.00 $2,140.00 $2,305.00 33505 90 $2,423.00 $2,676.00 $2,781.00 $2,909.00 $2,676.00 $2,781.00 $2,909.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 182
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 33506 90 $2,448.00 $2,827.00 $2,994.00 $3,217.00 $2,827.00 $2,994.00 $3,217.00 33507 90 ------- $2,413.00 $2,560.00 $2,756.00 $2,413.00 $2,560.00 $2,756.00 33508 ZZZ $17.00 $23.00 $24.00 $26.00 $23.00 $24.00 $26.00 33510 90 $2,354.00 $2,719.00 $2,883.00 $3,099.00 $2,719.00 $2,883.00 $3,099.00 33511 90 $2,546.00 $2,943.00 $3,114.00 $3,339.00 $2,943.00 $3,114.00 $3,339.00 33512 90 $2,732.00 $3,269.00 $3,447.00 $3,680.00 $3,269.00 $3,447.00 $3,680.00 33513 90 $2,933.00 $3,367.00 $3,552.00 $3,794.00 $3,367.00 $3,552.00 $3,794.00 33514 90 $3,197.00 $3,516.00 $3,700.00 $3,940.00 $3,516.00 $3,700.00 $3,940.00 33516 90 $3,404.00 $3,657.00 $3,853.00 $4,109.00 $3,657.00 $3,853.00 $4,109.00 33517 ZZZ $219.00 $248.00 $262.00 $280.00 $248.00 $262.00 $280.00 33518 ZZZ $414.00 $529.00 $554.00 $589.00 $529.00 $554.00 $589.00 33519 ZZZ $607.00 $712.00 $748.00 $797.00 $712.00 $748.00 $797.00 33521 ZZZ $801.00 $871.00 $918.00 $982.00 $871.00 $918.00 $982.00 33522 ZZZ $994.00 $1,006.00 $1,066.00 $1,147.00 $1,006.00 $1,066.00 $1,147.00 33523 ZZZ $1,189.00 $1,157.00 $1,228.00 $1,325.00 $1,157.00 $1,228.00 $1,325.00 33530 ZZZ $521.00 $667.00 $698.00 $740.00 $667.00 $698.00 $740.00 33533 90 $2,415.00 $2,667.00 $2,835.00 $3,057.00 $2,667.00 $2,835.00 $3,057.00 33534 90 $2,654.00 $3,052.00 $3,229.00 $3,462.00 $3,052.00 $3,229.00 $3,462.00 33535 90 $2,899.00 $3,356.00 $3,545.00 $3,793.00 $3,356.00 $3,545.00 $3,793.00 33536 90 $3,143.00 $3,591.00 $3,793.00 $4,059.00 $3,591.00 $3,793.00 $4,059.00 33542 90 $2,693.00 $3,352.00 $3,517.00 $3,733.00 $3,352.00 $3,517.00 $3,733.00 33545 90 $3,250.00 $3,981.00 $4,177.00 $4,435.00 $3,981.00 $4,177.00 $4,435.00 33548 90 ------- $3,939.00 $4,148.00 $4,422.00 $3,939.00 $4,148.00 $4,422.00 33572 ZZZ $340.00 $329.00 $350.00 $380.00 $329.00 $350.00 $380.00 33600 90 $2,644.00 $2,383.00 $2,539.00 $2,750.00 $2,383.00 $2,539.00 $2,750.00 33602 90 $2,556.00 $2,264.00 $2,403.00 $2,588.00 $2,264.00 $2,403.00 $2,588.00 33606 90 $2,831.00 $2,462.00 $2,620.00 $2,831.00 $2,462.00 $2,620.00 $2,831.00 33608 90 $2,940.00 $2,540.00 $2,708.00 $2,934.00 $2,540.00 $2,708.00 $2,934.00 33610 90 $2,871.00 $2,507.00 $2,672.00 $2,891.00 $2,507.00 $2,672.00 $2,891.00 33611 90 $2,985.00 $2,676.00 $2,834.00 $3,045.00 $2,676.00 $2,834.00 $3,045.00 33612 90 $3,152.00 $2,870.00 $3,058.00 $3,309.00 $2,870.00 $3,058.00 $3,309.00 33615 90 $3,051.00 $2,696.00 $2,853.00 $3,063.00 $2,696.00 $2,853.00 $3,063.00 33617 90 $3,272.00 $3,027.00 $3,224.00 $3,491.00 $3,027.00 $3,224.00 $3,491.00 33619 90 $3,678.00 $3,764.00 $3,998.00 $4,309.00 $3,764.00 $3,998.00 $4,309.00 33641 90 $1,981.00 $2,153.00 $2,272.00 $2,429.00 $2,153.00 $2,272.00 $2,429.00 33645 90 $2,352.00 $2,176.00 $2,312.00 $2,494.00 $2,176.00 $2,312.00 $2,494.00 33647 90 $2,732.00 $2,304.00 $2,436.00 $2,606.00 $2,304.00 $2,436.00 $2,606.00 33660 90 $2,444.00 $2,480.00 $2,639.00 $2,853.00 $2,480.00 $2,639.00 $2,853.00 33665 90 $2,700.00 $2,600.00 $2,748.00 $2,944.00 $2,600.00 $2,748.00 $2,944.00 33670 90 $2,820.00 $2,807.00 $2,976.00 $3,201.00 $2,807.00 $2,976.00 $3,201.00 33675 90 ------- $2,865.00 $3,047.00 $3,288.00 $2,865.00 $3,047.00 $3,288.00 33676 90 ------- $2,966.00 $3,161.00 $3,422.00 $2,966.00 $3,161.00 $3,422.00 33677 90 ------- $3,084.00 $3,287.00 $3,559.00 $3,084.00 $3,287.00 $3,559.00 33681 90 $2,657.00 $2,552.00 $2,715.00 $2,930.00 $2,552.00 $2,715.00 $2,930.00 33684 90 $2,740.00 $2,552.00 $2,686.00 $2,859.00 $2,552.00 $2,686.00 $2,859.00 33688 90 $2,602.00 $2,556.00 $2,715.00 $2,934.00 $2,556.00 $2,715.00 $2,934.00 33690 90 $1,884.00 $1,575.00 $1,658.00 $1,763.00 $1,575.00 $1,658.00 $1,763.00 33692 90 $2,816.00 $2,674.00 $2,850.00 $3,080.00 $2,674.00 $2,850.00 $3,080.00 33694 90 $2,856.00 $2,692.00 $2,869.00 $3,113.00 $2,692.00 $2,869.00 $3,113.00 33697 90 $3,064.00 $2,880.00 $3,040.00 $3,248.00 $2,880.00 $3,040.00 $3,248.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 183
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 33702 90 $2,549.00 $2,142.00 $2,277.00 $2,455.00 $2,142.00 $2,277.00 $2,455.00 33710 90 $2,731.00 $2,404.00 $2,561.00 $2,773.00 $2,404.00 $2,561.00 $2,773.00 33720 90 $2,508.00 $2,153.00 $2,291.00 $2,476.00 $2,153.00 $2,291.00 $2,476.00 33722 90 $2,704.00 $2,079.00 $2,155.00 $2,243.00 $2,079.00 $2,155.00 $2,243.00 33724 90 ------- $2,130.00 $2,268.00 $2,456.00 $2,130.00 $2,268.00 $2,456.00 33726 90 ------- $2,800.00 $2,975.00 $3,211.00 $2,800.00 $2,975.00 $3,211.00 33730 90 $2,785.00 $2,765.00 $2,941.00 $3,178.00 $2,765.00 $2,941.00 $3,178.00 33732 90 $2,622.00 $2,295.00 $2,435.00 $2,618.00 $2,295.00 $2,435.00 $2,618.00 33735 90 $2,036.00 $1,687.00 $1,772.00 $1,876.00 $1,687.00 $1,772.00 $1,876.00 33736 90 $2,288.00 $1,978.00 $2,099.00 $2,255.00 $1,978.00 $2,099.00 $2,255.00 33737 90 $1,977.00 $1,808.00 $1,926.00 $2,084.00 $1,808.00 $1,926.00 $2,084.00 33750 90 $1,877.00 $1,619.00 $1,683.00 $1,758.00 $1,619.00 $1,683.00 $1,758.00 33755 90 $1,831.00 $1,727.00 $1,840.00 $1,992.00 $1,727.00 $1,840.00 $1,992.00 33762 90 $1,900.00 $1,774.00 $1,887.00 $2,039.00 $1,774.00 $1,887.00 $2,039.00 33764 90 $1,895.00 $1,772.00 $1,882.00 $2,029.00 $1,772.00 $1,882.00 $2,029.00 33766 90 $2,119.00 $1,896.00 $2,026.00 $2,201.00 $1,896.00 $2,026.00 $2,201.00 33767 90 $2,173.00 $1,989.00 $2,123.00 $2,303.00 $1,989.00 $2,123.00 $2,303.00 33768 ZZZ ------- $582.00 $621.00 $674.00 $582.00 $621.00 $674.00 33770 90 $2,954.00 $2,952.00 $3,146.00 $3,410.00 $2,952.00 $3,146.00 $3,410.00 33771 90 $2,924.00 $2,993.00 $3,182.00 $3,443.00 $2,993.00 $3,182.00 $3,443.00 33774 90 $2,681.00 $2,534.00 $2,704.00 $2,933.00 $2,534.00 $2,704.00 $2,933.00 33775 90 $2,654.00 $2,565.00 $2,736.00 $2,969.00 $2,565.00 $2,736.00 $2,969.00 33776 90 $2,844.00 $2,677.00 $2,852.00 $3,091.00 $2,677.00 $2,852.00 $3,091.00 33777 90 $2,724.00 $2,669.00 $2,854.00 $3,107.00 $2,669.00 $2,854.00 $3,107.00 33778 90 $3,199.00 $3,289.00 $3,503.00 $3,794.00 $3,289.00 $3,503.00 $3,794.00 33779 90 $3,121.00 $2,954.00 $3,077.00 $3,233.00 $2,954.00 $3,077.00 $3,233.00 33780 90 $3,232.00 $3,156.00 $3,307.00 $3,499.00 $3,156.00 $3,307.00 $3,499.00 33781 90 $3,057.00 $3,112.00 $3,307.00 $3,578.00 $3,112.00 $3,307.00 $3,578.00 33786 90 $2,970.00 $3,183.00 $3,383.00 $3,653.00 $3,183.00 $3,383.00 $3,653.00 33788 90 $2,288.00 $2,105.00 $2,243.00 $2,431.00 $2,105.00 $2,243.00 $2,431.00 33800 90 $1,546.00 $1,377.00 $1,467.00 $1,585.00 $1,377.00 $1,467.00 $1,585.00 33802 90 $1,752.00 $1,466.00 $1,554.00 $1,669.00 $1,466.00 $1,554.00 $1,669.00 33803 90 $1,746.00 $1,605.00 $1,715.00 $1,865.00 $1,605.00 $1,715.00 $1,865.00 33813 90 $1,935.00 $1,739.00 $1,853.00 $2,006.00 $1,739.00 $1,853.00 $2,006.00 33814 90 $2,464.00 $2,122.00 $2,261.00 $2,446.00 $2,122.00 $2,261.00 $2,446.00 33820 90 $1,619.00 $1,349.00 $1,436.00 $1,551.00 $1,349.00 $1,436.00 $1,551.00 33822 90 $1,559.00 $1,413.00 $1,507.00 $1,635.00 $1,413.00 $1,507.00 $1,635.00 33824 90 $1,884.00 $1,634.00 $1,740.00 $1,881.00 $1,634.00 $1,740.00 $1,881.00 33840 90 $2,029.00 $1,658.00 $1,748.00 $1,862.00 $1,658.00 $1,748.00 $1,862.00 33845 90 $2,129.00 $1,843.00 $1,962.00 $2,119.00 $1,843.00 $1,962.00 $2,119.00 33851 90 $2,129.00 $1,767.00 $1,883.00 $2,036.00 $1,767.00 $1,883.00 $2,036.00 33852 90 $2,311.00 $1,965.00 $2,066.00 $2,189.00 $1,965.00 $2,066.00 $2,189.00 33853 90 $3,057.00 $2,551.00 $2,713.00 $2,929.00 $2,551.00 $2,713.00 $2,929.00 33860 90 $3,044.00 $4,160.00 $4,371.00 $4,652.00 $4,160.00 $4,371.00 $4,652.00 33861 90 $3,069.00 $3,404.00 $3,625.00 $3,925.00 $3,404.00 $3,625.00 $3,925.00 33863 90 $3,183.00 $4,237.00 $4,472.00 $4,788.00 $4,237.00 $4,472.00 $4,788.00 33864 90 ------- $4,357.00 $4,599.00 $4,923.00 $4,357.00 $4,599.00 $4,923.00 33870 90 $3,638.00 $3,549.00 $3,779.00 $4,090.00 $3,549.00 $3,779.00 $4,090.00 33875 90 $2,876.00 $2,739.00 $2,911.00 $3,143.00 $2,739.00 $2,911.00 $3,143.00 33877 90 $3,767.00 $4,638.00 $4,855.00 $5,144.00 $4,638.00 $4,855.00 $5,144.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 184
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 33880 90 ------- $2,447.00 $2,560.00 $2,704.00 $2,447.00 $2,560.00 $2,704.00 33881 90 ------- $2,110.00 $2,208.00 $2,331.00 $2,110.00 $2,208.00 $2,331.00 33883 90 ------- $1,563.00 $1,646.00 $1,753.00 $1,563.00 $1,646.00 $1,753.00 33884 ZZZ ------- $570.00 $600.00 $641.00 $570.00 $600.00 $641.00 33886 90 ------- $1,352.00 $1,423.00 $1,516.00 $1,352.00 $1,423.00 $1,516.00 33889 0 ------- $1,149.00 $1,221.00 $1,320.00 $1,149.00 $1,221.00 $1,320.00 33891 0 ------- $1,475.00 $1,567.00 $1,693.00 $1,475.00 $1,567.00 $1,693.00 33910 90 $1,987.00 $2,252.00 $2,387.00 $2,566.00 $2,252.00 $2,387.00 $2,566.00 33915 90 $1,588.00 $1,749.00 $1,819.00 $1,903.00 $1,749.00 $1,819.00 $1,903.00 33916 90 $2,096.00 $2,174.00 $2,307.00 $2,484.00 $2,174.00 $2,307.00 $2,484.00 33917 90 $2,345.00 $2,030.00 $2,164.00 $2,342.00 $2,030.00 $2,164.00 $2,342.00 33920 90 $2,981.00 $2,460.00 $2,612.00 $2,819.00 $2,460.00 $2,612.00 $2,819.00 33922 90 $2,227.00 $1,906.00 $2,022.00 $2,175.00 $1,906.00 $2,022.00 $2,175.00 33924 ZZZ $421.00 $409.00 $436.00 $473.00 $409.00 $436.00 $473.00 33925 90 ------- $2,611.00 $2,783.00 $3,010.00 $2,611.00 $2,783.00 $3,010.00 33926 90 ------- $3,404.00 $3,620.00 $3,912.00 $3,404.00 $3,620.00 $3,912.00 33935 90 $5,415.00 $4,908.00 $5,231.00 $5,663.00 $4,908.00 $5,231.00 $5,663.00 33945 90 $3,813.00 $5,974.00 $6,225.00 $6,547.00 $5,974.00 $6,225.00 $6,547.00 33960 0 $1,221.00 $1,373.00 $1,459.00 $1,579.00 $1,373.00 $1,459.00 $1,579.00 33961 ZZZ $800.00 $747.00 $781.00 $826.00 $747.00 $781.00 $826.00 33967 0 $258.00 $361.00 $378.00 $398.00 $361.00 $378.00 $398.00 33968 0 $51.00 $47.00 $50.00 $54.00 $47.00 $50.00 $54.00 33970 0 $576.00 $502.00 $532.00 $571.00 $502.00 $532.00 $571.00 33971 90 $578.00 $959.00 $1,012.00 $1,079.00 $959.00 $1,012.00 $1,079.00 33973 0 $756.00 $739.00 $784.00 $845.00 $739.00 $784.00 $845.00 33974 90 $1,095.00 $1,230.00 $1,302.00 $1,393.00 $1,230.00 $1,302.00 $1,393.00 33975 0 $1,758.00 $1,543.00 $1,643.00 $1,783.00 $1,543.00 $1,643.00 $1,783.00 33976 0 $2,056.00 $1,718.00 $1,828.00 $1,978.00 $1,718.00 $1,828.00 $1,978.00 33977 90 $1,561.00 $1,677.00 $1,785.00 $1,926.00 $1,677.00 $1,785.00 $1,926.00 33978 90 $1,754.00 $1,874.00 $1,997.00 $2,160.00 $1,874.00 $1,997.00 $2,160.00 33979 0 $2,496.00 $3,415.00 $3,643.00 $3,958.00 $3,415.00 $3,643.00 $3,958.00 33980 90 $3,212.00 $4,935.00 $5,240.00 $5,649.00 $4,935.00 $5,240.00 $5,649.00 33999 YYY BR ------- ------- ------- ------- ------- ------- 34001 90 $1,012.00 $1,309.00 $1,379.00 $1,471.00 $1,309.00 $1,379.00 $1,471.00 34051 90 $1,134.00 $1,350.00 $1,433.00 $1,542.00 $1,350.00 $1,433.00 $1,542.00 34101 90 $800.00 $862.00 $916.00 $985.00 $862.00 $916.00 $985.00 34111 90 $669.00 $861.00 $914.00 $983.00 $861.00 $914.00 $983.00 34151 90 $1,288.00 $1,999.00 $2,123.00 $2,292.00 $1,999.00 $2,123.00 $2,292.00 34201 90 $777.00 $1,324.00 $1,382.00 $1,457.00 $1,324.00 $1,382.00 $1,457.00 34203 90 $949.00 $1,380.00 $1,466.00 $1,580.00 $1,380.00 $1,466.00 $1,580.00 34401 90 $953.00 $1,985.00 $2,099.00 $2,250.00 $1,985.00 $2,099.00 $2,250.00 34421 90 $779.00 $1,034.00 $1,094.00 $1,172.00 $1,034.00 $1,094.00 $1,172.00 34451 90 $1,117.00 $2,160.00 $2,294.00 $2,476.00 $2,160.00 $2,294.00 $2,476.00 34471 90 $685.00 $1,409.00 $1,462.00 $1,528.00 $1,409.00 $1,462.00 $1,528.00 34490 90 $660.00 $865.00 $918.00 $988.00 $865.00 $918.00 $988.00 34501 90 $910.00 $1,345.00 $1,432.00 $1,546.00 $1,345.00 $1,432.00 $1,546.00 34502 90 $2,044.00 $2,165.00 $2,298.00 $2,474.00 $2,165.00 $2,298.00 $2,474.00 34510 90 $1,108.00 $1,538.00 $1,628.00 $1,744.00 $1,538.00 $1,628.00 $1,744.00 34520 90 $1,077.00 $1,463.00 $1,549.00 $1,662.00 $1,463.00 $1,549.00 $1,662.00 34530 90 $1,368.00 $1,357.00 $1,428.00 $1,520.00 $1,357.00 $1,428.00 $1,520.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 185
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 34800 90 $1,159.00 $1,613.00 $1,705.00 $1,826.00 $1,613.00 $1,705.00 $1,826.00 34802 90 $1,279.00 $1,748.00 $1,839.00 $1,957.00 $1,748.00 $1,839.00 $1,957.00 34803 90 ------- $1,777.00 $1,861.00 $1,967.00 $1,777.00 $1,861.00 $1,967.00 34804 90 $1,279.00 $1,743.00 $1,833.00 $1,950.00 $1,743.00 $1,833.00 $1,950.00 34805 90 ------- $1,643.00 $1,724.00 $1,828.00 $1,643.00 $1,724.00 $1,828.00 34806 ZZZ ------- $146.00 $155.00 $169.00 $146.00 $155.00 $169.00 34808 ZZZ $220.00 $301.00 $320.00 $347.00 $301.00 $320.00 $347.00 34812 0 $359.00 $508.00 $545.00 $597.00 $508.00 $545.00 $597.00 34813 ZZZ $256.00 $346.00 $368.00 $398.00 $346.00 $368.00 $398.00 34820 0 $519.00 $718.00 $767.00 $834.00 $718.00 $767.00 $834.00 34825 90 $694.00 $981.00 $1,034.00 $1,101.00 $981.00 $1,034.00 $1,101.00 34826 ZZZ $220.00 $291.00 $307.00 $328.00 $291.00 $307.00 $328.00 34830 90 $1,803.00 $2,610.00 $2,768.00 $2,983.00 $2,610.00 $2,768.00 $2,983.00 34831 90 $1,950.00 $2,741.00 $2,906.00 $3,132.00 $2,741.00 $2,906.00 $3,132.00 34832 90 $1,950.00 $2,823.00 $2,993.00 $3,223.00 $2,823.00 $2,993.00 $3,223.00 34833 0 $650.00 $890.00 $947.00 $1,026.00 $890.00 $947.00 $1,026.00 34834 0 $306.00 $405.00 $431.00 $466.00 $405.00 $431.00 $466.00 34900 90 $960.00 $1,287.00 $1,362.00 $1,461.00 $1,287.00 $1,362.00 $1,461.00 35001 90 $1,564.00 $1,626.00 $1,728.00 $1,864.00 $1,626.00 $1,728.00 $1,864.00 35002 90 $1,547.00 $1,707.00 $1,814.00 $1,957.00 $1,707.00 $1,814.00 $1,957.00 35005 90 $1,268.00 $1,475.00 $1,551.00 $1,646.00 $1,475.00 $1,551.00 $1,646.00 35011 90 $1,007.00 $1,428.00 $1,518.00 $1,639.00 $1,428.00 $1,518.00 $1,639.00 35013 90 $1,376.00 $1,766.00 $1,876.00 $2,024.00 $1,766.00 $1,876.00 $2,024.00 35021 90 $1,635.00 $1,712.00 $1,816.00 $1,956.00 $1,712.00 $1,816.00 $1,956.00 35022 90 $1,686.00 $1,965.00 $2,082.00 $2,237.00 $1,965.00 $2,082.00 $2,237.00 35045 90 $995.00 $1,381.00 $1,468.00 $1,585.00 $1,381.00 $1,468.00 $1,585.00 35081 90 $2,175.00 $2,440.00 $2,581.00 $2,771.00 $2,440.00 $2,581.00 $2,771.00 35082 90 $2,661.00 $3,102.00 $3,290.00 $3,546.00 $3,102.00 $3,290.00 $3,546.00 35091 90 $2,634.00 $2,657.00 $2,830.00 $3,066.00 $2,657.00 $2,830.00 $3,066.00 35092 90 $2,872.00 $3,697.00 $3,917.00 $4,216.00 $3,697.00 $3,917.00 $4,216.00 35102 90 $2,346.00 $2,655.00 $2,811.00 $3,022.00 $2,655.00 $2,811.00 $3,022.00 35103 90 $2,587.00 $3,212.00 $3,409.00 $3,677.00 $3,212.00 $3,409.00 $3,677.00 35111 90 $1,398.00 $1,979.00 $2,101.00 $2,265.00 $1,979.00 $2,101.00 $2,265.00 35112 90 $1,351.00 $2,398.00 $2,541.00 $2,734.00 $2,398.00 $2,541.00 $2,734.00 35121 90 $2,000.00 $2,374.00 $2,523.00 $2,725.00 $2,374.00 $2,523.00 $2,725.00 35122 90 $2,382.00 $2,783.00 $2,948.00 $3,172.00 $2,783.00 $2,948.00 $3,172.00 35131 90 $1,495.00 $2,020.00 $2,151.00 $2,329.00 $2,020.00 $2,151.00 $2,329.00 35132 90 $1,742.00 $2,431.00 $2,581.00 $2,784.00 $2,431.00 $2,581.00 $2,784.00 35141 90 $1,231.00 $1,604.00 $1,706.00 $1,844.00 $1,604.00 $1,706.00 $1,844.00 35142 90 $1,339.00 $1,907.00 $2,026.00 $2,185.00 $1,907.00 $2,026.00 $2,185.00 35151 90 $1,390.00 $1,806.00 $1,920.00 $2,074.00 $1,806.00 $1,920.00 $2,074.00 35152 90 $1,229.00 $2,091.00 $2,220.00 $2,392.00 $2,091.00 $2,220.00 $2,392.00 35180 90 $997.00 $1,114.00 $1,163.00 $1,222.00 $1,114.00 $1,163.00 $1,222.00 35182 90 $1,345.00 $2,420.00 $2,573.00 $2,779.00 $2,420.00 $2,573.00 $2,779.00 35184 90 $976.00 $1,449.00 $1,540.00 $1,661.00 $1,449.00 $1,540.00 $1,661.00 35188 90 $1,048.00 $1,226.00 $1,305.00 $1,411.00 $1,226.00 $1,305.00 $1,411.00 35189 90 $1,380.00 $2,286.00 $2,428.00 $2,619.00 $2,286.00 $2,428.00 $2,619.00 35190 90 $1,018.00 $1,062.00 $1,128.00 $1,216.00 $1,062.00 $1,128.00 $1,216.00 35201 90 $852.00 $1,334.00 $1,419.00 $1,532.00 $1,334.00 $1,419.00 $1,532.00 35206 90 $835.00 $1,091.00 $1,160.00 $1,251.00 $1,091.00 $1,160.00 $1,251.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 186
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 35207 90 $935.00 $976.00 $1,039.00 $1,118.00 $976.00 $1,039.00 $1,118.00 35211 90 $1,833.00 $1,912.00 $2,030.00 $2,186.00 $1,912.00 $2,030.00 $2,186.00 35216 90 $1,494.00 $2,487.00 $2,594.00 $2,732.00 $2,487.00 $2,594.00 $2,732.00 35221 90 $1,243.00 $1,970.00 $2,089.00 $2,248.00 $1,970.00 $2,089.00 $2,248.00 35226 90 $841.00 $1,206.00 $1,281.00 $1,379.00 $1,206.00 $1,281.00 $1,379.00 35231 90 $1,053.00 $1,656.00 $1,761.00 $1,900.00 $1,656.00 $1,761.00 $1,900.00 35236 90 $947.00 $1,390.00 $1,477.00 $1,593.00 $1,390.00 $1,477.00 $1,593.00 35241 90 $1,926.00 $2,006.00 $2,134.00 $2,304.00 $2,006.00 $2,134.00 $2,304.00 35246 90 $1,701.00 $2,166.00 $2,303.00 $2,486.00 $2,166.00 $2,303.00 $2,486.00 35251 90 $1,260.00 $2,354.00 $2,496.00 $2,690.00 $2,354.00 $2,496.00 $2,690.00 35256 90 $1,568.00 $1,468.00 $1,561.00 $1,686.00 $1,468.00 $1,561.00 $1,686.00 35261 90 $1,008.00 $1,469.00 $1,562.00 $1,686.00 $1,469.00 $1,562.00 $1,686.00 35266 90 $921.00 $1,218.00 $1,294.00 $1,395.00 $1,218.00 $1,294.00 $1,395.00 35271 90 $1,814.00 $1,906.00 $2,022.00 $2,176.00 $1,906.00 $2,022.00 $2,176.00 35276 90 $1,541.00 $2,009.00 $2,136.00 $2,304.00 $2,009.00 $2,136.00 $2,304.00 35281 90 $1,396.00 $2,245.00 $2,384.00 $2,571.00 $2,245.00 $2,384.00 $2,571.00 35286 90 $1,036.00 $1,346.00 $1,432.00 $1,545.00 $1,346.00 $1,432.00 $1,545.00 35301 90 $1,486.00 $1,508.00 $1,603.00 $1,730.00 $1,508.00 $1,603.00 $1,730.00 35302 90 ------- $1,581.00 $1,681.00 $1,818.00 $1,581.00 $1,681.00 $1,818.00 35303 90 ------- $1,736.00 $1,845.00 $1,995.00 $1,736.00 $1,845.00 $1,995.00 35304 90 ------- $1,807.00 $1,921.00 $2,078.00 $1,807.00 $1,921.00 $2,078.00 35305 90 ------- $1,736.00 $1,845.00 $1,995.00 $1,736.00 $1,845.00 $1,995.00 35306 ZZZ ------- $655.00 $697.00 $756.00 $655.00 $697.00 $756.00 35311 90 $1,999.00 $2,145.00 $2,270.00 $2,435.00 $2,145.00 $2,270.00 $2,435.00 35321 90 $1,031.00 $1,283.00 $1,363.00 $1,471.00 $1,283.00 $1,363.00 $1,471.00 35331 90 $1,724.00 $2,101.00 $2,235.00 $2,415.00 $2,101.00 $2,235.00 $2,415.00 35341 90 $1,908.00 $2,003.00 $2,133.00 $2,310.00 $2,003.00 $2,133.00 $2,310.00 35351 90 $1,555.00 $1,848.00 $1,964.00 $2,121.00 $1,848.00 $1,964.00 $2,121.00 35355 90 $1,336.00 $1,502.00 $1,595.00 $1,721.00 $1,502.00 $1,595.00 $1,721.00 35361 90 $1,859.00 $2,275.00 $2,419.00 $2,613.00 $2,275.00 $2,419.00 $2,613.00 35363 90 $2,006.00 $2,432.00 $2,583.00 $2,787.00 $2,432.00 $2,583.00 $2,787.00 35371 90 $1,006.00 $1,192.00 $1,268.00 $1,370.00 $1,192.00 $1,268.00 $1,370.00 35372 90 $1,085.00 $1,432.00 $1,524.00 $1,648.00 $1,432.00 $1,524.00 $1,648.00 35390 ZZZ $225.00 $233.00 $248.00 $269.00 $233.00 $248.00 $269.00 35400 ZZZ $224.00 $220.00 $235.00 $254.00 $220.00 $235.00 $254.00 35450 0 $643.00 $735.00 $778.00 $837.00 $735.00 $778.00 $837.00 35452 0 $518.00 $515.00 $547.00 $591.00 $515.00 $547.00 $591.00 35454 0 $520.00 $454.00 $484.00 $524.00 $454.00 $484.00 $524.00 35456 0 $631.00 $549.00 $584.00 $632.00 $549.00 $584.00 $632.00 35458 0 $804.00 $702.00 $745.00 $804.00 $702.00 $745.00 $804.00 35459 0 $736.00 $646.00 $687.00 $743.00 $646.00 $687.00 $743.00 35460 0 $430.00 $449.00 $478.00 $516.00 $449.00 $478.00 $516.00 35470 0 $537.00 $4,210.00 $4,495.00 $4,743.00 $629.00 $659.00 $696.00 35471 0 $626.00 $4,681.00 $4,996.00 $5,266.00 $741.00 $773.00 $812.00 35472 0 $388.00 $3,167.00 $3,381.00 $3,568.00 $509.00 $534.00 $565.00 35473 0 $375.00 $2,983.00 $3,186.00 $3,362.00 $447.00 $468.00 $496.00 35474 0 $456.00 $4,093.00 $4,372.00 $4,612.00 $537.00 $562.00 $593.00 35475 0 $569.00 $3,113.00 $3,316.00 $3,494.00 $668.00 $696.00 $731.00 35476 0 $338.00 $2,357.00 $2,512.00 $2,645.00 $425.00 $441.00 $461.00 35480 0 $935.00 $823.00 $870.00 $932.00 $823.00 $870.00 $932.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 187
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 35481 0 $565.00 $582.00 $621.00 $673.00 $582.00 $621.00 $673.00 35482 0 $577.00 $497.00 $528.00 $570.00 $497.00 $528.00 $570.00 35483 0 $696.00 $610.00 $650.00 $703.00 $610.00 $650.00 $703.00 35484 0 $853.00 $757.00 $801.00 $861.00 $757.00 $801.00 $861.00 35485 0 $670.00 $712.00 $758.00 $821.00 $712.00 $758.00 $821.00 35490 0 $691.00 $823.00 $858.00 $901.00 $823.00 $858.00 $901.00 35491 0 $423.00 $594.00 $625.00 $665.00 $594.00 $625.00 $665.00 35492 0 $423.00 $513.00 $536.00 $563.00 $513.00 $536.00 $563.00 35493 0 $523.00 $618.00 $646.00 $679.00 $618.00 $646.00 $679.00 35494 0 $605.00 $777.00 $809.00 $846.00 $777.00 $809.00 $846.00 35495 0 $532.00 $721.00 $754.00 $794.00 $721.00 $754.00 $794.00 35500 ZZZ $423.00 $467.00 $497.00 $539.00 $467.00 $497.00 $539.00 35501 90 $1,569.00 $2,175.00 $2,314.00 $2,504.00 $2,175.00 $2,314.00 $2,504.00 35506 90 $1,641.00 $1,857.00 $1,961.00 $2,100.00 $1,857.00 $1,961.00 $2,100.00 35508 90 $1,564.00 $1,896.00 $2,000.00 $2,136.00 $1,896.00 $2,000.00 $2,136.00 35509 90 $1,529.00 $2,114.00 $2,249.00 $2,432.00 $2,114.00 $2,249.00 $2,432.00 35510 90 ------- $1,756.00 $1,841.00 $1,951.00 $1,756.00 $1,841.00 $1,951.00 35511 90 $1,256.00 $1,695.00 $1,799.00 $1,939.00 $1,695.00 $1,799.00 $1,939.00 35512 90 ------- $1,722.00 $1,807.00 $1,916.00 $1,722.00 $1,807.00 $1,916.00 35515 90 $1,387.00 $1,900.00 $2,004.00 $2,140.00 $1,900.00 $2,004.00 $2,140.00 35516 90 $1,391.00 $1,674.00 $1,759.00 $1,872.00 $1,674.00 $1,759.00 $1,872.00 35518 90 $1,313.00 $1,708.00 $1,814.00 $1,957.00 $1,708.00 $1,814.00 $1,957.00 35521 90 $1,393.00 $1,819.00 $1,931.00 $2,080.00 $1,819.00 $1,931.00 $2,080.00 35522 90 ------- $1,679.00 $1,764.00 $1,872.00 $1,679.00 $1,764.00 $1,872.00 35523 90 ------- $1,757.00 $1,845.00 $1,956.00 $1,757.00 $1,845.00 $1,956.00 35525 90 ------- $1,592.00 $1,675.00 $1,783.00 $1,592.00 $1,675.00 $1,783.00 35526 90 $1,527.00 $2,429.00 $2,569.00 $2,751.00 $2,429.00 $2,569.00 $2,751.00 35531 90 $2,000.00 $2,890.00 $3,068.00 $3,310.00 $2,890.00 $3,068.00 $3,310.00 35533 90 $1,716.00 $2,234.00 $2,370.00 $2,553.00 $2,234.00 $2,370.00 $2,553.00 35536 90 $1,888.00 $2,506.00 $2,663.00 $2,878.00 $2,506.00 $2,663.00 $2,878.00 35537 90 ------- $3,069.00 $3,261.00 $3,525.00 $3,069.00 $3,261.00 $3,525.00 35538 90 ------- $3,428.00 $3,642.00 $3,935.00 $3,428.00 $3,642.00 $3,935.00 35539 90 ------- $3,216.00 $3,417.00 $3,693.00 $3,216.00 $3,417.00 $3,693.00 35540 90 ------- $3,588.00 $3,812.00 $4,122.00 $3,588.00 $3,812.00 $4,122.00 35548 90 $1,751.00 $1,725.00 $1,832.00 $1,974.00 $1,725.00 $1,832.00 $1,974.00 35549 90 $1,902.00 $1,882.00 $2,000.00 $2,158.00 $1,882.00 $2,000.00 $2,158.00 35551 90 $2,036.00 $2,121.00 $2,253.00 $2,432.00 $2,121.00 $2,253.00 $2,432.00 35556 90 $1,745.00 $1,955.00 $2,066.00 $2,215.00 $1,955.00 $2,066.00 $2,215.00 35558 90 $1,219.00 $1,753.00 $1,860.00 $2,004.00 $1,753.00 $1,860.00 $2,004.00 35560 90 $1,899.00 $2,567.00 $2,730.00 $2,952.00 $2,567.00 $2,730.00 $2,952.00 35563 90 $1,115.00 $1,985.00 $2,109.00 $2,276.00 $1,985.00 $2,109.00 $2,276.00 35565 90 $1,312.00 $1,893.00 $2,010.00 $2,166.00 $1,893.00 $2,010.00 $2,166.00 35566 90 $2,161.00 $2,347.00 $2,483.00 $2,664.00 $2,347.00 $2,483.00 $2,664.00 35571 90 $1,612.00 $1,938.00 $2,059.00 $2,221.00 $1,938.00 $2,059.00 $2,221.00 35572 ZZZ $369.00 $502.00 $535.00 $580.00 $502.00 $535.00 $580.00 35583 90 $1,843.00 $2,018.00 $2,132.00 $2,284.00 $2,018.00 $2,132.00 $2,284.00 35585 90 $2,277.00 $2,390.00 $2,532.00 $2,723.00 $2,390.00 $2,532.00 $2,723.00 35587 90 $1,698.00 $2,003.00 $2,128.00 $2,296.00 $2,003.00 $2,128.00 $2,296.00 35600 ZZZ $273.00 $368.00 $392.00 $426.00 $368.00 $392.00 $426.00 35601 90 $1,495.00 $2,039.00 $2,167.00 $2,342.00 $2,039.00 $2,167.00 $2,342.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 188
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 35606 90 $1,539.00 $1,672.00 $1,770.00 $1,900.00 $1,672.00 $1,770.00 $1,900.00 35612 90 $1,349.00 $1,305.00 $1,383.00 $1,487.00 $1,305.00 $1,383.00 $1,487.00 35616 90 $1,346.00 $1,576.00 $1,659.00 $1,768.00 $1,576.00 $1,659.00 $1,768.00 35621 90 $1,265.00 $1,602.00 $1,704.00 $1,841.00 $1,602.00 $1,704.00 $1,841.00 35623 90 $1,193.00 $1,959.00 $2,080.00 $2,244.00 $1,959.00 $2,080.00 $2,244.00 35626 90 $1,921.00 $2,245.00 $2,388.00 $2,581.00 $2,245.00 $2,388.00 $2,581.00 35631 90 $1,891.00 $2,689.00 $2,858.00 $3,089.00 $2,689.00 $2,858.00 $3,089.00 35636 90 $1,656.00 $2,360.00 $2,503.00 $2,697.00 $2,360.00 $2,503.00 $2,697.00 35637 90 ------- $2,430.00 $2,581.00 $2,787.00 $2,430.00 $2,581.00 $2,787.00 35638 90 ------- $2,469.00 $2,623.00 $2,832.00 $2,469.00 $2,623.00 $2,832.00 35642 90 $1,298.00 $1,438.00 $1,523.00 $1,634.00 $1,438.00 $1,523.00 $1,634.00 35645 90 $1,304.00 $1,466.00 $1,558.00 $1,681.00 $1,466.00 $1,558.00 $1,681.00 35646 90 $2,105.00 $2,483.00 $2,638.00 $2,847.00 $2,483.00 $2,638.00 $2,847.00 35647 90 $1,555.00 $2,243.00 $2,383.00 $2,571.00 $2,243.00 $2,383.00 $2,571.00 35650 90 $1,236.00 $1,541.00 $1,637.00 $1,767.00 $1,541.00 $1,637.00 $1,767.00 35651 90 $2,055.00 $1,972.00 $2,092.00 $2,253.00 $1,972.00 $2,092.00 $2,253.00 35654 90 $1,603.00 $1,984.00 $2,108.00 $2,275.00 $1,984.00 $2,108.00 $2,275.00 35656 90 $1,589.00 $1,566.00 $1,664.00 $1,797.00 $1,566.00 $1,664.00 $1,797.00 35661 90 $1,145.00 $1,565.00 $1,662.00 $1,793.00 $1,565.00 $1,662.00 $1,793.00 35663 90 $1,237.00 $1,811.00 $1,922.00 $2,071.00 $1,811.00 $1,922.00 $2,071.00 35665 90 $1,333.00 $1,703.00 $1,809.00 $1,952.00 $1,703.00 $1,809.00 $1,952.00 35666 90 $1,686.00 $1,834.00 $1,949.00 $2,101.00 $1,834.00 $1,949.00 $2,101.00 35671 90 $1,315.00 $1,615.00 $1,716.00 $1,850.00 $1,615.00 $1,716.00 $1,850.00 35681 ZZZ $751.00 $117.00 $124.00 $135.00 $117.00 $124.00 $135.00 35682 ZZZ $627.00 $521.00 $555.00 $601.00 $521.00 $555.00 $601.00 35683 ZZZ $702.00 $614.00 $653.00 $707.00 $614.00 $653.00 $707.00 35685 ZZZ $216.00 $293.00 $312.00 $338.00 $293.00 $312.00 $338.00 35686 ZZZ $178.00 $244.00 $259.00 $280.00 $244.00 $259.00 $280.00 35691 90 $1,546.00 $1,424.00 $1,516.00 $1,639.00 $1,424.00 $1,516.00 $1,639.00 35693 90 $1,140.00 $1,256.00 $1,337.00 $1,445.00 $1,256.00 $1,337.00 $1,445.00 35694 90 $1,353.00 $1,488.00 $1,583.00 $1,712.00 $1,488.00 $1,583.00 $1,712.00 35695 90 $1,351.00 $1,537.00 $1,633.00 $1,764.00 $1,537.00 $1,633.00 $1,764.00 35697 ZZZ ------- $217.00 $231.00 $250.00 $217.00 $231.00 $250.00 35700 ZZZ $264.00 $224.00 $238.00 $258.00 $224.00 $238.00 $258.00 35701 90 $494.00 $753.00 $798.00 $856.00 $753.00 $798.00 $856.00 35721 90 $500.00 $648.00 $689.00 $742.00 $648.00 $689.00 $742.00 35741 90 $499.00 $706.00 $750.00 $806.00 $706.00 $750.00 $806.00 35761 90 $532.00 $519.00 $552.00 $592.00 $519.00 $552.00 $592.00 35800 90 $567.00 $666.00 $705.00 $755.00 $666.00 $705.00 $755.00 35820 90 $951.00 $2,386.00 $2,471.00 $2,577.00 $2,386.00 $2,471.00 $2,577.00 35840 90 $771.00 $869.00 $921.00 $989.00 $869.00 $921.00 $989.00 35860 90 $496.00 $563.00 $596.00 $638.00 $563.00 $596.00 $638.00 35870 90 $1,583.00 $1,827.00 $1,935.00 $2,079.00 $1,827.00 $1,935.00 $2,079.00 35875 90 $827.00 $848.00 $901.00 $971.00 $848.00 $901.00 $971.00 35876 90 $1,232.00 $1,360.00 $1,445.00 $1,559.00 $1,360.00 $1,445.00 $1,559.00 35879 90 $1,163.00 $1,334.00 $1,416.00 $1,526.00 $1,334.00 $1,416.00 $1,526.00 35881 90 $1,275.00 $1,484.00 $1,576.00 $1,699.00 $1,484.00 $1,576.00 $1,699.00 35883 90 ------- $1,761.00 $1,873.00 $2,023.00 $1,761.00 $1,873.00 $2,023.00 35884 90 ------- $1,871.00 $1,990.00 $2,150.00 $1,871.00 $1,990.00 $2,150.00 35901 90 $709.00 $717.00 $764.00 $823.00 $717.00 $764.00 $823.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 189
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 35903 90 $818.00 $815.00 $867.00 $934.00 $815.00 $867.00 $934.00 35905 90 $1,343.00 $2,516.00 $2,671.00 $2,881.00 $2,516.00 $2,671.00 $2,881.00 35907 90 $1,335.00 $2,761.00 $2,930.00 $3,161.00 $2,761.00 $2,930.00 $3,161.00 36000 0 $46.00 $35.00 $37.00 $39.00 $12.00 $13.00 $13.00 36002 0 $181.00 $233.00 $247.00 $261.00 $151.00 $159.00 $168.00 36005 0 $68.00 $451.00 $482.00 $507.00 $66.00 $69.00 $72.00 36010 0 $136.00 $890.00 $949.00 $1,002.00 $169.00 $177.00 $188.00 36011 0 $194.00 $1,355.00 $1,446.00 $1,527.00 $221.00 $231.00 $245.00 36012 0 $186.00 $1,163.00 $1,239.00 $1,305.00 $244.00 $255.00 $267.00 36013 0 $141.00 $1,141.00 $1,220.00 $1,288.00 $179.00 $188.00 $200.00 36014 0 $159.00 $1,134.00 $1,208.00 $1,273.00 $210.00 $219.00 $230.00 36015 0 $186.00 $1,237.00 $1,317.00 $1,388.00 $237.00 $247.00 $258.00 36100 0 $176.00 $745.00 $793.00 $838.00 $220.00 $231.00 $245.00 36120 0 $120.00 $603.00 $642.00 $677.00 $136.00 $142.00 $150.00 36140 0 $106.00 $688.00 $734.00 $774.00 $141.00 $147.00 $155.00 36145 0 $10.00 $674.00 $718.00 $756.00 $136.00 $141.00 $148.00 36160 0 $196.00 $765.00 $816.00 $863.00 $186.00 $196.00 $209.00 36200 0 $240.00 $915.00 $975.00 $1,029.00 $211.00 $221.00 $233.00 36215 0 $240.00 $1,565.00 $1,667.00 $1,755.00 $328.00 $341.00 $357.00 36216 0 $270.00 $1,700.00 $1,810.00 $1,906.00 $369.00 $384.00 $402.00 36217 0 $325.00 $2,863.00 $3,055.00 $3,221.00 $445.00 $465.00 $489.00 36218 ZZZ $79.00 $274.00 $292.00 $308.00 $71.00 $74.00 $78.00 36245 0 $249.00 $1,766.00 $1,882.00 $1,984.00 $339.00 $353.00 $371.00 36246 0 $272.00 $1,713.00 $1,825.00 $1,924.00 $373.00 $389.00 $410.00 36247 0 $323.00 $2,699.00 $2,881.00 $3,038.00 $445.00 $465.00 $490.00 36248 ZZZ $53.00 $233.00 $248.00 $261.00 $71.00 $74.00 $78.00 36260 90 $749.00 $801.00 $851.00 $916.00 $801.00 $851.00 $916.00 36261 90 $388.00 $484.00 $514.00 $551.00 $484.00 $514.00 $551.00 36262 90 $297.00 $370.00 $393.00 $422.00 $370.00 $393.00 $422.00 36299 YYY BR ------- ------- ------- ------- ------- ------- 36410 0 $18.00 $24.00 $26.00 $27.00 $12.00 $12.00 $13.00 36415 0 BR ------- ------- ------- ------- ------- ------- 36416 0 BR ------- ------- ------- ------- ------- ------- 36425 0 $86.00 $51.00 $53.00 $56.00 $51.00 $53.00 $56.00 36430 0 $37.00 $53.00 $58.00 $63.00 $53.00 $58.00 $63.00 36455 0 $141.00 $168.00 $175.00 $183.00 $168.00 $175.00 $183.00 36468 0 NC BR BR BR BR BR BR 36469 0 NC BR BR BR BR BR BR 36470 10 $76.00 $188.00 $200.00 $212.00 $95.00 $101.00 $107.00 36471 10 $96.00 $231.00 $246.00 $262.00 $134.00 $142.00 $152.00 36475 0 ------- $2,523.00 $2,689.00 $2,831.00 $455.00 $473.00 $494.00 36476 ZZZ ------- $523.00 $553.00 $581.00 $222.00 $230.00 $240.00 36478 0 ------- $2,189.00 $2,330.00 $2,453.00 $459.00 $477.00 $498.00 36479 ZZZ ------- $532.00 $562.00 $590.00 $225.00 $233.00 $244.00 36481 0 $499.00 $496.00 $518.00 $547.00 $496.00 $518.00 $547.00 36500 0 $159.00 $246.00 $256.00 $268.00 $246.00 $256.00 $268.00 36511 0 $92.00 $120.00 $125.00 $130.00 $120.00 $125.00 $130.00 36512 0 $92.00 $121.00 $126.00 $131.00 $121.00 $126.00 $131.00 36513 0 $92.00 $127.00 $134.00 $142.00 $127.00 $134.00 $142.00 36514 0 $92.00 $774.00 $826.00 $869.00 $119.00 $123.00 $128.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 190
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 36515 0 $92.00 $2,882.00 $3,084.00 $3,251.00 $116.00 $120.00 $125.00 36516 0 $92.00 $3,403.00 $3,644.00 $3,843.00 $85.00 $88.00 $93.00 36522 0 $305.00 $1,833.00 $1,961.00 $2,069.00 $136.00 $143.00 $151.00 36556 0 ------- $344.00 $364.00 $384.00 $165.00 $172.00 $181.00 36558 10 ------- $1,168.00 $1,247.00 $1,322.00 $394.00 $418.00 $447.00 36561 10 ------- $1,623.00 $1,730.00 $1,829.00 $467.00 $492.00 $522.00 36563 10 ------- $1,604.00 $1,715.00 $1,821.00 $498.00 $529.00 $570.00 36565 10 ------- $1,383.00 $1,472.00 $1,557.00 $463.00 $487.00 $517.00 36566 10 ------- $3,785.00 $4,045.00 $4,269.00 $494.00 $518.00 $549.00 36569 0 ------- $396.00 $422.00 $446.00 $131.00 $138.00 $148.00 36571 10 ------- $1,739.00 $1,856.00 $1,964.00 $424.00 $447.00 $477.00 36575 0 ------- $231.00 $249.00 $268.00 $60.00 $66.00 $74.00 36576 10 ------- $487.00 $515.00 $541.00 $251.00 $262.00 $275.00 36578 10 ------- $687.00 $729.00 $766.00 $287.00 $300.00 $314.00 36580 0 ------- $349.00 $373.00 $396.00 $97.00 $104.00 $112.00 36581 10 ------- $1,052.00 $1,119.00 $1,178.00 $269.00 $280.00 $293.00 36582 10 ------- $1,448.00 $1,538.00 $1,616.00 $393.00 $407.00 $422.00 36583 10 ------- $1,452.00 $1,542.00 $1,619.00 $396.00 $410.00 $426.00 36584 0 ------- $345.00 $369.00 $393.00 $101.00 $107.00 $117.00 36585 10 ------- $1,500.00 $1,595.00 $1,676.00 $370.00 $384.00 $399.00 36589 10 ------- $228.00 $242.00 $257.00 $191.00 $202.00 $215.00 36590 10 ------- $365.00 $389.00 $417.00 $274.00 $291.00 $313.00 36591 0 ------- $28.00 $30.00 $32.00 $28.00 $30.00 $32.00 36592 0 ------- $34.00 $37.00 $39.00 $34.00 $37.00 $39.00 36593 0 ------- $59.00 $71.00 $87.00 $59.00 $71.00 $87.00 36595 0 ------- $887.00 $943.00 $992.00 $256.00 $266.00 $278.00 36596 0 ------- $196.00 $208.00 $219.00 $63.00 $66.00 $69.00 36597 0 ------- $174.00 $183.00 $193.00 $85.00 $88.00 $93.00 36598 0 ------- $160.00 $170.00 $179.00 $112.00 $118.00 $124.00 36600 0 $24.00 $41.00 $43.00 $45.00 $21.00 $21.00 $22.00 36620 0 $64.00 $69.00 $71.00 $75.00 $69.00 $71.00 $75.00 36625 0 $133.00 $146.00 $154.00 $166.00 $146.00 $154.00 $166.00 36640 0 $130.00 $164.00 $173.00 $184.00 $164.00 $173.00 $184.00 36680 0 $72.00 $85.00 $89.00 $94.00 $85.00 $89.00 $94.00 36800 0 $159.00 $217.00 $230.00 $244.00 $217.00 $230.00 $244.00 36810 0 $345.00 $297.00 $314.00 $336.00 $297.00 $314.00 $336.00 36815 0 $236.00 $206.00 $219.00 $236.00 $206.00 $219.00 $236.00 36818 90 ------- $968.00 $1,035.00 $1,125.00 $968.00 $1,035.00 $1,125.00 36819 90 $977.00 $1,118.00 $1,189.00 $1,283.00 $1,118.00 $1,189.00 $1,283.00 36820 90 $800.00 $1,121.00 $1,191.00 $1,285.00 $1,121.00 $1,191.00 $1,285.00 36821 90 $721.00 $742.00 $789.00 $850.00 $742.00 $789.00 $850.00 36822 90 $630.00 $524.00 $559.00 $602.00 $524.00 $559.00 $602.00 36823 90 $1,461.00 $1,751.00 $1,857.00 $1,997.00 $1,751.00 $1,857.00 $1,997.00 36825 90 $867.00 $809.00 $860.00 $926.00 $809.00 $860.00 $926.00 36830 90 $967.00 $929.00 $988.00 $1,067.00 $929.00 $988.00 $1,067.00 36831 90 $488.00 $641.00 $681.00 $735.00 $641.00 $681.00 $735.00 36832 90 $810.00 $819.00 $871.00 $940.00 $819.00 $871.00 $940.00 36833 90 $780.00 $925.00 $983.00 $1,062.00 $925.00 $983.00 $1,062.00 36834 90 $761.00 $855.00 $906.00 $973.00 $855.00 $906.00 $973.00 36835 90 $542.00 $628.00 $667.00 $718.00 $628.00 $667.00 $718.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 191
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 36838 90 ------- $1,664.00 $1,770.00 $1,913.00 $1,664.00 $1,770.00 $1,913.00 36860 0 $166.00 $232.00 $243.00 $255.00 $136.00 $141.00 $147.00 36861 0 $224.00 $207.00 $219.00 $234.00 $207.00 $219.00 $234.00 36870 90 $1,755.00 $2,611.00 $2,786.00 $2,935.00 $414.00 $431.00 $452.00 37140 90 $1,666.00 $1,825.00 $1,911.00 $2,019.00 $1,825.00 $1,911.00 $2,019.00 37145 90 $1,741.00 $2,018.00 $2,139.00 $2,299.00 $2,018.00 $2,139.00 $2,299.00 37160 90 $1,681.00 $1,740.00 $1,842.00 $1,978.00 $1,740.00 $1,842.00 $1,978.00 37180 90 $1,769.00 $1,982.00 $2,102.00 $2,263.00 $1,982.00 $2,102.00 $2,263.00 37181 90 $1,923.00 $2,094.00 $2,216.00 $2,379.00 $2,094.00 $2,216.00 $2,379.00 37182 0 $914.00 $1,186.00 $1,233.00 $1,291.00 $1,186.00 $1,233.00 $1,291.00 37183 0 $425.00 $565.00 $588.00 $615.00 $565.00 $588.00 $615.00 37184 0 ------- $3,491.00 $3,723.00 $3,923.00 $615.00 $641.00 $672.00 37185 ZZZ ------- $1,153.00 $1,228.00 $1,294.00 $227.00 $236.00 $248.00 37186 ZZZ ------- $2,364.00 $2,523.00 $2,659.00 $342.00 $356.00 $374.00 37187 0 ------- $3,378.00 $3,602.00 $3,796.00 $571.00 $595.00 $624.00 37188 0 ------- $2,903.00 $3,098.00 $3,266.00 $411.00 $428.00 $450.00 37195 0 $302.00 ------- ------- ------- ------- ------- ------- 37200 0 $232.00 $314.00 $327.00 $342.00 $314.00 $327.00 $342.00 37201 0 $408.00 $382.00 $399.00 $419.00 $382.00 $399.00 $419.00 37202 0 $340.00 $460.00 $482.00 $508.00 $460.00 $482.00 $508.00 37203 0 $287.00 $1,834.00 $1,953.00 $2,057.00 $362.00 $376.00 $394.00 37204 0 $957.00 $1,271.00 $1,331.00 $1,407.00 $1,271.00 $1,331.00 $1,407.00 37205 0 $589.00 $3,247.00 $3,463.00 $3,652.00 $611.00 $638.00 $672.00 37206 ZZZ $288.00 $1,916.00 $2,045.00 $2,157.00 $293.00 $306.00 $323.00 37207 0 $613.00 $619.00 $659.00 $713.00 $619.00 $659.00 $713.00 37208 ZZZ $299.00 $300.00 $319.00 $346.00 $300.00 $319.00 $346.00 37209 0 $116.00 $156.00 $163.00 $171.00 $156.00 $163.00 $171.00 37210 0 ------- $4,708.00 $5,020.00 $5,288.00 $729.00 $757.00 $792.00 37215 90 ------- $1,481.00 $1,543.00 $1,614.00 $1,481.00 $1,543.00 $1,614.00 37216 90 ------- $1,332.00 $1,384.00 $1,447.00 $1,332.00 $1,384.00 $1,447.00 37250 ZZZ $112.00 $153.00 $161.00 $172.00 $153.00 $161.00 $172.00 37251 ZZZ $85.00 $116.00 $123.00 $132.00 $116.00 $123.00 $132.00 37500 90 $739.00 $969.00 $1,030.00 $1,108.00 $969.00 $1,030.00 $1,108.00 37501 YYY BR ------- ------- ------- ------- ------- ------- 37565 90 $364.00 $936.00 $989.00 $1,058.00 $936.00 $989.00 $1,058.00 37600 90 $414.00 $980.00 $1,037.00 $1,109.00 $980.00 $1,037.00 $1,109.00 37605 90 $521.00 $1,133.00 $1,206.00 $1,302.00 $1,133.00 $1,206.00 $1,302.00 37606 90 $563.00 $742.00 $791.00 $853.00 $742.00 $791.00 $853.00 37607 90 $456.00 $522.00 $556.00 $599.00 $522.00 $556.00 $599.00 37609 10 $278.00 $388.00 $412.00 $439.00 $265.00 $281.00 $300.00 37615 90 $495.00 $621.00 $653.00 $692.00 $621.00 $653.00 $692.00 37616 90 $1,128.00 $1,472.00 $1,560.00 $1,675.00 $1,472.00 $1,560.00 $1,675.00 37617 90 $1,132.00 $1,776.00 $1,882.00 $2,025.00 $1,776.00 $1,882.00 $2,025.00 37618 90 $514.00 $507.00 $536.00 $573.00 $507.00 $536.00 $573.00 37620 90 $818.00 $891.00 $934.00 $986.00 $891.00 $934.00 $986.00 37650 90 $430.00 $698.00 $740.00 $793.00 $698.00 $740.00 $793.00 37660 90 $789.00 $1,656.00 $1,749.00 $1,872.00 $1,656.00 $1,749.00 $1,872.00 37700 90 $336.00 $348.00 $371.00 $399.00 $348.00 $371.00 $399.00 37718 90 ------- $531.00 $548.00 $564.00 $531.00 $548.00 $564.00 37722 90 ------- $650.00 $687.00 $732.00 $650.00 $687.00 $732.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 192
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 37735 90 $847.00 $880.00 $936.00 $1,009.00 $880.00 $936.00 $1,009.00 37760 90 $813.00 $861.00 $915.00 $987.00 $861.00 $915.00 $987.00 37765 90 ------- $601.00 $628.00 $658.00 $601.00 $628.00 $658.00 37766 90 ------- $724.00 $754.00 $786.00 $724.00 $754.00 $786.00 37780 90 $301.00 $355.00 $378.00 $406.00 $355.00 $378.00 $406.00 37785 90 $270.00 $478.00 $509.00 $545.00 $357.00 $380.00 $409.00 37788 90 $1,654.00 $1,797.00 $1,893.00 $2,013.00 $1,797.00 $1,893.00 $2,013.00 37790 90 $690.00 $678.00 $710.00 $747.00 $678.00 $710.00 $747.00 37799 YYY BR ------- ------- ------- ------- ------- ------- 38100 90 $974.00 $1,392.00 $1,464.00 $1,559.00 $1,392.00 $1,464.00 $1,559.00 38101 90 $982.00 $1,413.00 $1,489.00 $1,589.00 $1,413.00 $1,489.00 $1,589.00 38102 ZZZ $332.00 $346.00 $368.00 $397.00 $346.00 $368.00 $397.00 38115 90 $1,020.00 $1,541.00 $1,620.00 $1,723.00 $1,541.00 $1,620.00 $1,723.00 38120 90 $1,138.00 $1,333.00 $1,416.00 $1,525.00 $1,333.00 $1,416.00 $1,525.00 38129 YYY BR ------- ------- ------- ------- ------- ------- 38200 0 $180.00 $184.00 $191.00 $200.00 $184.00 $191.00 $200.00 38205 0 $79.00 $106.00 $110.00 $114.00 $106.00 $110.00 $114.00 38206 0 $79.00 $106.00 $110.00 $115.00 $106.00 $110.00 $115.00 38220 0 $212.00 $215.00 $227.00 $239.00 $79.00 $82.00 $85.00 38221 0 $228.00 $238.00 $252.00 $264.00 $101.00 $105.00 $109.00 38230 10 $265.00 $423.00 $446.00 $474.00 $423.00 $446.00 $474.00 38240 0 $128.00 $163.00 $169.00 $176.00 $163.00 $169.00 $176.00 38241 0 $128.00 $163.00 $170.00 $177.00 $163.00 $170.00 $177.00 38242 0 $90.00 $123.00 $128.00 $133.00 $123.00 $128.00 $133.00 38300 10 $104.00 $340.00 $361.00 $384.00 $229.00 $243.00 $259.00 38305 90 $375.00 $593.00 $631.00 $678.00 $593.00 $631.00 $678.00 38308 90 $425.00 $566.00 $600.00 $644.00 $566.00 $600.00 $644.00 38380 90 $628.00 $718.00 $756.00 $801.00 $718.00 $756.00 $801.00 38381 90 $1,087.00 $1,096.00 $1,166.00 $1,258.00 $1,096.00 $1,166.00 $1,258.00 38382 90 $798.00 $882.00 $937.00 $1,007.00 $882.00 $937.00 $1,007.00 38500 10 $234.00 $401.00 $427.00 $457.00 $318.00 $338.00 $363.00 38505 0 $139.00 $164.00 $174.00 $184.00 $98.00 $103.00 $109.00 38510 10 $349.00 $645.00 $682.00 $727.00 $536.00 $566.00 $604.00 38520 90 $431.00 $588.00 $623.00 $668.00 $588.00 $623.00 $668.00 38525 90 $369.00 $530.00 $563.00 $604.00 $530.00 $563.00 $604.00 38530 90 $517.00 $689.00 $733.00 $790.00 $689.00 $733.00 $790.00 38542 90 $507.00 $544.00 $574.00 $610.00 $544.00 $574.00 $610.00 38550 90 $519.00 $603.00 $640.00 $687.00 $603.00 $640.00 $687.00 38555 90 $1,115.00 $1,263.00 $1,336.00 $1,429.00 $1,263.00 $1,336.00 $1,429.00 38562 90 $799.00 $897.00 $948.00 $1,012.00 $897.00 $948.00 $1,012.00 38564 90 $831.00 $896.00 $948.00 $1,016.00 $896.00 $948.00 $1,016.00 38570 10 $695.00 $725.00 $768.00 $824.00 $725.00 $768.00 $824.00 38571 10 $902.00 $1,092.00 $1,143.00 $1,207.00 $1,092.00 $1,143.00 $1,207.00 38572 10 $1,049.00 $1,269.00 $1,340.00 $1,435.00 $1,269.00 $1,340.00 $1,435.00 38589 YYY BR ------- ------- ------- ------- ------- ------- 38700 90 $863.00 $972.00 $1,013.00 $1,060.00 $972.00 $1,013.00 $1,060.00 38720 90 $1,328.00 $1,603.00 $1,669.00 $1,745.00 $1,603.00 $1,669.00 $1,745.00 38724 90 $1,366.00 $1,734.00 $1,804.00 $1,885.00 $1,734.00 $1,804.00 $1,885.00 38740 90 $539.00 $850.00 $901.00 $967.00 $850.00 $901.00 $967.00 38745 90 $770.00 $1,085.00 $1,150.00 $1,237.00 $1,085.00 $1,150.00 $1,237.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 193
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 38746 ZZZ $312.00 $362.00 $386.00 $418.00 $362.00 $386.00 $418.00 38747 ZZZ $337.00 $354.00 $375.00 $405.00 $354.00 $375.00 $405.00 38760 90 $699.00 $1,071.00 $1,136.00 $1,221.00 $1,071.00 $1,136.00 $1,221.00 38765 90 $1,283.00 $1,648.00 $1,742.00 $1,865.00 $1,648.00 $1,742.00 $1,865.00 38770 90 $1,111.00 $1,079.00 $1,137.00 $1,210.00 $1,079.00 $1,137.00 $1,210.00 38780 90 $1,357.00 $1,379.00 $1,455.00 $1,554.00 $1,379.00 $1,455.00 $1,554.00 38790 0 $158.00 $109.00 $115.00 $122.00 $109.00 $115.00 $122.00 38792 0 $26.00 $52.00 $55.00 $59.00 $52.00 $55.00 $59.00 38794 90 $298.00 $402.00 $422.00 $445.00 $402.00 $422.00 $445.00 38999 YYY BR ------- ------- ------- ------- ------- ------- 39000 90 $664.00 $645.00 $684.00 $732.00 $645.00 $684.00 $732.00 39010 90 $1,148.00 $1,102.00 $1,171.00 $1,261.00 $1,102.00 $1,171.00 $1,261.00 39200 90 $1,249.00 $1,210.00 $1,286.00 $1,386.00 $1,210.00 $1,286.00 $1,386.00 39220 90 $1,542.00 $1,543.00 $1,637.00 $1,759.00 $1,543.00 $1,637.00 $1,759.00 39400 10 $614.00 $665.00 $702.00 $748.00 $665.00 $702.00 $748.00 39499 YYY BR ------- ------- ------- ------- ------- ------- 39501 90 $1,083.00 $1,100.00 $1,167.00 $1,255.00 $1,100.00 $1,167.00 $1,255.00 39502 90 $1,268.00 $1,318.00 $1,398.00 $1,503.00 $1,318.00 $1,398.00 $1,503.00 39503 90 $2,726.00 $7,493.00 $7,880.00 $8,402.00 $7,493.00 $7,880.00 $8,402.00 39520 90 $1,345.00 $1,329.00 $1,413.00 $1,522.00 $1,329.00 $1,413.00 $1,522.00 39530 90 $1,295.00 $1,263.00 $1,340.00 $1,443.00 $1,263.00 $1,340.00 $1,443.00 39531 90 $1,243.00 $1,334.00 $1,415.00 $1,523.00 $1,334.00 $1,415.00 $1,523.00 39540 90 $1,133.00 $1,122.00 $1,189.00 $1,277.00 $1,122.00 $1,189.00 $1,277.00 39541 90 $1,179.00 $1,205.00 $1,277.00 $1,371.00 $1,205.00 $1,277.00 $1,371.00 39545 90 $1,102.00 $1,192.00 $1,265.00 $1,359.00 $1,192.00 $1,265.00 $1,359.00 39560 90 $968.00 $1,030.00 $1,091.00 $1,171.00 $1,030.00 $1,091.00 $1,171.00 39561 90 $1,328.00 $1,588.00 $1,683.00 $1,807.00 $1,588.00 $1,683.00 $1,807.00 39599 YYY BR ------- ------- ------- ------- ------- ------- 40490 0 $108.00 $153.00 $161.00 $169.00 $90.00 $94.00 $98.00 40500 90 $422.00 $604.00 $640.00 $677.00 $452.00 $477.00 $505.00 40510 90 $469.00 $595.00 $631.00 $670.00 $452.00 $478.00 $509.00 40520 90 $467.00 $626.00 $665.00 $707.00 $461.00 $488.00 $520.00 40525 90 $714.00 $716.00 $758.00 $808.00 $716.00 $758.00 $808.00 40527 90 $851.00 $846.00 $895.00 $953.00 $846.00 $895.00 $953.00 40530 90 $501.00 $684.00 $726.00 $770.00 $520.00 $550.00 $585.00 40650 90 $368.00 $523.00 $555.00 $589.00 $365.00 $386.00 $410.00 40652 90 $436.00 $619.00 $659.00 $701.00 $453.00 $481.00 $514.00 40654 90 $529.00 $717.00 $762.00 $810.00 $540.00 $573.00 $610.00 40700 90 $1,009.00 $1,174.00 $1,230.00 $1,294.00 $1,174.00 $1,230.00 $1,294.00 40701 90 $1,452.00 $1,409.00 $1,486.00 $1,579.00 $1,409.00 $1,486.00 $1,579.00 40702 90 $1,030.00 $1,111.00 $1,167.00 $1,236.00 $1,111.00 $1,167.00 $1,236.00 40720 90 $1,107.00 $1,311.00 $1,391.00 $1,490.00 $1,311.00 $1,391.00 $1,490.00 40761 90 $1,202.00 $1,380.00 $1,464.00 $1,569.00 $1,380.00 $1,464.00 $1,569.00 40799 YYY BR ------- ------- ------- ------- ------- ------- 40800 10 $110.00 $236.00 $252.00 $267.00 $158.00 $168.00 $178.00 40801 10 $208.00 $367.00 $391.00 $416.00 $278.00 $295.00 $315.00 40804 10 $105.00 $247.00 $263.00 $278.00 $160.00 $170.00 $180.00 40805 10 $245.00 $394.00 $419.00 $446.00 $290.00 $308.00 $329.00 40806 0 $38.00 $124.00 $133.00 $140.00 $43.00 $45.00 $48.00 40808 10 $100.00 $210.00 $224.00 $237.00 $131.00 $139.00 $148.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 194
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 40810 10 $141.00 $237.00 $252.00 $267.00 $157.00 $166.00 $177.00 40812 10 $202.00 $338.00 $360.00 $383.00 $248.00 $264.00 $282.00 40814 90 $319.00 $460.00 $490.00 $522.00 $384.00 $408.00 $435.00 40816 90 $336.00 $482.00 $512.00 $544.00 $400.00 $424.00 $451.00 40818 90 $249.00 $419.00 $444.00 $469.00 $337.00 $357.00 $376.00 40819 90 $208.00 $364.00 $387.00 $412.00 $293.00 $312.00 $332.00 40820 10 $104.00 $300.00 $320.00 $338.00 $204.00 $216.00 $229.00 40830 10 $140.00 $293.00 $311.00 $330.00 $201.00 $213.00 $227.00 40831 10 $213.00 $388.00 $414.00 $440.00 $285.00 $303.00 $323.00 40840 90 $687.00 $1,005.00 $1,068.00 $1,139.00 $823.00 $873.00 $934.00 40842 90 $684.00 $1,016.00 $1,080.00 $1,152.00 $822.00 $872.00 $932.00 40843 90 $947.00 $1,285.00 $1,362.00 $1,451.00 $1,042.00 $1,101.00 $1,176.00 40844 90 $1,232.00 $1,711.00 $1,817.00 $1,941.00 $1,453.00 $1,541.00 $1,650.00 40845 90 $1,593.00 $1,885.00 $1,995.00 $2,123.00 $1,644.00 $1,737.00 $1,850.00 40899 YYY BR ------- ------- ------- ------- ------- ------- 41000 10 $119.00 $193.00 $205.00 $217.00 $140.00 $148.00 $157.00 41005 10 $109.00 $261.00 $278.00 $294.00 $157.00 $167.00 $176.00 41006 90 $237.00 $437.00 $464.00 $493.00 $332.00 $351.00 $374.00 41007 90 $283.00 $434.00 $461.00 $488.00 $316.00 $334.00 $354.00 41008 90 $248.00 $448.00 $476.00 $508.00 $344.00 $365.00 $391.00 41009 90 $319.00 $478.00 $509.00 $543.00 $376.00 $400.00 $428.00 41010 10 $91.00 $239.00 $254.00 $267.00 $135.00 $143.00 $150.00 41015 90 $267.00 $517.00 $549.00 $584.00 $427.00 $453.00 $483.00 41016 90 $357.00 $531.00 $565.00 $604.00 $442.00 $471.00 $504.00 41017 90 $300.00 $535.00 $570.00 $609.00 $445.00 $474.00 $507.00 41018 90 $424.00 $618.00 $658.00 $704.00 $522.00 $555.00 $595.00 41019 0 ------- $626.00 $652.00 $685.00 $626.00 $652.00 $685.00 41100 10 $140.00 $204.00 $217.00 $231.00 $141.00 $150.00 $160.00 41105 10 $136.00 $202.00 $215.00 $227.00 $141.00 $149.00 $158.00 41108 10 $110.00 $173.00 $184.00 $194.00 $114.00 $120.00 $127.00 41110 10 $159.00 $248.00 $263.00 $278.00 $164.00 $173.00 $183.00 41112 90 $255.00 $396.00 $420.00 $445.00 $314.00 $332.00 $353.00 41113 90 $301.00 $435.00 $462.00 $490.00 $350.00 $371.00 $394.00 41114 90 $682.00 $812.00 $857.00 $910.00 $812.00 $857.00 $910.00 41115 10 $176.00 $284.00 $302.00 $320.00 $186.00 $197.00 $210.00 41116 90 $242.00 $382.00 $406.00 $429.00 $274.00 $290.00 $307.00 41120 90 $813.00 $1,316.00 $1,389.00 $1,464.00 $1,316.00 $1,389.00 $1,464.00 41130 90 $937.00 $1,604.00 $1,685.00 $1,769.00 $1,604.00 $1,685.00 $1,769.00 41135 90 $1,869.00 $2,677.00 $2,806.00 $2,947.00 $2,677.00 $2,806.00 $2,947.00 41140 90 $2,005.00 $2,789.00 $2,936.00 $3,100.00 $2,789.00 $2,936.00 $3,100.00 41145 90 $2,406.00 $3,451.00 $3,622.00 $3,810.00 $3,451.00 $3,622.00 $3,810.00 41150 90 $1,897.00 $2,735.00 $2,870.00 $3,016.00 $2,735.00 $2,870.00 $3,016.00 41153 90 $2,091.00 $2,946.00 $3,085.00 $3,235.00 $2,946.00 $3,085.00 $3,235.00 41155 90 $2,448.00 $3,610.00 $3,766.00 $3,938.00 $3,610.00 $3,766.00 $3,938.00 41250 10 $168.00 $270.00 $286.00 $303.00 $174.00 $184.00 $195.00 41251 10 $203.00 $294.00 $312.00 $330.00 $208.00 $220.00 $233.00 41252 10 $294.00 $375.00 $398.00 $421.00 $273.00 $288.00 $306.00 41500 90 $334.00 $573.00 $608.00 $642.00 $573.00 $608.00 $642.00 41510 90 $313.00 $538.00 $569.00 $598.00 $538.00 $569.00 $598.00 41520 90 $255.00 $412.00 $438.00 $464.00 $323.00 $343.00 $363.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 195
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 41599 YYY BR ------- ------- ------- ------- ------- ------- 41800 10 $107.00 $251.00 $268.00 $283.00 $152.00 $161.00 $170.00 41805 10 $115.00 $253.00 $270.00 $286.00 $193.00 $206.00 $218.00 41806 10 $217.00 $393.00 $419.00 $447.00 $317.00 $338.00 $361.00 41820 0 NC BR BR BR BR BR BR 41821 0 NC BR BR BR BR BR BR 41822 10 $237.00 $352.00 $376.00 $401.00 $228.00 $242.00 $260.00 41823 90 $312.00 $508.00 $542.00 $578.00 $401.00 $427.00 $457.00 41825 10 $144.00 $244.00 $260.00 $276.00 $168.00 $179.00 $190.00 41826 10 $211.00 $322.00 $343.00 $366.00 $251.00 $267.00 $286.00 41827 90 $322.00 $506.00 $537.00 $569.00 $379.00 $400.00 $424.00 41828 10 $176.00 $378.00 $404.00 $433.00 $296.00 $315.00 $339.00 41830 10 $156.00 $467.00 $498.00 $531.00 $362.00 $385.00 $413.00 41850 0 NC BR BR BR BR BR BR 41870 0 NC BR BR BR BR BR BR 41872 90 $249.00 $436.00 $463.00 $491.00 $329.00 $348.00 $370.00 41874 90 $193.00 $445.00 $475.00 $508.00 $330.00 $352.00 $379.00 41899 YYY BR ------- ------- ------- ------- ------- ------- 42000 10 $106.00 $194.00 $206.00 $218.00 $130.00 $137.00 $145.00 42100 10 $122.00 $182.00 $193.00 $204.00 $138.00 $146.00 $155.00 42104 10 $161.00 $243.00 $258.00 $274.00 $171.00 $181.00 $192.00 42106 10 $204.00 $311.00 $331.00 $353.00 $232.00 $247.00 $263.00 42107 90 $409.00 $552.00 $585.00 $620.00 $436.00 $461.00 $490.00 42120 90 $573.00 $1,192.00 $1,248.00 $1,303.00 $1,192.00 $1,248.00 $1,303.00 42140 90 $174.00 $295.00 $313.00 $330.00 $193.00 $204.00 $215.00 42145 90 $741.00 $878.00 $921.00 $969.00 $878.00 $921.00 $969.00 42160 10 $176.00 $299.00 $318.00 $336.00 $198.00 $210.00 $222.00 42180 10 $222.00 $296.00 $313.00 $330.00 $234.00 $246.00 $260.00 42182 10 $324.00 $408.00 $433.00 $460.00 $347.00 $367.00 $391.00 42200 90 $946.00 $1,154.00 $1,220.00 $1,298.00 $1,154.00 $1,220.00 $1,298.00 42205 90 $863.00 $1,198.00 $1,270.00 $1,357.00 $1,198.00 $1,270.00 $1,357.00 42210 90 $1,174.00 $1,415.00 $1,509.00 $1,626.00 $1,415.00 $1,509.00 $1,626.00 42215 90 $766.00 $933.00 $996.00 $1,072.00 $933.00 $996.00 $1,072.00 42220 90 $586.00 $740.00 $783.00 $833.00 $740.00 $783.00 $833.00 42225 90 $803.00 $1,254.00 $1,329.00 $1,406.00 $1,254.00 $1,329.00 $1,406.00 42226 90 $848.00 $1,226.00 $1,299.00 $1,378.00 $1,226.00 $1,299.00 $1,378.00 42227 90 $762.00 $1,208.00 $1,280.00 $1,358.00 $1,208.00 $1,280.00 $1,358.00 42235 90 $631.00 $984.00 $1,042.00 $1,103.00 $984.00 $1,042.00 $1,103.00 42260 90 $491.00 $1,072.00 $1,140.00 $1,219.00 $901.00 $957.00 $1,026.00 42280 10 $148.00 $193.00 $205.00 $219.00 $138.00 $146.00 $156.00 42281 10 $160.00 $247.00 $261.00 $276.00 $194.00 $205.00 $217.00 42299 YYY BR ------- ------- ------- ------- ------- ------- 42300 10 $165.00 $253.00 $268.00 $283.00 $193.00 $204.00 $215.00 42305 90 $448.00 $551.00 $580.00 $612.00 $551.00 $580.00 $612.00 42310 10 $145.00 $198.00 $210.00 $222.00 $157.00 $166.00 $175.00 42320 10 $208.00 $303.00 $321.00 $340.00 $228.00 $240.00 $254.00 42330 10 $184.00 $283.00 $300.00 $317.00 $209.00 $220.00 $233.00 42335 90 $287.00 $447.00 $474.00 $501.00 $330.00 $348.00 $368.00 42340 90 $411.00 $570.00 $604.00 $639.00 $437.00 $461.00 $488.00 42400 0 $94.00 $132.00 $141.00 $148.00 $76.00 $79.00 $84.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 196
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 42405 10 $258.00 $376.00 $398.00 $420.00 $292.00 $308.00 $325.00 42408 90 $377.00 $559.00 $592.00 $628.00 $422.00 $446.00 $474.00 42409 90 $266.00 $401.00 $426.00 $451.00 $288.00 $304.00 $322.00 42410 90 $746.00 $806.00 $850.00 $903.00 $806.00 $850.00 $903.00 42415 90 $1,364.00 $1,445.00 $1,516.00 $1,601.00 $1,445.00 $1,516.00 $1,601.00 42420 90 $1,577.00 $1,660.00 $1,741.00 $1,838.00 $1,660.00 $1,741.00 $1,838.00 42425 90 $1,097.00 $1,094.00 $1,148.00 $1,212.00 $1,094.00 $1,148.00 $1,212.00 42426 90 $1,882.00 $1,778.00 $1,865.00 $1,970.00 $1,778.00 $1,865.00 $1,970.00 42440 90 $634.00 $594.00 $625.00 $661.00 $594.00 $625.00 $661.00 42450 90 $395.00 $559.00 $591.00 $626.00 $459.00 $484.00 $513.00 42500 90 $407.00 $531.00 $563.00 $596.00 $437.00 $462.00 $490.00 42505 90 $559.00 $696.00 $736.00 $779.00 $588.00 $620.00 $657.00 42507 90 $522.00 $650.00 $685.00 $723.00 $650.00 $685.00 $723.00 42508 90 $767.00 $926.00 $981.00 $1,046.00 $926.00 $981.00 $1,046.00 42509 90 $915.00 $1,099.00 $1,156.00 $1,221.00 $1,099.00 $1,156.00 $1,221.00 42510 90 $711.00 $807.00 $850.00 $898.00 $807.00 $850.00 $898.00 42550 0 $82.00 $202.00 $213.00 $224.00 $86.00 $89.00 $93.00 42600 90 $445.00 $591.00 $626.00 $662.00 $451.00 $475.00 $503.00 42650 0 $67.00 $101.00 $107.00 $114.00 $76.00 $80.00 $85.00 42660 0 $89.00 $130.00 $138.00 $145.00 $100.00 $106.00 $111.00 42665 90 $238.00 $368.00 $390.00 $413.00 $264.00 $278.00 $295.00 42699 YYY BR ------- ------- ------- ------- ------- ------- 42700 10 $144.00 $228.00 $241.00 $254.00 $171.00 $180.00 $190.00 42720 10 $270.00 $569.00 $597.00 $629.00 $505.00 $529.00 $556.00 42725 90 $720.00 $1,031.00 $1,081.00 $1,140.00 $1,031.00 $1,081.00 $1,140.00 42800 10 $123.00 $191.00 $202.00 $214.00 $142.00 $150.00 $158.00 42802 10 $150.00 $305.00 $324.00 $342.00 $176.00 $186.00 $196.00 42804 10 $136.00 $250.00 $266.00 $280.00 $148.00 $156.00 $165.00 42806 10 $167.00 $283.00 $300.00 $317.00 $174.00 $184.00 $194.00 42808 10 $250.00 $282.00 $298.00 $315.00 $212.00 $223.00 $236.00 42809 10 $152.00 $212.00 $225.00 $238.00 $165.00 $173.00 $183.00 42810 90 $335.00 $476.00 $505.00 $534.00 $360.00 $380.00 $403.00 42815 90 $659.00 $705.00 $743.00 $786.00 $705.00 $743.00 $786.00 42821 90 $378.00 $393.00 $413.00 $437.00 $393.00 $413.00 $437.00 42826 90 $320.00 $324.00 $341.00 $360.00 $324.00 $341.00 $360.00 42831 90 $235.00 $284.00 $299.00 $316.00 $284.00 $299.00 $316.00 42836 90 $286.00 $312.00 $329.00 $347.00 $312.00 $329.00 $347.00 42842 90 $729.00 $1,196.00 $1,255.00 $1,317.00 $1,196.00 $1,255.00 $1,317.00 42844 90 $1,173.00 $1,709.00 $1,796.00 $1,888.00 $1,709.00 $1,796.00 $1,888.00 42845 90 $1,958.00 $2,785.00 $2,915.00 $3,058.00 $2,785.00 $2,915.00 $3,058.00 42860 90 $207.00 $237.00 $250.00 $264.00 $237.00 $250.00 $264.00 42870 90 $427.00 $722.00 $764.00 $807.00 $722.00 $764.00 $807.00 42890 90 $1,047.00 $1,707.00 $1,786.00 $1,870.00 $1,707.00 $1,786.00 $1,870.00 42892 90 $1,262.00 $2,221.00 $2,318.00 $2,422.00 $2,221.00 $2,318.00 $2,422.00 42894 90 $1,825.00 $2,865.00 $2,994.00 $3,135.00 $2,865.00 $2,994.00 $3,135.00 42900 10 $429.00 $452.00 $476.00 $506.00 $452.00 $476.00 $506.00 42950 90 $745.00 $1,014.00 $1,073.00 $1,135.00 $1,014.00 $1,073.00 $1,135.00 42953 90 $752.00 $1,286.00 $1,364.00 $1,444.00 $1,286.00 $1,364.00 $1,444.00 42955 90 $561.00 $954.00 $1,012.00 $1,074.00 $954.00 $1,012.00 $1,074.00 42960 10 $178.00 $217.00 $229.00 $242.00 $217.00 $229.00 $242.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 197
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 42961 90 $406.00 $539.00 $567.00 $599.00 $539.00 $567.00 $599.00 42962 90 $602.00 $667.00 $701.00 $740.00 $667.00 $701.00 $740.00 42970 90 $284.00 $495.00 $519.00 $546.00 $495.00 $519.00 $546.00 42971 90 $472.00 $588.00 $618.00 $652.00 $588.00 $618.00 $652.00 42972 90 $562.00 $670.00 $705.00 $745.00 $670.00 $705.00 $745.00 42999 YYY BR ------- ------- ------- ------- ------- ------- 43020 90 $696.00 $701.00 $741.00 $790.00 $701.00 $741.00 $790.00 43030 90 $712.00 $678.00 $713.00 $755.00 $678.00 $713.00 $755.00 43045 90 $1,574.00 $1,725.00 $1,826.00 $1,958.00 $1,725.00 $1,826.00 $1,958.00 43100 90 $744.00 $808.00 $852.00 $905.00 $808.00 $852.00 $905.00 43101 90 $1,248.00 $1,358.00 $1,444.00 $1,557.00 $1,358.00 $1,444.00 $1,557.00 43107 90 $2,325.00 $3,344.00 $3,538.00 $3,795.00 $3,344.00 $3,538.00 $3,795.00 43108 90 $2,664.00 $5,172.00 $5,345.00 $5,562.00 $5,172.00 $5,345.00 $5,562.00 43112 90 $2,471.00 $3,590.00 $3,803.00 $4,085.00 $3,590.00 $3,803.00 $4,085.00 43113 90 $2,755.00 $5,113.00 $5,297.00 $5,531.00 $5,113.00 $5,297.00 $5,531.00 43116 90 $2,509.00 $5,774.00 $5,936.00 $6,126.00 $5,774.00 $5,936.00 $6,126.00 43117 90 $2,469.00 $3,266.00 $3,455.00 $3,707.00 $3,266.00 $3,455.00 $3,707.00 43118 90 $2,607.00 $4,348.00 $4,516.00 $4,729.00 $4,348.00 $4,516.00 $4,729.00 43121 90 $2,350.00 $3,514.00 $3,670.00 $3,871.00 $3,514.00 $3,670.00 $3,871.00 43122 90 $2,287.00 $3,320.00 $3,516.00 $3,778.00 $3,320.00 $3,516.00 $3,778.00 43123 90 $2,661.00 $5,220.00 $5,397.00 $5,619.00 $5,220.00 $5,397.00 $5,619.00 43124 90 $2,242.00 $4,465.00 $4,626.00 $4,829.00 $4,465.00 $4,626.00 $4,829.00 43130 90 $1,020.00 $1,023.00 $1,077.00 $1,144.00 $1,023.00 $1,077.00 $1,144.00 43135 90 $1,332.00 $1,861.00 $1,952.00 $2,071.00 $1,861.00 $1,952.00 $2,071.00 43200 0 $266.00 $281.00 $299.00 $315.00 $136.00 $143.00 $151.00 43201 0 $245.00 $366.00 $388.00 $409.00 $167.00 $175.00 $185.00 43202 0 $205.00 $368.00 $391.00 $413.00 $148.00 $156.00 $164.00 43204 0 $228.00 $288.00 $302.00 $319.00 $288.00 $302.00 $319.00 43205 0 $207.00 $289.00 $303.00 $319.00 $289.00 $303.00 $319.00 43215 0 $160.00 $202.00 $212.00 $224.00 $202.00 $212.00 $224.00 43216 0 $149.00 $232.00 $244.00 $258.00 $186.00 $196.00 $207.00 43217 0 $176.00 $495.00 $526.00 $556.00 $221.00 $232.00 $246.00 43219 0 $171.00 $223.00 $234.00 $248.00 $223.00 $234.00 $248.00 43220 0 $128.00 $165.00 $173.00 $182.00 $165.00 $173.00 $182.00 43226 0 $142.00 $183.00 $192.00 $203.00 $183.00 $192.00 $203.00 43227 0 $218.00 $271.00 $284.00 $300.00 $271.00 $284.00 $300.00 43228 0 $230.00 $289.00 $304.00 $323.00 $289.00 $304.00 $323.00 43231 0 $182.00 $245.00 $256.00 $269.00 $245.00 $256.00 $269.00 43232 0 $252.00 $342.00 $358.00 $378.00 $342.00 $358.00 $378.00 43234 0 $193.00 $366.00 $388.00 $410.00 $155.00 $163.00 $172.00 43235 0 $239.00 $388.00 $412.00 $435.00 $186.00 $195.00 $206.00 43236 0 $285.00 $481.00 $510.00 $538.00 $225.00 $236.00 $248.00 43237 0 ------- $315.00 $332.00 $355.00 $315.00 $332.00 $355.00 43238 0 ------- $383.00 $402.00 $426.00 $383.00 $402.00 $426.00 43239 0 $246.00 $447.00 $473.00 $499.00 $221.00 $231.00 $244.00 43240 0 $369.00 $513.00 $538.00 $569.00 $513.00 $538.00 $569.00 43241 0 $157.00 $201.00 $210.00 $222.00 $201.00 $210.00 $222.00 43242 0 $384.00 $545.00 $570.00 $601.00 $545.00 $570.00 $601.00 43243 0 $276.00 $344.00 $360.00 $379.00 $344.00 $360.00 $379.00 43244 0 $268.00 $382.00 $399.00 $421.00 $382.00 $399.00 $421.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 198
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 43245 0 $214.00 $243.00 $255.00 $269.00 $243.00 $255.00 $269.00 43246 0 $485.00 $325.00 $340.00 $359.00 $325.00 $340.00 $359.00 43247 0 $229.00 $259.00 $272.00 $287.00 $259.00 $272.00 $287.00 43248 0 $191.00 $243.00 $254.00 $268.00 $243.00 $254.00 $268.00 43249 0 $175.00 $224.00 $235.00 $247.00 $224.00 $235.00 $247.00 43250 0 $194.00 $244.00 $256.00 $270.00 $244.00 $256.00 $270.00 43251 0 $224.00 $281.00 $295.00 $311.00 $281.00 $295.00 $311.00 43255 0 $343.00 $364.00 $381.00 $401.00 $364.00 $381.00 $401.00 43256 0 $235.00 $328.00 $343.00 $362.00 $328.00 $343.00 $362.00 43257 0 ------- $395.00 $412.00 $433.00 $395.00 $412.00 $433.00 43258 0 $276.00 $343.00 $359.00 $378.00 $343.00 $359.00 $378.00 43259 0 $271.00 $388.00 $406.00 $426.00 $388.00 $406.00 $426.00 43260 0 $349.00 $447.00 $467.00 $492.00 $447.00 $467.00 $492.00 43261 0 $362.00 $470.00 $492.00 $518.00 $470.00 $492.00 $518.00 43262 0 $447.00 $552.00 $578.00 $609.00 $552.00 $578.00 $609.00 43263 0 $386.00 $545.00 $570.00 $600.00 $545.00 $570.00 $600.00 43264 0 $522.00 $663.00 $693.00 $730.00 $663.00 $693.00 $730.00 43265 0 $527.00 $745.00 $779.00 $820.00 $745.00 $779.00 $820.00 43267 0 $434.00 $544.00 $569.00 $599.00 $544.00 $569.00 $599.00 43268 0 $446.00 $559.00 $585.00 $616.00 $559.00 $585.00 $616.00 43269 0 $410.00 $612.00 $640.00 $674.00 $612.00 $640.00 $674.00 43271 0 $437.00 $552.00 $577.00 $608.00 $552.00 $577.00 $608.00 43272 0 $401.00 $553.00 $579.00 $610.00 $553.00 $579.00 $610.00 43280 90 $1,314.00 $1,374.00 $1,457.00 $1,567.00 $1,374.00 $1,457.00 $1,567.00 43289 YYY BR ------- ------- ------- ------- ------- ------- 43300 90 $837.00 $816.00 $866.00 $927.00 $816.00 $866.00 $927.00 43305 90 $1,428.00 $1,442.00 $1,515.00 $1,604.00 $1,442.00 $1,515.00 $1,604.00 43310 90 $2,138.00 $2,037.00 $2,166.00 $2,339.00 $2,037.00 $2,166.00 $2,339.00 43312 90 $2,331.00 $2,245.00 $2,386.00 $2,577.00 $2,245.00 $2,386.00 $2,577.00 43313 90 $2,632.00 $3,603.00 $3,807.00 $4,075.00 $3,603.00 $3,807.00 $4,075.00 43314 90 $2,891.00 $3,880.00 $4,110.00 $4,422.00 $3,880.00 $4,110.00 $4,422.00 43320 90 $1,299.00 $1,751.00 $1,852.00 $1,986.00 $1,751.00 $1,852.00 $1,986.00 43324 90 $1,280.00 $1,720.00 $1,821.00 $1,955.00 $1,720.00 $1,821.00 $1,955.00 43325 90 $1,261.00 $1,691.00 $1,788.00 $1,915.00 $1,691.00 $1,788.00 $1,915.00 43326 90 $1,198.00 $1,729.00 $1,834.00 $1,973.00 $1,729.00 $1,834.00 $1,973.00 43330 90 $1,236.00 $1,661.00 $1,757.00 $1,885.00 $1,661.00 $1,757.00 $1,885.00 43331 90 $1,378.00 $1,800.00 $1,910.00 $2,054.00 $1,800.00 $1,910.00 $2,054.00 43340 90 $1,292.00 $1,725.00 $1,820.00 $1,943.00 $1,725.00 $1,820.00 $1,943.00 43341 90 $1,351.00 $1,855.00 $1,964.00 $2,108.00 $1,855.00 $1,964.00 $2,108.00 43350 90 $986.00 $1,449.00 $1,516.00 $1,597.00 $1,449.00 $1,516.00 $1,597.00 43351 90 $1,180.00 $1,739.00 $1,839.00 $1,966.00 $1,739.00 $1,839.00 $1,966.00 43352 90 $1,028.00 $1,402.00 $1,483.00 $1,588.00 $1,402.00 $1,483.00 $1,588.00 43360 90 $2,277.00 $3,017.00 $3,197.00 $3,436.00 $3,017.00 $3,197.00 $3,436.00 43361 90 $2,596.00 $3,369.00 $3,546.00 $3,774.00 $3,369.00 $3,546.00 $3,774.00 43400 90 $1,261.00 $1,927.00 $2,018.00 $2,129.00 $1,927.00 $2,018.00 $2,129.00 43401 90 $1,299.00 $1,955.00 $2,067.00 $2,215.00 $1,955.00 $2,067.00 $2,215.00 43405 90 $1,330.00 $1,884.00 $1,993.00 $2,134.00 $1,884.00 $1,993.00 $2,134.00 43410 90 $946.00 $1,283.00 $1,354.00 $1,445.00 $1,283.00 $1,354.00 $1,445.00 43415 90 $1,382.00 $2,217.00 $2,348.00 $2,522.00 $2,217.00 $2,348.00 $2,522.00 43420 90 $854.00 $1,267.00 $1,330.00 $1,408.00 $1,267.00 $1,330.00 $1,408.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 199
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 43425 90 $1,338.00 $1,921.00 $2,034.00 $2,184.00 $1,921.00 $2,034.00 $2,184.00 43450 0 $91.00 $207.00 $219.00 $231.00 $114.00 $120.00 $127.00 43453 0 $102.00 $389.00 $414.00 $436.00 $123.00 $129.00 $136.00 43456 0 $149.00 $805.00 $858.00 $905.00 $200.00 $209.00 $221.00 43458 0 $164.00 $502.00 $532.00 $561.00 $234.00 $246.00 $259.00 43460 0 $203.00 $284.00 $297.00 $314.00 $284.00 $297.00 $314.00 43496 90 BR ------- ------- ------- ------- ------- ------- 43499 YYY BR ------- ------- ------- ------- ------- ------- 43500 90 $649.00 $968.00 $1,023.00 $1,095.00 $968.00 $1,023.00 $1,095.00 43501 90 $1,105.00 $1,675.00 $1,772.00 $1,900.00 $1,675.00 $1,772.00 $1,900.00 43502 90 $1,247.00 $1,907.00 $2,019.00 $2,168.00 $1,907.00 $2,019.00 $2,168.00 43510 90 $680.00 $1,215.00 $1,281.00 $1,362.00 $1,215.00 $1,281.00 $1,362.00 43520 90 $599.00 $886.00 $939.00 $1,007.00 $886.00 $939.00 $1,007.00 43600 0 $96.00 $136.00 $142.00 $150.00 $136.00 $142.00 $150.00 43605 90 $686.00 $1,032.00 $1,091.00 $1,169.00 $1,032.00 $1,091.00 $1,169.00 43610 90 $861.00 $1,222.00 $1,293.00 $1,387.00 $1,222.00 $1,293.00 $1,387.00 43611 90 $1,001.00 $1,514.00 $1,601.00 $1,716.00 $1,514.00 $1,601.00 $1,716.00 43620 90 $1,691.00 $2,479.00 $2,620.00 $2,809.00 $2,479.00 $2,620.00 $2,809.00 43621 90 $1,718.00 $2,780.00 $2,926.00 $3,121.00 $2,780.00 $2,926.00 $3,121.00 43622 90 $1,798.00 $2,842.00 $2,996.00 $3,202.00 $2,842.00 $2,996.00 $3,202.00 43631 90 $1,445.00 $1,826.00 $1,933.00 $2,077.00 $1,826.00 $1,933.00 $2,077.00 43632 90 $1,443.00 $2,392.00 $2,504.00 $2,652.00 $2,392.00 $2,504.00 $2,652.00 43633 90 $1,467.00 $2,295.00 $2,408.00 $2,558.00 $2,295.00 $2,408.00 $2,558.00 43634 90 $1,786.00 $2,525.00 $2,649.00 $2,812.00 $2,525.00 $2,649.00 $2,812.00 43635 ZZZ $143.00 $148.00 $157.00 $170.00 $148.00 $157.00 $170.00 43640 90 $1,119.00 $1,457.00 $1,540.00 $1,650.00 $1,457.00 $1,540.00 $1,650.00 43641 90 $1,138.00 $1,477.00 $1,561.00 $1,672.00 $1,477.00 $1,561.00 $1,672.00 43644 90 ------- $2,157.00 $2,275.00 $2,430.00 $2,157.00 $2,275.00 $2,430.00 43645 90 ------- $2,316.00 $2,446.00 $2,618.00 $2,316.00 $2,446.00 $2,618.00 43651 90 $716.00 $816.00 $866.00 $932.00 $816.00 $866.00 $932.00 43652 90 $856.00 $967.00 $1,026.00 $1,103.00 $967.00 $1,026.00 $1,103.00 43653 90 $617.00 $690.00 $731.00 $783.00 $690.00 $731.00 $783.00 43659 YYY BR ------- ------- ------- ------- ------- ------- 43752 0 BR $52.00 $54.00 $55.00 $52.00 $54.00 $55.00 43760 0 $81.00 $251.00 $268.00 $283.00 $69.00 $72.00 $77.00 43761 0 $107.00 $160.00 $167.00 $175.00 $139.00 $144.00 $152.00 43770 90 ------- $1,390.00 $1,472.00 $1,581.00 $1,390.00 $1,472.00 $1,581.00 43771 90 ------- $1,590.00 $1,684.00 $1,809.00 $1,590.00 $1,684.00 $1,809.00 43772 90 ------- $1,197.00 $1,268.00 $1,362.00 $1,197.00 $1,268.00 $1,362.00 43773 90 ------- $1,590.00 $1,685.00 $1,810.00 $1,590.00 $1,685.00 $1,810.00 43774 90 ------- $1,200.00 $1,270.00 $1,362.00 $1,200.00 $1,270.00 $1,362.00 43800 90 $793.00 $1,158.00 $1,225.00 $1,314.00 $1,158.00 $1,225.00 $1,314.00 43810 90 $846.00 $1,250.00 $1,322.00 $1,416.00 $1,250.00 $1,322.00 $1,416.00 43820 90 $896.00 $1,576.00 $1,653.00 $1,755.00 $1,576.00 $1,653.00 $1,755.00 43825 90 $1,128.00 $1,615.00 $1,708.00 $1,831.00 $1,615.00 $1,708.00 $1,831.00 43830 90 $592.00 $855.00 $904.00 $968.00 $855.00 $904.00 $968.00 43831 90 $593.00 $711.00 $754.00 $809.00 $711.00 $754.00 $809.00 43832 90 $904.00 $1,315.00 $1,391.00 $1,489.00 $1,315.00 $1,391.00 $1,489.00 43840 90 $893.00 $1,602.00 $1,681.00 $1,784.00 $1,602.00 $1,681.00 $1,784.00 43842 90 $1,260.00 $1,539.00 $1,627.00 $1,745.00 $1,539.00 $1,627.00 $1,745.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 200
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 43843 90 $1,249.00 $1,575.00 $1,665.00 $1,785.00 $1,575.00 $1,665.00 $1,785.00 43845 90 ------- $2,469.00 $2,614.00 $2,809.00 $2,469.00 $2,614.00 $2,809.00 43846 90 $1,528.00 $2,032.00 $2,149.00 $2,304.00 $2,032.00 $2,149.00 $2,304.00 43847 90 $1,678.00 $2,231.00 $2,360.00 $2,531.00 $2,231.00 $2,360.00 $2,531.00 43848 90 $1,795.00 $2,415.00 $2,555.00 $2,741.00 $2,415.00 $2,555.00 $2,741.00 43850 90 $1,425.00 $2,032.00 $2,150.00 $2,307.00 $2,032.00 $2,150.00 $2,307.00 43855 90 $1,454.00 $2,117.00 $2,241.00 $2,407.00 $2,117.00 $2,241.00 $2,407.00 43860 90 $1,435.00 $2,053.00 $2,171.00 $2,330.00 $2,053.00 $2,171.00 $2,330.00 43865 90 $1,549.00 $2,142.00 $2,268.00 $2,435.00 $2,142.00 $2,268.00 $2,435.00 43870 90 $590.00 $870.00 $920.00 $983.00 $870.00 $920.00 $983.00 43880 90 $1,352.00 $2,009.00 $2,126.00 $2,283.00 $2,009.00 $2,126.00 $2,283.00 43886 90 ------- $398.00 $416.00 $435.00 $398.00 $416.00 $435.00 43887 90 ------- $385.00 $408.00 $437.00 $385.00 $408.00 $437.00 43888 90 ------- $547.00 $579.00 $618.00 $547.00 $579.00 $618.00 43999 YYY BR ------- ------- ------- ------- ------- ------- 44005 90 $1,171.00 $1,366.00 $1,445.00 $1,549.00 $1,366.00 $1,445.00 $1,549.00 44010 90 $809.00 $1,070.00 $1,132.00 $1,212.00 $1,070.00 $1,132.00 $1,212.00 44015 ZZZ $1,171.00 $190.00 $202.00 $218.00 $190.00 $202.00 $218.00 44020 90 $891.00 $1,204.00 $1,272.00 $1,363.00 $1,204.00 $1,272.00 $1,363.00 44021 90 $888.00 $1,213.00 $1,282.00 $1,374.00 $1,213.00 $1,282.00 $1,374.00 44025 90 $905.00 $1,224.00 $1,294.00 $1,386.00 $1,224.00 $1,294.00 $1,386.00 44050 90 $862.00 $1,167.00 $1,235.00 $1,326.00 $1,167.00 $1,235.00 $1,326.00 44055 90 $957.00 $1,860.00 $1,965.00 $2,104.00 $1,860.00 $1,965.00 $2,104.00 44100 0 $117.00 $148.00 $156.00 $165.00 $148.00 $156.00 $165.00 44110 90 $784.00 $1,047.00 $1,105.00 $1,182.00 $1,047.00 $1,105.00 $1,182.00 44111 90 $963.00 $1,225.00 $1,295.00 $1,386.00 $1,225.00 $1,295.00 $1,386.00 44120 90 $1,078.00 $1,508.00 $1,590.00 $1,699.00 $1,508.00 $1,590.00 $1,699.00 44121 ZZZ $308.00 $320.00 $340.00 $367.00 $320.00 $340.00 $367.00 44125 90 $1,135.00 $1,473.00 $1,556.00 $1,666.00 $1,473.00 $1,556.00 $1,666.00 44126 90 $1,951.00 $3,038.00 $3,206.00 $3,432.00 $3,038.00 $3,206.00 $3,432.00 44127 90 $2,243.00 $3,547.00 $3,750.00 $4,023.00 $3,547.00 $3,750.00 $4,023.00 44128 ZZZ $242.00 $325.00 $346.00 $374.00 $325.00 $346.00 $374.00 44130 90 $938.00 $1,536.00 $1,609.00 $1,704.00 $1,536.00 $1,609.00 $1,704.00 44133 0 BR ------- ------- ------- ------- ------- ------- 44136 0 BR ------- ------- ------- ------- ------- ------- 44139 ZZZ $154.00 $160.00 $169.00 $182.00 $160.00 $169.00 $182.00 44140 90 $1,350.00 $1,688.00 $1,786.00 $1,917.00 $1,688.00 $1,786.00 $1,917.00 44141 90 $1,488.00 $2,145.00 $2,248.00 $2,380.00 $2,145.00 $2,248.00 $2,380.00 44143 90 $1,536.00 $2,064.00 $2,178.00 $2,329.00 $2,064.00 $2,178.00 $2,329.00 44144 90 $1,442.00 $2,130.00 $2,238.00 $2,381.00 $2,130.00 $2,238.00 $2,381.00 44145 90 $1,678.00 $2,104.00 $2,224.00 $2,383.00 $2,104.00 $2,224.00 $2,383.00 44146 90 $1,840.00 $2,576.00 $2,709.00 $2,882.00 $2,576.00 $2,709.00 $2,882.00 44147 90 $1,452.00 $2,266.00 $2,365.00 $2,495.00 $2,266.00 $2,365.00 $2,495.00 44150 90 $1,661.00 $2,265.00 $2,386.00 $2,542.00 $2,265.00 $2,386.00 $2,542.00 44151 90 $1,499.00 $2,591.00 $2,728.00 $2,906.00 $2,591.00 $2,728.00 $2,906.00 44155 90 $1,892.00 $2,536.00 $2,667.00 $2,835.00 $2,536.00 $2,667.00 $2,835.00 44156 90 $1,709.00 $2,799.00 $2,952.00 $3,151.00 $2,799.00 $2,952.00 $3,151.00 44157 90 ------- $2,833.00 $2,994.00 $3,198.00 $2,833.00 $2,994.00 $3,198.00 44158 90 ------- $2,907.00 $3,072.00 $3,283.00 $2,907.00 $3,072.00 $3,283.00 44160 90 $1,236.00 $1,545.00 $1,633.00 $1,748.00 $1,545.00 $1,633.00 $1,748.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 201
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 44180 90 ------- $1,162.00 $1,231.00 $1,321.00 $1,162.00 $1,231.00 $1,321.00 44186 90 ------- $819.00 $868.00 $932.00 $819.00 $868.00 $932.00 44187 90 ------- $1,376.00 $1,455.00 $1,557.00 $1,376.00 $1,455.00 $1,557.00 44188 90 ------- $1,517.00 $1,605.00 $1,719.00 $1,517.00 $1,605.00 $1,719.00 44202 90 $1,603.00 $1,749.00 $1,852.00 $1,990.00 $1,749.00 $1,852.00 $1,990.00 44203 ZZZ $235.00 $319.00 $338.00 $365.00 $319.00 $338.00 $365.00 44204 90 $1,353.00 $1,952.00 $2,065.00 $2,215.00 $1,952.00 $2,065.00 $2,215.00 44205 90 $1,198.00 $1,708.00 $1,807.00 $1,940.00 $1,708.00 $1,807.00 $1,940.00 44206 90 $1,480.00 $2,209.00 $2,336.00 $2,504.00 $2,209.00 $2,336.00 $2,504.00 44207 90 $1,620.00 $2,323.00 $2,455.00 $2,631.00 $2,323.00 $2,455.00 $2,631.00 44208 90 $1,752.00 $2,527.00 $2,670.00 $2,860.00 $2,527.00 $2,670.00 $2,860.00 44210 90 $1,551.00 $2,251.00 $2,378.00 $2,547.00 $2,251.00 $2,378.00 $2,547.00 44211 90 $1,926.00 $2,769.00 $2,925.00 $3,131.00 $2,769.00 $2,925.00 $3,131.00 44212 90 $1,800.00 $2,582.00 $2,726.00 $2,914.00 $2,582.00 $2,726.00 $2,914.00 44213 ZZZ ------- $251.00 $266.00 $286.00 $251.00 $266.00 $286.00 44227 90 ------- $2,109.00 $2,231.00 $2,393.00 $2,109.00 $2,231.00 $2,393.00 44238 YYY BR ------- ------- ------- ------- ------- ------- 44300 90 $697.00 $1,044.00 $1,104.00 $1,183.00 $1,044.00 $1,104.00 $1,183.00 44310 90 $950.00 $1,306.00 $1,380.00 $1,478.00 $1,306.00 $1,380.00 $1,478.00 44312 90 $453.00 $727.00 $766.00 $815.00 $727.00 $766.00 $815.00 44314 90 $892.00 $1,252.00 $1,321.00 $1,409.00 $1,252.00 $1,321.00 $1,409.00 44316 90 $1,229.00 $1,726.00 $1,817.00 $1,936.00 $1,726.00 $1,817.00 $1,936.00 44320 90 $1,029.00 $1,488.00 $1,573.00 $1,684.00 $1,488.00 $1,573.00 $1,684.00 44322 90 $1,015.00 $1,181.00 $1,252.00 $1,339.00 $1,181.00 $1,252.00 $1,339.00 44340 90 $397.00 $737.00 $778.00 $831.00 $737.00 $778.00 $831.00 44345 90 $816.00 $1,302.00 $1,377.00 $1,474.00 $1,302.00 $1,377.00 $1,474.00 44346 90 $923.00 $1,456.00 $1,537.00 $1,643.00 $1,456.00 $1,537.00 $1,643.00 44360 0 $177.00 $202.00 $211.00 $222.00 $202.00 $211.00 $222.00 44361 0 $195.00 $222.00 $232.00 $245.00 $222.00 $232.00 $245.00 44363 0 $213.00 $266.00 $278.00 $294.00 $266.00 $278.00 $294.00 44364 0 $255.00 $283.00 $296.00 $312.00 $283.00 $296.00 $312.00 44365 0 $226.00 $252.00 $263.00 $277.00 $252.00 $263.00 $277.00 44366 0 $300.00 $334.00 $350.00 $368.00 $334.00 $350.00 $368.00 44369 0 $308.00 $340.00 $356.00 $375.00 $340.00 $356.00 $375.00 44370 0 $253.00 $368.00 $385.00 $407.00 $368.00 $385.00 $407.00 44372 0 $301.00 $331.00 $346.00 $366.00 $331.00 $346.00 $366.00 44373 0 $238.00 $265.00 $277.00 $292.00 $265.00 $277.00 $292.00 44376 0 $305.00 $392.00 $411.00 $434.00 $392.00 $411.00 $434.00 44377 0 $320.00 $413.00 $432.00 $455.00 $413.00 $432.00 $455.00 44378 0 $410.00 $532.00 $557.00 $587.00 $532.00 $557.00 $587.00 44379 0 $396.00 $570.00 $598.00 $633.00 $570.00 $598.00 $633.00 44380 0 $91.00 $88.00 $92.00 $97.00 $88.00 $92.00 $97.00 44382 0 $110.00 $106.00 $111.00 $118.00 $106.00 $111.00 $118.00 44383 0 $165.00 $227.00 $237.00 $250.00 $227.00 $237.00 $250.00 44385 0 $219.00 $304.00 $322.00 $340.00 $138.00 $145.00 $153.00 44386 0 $183.00 $448.00 $477.00 $504.00 $163.00 $172.00 $182.00 44388 0 $326.00 $433.00 $459.00 $486.00 $215.00 $226.00 $240.00 44389 0 $301.00 $512.00 $543.00 $574.00 $240.00 $251.00 $266.00 44390 0 $319.00 $591.00 $627.00 $662.00 $290.00 $304.00 $321.00 44391 0 $376.00 $671.00 $711.00 $751.00 $327.00 $343.00 $362.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 202
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 44392 0 $359.00 $555.00 $588.00 $622.00 $286.00 $300.00 $319.00 44393 0 $413.00 $633.00 $671.00 $709.00 $360.00 $378.00 $400.00 44394 0 $395.00 $645.00 $684.00 $723.00 $332.00 $348.00 $369.00 44397 0 $259.00 $351.00 $368.00 $389.00 $351.00 $368.00 $389.00 44500 0 $28.00 $34.00 $35.00 $37.00 $34.00 $35.00 $37.00 44602 90 $815.00 $1,676.00 $1,754.00 $1,858.00 $1,676.00 $1,754.00 $1,858.00 44603 90 $1,041.00 $1,914.00 $2,004.00 $2,123.00 $1,914.00 $2,004.00 $2,123.00 44604 90 $1,027.00 $1,329.00 $1,405.00 $1,507.00 $1,329.00 $1,405.00 $1,507.00 44605 90 $1,132.00 $1,638.00 $1,731.00 $1,854.00 $1,638.00 $1,731.00 $1,854.00 44615 90 $994.00 $1,343.00 $1,420.00 $1,520.00 $1,343.00 $1,420.00 $1,520.00 44620 90 $741.00 $1,065.00 $1,122.00 $1,198.00 $1,065.00 $1,122.00 $1,198.00 44625 90 $1,277.00 $1,267.00 $1,336.00 $1,428.00 $1,267.00 $1,336.00 $1,428.00 44626 90 $1,581.00 $2,033.00 $2,150.00 $2,306.00 $2,033.00 $2,150.00 $2,306.00 44640 90 $1,036.00 $1,768.00 $1,868.00 $2,002.00 $1,768.00 $1,868.00 $2,002.00 44650 90 $1,076.00 $1,838.00 $1,943.00 $2,084.00 $1,838.00 $1,943.00 $2,084.00 44660 90 $1,050.00 $1,741.00 $1,827.00 $1,938.00 $1,741.00 $1,827.00 $1,938.00 44661 90 $1,326.00 $1,977.00 $2,082.00 $2,221.00 $1,977.00 $2,082.00 $2,221.00 44680 90 $1,049.00 $1,327.00 $1,401.00 $1,499.00 $1,327.00 $1,401.00 $1,499.00 44700 90 $1,115.00 $1,283.00 $1,353.00 $1,444.00 $1,283.00 $1,353.00 $1,444.00 44701 ZZZ $161.00 $220.00 $233.00 $250.00 $220.00 $233.00 $250.00 44720 0 ------- $338.00 $353.00 $372.00 $338.00 $353.00 $372.00 44721 0 ------- $510.00 $542.00 $586.00 $510.00 $542.00 $586.00 44799 YYY BR ------- ------- ------- ------- ------- ------- 44800 90 $791.00 $949.00 $1,006.00 $1,079.00 $949.00 $1,006.00 $1,079.00 44820 90 $755.00 $1,042.00 $1,103.00 $1,181.00 $1,042.00 $1,103.00 $1,181.00 44850 90 $708.00 $925.00 $979.00 $1,048.00 $925.00 $979.00 $1,048.00 44899 YYY BR ------- ------- ------- ------- ------- ------- 44900 90 $644.00 $932.00 $983.00 $1,050.00 $932.00 $983.00 $1,050.00 44901 0 $310.00 $1,368.00 $1,459.00 $1,537.00 $233.00 $243.00 $255.00 44950 90 $643.00 $807.00 $855.00 $919.00 $807.00 $855.00 $919.00 44955 ZZZ $136.00 $111.00 $118.00 $127.00 $111.00 $118.00 $127.00 44960 90 $790.00 $1,073.00 $1,134.00 $1,214.00 $1,073.00 $1,134.00 $1,214.00 44970 90 $631.00 $736.00 $780.00 $837.00 $736.00 $780.00 $837.00 44979 YYY BR ------- ------- ------- ------- ------- ------- 45000 90 $329.00 $496.00 $521.00 $551.00 $496.00 $521.00 $551.00 45005 10 $197.00 $315.00 $335.00 $357.00 $193.00 $205.00 $219.00 45020 90 $364.00 $635.00 $663.00 $696.00 $635.00 $663.00 $696.00 45100 90 $321.00 $350.00 $371.00 $396.00 $350.00 $371.00 $396.00 45108 90 $419.00 $430.00 $456.00 $488.00 $430.00 $456.00 $488.00 45110 90 $1,801.00 $2,308.00 $2,437.00 $2,605.00 $2,308.00 $2,437.00 $2,605.00 45111 90 $1,270.00 $1,358.00 $1,436.00 $1,538.00 $1,358.00 $1,436.00 $1,538.00 45112 90 $1,904.00 $2,376.00 $2,502.00 $2,669.00 $2,376.00 $2,502.00 $2,669.00 45113 90 $1,885.00 $2,435.00 $2,567.00 $2,740.00 $2,435.00 $2,567.00 $2,740.00 45114 90 $1,732.00 $2,234.00 $2,357.00 $2,520.00 $2,234.00 $2,357.00 $2,520.00 45116 90 $1,485.00 $2,014.00 $2,123.00 $2,265.00 $2,014.00 $2,123.00 $2,265.00 45119 90 $1,911.00 $2,432.00 $2,561.00 $2,728.00 $2,432.00 $2,561.00 $2,728.00 45120 90 $1,845.00 $1,948.00 $2,056.00 $2,199.00 $1,948.00 $2,056.00 $2,199.00 45121 90 $1,870.00 $2,145.00 $2,265.00 $2,424.00 $2,145.00 $2,265.00 $2,424.00 45123 90 $1,126.00 $1,371.00 $1,442.00 $1,536.00 $1,371.00 $1,442.00 $1,536.00 45126 90 $2,444.00 $3,566.00 $3,742.00 $3,967.00 $3,566.00 $3,742.00 $3,967.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 203
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 45130 90 $1,041.00 $1,341.00 $1,411.00 $1,502.00 $1,341.00 $1,411.00 $1,502.00 45135 90 $1,354.00 $1,653.00 $1,743.00 $1,861.00 $1,653.00 $1,743.00 $1,861.00 45136 90 $1,526.00 $2,274.00 $2,389.00 $2,536.00 $2,274.00 $2,389.00 $2,536.00 45150 90 $475.00 $477.00 $503.00 $537.00 $477.00 $503.00 $537.00 45160 90 $949.00 $1,219.00 $1,285.00 $1,371.00 $1,219.00 $1,285.00 $1,371.00 45170 90 $697.00 $958.00 $1,011.00 $1,080.00 $958.00 $1,011.00 $1,080.00 45190 90 $623.00 $826.00 $873.00 $932.00 $826.00 $873.00 $932.00 45300 0 $75.00 $127.00 $135.00 $141.00 $59.00 $61.00 $64.00 45303 0 $72.00 $1,039.00 $1,109.00 $1,168.00 $99.00 $102.00 $105.00 45305 0 $102.00 $213.00 $226.00 $239.00 $95.00 $100.00 $106.00 45307 0 $172.00 $246.00 $260.00 $273.00 $118.00 $123.00 $129.00 45308 0 $137.00 $208.00 $220.00 $231.00 $99.00 $103.00 $108.00 45309 0 $174.00 $246.00 $263.00 $281.00 $125.00 $134.00 $144.00 45315 0 $211.00 $264.00 $279.00 $295.00 $134.00 $141.00 $149.00 45317 0 $209.00 $251.00 $265.00 $279.00 $141.00 $148.00 $156.00 45320 0 $230.00 $254.00 $270.00 $285.00 $134.00 $141.00 $149.00 45321 0 $154.00 $128.00 $134.00 $141.00 $128.00 $134.00 $141.00 45327 0 $96.00 $147.00 $153.00 $162.00 $147.00 $153.00 $162.00 45330 0 $87.00 $172.00 $182.00 $192.00 $80.00 $84.00 $88.00 45331 0 $120.00 $220.00 $234.00 $246.00 $95.00 $100.00 $106.00 45332 0 $174.00 $360.00 $383.00 $405.00 $142.00 $149.00 $158.00 45333 0 $176.00 $359.00 $382.00 $403.00 $141.00 $148.00 $156.00 45334 0 $171.00 $211.00 $221.00 $232.00 $211.00 $221.00 $232.00 45335 0 $144.00 $291.00 $309.00 $326.00 $117.00 $123.00 $129.00 45337 0 $144.00 $184.00 $193.00 $204.00 $184.00 $193.00 $204.00 45338 0 $212.00 $403.00 $428.00 $452.00 $182.00 $191.00 $202.00 45339 0 $237.00 $398.00 $421.00 $445.00 $242.00 $254.00 $268.00 45340 0 $328.00 $511.00 $544.00 $574.00 $147.00 $154.00 $163.00 45341 0 $153.00 $201.00 $210.00 $221.00 $201.00 $210.00 $221.00 45342 0 $224.00 $307.00 $321.00 $338.00 $307.00 $321.00 $338.00 45345 0 $164.00 $222.00 $232.00 $245.00 $222.00 $232.00 $245.00 45355 0 $185.00 $267.00 $282.00 $300.00 $267.00 $282.00 $300.00 45378 0 $341.00 $510.00 $540.00 $571.00 $280.00 $293.00 $310.00 45379 0 $415.00 $644.00 $682.00 $720.00 $350.00 $367.00 $388.00 45380 0 $369.00 $609.00 $645.00 $681.00 $335.00 $351.00 $371.00 45381 0 $388.00 $591.00 $625.00 $659.00 $316.00 $330.00 $347.00 45382 0 $481.00 $806.00 $853.00 $899.00 $426.00 $446.00 $469.00 45383 0 $482.00 $725.00 $767.00 $810.00 $435.00 $456.00 $482.00 45384 0 $415.00 $600.00 $635.00 $670.00 $351.00 $368.00 $388.00 45385 0 $479.00 $687.00 $726.00 $766.00 $398.00 $417.00 $440.00 45386 0 $739.00 $864.00 $919.00 $970.00 $344.00 $361.00 $382.00 45387 0 $322.00 $444.00 $465.00 $492.00 $444.00 $465.00 $492.00 45391 0 ------- $387.00 $405.00 $429.00 $387.00 $405.00 $429.00 45392 0 ------- $483.00 $504.00 $529.00 $483.00 $504.00 $529.00 45395 90 ------- $2,493.00 $2,633.00 $2,815.00 $2,493.00 $2,633.00 $2,815.00 45397 90 ------- $2,687.00 $2,829.00 $3,014.00 $2,687.00 $2,829.00 $3,014.00 45400 90 ------- $1,440.00 $1,519.00 $1,620.00 $1,440.00 $1,519.00 $1,620.00 45402 90 ------- $1,931.00 $2,036.00 $2,174.00 $1,931.00 $2,036.00 $2,174.00 45500 90 $584.00 $618.00 $652.00 $693.00 $618.00 $652.00 $693.00 45505 90 $510.00 $676.00 $713.00 $760.00 $676.00 $713.00 $760.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 204
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 45520 0 $46.00 $142.00 $151.00 $160.00 $49.00 $51.00 $54.00 45540 90 $1,009.00 $1,309.00 $1,378.00 $1,470.00 $1,309.00 $1,378.00 $1,470.00 45541 90 $888.00 $1,127.00 $1,189.00 $1,268.00 $1,127.00 $1,189.00 $1,268.00 45550 90 $1,350.00 $1,820.00 $1,919.00 $2,049.00 $1,820.00 $1,919.00 $2,049.00 45560 90 $618.00 $890.00 $938.00 $998.00 $890.00 $938.00 $998.00 45562 90 $915.00 $1,360.00 $1,434.00 $1,528.00 $1,360.00 $1,434.00 $1,528.00 45563 90 $1,412.00 $2,010.00 $2,127.00 $2,280.00 $2,010.00 $2,127.00 $2,280.00 45800 90 $1,050.00 $1,509.00 $1,586.00 $1,684.00 $1,509.00 $1,586.00 $1,684.00 45805 90 $1,273.00 $1,736.00 $1,822.00 $1,930.00 $1,736.00 $1,822.00 $1,930.00 45820 90 $1,066.00 $1,493.00 $1,563.00 $1,650.00 $1,493.00 $1,563.00 $1,650.00 45825 90 $1,241.00 $1,793.00 $1,886.00 $2,006.00 $1,793.00 $1,886.00 $2,006.00 45900 10 $120.00 $242.00 $255.00 $272.00 $242.00 $255.00 $272.00 45905 10 $133.00 $206.00 $218.00 $233.00 $206.00 $218.00 $233.00 45910 10 $163.00 $243.00 $257.00 $274.00 $243.00 $257.00 $274.00 45915 10 $142.00 $385.00 $408.00 $432.00 $275.00 $290.00 $308.00 45990 0 ------- $136.00 $143.00 $152.00 $136.00 $143.00 $152.00 45999 YYY BR ------- ------- ------- ------- ------- ------- 46020 10 $230.00 $303.00 $320.00 $341.00 $268.00 $283.00 $301.00 46030 10 $94.00 $150.00 $160.00 $170.00 $107.00 $113.00 $121.00 46040 90 $393.00 $597.00 $634.00 $676.00 $485.00 $514.00 $550.00 46045 90 $312.00 $486.00 $512.00 $543.00 $486.00 $512.00 $543.00 46050 10 $105.00 $212.00 $225.00 $239.00 $114.00 $120.00 $129.00 46060 90 $482.00 $537.00 $568.00 $606.00 $537.00 $568.00 $606.00 46080 10 $246.00 $277.00 $294.00 $314.00 $198.00 $209.00 $224.00 46083 10 $98.00 $200.00 $213.00 $226.00 $126.00 $133.00 $141.00 46200 90 $323.00 $447.00 $475.00 $506.00 $359.00 $381.00 $406.00 46210 90 $196.00 $426.00 $453.00 $482.00 $300.00 $319.00 $340.00 46211 90 $353.00 $572.00 $608.00 $646.00 $445.00 $472.00 $503.00 46220 10 $118.00 $221.00 $234.00 $249.00 $139.00 $147.00 $156.00 46221 10 $124.00 $286.00 $303.00 $322.00 $220.00 $232.00 $247.00 46230 10 $198.00 $310.00 $329.00 $351.00 $211.00 $223.00 $239.00 46250 90 $400.00 $515.00 $547.00 $583.00 $370.00 $392.00 $418.00 46255 90 $501.00 $580.00 $616.00 $657.00 $423.00 $448.00 $479.00 46257 90 $504.00 $485.00 $514.00 $549.00 $485.00 $514.00 $549.00 46258 90 $539.00 $529.00 $559.00 $597.00 $529.00 $559.00 $597.00 46260 90 $598.00 $554.00 $586.00 $627.00 $554.00 $586.00 $627.00 46261 90 $655.00 $618.00 $653.00 $695.00 $618.00 $653.00 $695.00 46262 90 $686.00 $642.00 $678.00 $723.00 $642.00 $678.00 $723.00 46270 90 $328.00 $547.00 $579.00 $614.00 $431.00 $455.00 $483.00 46275 90 $442.00 $572.00 $605.00 $642.00 $464.00 $490.00 $520.00 46280 90 $514.00 $535.00 $565.00 $602.00 $535.00 $565.00 $602.00 46285 90 $335.00 $542.00 $571.00 $604.00 $452.00 $475.00 $502.00 46288 90 $521.00 $632.00 $666.00 $710.00 $632.00 $666.00 $710.00 46320 10 $126.00 $204.00 $217.00 $230.00 $134.00 $141.00 $151.00 46500 10 $109.00 $232.00 $247.00 $261.00 $149.00 $158.00 $168.00 46505 10 ------- $316.00 $331.00 $346.00 $264.00 $275.00 $287.00 46600 0 $38.00 $103.00 $110.00 $116.00 $48.00 $50.00 $53.00 46604 0 $92.00 $599.00 $641.00 $677.00 $86.00 $91.00 $97.00 46606 0 $66.00 $255.00 $271.00 $286.00 $89.00 $93.00 $98.00 46608 0 $115.00 $277.00 $296.00 $314.00 $104.00 $110.00 $118.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 205
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 46610 0 $114.00 $268.00 $285.00 $303.00 $102.00 $108.00 $116.00 46611 0 $149.00 $222.00 $238.00 $254.00 $109.00 $117.00 $126.00 46612 0 $196.00 $339.00 $364.00 $390.00 $135.00 $145.00 $159.00 46614 0 $169.00 $169.00 $182.00 $196.00 $97.00 $104.00 $114.00 46615 0 $202.00 $202.00 $218.00 $237.00 $139.00 $150.00 $166.00 46700 90 $585.00 $763.00 $803.00 $854.00 $763.00 $803.00 $854.00 46706 10 $140.00 $204.00 $216.00 $231.00 $204.00 $216.00 $231.00 46710 90 ------- $1,291.00 $1,353.00 $1,430.00 $1,291.00 $1,353.00 $1,430.00 46712 90 ------- $2,723.00 $2,868.00 $3,055.00 $2,723.00 $2,868.00 $3,055.00 46715 90 $545.00 $610.00 $646.00 $693.00 $610.00 $646.00 $693.00 46716 90 $906.00 $1,369.00 $1,441.00 $1,529.00 $1,369.00 $1,441.00 $1,529.00 46730 90 $1,584.00 $2,225.00 $2,332.00 $2,465.00 $2,225.00 $2,332.00 $2,465.00 46735 90 $1,881.00 $2,643.00 $2,775.00 $2,943.00 $2,643.00 $2,775.00 $2,943.00 46740 90 $1,671.00 $2,474.00 $2,586.00 $2,723.00 $2,474.00 $2,586.00 $2,723.00 46742 90 $2,236.00 $2,894.00 $3,031.00 $3,203.00 $2,894.00 $3,031.00 $3,203.00 46744 90 $2,412.00 $4,234.00 $4,467.00 $4,776.00 $4,234.00 $4,467.00 $4,776.00 46746 90 $2,725.00 $4,780.00 $5,056.00 $5,425.00 $4,780.00 $5,056.00 $5,425.00 46748 90 $2,933.00 $4,714.00 $4,879.00 $5,077.00 $4,714.00 $4,879.00 $5,077.00 46750 90 $636.00 $922.00 $969.00 $1,028.00 $922.00 $969.00 $1,028.00 46753 90 $511.00 $699.00 $738.00 $788.00 $699.00 $738.00 $788.00 46754 10 $188.00 $331.00 $349.00 $367.00 $247.00 $259.00 $272.00 46760 90 $846.00 $1,313.00 $1,380.00 $1,465.00 $1,313.00 $1,380.00 $1,465.00 46761 90 $813.00 $1,137.00 $1,196.00 $1,270.00 $1,137.00 $1,196.00 $1,270.00 46762 90 $731.00 $1,102.00 $1,156.00 $1,223.00 $1,102.00 $1,156.00 $1,223.00 46900 10 $128.00 $259.00 $274.00 $290.00 $168.00 $176.00 $187.00 46910 10 $144.00 $273.00 $290.00 $307.00 $160.00 $169.00 $180.00 46916 10 $145.00 $270.00 $285.00 $300.00 $171.00 $179.00 $188.00 46917 10 $228.00 $553.00 $590.00 $625.00 $164.00 $173.00 $185.00 46922 10 $189.00 $291.00 $310.00 $330.00 $162.00 $172.00 $184.00 46924 10 $297.00 $608.00 $647.00 $684.00 $223.00 $234.00 $249.00 46937 10 $268.00 $292.00 $307.00 $322.00 $204.00 $212.00 $222.00 46938 90 $405.00 $507.00 $539.00 $576.00 $432.00 $458.00 $491.00 46940 10 $165.00 $248.00 $263.00 $279.00 $181.00 $191.00 $203.00 46942 10 $145.00 $228.00 $241.00 $255.00 $161.00 $169.00 $180.00 46945 90 $199.00 $317.00 $336.00 $355.00 $252.00 $266.00 $282.00 46946 90 $270.00 $352.00 $374.00 $397.00 $269.00 $285.00 $303.00 46947 90 ------- $462.00 $492.00 $530.00 $462.00 $492.00 $530.00 46999 YYY BR ------- ------- ------- ------- ------- ------- 47000 0 $218.00 $367.00 $389.00 $410.00 $132.00 $137.00 $144.00 47001 ZZZ $141.00 $137.00 $146.00 $157.00 $137.00 $146.00 $157.00 47010 90 $788.00 $1,466.00 $1,542.00 $1,638.00 $1,466.00 $1,542.00 $1,638.00 47011 0 $347.00 $254.00 $264.00 $276.00 $254.00 $264.00 $276.00 47015 90 $755.00 $1,400.00 $1,475.00 $1,570.00 $1,400.00 $1,475.00 $1,570.00 47100 90 $550.00 $1,030.00 $1,091.00 $1,169.00 $1,030.00 $1,091.00 $1,169.00 47120 90 $1,663.00 $2,922.00 $3,093.00 $3,319.00 $2,922.00 $3,093.00 $3,319.00 47122 90 $2,512.00 $4,364.00 $4,619.00 $4,961.00 $4,364.00 $4,619.00 $4,961.00 47125 90 $2,293.00 $3,915.00 $4,145.00 $4,453.00 $3,915.00 $4,145.00 $4,453.00 47130 90 $2,482.00 $4,209.00 $4,455.00 $4,787.00 $4,209.00 $4,455.00 $4,787.00 47135 90 $6,164.00 $6,183.00 $6,542.00 $7,020.00 $6,183.00 $6,542.00 $7,020.00 47136 90 $4,985.00 $5,265.00 $5,571.00 $5,979.00 $5,265.00 $5,571.00 $5,979.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 206
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 47146 0 ------- $437.00 $464.00 $502.00 $437.00 $464.00 $502.00 47147 0 ------- $509.00 $541.00 $586.00 $509.00 $541.00 $586.00 47300 90 $778.00 $1,378.00 $1,455.00 $1,555.00 $1,378.00 $1,455.00 $1,555.00 47350 90 $942.00 $1,696.00 $1,793.00 $1,921.00 $1,696.00 $1,793.00 $1,921.00 47360 90 $1,305.00 $2,303.00 $2,429.00 $2,596.00 $2,303.00 $2,429.00 $2,596.00 47361 90 $2,129.00 $3,827.00 $4,041.00 $4,324.00 $3,827.00 $4,041.00 $4,324.00 47362 90 $849.00 $1,748.00 $1,844.00 $1,970.00 $1,748.00 $1,844.00 $1,970.00 47370 90 $943.00 $1,569.00 $1,662.00 $1,786.00 $1,569.00 $1,662.00 $1,786.00 47371 90 $889.00 $1,578.00 $1,673.00 $1,800.00 $1,578.00 $1,673.00 $1,800.00 47379 YYY BR ------- ------- ------- ------- ------- ------- 47380 90 $1,107.00 $1,823.00 $1,928.00 $2,068.00 $1,823.00 $1,928.00 $2,068.00 47381 90 $1,094.00 $1,860.00 $1,966.00 $2,106.00 $1,860.00 $1,966.00 $2,106.00 47382 10 $660.00 $1,096.00 $1,143.00 $1,199.00 $1,096.00 $1,143.00 $1,199.00 47399 YYY BR ------- ------- ------- ------- ------- ------- 47400 90 $1,435.00 $2,607.00 $2,732.00 $2,892.00 $2,607.00 $2,732.00 $2,892.00 47420 90 $1,222.00 $1,671.00 $1,768.00 $1,897.00 $1,671.00 $1,768.00 $1,897.00 47425 90 $1,275.00 $1,687.00 $1,784.00 $1,913.00 $1,687.00 $1,784.00 $1,913.00 47460 90 $1,039.00 $1,571.00 $1,658.00 $1,771.00 $1,571.00 $1,658.00 $1,771.00 47480 90 $755.00 $1,042.00 $1,101.00 $1,175.00 $1,042.00 $1,101.00 $1,175.00 47490 90 $467.00 $683.00 $714.00 $747.00 $683.00 $714.00 $747.00 47500 0 $103.00 $135.00 $141.00 $147.00 $135.00 $141.00 $147.00 47505 0 $96.00 $52.00 $54.00 $56.00 $52.00 $54.00 $56.00 47510 90 $487.00 $650.00 $679.00 $711.00 $650.00 $679.00 $711.00 47511 90 $627.00 $806.00 $840.00 $880.00 $806.00 $840.00 $880.00 47525 10 $295.00 $1,035.00 $1,097.00 $1,154.00 $424.00 $443.00 $464.00 47530 90 $35.00 $1,918.00 $2,043.00 $2,152.00 $488.00 $510.00 $535.00 47550 ZZZ $209.00 $219.00 $232.00 $250.00 $219.00 $232.00 $250.00 47552 0 $364.00 $438.00 $457.00 $481.00 $438.00 $457.00 $481.00 47553 0 $342.00 $435.00 $452.00 $473.00 $435.00 $452.00 $473.00 47554 0 $594.00 $667.00 $703.00 $751.00 $667.00 $703.00 $751.00 47555 0 $383.00 $521.00 $541.00 $567.00 $521.00 $541.00 $567.00 47556 0 $425.00 $588.00 $611.00 $640.00 $588.00 $611.00 $640.00 47560 0 $345.00 $353.00 $375.00 $405.00 $353.00 $375.00 $405.00 47561 0 $388.00 $382.00 $405.00 $437.00 $382.00 $405.00 $437.00 47562 90 $837.00 $918.00 $974.00 $1,046.00 $918.00 $974.00 $1,046.00 47563 90 $900.00 $949.00 $1,008.00 $1,085.00 $949.00 $1,008.00 $1,085.00 47564 90 $1,069.00 $1,101.00 $1,169.00 $1,260.00 $1,101.00 $1,169.00 $1,260.00 47570 90 $961.00 $979.00 $1,039.00 $1,119.00 $979.00 $1,039.00 $1,119.00 47579 YYY BR ------- ------- ------- ------- ------- ------- 47600 90 $868.00 $1,291.00 $1,361.00 $1,451.00 $1,291.00 $1,361.00 $1,451.00 47605 90 $935.00 $1,223.00 $1,296.00 $1,391.00 $1,223.00 $1,296.00 $1,391.00 47610 90 $1,164.00 $1,565.00 $1,656.00 $1,777.00 $1,565.00 $1,656.00 $1,777.00 47612 90 $1,276.00 $1,578.00 $1,669.00 $1,789.00 $1,578.00 $1,669.00 $1,789.00 47620 90 $1,295.00 $1,713.00 $1,813.00 $1,945.00 $1,713.00 $1,813.00 $1,945.00 47630 90 $465.00 $741.00 $775.00 $815.00 $741.00 $775.00 $815.00 47700 90 $1,111.00 $1,302.00 $1,380.00 $1,483.00 $1,302.00 $1,380.00 $1,483.00 47701 90 $1,913.00 $2,188.00 $2,321.00 $2,499.00 $2,188.00 $2,321.00 $2,499.00 47711 90 $1,442.00 $1,941.00 $2,053.00 $2,202.00 $1,941.00 $2,053.00 $2,202.00 47712 90 $1,793.00 $2,491.00 $2,634.00 $2,824.00 $2,491.00 $2,634.00 $2,824.00 47715 90 $1,157.00 $1,629.00 $1,723.00 $1,846.00 $1,629.00 $1,723.00 $1,846.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 207
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 47720 90 $1,040.00 $1,402.00 $1,483.00 $1,588.00 $1,402.00 $1,483.00 $1,588.00 47721 90 $1,248.00 $1,654.00 $1,749.00 $1,874.00 $1,654.00 $1,749.00 $1,874.00 47740 90 $1,188.00 $1,600.00 $1,691.00 $1,811.00 $1,600.00 $1,691.00 $1,811.00 47741 90 $1,425.00 $1,818.00 $1,923.00 $2,062.00 $1,818.00 $1,923.00 $2,062.00 47760 90 $1,568.00 $2,659.00 $2,789.00 $2,958.00 $2,659.00 $2,789.00 $2,958.00 47765 90 $1,624.00 $3,397.00 $3,530.00 $3,701.00 $3,397.00 $3,530.00 $3,701.00 47780 90 $1,635.00 $2,889.00 $3,023.00 $3,198.00 $2,889.00 $3,023.00 $3,198.00 47785 90 $1,871.00 $3,724.00 $3,883.00 $4,089.00 $3,724.00 $3,883.00 $4,089.00 47800 90 $1,485.00 $1,962.00 $2,076.00 $2,226.00 $1,962.00 $2,076.00 $2,226.00 47801 90 $906.00 $1,326.00 $1,385.00 $1,455.00 $1,326.00 $1,385.00 $1,455.00 47802 90 $1,352.00 $1,875.00 $1,982.00 $2,123.00 $1,875.00 $1,982.00 $2,123.00 47900 90 $1,331.00 $1,701.00 $1,800.00 $1,930.00 $1,701.00 $1,800.00 $1,930.00 47999 YYY BR ------- ------- ------- ------- ------- ------- 48000 90 $1,053.00 $2,329.00 $2,457.00 $2,627.00 $2,329.00 $2,457.00 $2,627.00 48001 90 $1,305.00 $2,896.00 $3,062.00 $3,286.00 $2,896.00 $3,062.00 $3,286.00 48020 90 $983.00 $1,432.00 $1,512.00 $1,618.00 $1,432.00 $1,512.00 $1,618.00 48100 90 $779.00 $1,092.00 $1,154.00 $1,234.00 $1,092.00 $1,154.00 $1,234.00 48102 10 $341.00 $681.00 $719.00 $756.00 $338.00 $352.00 $369.00 48105 90 ------- $3,552.00 $3,751.00 $4,017.00 $3,552.00 $3,751.00 $4,017.00 48120 90 $1,083.00 $1,370.00 $1,447.00 $1,550.00 $1,370.00 $1,447.00 $1,550.00 48140 90 $1,546.00 $1,943.00 $2,054.00 $2,200.00 $1,943.00 $2,054.00 $2,200.00 48145 90 $1,661.00 $2,017.00 $2,132.00 $2,286.00 $2,017.00 $2,132.00 $2,286.00 48146 90 $1,830.00 $2,304.00 $2,435.00 $2,608.00 $2,304.00 $2,435.00 $2,608.00 48148 90 $1,149.00 $1,529.00 $1,615.00 $1,729.00 $1,529.00 $1,615.00 $1,729.00 48150 90 $3,101.00 $3,911.00 $4,139.00 $4,442.00 $3,911.00 $4,139.00 $4,442.00 48152 90 $2,888.00 $3,612.00 $3,821.00 $4,101.00 $3,612.00 $3,821.00 $4,101.00 48153 90 $3,099.00 $3,907.00 $4,134.00 $4,437.00 $3,907.00 $4,134.00 $4,437.00 48154 90 $2,893.00 $3,632.00 $3,843.00 $4,125.00 $3,632.00 $3,843.00 $4,125.00 48155 90 $1,855.00 $2,224.00 $2,350.00 $2,513.00 $2,224.00 $2,350.00 $2,513.00 48160 0 BR ------- ------- ------- ------- ------- ------- 48400 ZZZ $100.00 $136.00 $142.00 $150.00 $136.00 $142.00 $150.00 48500 90 $1,012.00 $1,383.00 $1,461.00 $1,563.00 $1,383.00 $1,461.00 $1,563.00 48510 90 $938.00 $1,322.00 $1,395.00 $1,489.00 $1,322.00 $1,395.00 $1,489.00 48511 0 $286.00 $1,233.00 $1,312.00 $1,382.00 $275.00 $286.00 $299.00 48520 90 $1,103.00 $1,350.00 $1,426.00 $1,527.00 $1,350.00 $1,426.00 $1,527.00 48540 90 $1,350.00 $1,631.00 $1,726.00 $1,852.00 $1,631.00 $1,726.00 $1,852.00 48545 90 $1,170.00 $1,636.00 $1,726.00 $1,844.00 $1,636.00 $1,726.00 $1,844.00 48547 90 $1,630.00 $2,211.00 $2,335.00 $2,500.00 $2,211.00 $2,335.00 $2,500.00 48548 90 ------- $2,074.00 $2,193.00 $2,351.00 $2,074.00 $2,193.00 $2,351.00 48552 0 ------- $292.00 $304.00 $320.00 $292.00 $304.00 $320.00 48554 90 $2,365.00 $3,041.00 $3,216.00 $3,438.00 $3,041.00 $3,216.00 $3,438.00 48556 90 $1,117.00 $1,501.00 $1,584.00 $1,692.00 $1,501.00 $1,584.00 $1,692.00 48999 YYY BR ------- ------- ------- ------- ------- ------- 49000 90 $862.00 $969.00 $1,026.00 $1,102.00 $969.00 $1,026.00 $1,102.00 49002 90 $784.00 $1,217.00 $1,273.00 $1,343.00 $1,217.00 $1,273.00 $1,343.00 49010 90 $915.00 $1,172.00 $1,232.00 $1,310.00 $1,172.00 $1,232.00 $1,310.00 49020 90 $910.00 $1,970.00 $2,079.00 $2,220.00 $1,970.00 $2,079.00 $2,220.00 49021 0 $290.00 $1,191.00 $1,269.00 $1,337.00 $232.00 $241.00 $253.00 49040 90 $763.00 $1,229.00 $1,295.00 $1,381.00 $1,229.00 $1,295.00 $1,381.00 49041 0 $305.00 $1,192.00 $1,269.00 $1,336.00 $275.00 $286.00 $299.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 208
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 49060 90 $827.00 $1,371.00 $1,441.00 $1,532.00 $1,371.00 $1,441.00 $1,532.00 49061 0 $288.00 $1,175.00 $1,251.00 $1,317.00 $254.00 $264.00 $277.00 49062 90 $892.00 $943.00 $997.00 $1,067.00 $943.00 $997.00 $1,067.00 49080 0 $123.00 $238.00 $252.00 $265.00 $93.00 $97.00 $102.00 49081 0 $98.00 $204.00 $216.00 $228.00 $89.00 $93.00 $98.00 49180 0 $212.00 $228.00 $241.00 $253.00 $118.00 $123.00 $129.00 49203 90 ------- $1,502.00 $1,587.00 $1,699.00 $1,502.00 $1,587.00 $1,699.00 49204 90 ------- $1,918.00 $2,025.00 $2,168.00 $1,918.00 $2,025.00 $2,168.00 49205 90 ------- $2,196.00 $2,319.00 $2,483.00 $2,196.00 $2,319.00 $2,483.00 49215 90 $1,551.00 $2,784.00 $2,943.00 $3,154.00 $2,784.00 $2,943.00 $3,154.00 49220 90 $1,182.00 $1,214.00 $1,286.00 $1,379.00 $1,214.00 $1,286.00 $1,379.00 49250 90 $622.00 $720.00 $762.00 $818.00 $720.00 $762.00 $818.00 49255 90 $591.00 $977.00 $1,034.00 $1,106.00 $977.00 $1,034.00 $1,106.00 49320 10 $415.00 $417.00 $443.00 $476.00 $417.00 $443.00 $476.00 49321 10 $443.00 $439.00 $466.00 $501.00 $439.00 $466.00 $501.00 49322 10 $460.00 $477.00 $505.00 $541.00 $477.00 $505.00 $541.00 49323 90 $712.00 $800.00 $847.00 $908.00 $800.00 $847.00 $908.00 49324 10 ------- $492.00 $520.00 $557.00 $492.00 $520.00 $557.00 49325 10 ------- $531.00 $564.00 $606.00 $531.00 $564.00 $606.00 49326 ZZZ ------- $245.00 $260.00 $280.00 $245.00 $260.00 $280.00 49329 YYY BR ------- ------- ------- ------- ------- ------- 49400 0 $127.00 $239.00 $253.00 $267.00 $131.00 $137.00 $145.00 49402 90 ------- $1,062.00 $1,123.00 $1,203.00 $1,062.00 $1,123.00 $1,203.00 49419 90 $405.00 $569.00 $602.00 $644.00 $569.00 $602.00 $644.00 49420 0 $162.00 $177.00 $186.00 $198.00 $177.00 $186.00 $198.00 49421 90 $452.00 $491.00 $521.00 $560.00 $491.00 $521.00 $560.00 49422 10 $468.00 $497.00 $528.00 $569.00 $497.00 $528.00 $569.00 49423 0 $106.00 $755.00 $806.00 $849.00 $103.00 $107.00 $112.00 49424 0 $54.00 $209.00 $222.00 $233.00 $54.00 $56.00 $58.00 49425 90 $914.00 $964.00 $1,022.00 $1,099.00 $964.00 $1,022.00 $1,099.00 49426 90 $725.00 $820.00 $869.00 $933.00 $820.00 $869.00 $933.00 49427 0 $48.00 $63.00 $66.00 $69.00 $63.00 $66.00 $69.00 49428 10 $184.00 $555.00 $588.00 $630.00 $555.00 $588.00 $630.00 49429 10 $522.00 $590.00 $627.00 $676.00 $590.00 $627.00 $676.00 49435 ZZZ ------- $159.00 $168.00 $181.00 $159.00 $168.00 $181.00 49436 10 ------- $232.00 $245.00 $260.00 $232.00 $245.00 $260.00 49440 10 ------- $1,487.00 $1,589.00 $1,682.00 $326.00 $344.00 $369.00 49441 10 ------- $1,752.00 $1,867.00 $1,967.00 $347.00 $362.00 $379.00 49442 10 ------- $1,429.00 $1,522.00 $1,603.00 $288.00 $300.00 $314.00 49446 0 ------- $1,457.00 $1,554.00 $1,637.00 $227.00 $236.00 $246.00 49450 0 ------- $1,018.00 $1,088.00 $1,147.00 $92.00 $96.00 $100.00 49451 0 ------- $1,080.00 $1,153.00 $1,215.00 $127.00 $132.00 $138.00 49452 0 ------- $1,323.00 $1,412.00 $1,488.00 $199.00 $207.00 $217.00 49460 0 ------- $1,078.00 $1,153.00 $1,215.00 $65.00 $67.00 $70.00 49465 0 ------- $226.00 $241.00 $253.00 $43.00 $44.00 $46.00 49505 90 $510.00 $642.00 $682.00 $734.00 $642.00 $682.00 $734.00 49507 90 $636.00 $791.00 $839.00 $902.00 $791.00 $839.00 $902.00 49520 90 $631.00 $787.00 $835.00 $898.00 $787.00 $835.00 $898.00 49521 90 $730.00 $962.00 $1,020.00 $1,098.00 $962.00 $1,020.00 $1,098.00 49525 90 $584.00 $710.00 $753.00 $810.00 $710.00 $753.00 $810.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 209
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 49540 90 $668.00 $842.00 $894.00 $961.00 $842.00 $894.00 $961.00 49550 90 $557.00 $715.00 $759.00 $816.00 $715.00 $759.00 $816.00 49553 90 $598.00 $781.00 $828.00 $890.00 $781.00 $828.00 $890.00 49555 90 $621.00 $744.00 $789.00 $849.00 $744.00 $789.00 $849.00 49557 90 $715.00 $904.00 $959.00 $1,031.00 $904.00 $959.00 $1,031.00 49560 90 $734.00 $927.00 $984.00 $1,058.00 $927.00 $984.00 $1,058.00 49561 90 $856.00 $1,165.00 $1,234.00 $1,326.00 $1,165.00 $1,234.00 $1,326.00 49565 90 $754.00 $955.00 $1,012.00 $1,087.00 $955.00 $1,012.00 $1,087.00 49566 90 $881.00 $1,177.00 $1,247.00 $1,339.00 $1,177.00 $1,247.00 $1,339.00 49568 ZZZ $339.00 $353.00 $374.00 $403.00 $353.00 $374.00 $403.00 49570 90 $411.00 $503.00 $534.00 $573.00 $503.00 $534.00 $573.00 49572 90 $491.00 $618.00 $653.00 $698.00 $618.00 $653.00 $698.00 49585 90 $444.00 $541.00 $573.00 $616.00 $541.00 $573.00 $616.00 49587 90 $501.00 $642.00 $681.00 $731.00 $642.00 $681.00 $731.00 49590 90 $585.00 $708.00 $751.00 $808.00 $708.00 $751.00 $808.00 49600 90 $774.00 $911.00 $963.00 $1,031.00 $911.00 $963.00 $1,031.00 49605 90 $1,648.00 $6,225.00 $6,564.00 $7,015.00 $6,225.00 $6,564.00 $7,015.00 49606 90 $1,416.00 $1,445.00 $1,533.00 $1,651.00 $1,445.00 $1,533.00 $1,651.00 49610 90 $784.00 $855.00 $901.00 $959.00 $855.00 $901.00 $959.00 49611 90 $770.00 $776.00 $816.00 $863.00 $776.00 $816.00 $863.00 49650 90 $484.00 $533.00 $568.00 $615.00 $533.00 $568.00 $615.00 49651 90 $621.00 $686.00 $730.00 $787.00 $686.00 $730.00 $787.00 49659 YYY BR ------- ------- ------- ------- ------- ------- 49900 90 $512.00 $1,017.00 $1,081.00 $1,163.00 $1,017.00 $1,081.00 $1,163.00 49904 90 $1,394.00 $1,932.00 $2,049.00 $2,195.00 $1,932.00 $2,049.00 $2,195.00 49905 ZZZ $454.00 $466.00 $492.00 $528.00 $466.00 $492.00 $528.00 49906 90 BR ------- ------- ------- ------- ------- ------- 49999 YYY BR ------- ------- ------- ------- ------- ------- 50010 90 $886.00 $942.00 $987.00 $1,041.00 $942.00 $987.00 $1,041.00 50020 90 $1,084.00 $1,352.00 $1,415.00 $1,491.00 $1,352.00 $1,415.00 $1,491.00 50021 0 $335.00 $1,243.00 $1,324.00 $1,395.00 $232.00 $241.00 $253.00 50040 90 $910.00 $1,246.00 $1,300.00 $1,364.00 $1,246.00 $1,300.00 $1,364.00 50045 90 $1,137.00 $1,249.00 $1,307.00 $1,378.00 $1,249.00 $1,307.00 $1,378.00 50060 90 $1,394.00 $1,551.00 $1,619.00 $1,700.00 $1,551.00 $1,619.00 $1,700.00 50065 90 $1,514.00 $1,607.00 $1,679.00 $1,767.00 $1,607.00 $1,679.00 $1,767.00 50070 90 $1,476.00 $1,621.00 $1,693.00 $1,778.00 $1,621.00 $1,693.00 $1,778.00 50075 90 $1,839.00 $1,992.00 $2,080.00 $2,185.00 $1,992.00 $2,080.00 $2,185.00 50080 90 $1,186.00 $1,186.00 $1,239.00 $1,302.00 $1,186.00 $1,239.00 $1,302.00 50081 90 $1,635.00 $1,741.00 $1,817.00 $1,908.00 $1,741.00 $1,817.00 $1,908.00 50100 90 $1,250.00 $1,334.00 $1,412.00 $1,514.00 $1,334.00 $1,412.00 $1,514.00 50120 90 $1,180.00 $1,294.00 $1,353.00 $1,424.00 $1,294.00 $1,353.00 $1,424.00 50125 90 $1,228.00 $1,360.00 $1,426.00 $1,507.00 $1,360.00 $1,426.00 $1,507.00 50130 90 $1,301.00 $1,404.00 $1,465.00 $1,539.00 $1,404.00 $1,465.00 $1,539.00 50135 90 $1,506.00 $1,527.00 $1,594.00 $1,673.00 $1,527.00 $1,594.00 $1,673.00 50200 0 $151.00 $198.00 $207.00 $217.00 $198.00 $207.00 $217.00 50205 90 $807.00 $938.00 $990.00 $1,057.00 $938.00 $990.00 $1,057.00 50220 90 $1,316.00 $1,396.00 $1,460.00 $1,538.00 $1,396.00 $1,460.00 $1,538.00 50225 90 $1,554.00 $1,618.00 $1,691.00 $1,778.00 $1,618.00 $1,691.00 $1,778.00 50230 90 $1,695.00 $1,740.00 $1,815.00 $1,906.00 $1,740.00 $1,815.00 $1,906.00 50234 90 $1,671.00 $1,770.00 $1,848.00 $1,941.00 $1,770.00 $1,848.00 $1,941.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 210
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 50236 90 $1,873.00 $2,000.00 $2,088.00 $2,193.00 $2,000.00 $2,088.00 $2,193.00 50240 90 $1,679.00 $1,790.00 $1,868.00 $1,961.00 $1,790.00 $1,868.00 $1,961.00 50250 90 ------- $1,663.00 $1,735.00 $1,820.00 $1,663.00 $1,735.00 $1,820.00 50280 90 $1,170.00 $1,284.00 $1,342.00 $1,412.00 $1,284.00 $1,342.00 $1,412.00 50290 90 $1,080.00 $1,218.00 $1,279.00 $1,355.00 $1,218.00 $1,279.00 $1,355.00 50320 90 $1,680.00 $1,807.00 $1,908.00 $2,035.00 $1,807.00 $1,908.00 $2,035.00 50327 0 ------- $272.00 $283.00 $298.00 $272.00 $283.00 $298.00 50328 0 ------- $239.00 $249.00 $263.00 $239.00 $249.00 $263.00 50329 0 ------- $231.00 $241.00 $254.00 $231.00 $241.00 $254.00 50340 90 $1,083.00 $1,139.00 $1,207.00 $1,293.00 $1,139.00 $1,207.00 $1,293.00 50360 90 $2,475.00 $3,056.00 $3,214.00 $3,414.00 $3,056.00 $3,214.00 $3,414.00 50365 90 $2,941.00 $3,437.00 $3,616.00 $3,846.00 $3,437.00 $3,616.00 $3,846.00 50370 90 $1,128.00 $1,419.00 $1,491.00 $1,581.00 $1,419.00 $1,491.00 $1,581.00 50380 90 $1,507.00 $2,298.00 $2,412.00 $2,552.00 $2,298.00 $2,412.00 $2,552.00 50382 0 ------- $1,847.00 $1,967.00 $2,072.00 $383.00 $399.00 $418.00 50384 0 ------- $1,656.00 $1,764.00 $1,858.00 $348.00 $362.00 $380.00 50385 0 ------- $1,761.00 $1,877.00 $1,978.00 $332.00 $347.00 $363.00 50386 0 ------- $1,139.00 $1,214.00 $1,278.00 $251.00 $262.00 $275.00 50387 0 ------- $874.00 $932.00 $982.00 $138.00 $144.00 $151.00 50389 0 ------- $543.00 $579.00 $611.00 $77.00 $80.00 $84.00 50390 0 $118.00 $135.00 $141.00 $147.00 $135.00 $141.00 $147.00 50391 0 ------- $177.00 $186.00 $196.00 $137.00 $143.00 $150.00 50392 0 $189.00 $250.00 $261.00 $273.00 $250.00 $261.00 $273.00 50393 0 $235.00 $304.00 $317.00 $332.00 $304.00 $317.00 $332.00 50394 0 $64.00 $154.00 $163.00 $172.00 $71.00 $74.00 $78.00 50395 0 $203.00 $251.00 $262.00 $275.00 $251.00 $262.00 $275.00 50396 0 $101.00 $162.00 $170.00 $178.00 $162.00 $170.00 $178.00 50398 0 $99.00 $779.00 $832.00 $877.00 $103.00 $107.00 $112.00 50400 90 $1,441.00 $1,572.00 $1,640.00 $1,722.00 $1,572.00 $1,640.00 $1,722.00 50405 90 $1,802.00 $1,896.00 $1,980.00 $2,083.00 $1,896.00 $1,980.00 $2,083.00 50500 90 $1,471.00 $1,576.00 $1,658.00 $1,762.00 $1,576.00 $1,658.00 $1,762.00 50520 90 $1,281.00 $1,414.00 $1,482.00 $1,565.00 $1,414.00 $1,482.00 $1,565.00 50525 90 $1,644.00 $1,803.00 $1,886.00 $1,989.00 $1,803.00 $1,886.00 $1,989.00 50526 90 $1,639.00 $1,834.00 $1,916.00 $2,020.00 $1,834.00 $1,916.00 $2,020.00 50540 90 $1,468.00 $1,565.00 $1,633.00 $1,715.00 $1,565.00 $1,633.00 $1,715.00 50541 90 $1,037.00 $1,256.00 $1,312.00 $1,378.00 $1,256.00 $1,312.00 $1,378.00 50542 90 $1,093.00 $1,587.00 $1,657.00 $1,740.00 $1,587.00 $1,657.00 $1,740.00 50543 90 $1,374.00 $2,027.00 $2,116.00 $2,223.00 $2,027.00 $2,116.00 $2,223.00 50544 90 $1,428.00 $1,717.00 $1,792.00 $1,884.00 $1,717.00 $1,792.00 $1,884.00 50545 90 $1,273.00 $1,839.00 $1,921.00 $2,019.00 $1,839.00 $1,921.00 $2,019.00 50546 90 $1,325.00 $1,634.00 $1,709.00 $1,800.00 $1,634.00 $1,709.00 $1,800.00 50547 90 $1,702.00 $2,041.00 $2,154.00 $2,297.00 $2,041.00 $2,154.00 $2,297.00 50548 90 $1,555.00 $1,855.00 $1,937.00 $2,037.00 $1,855.00 $1,937.00 $2,037.00 50549 YYY BR ------- ------- ------- ------- ------- ------- 50551 0 $411.00 $512.00 $538.00 $567.00 $410.00 $428.00 $450.00 50553 0 $447.00 $533.00 $559.00 $587.00 $432.00 $450.00 $473.00 50555 0 $668.00 $589.00 $618.00 $650.00 $476.00 $497.00 $522.00 50557 0 $676.00 $593.00 $623.00 $656.00 $482.00 $503.00 $529.00 50561 0 $755.00 $671.00 $704.00 $741.00 $550.00 $574.00 $605.00 50562 90 $580.00 $812.00 $847.00 $890.00 $812.00 $847.00 $890.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 211
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 50570 0 $549.00 $685.00 $716.00 $753.00 $685.00 $716.00 $753.00 50572 0 $728.00 $748.00 $784.00 $829.00 $748.00 $784.00 $829.00 50574 0 $762.00 $791.00 $826.00 $869.00 $791.00 $826.00 $869.00 50575 0 $991.00 $998.00 $1,042.00 $1,097.00 $998.00 $1,042.00 $1,097.00 50576 0 $801.00 $788.00 $823.00 $866.00 $788.00 $823.00 $866.00 50580 0 $726.00 $848.00 $886.00 $932.00 $848.00 $886.00 $932.00 50590 90 $980.00 $1,241.00 $1,310.00 $1,379.00 $760.00 $795.00 $836.00 50592 10 ------- $5,963.00 $6,375.00 $6,722.00 $501.00 $523.00 $549.00 50593 10 ------- $6,199.00 $6,624.00 $6,983.00 $645.00 $672.00 $705.00 50600 90 $1,150.00 $1,269.00 $1,325.00 $1,392.00 $1,269.00 $1,325.00 $1,392.00 50605 90 $1,054.00 $1,263.00 $1,326.00 $1,404.00 $1,263.00 $1,326.00 $1,404.00 50610 90 $1,209.00 $1,316.00 $1,381.00 $1,460.00 $1,316.00 $1,381.00 $1,460.00 50620 90 $1,152.00 $1,230.00 $1,285.00 $1,349.00 $1,230.00 $1,285.00 $1,349.00 50630 90 $1,170.00 $1,203.00 $1,257.00 $1,321.00 $1,203.00 $1,257.00 $1,321.00 50650 90 $1,297.00 $1,403.00 $1,465.00 $1,539.00 $1,403.00 $1,465.00 $1,539.00 50660 90 $1,426.00 $1,556.00 $1,625.00 $1,706.00 $1,556.00 $1,625.00 $1,706.00 50684 0 $74.00 $263.00 $280.00 $295.00 $67.00 $70.00 $74.00 50686 0 $109.00 $223.00 $236.00 $249.00 $121.00 $126.00 $133.00 50688 10 $89.00 $111.00 $117.00 $123.00 $111.00 $117.00 $123.00 50690 0 $85.00 $142.00 $150.00 $157.00 $96.00 $101.00 $106.00 50700 90 $1,192.00 $1,274.00 $1,335.00 $1,408.00 $1,274.00 $1,335.00 $1,408.00 50715 90 $1,397.00 $1,564.00 $1,649.00 $1,758.00 $1,564.00 $1,649.00 $1,758.00 50722 90 $1,211.00 $1,364.00 $1,439.00 $1,537.00 $1,364.00 $1,439.00 $1,537.00 50725 90 $1,371.00 $1,484.00 $1,552.00 $1,637.00 $1,484.00 $1,552.00 $1,637.00 50727 90 $640.00 $682.00 $715.00 $754.00 $682.00 $715.00 $754.00 50728 90 $924.00 $950.00 $998.00 $1,055.00 $950.00 $998.00 $1,055.00 50740 90 $1,386.00 $1,509.00 $1,589.00 $1,691.00 $1,509.00 $1,589.00 $1,691.00 50750 90 $1,457.00 $1,575.00 $1,644.00 $1,726.00 $1,575.00 $1,644.00 $1,726.00 50760 90 $1,389.00 $1,497.00 $1,568.00 $1,654.00 $1,497.00 $1,568.00 $1,654.00 50770 90 $1,485.00 $1,575.00 $1,646.00 $1,731.00 $1,575.00 $1,646.00 $1,731.00 50780 90 $1,391.00 $1,492.00 $1,562.00 $1,647.00 $1,492.00 $1,562.00 $1,647.00 50782 90 $1,465.00 $1,510.00 $1,584.00 $1,675.00 $1,510.00 $1,584.00 $1,675.00 50783 90 $1,515.00 $1,580.00 $1,663.00 $1,768.00 $1,580.00 $1,663.00 $1,768.00 50785 90 $1,548.00 $1,638.00 $1,710.00 $1,796.00 $1,638.00 $1,710.00 $1,796.00 50800 90 $1,226.00 $1,247.00 $1,305.00 $1,375.00 $1,247.00 $1,305.00 $1,375.00 50810 90 $1,527.00 $1,726.00 $1,820.00 $1,940.00 $1,726.00 $1,820.00 $1,940.00 50815 90 $1,643.00 $1,655.00 $1,730.00 $1,820.00 $1,655.00 $1,730.00 $1,820.00 50820 90 $1,729.00 $1,785.00 $1,870.00 $1,975.00 $1,785.00 $1,870.00 $1,975.00 50825 90 $2,351.00 $2,247.00 $2,346.00 $2,466.00 $2,247.00 $2,346.00 $2,466.00 50830 90 $2,292.00 $2,460.00 $2,570.00 $2,704.00 $2,460.00 $2,570.00 $2,704.00 50840 90 $1,493.00 $1,667.00 $1,741.00 $1,829.00 $1,667.00 $1,741.00 $1,829.00 50845 90 $1,513.00 $1,691.00 $1,769.00 $1,861.00 $1,691.00 $1,769.00 $1,861.00 50860 90 $1,163.00 $1,293.00 $1,354.00 $1,428.00 $1,293.00 $1,354.00 $1,428.00 50900 90 $1,043.00 $1,142.00 $1,196.00 $1,262.00 $1,142.00 $1,196.00 $1,262.00 50920 90 $1,075.00 $1,192.00 $1,245.00 $1,307.00 $1,192.00 $1,245.00 $1,307.00 50930 90 $1,380.00 $1,479.00 $1,543.00 $1,619.00 $1,479.00 $1,543.00 $1,619.00 50940 90 $1,107.00 $1,195.00 $1,253.00 $1,323.00 $1,195.00 $1,253.00 $1,323.00 50945 90 $1,096.00 $1,355.00 $1,419.00 $1,496.00 $1,355.00 $1,419.00 $1,496.00 50947 90 $1,384.00 $1,925.00 $2,019.00 $2,137.00 $1,925.00 $2,019.00 $2,137.00 50948 90 $1,265.00 $1,745.00 $1,824.00 $1,920.00 $1,745.00 $1,824.00 $1,920.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 212
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 50949 YYY BR ------- ------- ------- ------- ------- ------- 50951 0 $414.00 $534.00 $561.00 $590.00 $426.00 $446.00 $469.00 50953 0 $461.00 $560.00 $588.00 $618.00 $466.00 $487.00 $512.00 50955 0 $546.00 $644.00 $676.00 $712.00 $508.00 $531.00 $559.00 50957 0 $546.00 $605.00 $635.00 $668.00 $494.00 $516.00 $543.00 50961 0 $510.00 $544.00 $570.00 $600.00 $441.00 $460.00 $483.00 50970 0 $510.00 $519.00 $542.00 $571.00 $519.00 $542.00 $571.00 50972 0 $408.00 $500.00 $522.00 $550.00 $500.00 $522.00 $550.00 50974 0 $661.00 $653.00 $682.00 $717.00 $653.00 $682.00 $717.00 50976 0 $641.00 $649.00 $678.00 $714.00 $649.00 $678.00 $714.00 50980 0 $443.00 $497.00 $519.00 $545.00 $497.00 $519.00 $545.00 51020 90 $587.00 $623.00 $652.00 $684.00 $623.00 $652.00 $684.00 51030 90 $538.00 $628.00 $658.00 $694.00 $628.00 $658.00 $694.00 51040 90 $439.00 $394.00 $413.00 $435.00 $394.00 $413.00 $435.00 51045 90 $548.00 $629.00 $658.00 $692.00 $629.00 $658.00 $692.00 51050 90 $596.00 $632.00 $661.00 $693.00 $632.00 $661.00 $693.00 51060 90 $768.00 $783.00 $818.00 $859.00 $783.00 $818.00 $859.00 51065 90 $704.00 $776.00 $811.00 $851.00 $776.00 $811.00 $851.00 51080 90 $510.00 $548.00 $573.00 $602.00 $548.00 $573.00 $602.00 51100 0 ------- $87.00 $91.00 $96.00 $54.00 $56.00 $59.00 51101 0 ------- $176.00 $187.00 $198.00 $73.00 $77.00 $82.00 51102 10 ------- $460.00 $484.00 $509.00 $341.00 $357.00 $375.00 51500 90 $775.00 $864.00 $909.00 $965.00 $864.00 $909.00 $965.00 51520 90 $764.00 $803.00 $840.00 $883.00 $803.00 $840.00 $883.00 51525 90 $1,069.00 $1,161.00 $1,212.00 $1,273.00 $1,161.00 $1,212.00 $1,273.00 51530 90 $957.00 $1,049.00 $1,099.00 $1,160.00 $1,049.00 $1,099.00 $1,160.00 51535 90 $932.00 $1,081.00 $1,136.00 $1,205.00 $1,081.00 $1,136.00 $1,205.00 51550 90 $1,171.00 $1,293.00 $1,354.00 $1,428.00 $1,293.00 $1,354.00 $1,428.00 51555 90 $1,514.00 $1,716.00 $1,795.00 $1,892.00 $1,716.00 $1,795.00 $1,892.00 51565 90 $1,624.00 $1,759.00 $1,838.00 $1,933.00 $1,759.00 $1,838.00 $1,933.00 51570 90 $1,762.00 $2,000.00 $2,085.00 $2,186.00 $2,000.00 $2,085.00 $2,186.00 51575 90 $2,284.00 $2,480.00 $2,586.00 $2,713.00 $2,480.00 $2,586.00 $2,713.00 51580 90 $2,252.00 $2,580.00 $2,691.00 $2,823.00 $2,580.00 $2,691.00 $2,823.00 51585 90 $2,601.00 $2,871.00 $2,993.00 $3,140.00 $2,871.00 $2,993.00 $3,140.00 51590 90 $2,441.00 $2,624.00 $2,735.00 $2,869.00 $2,624.00 $2,735.00 $2,869.00 51595 90 $2,900.00 $2,979.00 $3,105.00 $3,257.00 $2,979.00 $3,105.00 $3,257.00 51596 90 $3,063.00 $3,197.00 $3,333.00 $3,496.00 $3,197.00 $3,333.00 $3,496.00 51597 90 $2,914.00 $3,099.00 $3,234.00 $3,396.00 $3,099.00 $3,234.00 $3,396.00 51600 0 $54.00 $278.00 $296.00 $312.00 $61.00 $64.00 $67.00 51605 0 $83.00 $53.00 $55.00 $58.00 $53.00 $55.00 $58.00 51610 0 $45.00 $160.00 $169.00 $178.00 $87.00 $91.00 $96.00 51700 0 $29.00 $123.00 $130.00 $137.00 $61.00 $64.00 $67.00 51701 0 $58.00 $92.00 $98.00 $103.00 $38.00 $39.00 $42.00 51702 0 $92.00 $117.00 $125.00 $131.00 $41.00 $43.00 $46.00 51703 0 $128.00 $202.00 $213.00 $224.00 $111.00 $116.00 $122.00 51705 10 $37.00 $162.00 $171.00 $180.00 $91.00 $95.00 $100.00 51710 10 $119.00 $231.00 $244.00 $257.00 $128.00 $134.00 $141.00 51715 0 $322.00 $406.00 $428.00 $452.00 $275.00 $288.00 $304.00 51720 0 $140.00 $165.00 $175.00 $185.00 $117.00 $123.00 $131.00 51725 0 $116.00 $329.00 $351.00 $371.00 $329.00 $351.00 $371.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 213
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 51725-26 0 ------- $106.00 $111.00 $118.00 $106.00 $111.00 $118.00 51725-TC 0 ------- $223.00 $239.00 $254.00 $223.00 $239.00 $254.00 51726 0 $136.00 $460.00 $491.00 $519.00 $460.00 $491.00 $519.00 51726-26 0 ------- $121.00 $126.00 $133.00 $121.00 $126.00 $133.00 51726-TC 0 ------- $339.00 $364.00 $386.00 $339.00 $364.00 $386.00 51736 0 $47.00 $72.00 $76.00 $80.00 $72.00 $76.00 $80.00 51736-26 0 ------- $44.00 $46.00 $48.00 $44.00 $46.00 $48.00 51736-TC 0 ------- $28.00 $30.00 $32.00 $28.00 $30.00 $32.00 51741 0 $81.00 $114.00 $120.00 $127.00 $114.00 $120.00 $127.00 51741-26 0 ------- $81.00 $85.00 $89.00 $81.00 $85.00 $89.00 51741-TC 0 ------- $33.00 $35.00 $38.00 $33.00 $35.00 $38.00 51772 0 $96.00 $357.00 $381.00 $405.00 $357.00 $381.00 $405.00 51772-26 0 ------- $115.00 $121.00 $128.00 $115.00 $121.00 $128.00 51772-TC 0 ------- $242.00 $261.00 $277.00 $242.00 $261.00 $277.00 51784 0 $119.00 $287.00 $306.00 $324.00 $287.00 $306.00 $324.00 51784-26 0 ------- $108.00 $113.00 $119.00 $108.00 $113.00 $119.00 51784-TC 0 ------- $179.00 $193.00 $205.00 $179.00 $193.00 $205.00 51785 0 $52.00 $309.00 $329.00 $348.00 $309.00 $329.00 $348.00 51785-26 0 ------- $107.00 $112.00 $118.00 $107.00 $112.00 $118.00 51785-TC 0 ------- $202.00 $217.00 $230.00 $202.00 $217.00 $230.00 51792 0 $143.00 $343.00 $368.00 $392.00 $343.00 $368.00 $392.00 51792-26 0 ------- $77.00 $80.00 $84.00 $77.00 $80.00 $84.00 51792-TC 0 ------- $266.00 $288.00 $308.00 $266.00 $288.00 $308.00 51795 0 $132.00 $439.00 $470.00 $499.00 $439.00 $470.00 $499.00 51795-26 0 ------- $108.00 $113.00 $119.00 $108.00 $113.00 $119.00 51795-TC 0 ------- $331.00 $357.00 $380.00 $331.00 $357.00 $380.00 51797 ZZZ $109.00 $256.00 $275.00 $294.00 $256.00 $275.00 $294.00 51797-26 ZZZ ------- $67.00 $72.00 $78.00 $67.00 $72.00 $78.00 51797-TC ZZZ ------- $189.00 $203.00 $216.00 $189.00 $203.00 $216.00 51798 0 $20.00 $30.00 $34.00 $38.00 $30.00 $34.00 $38.00 51800 90 $1,294.00 $1,416.00 $1,481.00 $1,558.00 $1,416.00 $1,481.00 $1,558.00 51820 90 $1,236.00 $1,501.00 $1,578.00 $1,673.00 $1,501.00 $1,578.00 $1,673.00 51840 90 $858.00 $896.00 $944.00 $1,002.00 $896.00 $944.00 $1,002.00 51841 90 $1,040.00 $1,068.00 $1,123.00 $1,191.00 $1,068.00 $1,123.00 $1,191.00 51845 90 $843.00 $801.00 $840.00 $887.00 $801.00 $840.00 $887.00 51860 90 $912.00 $991.00 $1,043.00 $1,107.00 $991.00 $1,043.00 $1,107.00 51865 90 $1,150.00 $1,209.00 $1,267.00 $1,338.00 $1,209.00 $1,267.00 $1,338.00 51880 90 $590.00 $641.00 $675.00 $716.00 $641.00 $675.00 $716.00 51900 90 $1,050.00 $1,127.00 $1,182.00 $1,251.00 $1,127.00 $1,182.00 $1,251.00 51920 90 $881.00 $1,058.00 $1,113.00 $1,179.00 $1,058.00 $1,113.00 $1,179.00 51925 90 $1,167.00 $1,502.00 $1,591.00 $1,702.00 $1,502.00 $1,591.00 $1,702.00 51940 90 $2,082.00 $2,197.00 $2,294.00 $2,414.00 $2,197.00 $2,294.00 $2,414.00 51960 90 $1,848.00 $1,876.00 $1,957.00 $2,055.00 $1,876.00 $1,957.00 $2,055.00 51980 90 $858.00 $963.00 $1,007.00 $1,059.00 $963.00 $1,007.00 $1,059.00 51990 90 $850.00 $1,035.00 $1,092.00 $1,164.00 $1,035.00 $1,092.00 $1,164.00 51992 90 $925.00 $1,123.00 $1,182.00 $1,256.00 $1,123.00 $1,182.00 $1,256.00 52000 0 $190.00 $289.00 $305.00 $321.00 $167.00 $174.00 $183.00 52001 0 $133.00 $539.00 $567.00 $597.00 $397.00 $415.00 $437.00 52005 0 $265.00 $407.00 $432.00 $455.00 $181.00 $190.00 $200.00 52007 0 $230.00 $838.00 $892.00 $940.00 $228.00 $239.00 $251.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 214
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 52010 0 $292.00 $629.00 $668.00 $704.00 $227.00 $238.00 $250.00 52204 0 $286.00 $705.00 $750.00 $790.00 $192.00 $200.00 $210.00 52214 0 $367.00 $1,644.00 $1,754.00 $1,849.00 $273.00 $286.00 $301.00 52224 0 $339.00 $1,553.00 $1,657.00 $1,748.00 $234.00 $245.00 $257.00 52234 0 $471.00 $341.00 $357.00 $375.00 $341.00 $357.00 $375.00 52235 0 $546.00 $401.00 $419.00 $441.00 $401.00 $419.00 $441.00 52240 0 $887.00 $702.00 $733.00 $771.00 $702.00 $733.00 $771.00 52250 0 $311.00 $334.00 $350.00 $368.00 $334.00 $350.00 $368.00 52260 0 $262.00 $289.00 $302.00 $318.00 $289.00 $302.00 $318.00 52265 0 $243.00 $676.00 $719.00 $758.00 $220.00 $230.00 $243.00 52270 0 $374.00 $628.00 $666.00 $702.00 $251.00 $263.00 $277.00 52275 0 $446.00 $867.00 $920.00 $970.00 $344.00 $360.00 $378.00 52276 0 $490.00 $367.00 $384.00 $404.00 $367.00 $384.00 $404.00 52277 0 $448.00 $452.00 $472.00 $497.00 $452.00 $472.00 $497.00 52281 0 $259.00 $457.00 $484.00 $510.00 $213.00 $223.00 $235.00 52282 0 $560.00 $466.00 $487.00 $512.00 $466.00 $487.00 $512.00 52283 0 $309.00 $395.00 $416.00 $438.00 $276.00 $289.00 $304.00 52285 0 $375.00 $398.00 $420.00 $442.00 $269.00 $281.00 $296.00 52290 0 $304.00 $338.00 $353.00 $371.00 $338.00 $353.00 $371.00 52300 0 $370.00 $391.00 $408.00 $430.00 $391.00 $408.00 $430.00 52301 0 $382.00 $411.00 $431.00 $456.00 $411.00 $431.00 $456.00 52305 0 $370.00 $388.00 $405.00 $426.00 $388.00 $405.00 $426.00 52310 0 $348.00 $365.00 $386.00 $406.00 $209.00 $219.00 $230.00 52315 0 $553.00 $656.00 $693.00 $730.00 $381.00 $398.00 $419.00 52317 0 $772.00 $1,503.00 $1,597.00 $1,684.00 $485.00 $507.00 $533.00 52318 0 $684.00 $661.00 $690.00 $726.00 $661.00 $690.00 $726.00 52320 0 $369.00 $342.00 $358.00 $376.00 $342.00 $358.00 $376.00 52325 0 $494.00 $446.00 $466.00 $491.00 $446.00 $466.00 $491.00 52327 0 $369.00 $1,119.00 $1,189.00 $1,253.00 $369.00 $385.00 $405.00 52330 0 $507.00 $1,745.00 $1,860.00 $1,961.00 $367.00 $384.00 $404.00 52332 0 $451.00 $603.00 $641.00 $676.00 $214.00 $224.00 $236.00 52334 0 $340.00 $355.00 $371.00 $391.00 $355.00 $371.00 $391.00 52341 0 $317.00 $452.00 $473.00 $497.00 $452.00 $473.00 $497.00 52342 0 $344.00 $487.00 $508.00 $535.00 $487.00 $508.00 $535.00 52343 0 $380.00 $536.00 $560.00 $589.00 $536.00 $560.00 $589.00 52344 0 $407.00 $578.00 $604.00 $635.00 $578.00 $604.00 $635.00 52345 0 $433.00 $613.00 $640.00 $673.00 $613.00 $640.00 $673.00 52346 0 $488.00 $685.00 $715.00 $752.00 $685.00 $715.00 $752.00 52351 0 $297.00 $435.00 $454.00 $478.00 $435.00 $454.00 $478.00 52352 0 $349.00 $510.00 $533.00 $561.00 $510.00 $533.00 $561.00 52353 0 $404.00 $588.00 $614.00 $647.00 $588.00 $614.00 $647.00 52354 0 $372.00 $543.00 $568.00 $597.00 $543.00 $568.00 $597.00 52355 0 $447.00 $648.00 $677.00 $713.00 $648.00 $677.00 $713.00 52400 90 $580.00 $754.00 $788.00 $828.00 $754.00 $788.00 $828.00 52402 0 ------- $375.00 $392.00 $413.00 $375.00 $392.00 $413.00 52450 90 $602.00 $630.00 $660.00 $695.00 $630.00 $660.00 $695.00 52500 90 $705.00 $741.00 $774.00 $813.00 $741.00 $774.00 $813.00 52601 90 $1,021.00 $1,117.00 $1,163.00 $1,217.00 $1,117.00 $1,163.00 $1,217.00 52630 90 $653.00 $599.00 $626.00 $658.00 $599.00 $626.00 $658.00 52640 90 $573.00 $545.00 $570.00 $600.00 $545.00 $570.00 $600.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 215
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 52647 90 $858.00 $3,478.00 $3,704.00 $3,902.00 $867.00 $906.00 $951.00 52648 90 $957.00 $3,536.00 $3,764.00 $3,966.00 $926.00 $968.00 $1,016.00 52649 90 ------- $1,359.00 $1,421.00 $1,492.00 $1,359.00 $1,421.00 $1,492.00 52700 90 $517.00 $587.00 $614.00 $644.00 $587.00 $614.00 $644.00 53000 10 $224.00 $204.00 $214.00 $225.00 $204.00 $214.00 $225.00 53010 90 $336.00 $392.00 $410.00 $429.00 $392.00 $410.00 $429.00 53020 0 $153.00 $134.00 $140.00 $148.00 $134.00 $140.00 $148.00 53040 90 $460.00 $537.00 $562.00 $591.00 $537.00 $562.00 $591.00 53060 10 $180.00 $251.00 $265.00 $283.00 $219.00 $231.00 $246.00 53080 90 $567.00 $635.00 $667.00 $704.00 $635.00 $667.00 $704.00 53085 90 $836.00 $887.00 $932.00 $985.00 $887.00 $932.00 $985.00 53200 0 $218.00 $213.00 $223.00 $236.00 $194.00 $204.00 $215.00 53210 90 $904.00 $1,049.00 $1,096.00 $1,151.00 $1,049.00 $1,096.00 $1,151.00 53215 90 $1,142.00 $1,266.00 $1,322.00 $1,388.00 $1,266.00 $1,322.00 $1,388.00 53220 90 $546.00 $610.00 $638.00 $670.00 $610.00 $638.00 $670.00 53230 90 $760.00 $819.00 $857.00 $902.00 $819.00 $857.00 $902.00 53235 90 $607.00 $862.00 $902.00 $947.00 $862.00 $902.00 $947.00 53240 90 $506.00 $579.00 $607.00 $640.00 $579.00 $607.00 $640.00 53250 90 $464.00 $532.00 $558.00 $589.00 $532.00 $558.00 $589.00 53260 10 $240.00 $278.00 $293.00 $309.00 $242.00 $254.00 $269.00 53265 10 $295.00 $308.00 $324.00 $342.00 $252.00 $264.00 $278.00 53270 10 $226.00 $286.00 $302.00 $321.00 $254.00 $268.00 $285.00 53275 10 $332.00 $364.00 $381.00 $401.00 $364.00 $381.00 $401.00 53400 90 $929.00 $1,089.00 $1,139.00 $1,199.00 $1,089.00 $1,139.00 $1,199.00 53405 90 $1,088.00 $1,190.00 $1,245.00 $1,310.00 $1,190.00 $1,245.00 $1,310.00 53410 90 $1,151.00 $1,333.00 $1,392.00 $1,463.00 $1,333.00 $1,392.00 $1,463.00 53415 90 $1,381.00 $1,524.00 $1,591.00 $1,671.00 $1,524.00 $1,591.00 $1,671.00 53420 90 $1,088.00 $1,117.00 $1,165.00 $1,223.00 $1,117.00 $1,165.00 $1,223.00 53425 90 $1,150.00 $1,282.00 $1,339.00 $1,407.00 $1,282.00 $1,339.00 $1,407.00 53430 90 $1,116.00 $1,298.00 $1,356.00 $1,424.00 $1,298.00 $1,356.00 $1,424.00 53431 90 $1,053.00 $1,575.00 $1,645.00 $1,728.00 $1,575.00 $1,645.00 $1,728.00 53440 90 $1,057.00 $1,175.00 $1,227.00 $1,287.00 $1,175.00 $1,227.00 $1,287.00 53442 90 $639.00 $1,034.00 $1,079.00 $1,132.00 $1,034.00 $1,079.00 $1,132.00 53444 90 $755.00 $1,082.00 $1,131.00 $1,188.00 $1,082.00 $1,131.00 $1,188.00 53445 90 $1,197.00 $1,188.00 $1,242.00 $1,304.00 $1,188.00 $1,242.00 $1,304.00 53446 90 $699.00 $874.00 $914.00 $960.00 $874.00 $914.00 $960.00 53447 90 $991.00 $1,110.00 $1,160.00 $1,219.00 $1,110.00 $1,160.00 $1,219.00 53448 90 $1,259.00 $1,745.00 $1,821.00 $1,912.00 $1,745.00 $1,821.00 $1,912.00 53449 90 $784.00 $826.00 $864.00 $907.00 $826.00 $864.00 $907.00 53450 90 $447.00 $548.00 $573.00 $602.00 $548.00 $573.00 $602.00 53460 90 $494.00 $617.00 $646.00 $678.00 $617.00 $646.00 $678.00 53500 90 ------- $1,016.00 $1,063.00 $1,118.00 $1,016.00 $1,063.00 $1,118.00 53502 90 $590.00 $659.00 $691.00 $729.00 $659.00 $691.00 $729.00 53505 90 $586.00 $657.00 $687.00 $722.00 $657.00 $687.00 $722.00 53510 90 $777.00 $867.00 $907.00 $954.00 $867.00 $907.00 $954.00 53515 90 $987.00 $1,092.00 $1,144.00 $1,206.00 $1,092.00 $1,144.00 $1,206.00 53520 90 $661.00 $754.00 $789.00 $828.00 $754.00 $789.00 $828.00 53600 0 $37.00 $121.00 $128.00 $134.00 $89.00 $93.00 $98.00 53601 0 $37.00 $117.00 $124.00 $130.00 $73.00 $77.00 $81.00 53605 0 $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
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 53620 0 $59.00 $177.00 $187.00 $197.00 $120.00 $126.00 $132.00 53621 0 $45.00 $168.00 $178.00 $187.00 $100.00 $105.00 $111.00 53660 0 $49.00 $103.00 $109.00 $115.00 $57.00 $59.00 $62.00 53661 0 $50.00 $103.00 $108.00 $114.00 $55.00 $58.00 $61.00 53665 0 $50.00 $53.00 $56.00 $59.00 $53.00 $56.00 $59.00 53850 90 $741.00 $4,103.00 $4,376.00 $4,613.00 $767.00 $801.00 $842.00 53852 90 $728.00 $3,934.00 $4,194.00 $4,419.00 $832.00 $870.00 $913.00 53899 YYY BR ------- ------- ------- ------- ------- ------- 54015 10 $348.00 $424.00 $444.00 $467.00 $424.00 $444.00 $467.00 54050 10 $91.00 $159.00 $168.00 $177.00 $126.00 $132.00 $139.00 54055 10 $106.00 $152.00 $161.00 $169.00 $115.00 $121.00 $127.00 54056 10 $100.00 $165.00 $174.00 $182.00 $130.00 $137.00 $143.00 54057 10 $149.00 $187.00 $198.00 $209.00 $121.00 $128.00 $134.00 54060 10 $180.00 $257.00 $271.00 $286.00 $169.00 $178.00 $187.00 54065 10 $281.00 $273.00 $287.00 $301.00 $205.00 $214.00 $224.00 54100 0 $149.00 $251.00 $264.00 $277.00 $151.00 $158.00 $165.00 54105 10 $261.00 $391.00 $412.00 $434.00 $294.00 $308.00 $324.00 54110 90 $775.00 $851.00 $889.00 $934.00 $851.00 $889.00 $934.00 54111 90 $1,035.00 $1,092.00 $1,141.00 $1,199.00 $1,092.00 $1,141.00 $1,199.00 54112 90 $1,210.00 $1,281.00 $1,337.00 $1,405.00 $1,281.00 $1,337.00 $1,405.00 54115 90 $588.00 $608.00 $637.00 $669.00 $564.00 $590.00 $620.00 54120 90 $777.00 $850.00 $887.00 $931.00 $850.00 $887.00 $931.00 54125 90 $1,092.00 $1,100.00 $1,149.00 $1,207.00 $1,100.00 $1,149.00 $1,207.00 54130 90 $1,532.00 $1,631.00 $1,705.00 $1,793.00 $1,631.00 $1,705.00 $1,793.00 54135 90 $1,945.00 $2,070.00 $2,161.00 $2,271.00 $2,070.00 $2,161.00 $2,271.00 54162 10 $220.00 $387.00 $407.00 $428.00 $263.00 $275.00 $288.00 54163 10 $207.00 $292.00 $306.00 $321.00 $292.00 $306.00 $321.00 54164 10 $182.00 $257.00 $269.00 $283.00 $257.00 $269.00 $283.00 54200 10 $78.00 $152.00 $161.00 $170.00 $114.00 $120.00 $127.00 54205 90 $633.00 $728.00 $761.00 $799.00 $728.00 $761.00 $799.00 54220 0 $189.00 $306.00 $323.00 $340.00 $185.00 $193.00 $203.00 54230 0 $104.00 $132.00 $139.00 $146.00 $109.00 $114.00 $119.00 54231 0 $172.00 $192.00 $202.00 $213.00 $162.00 $169.00 $179.00 54235 0 $81.00 $121.00 $127.00 $134.00 $99.00 $103.00 $109.00 54240 0 $109.00 $138.00 $147.00 $157.00 $138.00 $147.00 $157.00 54240-26 0 ------- $93.00 $97.00 $103.00 $93.00 $97.00 $103.00 54240-TC 0 ------- $45.00 $50.00 $54.00 $45.00 $50.00 $54.00 54250 0 $104.00 $171.00 $180.00 $190.00 $171.00 $180.00 $190.00 54250-26 0 ------- $156.00 $162.00 $171.00 $156.00 $162.00 $171.00 54250-TC 0 ------- $16.00 $17.00 $19.00 $16.00 $17.00 $19.00 54300 90 $830.00 $887.00 $928.00 $976.00 $887.00 $928.00 $976.00 54304 90 $988.00 $1,040.00 $1,088.00 $1,143.00 $1,040.00 $1,088.00 $1,143.00 54308 90 $881.00 $921.00 $962.00 $1,010.00 $921.00 $962.00 $1,010.00 54312 90 $1,067.00 $1,169.00 $1,229.00 $1,301.00 $1,169.00 $1,229.00 $1,301.00 54316 90 $1,316.00 $1,383.00 $1,446.00 $1,520.00 $1,383.00 $1,446.00 $1,520.00 54318 90 $900.00 $952.00 $1,006.00 $1,077.00 $952.00 $1,006.00 $1,077.00 54322 90 $974.00 $1,083.00 $1,132.00 $1,190.00 $1,083.00 $1,132.00 $1,190.00 54324 90 $1,260.00 $1,350.00 $1,410.00 $1,481.00 $1,350.00 $1,410.00 $1,481.00 54326 90 $1,212.00 $1,304.00 $1,362.00 $1,431.00 $1,304.00 $1,362.00 $1,431.00 54328 90 $1,201.00 $1,281.00 $1,336.00 $1,399.00 $1,281.00 $1,336.00 $1,399.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 217
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 54332 90 $1,327.00 $1,396.00 $1,459.00 $1,532.00 $1,396.00 $1,459.00 $1,532.00 54336 90 $1,672.00 $1,622.00 $1,709.00 $1,822.00 $1,622.00 $1,709.00 $1,822.00 54340 90 $727.00 $785.00 $821.00 $863.00 $785.00 $821.00 $863.00 54344 90 $1,360.00 $1,348.00 $1,418.00 $1,504.00 $1,348.00 $1,418.00 $1,504.00 54348 90 $1,318.00 $1,412.00 $1,476.00 $1,552.00 $1,412.00 $1,476.00 $1,552.00 54352 90 $1,820.00 $2,026.00 $2,128.00 $2,254.00 $2,026.00 $2,128.00 $2,254.00 54360 90 $898.00 $997.00 $1,043.00 $1,096.00 $997.00 $1,043.00 $1,096.00 54380 90 $1,054.00 $1,098.00 $1,148.00 $1,206.00 $1,098.00 $1,148.00 $1,206.00 54385 90 $1,217.00 $1,326.00 $1,383.00 $1,445.00 $1,326.00 $1,383.00 $1,445.00 54390 90 $1,635.00 $1,604.00 $1,673.00 $1,758.00 $1,604.00 $1,673.00 $1,758.00 54400 90 $784.00 $730.00 $764.00 $804.00 $730.00 $764.00 $804.00 54401 90 $892.00 $886.00 $930.00 $979.00 $886.00 $930.00 $979.00 54405 90 $1,294.00 $1,102.00 $1,151.00 $1,209.00 $1,102.00 $1,151.00 $1,209.00 54406 90 $687.00 $993.00 $1,038.00 $1,091.00 $993.00 $1,038.00 $1,091.00 54408 90 $724.00 $1,065.00 $1,113.00 $1,169.00 $1,065.00 $1,113.00 $1,169.00 54410 90 $856.00 $1,260.00 $1,316.00 $1,383.00 $1,260.00 $1,316.00 $1,383.00 54411 90 $933.00 $1,377.00 $1,437.00 $1,507.00 $1,377.00 $1,437.00 $1,507.00 54415 90 $510.00 $712.00 $745.00 $783.00 $712.00 $745.00 $783.00 54416 90 $665.00 $950.00 $993.00 $1,043.00 $950.00 $993.00 $1,043.00 54417 90 $819.00 $1,209.00 $1,262.00 $1,324.00 $1,209.00 $1,262.00 $1,324.00 54420 90 $899.00 $964.00 $1,008.00 $1,059.00 $964.00 $1,008.00 $1,059.00 54430 90 $799.00 $871.00 $911.00 $957.00 $871.00 $911.00 $957.00 54435 90 $503.00 $564.00 $590.00 $620.00 $564.00 $590.00 $620.00 54440 90 BR ------- ------- ------- ------- ------- ------- 54450 0 $88.00 $104.00 $109.00 $115.00 $82.00 $86.00 $90.00 54500 0 $102.00 $102.00 $107.00 $113.00 $102.00 $107.00 $113.00 54505 10 $259.00 $294.00 $308.00 $325.00 $294.00 $308.00 $325.00 54512 90 $519.00 $732.00 $766.00 $807.00 $732.00 $766.00 $807.00 54520 90 $445.00 $448.00 $473.00 $502.00 $448.00 $473.00 $502.00 54522 90 $589.00 $808.00 $849.00 $900.00 $808.00 $849.00 $900.00 54530 90 $683.00 $747.00 $782.00 $823.00 $747.00 $782.00 $823.00 54535 90 $922.00 $999.00 $1,046.00 $1,101.00 $999.00 $1,046.00 $1,101.00 54550 90 $588.00 $662.00 $694.00 $730.00 $662.00 $694.00 $730.00 54560 90 $842.00 $934.00 $978.00 $1,031.00 $934.00 $978.00 $1,031.00 54600 90 $524.00 $611.00 $639.00 $672.00 $611.00 $639.00 $672.00 54620 10 $373.00 $413.00 $432.00 $455.00 $413.00 $432.00 $455.00 54640 90 $594.00 $632.00 $664.00 $701.00 $632.00 $664.00 $701.00 54650 90 $861.00 $943.00 $992.00 $1,054.00 $943.00 $992.00 $1,054.00 54660 90 $401.00 $483.00 $508.00 $536.00 $483.00 $508.00 $536.00 54670 90 $485.00 $554.00 $581.00 $611.00 $554.00 $581.00 $611.00 54680 90 $948.00 $1,091.00 $1,145.00 $1,211.00 $1,091.00 $1,145.00 $1,211.00 54690 90 $825.00 $888.00 $933.00 $988.00 $888.00 $933.00 $988.00 54692 90 $850.00 $1,068.00 $1,124.00 $1,194.00 $1,068.00 $1,124.00 $1,194.00 54699 YYY BR ------- ------- ------- ------- ------- ------- 54700 10 $133.00 $292.00 $307.00 $324.00 $292.00 $307.00 $324.00 54800 0 $257.00 $181.00 $190.00 $202.00 $181.00 $190.00 $202.00 54830 90 $411.00 $496.00 $519.00 $546.00 $496.00 $519.00 $546.00 54840 90 $432.00 $439.00 $460.00 $484.00 $439.00 $460.00 $484.00 54860 90 $503.00 $562.00 $588.00 $617.00 $562.00 $588.00 $617.00 54861 90 $696.00 $763.00 $798.00 $838.00 $763.00 $798.00 $838.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 218
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 54865 90 ------- $478.00 $501.00 $527.00 $478.00 $501.00 $527.00 54900 90 $969.00 $1,009.00 $1,053.00 $1,105.00 $1,009.00 $1,053.00 $1,105.00 54901 90 $1,340.00 $1,484.00 $1,562.00 $1,661.00 $1,484.00 $1,562.00 $1,661.00 55000 0 $109.00 $174.00 $184.00 $194.00 $115.00 $120.00 $127.00 55040 90 $439.00 $458.00 $481.00 $508.00 $458.00 $481.00 $508.00 55041 90 $634.00 $684.00 $716.00 $754.00 $684.00 $716.00 $754.00 55060 90 $430.00 $509.00 $534.00 $563.00 $509.00 $534.00 $563.00 55100 10 $156.00 $305.00 $322.00 $339.00 $217.00 $228.00 $240.00 55110 90 $223.00 $517.00 $541.00 $569.00 $517.00 $541.00 $569.00 55120 90 $350.00 $474.00 $496.00 $522.00 $474.00 $496.00 $522.00 55150 90 $562.00 $652.00 $683.00 $719.00 $652.00 $683.00 $719.00 55175 90 $426.00 $484.00 $506.00 $531.00 $484.00 $506.00 $531.00 55180 90 $796.00 $933.00 $979.00 $1,033.00 $933.00 $979.00 $1,033.00 55200 90 $310.00 $745.00 $790.00 $833.00 $379.00 $398.00 $419.00 55250 90 $349.00 $658.00 $699.00 $737.00 $307.00 $323.00 $341.00 55300 0 $167.00 $261.00 $272.00 $287.00 $261.00 $272.00 $287.00 55400 90 $660.00 $688.00 $721.00 $760.00 $688.00 $721.00 $760.00 55450 10 $391.00 $540.00 $570.00 $599.00 $340.00 $355.00 $373.00 55500 90 $445.00 $513.00 $540.00 $572.00 $513.00 $540.00 $572.00 55520 90 $446.00 $544.00 $576.00 $616.00 $544.00 $576.00 $616.00 55530 90 $467.00 $480.00 $504.00 $532.00 $480.00 $504.00 $532.00 55535 90 $496.00 $575.00 $602.00 $633.00 $575.00 $602.00 $633.00 55540 90 $572.00 $660.00 $699.00 $747.00 $660.00 $699.00 $747.00 55550 90 $486.00 $574.00 $603.00 $637.00 $574.00 $603.00 $637.00 55559 YYY BR ------- ------- ------- ------- ------- ------- 55600 90 $486.00 $579.00 $609.00 $646.00 $579.00 $609.00 $646.00 55605 90 $609.00 $678.00 $711.00 $749.00 $678.00 $711.00 $749.00 55650 90 $853.00 $977.00 $1,023.00 $1,078.00 $977.00 $1,023.00 $1,078.00 55680 90 $426.00 $472.00 $496.00 $525.00 $472.00 $496.00 $525.00 55700 0 $183.00 $327.00 $344.00 $360.00 $179.00 $185.00 $192.00 55705 10 $368.00 $369.00 $386.00 $406.00 $369.00 $386.00 $406.00 55720 90 $555.00 $653.00 $692.00 $742.00 $653.00 $692.00 $742.00 55725 90 $670.00 $789.00 $826.00 $870.00 $789.00 $826.00 $870.00 55801 90 $1,331.00 $1,476.00 $1,542.00 $1,621.00 $1,476.00 $1,542.00 $1,621.00 55810 90 $1,711.00 $1,792.00 $1,871.00 $1,965.00 $1,792.00 $1,871.00 $1,965.00 55812 90 $1,989.00 $2,186.00 $2,283.00 $2,401.00 $2,186.00 $2,283.00 $2,401.00 55815 90 $2,328.00 $2,411.00 $2,516.00 $2,643.00 $2,411.00 $2,516.00 $2,643.00 55821 90 $1,153.00 $1,185.00 $1,237.00 $1,299.00 $1,185.00 $1,237.00 $1,299.00 55831 90 $1,252.00 $1,285.00 $1,341.00 $1,408.00 $1,285.00 $1,341.00 $1,408.00 55840 90 $1,705.00 $1,824.00 $1,905.00 $2,000.00 $1,824.00 $1,905.00 $2,000.00 55842 90 $1,859.00 $1,955.00 $2,040.00 $2,143.00 $1,955.00 $2,040.00 $2,143.00 55845 90 $2,222.00 $2,238.00 $2,336.00 $2,454.00 $2,238.00 $2,336.00 $2,454.00 55860 90 $1,012.00 $1,192.00 $1,244.00 $1,306.00 $1,192.00 $1,244.00 $1,306.00 55862 90 $1,351.00 $1,516.00 $1,587.00 $1,672.00 $1,516.00 $1,587.00 $1,672.00 55865 90 $1,890.00 $1,816.00 $1,896.00 $1,992.00 $1,816.00 $1,896.00 $1,992.00 55866 90 $1,615.00 $2,378.00 $2,482.00 $2,608.00 $2,378.00 $2,482.00 $2,608.00 55870 0 $166.00 $234.00 $245.00 $258.00 $197.00 $206.00 $216.00 55873 90 $1,127.00 $1,565.00 $1,637.00 $1,721.00 $1,565.00 $1,637.00 $1,721.00 55875 90 ------- $1,037.00 $1,084.00 $1,139.00 $1,037.00 $1,084.00 $1,139.00 55876 0 ------- $207.00 $221.00 $238.00 $156.00 $167.00 $181.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 219
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 55899 YYY BR ------- ------- ------- ------- ------- ------- 55920 0 ------- $593.00 $619.00 $651.00 $593.00 $619.00 $651.00 56405 10 $131.00 $145.00 $154.00 $164.00 $140.00 $148.00 $158.00 56420 10 $130.00 $174.00 $185.00 $196.00 $124.00 $132.00 $141.00 56440 10 $271.00 $243.00 $257.00 $275.00 $243.00 $257.00 $275.00 56441 10 $183.00 $197.00 $208.00 $222.00 $183.00 $193.00 $206.00 56442 0 ------- $64.00 $68.00 $72.00 $64.00 $68.00 $72.00 56501 10 $122.00 $172.00 $183.00 $195.00 $148.00 $157.00 $168.00 56515 10 $200.00 $292.00 $309.00 $329.00 $258.00 $272.00 $290.00 56605 0 $96.00 $112.00 $119.00 $127.00 $82.00 $87.00 $93.00 56606 ZZZ $49.00 $53.00 $56.00 $60.00 $41.00 $43.00 $46.00 56620 90 $607.00 $697.00 $736.00 $785.00 $697.00 $736.00 $785.00 56625 90 $735.00 $782.00 $826.00 $881.00 $782.00 $826.00 $881.00 56630 90 $1,061.00 $1,135.00 $1,196.00 $1,274.00 $1,135.00 $1,196.00 $1,274.00 56631 90 $1,400.00 $1,453.00 $1,533.00 $1,634.00 $1,453.00 $1,533.00 $1,634.00 56632 90 $1,636.00 $1,675.00 $1,769.00 $1,891.00 $1,675.00 $1,769.00 $1,891.00 56633 90 $1,350.00 $1,481.00 $1,561.00 $1,663.00 $1,481.00 $1,561.00 $1,663.00 56634 90 $1,537.00 $1,574.00 $1,660.00 $1,772.00 $1,574.00 $1,660.00 $1,772.00 56637 90 $1,806.00 $1,870.00 $1,973.00 $2,105.00 $1,870.00 $1,973.00 $2,105.00 56640 90 $1,777.00 $1,873.00 $1,981.00 $2,124.00 $1,873.00 $1,981.00 $2,124.00 56700 10 $227.00 $245.00 $259.00 $276.00 $245.00 $259.00 $276.00 56740 10 $321.00 $393.00 $416.00 $446.00 $393.00 $416.00 $446.00 56800 10 $310.00 $322.00 $340.00 $364.00 $322.00 $340.00 $364.00 56805 90 $1,349.00 $1,525.00 $1,610.00 $1,720.00 $1,525.00 $1,610.00 $1,720.00 56810 10 $316.00 $347.00 $367.00 $393.00 $347.00 $367.00 $393.00 56820 0 $119.00 $147.00 $156.00 $167.00 $114.00 $121.00 $130.00 56821 0 $154.00 $199.00 $211.00 $226.00 $156.00 $166.00 $178.00 57000 10 $237.00 $251.00 $265.00 $283.00 $251.00 $265.00 $283.00 57010 90 $429.00 $563.00 $595.00 $634.00 $563.00 $595.00 $634.00 57020 0 $118.00 $128.00 $135.00 $145.00 $111.00 $117.00 $126.00 57022 10 $179.00 $221.00 $232.00 $247.00 $221.00 $232.00 $247.00 57023 10 $290.00 $410.00 $434.00 $464.00 $410.00 $434.00 $464.00 57061 10 $124.00 $151.00 $161.00 $171.00 $128.00 $135.00 $145.00 57065 10 $251.00 $256.00 $272.00 $290.00 $227.00 $241.00 $258.00 57100 0 $90.00 $119.00 $126.00 $134.00 $89.00 $94.00 $100.00 57105 10 $132.00 $181.00 $192.00 $205.00 $165.00 $175.00 $187.00 57106 90 $409.00 $614.00 $648.00 $689.00 $614.00 $648.00 $689.00 57107 90 $1,467.00 $1,851.00 $1,954.00 $2,090.00 $1,851.00 $1,954.00 $2,090.00 57109 90 $1,787.00 $2,119.00 $2,240.00 $2,398.00 $2,119.00 $2,240.00 $2,398.00 57110 90 $1,015.00 $1,196.00 $1,265.00 $1,353.00 $1,196.00 $1,265.00 $1,353.00 57111 90 $1,793.00 $2,155.00 $2,277.00 $2,436.00 $2,155.00 $2,277.00 $2,436.00 57112 90 $1,907.00 $2,238.00 $2,357.00 $2,511.00 $2,238.00 $2,357.00 $2,511.00 57120 90 $612.00 $674.00 $713.00 $761.00 $674.00 $713.00 $761.00 57130 10 $220.00 $241.00 $255.00 $273.00 $213.00 $225.00 $241.00 57135 10 $231.00 $258.00 $273.00 $292.00 $230.00 $243.00 $260.00 57150 0 $50.00 $73.00 $78.00 $83.00 $40.00 $43.00 $46.00 57155 90 $383.00 $554.00 $580.00 $608.00 $554.00 $580.00 $608.00 57160 0 $67.00 $101.00 $107.00 $114.00 $65.00 $68.00 $73.00 57170 0 $74.00 $102.00 $109.00 $116.00 $66.00 $70.00 $75.00 57180 10 $124.00 $191.00 $203.00 $216.00 $145.00 $153.00 $164.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 220
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 57200 90 $313.00 $387.00 $409.00 $436.00 $387.00 $409.00 $436.00 57210 90 $395.00 $481.00 $509.00 $543.00 $481.00 $509.00 $543.00 57220 90 $378.00 $417.00 $441.00 $470.00 $417.00 $441.00 $470.00 57230 90 $442.00 $511.00 $537.00 $569.00 $511.00 $537.00 $569.00 57240 90 $536.00 $818.00 $850.00 $888.00 $818.00 $850.00 $888.00 57250 90 $485.00 $803.00 $835.00 $873.00 $803.00 $835.00 $873.00 57260 90 $700.00 $1,018.00 $1,062.00 $1,116.00 $1,018.00 $1,062.00 $1,116.00 57265 90 $902.00 $1,158.00 $1,214.00 $1,284.00 $1,158.00 $1,214.00 $1,284.00 57267 ZZZ ------- $367.00 $389.00 $420.00 $367.00 $389.00 $420.00 57268 90 $577.00 $626.00 $662.00 $705.00 $626.00 $662.00 $705.00 57270 90 $867.00 $1,052.00 $1,109.00 $1,183.00 $1,052.00 $1,109.00 $1,183.00 57280 90 $1,071.00 $1,272.00 $1,341.00 $1,428.00 $1,272.00 $1,341.00 $1,428.00 57282 90 $734.00 $674.00 $716.00 $769.00 $674.00 $716.00 $769.00 57283 90 ------- $901.00 $946.00 $1,003.00 $901.00 $946.00 $1,003.00 57284 90 $950.00 $1,109.00 $1,169.00 $1,243.00 $1,109.00 $1,169.00 $1,243.00 57285 90 ------- $849.00 $883.00 $923.00 $849.00 $883.00 $923.00 57287 90 $685.00 $907.00 $951.00 $1,004.00 $907.00 $951.00 $1,004.00 57288 90 $1,009.00 $1,070.00 $1,121.00 $1,184.00 $1,070.00 $1,121.00 $1,184.00 57289 90 $879.00 $1,010.00 $1,063.00 $1,130.00 $1,010.00 $1,063.00 $1,130.00 57291 90 $622.00 $720.00 $761.00 $812.00 $720.00 $761.00 $812.00 57292 90 $925.00 $1,099.00 $1,162.00 $1,243.00 $1,099.00 $1,162.00 $1,243.00 57295 90 ------- $649.00 $687.00 $735.00 $649.00 $687.00 $735.00 57296 90 ------- $1,239.00 $1,306.00 $1,391.00 $1,239.00 $1,306.00 $1,391.00 57300 90 $653.00 $690.00 $728.00 $775.00 $690.00 $728.00 $775.00 57305 90 $995.00 $1,164.00 $1,230.00 $1,317.00 $1,164.00 $1,230.00 $1,317.00 57307 90 $997.00 $1,307.00 $1,383.00 $1,483.00 $1,307.00 $1,383.00 $1,483.00 57308 90 $769.00 $834.00 $881.00 $941.00 $834.00 $881.00 $941.00 57310 90 $517.00 $619.00 $648.00 $683.00 $619.00 $648.00 $683.00 57311 90 $612.00 $706.00 $739.00 $779.00 $706.00 $739.00 $779.00 57320 90 $693.00 $708.00 $743.00 $784.00 $708.00 $743.00 $784.00 57330 90 $916.00 $1,022.00 $1,072.00 $1,133.00 $1,022.00 $1,072.00 $1,133.00 57335 90 $963.00 $1,507.00 $1,586.00 $1,686.00 $1,507.00 $1,586.00 $1,686.00 57400 0 $70.00 $180.00 $190.00 $203.00 $180.00 $190.00 $203.00 57410 0 $57.00 $141.00 $149.00 $159.00 $141.00 $149.00 $159.00 57415 10 $75.00 $207.00 $218.00 $232.00 $207.00 $218.00 $232.00 57420 0 $124.00 $155.00 $164.00 $175.00 $121.00 $128.00 $137.00 57421 0 $162.00 $211.00 $224.00 $239.00 $167.00 $177.00 $190.00 57423 90 ------- $1,208.00 $1,273.00 $1,357.00 $1,208.00 $1,273.00 $1,357.00 57425 90 ------- $1,273.00 $1,342.00 $1,431.00 $1,273.00 $1,342.00 $1,431.00 57452 0 $96.00 $146.00 $155.00 $166.00 $122.00 $129.00 $139.00 57454 0 $125.00 $207.00 $220.00 $235.00 $184.00 $195.00 $209.00 57455 0 $149.00 $193.00 $205.00 $219.00 $150.00 $159.00 $171.00 57456 0 $141.00 $182.00 $193.00 $206.00 $140.00 $149.00 $159.00 57460 0 $223.00 $413.00 $439.00 $468.00 $221.00 $234.00 $251.00 57461 0 $333.00 $460.00 $490.00 $522.00 $257.00 $271.00 $291.00 57500 0 $89.00 $180.00 $191.00 $203.00 $98.00 $103.00 $110.00 57505 10 $105.00 $135.00 $143.00 $153.00 $119.00 $127.00 $136.00 57510 10 $140.00 $179.00 $190.00 $203.00 $156.00 $165.00 $177.00 57511 10 $159.00 $194.00 $206.00 $220.00 $174.00 $185.00 $198.00 57513 10 $191.00 $190.00 $202.00 $216.00 $175.00 $186.00 $199.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 221
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 57520 90 $359.00 $413.00 $438.00 $468.00 $364.00 $386.00 $413.00 57522 90 $319.00 $351.00 $372.00 $396.00 $320.00 $339.00 $362.00 57530 90 $386.00 $452.00 $478.00 $510.00 $452.00 $478.00 $510.00 57531 90 $2,036.00 $2,265.00 $2,393.00 $2,560.00 $2,265.00 $2,393.00 $2,560.00 57540 90 $815.00 $1,030.00 $1,088.00 $1,164.00 $1,030.00 $1,088.00 $1,164.00 57545 90 $700.00 $1,088.00 $1,149.00 $1,227.00 $1,088.00 $1,149.00 $1,227.00 57550 90 $486.00 $532.00 $562.00 $599.00 $532.00 $562.00 $599.00 57555 90 $774.00 $795.00 $840.00 $897.00 $795.00 $840.00 $897.00 57556 90 $718.00 $744.00 $784.00 $834.00 $744.00 $784.00 $834.00 57558 10 ------- $166.00 $176.00 $188.00 $150.00 $159.00 $170.00 57700 90 $279.00 $390.00 $412.00 $438.00 $390.00 $412.00 $438.00 57720 90 $328.00 $403.00 $426.00 $454.00 $403.00 $426.00 $454.00 57800 0 $71.00 $80.00 $85.00 $91.00 $65.00 $69.00 $74.00 58100 0 $74.00 $148.00 $157.00 $167.00 $119.00 $126.00 $135.00 58110 ZZZ ------- $67.00 $71.00 $76.00 $56.00 $60.00 $64.00 58120 10 $297.00 $322.00 $341.00 $364.00 $286.00 $302.00 $323.00 58140 90 $1,010.00 $1,213.00 $1,283.00 $1,374.00 $1,213.00 $1,283.00 $1,374.00 58145 90 $677.00 $716.00 $757.00 $808.00 $716.00 $757.00 $808.00 58146 90 $1,089.00 $1,544.00 $1,632.00 $1,748.00 $1,544.00 $1,632.00 $1,748.00 58150 90 $1,110.00 $1,306.00 $1,378.00 $1,471.00 $1,306.00 $1,378.00 $1,471.00 58152 90 $1,159.00 $1,665.00 $1,760.00 $1,883.00 $1,665.00 $1,760.00 $1,883.00 58180 90 $1,118.00 $1,249.00 $1,315.00 $1,400.00 $1,249.00 $1,315.00 $1,400.00 58200 90 $1,562.00 $1,735.00 $1,833.00 $1,959.00 $1,735.00 $1,833.00 $1,959.00 58210 90 $2,080.00 $2,310.00 $2,439.00 $2,607.00 $2,310.00 $2,439.00 $2,607.00 58240 90 $2,898.00 $3,519.00 $3,689.00 $3,907.00 $3,519.00 $3,689.00 $3,907.00 58260 90 $926.00 $1,095.00 $1,157.00 $1,237.00 $1,095.00 $1,157.00 $1,237.00 58262 90 $1,026.00 $1,225.00 $1,295.00 $1,386.00 $1,225.00 $1,295.00 $1,386.00 58263 90 $1,120.00 $1,321.00 $1,396.00 $1,494.00 $1,321.00 $1,396.00 $1,494.00 58267 90 $1,133.00 $1,403.00 $1,483.00 $1,587.00 $1,403.00 $1,483.00 $1,587.00 58270 90 $1,019.00 $1,177.00 $1,244.00 $1,332.00 $1,177.00 $1,244.00 $1,332.00 58275 90 $1,121.00 $1,305.00 $1,380.00 $1,476.00 $1,305.00 $1,380.00 $1,476.00 58280 90 $1,132.00 $1,399.00 $1,478.00 $1,582.00 $1,399.00 $1,478.00 $1,582.00 58285 90 $1,360.00 $1,756.00 $1,857.00 $1,990.00 $1,756.00 $1,857.00 $1,990.00 58290 90 $1,089.00 $1,541.00 $1,629.00 $1,744.00 $1,541.00 $1,629.00 $1,744.00 58291 90 $1,197.00 $1,674.00 $1,770.00 $1,896.00 $1,674.00 $1,770.00 $1,896.00 58292 90 $1,268.00 $1,768.00 $1,870.00 $2,002.00 $1,768.00 $1,870.00 $2,002.00 58293 90 $1,318.00 $1,839.00 $1,944.00 $2,082.00 $1,839.00 $1,944.00 $2,082.00 58294 90 $1,168.00 $1,624.00 $1,715.00 $1,835.00 $1,624.00 $1,715.00 $1,835.00 58300 0 $96.00 $108.00 $115.00 $123.00 $72.00 $77.00 $82.00 58301 0 $71.00 $131.00 $139.00 $148.00 $92.00 $97.00 $104.00 58321 0 $81.00 $103.00 $109.00 $116.00 $66.00 $70.00 $75.00 58322 0 $90.00 $118.00 $125.00 $134.00 $80.00 $85.00 $91.00 58323 0 $24.00 $30.00 $32.00 $34.00 $17.00 $18.00 $20.00 58340 0 $87.00 $181.00 $193.00 $204.00 $79.00 $83.00 $88.00 58345 10 $335.00 $365.00 $384.00 $406.00 $365.00 $384.00 $406.00 58346 90 $408.00 $587.00 $615.00 $648.00 $587.00 $615.00 $648.00 58350 10 $103.00 $129.00 $137.00 $146.00 $103.00 $109.00 $117.00 58353 10 $225.00 $1,663.00 $1,779.00 $1,882.00 $295.00 $313.00 $336.00 58356 10 ------- $2,983.00 $3,191.00 $3,377.00 $477.00 $506.00 $545.00 58400 90 $519.00 $586.00 $619.00 $660.00 $586.00 $619.00 $660.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 222
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 58410 90 $752.00 $1,057.00 $1,116.00 $1,190.00 $1,057.00 $1,116.00 $1,190.00 58520 90 $663.00 $1,033.00 $1,091.00 $1,165.00 $1,033.00 $1,091.00 $1,165.00 58540 90 $923.00 $1,203.00 $1,271.00 $1,361.00 $1,203.00 $1,271.00 $1,361.00 58541 90 ------- $1,124.00 $1,188.00 $1,272.00 $1,124.00 $1,188.00 $1,272.00 58542 90 ------- $1,238.00 $1,304.00 $1,390.00 $1,238.00 $1,304.00 $1,390.00 58543 90 ------- $1,259.00 $1,326.00 $1,414.00 $1,259.00 $1,326.00 $1,414.00 58544 90 ------- $1,362.00 $1,435.00 $1,530.00 $1,362.00 $1,435.00 $1,530.00 58545 90 $876.00 $1,193.00 $1,261.00 $1,350.00 $1,193.00 $1,261.00 $1,350.00 58546 90 $1,104.00 $1,514.00 $1,601.00 $1,716.00 $1,514.00 $1,601.00 $1,716.00 58548 90 ------- $2,379.00 $2,513.00 $2,688.00 $2,379.00 $2,513.00 $2,688.00 58550 90 $1,038.00 $1,175.00 $1,243.00 $1,331.00 $1,175.00 $1,243.00 $1,331.00 58552 90 $853.00 $1,290.00 $1,360.00 $1,449.00 $1,290.00 $1,360.00 $1,449.00 58553 90 $1,096.00 $1,520.00 $1,608.00 $1,722.00 $1,520.00 $1,608.00 $1,722.00 58554 90 $1,085.00 $1,726.00 $1,817.00 $1,934.00 $1,726.00 $1,817.00 $1,934.00 58555 0 $261.00 $312.00 $331.00 $354.00 $257.00 $273.00 $292.00 58558 0 $340.00 $412.00 $437.00 $468.00 $363.00 $384.00 $412.00 58559 0 $436.00 $467.00 $494.00 $531.00 $467.00 $494.00 $531.00 58560 0 $482.00 $530.00 $561.00 $602.00 $530.00 $561.00 $602.00 58561 0 $677.00 $750.00 $794.00 $853.00 $750.00 $794.00 $853.00 58562 0 $339.00 $441.00 $468.00 $501.00 $397.00 $420.00 $451.00 58563 0 $450.00 $2,683.00 $2,869.00 $3,035.00 $468.00 $495.00 $531.00 58565 90 ------- $2,714.00 $2,908.00 $3,089.00 $608.00 $651.00 $709.00 58570 90 ------- $1,207.00 $1,276.00 $1,367.00 $1,207.00 $1,276.00 $1,367.00 58571 90 ------- $1,315.00 $1,386.00 $1,478.00 $1,315.00 $1,386.00 $1,478.00 58572 90 ------- $1,501.00 $1,586.00 $1,699.00 $1,501.00 $1,586.00 $1,699.00 58573 90 ------- $1,681.00 $1,769.00 $1,883.00 $1,681.00 $1,769.00 $1,883.00 58578 YYY BR ------- ------- ------- ------- ------- ------- 58579 YYY BR ------- ------- ------- ------- ------- ------- 58600 90 $337.00 $484.00 $512.00 $547.00 $484.00 $512.00 $547.00 58605 90 $298.00 $439.00 $464.00 $496.00 $439.00 $464.00 $496.00 58611 ZZZ $47.00 $107.00 $113.00 $121.00 $107.00 $113.00 $121.00 58615 10 $319.00 $339.00 $360.00 $385.00 $339.00 $360.00 $385.00 58660 90 $793.00 $897.00 $950.00 $1,019.00 $897.00 $950.00 $1,019.00 58661 10 $804.00 $864.00 $915.00 $981.00 $864.00 $915.00 $981.00 58662 90 $807.00 $944.00 $999.00 $1,071.00 $944.00 $999.00 $1,071.00 58670 90 $450.00 $484.00 $512.00 $547.00 $484.00 $512.00 $547.00 58671 90 $463.00 $485.00 $513.00 $549.00 $485.00 $513.00 $549.00 58672 90 $872.00 $1,005.00 $1,066.00 $1,145.00 $1,005.00 $1,066.00 $1,145.00 58673 90 $928.00 $1,084.00 $1,148.00 $1,232.00 $1,084.00 $1,148.00 $1,232.00 58679 YYY BR ------- ------- ------- ------- ------- ------- 58700 90 $544.00 $1,010.00 $1,069.00 $1,145.00 $1,010.00 $1,069.00 $1,145.00 58720 90 $844.00 $949.00 $1,004.00 $1,074.00 $949.00 $1,004.00 $1,074.00 58740 90 $508.00 $1,160.00 $1,227.00 $1,314.00 $1,160.00 $1,227.00 $1,314.00 58750 90 $949.00 $1,213.00 $1,284.00 $1,376.00 $1,213.00 $1,284.00 $1,376.00 58752 90 $893.00 $1,197.00 $1,267.00 $1,357.00 $1,197.00 $1,267.00 $1,357.00 58760 90 $769.00 $1,101.00 $1,168.00 $1,257.00 $1,101.00 $1,168.00 $1,257.00 58770 90 $763.00 $1,144.00 $1,211.00 $1,298.00 $1,144.00 $1,211.00 $1,298.00 58800 90 $343.00 $419.00 $442.00 $469.00 $387.00 $408.00 $433.00 58805 90 $509.00 $527.00 $557.00 $595.00 $527.00 $557.00 $595.00 58820 90 $326.00 $413.00 $437.00 $467.00 $413.00 $437.00 $467.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 223
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 58822 90 $603.00 $901.00 $949.00 $1,010.00 $901.00 $949.00 $1,010.00 58823 0 $216.00 $1,210.00 $1,290.00 $1,360.00 $234.00 $245.00 $257.00 58825 90 $469.00 $920.00 $972.00 $1,040.00 $920.00 $972.00 $1,040.00 58900 90 $489.00 $538.00 $568.00 $606.00 $538.00 $568.00 $606.00 58920 90 $571.00 $936.00 $991.00 $1,063.00 $936.00 $991.00 $1,063.00 58925 90 $820.00 $964.00 $1,020.00 $1,091.00 $964.00 $1,020.00 $1,091.00 58940 90 $592.00 $657.00 $694.00 $742.00 $657.00 $694.00 $742.00 58943 90 $1,368.00 $1,484.00 $1,569.00 $1,680.00 $1,484.00 $1,569.00 $1,680.00 58950 90 $1,170.00 $1,410.00 $1,490.00 $1,593.00 $1,410.00 $1,490.00 $1,593.00 58951 90 $1,703.00 $1,819.00 $1,920.00 $2,052.00 $1,819.00 $1,920.00 $2,052.00 58952 90 $1,876.00 $2,055.00 $2,170.00 $2,321.00 $2,055.00 $2,170.00 $2,321.00 58953 90 $1,839.00 $2,554.00 $2,698.00 $2,887.00 $2,554.00 $2,698.00 $2,887.00 58954 90 $1,999.00 $2,773.00 $2,930.00 $3,136.00 $2,773.00 $2,930.00 $3,136.00 58956 90 ------- $1,854.00 $1,990.00 $2,175.00 $1,854.00 $1,990.00 $2,175.00 58957 90 ------- $1,936.00 $2,045.00 $2,189.00 $1,936.00 $2,045.00 $2,189.00 58958 90 ------- $2,143.00 $2,264.00 $2,424.00 $2,143.00 $2,264.00 $2,424.00 58960 90 $1,174.00 $1,219.00 $1,289.00 $1,380.00 $1,219.00 $1,289.00 $1,380.00 58999 YYY BR ------- ------- ------- ------- ------- ------- 59000 0 $123.00 $181.00 $196.00 $213.00 $116.00 $126.00 $140.00 59001 0 $167.00 $259.00 $282.00 $313.00 $259.00 $282.00 $313.00 59012 0 $267.00 $294.00 $319.00 $355.00 $294.00 $319.00 $355.00 59015 0 $168.00 $219.00 $237.00 $262.00 $191.00 $207.00 $230.00 59020 0 $85.00 $98.00 $107.00 $120.00 $98.00 $107.00 $120.00 59020-26 0 ------- $55.00 $59.00 $66.00 $55.00 $59.00 $66.00 59020-TC 0 ------- $43.00 $48.00 $54.00 $43.00 $48.00 $54.00 59025 0 $54.00 $64.00 $70.00 $77.00 $64.00 $70.00 $77.00 59025-26 0 ------- $44.00 $48.00 $54.00 $44.00 $48.00 $54.00 59025-TC 0 ------- $20.00 $21.00 $23.00 $20.00 $21.00 $23.00 59030 0 $155.00 $161.00 $175.00 $195.00 $161.00 $175.00 $195.00 59050 0 $71.00 $74.00 $80.00 $89.00 $74.00 $80.00 $89.00 59051 0 $47.00 $61.00 $66.00 $73.00 $61.00 $66.00 $73.00 59100 90 $633.00 $1,157.00 $1,253.00 $1,387.00 $1,157.00 $1,253.00 $1,387.00 59120 90 $893.00 $1,097.00 $1,187.00 $1,312.00 $1,097.00 $1,187.00 $1,312.00 59121 90 $768.00 $1,107.00 $1,198.00 $1,325.00 $1,107.00 $1,198.00 $1,325.00 59130 90 $832.00 $1,260.00 $1,367.00 $1,517.00 $1,260.00 $1,367.00 $1,517.00 59135 90 $1,083.00 $1,266.00 $1,372.00 $1,521.00 $1,266.00 $1,372.00 $1,521.00 59136 90 $934.00 $1,202.00 $1,302.00 $1,443.00 $1,202.00 $1,302.00 $1,443.00 59140 90 $461.00 $515.00 $558.00 $617.00 $515.00 $558.00 $617.00 59150 90 $543.00 $1,074.00 $1,165.00 $1,291.00 $1,074.00 $1,165.00 $1,291.00 59151 90 $690.00 $1,054.00 $1,144.00 $1,267.00 $1,054.00 $1,144.00 $1,267.00 59160 10 $279.00 $311.00 $336.00 $369.00 $261.00 $283.00 $313.00 59200 0 $79.00 $105.00 $114.00 $125.00 $65.00 $71.00 $79.00 59300 0 $179.00 $267.00 $289.00 $318.00 $207.00 $225.00 $251.00 59320 0 $196.00 $219.00 $238.00 $265.00 $219.00 $238.00 $265.00 59325 0 $316.00 $344.00 $372.00 $412.00 $344.00 $372.00 $412.00 59350 0 $375.00 $402.00 $437.00 $488.00 $402.00 $437.00 $488.00 59400 0 $1,816.00 $2,430.00 $2,622.00 $2,882.00 $2,430.00 $2,622.00 $2,882.00 59409 0 $1,019.00 $1,114.00 $1,212.00 $1,352.00 $1,114.00 $1,212.00 $1,352.00 59410 0 $1,123.00 $1,277.00 $1,387.00 $1,542.00 $1,277.00 $1,387.00 $1,542.00 59412 0 $141.00 $148.00 $161.00 $179.00 $148.00 $161.00 $179.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 224
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 59414 0 $134.00 $133.00 $144.00 $161.00 $133.00 $144.00 $161.00 59425 0 $414.00 $594.00 $638.00 $695.00 $471.00 $506.00 $556.00 59426 0 $708.00 $1,059.00 $1,136.00 $1,237.00 $831.00 $892.00 $979.00 59430 0 $140.00 $197.00 $214.00 $237.00 $181.00 $197.00 $219.00 59510 0 $2,064.00 $2,752.00 $2,970.00 $3,265.00 $2,752.00 $2,970.00 $3,265.00 59514 0 $1,199.00 $1,317.00 $1,432.00 $1,597.00 $1,317.00 $1,432.00 $1,597.00 59515 0 $1,324.00 $1,534.00 $1,664.00 $1,847.00 $1,534.00 $1,664.00 $1,847.00 59525 ZZZ $591.00 $694.00 $754.00 $838.00 $694.00 $754.00 $838.00 59610 0 $1,805.00 $2,560.00 $2,765.00 $3,041.00 $2,560.00 $2,765.00 $3,041.00 59612 0 $1,113.00 $1,247.00 $1,357.00 $1,513.00 $1,247.00 $1,357.00 $1,513.00 59614 0 $1,208.00 $1,389.00 $1,509.00 $1,680.00 $1,389.00 $1,509.00 $1,680.00 59618 0 $2,035.00 $2,882.00 $3,111.00 $3,422.00 $2,882.00 $3,111.00 $3,422.00 59620 0 $1,293.00 $1,438.00 $1,564.00 $1,745.00 $1,438.00 $1,564.00 $1,745.00 59622 0 $1,397.00 $1,666.00 $1,807.00 $2,007.00 $1,666.00 $1,807.00 $2,007.00 59812 90 $343.00 $423.00 $457.00 $503.00 $404.00 $437.00 $482.00 59820 90 $389.00 $507.00 $547.00 $597.00 $470.00 $507.00 $555.00 59821 90 $398.00 $522.00 $564.00 $617.00 $484.00 $522.00 $574.00 59830 90 $496.00 $605.00 $655.00 $723.00 $605.00 $655.00 $723.00 59840 10 $331.00 $301.00 $326.00 $360.00 $295.00 $320.00 $354.00 59841 10 $443.00 $525.00 $568.00 $626.00 $498.00 $539.00 $596.00 59850 90 $449.00 $522.00 $564.00 $623.00 $522.00 $564.00 $623.00 59851 90 $464.00 $555.00 $600.00 $660.00 $555.00 $600.00 $660.00 59852 90 $642.00 $752.00 $813.00 $898.00 $752.00 $813.00 $898.00 59855 90 $477.00 $580.00 $629.00 $696.00 $580.00 $629.00 $696.00 59856 90 $577.00 $690.00 $749.00 $830.00 $690.00 $749.00 $830.00 59857 90 $711.00 $806.00 $872.00 $964.00 $806.00 $872.00 $964.00 59866 0 $304.00 $338.00 $366.00 $405.00 $338.00 $366.00 $405.00 59870 90 $348.00 $635.00 $687.00 $756.00 $635.00 $687.00 $756.00 59871 0 $192.00 $191.00 $207.00 $230.00 $191.00 $207.00 $230.00 59898 YYY BR ------- ------- ------- ------- ------- ------- 59899 YYY BR ------- ------- ------- ------- ------- ------- 60000 10 $114.00 $196.00 $207.00 $219.00 $181.00 $190.00 $201.00 60100 0 $96.00 $149.00 $156.00 $164.00 $107.00 $111.00 $117.00 60200 90 $744.00 $832.00 $879.00 $935.00 $832.00 $879.00 $935.00 60210 90 $872.00 $893.00 $943.00 $1,008.00 $893.00 $943.00 $1,008.00 60212 90 $1,170.00 $1,286.00 $1,362.00 $1,460.00 $1,286.00 $1,362.00 $1,460.00 60220 90 $851.00 $977.00 $1,032.00 $1,101.00 $977.00 $1,032.00 $1,101.00 60225 90 $1,107.00 $1,177.00 $1,244.00 $1,330.00 $1,177.00 $1,244.00 $1,330.00 60240 90 $1,228.00 $1,257.00 $1,329.00 $1,423.00 $1,257.00 $1,329.00 $1,423.00 60252 90 $1,427.00 $1,683.00 $1,775.00 $1,893.00 $1,683.00 $1,775.00 $1,893.00 60254 90 $1,911.00 $2,169.00 $2,281.00 $2,421.00 $2,169.00 $2,281.00 $2,421.00 60260 90 $1,022.00 $1,409.00 $1,487.00 $1,587.00 $1,409.00 $1,487.00 $1,587.00 60270 90 $1,468.00 $1,763.00 $1,857.00 $1,978.00 $1,763.00 $1,857.00 $1,978.00 60271 90 $1,210.00 $1,356.00 $1,429.00 $1,520.00 $1,356.00 $1,429.00 $1,520.00 60280 90 $546.00 $555.00 $585.00 $620.00 $555.00 $585.00 $620.00 60281 90 $670.00 $746.00 $784.00 $829.00 $746.00 $784.00 $829.00 60300 0 ------- $134.00 $142.00 $150.00 $67.00 $70.00 $73.00 60500 90 $1,232.00 $1,300.00 $1,376.00 $1,476.00 $1,300.00 $1,376.00 $1,476.00 60502 90 $1,475.00 $1,637.00 $1,734.00 $1,860.00 $1,637.00 $1,734.00 $1,860.00 60505 90 $1,631.00 $1,794.00 $1,897.00 $2,031.00 $1,794.00 $1,897.00 $2,031.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 225
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 60512 ZZZ $310.00 $321.00 $340.00 $364.00 $321.00 $340.00 $364.00 60520 90 $1,405.00 $1,358.00 $1,441.00 $1,550.00 $1,358.00 $1,441.00 $1,550.00 60521 90 $1,591.00 $1,563.00 $1,666.00 $1,803.00 $1,563.00 $1,666.00 $1,803.00 60522 90 $1,820.00 $1,879.00 $1,999.00 $2,158.00 $1,879.00 $1,999.00 $2,158.00 60540 90 $1,272.00 $1,376.00 $1,448.00 $1,540.00 $1,376.00 $1,448.00 $1,540.00 60545 90 $1,505.00 $1,579.00 $1,663.00 $1,771.00 $1,579.00 $1,663.00 $1,771.00 60600 90 $1,477.00 $1,843.00 $1,934.00 $2,050.00 $1,843.00 $1,934.00 $2,050.00 60605 90 $1,624.00 $2,304.00 $2,411.00 $2,545.00 $2,304.00 $2,411.00 $2,545.00 60650 90 $1,340.00 $1,552.00 $1,639.00 $1,753.00 $1,552.00 $1,639.00 $1,753.00 60659 YYY BR ------- ------- ------- ------- ------- ------- 60699 YYY BR ------- ------- ------- ------- ------- ------- 61020 0 $150.00 $172.00 $186.00 $203.00 $172.00 $186.00 $203.00 61026 0 $138.00 $173.00 $186.00 $203.00 $173.00 $186.00 $203.00 61050 0 $106.00 $140.00 $147.00 $155.00 $140.00 $147.00 $155.00 61055 0 $143.00 $181.00 $190.00 $201.00 $181.00 $190.00 $201.00 61070 0 $67.00 $109.00 $117.00 $127.00 $109.00 $117.00 $127.00 61105 90 $503.00 $579.00 $629.00 $694.00 $579.00 $629.00 $694.00 61107 0 $863.00 $445.00 $486.00 $543.00 $445.00 $486.00 $543.00 61108 90 $959.00 $1,138.00 $1,232.00 $1,359.00 $1,138.00 $1,232.00 $1,359.00 61120 90 $733.00 $933.00 $1,009.00 $1,110.00 $933.00 $1,009.00 $1,110.00 61140 90 $1,389.00 $1,637.00 $1,778.00 $1,970.00 $1,637.00 $1,778.00 $1,970.00 61150 90 $1,503.00 $1,752.00 $1,899.00 $2,100.00 $1,752.00 $1,899.00 $2,100.00 61151 90 $795.00 $1,275.00 $1,380.00 $1,523.00 $1,275.00 $1,380.00 $1,523.00 61154 90 $1,393.00 $1,636.00 $1,780.00 $1,975.00 $1,636.00 $1,780.00 $1,975.00 61156 90 $1,473.00 $1,640.00 $1,783.00 $1,978.00 $1,640.00 $1,783.00 $1,978.00 61210 0 $527.00 $519.00 $566.00 $633.00 $519.00 $566.00 $633.00 61215 90 $637.00 $607.00 $656.00 $719.00 $607.00 $656.00 $719.00 61250 90 $888.00 $1,112.00 $1,207.00 $1,337.00 $1,112.00 $1,207.00 $1,337.00 61253 90 $1,042.00 $1,218.00 $1,312.00 $1,437.00 $1,218.00 $1,312.00 $1,437.00 61304 90 $2,005.00 $2,176.00 $2,364.00 $2,623.00 $2,176.00 $2,364.00 $2,623.00 61305 90 $2,419.00 $2,579.00 $2,788.00 $3,072.00 $2,579.00 $2,788.00 $3,072.00 61312 90 $2,187.00 $2,673.00 $2,889.00 $3,184.00 $2,673.00 $2,889.00 $3,184.00 61313 90 $2,207.00 $2,578.00 $2,795.00 $3,093.00 $2,578.00 $2,795.00 $3,093.00 61314 90 $2,200.00 $2,388.00 $2,596.00 $2,883.00 $2,388.00 $2,596.00 $2,883.00 61315 90 $2,393.00 $2,743.00 $2,981.00 $3,309.00 $2,743.00 $2,981.00 $3,309.00 61316 ZZZ $88.00 $121.00 $132.00 $147.00 $121.00 $132.00 $147.00 61320 90 $2,118.00 $2,533.00 $2,753.00 $3,056.00 $2,533.00 $2,753.00 $3,056.00 61321 90 $2,310.00 $2,799.00 $3,037.00 $3,366.00 $2,799.00 $3,037.00 $3,366.00 61322 90 $1,779.00 $3,034.00 $3,287.00 $3,636.00 $3,034.00 $3,287.00 $3,636.00 61323 90 $1,842.00 $3,112.00 $3,376.00 $3,741.00 $3,112.00 $3,376.00 $3,741.00 61330 90 $1,706.00 $1,997.00 $2,101.00 $2,229.00 $1,997.00 $2,101.00 $2,229.00 61332 90 $2,307.00 $2,435.00 $2,609.00 $2,841.00 $2,435.00 $2,609.00 $2,841.00 61333 90 $2,231.00 $2,393.00 $2,543.00 $2,739.00 $2,393.00 $2,543.00 $2,739.00 61334 90 $1,525.00 $1,546.00 $1,625.00 $1,723.00 $1,546.00 $1,625.00 $1,723.00 61340 90 $1,584.00 $1,893.00 $2,057.00 $2,281.00 $1,893.00 $2,057.00 $2,281.00 61343 90 $2,673.00 $2,914.00 $3,167.00 $3,515.00 $2,914.00 $3,167.00 $3,515.00 61345 90 $2,259.00 $2,682.00 $2,914.00 $3,236.00 $2,682.00 $2,914.00 $3,236.00 61440 90 $2,110.00 $2,623.00 $2,850.00 $3,165.00 $2,623.00 $2,850.00 $3,165.00 61450 90 $2,173.00 $2,464.00 $2,662.00 $2,931.00 $2,464.00 $2,662.00 $2,931.00 61458 90 $2,433.00 $2,666.00 $2,898.00 $3,220.00 $2,666.00 $2,898.00 $3,220.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 226
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 61460 90 $2,426.00 $2,668.00 $2,876.00 $3,159.00 $2,668.00 $2,876.00 $3,159.00 61470 90 $1,982.00 $2,458.00 $2,658.00 $2,931.00 $2,458.00 $2,658.00 $2,931.00 61480 90 $1,922.00 $2,432.00 $2,644.00 $2,943.00 $2,432.00 $2,644.00 $2,943.00 61490 90 $1,687.00 $2,536.00 $2,763.00 $3,077.00 $2,536.00 $2,763.00 $3,077.00 61500 90 $1,637.00 $1,758.00 $1,901.00 $2,094.00 $1,758.00 $1,901.00 $2,094.00 61501 90 $1,353.00 $1,483.00 $1,598.00 $1,752.00 $1,483.00 $1,598.00 $1,752.00 61510 90 $2,506.00 $2,863.00 $3,109.00 $3,448.00 $2,863.00 $3,109.00 $3,448.00 61512 90 $2,981.00 $3,411.00 $3,710.00 $4,123.00 $3,411.00 $3,710.00 $4,123.00 61514 90 $2,262.00 $2,512.00 $2,730.00 $3,030.00 $2,512.00 $2,730.00 $3,030.00 61516 90 $2,253.00 $2,454.00 $2,665.00 $2,957.00 $2,454.00 $2,665.00 $2,957.00 61517 ZZZ $74.00 $122.00 $133.00 $148.00 $122.00 $133.00 $148.00 61518 90 $3,163.00 $3,665.00 $3,983.00 $4,424.00 $3,665.00 $3,983.00 $4,424.00 61519 90 $3,450.00 $3,958.00 $4,305.00 $4,787.00 $3,958.00 $4,305.00 $4,787.00 61520 90 $4,349.00 $4,968.00 $5,353.00 $5,877.00 $4,968.00 $5,353.00 $5,877.00 61521 90 $3,667.00 $4,262.00 $4,634.00 $5,151.00 $4,262.00 $4,634.00 $5,151.00 61522 90 $2,415.00 $2,884.00 $3,135.00 $3,482.00 $2,884.00 $3,135.00 $3,482.00 61524 90 $2,484.00 $2,750.00 $2,988.00 $3,316.00 $2,750.00 $2,988.00 $3,316.00 61526 90 $3,918.00 $4,392.00 $4,664.00 $5,019.00 $4,392.00 $4,664.00 $5,019.00 61530 90 $3,611.00 $3,735.00 $3,971.00 $4,278.00 $3,735.00 $3,971.00 $4,278.00 61531 90 $1,344.00 $1,555.00 $1,686.00 $1,864.00 $1,555.00 $1,686.00 $1,864.00 61533 90 $1,712.00 $1,992.00 $2,164.00 $2,399.00 $1,992.00 $2,164.00 $2,399.00 61534 90 $1,535.00 $2,136.00 $2,320.00 $2,571.00 $2,136.00 $2,320.00 $2,571.00 61535 90 $958.00 $1,259.00 $1,364.00 $1,507.00 $1,259.00 $1,364.00 $1,507.00 61536 90 $2,862.00 $3,454.00 $3,756.00 $4,175.00 $3,454.00 $3,756.00 $4,175.00 61537 90 ------- $3,052.00 $3,285.00 $3,604.00 $3,052.00 $3,285.00 $3,604.00 61538 90 $2,466.00 $3,240.00 $3,476.00 $3,799.00 $3,240.00 $3,476.00 $3,799.00 61539 90 $2,660.00 $3,128.00 $3,401.00 $3,779.00 $3,128.00 $3,401.00 $3,779.00 61540 90 ------- $2,968.00 $3,240.00 $3,616.00 $2,968.00 $3,240.00 $3,616.00 61541 90 $2,363.00 $2,778.00 $3,003.00 $3,310.00 $2,778.00 $3,003.00 $3,310.00 61542 90 $2,533.00 $3,054.00 $3,319.00 $3,686.00 $3,054.00 $3,319.00 $3,686.00 61543 90 $2,307.00 $2,820.00 $3,066.00 $3,408.00 $2,820.00 $3,066.00 $3,408.00 61544 90 $2,271.00 $2,457.00 $2,658.00 $2,935.00 $2,457.00 $2,658.00 $2,935.00 61545 90 $3,474.00 $4,190.00 $4,544.00 $5,032.00 $4,190.00 $4,544.00 $5,032.00 61546 90 $2,695.00 $3,028.00 $3,284.00 $3,636.00 $3,028.00 $3,284.00 $3,636.00 61548 90 $1,964.00 $1,974.00 $2,105.00 $2,276.00 $1,974.00 $2,105.00 $2,276.00 61550 90 $1,141.00 $1,117.00 $1,165.00 $1,222.00 $1,117.00 $1,165.00 $1,222.00 61552 90 $1,463.00 $1,568.00 $1,632.00 $1,705.00 $1,568.00 $1,632.00 $1,705.00 61556 90 $1,760.00 $2,112.00 $2,274.00 $2,493.00 $2,112.00 $2,274.00 $2,493.00 61557 90 $1,807.00 $2,229.00 $2,425.00 $2,693.00 $2,229.00 $2,425.00 $2,693.00 61558 90 $2,085.00 $2,067.00 $2,153.00 $2,249.00 $2,067.00 $2,153.00 $2,249.00 61559 90 $2,700.00 $3,205.00 $3,489.00 $3,879.00 $3,205.00 $3,489.00 $3,879.00 61563 90 $2,175.00 $2,450.00 $2,632.00 $2,877.00 $2,450.00 $2,632.00 $2,877.00 61564 90 $2,597.00 $3,226.00 $3,513.00 $3,912.00 $3,226.00 $3,513.00 $3,912.00 61566 90 ------- $2,928.00 $3,166.00 $3,490.00 $2,928.00 $3,166.00 $3,490.00 61567 90 ------- $3,242.00 $3,479.00 $3,795.00 $3,242.00 $3,479.00 $3,795.00 61570 90 $1,975.00 $2,403.00 $2,603.00 $2,875.00 $2,403.00 $2,603.00 $2,875.00 61571 90 $2,140.00 $2,611.00 $2,837.00 $3,148.00 $2,611.00 $2,837.00 $3,148.00 61575 90 $2,992.00 $3,027.00 $3,227.00 $3,489.00 $3,027.00 $3,227.00 $3,489.00 61576 90 $3,772.00 $4,601.00 $4,854.00 $5,166.00 $4,601.00 $4,854.00 $5,166.00 61580 90 $2,383.00 $3,090.00 $3,262.00 $3,466.00 $3,090.00 $3,262.00 $3,466.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 227
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 61581 90 $2,674.00 $3,419.00 $3,610.00 $3,839.00 $3,419.00 $3,610.00 $3,839.00 61582 90 $2,557.00 $3,657.00 $3,943.00 $4,311.00 $3,657.00 $3,943.00 $4,311.00 61583 90 $2,972.00 $3,809.00 $4,134.00 $4,571.00 $3,809.00 $4,134.00 $4,571.00 61584 90 $2,830.00 $3,679.00 $3,977.00 $4,373.00 $3,679.00 $3,977.00 $4,373.00 61585 90 $3,142.00 $3,842.00 $4,113.00 $4,465.00 $3,842.00 $4,113.00 $4,465.00 61586 90 $2,097.00 $2,758.00 $2,950.00 $3,188.00 $2,758.00 $2,950.00 $3,188.00 61590 90 $3,299.00 $3,958.00 $4,188.00 $4,475.00 $3,958.00 $4,188.00 $4,475.00 61591 90 $3,491.00 $4,002.00 $4,243.00 $4,545.00 $4,002.00 $4,243.00 $4,545.00 61592 90 $3,245.00 $4,150.00 $4,501.00 $4,975.00 $4,150.00 $4,501.00 $4,975.00 61595 90 $2,350.00 $2,979.00 $3,158.00 $3,378.00 $2,979.00 $3,158.00 $3,378.00 61596 90 $2,827.00 $3,250.00 $3,417.00 $3,618.00 $3,250.00 $3,417.00 $3,618.00 61597 90 $3,046.00 $3,771.00 $4,078.00 $4,493.00 $3,771.00 $4,078.00 $4,493.00 61598 90 $2,693.00 $3,296.00 $3,522.00 $3,813.00 $3,296.00 $3,522.00 $3,813.00 61600 90 $2,039.00 $2,690.00 $2,857.00 $3,064.00 $2,690.00 $2,857.00 $3,064.00 61601 90 $2,279.00 $3,055.00 $3,300.00 $3,624.00 $3,055.00 $3,300.00 $3,624.00 61605 90 $2,299.00 $2,784.00 $2,930.00 $3,103.00 $2,784.00 $2,930.00 $3,103.00 61606 90 $3,178.00 $3,904.00 $4,219.00 $4,644.00 $3,904.00 $4,219.00 $4,644.00 61607 90 $2,961.00 $3,584.00 $3,839.00 $4,176.00 $3,584.00 $3,839.00 $4,176.00 61608 90 $3,458.00 $4,309.00 $4,677.00 $5,177.00 $4,309.00 $4,677.00 $5,177.00 61609 ZZZ $798.00 $869.00 $949.00 $1,062.00 $869.00 $949.00 $1,062.00 61610 ZZZ $2,354.00 $2,606.00 $2,844.00 $3,182.00 $2,606.00 $2,844.00 $3,182.00 61611 ZZZ $584.00 $636.00 $694.00 $776.00 $636.00 $694.00 $776.00 61612 ZZZ $2,219.00 $2,142.00 $2,287.00 $2,485.00 $2,142.00 $2,287.00 $2,485.00 61613 90 $3,375.00 $4,121.00 $4,431.00 $4,842.00 $4,121.00 $4,431.00 $4,842.00 61615 90 $2,576.00 $3,149.00 $3,348.00 $3,598.00 $3,149.00 $3,348.00 $3,598.00 61616 90 $3,535.00 $4,241.00 $4,551.00 $4,958.00 $4,241.00 $4,551.00 $4,958.00 61618 90 $1,389.00 $1,689.00 $1,821.00 $1,998.00 $1,689.00 $1,821.00 $1,998.00 61619 90 $1,682.00 $1,945.00 $2,088.00 $2,278.00 $1,945.00 $2,088.00 $2,278.00 61623 0 $540.00 $745.00 $786.00 $839.00 $745.00 $786.00 $839.00 61624 0 $1,073.00 $1,455.00 $1,530.00 $1,628.00 $1,455.00 $1,530.00 $1,628.00 61626 0 $877.00 $1,165.00 $1,217.00 $1,283.00 $1,165.00 $1,217.00 $1,283.00 61630 90 ------- $1,670.00 $1,755.00 $1,862.00 $1,670.00 $1,755.00 $1,862.00 61635 90 ------- $1,828.00 $1,920.00 $2,037.00 $1,828.00 $1,920.00 $2,037.00 61640 0 ------- $776.00 $804.00 $841.00 $776.00 $804.00 $841.00 61641 ZZZ ------- $273.00 $283.00 $296.00 $273.00 $283.00 $296.00 61642 ZZZ ------- $546.00 $566.00 $591.00 $546.00 $566.00 $591.00 61680 90 $2,758.00 $3,006.00 $3,269.00 $3,632.00 $3,006.00 $3,269.00 $3,632.00 61682 90 $4,798.00 $5,728.00 $6,239.00 $6,952.00 $5,728.00 $6,239.00 $6,952.00 61684 90 $3,341.00 $3,826.00 $4,163.00 $4,631.00 $3,826.00 $4,163.00 $4,631.00 61686 90 $5,012.00 $6,117.00 $6,658.00 $7,411.00 $6,117.00 $6,658.00 $7,411.00 61690 90 $2,556.00 $2,846.00 $3,082.00 $3,404.00 $2,846.00 $3,082.00 $3,404.00 61692 90 $4,007.00 $4,917.00 $5,351.00 $5,955.00 $4,917.00 $5,351.00 $5,955.00 61697 90 $3,231.00 $5,404.00 $5,831.00 $6,420.00 $5,404.00 $5,831.00 $6,420.00 61698 90 $3,103.00 $5,688.00 $6,109.00 $6,686.00 $5,688.00 $6,109.00 $6,686.00 61700 90 $4,037.00 $4,697.00 $5,120.00 $5,709.00 $4,697.00 $5,120.00 $5,709.00 61702 90 $4,019.00 $5,005.00 $5,375.00 $5,878.00 $5,005.00 $5,375.00 $5,878.00 61703 90 $1,444.00 $1,714.00 $1,853.00 $2,043.00 $1,714.00 $1,853.00 $2,043.00 61705 90 $3,043.00 $3,426.00 $3,718.00 $4,123.00 $3,426.00 $3,718.00 $4,123.00 61708 90 $2,546.00 $2,690.00 $2,808.00 $2,950.00 $2,690.00 $2,808.00 $2,950.00 61710 90 $2,129.00 $2,509.00 $2,673.00 $2,891.00 $2,509.00 $2,673.00 $2,891.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 228
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 61711 90 $3,150.00 $3,497.00 $3,804.00 $4,231.00 $3,497.00 $3,804.00 $4,231.00 61720 90 $1,558.00 $1,490.00 $1,593.00 $1,729.00 $1,490.00 $1,593.00 $1,729.00 61735 90 $1,664.00 $1,793.00 $1,901.00 $2,039.00 $1,793.00 $1,901.00 $2,039.00 61750 90 $1,521.00 $1,840.00 $1,998.00 $2,216.00 $1,840.00 $1,998.00 $2,216.00 61751 90 $1,628.00 $1,792.00 $1,947.00 $2,159.00 $1,792.00 $1,947.00 $2,159.00 61760 90 $1,670.00 $1,993.00 $2,168.00 $2,412.00 $1,993.00 $2,168.00 $2,412.00 61770 90 $1,867.00 $1,919.00 $2,049.00 $2,221.00 $1,919.00 $2,049.00 $2,221.00 61790 90 $952.00 $1,104.00 $1,200.00 $1,331.00 $1,104.00 $1,200.00 $1,331.00 61791 90 $1,205.00 $1,417.00 $1,534.00 $1,693.00 $1,417.00 $1,534.00 $1,693.00 61795 ZZZ $371.00 $338.00 $365.00 $401.00 $338.00 $365.00 $401.00 61850 90 $1,090.00 $1,267.00 $1,377.00 $1,526.00 $1,267.00 $1,377.00 $1,526.00 61860 90 $1,197.00 $2,024.00 $2,192.00 $2,422.00 $2,024.00 $2,192.00 $2,422.00 61863 90 ------- $2,001.00 $2,182.00 $2,432.00 $2,001.00 $2,182.00 $2,432.00 61864 ZZZ ------- $741.00 $886.00 $1,105.00 $741.00 $886.00 $1,105.00 61867 90 ------- $2,834.00 $3,033.00 $3,298.00 $2,834.00 $3,033.00 $3,298.00 61868 ZZZ ------- $977.00 $1,127.00 $1,351.00 $977.00 $1,127.00 $1,351.00 61870 90 $616.00 $1,554.00 $1,687.00 $1,868.00 $1,554.00 $1,687.00 $1,868.00 61875 90 $984.00 $1,350.00 $1,450.00 $1,586.00 $1,350.00 $1,450.00 $1,586.00 61880 90 $559.00 $698.00 $757.00 $837.00 $698.00 $757.00 $837.00 61885 90 $262.00 $782.00 $844.00 $925.00 $782.00 $844.00 $925.00 61886 90 $678.00 $985.00 $1,062.00 $1,161.00 $985.00 $1,062.00 $1,161.00 61888 10 $331.00 $528.00 $575.00 $637.00 $528.00 $575.00 $637.00 62000 90 $848.00 $1,062.00 $1,112.00 $1,173.00 $1,062.00 $1,112.00 $1,173.00 62005 90 $1,282.00 $1,590.00 $1,721.00 $1,901.00 $1,590.00 $1,721.00 $1,901.00 62010 90 $1,754.00 $1,996.00 $2,168.00 $2,405.00 $1,996.00 $2,168.00 $2,405.00 62100 90 $1,962.00 $2,105.00 $2,272.00 $2,499.00 $2,105.00 $2,272.00 $2,499.00 62115 90 $1,686.00 $2,142.00 $2,327.00 $2,582.00 $2,142.00 $2,327.00 $2,582.00 62116 90 $1,928.00 $2,322.00 $2,525.00 $2,804.00 $2,322.00 $2,525.00 $2,804.00 62117 90 $2,211.00 $2,389.00 $2,555.00 $2,774.00 $2,389.00 $2,555.00 $2,774.00 62120 90 $1,898.00 $2,278.00 $2,419.00 $2,589.00 $2,278.00 $2,419.00 $2,589.00 62121 90 $1,822.00 $2,150.00 $2,308.00 $2,516.00 $2,150.00 $2,308.00 $2,516.00 62140 90 $1,221.00 $1,377.00 $1,496.00 $1,657.00 $1,377.00 $1,496.00 $1,657.00 62141 90 $1,955.00 $1,507.00 $1,636.00 $1,811.00 $1,507.00 $1,636.00 $1,811.00 62142 90 $1,011.00 $1,137.00 $1,232.00 $1,362.00 $1,137.00 $1,232.00 $1,362.00 62143 90 $1,096.00 $1,346.00 $1,462.00 $1,619.00 $1,346.00 $1,462.00 $1,619.00 62145 90 $1,566.00 $1,824.00 $1,976.00 $2,184.00 $1,824.00 $1,976.00 $2,184.00 62146 90 $1,327.00 $1,573.00 $1,699.00 $1,869.00 $1,573.00 $1,699.00 $1,869.00 62147 90 $1,566.00 $1,866.00 $2,015.00 $2,218.00 $1,866.00 $2,015.00 $2,218.00 62148 ZZZ $120.00 $172.00 $187.00 $208.00 $172.00 $187.00 $208.00 62160 ZZZ $172.00 $268.00 $292.00 $326.00 $268.00 $292.00 $326.00 62161 90 $1,229.00 $2,009.00 $2,184.00 $2,424.00 $2,009.00 $2,184.00 $2,424.00 62162 90 $1,578.00 $2,459.00 $2,661.00 $2,937.00 $2,459.00 $2,661.00 $2,937.00 62163 90 $999.00 $1,567.00 $1,704.00 $1,889.00 $1,567.00 $1,704.00 $1,889.00 62164 90 $1,706.00 $2,573.00 $2,765.00 $3,022.00 $2,573.00 $2,765.00 $3,022.00 62165 90 $1,336.00 $1,952.00 $2,073.00 $2,229.00 $1,952.00 $2,073.00 $2,229.00 62180 90 $1,695.00 $2,066.00 $2,236.00 $2,468.00 $2,066.00 $2,236.00 $2,468.00 62190 90 $1,034.00 $1,150.00 $1,247.00 $1,379.00 $1,150.00 $1,247.00 $1,379.00 62192 90 $1,146.00 $1,253.00 $1,357.00 $1,499.00 $1,253.00 $1,357.00 $1,499.00 62194 10 $239.00 $479.00 $512.00 $557.00 $479.00 $512.00 $557.00 62200 90 $1,625.00 $1,808.00 $1,965.00 $2,179.00 $1,808.00 $1,965.00 $2,179.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 229
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 62201 90 $1,200.00 $1,533.00 $1,662.00 $1,835.00 $1,533.00 $1,662.00 $1,835.00 62220 90 $1,215.00 $1,338.00 $1,453.00 $1,609.00 $1,338.00 $1,453.00 $1,609.00 62223 90 $1,199.00 $1,342.00 $1,453.00 $1,602.00 $1,342.00 $1,453.00 $1,602.00 62225 90 $488.00 $637.00 $689.00 $758.00 $637.00 $689.00 $758.00 62230 90 $935.00 $1,090.00 $1,183.00 $1,310.00 $1,090.00 $1,183.00 $1,310.00 62252 0 $85.00 $132.00 $143.00 $156.00 $132.00 $143.00 $156.00 62252-26 0 ------- $66.00 $72.00 $80.00 $66.00 $72.00 $80.00 62252-TC 0 ------- $67.00 $72.00 $76.00 $67.00 $72.00 $76.00 62256 90 $616.00 $744.00 $807.00 $890.00 $744.00 $807.00 $890.00 62258 90 $1,308.00 $1,477.00 $1,604.00 $1,777.00 $1,477.00 $1,604.00 $1,777.00 62263 10 $426.00 $887.00 $937.00 $985.00 $488.00 $509.00 $534.00 62264 10 $593.00 $563.00 $593.00 $624.00 $295.00 $307.00 $321.00 62268 0 $285.00 $712.00 $756.00 $799.00 $355.00 $373.00 $396.00 62269 0 $271.00 $788.00 $834.00 $880.00 $351.00 $367.00 $386.00 62270 0 $109.00 $205.00 $217.00 $228.00 $99.00 $103.00 $108.00 62272 0 $137.00 $246.00 $263.00 $280.00 $111.00 $118.00 $127.00 62273 0 $130.00 $221.00 $232.00 $243.00 $143.00 $149.00 $156.00 62280 10 $199.00 $436.00 $465.00 $493.00 $201.00 $213.00 $228.00 62281 10 $186.00 $383.00 $405.00 $427.00 $188.00 $196.00 $206.00 62282 10 $211.00 $434.00 $460.00 $485.00 $174.00 $182.00 $191.00 62284 0 $196.00 $302.00 $321.00 $339.00 $118.00 $124.00 $131.00 62287 90 $784.00 $709.00 $742.00 $779.00 $709.00 $742.00 $779.00 62290 0 $235.00 $450.00 $476.00 $503.00 $222.00 $232.00 $245.00 62291 0 $232.00 $411.00 $436.00 $461.00 $215.00 $225.00 $239.00 62292 90 $1,064.00 $678.00 $712.00 $755.00 $678.00 $712.00 $755.00 62294 90 $821.00 $1,000.00 $1,053.00 $1,120.00 $1,000.00 $1,053.00 $1,120.00 62310 0 $200.00 $294.00 $311.00 $327.00 $129.00 $134.00 $141.00 62311 0 $201.00 $269.00 $285.00 $300.00 $108.00 $112.00 $117.00 62318 0 $208.00 $326.00 $345.00 $362.00 $132.00 $137.00 $144.00 62319 0 $203.00 $291.00 $308.00 $323.00 $123.00 $127.00 $133.00 62350 90 $488.00 $656.00 $696.00 $748.00 $656.00 $696.00 $748.00 62351 90 $782.00 $1,090.00 $1,173.00 $1,283.00 $1,090.00 $1,173.00 $1,283.00 62355 90 $402.00 $533.00 $563.00 $601.00 $533.00 $563.00 $601.00 62360 90 $195.00 $346.00 $365.00 $387.00 $346.00 $365.00 $387.00 62361 90 $390.00 $572.00 $607.00 $650.00 $572.00 $607.00 $650.00 62362 90 $517.00 $722.00 $768.00 $828.00 $722.00 $768.00 $828.00 62365 90 $418.00 $559.00 $594.00 $639.00 $559.00 $594.00 $639.00 62367 0 BR $51.00 $53.00 $56.00 $30.00 $31.00 $33.00 62368 0 BR $71.00 $75.00 $79.00 $48.00 $51.00 $53.00 63001 90 $1,882.00 $1,603.00 $1,733.00 $1,910.00 $1,603.00 $1,733.00 $1,910.00 63003 90 $1,591.00 $1,614.00 $1,744.00 $1,919.00 $1,614.00 $1,744.00 $1,919.00 63005 90 $1,390.00 $1,523.00 $1,643.00 $1,804.00 $1,523.00 $1,643.00 $1,804.00 63011 90 $1,151.00 $1,441.00 $1,558.00 $1,716.00 $1,441.00 $1,558.00 $1,716.00 63012 90 $1,568.00 $1,559.00 $1,683.00 $1,850.00 $1,559.00 $1,683.00 $1,850.00 63015 90 $1,862.00 $1,943.00 $2,106.00 $2,328.00 $1,943.00 $2,106.00 $2,328.00 63016 90 $1,788.00 $1,979.00 $2,137.00 $2,352.00 $1,979.00 $2,137.00 $2,352.00 63017 90 $1,489.00 $1,614.00 $1,743.00 $1,917.00 $1,614.00 $1,743.00 $1,917.00 63020 90 $1,395.00 $1,537.00 $1,667.00 $1,842.00 $1,537.00 $1,667.00 $1,842.00 63030 90 $1,145.00 $1,276.00 $1,383.00 $1,526.00 $1,276.00 $1,383.00 $1,526.00 63035 ZZZ $280.00 $280.00 $305.00 $340.00 $280.00 $305.00 $340.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 230
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 63040 90 $1,764.00 $1,882.00 $2,041.00 $2,258.00 $1,882.00 $2,041.00 $2,258.00 63042 90 $1,620.00 $1,760.00 $1,908.00 $2,107.00 $1,760.00 $1,908.00 $2,107.00 63043 ZZZ BR ------- ------- ------- ------- ------- ------- 63044 ZZZ BR ------- ------- ------- ------- ------- ------- 63045 90 $1,647.00 $1,671.00 $1,809.00 $1,996.00 $1,671.00 $1,809.00 $1,996.00 63046 90 $2,117.00 $1,586.00 $1,712.00 $1,881.00 $1,586.00 $1,712.00 $1,881.00 63047 90 $1,907.00 $1,452.00 $1,569.00 $1,725.00 $1,452.00 $1,569.00 $1,725.00 63048 ZZZ $367.00 $295.00 $318.00 $351.00 $295.00 $318.00 $351.00 63050 90 ------- $1,989.00 $2,150.00 $2,369.00 $1,989.00 $2,150.00 $2,369.00 63051 90 ------- $2,226.00 $2,392.00 $2,615.00 $2,226.00 $2,392.00 $2,615.00 63055 90 $2,029.00 $2,159.00 $2,339.00 $2,585.00 $2,159.00 $2,339.00 $2,585.00 63056 90 $1,960.00 $1,997.00 $2,161.00 $2,383.00 $1,997.00 $2,161.00 $2,383.00 63057 ZZZ $421.00 $459.00 $498.00 $553.00 $459.00 $498.00 $553.00 63064 90 $2,200.00 $2,369.00 $2,563.00 $2,828.00 $2,369.00 $2,563.00 $2,828.00 63066 ZZZ $263.00 $279.00 $302.00 $333.00 $279.00 $302.00 $333.00 63075 90 $1,720.00 $1,859.00 $2,018.00 $2,234.00 $1,859.00 $2,018.00 $2,234.00 63076 ZZZ $383.00 $355.00 $386.00 $429.00 $355.00 $386.00 $429.00 63077 90 $1,828.00 $1,981.00 $2,125.00 $2,317.00 $1,981.00 $2,125.00 $2,317.00 63078 ZZZ $261.00 $278.00 $300.00 $330.00 $278.00 $300.00 $330.00 63081 90 $2,203.00 $2,356.00 $2,547.00 $2,806.00 $2,356.00 $2,547.00 $2,806.00 63082 ZZZ $391.00 $383.00 $415.00 $461.00 $383.00 $415.00 $461.00 63085 90 $2,416.00 $2,459.00 $2,625.00 $2,844.00 $2,459.00 $2,625.00 $2,844.00 63086 ZZZ $282.00 $266.00 $286.00 $313.00 $266.00 $286.00 $313.00 63087 90 $2,930.00 $3,152.00 $3,374.00 $3,672.00 $3,152.00 $3,374.00 $3,672.00 63088 ZZZ $381.00 $362.00 $389.00 $427.00 $362.00 $389.00 $427.00 63090 90 $2,490.00 $2,540.00 $2,702.00 $2,913.00 $2,540.00 $2,702.00 $2,913.00 63091 ZZZ $249.00 $245.00 $262.00 $285.00 $245.00 $262.00 $285.00 63101 90 ------- $2,953.00 $3,163.00 $3,441.00 $2,953.00 $3,163.00 $3,441.00 63102 90 ------- $2,948.00 $3,158.00 $3,436.00 $2,948.00 $3,158.00 $3,436.00 63103 ZZZ ------- $387.00 $412.00 $445.00 $387.00 $412.00 $445.00 63170 90 $1,788.00 $1,980.00 $2,144.00 $2,368.00 $1,980.00 $2,144.00 $2,368.00 63172 90 $1,672.00 $1,822.00 $1,975.00 $2,183.00 $1,822.00 $1,975.00 $2,183.00 63173 90 $1,851.00 $2,247.00 $2,439.00 $2,702.00 $2,247.00 $2,439.00 $2,702.00 63180 90 $1,486.00 $1,820.00 $1,960.00 $2,148.00 $1,820.00 $1,960.00 $2,148.00 63182 90 $1,711.00 $1,941.00 $2,108.00 $2,344.00 $1,941.00 $2,108.00 $2,344.00 63185 90 $1,347.00 $1,438.00 $1,541.00 $1,677.00 $1,438.00 $1,541.00 $1,677.00 63190 90 $1,610.00 $1,632.00 $1,750.00 $1,907.00 $1,632.00 $1,750.00 $1,907.00 63191 90 $1,444.00 $1,752.00 $1,939.00 $2,211.00 $1,752.00 $1,939.00 $2,211.00 63194 90 $1,593.00 $1,864.00 $1,988.00 $2,150.00 $1,864.00 $1,988.00 $2,150.00 63195 90 $1,603.00 $1,977.00 $2,142.00 $2,368.00 $1,977.00 $2,142.00 $2,368.00 63196 90 $1,810.00 $2,318.00 $2,514.00 $2,781.00 $2,318.00 $2,514.00 $2,781.00 63197 90 $1,725.00 $2,043.00 $2,215.00 $2,456.00 $2,043.00 $2,215.00 $2,456.00 63198 90 $1,956.00 $2,343.00 $2,538.00 $2,817.00 $2,343.00 $2,538.00 $2,817.00 63199 90 $2,258.00 $2,189.00 $2,268.00 $2,359.00 $2,189.00 $2,268.00 $2,359.00 63200 90 $1,569.00 $1,980.00 $2,148.00 $2,378.00 $1,980.00 $2,148.00 $2,378.00 63250 90 $3,182.00 $3,791.00 $4,094.00 $4,509.00 $3,791.00 $4,094.00 $4,509.00 63251 90 $3,207.00 $4,021.00 $4,365.00 $4,840.00 $4,021.00 $4,365.00 $4,840.00 63252 90 $3,319.00 $4,013.00 $4,361.00 $4,844.00 $4,013.00 $4,361.00 $4,844.00 63265 90 $1,940.00 $2,189.00 $2,373.00 $2,625.00 $2,189.00 $2,373.00 $2,625.00 63266 90 $2,053.00 $2,253.00 $2,441.00 $2,698.00 $2,253.00 $2,441.00 $2,698.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 231
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 63267 90 $1,651.00 $1,809.00 $1,960.00 $2,165.00 $1,809.00 $1,960.00 $2,165.00 63268 90 $1,469.00 $1,768.00 $1,901.00 $2,078.00 $1,768.00 $1,901.00 $2,078.00 63270 90 $2,197.00 $2,706.00 $2,935.00 $3,249.00 $2,706.00 $2,935.00 $3,249.00 63271 90 $2,401.00 $2,720.00 $2,951.00 $3,268.00 $2,720.00 $2,951.00 $3,268.00 63272 90 $2,206.00 $2,501.00 $2,710.00 $2,997.00 $2,501.00 $2,710.00 $2,997.00 63273 90 $2,012.00 $2,404.00 $2,601.00 $2,870.00 $2,404.00 $2,601.00 $2,870.00 63275 90 $2,166.00 $2,358.00 $2,555.00 $2,824.00 $2,358.00 $2,555.00 $2,824.00 63276 90 $2,135.00 $2,344.00 $2,541.00 $2,811.00 $2,344.00 $2,541.00 $2,811.00 63277 90 $1,905.00 $2,060.00 $2,232.00 $2,466.00 $2,060.00 $2,232.00 $2,466.00 63278 90 $1,877.00 $2,002.00 $2,161.00 $2,376.00 $2,002.00 $2,161.00 $2,376.00 63280 90 $2,529.00 $2,798.00 $3,041.00 $3,375.00 $2,798.00 $3,041.00 $3,375.00 63281 90 $2,496.00 $2,773.00 $3,012.00 $3,342.00 $2,773.00 $3,012.00 $3,342.00 63282 90 $2,305.00 $2,611.00 $2,837.00 $3,149.00 $2,611.00 $2,837.00 $3,149.00 63283 90 $2,041.00 $2,481.00 $2,693.00 $2,983.00 $2,481.00 $2,693.00 $2,983.00 63285 90 $2,934.00 $3,461.00 $3,763.00 $4,181.00 $3,461.00 $3,763.00 $4,181.00 63286 90 $3,003.00 $3,458.00 $3,762.00 $4,182.00 $3,458.00 $3,762.00 $4,182.00 63287 90 $3,012.00 $3,623.00 $3,934.00 $4,363.00 $3,623.00 $3,934.00 $4,363.00 63290 90 $3,073.00 $3,624.00 $3,925.00 $4,340.00 $3,624.00 $3,925.00 $4,340.00 63295 ZZZ ------- $431.00 $464.00 $511.00 $431.00 $464.00 $511.00 63300 90 $2,006.00 $2,430.00 $2,632.00 $2,909.00 $2,430.00 $2,632.00 $2,909.00 63301 90 $2,209.00 $2,648.00 $2,839.00 $3,095.00 $2,648.00 $2,839.00 $3,095.00 63302 90 $2,290.00 $2,637.00 $2,831.00 $3,092.00 $2,637.00 $2,831.00 $3,092.00 63303 90 $2,357.00 $2,739.00 $2,915.00 $3,146.00 $2,739.00 $2,915.00 $3,146.00 63304 90 $2,513.00 $2,964.00 $3,189.00 $3,494.00 $2,964.00 $3,189.00 $3,494.00 63305 90 $2,574.00 $3,025.00 $3,233.00 $3,510.00 $3,025.00 $3,233.00 $3,510.00 63306 90 $2,596.00 $3,185.00 $3,459.00 $3,838.00 $3,185.00 $3,459.00 $3,838.00 63307 90 $2,522.00 $2,780.00 $2,950.00 $3,172.00 $2,780.00 $2,950.00 $3,172.00 63308 ZZZ $425.00 $462.00 $503.00 $560.00 $462.00 $503.00 $560.00 63600 90 $797.00 $1,062.00 $1,117.00 $1,191.00 $1,062.00 $1,117.00 $1,191.00 63610 0 $476.00 $2,318.00 $2,471.00 $2,613.00 $571.00 $600.00 $639.00 63615 90 $1,348.00 $1,479.00 $1,583.00 $1,722.00 $1,479.00 $1,583.00 $1,722.00 63650 90 $819.00 $550.00 $574.00 $604.00 $550.00 $574.00 $604.00 63655 90 $1,064.00 $1,093.00 $1,181.00 $1,299.00 $1,093.00 $1,181.00 $1,299.00 63660 90 $707.00 $560.00 $593.00 $634.00 $560.00 $593.00 $634.00 63685 90 $615.00 $648.00 $688.00 $741.00 $648.00 $688.00 $741.00 63688 90 $707.00 $534.00 $569.00 $615.00 $534.00 $569.00 $615.00 63700 90 $1,340.00 $1,600.00 $1,725.00 $1,894.00 $1,600.00 $1,725.00 $1,894.00 63702 90 $1,512.00 $1,757.00 $1,900.00 $2,093.00 $1,757.00 $1,900.00 $2,093.00 63704 90 $1,708.00 $2,022.00 $2,182.00 $2,398.00 $2,022.00 $2,182.00 $2,398.00 63706 90 $1,873.00 $2,374.00 $2,582.00 $2,869.00 $2,374.00 $2,582.00 $2,869.00 63707 90 $1,041.00 $1,176.00 $1,268.00 $1,390.00 $1,176.00 $1,268.00 $1,390.00 63709 90 $1,310.00 $1,434.00 $1,546.00 $1,695.00 $1,434.00 $1,546.00 $1,695.00 63710 90 $1,165.00 $1,444.00 $1,563.00 $1,724.00 $1,444.00 $1,563.00 $1,724.00 63740 90 $1,062.00 $1,211.00 $1,313.00 $1,452.00 $1,211.00 $1,313.00 $1,452.00 63741 90 $741.00 $797.00 $856.00 $936.00 $797.00 $856.00 $936.00 63744 90 $738.00 $842.00 $910.00 $1,001.00 $842.00 $910.00 $1,001.00 63746 90 $529.00 $698.00 $754.00 $828.00 $698.00 $754.00 $828.00 64400 0 $78.00 $141.00 $148.00 $156.00 $80.00 $83.00 $87.00 64402 0 $75.00 $141.00 $149.00 $157.00 $93.00 $98.00 $103.00 64405 0 $103.00 $134.00 $140.00 $147.00 $92.00 $96.00 $100.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 232
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 64408 0 $120.00 $150.00 $157.00 $166.00 $113.00 $118.00 $125.00 64410 0 $109.00 $185.00 $195.00 $205.00 $100.00 $104.00 $109.00 64412 0 $89.00 $181.00 $192.00 $202.00 $87.00 $91.00 $96.00 64413 0 $128.00 $151.00 $159.00 $166.00 $96.00 $100.00 $105.00 64415 0 $109.00 $182.00 $192.00 $201.00 $95.00 $99.00 $104.00 64416 10 $159.00 $237.00 $247.00 $261.00 $237.00 $247.00 $261.00 64417 0 $105.00 $188.00 $199.00 $209.00 $96.00 $101.00 $106.00 64418 0 $108.00 $180.00 $190.00 $200.00 $91.00 $95.00 $99.00 64420 0 $89.00 $219.00 $232.00 $244.00 $83.00 $87.00 $91.00 64421 0 $128.00 $328.00 $348.00 $367.00 $114.00 $118.00 $124.00 64425 0 $116.00 $166.00 $174.00 $184.00 $119.00 $124.00 $131.00 64430 0 $130.00 $199.00 $210.00 $222.00 $110.00 $115.00 $120.00 64435 0 $114.00 $194.00 $206.00 $219.00 $112.00 $118.00 $126.00 64445 0 $68.00 $185.00 $195.00 $205.00 $102.00 $107.00 $112.00 64446 10 $165.00 $222.00 $230.00 $240.00 $222.00 $230.00 $240.00 64447 0 $77.00 $93.00 $96.00 $100.00 $93.00 $96.00 $100.00 64448 10 $152.00 $202.00 $209.00 $218.00 $202.00 $209.00 $218.00 64449 10 ------- $198.00 $205.00 $213.00 $198.00 $205.00 $213.00 64450 0 $53.00 $133.00 $141.00 $150.00 $94.00 $99.00 $106.00 64470 0 $206.00 $372.00 $394.00 $415.00 $131.00 $136.00 $142.00 64472 ZZZ $166.00 $156.00 $164.00 $173.00 $84.00 $87.00 $91.00 64475 0 $183.00 $337.00 $358.00 $378.00 $104.00 $109.00 $114.00 64476 ZZZ $166.00 $132.00 $139.00 $147.00 $63.00 $66.00 $69.00 64479 0 $224.00 $394.00 $417.00 $438.00 $155.00 $162.00 $169.00 64480 ZZZ $194.00 $190.00 $201.00 $211.00 $102.00 $106.00 $111.00 64483 0 $206.00 $391.00 $414.00 $436.00 $137.00 $143.00 $150.00 64484 ZZZ $183.00 $191.00 $202.00 $212.00 $86.00 $90.00 $94.00 64505 0 $104.00 $131.00 $138.00 $145.00 $107.00 $112.00 $118.00 64508 0 $99.00 $192.00 $204.00 $214.00 $91.00 $95.00 $100.00 64510 0 $103.00 $197.00 $208.00 $218.00 $86.00 $90.00 $94.00 64517 0 ------- $223.00 $234.00 $245.00 $151.00 $157.00 $163.00 64520 0 $131.00 $263.00 $278.00 $293.00 $96.00 $100.00 $105.00 64530 0 $135.00 $263.00 $278.00 $293.00 $115.00 $119.00 $125.00 64550 0 $23.00 $21.00 $22.00 $24.00 $12.00 $12.00 $13.00 64553 10 $137.00 $260.00 $275.00 $290.00 $206.00 $216.00 $228.00 64555 10 $131.00 $270.00 $285.00 $301.00 $190.00 $199.00 $211.00 64560 10 $197.00 $255.00 $270.00 $286.00 $193.00 $203.00 $215.00 64561 10 $801.00 $1,614.00 $1,715.00 $1,808.00 $536.00 $561.00 $590.00 64565 10 $121.00 $238.00 $252.00 $265.00 $158.00 $166.00 $175.00 64573 90 $464.00 $770.00 $829.00 $908.00 $770.00 $829.00 $908.00 64575 90 $367.00 $372.00 $396.00 $427.00 $372.00 $396.00 $427.00 64577 90 $381.00 $502.00 $543.00 $596.00 $502.00 $543.00 $596.00 64580 90 $343.00 $380.00 $400.00 $423.00 $380.00 $400.00 $423.00 64581 90 $745.00 $1,047.00 $1,095.00 $1,154.00 $1,047.00 $1,095.00 $1,154.00 64585 10 $37.00 $543.00 $579.00 $612.00 $224.00 $237.00 $251.00 64590 10 $217.00 $467.00 $496.00 $523.00 $247.00 $260.00 $275.00 64595 10 $153.00 $518.00 $553.00 $585.00 $200.00 $212.00 $225.00 64600 10 $228.00 $559.00 $594.00 $629.00 $272.00 $286.00 $304.00 64605 10 $319.00 $746.00 $796.00 $852.00 $438.00 $466.00 $504.00 64610 10 $307.00 $913.00 $985.00 $1,074.00 $640.00 $693.00 $766.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 233
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 64612 10 $188.00 $203.00 $213.00 $223.00 $168.00 $176.00 $184.00 64613 10 $168.00 $209.00 $219.00 $230.00 $160.00 $167.00 $175.00 64614 10 $200.00 $232.00 $243.00 $255.00 $177.00 $184.00 $192.00 64620 10 $185.00 $359.00 $379.00 $399.00 $211.00 $221.00 $232.00 64622 10 $333.00 $451.00 $477.00 $502.00 $222.00 $231.00 $242.00 64623 ZZZ $113.00 $167.00 $177.00 $186.00 $62.00 $64.00 $67.00 64626 10 $262.00 $508.00 $535.00 $561.00 $291.00 $303.00 $316.00 64627 ZZZ $151.00 $232.00 $246.00 $259.00 $73.00 $76.00 $79.00 64630 10 $202.00 $297.00 $312.00 $329.00 $240.00 $252.00 $265.00 64640 10 $208.00 $319.00 $338.00 $359.00 $235.00 $248.00 $264.00 64650 0 ------- $77.00 $82.00 $86.00 $49.00 $52.00 $55.00 64653 0 ------- $89.00 $94.00 $99.00 $62.00 $65.00 $69.00 64680 10 $180.00 $412.00 $436.00 $459.00 $203.00 $213.00 $224.00 64681 10 ------- $553.00 $585.00 $617.00 $283.00 $296.00 $312.00 64702 90 $383.00 $561.00 $593.00 $630.00 $561.00 $593.00 $630.00 64704 90 $402.00 $430.00 $457.00 $491.00 $430.00 $457.00 $491.00 64708 90 $562.00 $595.00 $635.00 $686.00 $595.00 $635.00 $686.00 64712 90 $678.00 $684.00 $724.00 $775.00 $684.00 $724.00 $775.00 64713 90 $867.00 $973.00 $1,041.00 $1,130.00 $973.00 $1,041.00 $1,130.00 64714 90 $715.00 $799.00 $844.00 $904.00 $799.00 $844.00 $904.00 64716 90 $523.00 $658.00 $694.00 $736.00 $658.00 $694.00 $736.00 64718 90 $558.00 $720.00 $768.00 $827.00 $720.00 $768.00 $827.00 64719 90 $446.00 $507.00 $542.00 $585.00 $507.00 $542.00 $585.00 64721 90 $439.00 $537.00 $573.00 $617.00 $535.00 $572.00 $615.00 64722 90 $411.00 $411.00 $434.00 $462.00 $411.00 $434.00 $462.00 64726 90 $271.00 $381.00 $404.00 $434.00 $381.00 $404.00 $434.00 64727 ZZZ $261.00 $251.00 $268.00 $290.00 $251.00 $268.00 $290.00 64732 90 $405.00 $483.00 $520.00 $569.00 $483.00 $520.00 $569.00 64734 90 $432.00 $538.00 $576.00 $624.00 $538.00 $576.00 $624.00 64736 90 $388.00 $476.00 $503.00 $534.00 $476.00 $503.00 $534.00 64738 90 $475.00 $611.00 $655.00 $711.00 $611.00 $655.00 $711.00 64740 90 $461.00 $594.00 $630.00 $672.00 $594.00 $630.00 $672.00 64742 90 $517.00 $599.00 $634.00 $675.00 $599.00 $634.00 $675.00 64744 90 $798.00 $552.00 $596.00 $653.00 $552.00 $596.00 $653.00 64746 90 $494.00 $577.00 $613.00 $658.00 $577.00 $613.00 $658.00 64752 90 $560.00 $632.00 $670.00 $718.00 $632.00 $670.00 $718.00 64755 90 $1,042.00 $1,127.00 $1,194.00 $1,282.00 $1,127.00 $1,194.00 $1,282.00 64760 90 $578.00 $597.00 $631.00 $673.00 $597.00 $631.00 $673.00 64761 90 $495.00 $564.00 $591.00 $624.00 $564.00 $591.00 $624.00 64763 90 $561.00 $652.00 $692.00 $743.00 $652.00 $692.00 $743.00 64766 90 $713.00 $772.00 $817.00 $873.00 $772.00 $817.00 $873.00 64771 90 $632.00 $754.00 $805.00 $870.00 $754.00 $805.00 $870.00 64772 90 $636.00 $726.00 $779.00 $849.00 $726.00 $779.00 $849.00 64774 90 $392.00 $523.00 $556.00 $596.00 $523.00 $556.00 $596.00 64776 90 $390.00 $504.00 $537.00 $578.00 $504.00 $537.00 $578.00 64778 ZZZ $249.00 $250.00 $267.00 $289.00 $250.00 $267.00 $289.00 64782 90 $482.00 $585.00 $622.00 $667.00 $585.00 $622.00 $667.00 64783 ZZZ $298.00 $295.00 $313.00 $338.00 $295.00 $313.00 $338.00 64784 90 $751.00 $927.00 $985.00 $1,059.00 $927.00 $985.00 $1,059.00 64786 90 $1,281.00 $1,421.00 $1,520.00 $1,649.00 $1,421.00 $1,520.00 $1,649.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 234
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 64787 ZZZ $458.00 $342.00 $363.00 $391.00 $342.00 $363.00 $391.00 64788 90 $381.00 $487.00 $519.00 $559.00 $487.00 $519.00 $559.00 64790 90 $884.00 $1,084.00 $1,163.00 $1,266.00 $1,084.00 $1,163.00 $1,266.00 64792 90 $1,148.00 $1,363.00 $1,457.00 $1,580.00 $1,363.00 $1,457.00 $1,580.00 64795 0 $247.00 $257.00 $276.00 $300.00 $257.00 $276.00 $300.00 64802 90 $711.00 $799.00 $847.00 $911.00 $799.00 $847.00 $911.00 64804 90 $1,202.00 $1,240.00 $1,318.00 $1,422.00 $1,240.00 $1,318.00 $1,422.00 64809 90 $1,080.00 $1,125.00 $1,186.00 $1,264.00 $1,125.00 $1,186.00 $1,264.00 64818 90 $845.00 $873.00 $924.00 $991.00 $873.00 $924.00 $991.00 64820 90 $838.00 $969.00 $1,032.00 $1,111.00 $969.00 $1,032.00 $1,111.00 64821 90 $609.00 $877.00 $933.00 $1,002.00 $877.00 $933.00 $1,002.00 64822 90 $609.00 $876.00 $933.00 $1,004.00 $876.00 $933.00 $1,004.00 64823 90 $703.00 $996.00 $1,062.00 $1,146.00 $996.00 $1,062.00 $1,146.00 64831 90 $592.00 $935.00 $995.00 $1,070.00 $935.00 $995.00 $1,070.00 64832 ZZZ $171.00 $464.00 $495.00 $536.00 $464.00 $495.00 $536.00 64834 90 $711.00 $963.00 $1,027.00 $1,107.00 $963.00 $1,027.00 $1,107.00 64835 90 $834.00 $1,047.00 $1,118.00 $1,207.00 $1,047.00 $1,118.00 $1,207.00 64836 90 $856.00 $1,046.00 $1,115.00 $1,203.00 $1,046.00 $1,115.00 $1,203.00 64837 ZZZ $480.00 $515.00 $550.00 $597.00 $515.00 $550.00 $597.00 64840 90 $1,058.00 $1,154.00 $1,217.00 $1,294.00 $1,154.00 $1,217.00 $1,294.00 64856 90 $1,063.00 $1,313.00 $1,398.00 $1,508.00 $1,313.00 $1,398.00 $1,508.00 64857 90 $1,137.00 $1,373.00 $1,462.00 $1,576.00 $1,373.00 $1,462.00 $1,576.00 64858 90 $1,313.00 $1,604.00 $1,725.00 $1,886.00 $1,604.00 $1,725.00 $1,886.00 64859 ZZZ $341.00 $351.00 $375.00 $407.00 $351.00 $375.00 $407.00 64861 90 $1,524.00 $1,842.00 $1,985.00 $2,178.00 $1,842.00 $1,985.00 $2,178.00 64862 90 $1,798.00 $1,877.00 $2,026.00 $2,229.00 $1,877.00 $2,026.00 $2,229.00 64864 90 $970.00 $1,131.00 $1,192.00 $1,265.00 $1,131.00 $1,192.00 $1,265.00 64865 90 $1,250.00 $1,494.00 $1,577.00 $1,673.00 $1,494.00 $1,577.00 $1,673.00 64866 90 $1,238.00 $1,554.00 $1,649.00 $1,765.00 $1,554.00 $1,649.00 $1,765.00 64868 90 $1,162.00 $1,338.00 $1,413.00 $1,500.00 $1,338.00 $1,413.00 $1,500.00 64870 90 $1,313.00 $1,319.00 $1,382.00 $1,458.00 $1,319.00 $1,382.00 $1,458.00 64872 ZZZ $155.00 $163.00 $173.00 $188.00 $163.00 $173.00 $188.00 64874 ZZZ $230.00 $242.00 $258.00 $279.00 $242.00 $258.00 $279.00 64876 ZZZ $189.00 $275.00 $293.00 $316.00 $275.00 $293.00 $316.00 64885 90 $1,382.00 $1,465.00 $1,543.00 $1,637.00 $1,465.00 $1,543.00 $1,637.00 64886 90 $1,636.00 $1,737.00 $1,832.00 $1,950.00 $1,737.00 $1,832.00 $1,950.00 64890 90 $1,112.00 $1,413.00 $1,506.00 $1,624.00 $1,413.00 $1,506.00 $1,624.00 64891 90 $1,243.00 $1,368.00 $1,441.00 $1,530.00 $1,368.00 $1,441.00 $1,530.00 64892 90 $1,177.00 $1,380.00 $1,475.00 $1,599.00 $1,380.00 $1,475.00 $1,599.00 64893 90 $1,321.00 $1,481.00 $1,582.00 $1,714.00 $1,481.00 $1,582.00 $1,714.00 64895 90 $1,500.00 $1,673.00 $1,776.00 $1,908.00 $1,673.00 $1,776.00 $1,908.00 64896 90 $1,185.00 $1,842.00 $1,963.00 $2,121.00 $1,842.00 $1,963.00 $2,121.00 64897 90 $1,419.00 $1,636.00 $1,738.00 $1,870.00 $1,636.00 $1,738.00 $1,870.00 64898 90 $1,549.00 $1,779.00 $1,891.00 $2,035.00 $1,779.00 $1,891.00 $2,035.00 64901 ZZZ $865.00 $810.00 $861.00 $928.00 $810.00 $861.00 $928.00 64902 ZZZ $982.00 $943.00 $1,001.00 $1,078.00 $943.00 $1,001.00 $1,078.00 64905 90 $1,059.00 $1,250.00 $1,329.00 $1,431.00 $1,250.00 $1,329.00 $1,431.00 64907 90 $1,472.00 $1,658.00 $1,772.00 $1,924.00 $1,658.00 $1,772.00 $1,924.00 64910 90 ------- $897.00 $958.00 $1,040.00 $897.00 $958.00 $1,040.00 64911 90 ------- $1,085.00 $1,152.00 $1,243.00 $1,085.00 $1,152.00 $1,243.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 235
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 64999 YYY BR ------- ------- ------- ------- ------- ------- 65091 90 $678.00 $737.00 $772.00 $807.00 $737.00 $772.00 $807.00 65093 90 $712.00 $740.00 $776.00 $812.00 $740.00 $776.00 $812.00 65101 90 $726.00 $845.00 $885.00 $925.00 $845.00 $885.00 $925.00 65103 90 $769.00 $881.00 $923.00 $963.00 $881.00 $923.00 $963.00 65105 90 $846.00 $969.00 $1,014.00 $1,059.00 $969.00 $1,014.00 $1,059.00 65110 90 $1,305.00 $1,415.00 $1,481.00 $1,550.00 $1,415.00 $1,481.00 $1,550.00 65112 90 $1,386.00 $1,692.00 $1,778.00 $1,872.00 $1,692.00 $1,778.00 $1,872.00 65114 90 $1,456.00 $1,735.00 $1,815.00 $1,899.00 $1,735.00 $1,815.00 $1,899.00 65125 90 $312.00 $552.00 $585.00 $615.00 $333.00 $350.00 $368.00 65130 90 $730.00 $835.00 $873.00 $912.00 $835.00 $873.00 $912.00 65135 90 $678.00 $849.00 $889.00 $928.00 $849.00 $889.00 $928.00 65140 90 $738.00 $921.00 $964.00 $1,007.00 $921.00 $964.00 $1,007.00 65150 90 $652.00 $678.00 $711.00 $744.00 $678.00 $711.00 $744.00 65155 90 $862.00 $984.00 $1,031.00 $1,079.00 $984.00 $1,031.00 $1,079.00 65175 90 $654.00 $751.00 $787.00 $822.00 $751.00 $787.00 $822.00 65205 0 $45.00 $66.00 $69.00 $72.00 $51.00 $53.00 $55.00 65210 0 $53.00 $81.00 $84.00 $88.00 $62.00 $64.00 $67.00 65220 0 $58.00 $69.00 $72.00 $76.00 $52.00 $54.00 $57.00 65222 0 $62.00 $88.00 $92.00 $96.00 $67.00 $69.00 $72.00 65235 90 $627.00 $779.00 $813.00 $847.00 $779.00 $813.00 $847.00 65260 90 $956.00 $1,082.00 $1,129.00 $1,179.00 $1,082.00 $1,129.00 $1,179.00 65265 90 $1,104.00 $1,214.00 $1,266.00 $1,320.00 $1,214.00 $1,266.00 $1,320.00 65270 10 $88.00 $323.00 $342.00 $358.00 $162.00 $169.00 $176.00 65272 90 $223.00 $575.00 $605.00 $633.00 $387.00 $403.00 $420.00 65273 90 $376.00 $427.00 $445.00 $464.00 $427.00 $445.00 $464.00 65275 90 $75.00 $624.00 $654.00 $682.00 $505.00 $526.00 $547.00 65280 90 $711.00 $748.00 $779.00 $812.00 $748.00 $779.00 $812.00 65285 90 $1,177.00 $1,168.00 $1,216.00 $1,267.00 $1,168.00 $1,216.00 $1,267.00 65286 90 $692.00 $820.00 $862.00 $902.00 $549.00 $572.00 $596.00 65290 90 $519.00 $552.00 $576.00 $602.00 $552.00 $576.00 $602.00 65400 90 $603.00 $759.00 $795.00 $829.00 $664.00 $693.00 $722.00 65410 0 $142.00 $169.00 $177.00 $186.00 $120.00 $125.00 $130.00 65420 90 $448.00 $608.00 $642.00 $673.00 $425.00 $446.00 $466.00 65426 90 $534.00 $754.00 $793.00 $830.00 $534.00 $557.00 $580.00 65430 0 $81.00 $134.00 $140.00 $146.00 $120.00 $125.00 $131.00 65435 0 $88.00 $93.00 $97.00 $101.00 $80.00 $84.00 $87.00 65436 90 $319.00 $434.00 $454.00 $473.00 $416.00 $434.00 $453.00 65450 90 $52.00 $363.00 $381.00 $399.00 $358.00 $376.00 $393.00 65600 90 $325.00 $440.00 $461.00 $482.00 $373.00 $389.00 $406.00 65710 90 $1,124.00 $1,243.00 $1,297.00 $1,352.00 $1,243.00 $1,297.00 $1,352.00 65730 90 $1,314.00 $1,380.00 $1,439.00 $1,500.00 $1,380.00 $1,439.00 $1,500.00 65750 90 $1,381.00 $1,402.00 $1,462.00 $1,524.00 $1,402.00 $1,462.00 $1,524.00 65755 90 $1,373.00 $1,394.00 $1,452.00 $1,514.00 $1,394.00 $1,452.00 $1,514.00 65770 90 $1,461.00 $1,601.00 $1,668.00 $1,739.00 $1,601.00 $1,668.00 $1,739.00 65772 90 $449.00 $509.00 $533.00 $556.00 $451.00 $470.00 $490.00 65775 90 $595.00 $620.00 $647.00 $674.00 $620.00 $647.00 $674.00 65780 90 ------- $1,005.00 $1,050.00 $1,096.00 $1,005.00 $1,050.00 $1,096.00 65781 90 ------- $1,504.00 $1,560.00 $1,614.00 $1,504.00 $1,560.00 $1,614.00 65782 90 ------- $1,301.00 $1,352.00 $1,401.00 $1,301.00 $1,352.00 $1,401.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 236
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 65800 0 $88.00 $177.00 $185.00 $193.00 $152.00 $158.00 $165.00 65805 0 $178.00 $194.00 $203.00 $212.00 $152.00 $158.00 $165.00 65810 90 $516.00 $519.00 $542.00 $565.00 $519.00 $542.00 $565.00 65815 90 $327.00 $742.00 $780.00 $817.00 $529.00 $552.00 $575.00 65820 90 $813.00 $855.00 $895.00 $935.00 $855.00 $895.00 $935.00 65850 90 $968.00 $963.00 $1,004.00 $1,048.00 $963.00 $1,004.00 $1,048.00 65855 10 $441.00 $393.00 $412.00 $431.00 $341.00 $356.00 $372.00 65860 90 $339.00 $364.00 $381.00 $399.00 $296.00 $308.00 $322.00 65865 90 $540.00 $546.00 $571.00 $597.00 $546.00 $571.00 $597.00 65870 90 $572.00 $666.00 $695.00 $725.00 $666.00 $695.00 $725.00 65875 90 $597.00 $705.00 $737.00 $768.00 $705.00 $737.00 $768.00 65880 90 $641.00 $744.00 $777.00 $810.00 $744.00 $777.00 $810.00 65900 90 $945.00 $1,097.00 $1,145.00 $1,195.00 $1,097.00 $1,145.00 $1,195.00 65920 90 $752.00 $881.00 $919.00 $958.00 $881.00 $919.00 $958.00 65930 90 $700.00 $731.00 $763.00 $796.00 $731.00 $763.00 $796.00 66020 10 $164.00 $220.00 $232.00 $244.00 $150.00 $157.00 $164.00 66030 10 $160.00 $196.00 $207.00 $217.00 $125.00 $131.00 $137.00 66130 90 $631.00 $822.00 $862.00 $902.00 $656.00 $684.00 $714.00 66150 90 $798.00 $969.00 $1,014.00 $1,058.00 $969.00 $1,014.00 $1,058.00 66155 90 $795.00 $964.00 $1,007.00 $1,050.00 $964.00 $1,007.00 $1,050.00 66160 90 $942.00 $1,096.00 $1,144.00 $1,192.00 $1,096.00 $1,144.00 $1,192.00 66165 90 $769.00 $946.00 $989.00 $1,031.00 $946.00 $989.00 $1,031.00 66170 90 $1,089.00 $1,326.00 $1,384.00 $1,442.00 $1,326.00 $1,384.00 $1,442.00 66172 90 $1,264.00 $1,662.00 $1,734.00 $1,807.00 $1,662.00 $1,734.00 $1,807.00 66180 90 $1,313.00 $1,320.00 $1,374.00 $1,432.00 $1,320.00 $1,374.00 $1,432.00 66185 90 $769.00 $831.00 $867.00 $904.00 $831.00 $867.00 $904.00 66220 90 $711.00 $810.00 $845.00 $882.00 $810.00 $845.00 $882.00 66225 90 $1,006.00 $1,046.00 $1,090.00 $1,137.00 $1,046.00 $1,090.00 $1,137.00 66250 90 $602.00 $872.00 $917.00 $959.00 $617.00 $644.00 $671.00 66500 90 $359.00 $405.00 $424.00 $444.00 $405.00 $424.00 $444.00 66505 90 $359.00 $442.00 $464.00 $485.00 $442.00 $464.00 $485.00 66600 90 $825.00 $910.00 $951.00 $992.00 $910.00 $951.00 $992.00 66605 90 $1,136.00 $1,205.00 $1,259.00 $1,318.00 $1,205.00 $1,259.00 $1,318.00 66625 90 $543.00 $488.00 $510.00 $534.00 $488.00 $510.00 $534.00 66630 90 $623.00 $634.00 $662.00 $690.00 $634.00 $662.00 $690.00 66635 90 $595.00 $640.00 $668.00 $696.00 $640.00 $668.00 $696.00 66680 90 $526.00 $572.00 $598.00 $624.00 $572.00 $598.00 $624.00 66682 90 $627.00 $693.00 $725.00 $757.00 $693.00 $725.00 $757.00 66700 90 $506.00 $507.00 $531.00 $555.00 $445.00 $464.00 $485.00 66710 90 $513.00 $500.00 $523.00 $547.00 $442.00 $461.00 $481.00 66711 90 ------- $704.00 $735.00 $765.00 $704.00 $735.00 $765.00 66720 90 $506.00 $528.00 $554.00 $581.00 $475.00 $497.00 $521.00 66740 90 $473.00 $496.00 $519.00 $543.00 $445.00 $465.00 $485.00 66761 90 $506.00 $510.00 $534.00 $557.00 $457.00 $477.00 $498.00 66762 90 $433.00 $533.00 $558.00 $583.00 $473.00 $494.00 $516.00 66770 90 $483.00 $592.00 $619.00 $647.00 $536.00 $559.00 $583.00 66820 90 $433.00 $460.00 $484.00 $507.00 $460.00 $484.00 $507.00 66821 90 $275.00 $362.00 $379.00 $395.00 $340.00 $356.00 $370.00 66825 90 $753.00 $867.00 $907.00 $947.00 $867.00 $907.00 $947.00 66830 90 $651.00 $796.00 $829.00 $863.00 $796.00 $829.00 $863.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 237
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 66840 90 $707.00 $781.00 $815.00 $850.00 $781.00 $815.00 $850.00 66850 90 $805.00 $888.00 $925.00 $965.00 $888.00 $925.00 $965.00 66852 90 $878.00 $951.00 $991.00 $1,033.00 $951.00 $991.00 $1,033.00 66920 90 $785.00 $849.00 $885.00 $923.00 $849.00 $885.00 $923.00 66930 90 $906.00 $963.00 $1,003.00 $1,045.00 $963.00 $1,003.00 $1,045.00 66940 90 $819.00 $875.00 $912.00 $950.00 $875.00 $912.00 $950.00 66982 90 $846.00 $1,217.00 $1,266.00 $1,319.00 $1,217.00 $1,266.00 $1,319.00 66983 90 $763.00 $805.00 $831.00 $855.00 $805.00 $831.00 $855.00 66984 90 $898.00 $864.00 $898.00 $934.00 $864.00 $898.00 $934.00 66985 90 $744.00 $850.00 $885.00 $921.00 $850.00 $885.00 $921.00 66986 90 $1,038.00 $1,054.00 $1,100.00 $1,149.00 $1,054.00 $1,100.00 $1,149.00 66990 ZZZ $84.00 $107.00 $111.00 $115.00 $107.00 $111.00 $115.00 66999 YYY BR ------- ------- ------- ------- ------- ------- 67005 90 $639.00 $529.00 $553.00 $578.00 $529.00 $553.00 $578.00 67010 90 $647.00 $613.00 $640.00 $669.00 $613.00 $640.00 $669.00 67015 90 $637.00 $659.00 $690.00 $721.00 $659.00 $690.00 $721.00 67025 90 $774.00 $825.00 $864.00 $903.00 $702.00 $732.00 $763.00 67027 90 $1,089.00 $964.00 $1,005.00 $1,048.00 $964.00 $1,005.00 $1,048.00 67028 0 $338.00 $249.00 $261.00 $273.00 $195.00 $203.00 $212.00 67030 90 $485.00 $583.00 $609.00 $635.00 $583.00 $609.00 $635.00 67031 90 $402.00 $435.00 $455.00 $475.00 $394.00 $412.00 $429.00 67036 90 $1,384.00 $1,090.00 $1,135.00 $1,183.00 $1,090.00 $1,135.00 $1,183.00 67039 90 $1,490.00 $1,397.00 $1,456.00 $1,518.00 $1,397.00 $1,456.00 $1,518.00 67040 90 $1,960.00 $1,612.00 $1,679.00 $1,750.00 $1,612.00 $1,679.00 $1,750.00 67041 90 ------- $1,478.00 $1,537.00 $1,602.00 $1,478.00 $1,537.00 $1,602.00 67042 90 ------- $1,693.00 $1,759.00 $1,832.00 $1,693.00 $1,759.00 $1,832.00 67043 90 ------- $1,777.00 $1,847.00 $1,924.00 $1,777.00 $1,847.00 $1,924.00 67101 90 $767.00 $873.00 $914.00 $954.00 $750.00 $782.00 $816.00 67105 90 $941.00 $809.00 $846.00 $883.00 $720.00 $750.00 $782.00 67107 90 $1,350.00 $1,367.00 $1,424.00 $1,485.00 $1,367.00 $1,424.00 $1,485.00 67108 90 $1,878.00 $1,820.00 $1,895.00 $1,975.00 $1,820.00 $1,895.00 $1,975.00 67110 90 $1,040.00 $984.00 $1,029.00 $1,075.00 $864.00 $901.00 $939.00 67112 90 $1,500.00 $1,498.00 $1,560.00 $1,626.00 $1,498.00 $1,560.00 $1,626.00 67113 90 ------- $1,951.00 $2,029.00 $2,113.00 $1,951.00 $2,029.00 $2,113.00 67115 90 $496.00 $548.00 $572.00 $597.00 $548.00 $572.00 $597.00 67120 90 $751.00 $746.00 $782.00 $817.00 $618.00 $645.00 $672.00 67121 90 $962.00 $1,017.00 $1,060.00 $1,105.00 $1,017.00 $1,060.00 $1,105.00 67141 90 $536.00 $583.00 $610.00 $637.00 $540.00 $564.00 $588.00 67145 90 $514.00 $587.00 $614.00 $641.00 $552.00 $576.00 $601.00 67208 90 $655.00 $672.00 $702.00 $732.00 $646.00 $673.00 $702.00 67210 90 $779.00 $786.00 $819.00 $855.00 $757.00 $788.00 $822.00 67218 90 $1,217.00 $1,592.00 $1,656.00 $1,725.00 $1,592.00 $1,656.00 $1,725.00 67220 90 $894.00 $1,209.00 $1,260.00 $1,315.00 $1,147.00 $1,194.00 $1,245.00 67221 0 $325.00 $359.00 $377.00 $395.00 $257.00 $268.00 $281.00 67225 ZZZ $44.00 $35.00 $37.00 $38.00 $33.00 $34.00 $35.00 67227 90 $652.00 $687.00 $718.00 $749.00 $640.00 $667.00 $696.00 67228 90 $1,025.00 $1,319.00 $1,379.00 $1,441.00 $1,160.00 $1,210.00 $1,262.00 67229 90 ------- $1,283.00 $1,335.00 $1,391.00 $1,283.00 $1,335.00 $1,391.00 67250 90 $793.00 $902.00 $944.00 $987.00 $902.00 $944.00 $987.00 67255 90 $872.00 $961.00 $1,005.00 $1,049.00 $961.00 $1,005.00 $1,049.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 238
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 67299 YYY BR ------- ------- ------- ------- ------- ------- 67311 90 $616.00 $673.00 $703.00 $735.00 $673.00 $703.00 $735.00 67312 90 $773.00 $803.00 $837.00 $873.00 $803.00 $837.00 $873.00 67314 90 $688.00 $751.00 $784.00 $818.00 $751.00 $784.00 $818.00 67316 90 $857.00 $903.00 $941.00 $982.00 $903.00 $941.00 $982.00 67318 90 $663.00 $787.00 $821.00 $857.00 $787.00 $821.00 $857.00 67320 ZZZ $602.00 $368.00 $381.00 $395.00 $368.00 $381.00 $395.00 67331 ZZZ $560.00 $349.00 $360.00 $374.00 $349.00 $360.00 $374.00 67332 ZZZ $621.00 $379.00 $392.00 $407.00 $379.00 $392.00 $407.00 67334 ZZZ $447.00 $343.00 $355.00 $368.00 $343.00 $355.00 $368.00 67335 ZZZ $253.00 $177.00 $184.00 $192.00 $177.00 $184.00 $192.00 67340 ZZZ $559.00 $410.00 $424.00 $440.00 $410.00 $424.00 $440.00 67343 90 $628.00 $733.00 $765.00 $798.00 $733.00 $765.00 $798.00 67345 10 $275.00 $272.00 $285.00 $299.00 $246.00 $257.00 $269.00 67346 0 ------- $234.00 $244.00 $255.00 $234.00 $244.00 $255.00 67399 YYY BR ------- ------- ------- ------- ------- ------- 67400 90 $960.00 $1,076.00 $1,127.00 $1,180.00 $1,076.00 $1,127.00 $1,180.00 67405 90 $799.00 $910.00 $954.00 $998.00 $910.00 $954.00 $998.00 67412 90 $976.00 $1,002.00 $1,049.00 $1,096.00 $1,002.00 $1,049.00 $1,096.00 67413 90 $909.00 $1,000.00 $1,048.00 $1,096.00 $1,000.00 $1,048.00 $1,096.00 67414 90 $1,023.00 $1,478.00 $1,537.00 $1,597.00 $1,478.00 $1,537.00 $1,597.00 67415 0 $146.00 $124.00 $129.00 $135.00 $124.00 $129.00 $135.00 67420 90 $1,729.00 $1,897.00 $1,983.00 $2,074.00 $1,897.00 $1,983.00 $2,074.00 67430 90 $1,203.00 $1,441.00 $1,510.00 $1,583.00 $1,441.00 $1,510.00 $1,583.00 67440 90 $1,257.00 $1,392.00 $1,457.00 $1,523.00 $1,392.00 $1,457.00 $1,523.00 67445 90 $1,269.00 $1,613.00 $1,682.00 $1,756.00 $1,613.00 $1,682.00 $1,756.00 67450 90 $1,300.00 $1,438.00 $1,504.00 $1,570.00 $1,438.00 $1,504.00 $1,570.00 67500 0 $75.00 $103.00 $106.00 $110.00 $90.00 $93.00 $96.00 67505 0 $109.00 $97.00 $101.00 $105.00 $84.00 $87.00 $90.00 67515 0 $53.00 $102.00 $105.00 $108.00 $93.00 $95.00 $98.00 67550 90 $946.00 $1,126.00 $1,182.00 $1,241.00 $1,126.00 $1,182.00 $1,241.00 67560 90 $936.00 $1,137.00 $1,190.00 $1,244.00 $1,137.00 $1,190.00 $1,244.00 67570 90 $1,148.00 $1,336.00 $1,397.00 $1,460.00 $1,336.00 $1,397.00 $1,460.00 67599 YYY BR ------- ------- ------- ------- ------- ------- 67700 10 $87.00 $328.00 $349.00 $367.00 $131.00 $137.00 $144.00 67710 10 $117.00 $280.00 $297.00 $313.00 $110.00 $115.00 $121.00 67715 10 $102.00 $293.00 $311.00 $327.00 $124.00 $130.00 $136.00 67800 10 $119.00 $146.00 $153.00 $160.00 $119.00 $124.00 $130.00 67801 10 $189.00 $187.00 $195.00 $204.00 $154.00 $161.00 $168.00 67805 10 $208.00 $231.00 $242.00 $254.00 $190.00 $198.00 $207.00 67808 90 $308.00 $410.00 $428.00 $446.00 $410.00 $428.00 $446.00 67810 0 $133.00 $256.00 $270.00 $284.00 $108.00 $112.00 $116.00 67820 0 $36.00 $63.00 $66.00 $69.00 $63.00 $66.00 $69.00 67825 10 $130.00 $150.00 $157.00 $164.00 $138.00 $144.00 $151.00 67830 10 $239.00 $325.00 $344.00 $361.00 $157.00 $164.00 $172.00 67835 90 $500.00 $504.00 $527.00 $551.00 $504.00 $527.00 $551.00 67840 10 $187.00 $339.00 $358.00 $376.00 $182.00 $190.00 $198.00 67850 10 $143.00 $252.00 $266.00 $279.00 $159.00 $166.00 $173.00 67875 0 $163.00 $211.00 $223.00 $234.00 $113.00 $118.00 $124.00 67880 90 $442.00 $526.00 $553.00 $578.00 $410.00 $428.00 $446.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 239
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 67882 90 $643.00 $645.00 $676.00 $706.00 $527.00 $550.00 $573.00 67900 90 $487.00 $755.00 $794.00 $833.00 $591.00 $618.00 $647.00 67901 90 $646.00 $753.00 $793.00 $835.00 $661.00 $694.00 $731.00 67902 90 $650.00 $797.00 $833.00 $874.00 $797.00 $833.00 $874.00 67903 90 $657.00 $743.00 $784.00 $826.00 $585.00 $614.00 $647.00 67904 90 $720.00 $845.00 $887.00 $930.00 $665.00 $695.00 $726.00 67906 90 $633.00 $595.00 $623.00 $656.00 $595.00 $623.00 $656.00 67908 90 $550.00 $570.00 $599.00 $628.00 $503.00 $527.00 $552.00 67909 90 $577.00 $636.00 $670.00 $703.00 $509.00 $533.00 $559.00 67911 90 $517.00 $617.00 $642.00 $669.00 $617.00 $642.00 $669.00 67912 90 ------- $1,116.00 $1,181.00 $1,239.00 $572.00 $597.00 $623.00 67914 90 $487.00 $466.00 $491.00 $515.00 $332.00 $347.00 $363.00 67915 90 $252.00 $421.00 $443.00 $465.00 $295.00 $308.00 $322.00 67916 90 $675.00 $635.00 $668.00 $700.00 $497.00 $520.00 $544.00 67917 90 $631.00 $693.00 $729.00 $766.00 $551.00 $577.00 $605.00 67921 90 $419.00 $444.00 $468.00 $490.00 $310.00 $324.00 $339.00 67922 90 $243.00 $409.00 $431.00 $451.00 $284.00 $297.00 $310.00 67923 90 $718.00 $666.00 $700.00 $733.00 $535.00 $559.00 $585.00 67924 90 $605.00 $694.00 $730.00 $765.00 $516.00 $539.00 $564.00 67930 10 $280.00 $437.00 $460.00 $482.00 $284.00 $296.00 $309.00 67935 90 $520.00 $707.00 $744.00 $782.00 $525.00 $549.00 $576.00 67938 10 $67.00 $299.00 $317.00 $332.00 $130.00 $136.00 $142.00 67950 90 $584.00 $687.00 $723.00 $760.00 $545.00 $571.00 $599.00 67961 90 $571.00 $683.00 $719.00 $755.00 $529.00 $554.00 $581.00 67966 90 $645.00 $873.00 $913.00 $953.00 $727.00 $757.00 $788.00 67971 90 $875.00 $842.00 $879.00 $920.00 $842.00 $879.00 $920.00 67973 90 $1,126.00 $1,094.00 $1,143.00 $1,198.00 $1,094.00 $1,143.00 $1,198.00 67974 90 $1,140.00 $1,090.00 $1,139.00 $1,193.00 $1,090.00 $1,139.00 $1,193.00 67975 90 $681.00 $794.00 $830.00 $869.00 $794.00 $830.00 $869.00 67999 YYY BR ------- ------- ------- ------- ------- ------- 68020 10 $106.00 $136.00 $142.00 $148.00 $126.00 $132.00 $138.00 68040 0 $75.00 $76.00 $80.00 $83.00 $63.00 $65.00 $68.00 68100 0 $137.00 $209.00 $221.00 $232.00 $114.00 $119.00 $124.00 68110 10 $172.00 $271.00 $286.00 $300.00 $169.00 $177.00 $185.00 68115 10 $248.00 $379.00 $400.00 $420.00 $211.00 $221.00 $231.00 68130 90 $378.00 $637.00 $670.00 $702.00 $468.00 $490.00 $512.00 68135 10 $146.00 $180.00 $188.00 $196.00 $173.00 $180.00 $189.00 68200 0 $59.00 $49.00 $51.00 $53.00 $40.00 $42.00 $43.00 68320 90 $502.00 $834.00 $878.00 $918.00 $595.00 $621.00 $647.00 68325 90 $672.00 $746.00 $780.00 $816.00 $746.00 $780.00 $816.00 68326 90 $654.00 $722.00 $753.00 $785.00 $722.00 $753.00 $785.00 68328 90 $741.00 $819.00 $857.00 $899.00 $819.00 $857.00 $899.00 68330 90 $488.00 $704.00 $740.00 $775.00 $512.00 $535.00 $558.00 68335 90 $636.00 $724.00 $755.00 $787.00 $724.00 $755.00 $787.00 68340 90 $413.00 $638.00 $671.00 $702.00 $443.00 $462.00 $482.00 68360 90 $449.00 $616.00 $647.00 $677.00 $458.00 $478.00 $498.00 68362 90 $691.00 $733.00 $764.00 $797.00 $733.00 $764.00 $797.00 68371 10 ------- $488.00 $515.00 $545.00 $488.00 $515.00 $545.00 68399 YYY BR ------- ------- ------- ------- ------- ------- 68400 10 $154.00 $345.00 $365.00 $383.00 $163.00 $170.00 $178.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 240
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 68420 10 $191.00 $387.00 $409.00 $429.00 $205.00 $215.00 $224.00 68440 10 $96.00 $133.00 $140.00 $147.00 $111.00 $116.00 $122.00 68500 90 $882.00 $1,111.00 $1,160.00 $1,210.00 $1,111.00 $1,160.00 $1,210.00 68505 90 $921.00 $1,116.00 $1,165.00 $1,215.00 $1,116.00 $1,165.00 $1,215.00 68510 0 $491.00 $547.00 $576.00 $603.00 $337.00 $350.00 $365.00 68520 90 $687.00 $780.00 $814.00 $849.00 $780.00 $814.00 $849.00 68525 0 $340.00 $315.00 $327.00 $341.00 $315.00 $327.00 $341.00 68530 10 $379.00 $531.00 $560.00 $587.00 $304.00 $317.00 $331.00 68540 90 $875.00 $1,048.00 $1,093.00 $1,140.00 $1,048.00 $1,093.00 $1,140.00 68550 90 $1,107.00 $1,287.00 $1,345.00 $1,407.00 $1,287.00 $1,345.00 $1,407.00 68700 90 $628.00 $674.00 $702.00 $732.00 $674.00 $702.00 $732.00 68705 10 $176.00 $285.00 $301.00 $315.00 $190.00 $199.00 $207.00 68720 90 $807.00 $862.00 $900.00 $939.00 $862.00 $900.00 $939.00 68745 90 $704.00 $867.00 $907.00 $949.00 $867.00 $907.00 $949.00 68750 90 $792.00 $890.00 $929.00 $969.00 $890.00 $929.00 $969.00 68760 10 $109.00 $242.00 $255.00 $268.00 $166.00 $174.00 $182.00 68761 10 $130.00 $172.00 $181.00 $189.00 $134.00 $140.00 $146.00 68770 90 $634.00 $631.00 $656.00 $683.00 $631.00 $656.00 $683.00 68801 10 $202.00 $142.00 $150.00 $158.00 $122.00 $128.00 $134.00 68810 10 $290.00 $308.00 $323.00 $337.00 $266.00 $278.00 $289.00 68811 10 $191.00 $236.00 $247.00 $259.00 $236.00 $247.00 $259.00 68815 10 $399.00 $532.00 $562.00 $590.00 $296.00 $310.00 $324.00 68816 10 ------- $790.00 $840.00 $884.00 $279.00 $292.00 $306.00 68840 10 $100.00 $142.00 $149.00 $156.00 $124.00 $130.00 $136.00 68850 0 $76.00 $80.00 $84.00 $88.00 $72.00 $76.00 $79.00 68899 YYY BR ------- ------- ------- ------- ------- ------- 69000 10 $52.00 $222.00 $236.00 $249.00 $146.00 $154.00 $162.00 69005 10 $175.00 $262.00 $277.00 $292.00 $200.00 $211.00 $222.00 69020 10 $109.00 $282.00 $299.00 $316.00 $179.00 $189.00 $199.00 69100 0 $85.00 $129.00 $136.00 $143.00 $60.00 $62.00 $64.00 69105 0 $87.00 $170.00 $181.00 $191.00 $83.00 $87.00 $92.00 69110 90 $294.00 $551.00 $585.00 $618.00 $410.00 $433.00 $458.00 69120 90 $274.00 $510.00 $540.00 $572.00 $510.00 $540.00 $572.00 69140 90 $722.00 $1,091.00 $1,155.00 $1,219.00 $1,091.00 $1,155.00 $1,219.00 69145 90 $248.00 $461.00 $489.00 $516.00 $308.00 $325.00 $343.00 69150 90 $1,111.00 $1,352.00 $1,427.00 $1,512.00 $1,352.00 $1,427.00 $1,512.00 69155 90 $1,680.00 $2,150.00 $2,264.00 $2,393.00 $2,150.00 $2,264.00 $2,393.00 69200 0 $53.00 $154.00 $164.00 $173.00 $70.00 $74.00 $78.00 69205 10 $110.00 $129.00 $137.00 $144.00 $129.00 $137.00 $144.00 69210 0 $39.00 $63.00 $66.00 $70.00 $43.00 $45.00 $47.00 69220 0 $78.00 $167.00 $178.00 $188.00 $79.00 $84.00 $89.00 69222 10 $123.00 $272.00 $289.00 $305.00 $175.00 $185.00 $196.00 69300 YYY $522.00 $744.00 $789.00 $840.00 $606.00 $641.00 $683.00 69310 90 $937.00 $1,371.00 $1,449.00 $1,530.00 $1,371.00 $1,449.00 $1,530.00 69320 90 $1,434.00 $1,956.00 $2,065.00 $2,181.00 $1,956.00 $2,065.00 $2,181.00 69399 YYY BR ------- ------- ------- ------- ------- ------- 69400 0 $76.00 $169.00 $180.00 $190.00 $78.00 $82.00 $87.00 69401 0 $52.00 $102.00 $108.00 $114.00 $64.00 $68.00 $72.00 69405 10 $176.00 $320.00 $338.00 $357.00 $248.00 $261.00 $275.00 69420 10 $117.00 $234.00 $248.00 $262.00 $151.00 $159.00 $168.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 241
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 69421 10 $155.00 $194.00 $205.00 $217.00 $194.00 $205.00 $217.00 69424 0 $84.00 $158.00 $168.00 $178.00 $80.00 $84.00 $88.00 69433 10 $145.00 $243.00 $258.00 $273.00 $164.00 $173.00 $183.00 69436 10 $182.00 $213.00 $225.00 $239.00 $213.00 $225.00 $239.00 69440 90 $699.00 $853.00 $901.00 $951.00 $853.00 $901.00 $951.00 69450 90 $525.00 $665.00 $703.00 $742.00 $665.00 $703.00 $742.00 69501 90 $829.00 $928.00 $978.00 $1,033.00 $928.00 $978.00 $1,033.00 69502 90 $1,118.00 $1,229.00 $1,295.00 $1,367.00 $1,229.00 $1,295.00 $1,367.00 69505 90 $1,176.00 $1,529.00 $1,616.00 $1,706.00 $1,529.00 $1,616.00 $1,706.00 69511 90 $1,221.00 $1,569.00 $1,657.00 $1,750.00 $1,569.00 $1,657.00 $1,750.00 69530 90 $1,616.00 $2,105.00 $2,218.00 $2,339.00 $2,105.00 $2,218.00 $2,339.00 69535 90 $2,824.00 $3,451.00 $3,630.00 $3,831.00 $3,451.00 $3,630.00 $3,831.00 69540 10 $126.00 $256.00 $272.00 $287.00 $161.00 $170.00 $180.00 69550 90 $998.00 $1,317.00 $1,392.00 $1,470.00 $1,317.00 $1,392.00 $1,470.00 69552 90 $1,621.00 $2,022.00 $2,132.00 $2,251.00 $2,022.00 $2,132.00 $2,251.00 69554 90 $2,600.00 $3,267.00 $3,438.00 $3,633.00 $3,267.00 $3,438.00 $3,633.00 69601 90 $1,195.00 $1,325.00 $1,396.00 $1,474.00 $1,325.00 $1,396.00 $1,474.00 69602 90 $1,225.00 $1,379.00 $1,453.00 $1,535.00 $1,379.00 $1,453.00 $1,535.00 69603 90 $1,264.00 $1,622.00 $1,713.00 $1,809.00 $1,622.00 $1,713.00 $1,809.00 69604 90 $1,263.00 $1,413.00 $1,489.00 $1,573.00 $1,413.00 $1,489.00 $1,573.00 69605 90 $1,526.00 $1,996.00 $2,106.00 $2,224.00 $1,996.00 $2,106.00 $2,224.00 69610 10 $41.00 $499.00 $527.00 $556.00 $383.00 $403.00 $426.00 69620 90 $651.00 $868.00 $919.00 $970.00 $620.00 $654.00 $691.00 69631 90 $985.00 $1,098.00 $1,159.00 $1,223.00 $1,098.00 $1,159.00 $1,223.00 69632 90 $1,166.00 $1,353.00 $1,427.00 $1,507.00 $1,353.00 $1,427.00 $1,507.00 69633 90 $1,110.00 $1,303.00 $1,375.00 $1,451.00 $1,303.00 $1,375.00 $1,451.00 69635 90 $1,207.00 $1,540.00 $1,627.00 $1,718.00 $1,540.00 $1,627.00 $1,718.00 69636 90 $1,381.00 $1,753.00 $1,851.00 $1,954.00 $1,753.00 $1,851.00 $1,954.00 69637 90 $1,370.00 $1,743.00 $1,841.00 $1,944.00 $1,743.00 $1,841.00 $1,944.00 69641 90 $1,154.00 $1,313.00 $1,384.00 $1,462.00 $1,313.00 $1,384.00 $1,462.00 69642 90 $1,519.00 $1,697.00 $1,789.00 $1,889.00 $1,697.00 $1,789.00 $1,889.00 69643 90 $1,389.00 $1,549.00 $1,632.00 $1,723.00 $1,549.00 $1,632.00 $1,723.00 69644 90 $1,529.00 $1,890.00 $1,994.00 $2,106.00 $1,890.00 $1,994.00 $2,106.00 69645 90 $1,479.00 $1,849.00 $1,952.00 $2,061.00 $1,849.00 $1,952.00 $2,061.00 69646 90 $1,620.00 $1,968.00 $2,077.00 $2,193.00 $1,968.00 $2,077.00 $2,193.00 69650 90 $879.00 $1,004.00 $1,059.00 $1,118.00 $1,004.00 $1,059.00 $1,118.00 69660 90 $1,072.00 $1,179.00 $1,242.00 $1,311.00 $1,179.00 $1,242.00 $1,311.00 69661 90 $1,412.00 $1,547.00 $1,629.00 $1,720.00 $1,547.00 $1,629.00 $1,720.00 69662 90 $1,386.00 $1,483.00 $1,561.00 $1,649.00 $1,483.00 $1,561.00 $1,649.00 69666 90 $887.00 $1,017.00 $1,072.00 $1,133.00 $1,017.00 $1,072.00 $1,133.00 69667 90 $887.00 $1,019.00 $1,075.00 $1,135.00 $1,019.00 $1,075.00 $1,135.00 69670 90 $988.00 $1,193.00 $1,258.00 $1,328.00 $1,193.00 $1,258.00 $1,328.00 69676 90 $828.00 $1,048.00 $1,107.00 $1,170.00 $1,048.00 $1,107.00 $1,170.00 69700 90 $702.00 $890.00 $939.00 $992.00 $890.00 $939.00 $992.00 69710 0 BR ------- ------- ------- ------- ------- ------- 69711 90 $878.00 $1,089.00 $1,148.00 $1,212.00 $1,089.00 $1,148.00 $1,212.00 69714 90 $961.00 $1,373.00 $1,445.00 $1,525.00 $1,373.00 $1,445.00 $1,525.00 69715 90 $1,217.00 $1,709.00 $1,798.00 $1,898.00 $1,709.00 $1,798.00 $1,898.00 69717 90 $996.00 $1,450.00 $1,520.00 $1,594.00 $1,450.00 $1,520.00 $1,594.00 69718 90 $1,232.00 $1,868.00 $2,001.00 $2,170.00 $1,868.00 $2,001.00 $2,170.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 242
Surgery CPT Code FUD 2003 MRA Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 69720 90 $1,307.00 $1,490.00 $1,570.00 $1,658.00 $1,490.00 $1,570.00 $1,658.00 69725 90 $1,922.00 $2,437.00 $2,567.00 $2,719.00 $2,437.00 $2,567.00 $2,719.00 69740 90 $1,274.00 $1,486.00 $1,563.00 $1,649.00 $1,486.00 $1,563.00 $1,649.00 69745 90 $1,447.00 $1,507.00 $1,580.00 $1,662.00 $1,507.00 $1,580.00 $1,662.00 69799 YYY BR ------- ------- ------- ------- ------- ------- 69801 90 $785.00 $936.00 $988.00 $1,043.00 $936.00 $988.00 $1,043.00 69802 90 $1,115.00 $1,317.00 $1,387.00 $1,465.00 $1,317.00 $1,387.00 $1,465.00 69805 90 $1,187.00 $1,341.00 $1,410.00 $1,488.00 $1,341.00 $1,410.00 $1,488.00 69806 90 $1,123.00 $1,203.00 $1,267.00 $1,338.00 $1,203.00 $1,267.00 $1,338.00 69820 90 $876.00 $1,096.00 $1,158.00 $1,225.00 $1,096.00 $1,158.00 $1,225.00 69840 90 $869.00 $1,161.00 $1,225.00 $1,292.00 $1,161.00 $1,225.00 $1,292.00 69905 90 $1,013.00 $1,155.00 $1,218.00 $1,286.00 $1,155.00 $1,218.00 $1,286.00 69910 90 $1,228.00 $1,303.00 $1,371.00 $1,446.00 $1,303.00 $1,371.00 $1,446.00 69915 90 $1,754.00 $1,981.00 $2,080.00 $2,193.00 $1,981.00 $2,080.00 $2,193.00 69930 90 $1,498.00 $1,631.00 $1,715.00 $1,810.00 $1,631.00 $1,715.00 $1,810.00 69949 YYY BR ------- ------- ------- ------- ------- ------- 69950 90 $2,017.00 $2,364.00 $2,486.00 $2,629.00 $2,364.00 $2,486.00 $2,629.00 69955 90 $2,185.00 $2,589.00 $2,725.00 $2,883.00 $2,589.00 $2,725.00 $2,883.00 69960 90 $2,116.00 $2,494.00 $2,617.00 $2,758.00 $2,494.00 $2,617.00 $2,758.00 69970 90 $2,306.00 $2,774.00 $2,912.00 $3,070.00 $2,774.00 $2,912.00 $3,070.00 69979 YYY BR ------- ------- ------- ------- ------- ------- 69990 ZZZ $262.00 $310.00 $338.00 $377.00 $310.00 $338.00 $377.00 G0127 0 ------- $25.00 $26.00 $28.00 $12.00 $12.00 $13.00 G0168 0 ------- $112.00 $119.00 $125.00 $34.00 $36.00 $38.00 G0247 ZZZ ------- $55.00 $58.00 $60.00 $34.00 $35.00 $37.00 G0289 ZZZ ------- $124.00 $134.00 $146.00 $124.00 $134.00 $146.00 G0341 0 ------- $490.00 $511.00 $537.00 $490.00 $511.00 $537.00 G0342 90 ------- $935.00 $990.00 $1,063.00 $935.00 $990.00 $1,063.00 G0343 90 ------- $1,529.00 $1,613.00 $1,719.00 $1,529.00 $1,613.00 $1,719.00 G0364 ZZZ ------- $18.00 $20.00 $22.00 $14.00 $15.00 $17.00 G0392 0 ------- $3,113.00 $3,316.00 $3,494.00 $668.00 $696.00 $731.00 G0393 0 ------- $2,357.00 $2,512.00 $2,645.00 $425.00 $441.00 $461.00 CPT only 2008 American Medical Association. All rights reserved. Part B, 243
Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition PART C SCHEDULE OF MAXIMUM REIMBURSEMENT ALLOWANCES 244
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 70010 $70.00 $209.00 $225.00 $242.00 $209.00 $225.00 $242.00 70010-26 NC $63.00 $65.00 $67.00 $63.00 $65.00 $67.00 70010-TC NC $146.00 $160.00 $174.00 $146.00 $160.00 $174.00 70015 $58.00 $145.00 $155.00 $165.00 $145.00 $155.00 $165.00 70015-26 NC $65.00 $68.00 $71.00 $65.00 $68.00 $71.00 70015-TC NC $80.00 $87.00 $94.00 $80.00 $87.00 $94.00 70030 $24.00 $29.00 $31.00 $34.00 $29.00 $31.00 $34.00 70030-26 $10.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 70030-TC $15.00 $20.00 $22.00 $24.00 $20.00 $22.00 $24.00 70100 $29.00 $33.00 $35.00 $37.00 $33.00 $35.00 $37.00 70100-26 $9.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 70100-TC $19.00 $23.00 $25.00 $27.00 $23.00 $25.00 $27.00 70110 $36.00 $42.00 $45.00 $48.00 $42.00 $45.00 $48.00 70110-26 $12.00 $13.00 $13.00 $14.00 $13.00 $13.00 $14.00 70110-TC $22.00 $29.00 $31.00 $34.00 $29.00 $31.00 $34.00 70120 $32.00 $37.00 $40.00 $43.00 $37.00 $40.00 $43.00 70120-26 $9.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 70120-TC $22.00 $27.00 $30.00 $32.00 $27.00 $30.00 $32.00 70130 $46.00 $57.00 $61.00 $66.00 $57.00 $61.00 $66.00 70130-26 $17.00 $18.00 $19.00 $20.00 $18.00 $19.00 $20.00 70130-TC $29.00 $39.00 $42.00 $46.00 $39.00 $42.00 $46.00 70134 $45.00 $51.00 $55.00 $59.00 $51.00 $55.00 $59.00 70134-26 $17.00 $18.00 $19.00 $20.00 $18.00 $19.00 $20.00 70134-TC $28.00 $33.00 $36.00 $39.00 $33.00 $36.00 $39.00 70140 $33.00 $35.00 $37.00 $40.00 $35.00 $37.00 $40.00 70140-26 $9.00 $10.00 $10.00 $11.00 $10.00 $10.00 $11.00 70140-TC $22.00 $24.00 $27.00 $29.00 $24.00 $27.00 $29.00 70150 $42.00 $47.00 $50.00 $54.00 $47.00 $50.00 $54.00 70150-26 $12.00 $13.00 $14.00 $14.00 $13.00 $14.00 $14.00 70150-TC $29.00 $33.00 $37.00 $40.00 $33.00 $37.00 $40.00 70160 $29.00 $33.00 $36.00 $38.00 $33.00 $36.00 $38.00 70160-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 70160-TC $19.00 $24.00 $26.00 $28.00 $24.00 $26.00 $28.00 70170 $52.00 $371.00 $406.00 $445.00 $371.00 $406.00 $445.00 70170-26 NC $15.00 $16.00 $16.00 $15.00 $16.00 $16.00 70170-TC NC $366.00 $401.00 $439.00 $366.00 $401.00 $439.00 70190 $34.00 $39.00 $42.00 $45.00 $39.00 $42.00 $45.00 70190-26 $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 70190-TC $22.00 $28.00 $30.00 $33.00 $28.00 $30.00 $33.00 70200 $43.00 $48.00 $52.00 $56.00 $48.00 $52.00 $56.00 70200-26 $14.00 $15.00 $15.00 $16.00 $15.00 $15.00 $16.00 70200-TC $29.00 $34.00 $37.00 $40.00 $34.00 $37.00 $40.00 70210 $32.00 $34.00 $36.00 $39.00 $34.00 $36.00 $39.00 70210-26 $8.00 $9.00 $9.00 $10.00 $9.00 $9.00 $10.00 70210-TC $22.00 $25.00 $27.00 $30.00 $25.00 $27.00 $30.00 70220 $42.00 $44.00 $48.00 $52.00 $44.00 $48.00 $52.00 70220-26 $12.00 $13.00 $13.00 $14.00 $13.00 $13.00 $14.00 70220-TC $29.00 $31.00 $34.00 $38.00 $31.00 $34.00 $38.00 70240 $26.00 $30.00 $32.00 $34.00 $30.00 $32.00 $34.00 70240-26 $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
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 70240-TC $15.00 $20.00 $22.00 $24.00 $20.00 $22.00 $24.00 70250 $35.00 $39.00 $42.00 $45.00 $39.00 $42.00 $45.00 70250-26 $12.00 $12.00 $13.00 $13.00 $12.00 $13.00 $13.00 70250-TC $22.00 $27.00 $29.00 $32.00 $27.00 $29.00 $32.00 70260 $50.00 $54.00 $59.00 $63.00 $54.00 $59.00 $63.00 70260-26 $17.00 $18.00 $19.00 $20.00 $18.00 $19.00 $20.00 70260-TC $33.00 $36.00 $40.00 $44.00 $36.00 $40.00 $44.00 70300 $15.00 $16.00 $18.00 $19.00 $16.00 $18.00 $19.00 70300-26 $5.00 $6.00 $6.00 $7.00 $6.00 $6.00 $7.00 70300-TC $10.00 $10.00 $11.00 $12.00 $10.00 $11.00 $12.00 70310 $24.00 $33.00 $36.00 $38.00 $33.00 $36.00 $38.00 70310-26 $8.00 $9.00 $9.00 $10.00 $9.00 $9.00 $10.00 70310-TC $15.00 $24.00 $26.00 $28.00 $24.00 $26.00 $28.00 70320 $40.00 $50.00 $54.00 $58.00 $50.00 $54.00 $58.00 70320-26 $11.00 $12.00 $12.00 $13.00 $12.00 $12.00 $13.00 70320-TC $29.00 $38.00 $42.00 $45.00 $38.00 $42.00 $45.00 70328 $28.00 $32.00 $34.00 $36.00 $32.00 $34.00 $36.00 70328-26 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 70328-TC $18.00 $22.00 $24.00 $26.00 $22.00 $24.00 $26.00 70330 $43.00 $50.00 $54.00 $58.00 $50.00 $54.00 $58.00 70330-26 $12.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 70330-TC $31.00 $38.00 $41.00 $45.00 $38.00 $41.00 $45.00 70332 $107.00 $103.00 $111.00 $119.00 $103.00 $111.00 $119.00 70332-26 NC $28.00 $29.00 $30.00 $28.00 $29.00 $30.00 70332-TC NC $74.00 $81.00 $89.00 $74.00 $81.00 $89.00 70336 $497.00 $408.00 $441.00 $475.00 $408.00 $441.00 $475.00 70336-26 $72.00 $78.00 $81.00 $85.00 $78.00 $81.00 $85.00 70336-TC $419.00 $330.00 $360.00 $390.00 $330.00 $360.00 $390.00 70350 $24.00 $23.00 $25.00 $27.00 $23.00 $25.00 $27.00 70350-26 $10.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 70350-TC $14.00 $14.00 $16.00 $17.00 $14.00 $16.00 $17.00 70355 $32.00 $29.00 $31.00 $34.00 $29.00 $31.00 $34.00 70355-26 $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 70355-TC $21.00 $18.00 $20.00 $22.00 $18.00 $20.00 $22.00 70360 $24.00 $29.00 $31.00 $33.00 $29.00 $31.00 $33.00 70360-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 70360-TC $15.00 $19.00 $21.00 $23.00 $19.00 $21.00 $23.00 70370 $65.00 $77.00 $83.00 $89.00 $77.00 $83.00 $89.00 70370-26 $16.00 $16.00 $17.00 $17.00 $16.00 $17.00 $17.00 70370-TC $48.00 $61.00 $66.00 $71.00 $61.00 $66.00 $71.00 70371 $122.00 $117.00 $125.00 $135.00 $117.00 $125.00 $135.00 70371-26 $43.00 $44.00 $46.00 $48.00 $44.00 $46.00 $48.00 70371-TC $79.00 $73.00 $80.00 $87.00 $73.00 $80.00 $87.00 70373 $90.00 $94.00 $101.00 $109.00 $94.00 $101.00 $109.00 70373-26 NC $23.00 $23.00 $24.00 $23.00 $23.00 $24.00 70373-TC NC $71.00 $78.00 $85.00 $71.00 $78.00 $85.00 70380 $34.00 $40.00 $43.00 $47.00 $40.00 $43.00 $47.00 70380-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 70380-TC $24.00 $31.00 $34.00 $36.00 $31.00 $34.00 $36.00 70390 $87.00 $106.00 $114.00 $123.00 $106.00 $114.00 $123.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 246
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 70390-26 NC $20.00 $21.00 $22.00 $20.00 $21.00 $22.00 70390-TC NC $85.00 $93.00 $101.00 $85.00 $93.00 $101.00 70450 $221.00 $244.00 $264.00 $284.00 $244.00 $264.00 $284.00 70450-26 $43.00 $45.00 $47.00 $49.00 $45.00 $47.00 $49.00 70450-TC $176.00 $199.00 $217.00 $236.00 $199.00 $217.00 $236.00 70460 $271.00 $310.00 $335.00 $360.00 $310.00 $335.00 $360.00 70460-26 $58.00 $60.00 $62.00 $65.00 $60.00 $62.00 $65.00 70460-TC $211.00 $250.00 $272.00 $295.00 $250.00 $272.00 $295.00 70470 $332.00 $376.00 $407.00 $438.00 $376.00 $407.00 $438.00 70470-26 $65.00 $68.00 $70.00 $73.00 $68.00 $70.00 $73.00 70470-TC $264.00 $309.00 $337.00 $365.00 $309.00 $337.00 $365.00 70480 $244.00 $270.00 $290.00 $310.00 $270.00 $290.00 $310.00 70480-26 $65.00 $68.00 $70.00 $73.00 $68.00 $70.00 $73.00 70480-TC $176.00 $202.00 $220.00 $237.00 $202.00 $220.00 $237.00 70481 $284.00 $366.00 $394.00 $421.00 $366.00 $394.00 $421.00 70481-26 $70.00 $73.00 $76.00 $79.00 $73.00 $76.00 $79.00 70481-TC $211.00 $293.00 $318.00 $343.00 $293.00 $318.00 $343.00 70482 $340.00 $420.00 $453.00 $485.00 $420.00 $453.00 $485.00 70482-26 $74.00 $77.00 $79.00 $82.00 $77.00 $79.00 $82.00 70482-TC $264.00 $344.00 $373.00 $403.00 $344.00 $373.00 $403.00 70486 $236.00 $263.00 $283.00 $303.00 $263.00 $283.00 $303.00 70486-26 $58.00 $60.00 $62.00 $64.00 $60.00 $62.00 $64.00 70486-TC $176.00 $203.00 $221.00 $239.00 $203.00 $221.00 $239.00 70487 $279.00 $354.00 $382.00 $409.00 $354.00 $382.00 $409.00 70487-26 $66.00 $69.00 $72.00 $75.00 $69.00 $72.00 $75.00 70487-TC $211.00 $285.00 $310.00 $335.00 $285.00 $310.00 $335.00 70488 $339.00 $419.00 $452.00 $485.00 $419.00 $452.00 $485.00 70488-26 $72.00 $75.00 $77.00 $80.00 $75.00 $77.00 $80.00 70488-TC $264.00 $344.00 $374.00 $404.00 $344.00 $374.00 $404.00 70490 $244.00 $271.00 $291.00 $312.00 $271.00 $291.00 $312.00 70490-26 $65.00 $68.00 $71.00 $74.00 $68.00 $71.00 $74.00 70490-TC $176.00 $203.00 $220.00 $238.00 $203.00 $220.00 $238.00 70491 $284.00 $352.00 $379.00 $406.00 $352.00 $379.00 $406.00 70491-26 $70.00 $73.00 $76.00 $79.00 $73.00 $76.00 $79.00 70491-TC $211.00 $278.00 $303.00 $327.00 $278.00 $303.00 $327.00 70492 $340.00 $421.00 $453.00 $486.00 $421.00 $453.00 $486.00 70492-26 $74.00 $77.00 $79.00 $82.00 $77.00 $79.00 $82.00 70492-TC $264.00 $344.00 $374.00 $404.00 $344.00 $374.00 $404.00 70496 $366.00 $440.00 $473.00 $507.00 $440.00 $473.00 $507.00 70496-26 $92.00 $93.00 $96.00 $100.00 $93.00 $96.00 $100.00 70496-TC $270.00 $347.00 $377.00 $407.00 $347.00 $377.00 $407.00 70498 $366.00 $440.00 $474.00 $508.00 $440.00 $474.00 $508.00 70498-26 $92.00 $93.00 $97.00 $101.00 $93.00 $97.00 $101.00 70498-TC $270.00 $347.00 $377.00 $407.00 $347.00 $377.00 $407.00 70540 $482.00 $432.00 $464.00 $495.00 $432.00 $464.00 $495.00 70540-26 $70.00 $71.00 $74.00 $77.00 $71.00 $74.00 $77.00 70540-TC $413.00 $360.00 $390.00 $419.00 $360.00 $390.00 $419.00 70542 $579.00 $503.00 $541.00 $578.00 $503.00 $541.00 $578.00 70542-26 $82.00 $86.00 $89.00 $92.00 $86.00 $89.00 $92.00 70542-TC $495.00 $417.00 $452.00 $486.00 $417.00 $452.00 $486.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 247
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 70543 $1,029.00 $667.00 $719.00 $770.00 $667.00 $719.00 $770.00 70543-26 $109.00 $114.00 $118.00 $122.00 $114.00 $118.00 $122.00 70543-TC $916.00 $553.00 $601.00 $648.00 $553.00 $601.00 $648.00 70544 $481.00 $427.00 $460.00 $495.00 $427.00 $460.00 $495.00 70544-26 $61.00 $64.00 $66.00 $68.00 $64.00 $66.00 $68.00 70544-TC $419.00 $363.00 $395.00 $426.00 $363.00 $395.00 $426.00 70545 $481.00 $483.00 $522.00 $561.00 $483.00 $522.00 $561.00 70545-26 $61.00 $64.00 $66.00 $68.00 $64.00 $66.00 $68.00 70545-TC $419.00 $419.00 $456.00 $493.00 $419.00 $456.00 $493.00 70546 $914.00 $645.00 $693.00 $739.00 $645.00 $693.00 $739.00 70546-26 $92.00 $96.00 $99.00 $103.00 $96.00 $99.00 $103.00 70546-TC $820.00 $549.00 $594.00 $636.00 $549.00 $594.00 $636.00 70547 $481.00 $426.00 $460.00 $494.00 $426.00 $460.00 $494.00 70547-26 $61.00 $63.00 $65.00 $68.00 $63.00 $65.00 $68.00 70547-TC $419.00 $363.00 $395.00 $426.00 $363.00 $395.00 $426.00 70548 $481.00 $483.00 $522.00 $561.00 $483.00 $522.00 $561.00 70548-26 $61.00 $64.00 $66.00 $68.00 $64.00 $66.00 $68.00 70548-TC $419.00 $419.00 $456.00 $492.00 $419.00 $456.00 $492.00 70549 $914.00 $645.00 $693.00 $739.00 $645.00 $693.00 $739.00 70549-26 $92.00 $96.00 $99.00 $103.00 $96.00 $99.00 $103.00 70549-TC $820.00 $549.00 $594.00 $636.00 $549.00 $594.00 $636.00 70551 $497.00 $441.00 $476.00 $512.00 $441.00 $476.00 $512.00 70551-26 $76.00 $78.00 $81.00 $85.00 $78.00 $81.00 $85.00 70551-TC $419.00 $363.00 $395.00 $427.00 $363.00 $395.00 $427.00 70552 $596.00 $515.00 $556.00 $598.00 $515.00 $556.00 $598.00 70552-26 $91.00 $95.00 $98.00 $102.00 $95.00 $98.00 $102.00 70552-TC $502.00 $421.00 $458.00 $497.00 $421.00 $458.00 $497.00 70553 $1,055.00 $685.00 $742.00 $802.00 $685.00 $742.00 $802.00 70553-26 $120.00 $125.00 $129.00 $134.00 $125.00 $129.00 $134.00 70553-TC $931.00 $560.00 $613.00 $668.00 $560.00 $613.00 $668.00 70554 ------- $741.00 $802.00 $866.00 $741.00 $802.00 $866.00 70554-26 ------- $111.00 $115.00 $120.00 $111.00 $115.00 $120.00 70554-TC ------- $629.00 $687.00 $746.00 $629.00 $687.00 $746.00 70555 ------- BR BR BR BR BR BR 70555-26 ------- $136.00 $141.00 $146.00 $136.00 $141.00 $146.00 70555-TC ------- BR BR BR BR BR BR 70557 ------- $418.00 $460.00 $507.00 $418.00 $460.00 $507.00 70557-26 ------- $154.00 $159.00 $164.00 $154.00 $159.00 $164.00 70557-TC ------- $371.00 $408.00 $450.00 $371.00 $408.00 $450.00 70558 ------- $480.00 $529.00 $583.00 $480.00 $529.00 $583.00 70558-26 ------- $170.00 $176.00 $181.00 $170.00 $176.00 $181.00 70558-TC ------- $428.00 $472.00 $519.00 $428.00 $472.00 $519.00 70559 ------- $621.00 $684.00 $754.00 $621.00 $684.00 $754.00 70559-26 ------- $172.00 $178.00 $185.00 $172.00 $178.00 $185.00 70559-TC ------- $567.00 $624.00 $688.00 $567.00 $624.00 $688.00 71010 $27.00 $27.00 $29.00 $31.00 $27.00 $29.00 $31.00 71010-26 $9.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 71010-TC $17.00 $18.00 $19.00 $21.00 $18.00 $19.00 $21.00 71015 $30.00 $32.00 $34.00 $37.00 $32.00 $34.00 $37.00 71015-26 $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
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 71015-TC $19.00 $21.00 $23.00 $25.00 $21.00 $23.00 $25.00 71020 $35.00 $36.00 $39.00 $42.00 $36.00 $39.00 $42.00 71020-26 $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 71020-TC $22.00 $24.00 $27.00 $29.00 $24.00 $27.00 $29.00 71021 $41.00 $44.00 $47.00 $51.00 $44.00 $47.00 $51.00 71021-26 $13.00 $14.00 $15.00 $15.00 $14.00 $15.00 $15.00 71021-TC $28.00 $30.00 $33.00 $36.00 $30.00 $33.00 $36.00 71022 $44.00 $49.00 $52.00 $56.00 $49.00 $52.00 $56.00 71022-26 $16.00 $16.00 $16.00 $17.00 $16.00 $16.00 $17.00 71022-TC $28.00 $33.00 $36.00 $39.00 $33.00 $36.00 $39.00 71023 $49.00 $66.00 $70.00 $75.00 $66.00 $70.00 $75.00 71023-26 $19.00 $20.00 $21.00 $21.00 $20.00 $21.00 $21.00 71023-TC $29.00 $46.00 $50.00 $54.00 $46.00 $50.00 $54.00 71030 $45.00 $50.00 $54.00 $58.00 $50.00 $54.00 $58.00 71030-26 $16.00 $16.00 $16.00 $17.00 $16.00 $16.00 $17.00 71030-TC $29.00 $35.00 $38.00 $41.00 $35.00 $38.00 $41.00 71034 $79.00 $96.00 $103.00 $111.00 $96.00 $103.00 $111.00 71034-26 $23.00 $25.00 $26.00 $27.00 $25.00 $26.00 $27.00 71034-TC $54.00 $71.00 $77.00 $83.00 $71.00 $77.00 $83.00 71035 $56.00 $35.00 $38.00 $40.00 $35.00 $38.00 $40.00 71035-26 $19.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 71035-TC $38.00 $26.00 $28.00 $30.00 $26.00 $28.00 $30.00 71040 $34.00 $101.00 $108.00 $116.00 $101.00 $108.00 $116.00 71040-26 NC $30.00 $31.00 $33.00 $30.00 $31.00 $33.00 71040-TC NC $71.00 $77.00 $83.00 $71.00 $77.00 $83.00 71060 $108.00 $146.00 $157.00 $169.00 $146.00 $157.00 $169.00 71060-26 NC $39.00 $40.00 $42.00 $39.00 $40.00 $42.00 71060-TC NC $107.00 $117.00 $127.00 $107.00 $117.00 $127.00 71090 $92.00 ------- ------- ------- ------- ------- ------- 71090-26 NC $31.00 $32.00 $33.00 $31.00 $32.00 $33.00 71090-TC NC BR BR BR BR BR BR 71100 $33.00 $36.00 $39.00 $42.00 $36.00 $39.00 $42.00 71100-26 $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 71100-TC $21.00 $24.00 $27.00 $29.00 $24.00 $27.00 $29.00 71101 $38.00 $43.00 $46.00 $49.00 $43.00 $46.00 $49.00 71101-26 $13.00 $14.00 $15.00 $15.00 $14.00 $15.00 $15.00 71101-TC $24.00 $29.00 $31.00 $34.00 $29.00 $31.00 $34.00 71110 $43.00 $46.00 $49.00 $53.00 $46.00 $49.00 $53.00 71110-26 $13.00 $14.00 $15.00 $15.00 $14.00 $15.00 $15.00 71110-TC $29.00 $32.00 $35.00 $38.00 $32.00 $35.00 $38.00 71111 $49.00 $57.00 $61.00 $65.00 $57.00 $61.00 $65.00 71111-26 $16.00 $16.00 $17.00 $17.00 $16.00 $17.00 $17.00 71111-TC $33.00 $40.00 $44.00 $48.00 $40.00 $44.00 $48.00 71120 $35.00 $37.00 $40.00 $43.00 $37.00 $40.00 $43.00 71120-26 $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 71120-TC $24.00 $26.00 $29.00 $32.00 $26.00 $29.00 $32.00 71130 $38.00 $41.00 $44.00 $47.00 $41.00 $44.00 $47.00 71130-26 $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 71130-TC $26.00 $30.00 $32.00 $35.00 $30.00 $32.00 $35.00 71250 $282.00 $265.00 $285.00 $307.00 $265.00 $285.00 $307.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 249
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 71250-26 $59.00 $61.00 $63.00 $66.00 $61.00 $63.00 $66.00 71250-TC $220.00 $204.00 $222.00 $241.00 $204.00 $222.00 $241.00 71260 $328.00 $359.00 $388.00 $417.00 $359.00 $388.00 $417.00 71260-26 $63.00 $65.00 $67.00 $70.00 $65.00 $67.00 $70.00 71260-TC $264.00 $294.00 $320.00 $347.00 $294.00 $320.00 $347.00 71270 $402.00 $418.00 $452.00 $486.00 $418.00 $452.00 $486.00 71270-26 $70.00 $73.00 $76.00 $79.00 $73.00 $76.00 $79.00 71270-TC $330.00 $345.00 $376.00 $408.00 $345.00 $376.00 $408.00 71275 $431.00 $448.00 $481.00 $513.00 $448.00 $481.00 $513.00 71275-26 $100.00 $102.00 $106.00 $110.00 $102.00 $106.00 $110.00 71275-TC $328.00 $346.00 $375.00 $403.00 $346.00 $375.00 $403.00 71550 $490.00 $438.00 $471.00 $503.00 $438.00 $471.00 $503.00 71550-26 $75.00 $77.00 $80.00 $83.00 $77.00 $80.00 $83.00 71550-TC $415.00 $361.00 $391.00 $420.00 $361.00 $391.00 $420.00 71551 $587.00 $509.00 $547.00 $585.00 $509.00 $547.00 $585.00 71551-26 $88.00 $91.00 $95.00 $98.00 $91.00 $95.00 $98.00 71551-TC $496.00 $417.00 $452.00 $486.00 $417.00 $452.00 $486.00 71552 $1,029.00 $670.00 $720.00 $768.00 $670.00 $720.00 $768.00 71552-26 $114.00 $120.00 $124.00 $129.00 $120.00 $124.00 $129.00 71552-TC $911.00 $550.00 $596.00 $639.00 $550.00 $596.00 $639.00 71555 $514.00 $516.00 $557.00 $598.00 $516.00 $557.00 $598.00 71555-26 $92.00 $96.00 $100.00 $104.00 $96.00 $100.00 $104.00 71555-TC $419.00 $420.00 $457.00 $494.00 $420.00 $457.00 $494.00 72010 $62.00 $71.00 $76.00 $81.00 $71.00 $76.00 $81.00 72010-26 $22.00 $24.00 $24.00 $25.00 $24.00 $24.00 $25.00 72010-TC $38.00 $47.00 $52.00 $56.00 $47.00 $52.00 $56.00 72020 $22.00 $26.00 $28.00 $30.00 $26.00 $28.00 $30.00 72020-26 $7.00 $8.00 $8.00 $9.00 $8.00 $8.00 $9.00 72020-TC $15.00 $18.00 $19.00 $21.00 $18.00 $19.00 $21.00 72040 $34.00 $39.00 $42.00 $46.00 $39.00 $42.00 $46.00 72040-26 $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 72040-TC $22.00 $28.00 $31.00 $33.00 $28.00 $31.00 $33.00 72050 $49.00 $56.00 $60.00 $65.00 $56.00 $60.00 $65.00 72050-26 $16.00 $16.00 $16.00 $17.00 $16.00 $16.00 $17.00 72050-TC $33.00 $40.00 $44.00 $48.00 $40.00 $44.00 $48.00 72052 $61.00 $70.00 $76.00 $81.00 $70.00 $76.00 $81.00 72052-26 $18.00 $19.00 $20.00 $21.00 $19.00 $20.00 $21.00 72052-TC $42.00 $51.00 $55.00 $60.00 $51.00 $55.00 $60.00 72069 $40.00 $36.00 $38.00 $41.00 $36.00 $38.00 $41.00 72069-26 $17.00 $12.00 $12.00 $13.00 $12.00 $12.00 $13.00 72069-TC $24.00 $24.00 $26.00 $28.00 $24.00 $26.00 $28.00 72070 $36.00 $38.00 $41.00 $44.00 $38.00 $41.00 $44.00 72070-26 $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 72070-TC $24.00 $26.00 $29.00 $32.00 $26.00 $29.00 $32.00 72072 $39.00 $42.00 $46.00 $49.00 $42.00 $46.00 $49.00 72072-26 $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 72072-TC $28.00 $31.00 $34.00 $37.00 $31.00 $34.00 $37.00 72074 $45.00 $50.00 $54.00 $58.00 $50.00 $54.00 $58.00 72074-26 $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 72074-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
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 72080 $36.00 $39.00 $42.00 $45.00 $39.00 $42.00 $45.00 72080-26 $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 72080-TC $24.00 $28.00 $30.00 $33.00 $28.00 $30.00 $33.00 72090 $39.00 $49.00 $52.00 $56.00 $49.00 $52.00 $56.00 72090-26 $14.00 $15.00 $15.00 $16.00 $15.00 $15.00 $16.00 72090-TC $24.00 $34.00 $37.00 $40.00 $34.00 $37.00 $40.00 72100 $36.00 $41.00 $44.00 $48.00 $41.00 $44.00 $48.00 72100-26 $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 72100-TC $24.00 $30.00 $33.00 $36.00 $30.00 $33.00 $36.00 72110 $50.00 $58.00 $62.00 $67.00 $58.00 $62.00 $67.00 72110-26 $16.00 $16.00 $16.00 $17.00 $16.00 $16.00 $17.00 72110-TC $34.00 $42.00 $46.00 $50.00 $42.00 $46.00 $50.00 72114 $64.00 $75.00 $80.00 $86.00 $75.00 $80.00 $86.00 72114-26 $18.00 $19.00 $20.00 $21.00 $19.00 $20.00 $21.00 72114-TC $44.00 $55.00 $60.00 $65.00 $55.00 $60.00 $65.00 72120 $45.00 $52.00 $56.00 $61.00 $52.00 $56.00 $61.00 72120-26 $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 72120-TC $33.00 $41.00 $44.00 $48.00 $41.00 $44.00 $48.00 72125 $282.00 $265.00 $285.00 $307.00 $265.00 $285.00 $307.00 72125-26 $59.00 $61.00 $63.00 $66.00 $61.00 $63.00 $66.00 72125-TC $220.00 $204.00 $222.00 $241.00 $204.00 $222.00 $241.00 72126 $328.00 $358.00 $387.00 $416.00 $358.00 $387.00 $416.00 72126-26 $62.00 $64.00 $66.00 $69.00 $64.00 $66.00 $69.00 72126-TC $264.00 $294.00 $320.00 $347.00 $294.00 $320.00 $347.00 72127 $397.00 $413.00 $446.00 $480.00 $413.00 $446.00 $480.00 72127-26 $65.00 $68.00 $70.00 $73.00 $68.00 $70.00 $73.00 72127-TC $330.00 $345.00 $376.00 $408.00 $345.00 $376.00 $408.00 72128 $282.00 $265.00 $285.00 $307.00 $265.00 $285.00 $307.00 72128-26 $59.00 $61.00 $63.00 $66.00 $61.00 $63.00 $66.00 72128-TC $220.00 $204.00 $222.00 $241.00 $204.00 $222.00 $241.00 72129 $328.00 $358.00 $387.00 $416.00 $358.00 $387.00 $416.00 72129-26 $62.00 $64.00 $67.00 $69.00 $64.00 $67.00 $69.00 72129-TC $264.00 $294.00 $320.00 $347.00 $294.00 $320.00 $347.00 72130 $397.00 $413.00 $446.00 $480.00 $413.00 $446.00 $480.00 72130-26 $65.00 $68.00 $70.00 $73.00 $68.00 $70.00 $73.00 72130-TC $330.00 $345.00 $376.00 $408.00 $345.00 $376.00 $408.00 72131 $282.00 $265.00 $285.00 $307.00 $265.00 $285.00 $307.00 72131-26 $59.00 $61.00 $63.00 $66.00 $61.00 $63.00 $66.00 72131-TC $220.00 $204.00 $222.00 $241.00 $204.00 $222.00 $241.00 72132 $328.00 $358.00 $387.00 $416.00 $358.00 $387.00 $416.00 72132-26 $62.00 $64.00 $66.00 $69.00 $64.00 $66.00 $69.00 72132-TC $264.00 $294.00 $320.00 $347.00 $294.00 $320.00 $347.00 72133 $391.00 $413.00 $446.00 $480.00 $413.00 $446.00 $480.00 72133-26 $65.00 $68.00 $70.00 $73.00 $68.00 $70.00 $73.00 72133-TC $323.00 $345.00 $376.00 $408.00 $345.00 $376.00 $408.00 72141 $503.00 $449.00 $485.00 $521.00 $449.00 $485.00 $521.00 72141-26 $82.00 $85.00 $88.00 $91.00 $85.00 $88.00 $91.00 72141-TC $419.00 $364.00 $397.00 $430.00 $364.00 $397.00 $430.00 72142 $604.00 $523.00 $564.00 $606.00 $523.00 $564.00 $606.00 72142-26 $99.00 $102.00 $106.00 $110.00 $102.00 $106.00 $110.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 251
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 72142-TC $502.00 $421.00 $458.00 $497.00 $421.00 $458.00 $497.00 72146 $549.00 $449.00 $485.00 $522.00 $449.00 $485.00 $522.00 72146-26 $82.00 $85.00 $88.00 $91.00 $85.00 $88.00 $91.00 72146-TC $465.00 $364.00 $398.00 $431.00 $364.00 $398.00 $431.00 72147 $603.00 $524.00 $566.00 $609.00 $524.00 $566.00 $609.00 72147-26 $98.00 $102.00 $106.00 $110.00 $102.00 $106.00 $110.00 72147-TC $502.00 $422.00 $460.00 $499.00 $422.00 $460.00 $499.00 72148 $543.00 $443.00 $479.00 $516.00 $443.00 $479.00 $516.00 72148-26 $76.00 $78.00 $81.00 $85.00 $78.00 $81.00 $85.00 72148-TC $465.00 $364.00 $398.00 $431.00 $364.00 $398.00 $431.00 72149 $597.00 $515.00 $556.00 $598.00 $515.00 $556.00 $598.00 72149-26 $92.00 $95.00 $98.00 $102.00 $95.00 $98.00 $102.00 72149-TC $502.00 $421.00 $458.00 $497.00 $421.00 $458.00 $497.00 72156 $1,066.00 $696.00 $753.00 $813.00 $696.00 $753.00 $813.00 72156-26 $131.00 $136.00 $140.00 $146.00 $136.00 $140.00 $146.00 72156-TC $931.00 $560.00 $613.00 $668.00 $560.00 $613.00 $668.00 72157 $1,066.00 $696.00 $754.00 $815.00 $696.00 $754.00 $815.00 72157-26 $131.00 $136.00 $140.00 $146.00 $136.00 $140.00 $146.00 72157-TC $931.00 $561.00 $614.00 $670.00 $561.00 $614.00 $670.00 72158 $1,056.00 $685.00 $742.00 $802.00 $685.00 $742.00 $802.00 72158-26 $121.00 $125.00 $129.00 $134.00 $125.00 $129.00 $134.00 72158-TC $931.00 $560.00 $613.00 $668.00 $560.00 $613.00 $668.00 72159 $563.00 $655.00 $708.00 $763.00 $655.00 $708.00 $763.00 72159-26 $94.00 $94.00 $98.00 $102.00 $94.00 $98.00 $102.00 72159-TC $465.00 $560.00 $610.00 $660.00 $560.00 $610.00 $660.00 72170 $29.00 $29.00 $31.00 $34.00 $29.00 $31.00 $34.00 72170-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 72170-TC $19.00 $20.00 $22.00 $24.00 $20.00 $22.00 $24.00 72190 $35.00 $42.00 $45.00 $48.00 $42.00 $45.00 $48.00 72190-26 $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 72190-TC $24.00 $31.00 $34.00 $36.00 $31.00 $34.00 $36.00 72191 $413.00 $442.00 $475.00 $507.00 $442.00 $475.00 $507.00 72191-26 $94.00 $96.00 $100.00 $104.00 $96.00 $100.00 $104.00 72191-TC $315.00 $346.00 $375.00 $403.00 $346.00 $375.00 $403.00 72192 $278.00 $262.00 $282.00 $304.00 $262.00 $282.00 $304.00 72192-26 $56.00 $58.00 $60.00 $62.00 $58.00 $60.00 $62.00 72192-TC $220.00 $204.00 $222.00 $242.00 $204.00 $222.00 $242.00 72193 $317.00 $356.00 $385.00 $414.00 $356.00 $385.00 $414.00 72193-26 $59.00 $62.00 $64.00 $66.00 $62.00 $64.00 $66.00 72193-TC $256.00 $295.00 $321.00 $348.00 $295.00 $321.00 $348.00 72194 $380.00 $409.00 $442.00 $475.00 $409.00 $442.00 $475.00 72194-26 $62.00 $64.00 $66.00 $69.00 $64.00 $66.00 $69.00 72194-TC $317.00 $345.00 $375.00 $406.00 $345.00 $375.00 $406.00 72195 $491.00 $438.00 $471.00 $504.00 $438.00 $471.00 $504.00 72195-26 $74.00 $77.00 $80.00 $83.00 $77.00 $80.00 $83.00 72195-TC $415.00 $361.00 $392.00 $422.00 $361.00 $392.00 $422.00 72196 $526.00 $510.00 $549.00 $587.00 $510.00 $549.00 $587.00 72196-26 $84.00 $92.00 $95.00 $99.00 $92.00 $95.00 $99.00 72196-TC $442.00 $418.00 $454.00 $488.00 $418.00 $454.00 $488.00 72197 $1,037.00 $674.00 $726.00 $779.00 $674.00 $726.00 $779.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 252
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 72197-26 $114.00 $119.00 $124.00 $128.00 $119.00 $124.00 $128.00 72197-TC $919.00 $554.00 $603.00 $650.00 $554.00 $603.00 $650.00 72198 $517.00 $516.00 $556.00 $597.00 $516.00 $556.00 $597.00 72198-26 $95.00 $96.00 $99.00 $103.00 $96.00 $99.00 $103.00 72198-TC $419.00 $420.00 $457.00 $494.00 $420.00 $457.00 $494.00 72200 $29.00 $31.00 $34.00 $36.00 $31.00 $34.00 $36.00 72200-26 $9.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 72200-TC $19.00 $22.00 $24.00 $26.00 $22.00 $24.00 $26.00 72202 $33.00 $38.00 $41.00 $44.00 $38.00 $41.00 $44.00 72202-26 $9.00 $10.00 $10.00 $11.00 $10.00 $10.00 $11.00 72202-TC $22.00 $28.00 $31.00 $33.00 $28.00 $31.00 $33.00 72220 $30.00 $33.00 $36.00 $39.00 $33.00 $36.00 $39.00 72220-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 72220-TC $21.00 $24.00 $26.00 $29.00 $24.00 $26.00 $29.00 72240 $132.00 $201.00 $217.00 $235.00 $201.00 $217.00 $235.00 72240-26 NC $48.00 $49.00 $51.00 $48.00 $49.00 $51.00 72240-TC NC $153.00 $168.00 $184.00 $153.00 $168.00 $184.00 72255 $129.00 $184.00 $199.00 $215.00 $184.00 $199.00 $215.00 72255-26 NC $47.00 $49.00 $50.00 $47.00 $49.00 $50.00 72255-TC NC $137.00 $151.00 $165.00 $137.00 $151.00 $165.00 72265 $132.00 $181.00 $196.00 $212.00 $181.00 $196.00 $212.00 72265-26 NC $44.00 $45.00 $47.00 $44.00 $45.00 $47.00 72265-TC NC $138.00 $151.00 $165.00 $138.00 $151.00 $165.00 72270 $176.00 $280.00 $303.00 $327.00 $280.00 $303.00 $327.00 72270-26 NC $70.00 $73.00 $76.00 $70.00 $73.00 $76.00 72270-TC NC $210.00 $230.00 $251.00 $210.00 $230.00 $251.00 72275 $112.00 $124.00 $134.00 $147.00 $124.00 $134.00 $147.00 72275-26 NC $38.00 $40.00 $41.00 $38.00 $40.00 $41.00 72275-TC NC $85.00 $95.00 $106.00 $85.00 $95.00 $106.00 72285 $101.00 $274.00 $298.00 $325.00 $274.00 $298.00 $325.00 72285-26 NC $60.00 $62.00 $65.00 $60.00 $62.00 $65.00 72285-TC NC $214.00 $236.00 $260.00 $214.00 $236.00 $260.00 72291 ------- BR BR BR BR BR BR 72291-26 ------- $73.00 $76.00 $80.00 $73.00 $76.00 $80.00 72291-TC ------- BR BR BR BR BR BR 72292 ------- BR BR BR BR BR BR 72292-26 ------- $75.00 $77.00 $81.00 $75.00 $77.00 $81.00 72292-TC ------- BR BR BR BR BR BR 72295 $107.00 $248.00 $270.00 $296.00 $248.00 $270.00 $296.00 72295-26 NC $45.00 $46.00 $49.00 $45.00 $46.00 $49.00 72295-TC NC $203.00 $224.00 $247.00 $203.00 $224.00 $247.00 73000 $28.00 $30.00 $32.00 $34.00 $30.00 $32.00 $34.00 73000-26 $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $9.00 73000-TC $19.00 $21.00 $23.00 $25.00 $21.00 $23.00 $25.00 73010 $29.00 $31.00 $33.00 $35.00 $31.00 $33.00 $35.00 73010-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 73010-TC $19.00 $22.00 $24.00 $25.00 $22.00 $24.00 $25.00 73020 $26.00 $26.00 $28.00 $30.00 $26.00 $28.00 $30.00 73020-26 $7.00 $8.00 $8.00 $9.00 $8.00 $8.00 $9.00 73020-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
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 73030 $31.00 $33.00 $36.00 $39.00 $33.00 $36.00 $39.00 73030-26 $9.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 73030-TC $21.00 $24.00 $26.00 $28.00 $24.00 $26.00 $28.00 73040 $68.00 $118.00 $127.00 $137.00 $118.00 $127.00 $137.00 73040-26 NC $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 73040-TC NC $89.00 $97.00 $106.00 $89.00 $97.00 $106.00 73050 $35.00 $39.00 $42.00 $46.00 $39.00 $42.00 $46.00 73050-26 $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 73050-TC $24.00 $28.00 $31.00 $34.00 $28.00 $31.00 $34.00 73060 $30.00 $33.00 $36.00 $39.00 $33.00 $36.00 $39.00 73060-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 73060-TC $21.00 $24.00 $26.00 $28.00 $24.00 $26.00 $28.00 73070 $27.00 $29.00 $31.00 $34.00 $29.00 $31.00 $34.00 73070-26 $7.00 $8.00 $8.00 $9.00 $8.00 $8.00 $9.00 73070-TC $19.00 $21.00 $23.00 $25.00 $21.00 $23.00 $25.00 73080 $30.00 $36.00 $39.00 $43.00 $36.00 $39.00 $43.00 73080-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 73080-TC $21.00 $27.00 $30.00 $32.00 $27.00 $30.00 $32.00 73085 $74.00 $110.00 $119.00 $128.00 $110.00 $119.00 $128.00 73085-26 NC $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 73085-TC NC $81.00 $89.00 $97.00 $81.00 $89.00 $97.00 73090 $28.00 $30.00 $32.00 $34.00 $30.00 $32.00 $34.00 73090-26 $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $9.00 73090-TC $19.00 $21.00 $23.00 $25.00 $21.00 $23.00 $25.00 73100 $27.00 $30.00 $32.00 $35.00 $30.00 $32.00 $35.00 73100-26 $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $9.00 73100-TC $18.00 $22.00 $24.00 $25.00 $22.00 $24.00 $25.00 73110 $29.00 $35.00 $37.00 $40.00 $35.00 $37.00 $40.00 73110-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 73110-TC $19.00 $26.00 $28.00 $30.00 $26.00 $28.00 $30.00 73115 $54.00 $108.00 $116.00 $124.00 $108.00 $116.00 $124.00 73115-26 NC $28.00 $29.00 $30.00 $28.00 $29.00 $30.00 73115-TC NC $79.00 $86.00 $94.00 $79.00 $86.00 $94.00 73120 $27.00 $29.00 $31.00 $34.00 $29.00 $31.00 $34.00 73120-26 $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $9.00 73120-TC $18.00 $21.00 $23.00 $24.00 $21.00 $23.00 $24.00 73130 $29.00 $33.00 $35.00 $38.00 $33.00 $35.00 $38.00 73130-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 73130-TC $19.00 $24.00 $26.00 $28.00 $24.00 $26.00 $28.00 73140 $22.00 $29.00 $31.00 $33.00 $29.00 $31.00 $33.00 73140-26 $7.00 $7.00 $7.00 $8.00 $7.00 $7.00 $8.00 73140-TC $15.00 $22.00 $24.00 $26.00 $22.00 $24.00 $26.00 73200 $242.00 $261.00 $281.00 $301.00 $261.00 $281.00 $301.00 73200-26 $56.00 $58.00 $60.00 $62.00 $58.00 $60.00 $62.00 73200-TC $185.00 $203.00 $221.00 $239.00 $203.00 $221.00 $239.00 73201 $282.00 $344.00 $371.00 $399.00 $344.00 $371.00 $399.00 73201-26 $59.00 $61.00 $63.00 $66.00 $61.00 $63.00 $66.00 73201-TC $220.00 $283.00 $308.00 $333.00 $283.00 $308.00 $333.00 73202 $342.00 $408.00 $440.00 $473.00 $408.00 $440.00 $473.00 73202-26 $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
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 73202-TC $277.00 $344.00 $374.00 $404.00 $344.00 $374.00 $404.00 73206 $375.00 $443.00 $476.00 $508.00 $443.00 $476.00 $508.00 73206-26 $94.00 $96.00 $100.00 $104.00 $96.00 $100.00 $104.00 73206-TC $277.00 $346.00 $376.00 $405.00 $346.00 $376.00 $405.00 73218 $482.00 $432.00 $464.00 $495.00 $432.00 $464.00 $495.00 73218-26 $68.00 $71.00 $74.00 $77.00 $71.00 $74.00 $77.00 73218-TC $413.00 $360.00 $390.00 $419.00 $360.00 $390.00 $419.00 73219 $579.00 $503.00 $541.00 $578.00 $503.00 $541.00 $578.00 73219-26 $82.00 $86.00 $89.00 $92.00 $86.00 $89.00 $92.00 73219-TC $495.00 $417.00 $452.00 $486.00 $417.00 $452.00 $486.00 73220 $520.00 $667.00 $719.00 $771.00 $667.00 $719.00 $771.00 73220-26 $78.00 $114.00 $118.00 $123.00 $114.00 $118.00 $123.00 73220-TC $442.00 $553.00 $601.00 $648.00 $553.00 $601.00 $648.00 73221 $482.00 $432.00 $464.00 $496.00 $432.00 $464.00 $496.00 73221-26 $68.00 $71.00 $74.00 $77.00 $71.00 $74.00 $77.00 73221-TC $413.00 $361.00 $391.00 $419.00 $361.00 $391.00 $419.00 73222 $579.00 $503.00 $542.00 $579.00 $503.00 $542.00 $579.00 73222-26 $82.00 $86.00 $89.00 $92.00 $86.00 $89.00 $92.00 73222-TC $495.00 $418.00 $453.00 $487.00 $418.00 $453.00 $487.00 73223 $1,029.00 $667.00 $719.00 $771.00 $667.00 $719.00 $771.00 73223-26 $109.00 $114.00 $118.00 $122.00 $114.00 $118.00 $122.00 73223-TC $916.00 $554.00 $601.00 $648.00 $554.00 $601.00 $648.00 73225 $513.00 $623.00 $674.00 $726.00 $623.00 $674.00 $726.00 73225-26 $92.00 $91.00 $94.00 $99.00 $91.00 $94.00 $99.00 73225-TC $419.00 $533.00 $580.00 $627.00 $533.00 $580.00 $627.00 73500 $27.00 $28.00 $30.00 $32.00 $28.00 $30.00 $32.00 73500-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 73500-TC $17.00 $19.00 $21.00 $22.00 $19.00 $21.00 $22.00 73510 $32.00 $39.00 $42.00 $45.00 $39.00 $42.00 $45.00 73510-26 $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 73510-TC $21.00 $28.00 $30.00 $33.00 $28.00 $30.00 $33.00 73520 $38.00 $43.00 $46.00 $49.00 $43.00 $46.00 $49.00 73520-26 $12.00 $14.00 $14.00 $15.00 $14.00 $14.00 $15.00 73520-TC $24.00 $29.00 $32.00 $35.00 $29.00 $32.00 $35.00 73525 $84.00 $110.00 $119.00 $128.00 $110.00 $119.00 $128.00 73525-26 NC $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 73525-TC NC $81.00 $89.00 $97.00 $81.00 $89.00 $97.00 73530 $34.00 ------- ------- ------- ------- ------- ------- 73530-26 $14.00 $15.00 $16.00 $16.00 $15.00 $16.00 $16.00 73530-TC $19.00 ------- ------- ------- ------- ------- ------- 73542 $108.00 $98.00 $106.00 $114.00 $98.00 $106.00 $114.00 73542-26 NC $30.00 $31.00 $32.00 $30.00 $31.00 $32.00 73542-TC NC $68.00 $75.00 $82.00 $68.00 $75.00 $82.00 73550 $30.00 $33.00 $35.00 $38.00 $33.00 $35.00 $38.00 73550-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 73550-TC $21.00 $23.00 $26.00 $28.00 $23.00 $26.00 $28.00 73560 $29.00 $31.00 $33.00 $35.00 $31.00 $33.00 $35.00 73560-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 73560-TC $19.00 $22.00 $24.00 $25.00 $22.00 $24.00 $25.00 73562 $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
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 73562-26 $9.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 73562-TC $21.00 $27.00 $29.00 $32.00 $27.00 $29.00 $32.00 73564 $35.00 $41.00 $44.00 $48.00 $41.00 $44.00 $48.00 73564-26 $11.00 $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 73564-TC $22.00 $30.00 $33.00 $36.00 $30.00 $33.00 $36.00 73565 $28.00 $32.00 $34.00 $36.00 $32.00 $34.00 $36.00 73565-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 73565-TC $18.00 $22.00 $24.00 $26.00 $22.00 $24.00 $26.00 73580 $84.00 $136.00 $147.00 $158.00 $136.00 $147.00 $158.00 73580-26 NC $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 73580-TC NC $107.00 $117.00 $127.00 $107.00 $117.00 $127.00 73590 $29.00 $30.00 $32.00 $35.00 $30.00 $32.00 $35.00 73590-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 73590-TC $19.00 $21.00 $23.00 $24.00 $21.00 $23.00 $24.00 73600 $27.00 $29.00 $31.00 $34.00 $29.00 $31.00 $34.00 73600-26 $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $9.00 73600-TC $18.00 $21.00 $23.00 $24.00 $21.00 $23.00 $24.00 73610 $29.00 $33.00 $35.00 $38.00 $33.00 $35.00 $38.00 73610-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 73610-TC $19.00 $24.00 $26.00 $28.00 $24.00 $26.00 $28.00 73615 $72.00 $113.00 $122.00 $132.00 $113.00 $122.00 $132.00 73615-26 NC $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 73615-TC NC $84.00 $92.00 $101.00 $84.00 $92.00 $101.00 73620 $27.00 $29.00 $31.00 $33.00 $29.00 $31.00 $33.00 73620-26 $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $9.00 73620-TC $18.00 $20.00 $22.00 $24.00 $20.00 $22.00 $24.00 73630 $29.00 $33.00 $35.00 $38.00 $33.00 $35.00 $38.00 73630-26 $8.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 73630-TC $19.00 $24.00 $26.00 $28.00 $24.00 $26.00 $28.00 73650 $26.00 $29.00 $31.00 $33.00 $29.00 $31.00 $33.00 73650-26 $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $9.00 73650-TC $17.00 $20.00 $22.00 $24.00 $20.00 $22.00 $24.00 73660 $22.00 $28.00 $30.00 $32.00 $28.00 $30.00 $32.00 73660-26 $7.00 $7.00 $7.00 $8.00 $7.00 $7.00 $8.00 73660-TC $15.00 $21.00 $23.00 $25.00 $21.00 $23.00 $25.00 73700 $242.00 $261.00 $281.00 $301.00 $261.00 $281.00 $301.00 73700-26 $56.00 $58.00 $60.00 $62.00 $58.00 $60.00 $62.00 73700-TC $185.00 $203.00 $221.00 $239.00 $203.00 $221.00 $239.00 73701 $282.00 $345.00 $373.00 $400.00 $345.00 $373.00 $400.00 73701-26 $61.00 $62.00 $64.00 $66.00 $62.00 $64.00 $66.00 73701-TC $220.00 $284.00 $309.00 $334.00 $284.00 $309.00 $334.00 73702 $341.00 $408.00 $441.00 $473.00 $408.00 $441.00 $473.00 73702-26 $62.00 $64.00 $67.00 $69.00 $64.00 $67.00 $69.00 73702-TC $277.00 $344.00 $374.00 $404.00 $344.00 $374.00 $404.00 73706 $379.00 $447.00 $480.00 $512.00 $447.00 $480.00 $512.00 73706-26 $98.00 $101.00 $105.00 $109.00 $101.00 $105.00 $109.00 73706-TC $277.00 $346.00 $375.00 $403.00 $346.00 $375.00 $403.00 73718 $482.00 $432.00 $464.00 $495.00 $432.00 $464.00 $495.00 73718-26 $68.00 $71.00 $74.00 $77.00 $71.00 $74.00 $77.00 73718-TC $413.00 $360.00 $390.00 $419.00 $360.00 $390.00 $419.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 256
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 73719 $579.00 $503.00 $541.00 $578.00 $503.00 $541.00 $578.00 73719-26 $82.00 $86.00 $89.00 $92.00 $86.00 $89.00 $92.00 73719-TC $495.00 $417.00 $452.00 $486.00 $417.00 $452.00 $486.00 73720 $520.00 $667.00 $719.00 $770.00 $667.00 $719.00 $770.00 73720-26 $78.00 $114.00 $118.00 $122.00 $114.00 $118.00 $122.00 73720-TC $442.00 $553.00 $601.00 $648.00 $553.00 $601.00 $648.00 73721 $482.00 $432.00 $464.00 $496.00 $432.00 $464.00 $496.00 73721-26 $68.00 $71.00 $74.00 $77.00 $71.00 $74.00 $77.00 73721-TC $413.00 $361.00 $391.00 $419.00 $361.00 $391.00 $419.00 73722 $579.00 $503.00 $542.00 $579.00 $503.00 $542.00 $579.00 73722-26 $82.00 $86.00 $89.00 $92.00 $86.00 $89.00 $92.00 73722-TC $495.00 $418.00 $453.00 $487.00 $418.00 $453.00 $487.00 73723 $1,029.00 $668.00 $720.00 $771.00 $668.00 $720.00 $771.00 73723-26 $109.00 $114.00 $118.00 $123.00 $114.00 $118.00 $123.00 73723-TC $916.00 $554.00 $601.00 $648.00 $554.00 $601.00 $648.00 73725 $515.00 $516.00 $557.00 $598.00 $516.00 $557.00 $598.00 73725-26 $92.00 $96.00 $100.00 $104.00 $96.00 $100.00 $104.00 73725-TC $419.00 $420.00 $457.00 $494.00 $420.00 $457.00 $494.00 74000 $29.00 $29.00 $31.00 $33.00 $29.00 $31.00 $33.00 74000-26 $9.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 74000-TC $19.00 $19.00 $21.00 $23.00 $19.00 $21.00 $23.00 74010 $33.00 $40.00 $43.00 $46.00 $40.00 $43.00 $46.00 74010-26 $11.00 $12.00 $13.00 $13.00 $12.00 $13.00 $13.00 74010-TC $21.00 $28.00 $30.00 $33.00 $28.00 $30.00 $33.00 74020 $37.00 $43.00 $46.00 $49.00 $43.00 $46.00 $49.00 74020-26 $13.00 $14.00 $15.00 $15.00 $14.00 $15.00 $15.00 74020-TC $22.00 $29.00 $31.00 $34.00 $29.00 $31.00 $34.00 74022 $44.00 $51.00 $55.00 $59.00 $51.00 $55.00 $59.00 74022-26 $16.00 $17.00 $17.00 $18.00 $17.00 $17.00 $18.00 74022-TC $28.00 $35.00 $38.00 $41.00 $35.00 $38.00 $41.00 74150 $274.00 $266.00 $287.00 $308.00 $266.00 $287.00 $308.00 74150-26 $60.00 $63.00 $65.00 $68.00 $63.00 $65.00 $68.00 74150-TC $211.00 $203.00 $222.00 $240.00 $203.00 $222.00 $240.00 74160 $322.00 $362.00 $390.00 $419.00 $362.00 $390.00 $419.00 74160-26 $65.00 $68.00 $70.00 $73.00 $68.00 $70.00 $73.00 74160-TC $256.00 $294.00 $320.00 $346.00 $294.00 $320.00 $346.00 74170 $390.00 $418.00 $450.00 $483.00 $418.00 $450.00 $483.00 74170-26 $71.00 $74.00 $77.00 $80.00 $74.00 $77.00 $80.00 74170-TC $317.00 $344.00 $374.00 $403.00 $344.00 $374.00 $403.00 74175 $418.00 $446.00 $479.00 $510.00 $446.00 $479.00 $510.00 74175-26 $98.00 $100.00 $104.00 $108.00 $100.00 $104.00 $108.00 74175-TC $315.00 $346.00 $375.00 $403.00 $346.00 $375.00 $403.00 74181 $498.00 $439.00 $473.00 $507.00 $439.00 $473.00 $507.00 74181-26 $85.00 $77.00 $80.00 $83.00 $77.00 $80.00 $83.00 74181-TC $415.00 $362.00 $393.00 $424.00 $362.00 $393.00 $424.00 74182 $587.00 $509.00 $548.00 $586.00 $509.00 $548.00 $586.00 74182-26 $88.00 $92.00 $95.00 $99.00 $92.00 $95.00 $99.00 74182-TC $496.00 $418.00 $453.00 $487.00 $418.00 $453.00 $487.00 74183 $1,037.00 $674.00 $726.00 $779.00 $674.00 $726.00 $779.00 74183-26 $114.00 $119.00 $124.00 $128.00 $119.00 $124.00 $128.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 257
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 74183-TC $919.00 $554.00 $603.00 $650.00 $554.00 $603.00 $650.00 74185 $514.00 $516.00 $556.00 $597.00 $516.00 $556.00 $597.00 74185-26 $92.00 $96.00 $99.00 $103.00 $96.00 $99.00 $103.00 74185-TC $419.00 $420.00 $457.00 $494.00 $420.00 $457.00 $494.00 74190 $73.00 $371.00 $405.00 $441.00 $371.00 $405.00 $441.00 74190-26 NC $25.00 $26.00 $27.00 $25.00 $26.00 $27.00 74190-TC NC $363.00 $397.00 $431.00 $363.00 $397.00 $431.00 74210 $63.00 $79.00 $85.00 $91.00 $79.00 $85.00 $91.00 74210-26 $18.00 $19.00 $20.00 $21.00 $19.00 $20.00 $21.00 74210-TC $44.00 $59.00 $65.00 $70.00 $59.00 $65.00 $70.00 74220 $68.00 $88.00 $94.00 $101.00 $88.00 $94.00 $101.00 74220-26 $23.00 $25.00 $26.00 $27.00 $25.00 $26.00 $27.00 74220-TC $44.00 $63.00 $69.00 $74.00 $63.00 $69.00 $74.00 74230 $77.00 $93.00 $99.00 $106.00 $93.00 $99.00 $106.00 74230-26 $27.00 $28.00 $29.00 $30.00 $28.00 $29.00 $30.00 74230-TC $48.00 $65.00 $71.00 $76.00 $65.00 $71.00 $76.00 74235 $160.00 ------- ------- ------- ------- ------- ------- 74235-26 NC $64.00 $66.00 $69.00 $64.00 $66.00 $69.00 74235-TC NC BR BR BR BR BR BR 74240 $91.00 $111.00 $119.00 $127.00 $111.00 $119.00 $127.00 74240-26 $35.00 $37.00 $38.00 $40.00 $37.00 $38.00 $40.00 74240-TC $55.00 $74.00 $81.00 $87.00 $74.00 $81.00 $87.00 74241 $91.00 $116.00 $125.00 $133.00 $116.00 $125.00 $133.00 74241-26 $35.00 $36.00 $38.00 $39.00 $36.00 $38.00 $39.00 74241-TC $56.00 $80.00 $87.00 $94.00 $80.00 $87.00 $94.00 74245 $137.00 $174.00 $187.00 $200.00 $174.00 $187.00 $200.00 74245-26 $46.00 $48.00 $50.00 $52.00 $48.00 $50.00 $52.00 74245-TC $89.00 $126.00 $137.00 $148.00 $126.00 $137.00 $148.00 74246 $97.00 $126.00 $135.00 $144.00 $126.00 $135.00 $144.00 74246-26 $35.00 $37.00 $38.00 $40.00 $37.00 $38.00 $40.00 74246-TC $61.00 $89.00 $97.00 $105.00 $89.00 $97.00 $105.00 74247 $99.00 $130.00 $139.00 $149.00 $130.00 $139.00 $149.00 74247-26 $35.00 $37.00 $38.00 $40.00 $37.00 $38.00 $40.00 74247-TC $63.00 $93.00 $101.00 $109.00 $93.00 $101.00 $109.00 74249 $144.00 $186.00 $200.00 $214.00 $186.00 $200.00 $214.00 74249-26 $46.00 $48.00 $50.00 $52.00 $48.00 $50.00 $52.00 74249-TC $96.00 $138.00 $150.00 $162.00 $138.00 $150.00 $162.00 74250 $73.00 $100.00 $107.00 $115.00 $100.00 $107.00 $115.00 74250-26 $23.00 $25.00 $26.00 $27.00 $25.00 $26.00 $27.00 74250-TC $48.00 $75.00 $82.00 $88.00 $75.00 $82.00 $88.00 74251 $85.00 $184.00 $197.00 $208.00 $184.00 $197.00 $208.00 74251-26 $34.00 $37.00 $38.00 $40.00 $37.00 $38.00 $40.00 74251-TC $48.00 $147.00 $158.00 $168.00 $147.00 $158.00 $168.00 74260 $82.00 $118.00 $126.00 $134.00 $118.00 $126.00 $134.00 74260-26 $25.00 $26.00 $27.00 $28.00 $26.00 $27.00 $28.00 74260-TC $56.00 $92.00 $99.00 $106.00 $92.00 $99.00 $106.00 74270 $100.00 $130.00 $140.00 $149.00 $130.00 $140.00 $149.00 74270-26 $35.00 $37.00 $38.00 $40.00 $37.00 $38.00 $40.00 74270-TC $64.00 $93.00 $102.00 $110.00 $93.00 $102.00 $110.00 74280 $136.00 $194.00 $208.00 $222.00 $194.00 $208.00 $222.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 258
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 74280-26 $50.00 $52.00 $54.00 $56.00 $52.00 $54.00 $56.00 74280-TC $84.00 $142.00 $155.00 $166.00 $142.00 $155.00 $166.00 74283 $201.00 $200.00 $212.00 $225.00 $200.00 $212.00 $225.00 74283-26 $103.00 $106.00 $110.00 $114.00 $106.00 $110.00 $114.00 74283-TC $95.00 $93.00 $102.00 $110.00 $93.00 $102.00 $110.00 74290 $44.00 $63.00 $68.00 $72.00 $63.00 $68.00 $72.00 74290-26 $16.00 $17.00 $17.00 $18.00 $17.00 $17.00 $18.00 74290-TC $28.00 $46.00 $50.00 $54.00 $46.00 $50.00 $54.00 74291 $26.00 $49.00 $53.00 $56.00 $49.00 $53.00 $56.00 74291-26 $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 74291-TC $15.00 $39.00 $42.00 $44.00 $39.00 $42.00 $44.00 74300 $31.00 ------- ------- ------- ------- ------- ------- 74300-26 NC $19.00 $20.00 $21.00 $19.00 $20.00 $21.00 74300-TC NC BR BR BR BR BR BR 74301 BR ------- ------- ------- ------- ------- ------- 74301-26 NC $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 74301-TC NC BR BR BR BR BR BR 74305 $51.00 ------- ------- ------- ------- ------- ------- 74305-26 NC $23.00 $23.00 $24.00 $23.00 $23.00 $24.00 74305-TC NC BR BR BR BR BR BR 74320 $145.00 $139.00 $151.00 $163.00 $139.00 $151.00 $163.00 74320-26 NC $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 74320-TC NC $110.00 $121.00 $132.00 $110.00 $121.00 $132.00 74327 $103.00 $132.00 $142.00 $152.00 $132.00 $142.00 $152.00 74327-26 NC $37.00 $39.00 $40.00 $37.00 $39.00 $40.00 74327-TC NC $95.00 $103.00 $112.00 $95.00 $103.00 $112.00 74328 $155.00 ------- ------- ------- ------- ------- ------- 74328-26 NC $38.00 $39.00 $40.00 $38.00 $39.00 $40.00 74328-TC NC BR BR BR BR BR BR 74329 $155.00 ------- ------- ------- ------- ------- ------- 74329-26 NC $38.00 $39.00 $40.00 $38.00 $39.00 $40.00 74329-TC NC BR BR BR BR BR BR 74330 $165.00 ------- ------- ------- ------- ------- ------- 74330-26 NC $48.00 $49.00 $51.00 $48.00 $49.00 $51.00 74330-TC NC BR BR BR BR BR BR 74340 $121.00 ------- ------- ------- ------- ------- ------- 74340-26 NC $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 74340-TC NC BR BR BR BR BR BR 74355 $137.00 ------- ------- ------- ------- ------- ------- 74355-26 NC $40.00 $41.00 $43.00 $40.00 $41.00 $43.00 74355-TC NC BR BR BR BR BR BR 74360 $145.00 ------- ------- ------- ------- ------- ------- 74360-26 NC $30.00 $31.00 $32.00 $30.00 $31.00 $32.00 74360-TC NC BR BR BR BR BR BR 74363 $274.00 ------- ------- ------- ------- ------- ------- 74363-26 NC $47.00 $48.00 $50.00 $47.00 $48.00 $50.00 74363-TC NC BR BR BR BR BR BR 74400 $89.00 $113.00 $122.00 $131.00 $113.00 $122.00 $131.00 74400-26 $24.00 $26.00 $27.00 $28.00 $26.00 $27.00 $28.00 74400-TC $63.00 $87.00 $95.00 $103.00 $87.00 $95.00 $103.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 259
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 74410 $98.00 $120.00 $130.00 $139.00 $120.00 $130.00 $139.00 74410-26 $24.00 $26.00 $27.00 $28.00 $26.00 $27.00 $28.00 74410-TC $72.00 $94.00 $103.00 $111.00 $94.00 $103.00 $111.00 74415 $105.00 $136.00 $146.00 $157.00 $136.00 $146.00 $157.00 74415-26 $24.00 $26.00 $27.00 $28.00 $26.00 $27.00 $28.00 74415-TC $79.00 $110.00 $120.00 $129.00 $110.00 $120.00 $129.00 74420 $117.00 $184.00 $201.00 $219.00 $184.00 $201.00 $219.00 74420-26 $18.00 $20.00 $21.00 $21.00 $20.00 $21.00 $21.00 74420-TC $97.00 $177.00 $194.00 $211.00 $177.00 $194.00 $211.00 74425 $68.00 $183.00 $201.00 $218.00 $183.00 $201.00 $218.00 74425-26 NC $20.00 $21.00 $21.00 $20.00 $21.00 $21.00 74425-TC NC $177.00 $193.00 $210.00 $177.00 $193.00 $210.00 74430 $48.00 $78.00 $84.00 $90.00 $78.00 $84.00 $90.00 74430-26 NC $17.00 $18.00 $19.00 $17.00 $18.00 $19.00 74430-TC NC $61.00 $66.00 $71.00 $61.00 $66.00 $71.00 74440 $62.00 $85.00 $91.00 $97.00 $85.00 $91.00 $97.00 74440-26 NC $20.00 $21.00 $22.00 $20.00 $21.00 $22.00 74440-TC NC $65.00 $70.00 $76.00 $65.00 $70.00 $76.00 74445 $101.00 $198.00 $217.00 $237.00 $198.00 $217.00 $237.00 74445-26 NC $62.00 $65.00 $68.00 $62.00 $65.00 $68.00 74445-TC NC $177.00 $194.00 $211.00 $177.00 $194.00 $211.00 74450 $60.00 $184.00 $201.00 $219.00 $184.00 $201.00 $219.00 74450-26 NC $18.00 $19.00 $20.00 $18.00 $19.00 $20.00 74450-TC NC $178.00 $194.00 $212.00 $178.00 $194.00 $212.00 74455 $75.00 $96.00 $104.00 $112.00 $96.00 $104.00 $112.00 74455-26 NC $18.00 $19.00 $20.00 $18.00 $19.00 $20.00 74455-TC NC $78.00 $85.00 $92.00 $78.00 $85.00 $92.00 74470 $74.00 $190.00 $209.00 $228.00 $190.00 $209.00 $228.00 74470-26 NC $28.00 $29.00 $30.00 $28.00 $29.00 $30.00 74470-TC NC $182.00 $199.00 $217.00 $182.00 $199.00 $217.00 74475 $181.00 $160.00 $174.00 $189.00 $160.00 $174.00 $189.00 74475-26 NC $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 74475-TC NC $131.00 $144.00 $158.00 $131.00 $144.00 $158.00 74480 $181.00 $160.00 $174.00 $189.00 $160.00 $174.00 $189.00 74480-26 NC $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 74480-TC NC $131.00 $144.00 $158.00 $131.00 $144.00 $158.00 74485 $146.00 $143.00 $154.00 $167.00 $143.00 $154.00 $167.00 74485-26 NC $29.00 $31.00 $32.00 $29.00 $31.00 $32.00 74485-TC NC $113.00 $124.00 $135.00 $113.00 $124.00 $135.00 74710 $57.00 $53.00 $57.00 $62.00 $53.00 $57.00 $62.00 74710-26 $17.00 $18.00 $19.00 $20.00 $18.00 $19.00 $20.00 74710-TC $39.00 $35.00 $38.00 $42.00 $35.00 $38.00 $42.00 74740 $68.00 $82.00 $89.00 $95.00 $82.00 $89.00 $95.00 74740-26 NC $20.00 $21.00 $22.00 $20.00 $21.00 $22.00 74740-TC NC $62.00 $68.00 $73.00 $62.00 $68.00 $73.00 74742 $150.00 ------- ------- ------- ------- ------- ------- 74742-26 NC $32.00 $34.00 $35.00 $32.00 $34.00 $35.00 74742-TC NC BR BR BR BR BR BR 74775 $88.00 $190.00 $209.00 $231.00 $190.00 $209.00 $231.00 74775-26 $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
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 74775-TC $55.00 $180.00 $198.00 $218.00 $180.00 $198.00 $218.00 75557 ------- $500.00 $542.00 $588.00 $500.00 $542.00 $588.00 75557-26 ------- $130.00 $134.00 $140.00 $130.00 $134.00 $140.00 75557-TC ------- $370.00 $408.00 $448.00 $370.00 $408.00 $448.00 75558 ------- $649.00 $705.00 $767.00 $649.00 $705.00 $767.00 75558-26 ------- $126.00 $130.00 $135.00 $126.00 $130.00 $135.00 75558-TC ------- $523.00 $575.00 $632.00 $523.00 $575.00 $632.00 75559 ------- $530.00 $569.00 $609.00 $530.00 $569.00 $609.00 75559-26 ------- $165.00 $171.00 $177.00 $165.00 $171.00 $177.00 75559-TC ------- $365.00 $398.00 $433.00 $365.00 $398.00 $433.00 75560 ------- $834.00 $901.00 $971.00 $834.00 $901.00 $971.00 75560-26 ------- $145.00 $149.00 $154.00 $145.00 $149.00 $154.00 75560-TC ------- $690.00 $753.00 $817.00 $690.00 $753.00 $817.00 75561 ------- $704.00 $762.00 $824.00 $704.00 $762.00 $824.00 75561-26 ------- $144.00 $149.00 $155.00 $144.00 $149.00 $155.00 75561-TC ------- $561.00 $613.00 $669.00 $561.00 $613.00 $669.00 75562 ------- $828.00 $896.00 $966.00 $828.00 $896.00 $966.00 75562-26 ------- $138.00 $142.00 $147.00 $138.00 $142.00 $147.00 75562-TC ------- $690.00 $753.00 $819.00 $690.00 $753.00 $819.00 75563 ------- $729.00 $786.00 $843.00 $729.00 $786.00 $843.00 75563-26 ------- $172.00 $178.00 $184.00 $172.00 $178.00 $184.00 75563-TC ------- $557.00 $608.00 $659.00 $557.00 $608.00 $659.00 75564 ------- $974.00 $1,053.00 $1,136.00 $974.00 $1,053.00 $1,136.00 75564-26 ------- $162.00 $167.00 $172.00 $162.00 $167.00 $172.00 75564-TC ------- $812.00 $886.00 $964.00 $812.00 $886.00 $964.00 75600 $497.00 $437.00 $478.00 $521.00 $437.00 $478.00 $521.00 75600-26 NC $28.00 $29.00 $30.00 $28.00 $29.00 $30.00 75600-TC NC $410.00 $449.00 $491.00 $410.00 $449.00 $491.00 75605 $183.00 $411.00 $448.00 $489.00 $411.00 $448.00 $489.00 75605-26 NC $62.00 $65.00 $67.00 $62.00 $65.00 $67.00 75605-TC NC $348.00 $383.00 $421.00 $348.00 $383.00 $421.00 75625 $143.00 $407.00 $444.00 $485.00 $407.00 $444.00 $485.00 75625-26 NC $61.00 $64.00 $66.00 $61.00 $64.00 $66.00 75625-TC NC $346.00 $380.00 $418.00 $346.00 $380.00 $418.00 75630 $239.00 $460.00 $501.00 $545.00 $460.00 $501.00 $545.00 75630-26 NC $99.00 $103.00 $108.00 $99.00 $103.00 $108.00 75630-TC NC $361.00 $398.00 $438.00 $361.00 $398.00 $438.00 75635 $445.00 $473.00 $505.00 $537.00 $473.00 $505.00 $537.00 75635-26 NC $129.00 $133.00 $139.00 $129.00 $133.00 $139.00 75635-TC NC $344.00 $372.00 $399.00 $344.00 $372.00 $399.00 75650 $218.00 $426.00 $464.00 $505.00 $426.00 $464.00 $505.00 75650-26 NC $80.00 $83.00 $86.00 $80.00 $83.00 $86.00 75650-TC NC $346.00 $381.00 $419.00 $346.00 $381.00 $419.00 75658 $540.00 $423.00 $461.00 $503.00 $423.00 $461.00 $503.00 75658-26 NC $71.00 $73.00 $77.00 $71.00 $73.00 $77.00 75658-TC NC $353.00 $388.00 $426.00 $353.00 $388.00 $426.00 75660 $540.00 $425.00 $463.00 $504.00 $425.00 $463.00 $504.00 75660-26 NC $70.00 $73.00 $76.00 $70.00 $73.00 $76.00 75660-TC NC $355.00 $390.00 $429.00 $355.00 $390.00 $429.00 75662 $560.00 $463.00 $503.00 $546.00 $463.00 $503.00 $546.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 261
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 75662-26 NC $90.00 $93.00 $97.00 $90.00 $93.00 $97.00 75662-TC NC $373.00 $409.00 $449.00 $373.00 $409.00 $449.00 75665 $540.00 $431.00 $470.00 $513.00 $431.00 $470.00 $513.00 75665-26 NC $72.00 $75.00 $79.00 $72.00 $75.00 $79.00 75665-TC NC $359.00 $395.00 $434.00 $359.00 $395.00 $434.00 75671 $219.00 $464.00 $504.00 $548.00 $464.00 $504.00 $548.00 75671-26 NC $89.00 $92.00 $95.00 $89.00 $92.00 $95.00 75671-TC NC $376.00 $413.00 $453.00 $376.00 $413.00 $453.00 75676 $540.00 $425.00 $463.00 $505.00 $425.00 $463.00 $505.00 75676-26 NC $71.00 $73.00 $77.00 $71.00 $73.00 $77.00 75676-TC NC $355.00 $390.00 $429.00 $355.00 $390.00 $429.00 75680 $207.00 $455.00 $494.00 $537.00 $455.00 $494.00 $537.00 75680-26 NC $89.00 $92.00 $96.00 $89.00 $92.00 $96.00 75680-TC NC $366.00 $402.00 $441.00 $366.00 $402.00 $441.00 75685 $160.00 $425.00 $463.00 $504.00 $425.00 $463.00 $504.00 75685-26 NC $70.00 $73.00 $76.00 $70.00 $73.00 $76.00 75685-TC NC $355.00 $390.00 $429.00 $355.00 $390.00 $429.00 75705 $587.00 $473.00 $513.00 $557.00 $473.00 $513.00 $557.00 75705-26 NC $118.00 $123.00 $129.00 $118.00 $123.00 $129.00 75705-TC NC $354.00 $390.00 $428.00 $354.00 $390.00 $428.00 75710 $194.00 $420.00 $458.00 $500.00 $420.00 $458.00 $500.00 75710-26 NC $62.00 $65.00 $68.00 $62.00 $65.00 $68.00 75710-TC NC $357.00 $393.00 $432.00 $357.00 $393.00 $432.00 75716 $293.00 $446.00 $485.00 $528.00 $446.00 $485.00 $528.00 75716-26 NC $71.00 $73.00 $77.00 $71.00 $73.00 $77.00 75716-TC NC $375.00 $412.00 $452.00 $375.00 $412.00 $452.00 75722 $206.00 $416.00 $454.00 $495.00 $416.00 $454.00 $495.00 75722-26 NC $62.00 $65.00 $67.00 $62.00 $65.00 $67.00 75722-TC NC $354.00 $390.00 $428.00 $354.00 $390.00 $428.00 75724 $214.00 $458.00 $497.00 $540.00 $458.00 $497.00 $540.00 75724-26 NC $84.00 $86.00 $89.00 $84.00 $86.00 $89.00 75724-TC NC $374.00 $411.00 $451.00 $374.00 $411.00 $451.00 75726 $530.00 $414.00 $452.00 $493.00 $414.00 $452.00 $493.00 75726-26 NC $60.00 $62.00 $65.00 $60.00 $62.00 $65.00 75726-TC NC $354.00 $389.00 $428.00 $354.00 $389.00 $428.00 75731 $530.00 $421.00 $460.00 $501.00 $421.00 $460.00 $501.00 75731-26 NC $63.00 $65.00 $68.00 $63.00 $65.00 $68.00 75731-TC NC $359.00 $394.00 $433.00 $359.00 $394.00 $433.00 75733 $540.00 $456.00 $496.00 $539.00 $456.00 $496.00 $539.00 75733-26 NC $74.00 $76.00 $79.00 $74.00 $76.00 $79.00 75733-TC NC $382.00 $420.00 $460.00 $382.00 $420.00 $460.00 75736 $530.00 $418.00 $455.00 $497.00 $418.00 $455.00 $497.00 75736-26 NC $62.00 $64.00 $67.00 $62.00 $64.00 $67.00 75736-TC NC $356.00 $391.00 $430.00 $356.00 $391.00 $430.00 75741 $540.00 $411.00 $448.00 $488.00 $411.00 $448.00 $488.00 75741-26 NC $70.00 $72.00 $75.00 $70.00 $72.00 $75.00 75741-TC NC $341.00 $375.00 $413.00 $341.00 $375.00 $413.00 75743 $253.00 $434.00 $472.00 $514.00 $434.00 $472.00 $514.00 75743-26 NC $88.00 $91.00 $95.00 $88.00 $91.00 $95.00 75743-TC NC $346.00 $381.00 $419.00 $346.00 $381.00 $419.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 262
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 75746 $530.00 $410.00 $447.00 $488.00 $410.00 $447.00 $488.00 75746-26 NC $60.00 $62.00 $65.00 $60.00 $62.00 $65.00 75746-TC NC $349.00 $385.00 $423.00 $349.00 $385.00 $423.00 75756 $183.00 $426.00 $465.00 $506.00 $426.00 $465.00 $506.00 75756-26 NC $64.00 $67.00 $69.00 $64.00 $67.00 $69.00 75756-TC NC $362.00 $398.00 $437.00 $362.00 $398.00 $437.00 75774 $80.00 $354.00 $389.00 $427.00 $354.00 $389.00 $427.00 75774-26 NC $20.00 $21.00 $21.00 $20.00 $21.00 $21.00 75774-TC NC $335.00 $369.00 $406.00 $335.00 $369.00 $406.00 75790 $146.00 $178.00 $189.00 $200.00 $178.00 $189.00 $200.00 75790-26 NC $97.00 $101.00 $105.00 $97.00 $101.00 $105.00 75790-TC NC $81.00 $88.00 $95.00 $81.00 $88.00 $95.00 75801 $245.00 $384.00 $423.00 $468.00 $384.00 $423.00 $468.00 75801-26 NC $45.00 $47.00 $50.00 $45.00 $47.00 $50.00 75801-TC NC $369.00 $406.00 $448.00 $369.00 $406.00 $448.00 75803 $264.00 $387.00 $427.00 $471.00 $387.00 $427.00 $471.00 75803-26 NC $62.00 $64.00 $66.00 $62.00 $64.00 $66.00 75803-TC NC $369.00 $406.00 $448.00 $369.00 $406.00 $448.00 75805 $271.00 $383.00 $422.00 $465.00 $383.00 $422.00 $465.00 75805-26 NC $43.00 $45.00 $47.00 $43.00 $45.00 $47.00 75805-TC NC $369.00 $406.00 $448.00 $369.00 $406.00 $448.00 75807 $289.00 $387.00 $427.00 $471.00 $387.00 $427.00 $471.00 75807-26 NC $62.00 $64.00 $66.00 $62.00 $64.00 $66.00 75807-TC NC $369.00 $406.00 $448.00 $369.00 $406.00 $448.00 75809 $54.00 $82.00 $88.00 $93.00 $82.00 $88.00 $93.00 75809-26 NC $24.00 $25.00 $26.00 $24.00 $25.00 $26.00 75809-TC NC $58.00 $63.00 $67.00 $58.00 $63.00 $67.00 75810 $530.00 $2,003.00 $2,207.00 $2,431.00 $2,003.00 $2,207.00 $2,431.00 75810-26 NC $60.00 $62.00 $64.00 $60.00 $62.00 $64.00 75810-TC NC $1,985.00 $2,187.00 $2,408.00 $1,985.00 $2,187.00 $2,408.00 75820 $72.00 $114.00 $121.00 $129.00 $114.00 $121.00 $129.00 75820-26 NC $38.00 $39.00 $41.00 $38.00 $39.00 $41.00 75820-TC NC $76.00 $82.00 $88.00 $76.00 $82.00 $88.00 75822 $111.00 $145.00 $155.00 $165.00 $145.00 $155.00 $165.00 75822-26 NC $56.00 $58.00 $61.00 $56.00 $58.00 $61.00 75822-TC NC $89.00 $97.00 $104.00 $89.00 $97.00 $104.00 75825 $194.00 $399.00 $436.00 $477.00 $399.00 $436.00 $477.00 75825-26 NC $61.00 $64.00 $67.00 $61.00 $64.00 $67.00 75825-TC NC $338.00 $372.00 $410.00 $338.00 $372.00 $410.00 75827 $530.00 $398.00 $435.00 $475.00 $398.00 $435.00 $475.00 75827-26 NC $60.00 $62.00 $64.00 $60.00 $62.00 $64.00 75827-TC NC $339.00 $373.00 $411.00 $339.00 $373.00 $411.00 75831 $54.00 $401.00 $437.00 $478.00 $401.00 $437.00 $478.00 75831-26 NC $60.00 $62.00 $65.00 $60.00 $62.00 $65.00 75831-TC NC $340.00 $375.00 $413.00 $340.00 $375.00 $413.00 75833 $549.00 $430.00 $469.00 $511.00 $430.00 $469.00 $511.00 75833-26 NC $80.00 $83.00 $87.00 $80.00 $83.00 $87.00 75833-TC NC $350.00 $385.00 $424.00 $350.00 $385.00 $424.00 75840 $531.00 $400.00 $437.00 $477.00 $400.00 $437.00 $477.00 75840-26 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
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 75840-TC NC $339.00 $374.00 $411.00 $339.00 $374.00 $411.00 75842 $549.00 $430.00 $468.00 $510.00 $430.00 $468.00 $510.00 75842-26 NC $79.00 $82.00 $85.00 $79.00 $82.00 $85.00 75842-TC NC $351.00 $386.00 $425.00 $351.00 $386.00 $425.00 75860 $531.00 $407.00 $444.00 $484.00 $407.00 $444.00 $484.00 75860-26 NC $62.00 $64.00 $66.00 $62.00 $64.00 $66.00 75860-TC NC $345.00 $380.00 $418.00 $345.00 $380.00 $418.00 75870 $531.00 $406.00 $442.00 $483.00 $406.00 $442.00 $483.00 75870-26 NC $61.00 $63.00 $65.00 $61.00 $63.00 $65.00 75870-TC NC $345.00 $380.00 $417.00 $345.00 $380.00 $417.00 75872 $530.00 $426.00 $465.00 $509.00 $426.00 $465.00 $509.00 75872-26 NC $67.00 $71.00 $76.00 $67.00 $71.00 $76.00 75872-TC NC $359.00 $395.00 $433.00 $359.00 $395.00 $433.00 75880 $72.00 $118.00 $126.00 $134.00 $118.00 $126.00 $134.00 75880-26 NC $38.00 $39.00 $40.00 $38.00 $39.00 $40.00 75880-TC NC $80.00 $87.00 $93.00 $80.00 $87.00 $93.00 75885 $546.00 $417.00 $454.00 $494.00 $417.00 $454.00 $494.00 75885-26 NC $76.00 $79.00 $82.00 $76.00 $79.00 $82.00 75885-TC NC $340.00 $375.00 $413.00 $340.00 $375.00 $413.00 75887 $546.00 $421.00 $459.00 $500.00 $421.00 $459.00 $500.00 75887-26 NC $77.00 $80.00 $83.00 $77.00 $80.00 $83.00 75887-TC NC $344.00 $379.00 $417.00 $344.00 $379.00 $417.00 75889 $530.00 $401.00 $437.00 $477.00 $401.00 $437.00 $477.00 75889-26 NC $60.00 $62.00 $65.00 $60.00 $62.00 $65.00 75889-TC NC $340.00 $375.00 $413.00 $340.00 $375.00 $413.00 75891 $530.00 $400.00 $437.00 $477.00 $400.00 $437.00 $477.00 75891-26 NC $60.00 $62.00 $65.00 $60.00 $62.00 $65.00 75891-TC NC $340.00 $374.00 $412.00 $340.00 $374.00 $412.00 75893 $499.00 $369.00 $405.00 $443.00 $369.00 $405.00 $443.00 75893-26 NC $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 75893-TC NC $340.00 $375.00 $413.00 $340.00 $375.00 $413.00 75894 $972.00 ------- ------- ------- ------- ------- ------- 75894-26 NC $70.00 $73.00 $77.00 $70.00 $73.00 $77.00 75894-TC NC BR BR BR BR BR BR 75896 $241.00 ------- ------- ------- ------- ------- ------- 75896-26 NC $70.00 $72.00 $75.00 $70.00 $72.00 $75.00 75896-TC NC BR BR BR BR BR BR 75898 $124.00 $209.00 $229.00 $250.00 $209.00 $229.00 $250.00 75898-26 $84.00 $88.00 $91.00 $95.00 $88.00 $91.00 $95.00 75898-TC $39.00 $182.00 $199.00 $216.00 $182.00 $199.00 $216.00 75900 $810.00 ------- ------- ------- ------- ------- ------- 75900-26 NC $26.00 $27.00 $29.00 $26.00 $27.00 $29.00 75900-TC NC BR BR BR BR BR BR 75901 $98.00 $181.00 $206.00 $239.00 $181.00 $206.00 $239.00 75901-26 NC $26.00 $27.00 $28.00 $26.00 $27.00 $28.00 75901-TC NC $155.00 $179.00 $211.00 $155.00 $179.00 $211.00 75902 $93.00 $127.00 $149.00 $178.00 $127.00 $149.00 $178.00 75902-26 NC $21.00 $21.00 $22.00 $21.00 $21.00 $22.00 75902-TC NC $107.00 $127.00 $156.00 $107.00 $127.00 $156.00 75940 $151.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 264
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 75940-26 NC $30.00 $31.00 $33.00 $30.00 $31.00 $33.00 75940-TC NC BR BR BR BR BR BR 75945 $192.00 $169.00 $185.00 $202.00 $169.00 $185.00 $202.00 75945-26 NC $23.00 $24.00 $25.00 $23.00 $24.00 $25.00 75945-TC NC $161.00 $176.00 $191.00 $161.00 $176.00 $191.00 75946 $108.00 ------- ------- ------- ------- ------- ------- 75946-26 NC $23.00 $24.00 $26.00 $23.00 $24.00 $26.00 75946-TC NC BR BR BR BR BR BR 75952 BR ------- ------- ------- ------- ------- ------- 75952-26 NC $247.00 $259.00 $276.00 $247.00 $259.00 $276.00 75952-TC NC BR BR BR BR BR BR 75953 BR ------- ------- ------- ------- ------- ------- 75953-26 NC $75.00 $79.00 $84.00 $75.00 $79.00 $84.00 75953-TC NC BR BR BR BR BR BR 75954 BR ------- ------- ------- ------- ------- ------- 75954-26 NC $120.00 $125.00 $131.00 $120.00 $125.00 $131.00 75954-TC NC BR BR BR BR BR BR 75956 ------- BR BR BR BR BR BR 75956-26 ------- $391.00 $411.00 $438.00 $391.00 $411.00 $438.00 75956-TC ------- BR BR BR BR BR BR 75957 ------- BR BR BR BR BR BR 75957-26 ------- $335.00 $353.00 $375.00 $335.00 $353.00 $375.00 75957-TC ------- BR BR BR BR BR BR 75958 ------- BR BR BR BR BR BR 75958-26 ------- $223.00 $234.00 $249.00 $223.00 $234.00 $249.00 75958-TC ------- BR BR BR BR BR BR 75959 ------- BR BR BR BR BR BR 75959-26 ------- $195.00 $205.00 $218.00 $195.00 $205.00 $218.00 75959-TC ------- BR BR BR BR BR BR 75960 $600.00 $433.00 $474.00 $520.00 $433.00 $474.00 $520.00 75960-26 NC $45.00 $47.00 $49.00 $45.00 $47.00 $49.00 75960-TC NC $388.00 $427.00 $471.00 $388.00 $427.00 $471.00 75961 $616.00 $527.00 $565.00 $607.00 $527.00 $565.00 $607.00 75961-26 NC $224.00 $232.00 $241.00 $224.00 $232.00 $241.00 75961-TC NC $303.00 $333.00 $366.00 $303.00 $333.00 $366.00 75962 $618.00 $455.00 $500.00 $549.00 $455.00 $500.00 $549.00 75962-26 NC $29.00 $31.00 $32.00 $29.00 $31.00 $32.00 75962-TC NC $426.00 $469.00 $517.00 $426.00 $469.00 $517.00 75964 $333.00 $255.00 $280.00 $306.00 $255.00 $280.00 $306.00 75964-26 NC $20.00 $21.00 $22.00 $20.00 $21.00 $22.00 75964-TC NC $235.00 $259.00 $284.00 $235.00 $259.00 $284.00 75966 $659.00 $504.00 $550.00 $601.00 $504.00 $550.00 $601.00 75966-26 NC $72.00 $75.00 $78.00 $72.00 $75.00 $78.00 75966-TC NC $432.00 $475.00 $523.00 $432.00 $475.00 $523.00 75968 $333.00 $256.00 $280.00 $307.00 $256.00 $280.00 $307.00 75968-26 NC $20.00 $21.00 $22.00 $20.00 $21.00 $22.00 75968-TC NC $236.00 $259.00 $285.00 $236.00 $259.00 $285.00 75970 $475.00 ------- ------- ------- ------- ------- ------- 75970-26 NC $44.00 $46.00 $48.00 $44.00 $46.00 $48.00 75970-TC NC BR BR BR BR BR BR CPT only 2008 American Medical Association. All rights reserved. Part C, 265
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 75978 $617.00 $450.00 $494.00 $542.00 $450.00 $494.00 $542.00 75978-26 NC $28.00 $29.00 $30.00 $28.00 $29.00 $30.00 75978-TC NC $422.00 $465.00 $512.00 $422.00 $465.00 $512.00 75980 $277.00 ------- ------- ------- ------- ------- ------- 75980-26 NC $77.00 $79.00 $82.00 $77.00 $79.00 $82.00 75980-TC NC BR BR BR BR BR BR 75982 $303.00 ------- ------- ------- ------- ------- ------- 75982-26 NC $77.00 $79.00 $82.00 $77.00 $79.00 $82.00 75982-TC NC BR BR BR BR BR BR 75984 $110.00 $123.00 $132.00 $142.00 $123.00 $132.00 $142.00 75984-26 NC $38.00 $39.00 $40.00 $38.00 $39.00 $40.00 75984-TC NC $85.00 $93.00 $101.00 $85.00 $93.00 $101.00 75989 $180.00 $172.00 $184.00 $198.00 $172.00 $184.00 $198.00 75989-26 NC $63.00 $65.00 $68.00 $63.00 $65.00 $68.00 75989-TC NC $108.00 $119.00 $130.00 $108.00 $119.00 $130.00 75992 $618.00 ------- ------- ------- ------- ------- ------- 75992-26 NC $30.00 $31.00 $33.00 $30.00 $31.00 $33.00 75992-TC NC BR BR BR BR BR BR 75993 $333.00 ------- ------- ------- ------- ------- ------- 75993-26 NC $20.00 $21.00 $21.00 $20.00 $21.00 $21.00 75993-TC NC BR BR BR BR BR BR 75994 $659.00 ------- ------- ------- ------- ------- ------- 75994-26 NC $72.00 $75.00 $78.00 $72.00 $75.00 $78.00 75994-TC NC BR BR BR BR BR BR 75995 $658.00 ------- ------- ------- ------- ------- ------- 75995-26 NC $70.00 $72.00 $75.00 $70.00 $72.00 $75.00 75995-TC NC BR BR BR BR BR BR 75996 $332.00 ------- ------- ------- ------- ------- ------- 75996-26 NC $19.00 $20.00 $21.00 $19.00 $20.00 $21.00 75996-TC NC BR BR BR BR BR BR 76000 $58.00 $92.00 $100.00 $107.00 $92.00 $100.00 $107.00 76000-26 $8.00 $9.00 $9.00 $10.00 $9.00 $9.00 $10.00 76000-TC $48.00 $83.00 $90.00 $97.00 $83.00 $90.00 $97.00 76001 $134.00 ------- ------- ------- ------- ------- ------- 76001-26 $34.00 $37.00 $39.00 $41.00 $37.00 $39.00 $41.00 76001-TC $97.00 ------- ------- ------- ------- ------- ------- 76080 $67.00 $71.00 $75.00 $81.00 $71.00 $75.00 $81.00 76080-26 NC $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 76080-TC NC $42.00 $46.00 $50.00 $42.00 $46.00 $50.00 76098 $23.00 $23.00 $25.00 $27.00 $23.00 $25.00 $27.00 76098-26 $8.00 $8.00 $9.00 $9.00 $8.00 $9.00 $9.00 76098-TC $15.00 $15.00 $16.00 $17.00 $15.00 $16.00 $17.00 76100 $77.00 $109.00 $116.00 $124.00 $109.00 $116.00 $124.00 76100-26 $30.00 $31.00 $32.00 $34.00 $31.00 $32.00 $34.00 76100-TC $46.00 $78.00 $84.00 $90.00 $78.00 $84.00 $90.00 76101 $94.00 $167.00 $179.00 $191.00 $167.00 $179.00 $191.00 76101-26 $36.00 $31.00 $32.00 $33.00 $31.00 $32.00 $33.00 76101-TC $59.00 $136.00 $147.00 $158.00 $136.00 $147.00 $158.00 76102 $95.00 $208.00 $224.00 $238.00 $208.00 $224.00 $238.00 76102-26 $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
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 76102-TC $65.00 $178.00 $192.00 $206.00 $178.00 $192.00 $206.00 76120 $157.00 $79.00 $85.00 $91.00 $79.00 $85.00 $91.00 76120-26 $56.00 $20.00 $21.00 $22.00 $20.00 $21.00 $22.00 76120-TC $102.00 $59.00 $64.00 $69.00 $59.00 $64.00 $69.00 76125 $49.00 ------- ------- ------- ------- ------- ------- 76125-26 $17.00 $15.00 $16.00 $16.00 $15.00 $16.00 $16.00 76125-TC $33.00 ------- ------- ------- ------- ------- ------- 76140 $31.00 ------- ------- ------- ------- ------- ------- 76150 $15.00 $23.00 $25.00 $27.00 $23.00 $25.00 $27.00 76350 BR ------- ------- ------- ------- ------- ------- 76376 ------- $110.00 $119.00 $128.00 $110.00 $119.00 $128.00 76376-26 ------- $12.00 $12.00 $13.00 $12.00 $12.00 $13.00 76376-TC ------- $98.00 $107.00 $115.00 $98.00 $107.00 $115.00 76377 ------- $153.00 $168.00 $186.00 $153.00 $168.00 $186.00 76377-26 ------- $45.00 $47.00 $50.00 $45.00 $47.00 $50.00 76377-TC ------- $108.00 $121.00 $136.00 $108.00 $121.00 $136.00 76380 $182.00 $158.00 $169.00 $181.00 $158.00 $169.00 $181.00 76380-26 $50.00 $51.00 $53.00 $55.00 $51.00 $53.00 $55.00 76380-TC $131.00 $107.00 $116.00 $126.00 $107.00 $116.00 $126.00 76390 $493.00 $503.00 $546.00 $590.00 $503.00 $546.00 $590.00 76390-26 $71.00 $72.00 $74.00 $77.00 $72.00 $74.00 $77.00 76390-TC $419.00 $432.00 $472.00 $513.00 $432.00 $472.00 $513.00 76496 BR ------- ------- ------- ------- ------- ------- 76496-26 BR ------- ------- ------- ------- ------- ------- 76496-TC BR $91.00 $101.00 $111.00 $91.00 $101.00 $111.00 76497 BR ------- ------- ------- ------- ------- ------- 76497-26 BR ------- ------- ------- ------- ------- ------- 76497-TC BR $109.00 $120.00 $132.00 $109.00 $120.00 $132.00 76498 BR ------- ------- ------- ------- ------- ------- 76498-26 BR ------- ------- ------- ------- ------- ------- 76498-TC BR $335.00 $369.00 $407.00 $335.00 $369.00 $407.00 76499 BR ------- ------- ------- ------- ------- ------- 76499-26 BR ------- ------- ------- ------- ------- ------- 76499-TC BR ------- ------- ------- ------- ------- ------- 76506 $88.00 $100.00 $107.00 $115.00 $100.00 $107.00 $115.00 76506-26 $33.00 $35.00 $37.00 $40.00 $35.00 $37.00 $40.00 76506-TC $53.00 $64.00 $70.00 $75.00 $64.00 $70.00 $75.00 76510 ------- $163.00 $172.00 $181.00 $163.00 $172.00 $181.00 76510-26 ------- $83.00 $85.00 $87.00 $83.00 $85.00 $87.00 76510-TC ------- $81.00 $87.00 $94.00 $81.00 $87.00 $94.00 76511 $96.00 $115.00 $123.00 $130.00 $115.00 $123.00 $130.00 76511-26 $48.00 $51.00 $52.00 $54.00 $51.00 $52.00 $54.00 76511-TC $48.00 $64.00 $70.00 $76.00 $64.00 $70.00 $76.00 76512 $96.00 $109.00 $116.00 $123.00 $109.00 $116.00 $123.00 76512-26 $36.00 $51.00 $52.00 $53.00 $51.00 $52.00 $53.00 76512-TC $60.00 $58.00 $64.00 $70.00 $58.00 $64.00 $70.00 76513 $96.00 $97.00 $104.00 $112.00 $97.00 $104.00 $112.00 76513-26 $36.00 $36.00 $37.00 $38.00 $36.00 $37.00 $38.00 76513-TC $60.00 $62.00 $68.00 $74.00 $62.00 $68.00 $74.00 76514 ------- $13.00 $14.00 $15.00 $13.00 $14.00 $15.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 267
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 76514-26 ------- $10.00 $10.00 $11.00 $10.00 $10.00 $11.00 76514-TC ------- $4.00 $4.00 $5.00 $4.00 $4.00 $5.00 76516 $99.00 $77.00 $82.00 $87.00 $77.00 $82.00 $87.00 76516-26 $37.00 $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 76516-TC $63.00 $48.00 $52.00 $57.00 $48.00 $52.00 $57.00 76519 $88.00 $81.00 $86.00 $92.00 $81.00 $86.00 $92.00 76519-26 $31.00 $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 76519-TC $53.00 $51.00 $56.00 $61.00 $51.00 $56.00 $61.00 76529 $86.00 $77.00 $82.00 $88.00 $77.00 $82.00 $88.00 76529-26 $31.00 $31.00 $32.00 $33.00 $31.00 $32.00 $33.00 76529-TC $53.00 $46.00 $50.00 $55.00 $46.00 $50.00 $55.00 76536 $83.00 $111.00 $119.00 $127.00 $111.00 $119.00 $127.00 76536-26 $31.00 $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 76536-TC $54.00 $82.00 $89.00 $96.00 $82.00 $89.00 $96.00 76604 $78.00 $91.00 $97.00 $104.00 $91.00 $97.00 $104.00 76604-26 $28.00 $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 76604-TC $48.00 $62.00 $68.00 $73.00 $62.00 $68.00 $73.00 76645 $69.00 $91.00 $97.00 $103.00 $91.00 $97.00 $103.00 76645-26 $31.00 $28.00 $29.00 $30.00 $28.00 $29.00 $30.00 76645-TC $40.00 $62.00 $68.00 $73.00 $62.00 $68.00 $73.00 76700 $116.00 $142.00 $153.00 $163.00 $142.00 $153.00 $163.00 76700-26 $42.00 $43.00 $44.00 $46.00 $43.00 $44.00 $46.00 76700-TC $73.00 $100.00 $108.00 $117.00 $100.00 $108.00 $117.00 76705 $84.00 $106.00 $114.00 $122.00 $106.00 $114.00 $122.00 76705-26 $30.00 $32.00 $33.00 $34.00 $32.00 $33.00 $34.00 76705-TC $53.00 $75.00 $81.00 $88.00 $75.00 $81.00 $88.00 76770 $112.00 $137.00 $147.00 $157.00 $137.00 $147.00 $157.00 76770-26 $38.00 $39.00 $40.00 $42.00 $39.00 $40.00 $42.00 76770-TC $73.00 $98.00 $107.00 $115.00 $98.00 $107.00 $115.00 76775 $84.00 $107.00 $115.00 $123.00 $107.00 $115.00 $123.00 76775-26 $30.00 $31.00 $32.00 $34.00 $31.00 $32.00 $34.00 76775-TC $53.00 $76.00 $83.00 $89.00 $76.00 $83.00 $89.00 76776 ------- $148.00 $159.00 $169.00 $148.00 $159.00 $169.00 76776-26 ------- $40.00 $41.00 $43.00 $40.00 $41.00 $43.00 76776-TC ------- $108.00 $117.00 $126.00 $108.00 $117.00 $126.00 76800 $112.00 $130.00 $138.00 $147.00 $130.00 $138.00 $147.00 76800-26 $61.00 $57.00 $59.00 $61.00 $57.00 $59.00 $61.00 76800-TC $54.00 $73.00 $79.00 $85.00 $73.00 $79.00 $85.00 76801 $93.00 $143.00 $153.00 $163.00 $143.00 $153.00 $163.00 76801-26 $51.00 $52.00 $53.00 $55.00 $52.00 $53.00 $55.00 76801-TC $42.00 $91.00 $99.00 $108.00 $91.00 $99.00 $108.00 76802 $73.00 $86.00 $93.00 $100.00 $86.00 $93.00 $100.00 76802-26 $43.00 $44.00 $46.00 $48.00 $44.00 $46.00 $48.00 76802-TC $30.00 $42.00 $47.00 $53.00 $42.00 $47.00 $53.00 76805 $131.00 $153.00 $164.00 $175.00 $153.00 $164.00 $175.00 76805-26 $51.00 $52.00 $53.00 $55.00 $52.00 $53.00 $55.00 76805-TC $79.00 $102.00 $111.00 $120.00 $102.00 $111.00 $120.00 76810 $252.00 $112.00 $121.00 $133.00 $112.00 $121.00 $133.00 76810-26 $100.00 $51.00 $53.00 $55.00 $51.00 $53.00 $55.00 76810-TC $151.00 $61.00 $69.00 $78.00 $61.00 $69.00 $78.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 268
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 76811 $243.00 $245.00 $266.00 $290.00 $245.00 $266.00 $290.00 76811-26 $100.00 $100.00 $103.00 $108.00 $100.00 $103.00 $108.00 76811-TC $142.00 $145.00 $162.00 $183.00 $145.00 $162.00 $183.00 76812 $145.00 $162.00 $174.00 $189.00 $162.00 $174.00 $189.00 76812-26 $94.00 $94.00 $97.00 $101.00 $94.00 $97.00 $101.00 76812-TC $51.00 $69.00 $77.00 $88.00 $69.00 $77.00 $88.00 76813 ------- $142.00 $152.00 $163.00 $142.00 $152.00 $163.00 76813-26 ------- $62.00 $65.00 $67.00 $62.00 $65.00 $67.00 76813-TC ------- $80.00 $88.00 $96.00 $80.00 $88.00 $96.00 76814 ------- $93.00 $100.00 $109.00 $93.00 $100.00 $109.00 76814-26 ------- $51.00 $53.00 $55.00 $51.00 $53.00 $55.00 76814-TC ------- $42.00 $48.00 $54.00 $42.00 $48.00 $54.00 76815 $88.00 $98.00 $105.00 $113.00 $98.00 $105.00 $113.00 76815-26 $33.00 $34.00 $35.00 $37.00 $34.00 $35.00 $37.00 76815-TC $53.00 $64.00 $70.00 $76.00 $64.00 $70.00 $76.00 76816 $72.00 $109.00 $116.00 $123.00 $109.00 $116.00 $123.00 76816-26 $30.00 $45.00 $46.00 $48.00 $45.00 $46.00 $48.00 76816-TC $41.00 $64.00 $70.00 $75.00 $64.00 $70.00 $75.00 76817 $96.00 $103.00 $110.00 $117.00 $103.00 $110.00 $117.00 76817-26 $39.00 $39.00 $40.00 $42.00 $39.00 $40.00 $42.00 76817-TC $57.00 $64.00 $70.00 $75.00 $64.00 $70.00 $75.00 76818 $105.00 $131.00 $140.00 $149.00 $131.00 $140.00 $149.00 76818-26 $40.00 $55.00 $57.00 $60.00 $55.00 $57.00 $60.00 76818-TC $60.00 $75.00 $82.00 $89.00 $75.00 $82.00 $89.00 76819 $101.00 $106.00 $113.00 $121.00 $106.00 $113.00 $121.00 76819-26 $40.00 $41.00 $42.00 $43.00 $41.00 $42.00 $43.00 76819-TC $60.00 $65.00 $71.00 $78.00 $65.00 $71.00 $78.00 76820 ------- $74.00 $80.00 $88.00 $74.00 $80.00 $88.00 76820-26 ------- $27.00 $28.00 $29.00 $27.00 $28.00 $29.00 76820-TC ------- $47.00 $52.00 $58.00 $47.00 $52.00 $58.00 76821 ------- $109.00 $117.00 $126.00 $109.00 $117.00 $126.00 76821-26 ------- $37.00 $39.00 $40.00 $37.00 $39.00 $40.00 76821-TC ------- $72.00 $79.00 $86.00 $72.00 $79.00 $86.00 76825 $160.00 $189.00 $200.00 $212.00 $189.00 $200.00 $212.00 76825-26 $65.00 $88.00 $90.00 $94.00 $88.00 $90.00 $94.00 76825-TC $73.00 $101.00 $110.00 $118.00 $101.00 $110.00 $118.00 76826 $71.00 $107.00 $114.00 $120.00 $107.00 $114.00 $120.00 76826-26 $46.00 $43.00 $44.00 $46.00 $43.00 $44.00 $46.00 76826-TC $27.00 $64.00 $69.00 $74.00 $64.00 $69.00 $74.00 76827 $97.00 $89.00 $96.00 $104.00 $89.00 $96.00 $104.00 76827-26 $35.00 $30.00 $31.00 $32.00 $30.00 $31.00 $32.00 76827-TC $65.00 $59.00 $65.00 $72.00 $59.00 $65.00 $72.00 76828 $72.00 $66.00 $71.00 $76.00 $66.00 $71.00 $76.00 76828-26 $29.00 $30.00 $31.00 $32.00 $30.00 $31.00 $32.00 76828-TC $42.00 $36.00 $40.00 $44.00 $36.00 $40.00 $44.00 76830 $93.00 $122.00 $131.00 $141.00 $122.00 $131.00 $141.00 76830-26 $35.00 $36.00 $38.00 $39.00 $36.00 $38.00 $39.00 76830-TC $57.00 $86.00 $94.00 $101.00 $86.00 $94.00 $101.00 76831 $95.00 $123.00 $132.00 $141.00 $123.00 $132.00 $141.00 76831-26 $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
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 76831-TC $57.00 $86.00 $93.00 $101.00 $86.00 $93.00 $101.00 76856 $93.00 $123.00 $132.00 $141.00 $123.00 $132.00 $141.00 76856-26 $35.00 $36.00 $38.00 $39.00 $36.00 $38.00 $39.00 76856-TC $57.00 $86.00 $94.00 $102.00 $86.00 $94.00 $102.00 76857 $59.00 $84.00 $90.00 $96.00 $84.00 $90.00 $96.00 76857-26 $19.00 $20.00 $21.00 $22.00 $20.00 $21.00 $22.00 76857-TC $39.00 $64.00 $69.00 $74.00 $64.00 $69.00 $74.00 76870 $90.00 $121.00 $130.00 $139.00 $121.00 $130.00 $139.00 76870-26 $33.00 $34.00 $35.00 $37.00 $34.00 $35.00 $37.00 76870-TC $57.00 $87.00 $95.00 $103.00 $87.00 $95.00 $103.00 76872 $93.00 $138.00 $149.00 $159.00 $138.00 $149.00 $159.00 76872-26 $36.00 $37.00 $39.00 $41.00 $37.00 $39.00 $41.00 76872-TC $57.00 $101.00 $110.00 $118.00 $101.00 $110.00 $118.00 76873 $151.00 $185.00 $198.00 $212.00 $185.00 $198.00 $212.00 76873-26 $68.00 $83.00 $86.00 $90.00 $83.00 $86.00 $90.00 76873-TC $80.00 $102.00 $112.00 $122.00 $102.00 $112.00 $122.00 76880 $85.00 $123.00 $132.00 $141.00 $123.00 $132.00 $141.00 76880-26 $32.00 $31.00 $32.00 $34.00 $31.00 $32.00 $34.00 76880-TC $54.00 $92.00 $100.00 $107.00 $92.00 $100.00 $107.00 76930 $93.00 $108.00 $115.00 $123.00 $108.00 $115.00 $123.00 76930-26 NC $37.00 $39.00 $40.00 $37.00 $39.00 $40.00 76930-TC NC $70.00 $77.00 $84.00 $70.00 $77.00 $84.00 76932 $93.00 ------- ------- ------- ------- ------- ------- 76932-26 NC $38.00 $39.00 $40.00 $38.00 $39.00 $40.00 76932-TC NC BR BR BR BR BR BR 76936 $341.00 $360.00 $388.00 $417.00 $360.00 $388.00 $417.00 76936-26 $102.00 $109.00 $113.00 $119.00 $109.00 $113.00 $119.00 76936-TC $236.00 $251.00 $274.00 $298.00 $251.00 $274.00 $298.00 76937 ------- $41.00 $45.00 $50.00 $41.00 $45.00 $50.00 76937-26 ------- $17.00 $18.00 $19.00 $17.00 $18.00 $19.00 76937-TC ------- $24.00 $27.00 $31.00 $24.00 $27.00 $31.00 76940 ------- BR BR BR BR BR BR 76940-26 ------- $119.00 $127.00 $138.00 $119.00 $127.00 $138.00 76940-TC ------- BR BR BR BR BR BR 76941 $128.00 ------- ------- ------- ------- ------- ------- 76941-26 NC $71.00 $73.00 $76.00 $71.00 $73.00 $76.00 76941-TC NC BR BR BR BR BR BR 76942 $92.00 $186.00 $200.00 $213.00 $186.00 $200.00 $213.00 76942-26 NC $36.00 $37.00 $38.00 $36.00 $37.00 $38.00 76942-TC NC $151.00 $163.00 $175.00 $151.00 $163.00 $175.00 76945 $93.00 ------- ------- ------- ------- ------- ------- 76945-26 NC $35.00 $36.00 $37.00 $35.00 $36.00 $37.00 76945-TC NC BR BR BR BR BR BR 76946 $78.00 $63.00 $68.00 $74.00 $63.00 $68.00 $74.00 76946-26 NC $20.00 $21.00 $21.00 $20.00 $21.00 $21.00 76946-TC NC $43.00 $47.00 $53.00 $43.00 $47.00 $53.00 76948 $77.00 $62.00 $67.00 $74.00 $62.00 $67.00 $74.00 76948-26 NC $19.00 $20.00 $21.00 $19.00 $20.00 $21.00 76948-TC NC $43.00 $47.00 $53.00 $43.00 $47.00 $53.00 76950 $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
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 76950-26 $30.00 $31.00 $32.00 $33.00 $31.00 $32.00 $33.00 76950-TC $48.00 $50.00 $55.00 $59.00 $50.00 $55.00 $59.00 76965 $281.00 $214.00 $231.00 $251.00 $214.00 $231.00 $251.00 76965-26 $84.00 $72.00 $75.00 $79.00 $72.00 $75.00 $79.00 76965-TC $208.00 $141.00 $156.00 $172.00 $141.00 $156.00 $172.00 76970 $60.00 $82.00 $88.00 $94.00 $82.00 $88.00 $94.00 76970-26 $20.00 $21.00 $21.00 $22.00 $21.00 $21.00 $22.00 76970-TC $39.00 $61.00 $66.00 $72.00 $61.00 $66.00 $72.00 76975 $99.00 $177.00 $195.00 $214.00 $177.00 $195.00 $214.00 76975-26 NC $44.00 $45.00 $47.00 $44.00 $45.00 $47.00 76975-TC NC $163.00 $179.00 $197.00 $163.00 $179.00 $197.00 76977 $34.00 $24.00 $27.00 $30.00 $24.00 $27.00 $30.00 76977-26 $3.00 $3.00 $3.00 $4.00 $3.00 $3.00 $4.00 76977-TC $31.00 $21.00 $23.00 $26.00 $21.00 $23.00 $26.00 76998 ------- BR BR BR BR BR BR 76998-26 ------- $67.00 $71.00 $76.00 $67.00 $71.00 $76.00 76998-TC ------- BR BR BR BR BR BR 76999 BR ------- ------- ------- ------- ------- ------- 76999-26 BR ------- ------- ------- ------- ------- ------- 76999-TC BR ------- ------- ------- ------- ------- ------- 77001 ------- $102.00 $110.00 $119.00 $102.00 $110.00 $119.00 77001-26 ------- $20.00 $20.00 $21.00 $20.00 $20.00 $21.00 77001-TC ------- $83.00 $90.00 $98.00 $83.00 $90.00 $98.00 77002 ------- $79.00 $84.00 $90.00 $79.00 $84.00 $90.00 77002-26 ------- $28.00 $28.00 $29.00 $28.00 $28.00 $29.00 77002-TC ------- $51.00 $56.00 $61.00 $51.00 $56.00 $61.00 77003 ------- $72.00 $77.00 $83.00 $72.00 $77.00 $83.00 77003-26 ------- $30.00 $31.00 $32.00 $30.00 $31.00 $32.00 77003-TC ------- $42.00 $46.00 $51.00 $42.00 $46.00 $51.00 77011 ------- $642.00 $692.00 $740.00 $642.00 $692.00 $740.00 77011-26 ------- $64.00 $66.00 $68.00 $64.00 $66.00 $68.00 77011-TC ------- $579.00 $626.00 $672.00 $579.00 $626.00 $672.00 77012 ------- $288.00 $312.00 $340.00 $288.00 $312.00 $340.00 77012-26 ------- $62.00 $64.00 $66.00 $62.00 $64.00 $66.00 77012-TC ------- $226.00 $249.00 $273.00 $226.00 $249.00 $273.00 77013-26 ------- $212.00 $219.00 $228.00 $212.00 $219.00 $228.00 77013-TC ------- BR BR BR BR BR BR 77014 ------- $195.00 $210.00 $225.00 $195.00 $210.00 $225.00 77014-26 ------- $45.00 $46.00 $48.00 $45.00 $46.00 $48.00 77014-TC ------- $151.00 $164.00 $177.00 $151.00 $164.00 $177.00 77021 ------- $516.00 $558.00 $603.00 $516.00 $558.00 $603.00 77021-26 ------- $81.00 $84.00 $88.00 $81.00 $84.00 $88.00 77021-TC ------- $435.00 $474.00 $515.00 $435.00 $474.00 $515.00 77022 ------- BR BR BR BR BR BR 77022-26 ------- $228.00 $237.00 $248.00 $228.00 $237.00 $248.00 77022-TC ------- BR BR BR BR BR BR 77031 ------- $275.00 $298.00 $323.00 $275.00 $298.00 $323.00 77031-26 ------- $85.00 $88.00 $92.00 $85.00 $88.00 $92.00 77031-TC ------- $190.00 $209.00 $230.00 $190.00 $209.00 $230.00 77032 ------- $72.00 $77.00 $83.00 $72.00 $77.00 $83.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 271
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 77032-26 ------- $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 77032-TC ------- $43.00 $47.00 $51.00 $43.00 $47.00 $51.00 77051 ------- $16.00 $17.00 $19.00 $16.00 $17.00 $19.00 77051-26 ------- $4.00 $4.00 $4.00 $4.00 $4.00 $4.00 77051-TC ------- $12.00 $13.00 $14.00 $12.00 $13.00 $14.00 77052 ------- $16.00 $17.00 $19.00 $16.00 $17.00 $19.00 77052-26 ------- $4.00 $4.00 $4.00 $4.00 $4.00 $4.00 77052-TC ------- $12.00 $13.00 $14.00 $12.00 $13.00 $14.00 77053 ------- $102.00 $110.00 $120.00 $102.00 $110.00 $120.00 77053-26 ------- $19.00 $20.00 $21.00 $19.00 $20.00 $21.00 77053-TC ------- $82.00 $90.00 $99.00 $82.00 $90.00 $99.00 77054 ------- $137.00 $149.00 $162.00 $137.00 $149.00 $162.00 77054-26 ------- $24.00 $25.00 $26.00 $24.00 $25.00 $26.00 77054-TC ------- $114.00 $125.00 $136.00 $114.00 $125.00 $136.00 77055 ------- $89.00 $95.00 $101.00 $89.00 $95.00 $101.00 77055-26 ------- $37.00 $39.00 $40.00 $37.00 $39.00 $40.00 77055-TC ------- $52.00 $56.00 $61.00 $52.00 $56.00 $61.00 77056 ------- $112.00 $120.00 $127.00 $112.00 $120.00 $127.00 77056-26 ------- $46.00 $48.00 $50.00 $46.00 $48.00 $50.00 77056-TC ------- $66.00 $72.00 $78.00 $66.00 $72.00 $78.00 77057 ------- $90.00 $96.00 $102.00 $90.00 $96.00 $102.00 77057-26 ------- $37.00 $39.00 $40.00 $37.00 $39.00 $40.00 77057-TC ------- $52.00 $57.00 $62.00 $52.00 $57.00 $62.00 77058 ------- $904.00 $979.00 $1,056.00 $904.00 $979.00 $1,056.00 77058-26 ------- $86.00 $89.00 $93.00 $86.00 $89.00 $93.00 77058-TC ------- $817.00 $890.00 $963.00 $817.00 $890.00 $963.00 77059 ------- $1,046.00 $1,136.00 $1,230.00 $1,046.00 $1,136.00 $1,230.00 77059-26 ------- $86.00 $89.00 $93.00 $86.00 $89.00 $93.00 77059-TC ------- $959.00 $1,047.00 $1,137.00 $959.00 $1,047.00 $1,137.00 77071 ------- $38.00 $40.00 $43.00 $38.00 $40.00 $43.00 77072 ------- $25.00 $27.00 $29.00 $25.00 $27.00 $29.00 77072-26 ------- $10.00 $10.00 $11.00 $10.00 $10.00 $11.00 77072-TC ------- $15.00 $17.00 $18.00 $15.00 $17.00 $18.00 77073 ------- $44.00 $48.00 $51.00 $44.00 $48.00 $51.00 77073-26 ------- $15.00 $15.00 $16.00 $15.00 $15.00 $16.00 77073-TC ------- $30.00 $33.00 $36.00 $30.00 $33.00 $36.00 77074 ------- $73.00 $78.00 $84.00 $73.00 $78.00 $84.00 77074-26 ------- $24.00 $25.00 $26.00 $24.00 $25.00 $26.00 77074-TC ------- $48.00 $53.00 $57.00 $48.00 $53.00 $57.00 77075 ------- $103.00 $111.00 $118.00 $103.00 $111.00 $118.00 77075-26 ------- $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 77075-TC ------- $74.00 $81.00 $88.00 $74.00 $81.00 $88.00 77077 ------- $53.00 $57.00 $62.00 $53.00 $57.00 $62.00 77077-26 ------- $16.00 $17.00 $18.00 $16.00 $17.00 $18.00 77077-TC ------- $36.00 $40.00 $44.00 $36.00 $40.00 $44.00 77078 ------- $90.00 $97.00 $104.00 $90.00 $97.00 $104.00 77078-26 ------- $13.00 $13.00 $14.00 $13.00 $13.00 $14.00 77078-TC ------- $77.00 $84.00 $90.00 $77.00 $84.00 $90.00 77079 ------- $87.00 $94.00 $100.00 $87.00 $94.00 $100.00 77079-26 ------- $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 272
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 77079-TC ------- $76.00 $82.00 $88.00 $76.00 $82.00 $88.00 77080 ------- $89.00 $97.00 $106.00 $89.00 $97.00 $106.00 77080-26 ------- $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 77080-TC ------- $78.00 $86.00 $94.00 $78.00 $86.00 $94.00 77081 ------- $37.00 $40.00 $44.00 $37.00 $40.00 $44.00 77081-26 ------- $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 77081-TC ------- $26.00 $29.00 $31.00 $26.00 $29.00 $31.00 77082 ------- $36.00 $39.00 $42.00 $36.00 $39.00 $42.00 77082-26 ------- $9.00 $9.00 $10.00 $9.00 $9.00 $10.00 77082-TC ------- $27.00 $30.00 $33.00 $27.00 $30.00 $33.00 77083 ------- $34.00 $37.00 $41.00 $34.00 $37.00 $41.00 77083-26 ------- $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 77083-TC ------- $24.00 $26.00 $29.00 $24.00 $26.00 $29.00 77084 ------- $413.00 $446.00 $479.00 $413.00 $446.00 $479.00 77084-26 ------- $84.00 $87.00 $90.00 $84.00 $87.00 $90.00 77084-TC ------- $330.00 $359.00 $389.00 $330.00 $359.00 $389.00 77261 $73.00 $75.00 $77.00 $81.00 $75.00 $77.00 $81.00 77262 $110.00 $113.00 $117.00 $122.00 $113.00 $117.00 $122.00 77263 $163.00 $168.00 $174.00 $182.00 $168.00 $174.00 $182.00 77280 $166.00 $199.00 $215.00 $231.00 $199.00 $215.00 $231.00 77280-26 $36.00 $37.00 $39.00 $41.00 $37.00 $39.00 $41.00 77280-TC $130.00 $162.00 $176.00 $191.00 $162.00 $176.00 $191.00 77285 $264.00 $334.00 $361.00 $387.00 $334.00 $361.00 $387.00 77285-26 $53.00 $55.00 $57.00 $59.00 $55.00 $57.00 $59.00 77285-TC $209.00 $279.00 $304.00 $328.00 $279.00 $304.00 $328.00 77290 $325.00 $485.00 $523.00 $560.00 $485.00 $523.00 $560.00 77290-26 $79.00 $82.00 $85.00 $89.00 $82.00 $85.00 $89.00 77290-TC $243.00 $403.00 $438.00 $471.00 $403.00 $438.00 $471.00 77295 $1,287.00 $999.00 $1,084.00 $1,180.00 $999.00 $1,084.00 $1,180.00 77295-26 $232.00 $241.00 $250.00 $260.00 $241.00 $250.00 $260.00 77295-TC $1,046.00 $758.00 $835.00 $920.00 $758.00 $835.00 $920.00 77299 BR ------- ------- ------- ------- ------- ------- 77299-26 BR ------- ------- ------- ------- ------- ------- 77299-TC BR ------- ------- ------- ------- ------- ------- 77300 $87.00 $83.00 $88.00 $95.00 $83.00 $88.00 $95.00 77300-26 $36.00 $33.00 $34.00 $35.00 $33.00 $34.00 $35.00 77300-TC $52.00 $50.00 $55.00 $59.00 $50.00 $55.00 $59.00 77301 $1,473.00 $2,139.00 $2,300.00 $2,460.00 $2,139.00 $2,300.00 $2,460.00 77301-26 $415.00 $422.00 $437.00 $455.00 $422.00 $437.00 $455.00 77301-TC $1,046.00 $1,718.00 $1,863.00 $2,004.00 $1,718.00 $1,863.00 $2,004.00 77305 $106.00 $94.00 $101.00 $110.00 $94.00 $101.00 $110.00 77305-26 $36.00 $37.00 $39.00 $41.00 $37.00 $39.00 $41.00 77305-TC $69.00 $57.00 $62.00 $69.00 $57.00 $62.00 $69.00 77310 $142.00 $127.00 $136.00 $146.00 $127.00 $136.00 $146.00 77310-26 $53.00 $55.00 $57.00 $59.00 $55.00 $57.00 $59.00 77310-TC $87.00 $72.00 $79.00 $87.00 $72.00 $79.00 $87.00 77315 $181.00 $174.00 $186.00 $199.00 $174.00 $186.00 $199.00 77315-26 $79.00 $82.00 $85.00 $89.00 $82.00 $85.00 $89.00 77315-TC $99.00 $92.00 $101.00 $110.00 $92.00 $101.00 $110.00 77321 $200.00 $166.00 $180.00 $195.00 $166.00 $180.00 $195.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 273
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 77321-26 $48.00 $50.00 $52.00 $55.00 $50.00 $52.00 $55.00 77321-TC $150.00 $116.00 $127.00 $140.00 $116.00 $127.00 $140.00 77326 $137.00 $156.00 $168.00 $180.00 $156.00 $168.00 $180.00 77326-26 $47.00 $49.00 $51.00 $53.00 $49.00 $51.00 $53.00 77326-TC $88.00 $107.00 $117.00 $127.00 $107.00 $117.00 $127.00 77327 $202.00 $224.00 $240.00 $257.00 $224.00 $240.00 $257.00 77327-26 $71.00 $73.00 $76.00 $79.00 $73.00 $76.00 $79.00 77327-TC $130.00 $151.00 $165.00 $178.00 $151.00 $165.00 $178.00 77328 $295.00 $313.00 $336.00 $359.00 $313.00 $336.00 $359.00 77328-26 $106.00 $111.00 $115.00 $120.00 $111.00 $115.00 $120.00 77328-TC $185.00 $202.00 $221.00 $240.00 $202.00 $221.00 $240.00 77331 $64.00 $67.00 $70.00 $74.00 $67.00 $70.00 $74.00 77331-26 $45.00 $46.00 $47.00 $49.00 $46.00 $47.00 $49.00 77331-TC $18.00 $21.00 $23.00 $25.00 $21.00 $23.00 $25.00 77332 $78.00 $86.00 $93.00 $99.00 $86.00 $93.00 $99.00 77332-26 $27.00 $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 77332-TC $50.00 $58.00 $63.00 $68.00 $58.00 $63.00 $68.00 77333 $115.00 $93.00 $100.00 $107.00 $93.00 $100.00 $107.00 77333-26 $43.00 $44.00 $46.00 $48.00 $44.00 $46.00 $48.00 77333-TC $70.00 $49.00 $54.00 $60.00 $49.00 $54.00 $60.00 77334 $187.00 $185.00 $198.00 $213.00 $185.00 $198.00 $213.00 77334-26 $63.00 $65.00 $67.00 $70.00 $65.00 $67.00 $70.00 77334-TC $121.00 $120.00 $131.00 $143.00 $120.00 $131.00 $143.00 77336 $111.00 $91.00 $100.00 $110.00 $91.00 $100.00 $110.00 77370 $130.00 $140.00 $152.00 $165.00 $140.00 $152.00 $165.00 77371 ------- $1,190.00 $1,277.00 $1,351.00 $1,190.00 $1,277.00 $1,351.00 77372 ------- $904.00 $971.00 $1,028.00 $904.00 $971.00 $1,028.00 77373 ------- $1,683.00 $1,806.00 $1,908.00 $1,683.00 $1,806.00 $1,908.00 77399 BR ------- ------- ------- ------- ------- ------- 77399-26 BR ------- ------- ------- ------- ------- ------- 77399-TC BR ------- ------- ------- ------- ------- ------- 77401 $66.00 $51.00 $56.00 $62.00 $51.00 $56.00 $62.00 77402 $66.00 $127.00 $138.00 $148.00 $127.00 $138.00 $148.00 77403 $66.00 $116.00 $126.00 $135.00 $116.00 $126.00 $135.00 77404 $66.00 $124.00 $135.00 $145.00 $124.00 $135.00 $145.00 77406 $66.00 $125.00 $136.00 $146.00 $125.00 $136.00 $146.00 77407 $78.00 $162.00 $176.00 $188.00 $162.00 $176.00 $188.00 77408 $78.00 $150.00 $163.00 $175.00 $150.00 $163.00 $175.00 77409 $78.00 $162.00 $175.00 $188.00 $162.00 $175.00 $188.00 77411 $78.00 $161.00 $175.00 $188.00 $161.00 $175.00 $188.00 77412 $87.00 $187.00 $203.00 $217.00 $187.00 $203.00 $217.00 77413 $87.00 $189.00 $204.00 $219.00 $189.00 $204.00 $219.00 77414 $87.00 $206.00 $222.00 $238.00 $206.00 $222.00 $238.00 77416 $87.00 $206.00 $222.00 $238.00 $206.00 $222.00 $238.00 77417 $21.00 $21.00 $23.00 $26.00 $21.00 $23.00 $26.00 77418 $609.00 $621.00 $667.00 $707.00 $621.00 $667.00 $707.00 77421 ------- $137.00 $147.00 $158.00 $137.00 $147.00 $158.00 77421-26 ------- $21.00 $21.00 $22.00 $21.00 $21.00 $22.00 77421-TC ------- $116.00 $126.00 $136.00 $116.00 $126.00 $136.00 77422 ------- $147.00 $159.00 $171.00 $147.00 $159.00 $171.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 274
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 77423 ------- $199.00 $215.00 $230.00 $199.00 $215.00 $230.00 77427 $166.00 $195.00 $202.00 $210.00 $195.00 $202.00 $210.00 77431 $95.00 $101.00 $105.00 $109.00 $101.00 $105.00 $109.00 77432 $417.00 $426.00 $441.00 $460.00 $426.00 $441.00 $460.00 77435 ------- $708.00 $735.00 $767.00 $708.00 $735.00 $767.00 77470 $527.00 $391.00 $424.00 $462.00 $391.00 $424.00 $462.00 77470-26 $106.00 $111.00 $115.00 $120.00 $111.00 $115.00 $120.00 77470-TC $417.00 $280.00 $309.00 $342.00 $280.00 $309.00 $342.00 77499 BR ------- ------- ------- ------- ------- ------- 77499-26 BR ------- ------- ------- ------- ------- ------- 77499-TC BR ------- ------- ------- ------- ------- ------- 77520 BR ------- ------- ------- ------- ------- ------- 77522 BR ------- ------- ------- ------- ------- ------- 77523 BR ------- ------- ------- ------- ------- ------- 77525 BR ------- ------- ------- ------- ------- ------- 77600 $196.00 $343.00 $367.00 $391.00 $343.00 $367.00 $391.00 77600-26 $80.00 $82.00 $85.00 $89.00 $82.00 $85.00 $89.00 77600-TC $113.00 $261.00 $282.00 $302.00 $261.00 $282.00 $302.00 77605 $263.00 $556.00 $596.00 $635.00 $556.00 $596.00 $635.00 77605-26 $108.00 $111.00 $116.00 $122.00 $111.00 $116.00 $122.00 77605-TC $151.00 $446.00 $481.00 $513.00 $446.00 $481.00 $513.00 77610 $195.00 $494.00 $529.00 $562.00 $494.00 $529.00 $562.00 77610-26 $79.00 $79.00 $82.00 $86.00 $79.00 $82.00 $86.00 77610-TC $113.00 $415.00 $447.00 $476.00 $415.00 $447.00 $476.00 77615 $262.00 $699.00 $749.00 $794.00 $699.00 $749.00 $794.00 77615-26 $106.00 $109.00 $113.00 $118.00 $109.00 $113.00 $118.00 77615-TC $151.00 $590.00 $635.00 $676.00 $590.00 $635.00 $676.00 77620 $196.00 $356.00 $383.00 $411.00 $356.00 $383.00 $411.00 77620-26 $80.00 $88.00 $93.00 $100.00 $88.00 $93.00 $100.00 77620-TC $113.00 $268.00 $290.00 $310.00 $268.00 $290.00 $310.00 77750 $299.00 $349.00 $365.00 $384.00 $349.00 $365.00 $384.00 77750-26 $248.00 $261.00 $270.00 $282.00 $261.00 $270.00 $282.00 77750-TC $49.00 $88.00 $95.00 $102.00 $88.00 $95.00 $102.00 77761 $284.00 $356.00 $377.00 $399.00 $356.00 $377.00 $399.00 77761-26 $188.00 $199.00 $206.00 $214.00 $199.00 $206.00 $214.00 77761-TC $93.00 $158.00 $171.00 $184.00 $158.00 $171.00 $184.00 77762 $427.00 $498.00 $526.00 $556.00 $498.00 $526.00 $556.00 77762-26 $289.00 $303.00 $314.00 $327.00 $303.00 $314.00 $327.00 77762-TC $135.00 $196.00 $212.00 $229.00 $196.00 $212.00 $229.00 77763 $605.00 $703.00 $741.00 $782.00 $703.00 $741.00 $782.00 77763-26 $435.00 $453.00 $469.00 $489.00 $453.00 $469.00 $489.00 77763-TC $167.00 $250.00 $272.00 $293.00 $250.00 $272.00 $293.00 77776 $316.00 $416.00 $442.00 $472.00 $416.00 $442.00 $472.00 77776-26 $233.00 $251.00 $264.00 $280.00 $251.00 $264.00 $280.00 77776-TC $82.00 $165.00 $179.00 $192.00 $165.00 $179.00 $192.00 77777 $540.00 $600.00 $632.00 $668.00 $600.00 $632.00 $668.00 77777-26 $378.00 $395.00 $410.00 $428.00 $395.00 $410.00 $428.00 77777-TC $158.00 $204.00 $222.00 $240.00 $204.00 $222.00 $240.00 77778 $764.00 $860.00 $905.00 $954.00 $860.00 $905.00 $954.00 77778-26 $568.00 $592.00 $614.00 $640.00 $592.00 $614.00 $640.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 275
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 77778-TC $192.00 $267.00 $291.00 $314.00 $267.00 $291.00 $314.00 77789 $74.00 $103.00 $108.00 $114.00 $103.00 $108.00 $114.00 77789-26 $57.00 $61.00 $63.00 $66.00 $61.00 $63.00 $66.00 77789-TC $16.00 $42.00 $45.00 $48.00 $42.00 $45.00 $48.00 77790 $72.00 $88.00 $93.00 $97.00 $88.00 $93.00 $97.00 77790-26 $53.00 $55.00 $57.00 $59.00 $55.00 $57.00 $59.00 77790-TC $18.00 $33.00 $36.00 $38.00 $33.00 $36.00 $38.00 77799 BR ------- ------- ------- ------- ------- ------- 77799-26 BR ------- ------- ------- ------- ------- ------- 77799-TC BR ------- ------- ------- ------- ------- ------- 78000 $46.00 $68.00 $73.00 $79.00 $68.00 $73.00 $79.00 78000-26 $9.00 $10.00 $10.00 $11.00 $10.00 $10.00 $11.00 78000-TC $36.00 $58.00 $63.00 $68.00 $58.00 $63.00 $68.00 78001 $62.00 $87.00 $94.00 $101.00 $87.00 $94.00 $101.00 78001-26 $12.00 $14.00 $14.00 $15.00 $14.00 $14.00 $15.00 78001-TC $48.00 $73.00 $80.00 $86.00 $73.00 $80.00 $86.00 78003 $54.00 $75.00 $81.00 $87.00 $75.00 $81.00 $87.00 78003-26 $17.00 $17.00 $18.00 $18.00 $17.00 $18.00 $18.00 78003-TC $36.00 $58.00 $63.00 $68.00 $58.00 $63.00 $68.00 78006 $115.00 $199.00 $215.00 $229.00 $199.00 $215.00 $229.00 78006-26 $24.00 $26.00 $26.00 $27.00 $26.00 $26.00 $27.00 78006-TC $89.00 $174.00 $188.00 $202.00 $174.00 $188.00 $202.00 78007 $122.00 $142.00 $154.00 $165.00 $142.00 $154.00 $165.00 78007-26 $25.00 $26.00 $27.00 $28.00 $26.00 $27.00 $28.00 78007-TC $96.00 $116.00 $126.00 $137.00 $116.00 $126.00 $137.00 78010 $89.00 $143.00 $154.00 $165.00 $143.00 $154.00 $165.00 78010-26 $19.00 $21.00 $21.00 $22.00 $21.00 $21.00 $22.00 78010-TC $68.00 $122.00 $133.00 $143.00 $122.00 $133.00 $143.00 78011 $114.00 $162.00 $174.00 $187.00 $162.00 $174.00 $187.00 78011-26 $22.00 $24.00 $25.00 $26.00 $24.00 $25.00 $26.00 78011-TC $90.00 $138.00 $150.00 $161.00 $138.00 $150.00 $161.00 78015 $132.00 $195.00 $210.00 $225.00 $195.00 $210.00 $225.00 78015-26 $34.00 $36.00 $37.00 $38.00 $36.00 $37.00 $38.00 78015-TC $96.00 $160.00 $173.00 $187.00 $160.00 $173.00 $187.00 78016 $173.00 $285.00 $306.00 $327.00 $285.00 $306.00 $327.00 78016-26 $42.00 $43.00 $44.00 $46.00 $43.00 $44.00 $46.00 78016-TC $130.00 $242.00 $262.00 $281.00 $242.00 $262.00 $281.00 78018 $248.00 $321.00 $346.00 $372.00 $321.00 $346.00 $372.00 78018-26 $44.00 $46.00 $48.00 $50.00 $46.00 $48.00 $50.00 78018-TC $202.00 $274.00 $299.00 $323.00 $274.00 $299.00 $323.00 78020 $35.00 $97.00 $105.00 $114.00 $97.00 $105.00 $114.00 78020-26 $30.00 $32.00 $33.00 $34.00 $32.00 $33.00 $34.00 78020-TC $5.00 $66.00 $73.00 $80.00 $66.00 $73.00 $80.00 78070 $112.00 $197.00 $212.00 $226.00 $197.00 $212.00 $226.00 78070-26 $36.00 $44.00 $45.00 $47.00 $44.00 $45.00 $47.00 78070-TC $68.00 $154.00 $166.00 $178.00 $154.00 $166.00 $178.00 78075 $242.00 $387.00 $417.00 $447.00 $387.00 $417.00 $447.00 78075-26 $38.00 $39.00 $40.00 $42.00 $39.00 $40.00 $42.00 78075-TC $202.00 $348.00 $377.00 $406.00 $348.00 $377.00 $406.00 78099 BR ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 276
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 78099-26 BR ------- ------- ------- ------- ------- ------- 78099-TC BR ------- ------- ------- ------- ------- ------- 78102 $106.00 $155.00 $167.00 $178.00 $155.00 $167.00 $178.00 78102-26 $28.00 $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 78102-TC $77.00 $126.00 $137.00 $148.00 $126.00 $137.00 $148.00 78103 $158.00 $214.00 $231.00 $247.00 $214.00 $231.00 $247.00 78103-26 $39.00 $40.00 $41.00 $43.00 $40.00 $41.00 $43.00 78103-TC $118.00 $175.00 $190.00 $205.00 $175.00 $190.00 $205.00 78104 $194.00 $253.00 $272.00 $292.00 $253.00 $272.00 $292.00 78104-26 $41.00 $42.00 $44.00 $45.00 $42.00 $44.00 $45.00 78104-TC $152.00 $210.00 $229.00 $247.00 $210.00 $229.00 $247.00 78110 $45.00 $74.00 $79.00 $85.00 $74.00 $79.00 $85.00 78110-26 $9.00 $10.00 $11.00 $11.00 $10.00 $11.00 $11.00 78110-TC $35.00 $63.00 $68.00 $74.00 $63.00 $68.00 $74.00 78111 $108.00 $112.00 $121.00 $131.00 $112.00 $121.00 $131.00 78111-26 $11.00 $12.00 $12.00 $13.00 $12.00 $12.00 $13.00 78111-TC $96.00 $100.00 $109.00 $119.00 $100.00 $109.00 $119.00 78120 $78.00 $93.00 $101.00 $109.00 $93.00 $101.00 $109.00 78120-26 $11.00 $12.00 $13.00 $13.00 $12.00 $13.00 $13.00 78120-TC $65.00 $81.00 $88.00 $96.00 $81.00 $88.00 $96.00 78121 $125.00 $124.00 $134.00 $145.00 $124.00 $134.00 $145.00 78121-26 $16.00 $17.00 $17.00 $18.00 $17.00 $17.00 $18.00 78121-TC $108.00 $107.00 $117.00 $127.00 $107.00 $117.00 $127.00 78122 $196.00 $171.00 $186.00 $202.00 $171.00 $186.00 $202.00 78122-26 $22.00 $24.00 $25.00 $26.00 $24.00 $25.00 $26.00 78122-TC $171.00 $146.00 $161.00 $176.00 $146.00 $161.00 $176.00 78130 $139.00 $162.00 $175.00 $187.00 $162.00 $175.00 $187.00 78130-26 $32.00 $33.00 $34.00 $35.00 $33.00 $34.00 $35.00 78130-TC $106.00 $129.00 $141.00 $152.00 $129.00 $141.00 $152.00 78135 $216.00 $311.00 $336.00 $361.00 $311.00 $336.00 $361.00 78135-26 $33.00 $34.00 $35.00 $37.00 $34.00 $35.00 $37.00 78135-TC $182.00 $277.00 $301.00 $324.00 $277.00 $301.00 $324.00 78140 $179.00 $177.00 $191.00 $207.00 $177.00 $191.00 $207.00 78140-26 $31.00 $33.00 $34.00 $35.00 $33.00 $34.00 $35.00 78140-TC $147.00 $144.00 $157.00 $172.00 $144.00 $157.00 $172.00 78185 $110.00 $175.00 $189.00 $202.00 $175.00 $189.00 $202.00 78185-26 $20.00 $21.00 $22.00 $23.00 $21.00 $22.00 $23.00 78185-TC $88.00 $154.00 $167.00 $179.00 $154.00 $167.00 $179.00 78190 $272.00 $253.00 $272.00 $292.00 $253.00 $272.00 $292.00 78190-26 $57.00 $58.00 $60.00 $63.00 $58.00 $60.00 $63.00 78190-TC $214.00 $195.00 $212.00 $229.00 $195.00 $212.00 $229.00 78191 $307.00 $265.00 $288.00 $313.00 $265.00 $288.00 $313.00 78191-26 $31.00 $33.00 $34.00 $35.00 $33.00 $34.00 $35.00 78191-TC $274.00 $232.00 $254.00 $278.00 $232.00 $254.00 $278.00 78195 $216.00 $320.00 $344.00 $368.00 $320.00 $344.00 $368.00 78195-26 $49.00 $64.00 $67.00 $69.00 $64.00 $67.00 $69.00 78195-TC $152.00 $256.00 $278.00 $299.00 $256.00 $278.00 $299.00 78199 BR ------- ------- ------- ------- ------- ------- 78199-26 BR ------- ------- ------- ------- ------- ------- 78199-TC BR ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 277
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 78201 $112.00 $165.00 $178.00 $191.00 $165.00 $178.00 $191.00 78201-26 $22.00 $23.00 $24.00 $25.00 $23.00 $24.00 $25.00 78201-TC $88.00 $142.00 $155.00 $166.00 $142.00 $155.00 $166.00 78202 $135.00 $194.00 $209.00 $223.00 $194.00 $209.00 $223.00 78202-26 $26.00 $27.00 $28.00 $29.00 $27.00 $28.00 $29.00 78202-TC $108.00 $167.00 $181.00 $195.00 $167.00 $181.00 $195.00 78205 $259.00 $272.00 $295.00 $318.00 $272.00 $295.00 $318.00 78205-26 $36.00 $38.00 $39.00 $40.00 $38.00 $39.00 $40.00 78205-TC $220.00 $234.00 $256.00 $278.00 $234.00 $256.00 $278.00 78206 $265.00 $336.00 $360.00 $382.00 $336.00 $360.00 $382.00 78206-26 $46.00 $51.00 $53.00 $55.00 $51.00 $53.00 $55.00 78206-TC $214.00 $285.00 $307.00 $327.00 $285.00 $307.00 $327.00 78215 $135.00 $184.00 $198.00 $212.00 $184.00 $198.00 $212.00 78215-26 $24.00 $26.00 $27.00 $28.00 $26.00 $27.00 $28.00 78215-TC $109.00 $158.00 $171.00 $184.00 $158.00 $171.00 $184.00 78216 $160.00 $161.00 $175.00 $188.00 $161.00 $175.00 $188.00 78216-26 $29.00 $30.00 $31.00 $32.00 $30.00 $31.00 $32.00 78216-TC $130.00 $132.00 $144.00 $157.00 $132.00 $144.00 $157.00 78220 $165.00 $168.00 $182.00 $196.00 $168.00 $182.00 $196.00 78220-26 $24.00 $26.00 $26.00 $27.00 $26.00 $26.00 $27.00 78220-TC $139.00 $142.00 $155.00 $169.00 $142.00 $155.00 $169.00 78223 $181.00 $290.00 $312.00 $333.00 $290.00 $312.00 $333.00 78223-26 $43.00 $45.00 $46.00 $48.00 $45.00 $46.00 $48.00 78223-TC $137.00 $245.00 $265.00 $285.00 $245.00 $265.00 $285.00 78230 $106.00 $154.00 $166.00 $178.00 $154.00 $166.00 $178.00 78230-26 $23.00 $24.00 $25.00 $26.00 $24.00 $25.00 $26.00 78230-TC $82.00 $130.00 $141.00 $152.00 $130.00 $141.00 $152.00 78231 $146.00 $152.00 $164.00 $177.00 $152.00 $164.00 $177.00 78231-26 $27.00 $27.00 $28.00 $29.00 $27.00 $28.00 $29.00 78231-TC $118.00 $124.00 $136.00 $148.00 $124.00 $136.00 $148.00 78232 $157.00 $157.00 $170.00 $184.00 $157.00 $170.00 $184.00 78232-26 $23.00 $25.00 $26.00 $27.00 $25.00 $26.00 $27.00 78232-TC $132.00 $132.00 $144.00 $157.00 $132.00 $144.00 $157.00 78258 $146.00 $208.00 $223.00 $239.00 $208.00 $223.00 $239.00 78258-26 $38.00 $39.00 $41.00 $42.00 $39.00 $41.00 $42.00 78258-TC $108.00 $169.00 $183.00 $196.00 $169.00 $183.00 $196.00 78261 $190.00 $244.00 $264.00 $283.00 $244.00 $264.00 $283.00 78261-26 $36.00 $37.00 $38.00 $40.00 $37.00 $38.00 $40.00 78261-TC $152.00 $207.00 $225.00 $244.00 $207.00 $225.00 $244.00 78262 $195.00 $246.00 $265.00 $285.00 $246.00 $265.00 $285.00 78262-26 $35.00 $36.00 $37.00 $38.00 $36.00 $37.00 $38.00 78262-TC $159.00 $210.00 $228.00 $247.00 $210.00 $228.00 $247.00 78264 $195.00 $271.00 $293.00 $314.00 $271.00 $293.00 $314.00 78264-26 $40.00 $41.00 $43.00 $44.00 $41.00 $43.00 $44.00 78264-TC $154.00 $230.00 $250.00 $269.00 $230.00 $250.00 $269.00 78267 BR ------- ------- ------- ------- ------- ------- 78268 BR ------- ------- ------- ------- ------- ------- 78270 $68.00 $84.00 $91.00 $99.00 $84.00 $91.00 $99.00 78270-26 $10.00 $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 78270-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
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 78271 $72.00 $85.00 $92.00 $100.00 $85.00 $92.00 $100.00 78271-26 $10.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 78271-TC $61.00 $75.00 $81.00 $89.00 $75.00 $81.00 $89.00 78272 $100.00 $107.00 $116.00 $125.00 $107.00 $116.00 $125.00 78272-26 $14.00 $14.00 $14.00 $15.00 $14.00 $14.00 $15.00 78272-TC $87.00 $93.00 $102.00 $111.00 $93.00 $102.00 $111.00 78278 $234.00 $306.00 $330.00 $353.00 $306.00 $330.00 $353.00 78278-26 $50.00 $52.00 $54.00 $56.00 $52.00 $54.00 $56.00 78278-TC $182.00 $254.00 $276.00 $297.00 $254.00 $276.00 $297.00 78282 BR $267.00 $294.00 $324.00 $267.00 $294.00 $324.00 78282-26 $19.00 $20.00 $21.00 $22.00 $20.00 $21.00 $22.00 78282-TC BR $261.00 $287.00 $316.00 $261.00 $287.00 $316.00 78290 $149.00 $269.00 $289.00 $309.00 $269.00 $289.00 $309.00 78290-26 $35.00 $36.00 $38.00 $39.00 $36.00 $38.00 $39.00 78290-TC $113.00 $233.00 $252.00 $270.00 $233.00 $252.00 $270.00 78291 $161.00 $232.00 $249.00 $266.00 $232.00 $249.00 $266.00 78291-26 $45.00 $47.00 $48.00 $50.00 $47.00 $48.00 $50.00 78291-TC $114.00 $185.00 $201.00 $216.00 $185.00 $201.00 $216.00 78299 BR ------- ------- ------- ------- ------- ------- 78299-26 BR ------- ------- ------- ------- ------- ------- 78299-TC BR ------- ------- ------- ------- ------- ------- 78300 $125.00 $169.00 $183.00 $196.00 $169.00 $183.00 $196.00 78300-26 $32.00 $33.00 $34.00 $36.00 $33.00 $34.00 $36.00 78300-TC $93.00 $136.00 $148.00 $160.00 $136.00 $148.00 $160.00 78305 $181.00 $230.00 $248.00 $266.00 $230.00 $248.00 $266.00 78305-26 $42.00 $44.00 $46.00 $48.00 $44.00 $46.00 $48.00 78305-TC $137.00 $186.00 $202.00 $218.00 $186.00 $202.00 $218.00 78306 $205.00 $257.00 $277.00 $297.00 $257.00 $277.00 $297.00 78306-26 $44.00 $46.00 $48.00 $50.00 $46.00 $48.00 $50.00 78306-TC $159.00 $211.00 $229.00 $248.00 $211.00 $229.00 $248.00 78315 $233.00 $310.00 $333.00 $357.00 $310.00 $333.00 $357.00 78315-26 $52.00 $54.00 $56.00 $58.00 $54.00 $56.00 $58.00 78315-TC $179.00 $256.00 $278.00 $299.00 $256.00 $278.00 $299.00 78320 $276.00 $289.00 $312.00 $336.00 $289.00 $312.00 $336.00 78320-26 $53.00 $55.00 $57.00 $59.00 $55.00 $57.00 $59.00 78320-TC $220.00 $234.00 $255.00 $277.00 $234.00 $255.00 $277.00 78350 $40.00 $38.00 $41.00 $44.00 $38.00 $41.00 $44.00 78350-26 $11.00 $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 78350-TC $29.00 $27.00 $30.00 $33.00 $27.00 $30.00 $33.00 78351 $23.00 $15.00 $15.00 $16.00 $15.00 $15.00 $16.00 78399 BR ------- ------- ------- ------- ------- ------- 78399-26 BR ------- ------- ------- ------- ------- ------- 78399-TC BR ------- ------- ------- ------- ------- ------- 78414 BR ------- ------- ------- ------- ------- ------- 78414-26 $23.00 $25.00 $26.00 $27.00 $25.00 $26.00 $27.00 78414-TC BR ------- ------- ------- ------- ------- ------- 78428 $126.00 $192.00 $206.00 $220.00 $192.00 $206.00 $220.00 78428-26 $41.00 $43.00 $45.00 $47.00 $43.00 $45.00 $47.00 78428-TC $84.00 $149.00 $161.00 $174.00 $149.00 $161.00 $174.00 78445 $97.00 $154.00 $166.00 $177.00 $154.00 $166.00 $177.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 279
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 78445-26 $28.00 $26.00 $27.00 $28.00 $26.00 $27.00 $28.00 78445-TC $69.00 $128.00 $139.00 $150.00 $128.00 $139.00 $150.00 78456 $205.00 $265.00 $285.00 $306.00 $265.00 $285.00 $306.00 78456-26 $49.00 $53.00 $55.00 $57.00 $53.00 $55.00 $57.00 78456-TC $151.00 $211.00 $230.00 $249.00 $211.00 $230.00 $249.00 78457 $140.00 $188.00 $202.00 $216.00 $188.00 $202.00 $216.00 78457-26 $39.00 $40.00 $41.00 $43.00 $40.00 $41.00 $43.00 78457-TC $99.00 $148.00 $160.00 $173.00 $148.00 $160.00 $173.00 78458 $198.00 $223.00 $240.00 $258.00 $223.00 $240.00 $258.00 78458-26 $46.00 $48.00 $49.00 $51.00 $48.00 $49.00 $51.00 78458-TC $149.00 $175.00 $191.00 $207.00 $175.00 $191.00 $207.00 78459 BR $1,538.00 $1,694.00 $1,866.00 $1,538.00 $1,694.00 $1,866.00 78459-26 $100.00 $82.00 $84.00 $87.00 $82.00 $84.00 $87.00 78459-TC BR $1,512.00 $1,665.00 $1,834.00 $1,512.00 $1,665.00 $1,834.00 78460 $134.00 $186.00 $199.00 $213.00 $186.00 $199.00 $213.00 78460-26 $44.00 $46.00 $48.00 $50.00 $46.00 $48.00 $50.00 78460-TC $88.00 $140.00 $152.00 $163.00 $140.00 $152.00 $163.00 78461 $294.00 $245.00 $264.00 $284.00 $245.00 $264.00 $284.00 78461-26 $82.00 $66.00 $68.00 $70.00 $66.00 $68.00 $70.00 78461-TC $213.00 $179.00 $196.00 $213.00 $179.00 $196.00 $213.00 78464 $322.00 $327.00 $354.00 $382.00 $327.00 $354.00 $382.00 78464-26 $56.00 $60.00 $62.00 $64.00 $60.00 $62.00 $64.00 78464-TC $264.00 $267.00 $292.00 $318.00 $267.00 $292.00 $318.00 78465 $519.00 $562.00 $609.00 $657.00 $562.00 $609.00 $657.00 78465-26 $75.00 $81.00 $84.00 $87.00 $81.00 $84.00 $87.00 78465-TC $441.00 $481.00 $525.00 $570.00 $481.00 $525.00 $570.00 78466 $135.00 $182.00 $196.00 $210.00 $182.00 $196.00 $210.00 78466-26 $36.00 $38.00 $39.00 $40.00 $38.00 $39.00 $40.00 78466-TC $97.00 $145.00 $157.00 $169.00 $145.00 $157.00 $169.00 78468 $180.00 $235.00 $254.00 $272.00 $235.00 $254.00 $272.00 78468-26 $41.00 $44.00 $46.00 $47.00 $44.00 $46.00 $47.00 78468-TC $137.00 $191.00 $208.00 $224.00 $191.00 $208.00 $224.00 78469 $244.00 $286.00 $308.00 $332.00 $286.00 $308.00 $332.00 78469-26 $47.00 $51.00 $52.00 $54.00 $51.00 $52.00 $54.00 78469-TC $195.00 $235.00 $256.00 $278.00 $235.00 $256.00 $278.00 78472 $259.00 $290.00 $314.00 $338.00 $290.00 $314.00 $338.00 78472-26 $50.00 $53.00 $55.00 $57.00 $53.00 $55.00 $57.00 78472-TC $206.00 $237.00 $259.00 $281.00 $237.00 $259.00 $281.00 78473 $387.00 $409.00 $441.00 $475.00 $409.00 $441.00 $475.00 78473-26 $75.00 $81.00 $83.00 $87.00 $81.00 $83.00 $87.00 78473-TC $308.00 $328.00 $358.00 $389.00 $328.00 $358.00 $389.00 78478 $91.00 $77.00 $83.00 $90.00 $77.00 $83.00 $90.00 78478-26 $32.00 $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 78478-TC $58.00 $48.00 $53.00 $58.00 $48.00 $53.00 $58.00 78480 $91.00 $67.00 $73.00 $79.00 $67.00 $73.00 $79.00 78480-26 $32.00 $19.00 $20.00 $21.00 $19.00 $20.00 $21.00 78480-TC $58.00 $48.00 $53.00 $58.00 $48.00 $53.00 $58.00 78481 $248.00 $265.00 $286.00 $308.00 $265.00 $286.00 $308.00 78481-26 $51.00 $55.00 $57.00 $59.00 $55.00 $57.00 $59.00 78481-TC $195.00 $210.00 $229.00 $249.00 $210.00 $229.00 $249.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 280
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 78483 $373.00 $383.00 $413.00 $445.00 $383.00 $413.00 $445.00 78483-26 $77.00 $83.00 $86.00 $89.00 $83.00 $86.00 $89.00 78483-TC $294.00 $300.00 $327.00 $356.00 $300.00 $327.00 $356.00 78491 BR $1,540.00 $1,696.00 $1,868.00 $1,540.00 $1,696.00 $1,868.00 78491-26 $85.00 $83.00 $86.00 $89.00 $83.00 $86.00 $89.00 78491-TC BR $1,512.00 $1,665.00 $1,834.00 $1,512.00 $1,665.00 $1,834.00 78492 BR $1,548.00 $1,706.00 $1,879.00 $1,548.00 $1,706.00 $1,879.00 78492-26 $100.00 $106.00 $109.00 $113.00 $106.00 $109.00 $113.00 78492-TC BR $1,512.00 $1,665.00 $1,834.00 $1,512.00 $1,665.00 $1,834.00 78494 $324.00 $335.00 $361.00 $388.00 $335.00 $361.00 $388.00 78494-26 $59.00 $66.00 $68.00 $71.00 $66.00 $68.00 $71.00 78494-TC $262.00 $269.00 $293.00 $317.00 $269.00 $293.00 $317.00 78496 $92.00 $198.00 $216.00 $235.00 $198.00 $216.00 $235.00 78496-26 $24.00 $28.00 $28.00 $30.00 $28.00 $28.00 $30.00 78496-TC $66.00 $170.00 $187.00 $205.00 $170.00 $187.00 $205.00 78499 BR ------- ------- ------- ------- ------- ------- 78499-26 BR ------- ------- ------- ------- ------- ------- 78499-TC BR ------- ------- ------- ------- ------- ------- 78580 $167.00 $213.00 $230.00 $247.00 $213.00 $230.00 $247.00 78580-26 $38.00 $39.00 $41.00 $42.00 $39.00 $41.00 $42.00 78580-TC $128.00 $174.00 $189.00 $205.00 $174.00 $189.00 $205.00 78584 $171.00 $178.00 $192.00 $206.00 $178.00 $192.00 $206.00 78584-26 $50.00 $52.00 $54.00 $56.00 $52.00 $54.00 $56.00 78584-TC $119.00 $126.00 $138.00 $150.00 $126.00 $138.00 $150.00 78585 $171.00 $349.00 $377.00 $405.00 $349.00 $377.00 $405.00 78585-26 $36.00 $58.00 $60.00 $62.00 $58.00 $60.00 $62.00 78585-TC $133.00 $292.00 $317.00 $342.00 $292.00 $317.00 $342.00 78586 $118.00 $160.00 $173.00 $185.00 $160.00 $173.00 $185.00 78586-26 $20.00 $21.00 $22.00 $23.00 $21.00 $22.00 $23.00 78586-TC $96.00 $139.00 $151.00 $163.00 $139.00 $151.00 $163.00 78587 $131.00 $193.00 $208.00 $223.00 $193.00 $208.00 $223.00 78587-26 $24.00 $26.00 $27.00 $28.00 $26.00 $27.00 $28.00 78587-TC $105.00 $167.00 $181.00 $195.00 $167.00 $181.00 $195.00 78588 $239.00 $294.00 $316.00 $337.00 $294.00 $316.00 $337.00 78588-26 $53.00 $58.00 $60.00 $62.00 $58.00 $60.00 $62.00 78588-TC $192.00 $237.00 $256.00 $275.00 $237.00 $256.00 $275.00 78591 $128.00 $165.00 $178.00 $192.00 $165.00 $178.00 $192.00 78591-26 $20.00 $21.00 $22.00 $23.00 $21.00 $22.00 $23.00 78591-TC $106.00 $144.00 $156.00 $168.00 $144.00 $156.00 $168.00 78593 $151.00 $196.00 $212.00 $227.00 $196.00 $212.00 $227.00 78593-26 $24.00 $26.00 $26.00 $27.00 $26.00 $26.00 $27.00 78593-TC $126.00 $170.00 $185.00 $200.00 $170.00 $185.00 $200.00 78594 $214.00 $242.00 $262.00 $282.00 $242.00 $262.00 $282.00 78594-26 $27.00 $28.00 $29.00 $30.00 $28.00 $29.00 $30.00 78594-TC $186.00 $214.00 $233.00 $252.00 $214.00 $233.00 $252.00 78596 $332.00 $391.00 $422.00 $453.00 $391.00 $422.00 $453.00 78596-26 $65.00 $66.00 $68.00 $71.00 $66.00 $68.00 $71.00 78596-TC $264.00 $325.00 $354.00 $383.00 $325.00 $354.00 $383.00 78599 BR ------- ------- ------- ------- ------- ------- 78599-26 BR ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 281
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 78599-TC BR ------- ------- ------- ------- ------- ------- 78600 $131.00 $172.00 $186.00 $199.00 $172.00 $186.00 $199.00 78600-26 $22.00 $23.00 $24.00 $25.00 $23.00 $24.00 $25.00 78600-TC $108.00 $148.00 $161.00 $174.00 $148.00 $161.00 $174.00 78601 $154.00 $207.00 $223.00 $240.00 $207.00 $223.00 $240.00 78601-26 $26.00 $27.00 $28.00 $29.00 $27.00 $28.00 $29.00 78601-TC $126.00 $180.00 $196.00 $211.00 $180.00 $196.00 $211.00 78605 $155.00 $198.00 $214.00 $230.00 $198.00 $214.00 $230.00 78605-26 $27.00 $28.00 $29.00 $30.00 $28.00 $29.00 $30.00 78605-TC $126.00 $169.00 $184.00 $199.00 $169.00 $184.00 $199.00 78606 $221.00 $286.00 $309.00 $331.00 $286.00 $309.00 $331.00 78606-26 $45.00 $34.00 $35.00 $36.00 $34.00 $35.00 $36.00 78606-TC $177.00 $253.00 $274.00 $294.00 $253.00 $274.00 $294.00 78607 $311.00 $377.00 $407.00 $437.00 $377.00 $407.00 $437.00 78607-26 $64.00 $65.00 $67.00 $70.00 $65.00 $67.00 $70.00 78607-TC $245.00 $312.00 $340.00 $368.00 $312.00 $340.00 $368.00 78608 BR $1,164.00 $1,283.00 $1,414.00 $1,164.00 $1,283.00 $1,414.00 78608-26 ------- $79.00 $81.00 $84.00 $79.00 $81.00 $84.00 78608-TC ------- $1,141.00 $1,257.00 $1,385.00 $1,141.00 $1,257.00 $1,385.00 78609 BR $78.00 $81.00 $84.00 $78.00 $81.00 $84.00 78609-26 ------- $78.00 $81.00 $84.00 $78.00 $81.00 $84.00 78609-TC ------- BR BR BR BR BR BR 78610 $74.00 $184.00 $198.00 $211.00 $184.00 $198.00 $211.00 78610-26 $15.00 $17.00 $17.00 $18.00 $17.00 $17.00 $18.00 78610-TC $59.00 $168.00 $181.00 $194.00 $168.00 $181.00 $194.00 78630 $223.00 $317.00 $343.00 $368.00 $317.00 $343.00 $368.00 78630-26 $35.00 $36.00 $37.00 $39.00 $36.00 $37.00 $39.00 78630-TC $188.00 $281.00 $305.00 $329.00 $281.00 $305.00 $329.00 78635 $129.00 $260.00 $279.00 $298.00 $260.00 $279.00 $298.00 78635-26 $32.00 $33.00 $34.00 $35.00 $33.00 $34.00 $35.00 78635-TC $95.00 $227.00 $246.00 $263.00 $227.00 $246.00 $263.00 78645 $158.00 $245.00 $264.00 $282.00 $245.00 $264.00 $282.00 78645-26 $29.00 $30.00 $31.00 $32.00 $30.00 $31.00 $32.00 78645-TC $128.00 $216.00 $234.00 $251.00 $216.00 $234.00 $251.00 78647 $268.00 $345.00 $372.00 $400.00 $345.00 $372.00 $400.00 78647-26 $46.00 $47.00 $49.00 $51.00 $47.00 $49.00 $51.00 78647-TC $220.00 $297.00 $323.00 $349.00 $297.00 $323.00 $349.00 78650 $206.00 $303.00 $327.00 $351.00 $303.00 $327.00 $351.00 78650-26 $31.00 $33.00 $34.00 $35.00 $33.00 $34.00 $35.00 78650-TC $173.00 $270.00 $293.00 $316.00 $270.00 $293.00 $316.00 78660 $107.00 $157.00 $169.00 $181.00 $157.00 $169.00 $181.00 78660-26 $27.00 $28.00 $29.00 $30.00 $28.00 $29.00 $30.00 78660-TC $79.00 $129.00 $140.00 $151.00 $129.00 $140.00 $151.00 78699 BR ------- ------- ------- ------- ------- ------- 78699-26 BR ------- ------- ------- ------- ------- ------- 78699-TC BR ------- ------- ------- ------- ------- ------- 78700 $137.00 $177.00 $191.00 $206.00 $177.00 $191.00 $206.00 78700-26 $22.00 $24.00 $25.00 $26.00 $24.00 $25.00 $26.00 78700-TC $113.00 $153.00 $166.00 $180.00 $153.00 $166.00 $180.00 78701 $158.00 $209.00 $226.00 $243.00 $209.00 $226.00 $243.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 282
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 78701-26 $24.00 $26.00 $27.00 $28.00 $26.00 $27.00 $28.00 78701-TC $133.00 $184.00 $199.00 $215.00 $184.00 $199.00 $215.00 78707 $217.00 $254.00 $274.00 $294.00 $254.00 $274.00 $294.00 78707-26 $49.00 $51.00 $53.00 $55.00 $51.00 $53.00 $55.00 78707-TC $166.00 $203.00 $221.00 $239.00 $203.00 $221.00 $239.00 78708 $231.00 $226.00 $244.00 $262.00 $226.00 $244.00 $262.00 78708-26 $61.00 $64.00 $67.00 $69.00 $64.00 $67.00 $69.00 78708-TC $166.00 $162.00 $177.00 $193.00 $162.00 $177.00 $193.00 78709 $241.00 $341.00 $366.00 $391.00 $341.00 $366.00 $391.00 78709-26 $68.00 $75.00 $77.00 $80.00 $75.00 $77.00 $80.00 78709-TC $166.00 $267.00 $289.00 $311.00 $267.00 $289.00 $311.00 78710 $256.00 $270.00 $292.00 $316.00 $270.00 $292.00 $316.00 78710-26 $34.00 $35.00 $36.00 $37.00 $35.00 $36.00 $37.00 78710-TC $220.00 $235.00 $256.00 $279.00 $235.00 $256.00 $279.00 78725 $87.00 $106.00 $115.00 $123.00 $106.00 $115.00 $123.00 78725-26 $19.00 $20.00 $21.00 $22.00 $20.00 $21.00 $22.00 78725-TC $66.00 $86.00 $94.00 $102.00 $86.00 $94.00 $102.00 78730 $73.00 $82.00 $89.00 $96.00 $82.00 $89.00 $96.00 78730-26 $18.00 $10.00 $11.00 $12.00 $10.00 $11.00 $12.00 78730-TC $55.00 $71.00 $78.00 $84.00 $71.00 $78.00 $84.00 78740 $109.00 $187.00 $201.00 $215.00 $187.00 $201.00 $215.00 78740-26 $29.00 $30.00 $31.00 $33.00 $30.00 $31.00 $33.00 78740-TC $79.00 $156.00 $169.00 $182.00 $156.00 $169.00 $182.00 78761 $157.00 $205.00 $221.00 $237.00 $205.00 $221.00 $237.00 78761-26 $36.00 $38.00 $39.00 $40.00 $38.00 $39.00 $40.00 78761-TC $119.00 $168.00 $182.00 $197.00 $168.00 $182.00 $197.00 78799 BR ------- ------- ------- ------- ------- ------- 78799-26 BR ------- ------- ------- ------- ------- ------- 78799-TC BR ------- ------- ------- ------- ------- ------- 78800 $162.00 $195.00 $210.00 $226.00 $195.00 $210.00 $226.00 78800-26 $34.00 $35.00 $37.00 $39.00 $35.00 $37.00 $39.00 78800-TC $126.00 $159.00 $173.00 $188.00 $159.00 $173.00 $188.00 78801 $199.00 $253.00 $273.00 $294.00 $253.00 $273.00 $294.00 78801-26 $40.00 $43.00 $45.00 $47.00 $43.00 $45.00 $47.00 78801-TC $158.00 $210.00 $228.00 $247.00 $210.00 $228.00 $247.00 78802 $252.00 $327.00 $353.00 $380.00 $327.00 $353.00 $380.00 78802-26 $44.00 $46.00 $47.00 $49.00 $46.00 $47.00 $49.00 78802-TC $207.00 $281.00 $306.00 $331.00 $281.00 $306.00 $331.00 78803 $303.00 $369.00 $399.00 $429.00 $369.00 $399.00 $429.00 78803-26 $56.00 $58.00 $60.00 $63.00 $58.00 $60.00 $63.00 78803-TC $245.00 $311.00 $338.00 $366.00 $311.00 $338.00 $366.00 78804 ------- $576.00 $620.00 $661.00 $576.00 $620.00 $661.00 78804-26 ------- $56.00 $58.00 $60.00 $56.00 $58.00 $60.00 78804-TC ------- $520.00 $562.00 $601.00 $520.00 $562.00 $601.00 78805 $166.00 $195.00 $210.00 $225.00 $195.00 $210.00 $225.00 78805-26 $38.00 $39.00 $40.00 $41.00 $39.00 $40.00 $41.00 78805-TC $126.00 $156.00 $170.00 $184.00 $156.00 $170.00 $184.00 78806 $286.00 $352.00 $381.00 $411.00 $352.00 $381.00 $411.00 78806-26 $44.00 $46.00 $47.00 $49.00 $46.00 $47.00 $49.00 78806-TC $241.00 $306.00 $334.00 $361.00 $306.00 $334.00 $361.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 283
Radiology CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 78807 $303.00 $368.00 $397.00 $427.00 $368.00 $397.00 $427.00 78807-26 $57.00 $58.00 $59.00 $62.00 $58.00 $59.00 $62.00 78807-TC $245.00 $310.00 $338.00 $366.00 $310.00 $338.00 $366.00 78811 ------- $1,169.00 $1,288.00 $1,421.00 $1,169.00 $1,288.00 $1,421.00 78811-26 ------- $85.00 $88.00 $93.00 $85.00 $88.00 $93.00 78811-TC ------- $1,141.00 $1,257.00 $1,385.00 $1,141.00 $1,257.00 $1,385.00 78812 ------- $1,174.00 $1,294.00 $1,426.00 $1,174.00 $1,294.00 $1,426.00 78812-26 ------- $104.00 $108.00 $113.00 $104.00 $108.00 $113.00 78812-TC ------- $1,141.00 $1,257.00 $1,385.00 $1,141.00 $1,257.00 $1,385.00 78813 ------- $1,175.00 $1,295.00 $1,428.00 $1,175.00 $1,295.00 $1,428.00 78813-26 ------- $108.00 $112.00 $117.00 $108.00 $112.00 $117.00 78813-TC ------- $1,141.00 $1,257.00 $1,385.00 $1,141.00 $1,257.00 $1,385.00 78814 ------- $1,177.00 $1,298.00 $1,430.00 $1,177.00 $1,298.00 $1,430.00 78814-26 ------- $118.00 $122.00 $127.00 $118.00 $122.00 $127.00 78814-TC ------- $1,141.00 $1,257.00 $1,385.00 $1,141.00 $1,257.00 $1,385.00 78815 ------- $1,181.00 $1,301.00 $1,434.00 $1,181.00 $1,301.00 $1,434.00 78815-26 ------- $130.00 $134.00 $140.00 $130.00 $134.00 $140.00 78815-TC ------- $1,141.00 $1,257.00 $1,385.00 $1,141.00 $1,257.00 $1,385.00 78816 ------- $1,182.00 $1,302.00 $1,435.00 $1,182.00 $1,302.00 $1,435.00 78816-26 ------- $133.00 $137.00 $143.00 $133.00 $137.00 $143.00 78816-TC ------- $1,141.00 $1,257.00 $1,385.00 $1,141.00 $1,257.00 $1,385.00 78999 BR ------- ------- ------- ------- ------- ------- 78999-26 BR ------- ------- ------- ------- ------- ------- 78999-TC BR ------- ------- ------- ------- ------- ------- 79005 ------- $180.00 $192.00 $204.00 $180.00 $192.00 $204.00 79005-26 ------- $95.00 $98.00 $102.00 $95.00 $98.00 $102.00 79005-TC ------- $85.00 $94.00 $102.00 $85.00 $94.00 $102.00 79101 ------- $193.00 $205.00 $219.00 $193.00 $205.00 $219.00 79101-26 ------- $105.00 $109.00 $113.00 $105.00 $109.00 $113.00 79101-TC ------- $88.00 $97.00 $106.00 $88.00 $97.00 $106.00 79200 $203.00 $196.00 $209.00 $222.00 $196.00 $209.00 $222.00 79200-26 $102.00 $105.00 $109.00 $113.00 $105.00 $109.00 $113.00 79200-TC $97.00 $91.00 $100.00 $109.00 $91.00 $100.00 $109.00 79300 BR ------- ------- ------- ------- ------- ------- 79300-26 $83.00 $89.00 $93.00 $98.00 $89.00 $93.00 $98.00 79300-TC BR ------- ------- ------- ------- ------- ------- 79403 ------- $257.00 $273.00 $289.00 $257.00 $273.00 $289.00 79403-26 ------- $121.00 $126.00 $131.00 $121.00 $126.00 $131.00 79403-TC ------- $135.00 $147.00 $159.00 $135.00 $147.00 $159.00 79440 $204.00 $189.00 $200.00 $213.00 $189.00 $200.00 $213.00 79440-26 $104.00 $106.00 $109.00 $113.00 $106.00 $109.00 $113.00 79440-TC $97.00 $83.00 $91.00 $100.00 $83.00 $91.00 $100.00 79445 ------- BR BR BR BR BR BR 79445-26 ------- $128.00 $133.00 $139.00 $128.00 $133.00 $139.00 79445-TC ------- BR BR BR BR BR BR 79999 BR ------- ------- ------- ------- ------- ------- 79999-26 BR ------- ------- ------- ------- ------- ------- 79999-TC BR ------- ------- ------- ------- ------- ------- G0130 ------- $40.00 $43.00 $47.00 $40.00 $43.00 $47.00 G0130-26 ------- $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 284
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 G0202 ------- $142.00 $152.00 $161.00 $142.00 $152.00 $161.00 G0202-26 ------- $37.00 $38.00 $40.00 $37.00 $38.00 $40.00 G0202-TC ------- $105.00 $113.00 $122.00 $105.00 $113.00 $122.00 G0204 ------- $160.00 $171.00 $182.00 $160.00 $171.00 $182.00 G0204-26 ------- $46.00 $48.00 $50.00 $46.00 $48.00 $50.00 G0204-TC ------- $114.00 $124.00 $132.00 $114.00 $124.00 $132.00 G0206 ------- $128.00 $137.00 $145.00 $128.00 $137.00 $145.00 G0206-26 ------- $37.00 $38.00 $40.00 $37.00 $38.00 $40.00 G0206-TC ------- $91.00 $99.00 $106.00 $91.00 $99.00 $106.00 G0275 ------- $15.00 $15.00 $16.00 $15.00 $15.00 $16.00 G0278 ------- $15.00 $15.00 $16.00 $15.00 $15.00 $16.00 G0288 ------- $240.00 $260.00 $279.00 $240.00 $260.00 $279.00 G0365 ------- $174.00 $189.00 $205.00 $174.00 $189.00 $205.00 G0365-26 ------- $14.00 $14.00 $15.00 $14.00 $14.00 $15.00 G0365-TC ------- $161.00 $175.00 $190.00 $161.00 $175.00 $190.00 G0389 ------- $123.00 $132.00 $141.00 $123.00 $132.00 $141.00 G0389-26 ------- $31.00 $32.00 $34.00 $31.00 $32.00 $34.00 G0389-TC ------- $92.00 $100.00 $107.00 $92.00 $100.00 $107.00 Q0092 ------- $16.00 $18.00 $19.00 $16.00 $18.00 $19.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 285
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 80048 $23.00 ------- ------- ------- ------- ------- ------- 80048-26 $4.00 ------- ------- ------- ------- ------- ------- 80048-TC $19.00 ------- ------- ------- ------- ------- ------- 80050 $45.00 ------- ------- ------- ------- ------- ------- 80050-26 $18.00 ------- ------- ------- ------- ------- ------- 80050-TC $26.00 ------- ------- ------- ------- ------- ------- 80051 $16.00 ------- ------- ------- ------- ------- ------- 80051-26 $6.00 ------- ------- ------- ------- ------- ------- 80051-TC $10.00 ------- ------- ------- ------- ------- ------- 80053 $29.00 ------- ------- ------- ------- ------- ------- 80053-26 $8.00 ------- ------- ------- ------- ------- ------- 80053-TC $21.00 ------- ------- ------- ------- ------- ------- 80055 $67.00 ------- ------- ------- ------- ------- ------- 80055-26 $21.00 ------- ------- ------- ------- ------- ------- 80055-TC $43.00 ------- ------- ------- ------- ------- ------- 80061 $31.00 ------- ------- ------- ------- ------- ------- 80061-26 $11.00 ------- ------- ------- ------- ------- ------- 80061-TC $19.00 ------- ------- ------- ------- ------- ------- 80069 $26.00 ------- ------- ------- ------- ------- ------- 80069-26 $6.00 ------- ------- ------- ------- ------- ------- 80069-TC $20.00 ------- ------- ------- ------- ------- ------- 80074 $107.00 ------- ------- ------- ------- ------- ------- 80074-26 $43.00 ------- ------- ------- ------- ------- ------- 80074-TC $64.00 ------- ------- ------- ------- ------- ------- 80076 $18.00 ------- ------- ------- ------- ------- ------- 80076-26 $7.00 ------- ------- ------- ------- ------- ------- 80076-TC $11.00 ------- ------- ------- ------- ------- ------- 80100 $38.00 ------- ------- ------- ------- ------- ------- 80100-26 $11.00 ------- ------- ------- ------- ------- ------- 80100-TC $26.00 ------- ------- ------- ------- ------- ------- 80101 $13.00 ------- ------- ------- ------- ------- ------- 80101-26 $3.00 ------- ------- ------- ------- ------- ------- 80101-TC $9.00 ------- ------- ------- ------- ------- ------- 80102 $23.00 ------- ------- ------- ------- ------- ------- 80102-26 $6.00 ------- ------- ------- ------- ------- ------- 80102-TC $16.00 ------- ------- ------- ------- ------- ------- 80103 $12.00 ------- ------- ------- ------- ------- ------- 80103-26 $4.00 ------- ------- ------- ------- ------- ------- 80103-TC $7.00 ------- ------- ------- ------- ------- ------- 80150 $40.00 ------- ------- ------- ------- ------- ------- 80150-26 $13.00 ------- ------- ------- ------- ------- ------- 80150-TC $26.00 ------- ------- ------- ------- ------- ------- 80152 $43.00 ------- ------- ------- ------- ------- ------- 80152-26 $14.00 ------- ------- ------- ------- ------- ------- 80152-TC $29.00 ------- ------- ------- ------- ------- ------- 80154 $49.00 ------- ------- ------- ------- ------- ------- 80154-26 $15.00 ------- ------- ------- ------- ------- ------- 80154-TC $34.00 ------- ------- ------- ------- ------- ------- 80156 $35.00 ------- ------- ------- ------- ------- ------- 80156-26 $11.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 286
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 80156-TC $23.00 ------- ------- ------- ------- ------- ------- 80157 $22.00 ------- ------- ------- ------- ------- ------- 80157-26 $8.00 ------- ------- ------- ------- ------- ------- 80157-TC $14.00 ------- ------- ------- ------- ------- ------- 80158 $35.00 ------- ------- ------- ------- ------- ------- 80158-26 $12.00 ------- ------- ------- ------- ------- ------- 80158-TC $22.00 ------- ------- ------- ------- ------- ------- 80160 $35.00 ------- ------- ------- ------- ------- ------- 80160-26 $12.00 ------- ------- ------- ------- ------- ------- 80160-TC $22.00 ------- ------- ------- ------- ------- ------- 80162 $13.00 ------- ------- ------- ------- ------- ------- 80162-26 $3.00 ------- ------- ------- ------- ------- ------- 80162-TC $9.00 ------- ------- ------- ------- ------- ------- 80164 $43.00 ------- ------- ------- ------- ------- ------- 80164-26 $14.00 ------- ------- ------- ------- ------- ------- 80164-TC $29.00 ------- ------- ------- ------- ------- ------- 80166 $35.00 ------- ------- ------- ------- ------- ------- 80166-26 $10.00 ------- ------- ------- ------- ------- ------- 80166-TC $24.00 ------- ------- ------- ------- ------- ------- 80168 $43.00 ------- ------- ------- ------- ------- ------- 80168-26 $17.00 ------- ------- ------- ------- ------- ------- 80168-TC $25.00 ------- ------- ------- ------- ------- ------- 80170 $18.00 ------- ------- ------- ------- ------- ------- 80170-26 $6.00 ------- ------- ------- ------- ------- ------- 80170-TC $11.00 ------- ------- ------- ------- ------- ------- 80172 $44.00 ------- ------- ------- ------- ------- ------- 80172-26 $13.00 ------- ------- ------- ------- ------- ------- 80172-TC $32.00 ------- ------- ------- ------- ------- ------- 80173 $33.00 ------- ------- ------- ------- ------- ------- 80173-26 $11.00 ------- ------- ------- ------- ------- ------- 80173-TC $22.00 ------- ------- ------- ------- ------- ------- 80174 $41.00 ------- ------- ------- ------- ------- ------- 80174-26 $12.00 ------- ------- ------- ------- ------- ------- 80174-TC $29.00 ------- ------- ------- ------- ------- ------- 80176 $35.00 ------- ------- ------- ------- ------- ------- 80176-26 $11.00 ------- ------- ------- ------- ------- ------- 80176-TC $23.00 ------- ------- ------- ------- ------- ------- 80178 $17.00 ------- ------- ------- ------- ------- ------- 80178-26 $6.00 ------- ------- ------- ------- ------- ------- 80178-TC $11.00 ------- ------- ------- ------- ------- ------- 80182 $43.00 ------- ------- ------- ------- ------- ------- 80182-26 $14.00 ------- ------- ------- ------- ------- ------- 80182-TC $29.00 ------- ------- ------- ------- ------- ------- 80184 $34.00 ------- ------- ------- ------- ------- ------- 80184-26 $10.00 ------- ------- ------- ------- ------- ------- 80184-TC $23.00 ------- ------- ------- ------- ------- ------- 80185 $36.00 ------- ------- ------- ------- ------- ------- 80185-26 $10.00 ------- ------- ------- ------- ------- ------- 80185-TC $25.00 ------- ------- ------- ------- ------- ------- 80186 $38.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 287
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 80186-26 $11.00 ------- ------- ------- ------- ------- ------- 80186-TC $26.00 ------- ------- ------- ------- ------- ------- 80188 $35.00 ------- ------- ------- ------- ------- ------- 80188-26 $11.00 ------- ------- ------- ------- ------- ------- 80188-TC $23.00 ------- ------- ------- ------- ------- ------- 80190 $41.00 ------- ------- ------- ------- ------- ------- 80190-26 $13.00 ------- ------- ------- ------- ------- ------- 80190-TC $28.00 ------- ------- ------- ------- ------- ------- 80192 $44.00 ------- ------- ------- ------- ------- ------- 80192-26 $17.00 ------- ------- ------- ------- ------- ------- 80192-TC $26.00 ------- ------- ------- ------- ------- ------- 80194 $33.00 ------- ------- ------- ------- ------- ------- 80194-26 $10.00 ------- ------- ------- ------- ------- ------- 80194-TC $22.00 ------- ------- ------- ------- ------- ------- 80196 $13.00 ------- ------- ------- ------- ------- ------- 80196-26 $3.00 ------- ------- ------- ------- ------- ------- 80196-TC $9.00 ------- ------- ------- ------- ------- ------- 80197 $34.00 ------- ------- ------- ------- ------- ------- 80197-26 $11.00 ------- ------- ------- ------- ------- ------- 80197-TC $22.00 ------- ------- ------- ------- ------- ------- 80198 $20.00 ------- ------- ------- ------- ------- ------- 80198-26 $5.00 ------- ------- ------- ------- ------- ------- 80198-TC $15.00 ------- ------- ------- ------- ------- ------- 80200 $24.00 ------- ------- ------- ------- ------- ------- 80200-26 $7.00 ------- ------- ------- ------- ------- ------- 80200-TC $16.00 ------- ------- ------- ------- ------- ------- 80201 $33.00 ------- ------- ------- ------- ------- ------- 80201-26 $11.00 ------- ------- ------- ------- ------- ------- 80201-TC $21.00 ------- ------- ------- ------- ------- ------- 80202 $42.00 ------- ------- ------- ------- ------- ------- 80202-26 $14.00 ------- ------- ------- ------- ------- ------- 80202-TC $28.00 ------- ------- ------- ------- ------- ------- 80299 BR ------- ------- ------- ------- ------- ------- 80299-26 BR ------- ------- ------- ------- ------- ------- 80299-TC BR ------- ------- ------- ------- ------- ------- 80400 $54.00 ------- ------- ------- ------- ------- ------- 80400-26 $18.00 ------- ------- ------- ------- ------- ------- 80400-TC $36.00 ------- ------- ------- ------- ------- ------- 80402 $138.00 ------- ------- ------- ------- ------- ------- 80402-26 $42.00 ------- ------- ------- ------- ------- ------- 80402-TC $95.00 ------- ------- ------- ------- ------- ------- 80406 $138.00 ------- ------- ------- ------- ------- ------- 80406-26 $42.00 ------- ------- ------- ------- ------- ------- 80406-TC $95.00 ------- ------- ------- ------- ------- ------- 80408 $213.00 ------- ------- ------- ------- ------- ------- 80408-26 $77.00 ------- ------- ------- ------- ------- ------- 80408-TC $136.00 ------- ------- ------- ------- ------- ------- 80410 $166.00 ------- ------- ------- ------- ------- ------- 80410-26 $54.00 ------- ------- ------- ------- ------- ------- 80410-TC $110.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 288
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 80412 $533.00 ------- ------- ------- ------- ------- ------- 80412-26 $176.00 ------- ------- ------- ------- ------- ------- 80412-TC $355.00 ------- ------- ------- ------- ------- ------- 80414 $88.00 ------- ------- ------- ------- ------- ------- 80414-26 $26.00 ------- ------- ------- ------- ------- ------- 80414-TC $59.00 ------- ------- ------- ------- ------- ------- 80415 $93.00 ------- ------- ------- ------- ------- ------- 80415-26 $28.00 ------- ------- ------- ------- ------- ------- 80415-TC $64.00 ------- ------- ------- ------- ------- ------- 80416 $256.00 ------- ------- ------- ------- ------- ------- 80416-26 $88.00 ------- ------- ------- ------- ------- ------- 80416-TC $166.00 ------- ------- ------- ------- ------- ------- 80417 $256.00 ------- ------- ------- ------- ------- ------- 80417-26 $88.00 ------- ------- ------- ------- ------- ------- 80417-TC $166.00 ------- ------- ------- ------- ------- ------- 80418 $934.00 ------- ------- ------- ------- ------- ------- 80418-26 $266.00 ------- ------- ------- ------- ------- ------- 80418-TC $666.00 ------- ------- ------- ------- ------- ------- 80420 $107.00 ------- ------- ------- ------- ------- ------- 80420-26 $33.00 ------- ------- ------- ------- ------- ------- 80420-TC $74.00 ------- ------- ------- ------- ------- ------- 80422 $62.00 ------- ------- ------- ------- ------- ------- 80422-26 $18.00 ------- ------- ------- ------- ------- ------- 80422-TC $43.00 ------- ------- ------- ------- ------- ------- 80424 $94.00 ------- ------- ------- ------- ------- ------- 80424-26 $26.00 ------- ------- ------- ------- ------- ------- 80424-TC $67.00 ------- ------- ------- ------- ------- ------- 80426 $232.00 ------- ------- ------- ------- ------- ------- 80426-26 $54.00 ------- ------- ------- ------- ------- ------- 80426-TC $176.00 ------- ------- ------- ------- ------- ------- 80428 $93.00 ------- ------- ------- ------- ------- ------- 80428-26 $19.00 ------- ------- ------- ------- ------- ------- 80428-TC $73.00 ------- ------- ------- ------- ------- ------- 80430 $99.00 ------- ------- ------- ------- ------- ------- 80430-26 $24.00 ------- ------- ------- ------- ------- ------- 80430-TC $74.00 ------- ------- ------- ------- ------- ------- 80432 $243.00 ------- ------- ------- ------- ------- ------- 80432-26 $56.00 ------- ------- ------- ------- ------- ------- 80432-TC $186.00 ------- ------- ------- ------- ------- ------- 80434 $161.00 ------- ------- ------- ------- ------- ------- 80434-26 $49.00 ------- ------- ------- ------- ------- ------- 80434-TC $110.00 ------- ------- ------- ------- ------- ------- 80435 $166.00 ------- ------- ------- ------- ------- ------- 80435-26 $49.00 ------- ------- ------- ------- ------- ------- 80435-TC $115.00 ------- ------- ------- ------- ------- ------- 80436 $119.00 ------- ------- ------- ------- ------- ------- 80436-26 $35.00 ------- ------- ------- ------- ------- ------- 80436-TC $85.00 ------- ------- ------- ------- ------- ------- 80438 $82.00 ------- ------- ------- ------- ------- ------- 80438-26 $24.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 289
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 80438-TC $56.00 ------- ------- ------- ------- ------- ------- 80439 $176.00 ------- ------- ------- ------- ------- ------- 80439-26 $33.00 ------- ------- ------- ------- ------- ------- 80439-TC $144.00 ------- ------- ------- ------- ------- ------- 80440 $188.00 ------- ------- ------- ------- ------- ------- 80440-26 $36.00 ------- ------- ------- ------- ------- ------- 80440-TC $151.00 ------- ------- ------- ------- ------- ------- 80500 $34.00 $22.00 $23.00 $24.00 $20.00 $21.00 $21.00 80500-26 $34.00 ------- ------- ------- ------- ------- ------- 80500-TC BR ------- ------- ------- ------- ------- ------- 80502 $72.00 $68.00 $70.00 $73.00 $67.00 $69.00 $71.00 80502-26 $72.00 ------- ------- ------- ------- ------- ------- 80502-TC BR ------- ------- ------- ------- ------- ------- 81000 $7.00 ------- ------- ------- ------- ------- ------- 81000-26 $3.00 ------- ------- ------- ------- ------- ------- 81000-TC $4.00 ------- ------- ------- ------- ------- ------- 81001 $7.00 ------- ------- ------- ------- ------- ------- 81001-26 $3.00 ------- ------- ------- ------- ------- ------- 81001-TC $4.00 ------- ------- ------- ------- ------- ------- 81002 $5.00 ------- ------- ------- ------- ------- ------- 81002-26 $3.00 ------- ------- ------- ------- ------- ------- 81002-TC $3.00 ------- ------- ------- ------- ------- ------- 81003 $5.00 ------- ------- ------- ------- ------- ------- 81003-26 $2.00 ------- ------- ------- ------- ------- ------- 81003-TC $3.00 ------- ------- ------- ------- ------- ------- 81005 $3.00 ------- ------- ------- ------- ------- ------- 81005-26 $1.00 ------- ------- ------- ------- ------- ------- 81005-TC $3.00 ------- ------- ------- ------- ------- ------- 81007 $5.00 ------- ------- ------- ------- ------- ------- 81007-26 $2.00 ------- ------- ------- ------- ------- ------- 81007-TC $4.00 ------- ------- ------- ------- ------- ------- 81015 $5.00 ------- ------- ------- ------- ------- ------- 81015-26 $3.00 ------- ------- ------- ------- ------- ------- 81015-TC $3.00 ------- ------- ------- ------- ------- ------- 81020 $8.00 ------- ------- ------- ------- ------- ------- 81020-26 $3.00 ------- ------- ------- ------- ------- ------- 81020-TC $5.00 ------- ------- ------- ------- ------- ------- 81025 $7.00 ------- ------- ------- ------- ------- ------- 81025-26 $4.00 ------- ------- ------- ------- ------- ------- 81025-TC $4.00 ------- ------- ------- ------- ------- ------- 81050 $33.00 ------- ------- ------- ------- ------- ------- 81050-26 $11.00 ------- ------- ------- ------- ------- ------- 81050-TC $21.00 ------- ------- ------- ------- ------- ------- 81099 BR ------- ------- ------- ------- ------- ------- 81099-26 BR ------- ------- ------- ------- ------- ------- 81099-TC BR ------- ------- ------- ------- ------- ------- 82000 $24.00 ------- ------- ------- ------- ------- ------- 82000-26 $7.00 ------- ------- ------- ------- ------- ------- 82000-TC $17.00 ------- ------- ------- ------- ------- ------- 82003 $36.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 290
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 82003-26 $10.00 ------- ------- ------- ------- ------- ------- 82003-TC $25.00 ------- ------- ------- ------- ------- ------- 82009 $10.00 ------- ------- ------- ------- ------- ------- 82009-26 $3.00 ------- ------- ------- ------- ------- ------- 82009-TC $6.00 ------- ------- ------- ------- ------- ------- 82010 $22.00 ------- ------- ------- ------- ------- ------- 82010-26 $7.00 ------- ------- ------- ------- ------- ------- 82010-TC $15.00 ------- ------- ------- ------- ------- ------- 82013 $24.00 ------- ------- ------- ------- ------- ------- 82013-26 $7.00 ------- ------- ------- ------- ------- ------- 82013-TC $17.00 ------- ------- ------- ------- ------- ------- 82024 $26.00 ------- ------- ------- ------- ------- ------- 82024-26 $7.00 ------- ------- ------- ------- ------- ------- 82024-TC $18.00 ------- ------- ------- ------- ------- ------- 82030 $43.00 ------- ------- ------- ------- ------- ------- 82030-26 $17.00 ------- ------- ------- ------- ------- ------- 82030-TC $25.00 ------- ------- ------- ------- ------- ------- 82040 $11.00 ------- ------- ------- ------- ------- ------- 82040-26 $3.00 ------- ------- ------- ------- ------- ------- 82040-TC $7.00 ------- ------- ------- ------- ------- ------- 82042 $12.00 ------- ------- ------- ------- ------- ------- 82042-26 $3.00 ------- ------- ------- ------- ------- ------- 82042-TC $8.00 ------- ------- ------- ------- ------- ------- 82043 $14.00 ------- ------- ------- ------- ------- ------- 82043-26 $4.00 ------- ------- ------- ------- ------- ------- 82043-TC $10.00 ------- ------- ------- ------- ------- ------- 82044 $12.00 ------- ------- ------- ------- ------- ------- 82044-26 $4.00 ------- ------- ------- ------- ------- ------- 82044-TC $9.00 ------- ------- ------- ------- ------- ------- 82055 $33.00 ------- ------- ------- ------- ------- ------- 82055-26 $10.00 ------- ------- ------- ------- ------- ------- 82055-TC $22.00 ------- ------- ------- ------- ------- ------- 82075 $32.00 ------- ------- ------- ------- ------- ------- 82075-26 $10.00 ------- ------- ------- ------- ------- ------- 82075-TC $21.00 ------- ------- ------- ------- ------- ------- 82085 $24.00 ------- ------- ------- ------- ------- ------- 82085-26 $7.00 ------- ------- ------- ------- ------- ------- 82085-TC $17.00 ------- ------- ------- ------- ------- ------- 82088 $91.00 ------- ------- ------- ------- ------- ------- 82088-26 $28.00 ------- ------- ------- ------- ------- ------- 82088-TC $62.00 ------- ------- ------- ------- ------- ------- 82101 $59.00 ------- ------- ------- ------- ------- ------- 82101-26 $18.00 ------- ------- ------- ------- ------- ------- 82101-TC $41.00 ------- ------- ------- ------- ------- ------- 82103 $21.00 ------- ------- ------- ------- ------- ------- 82103-26 $7.00 ------- ------- ------- ------- ------- ------- 82103-TC $14.00 ------- ------- ------- ------- ------- ------- 82104 $22.00 ------- ------- ------- ------- ------- ------- 82104-26 $7.00 ------- ------- ------- ------- ------- ------- 82104-TC $15.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 291
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 82105 $26.00 ------- ------- ------- ------- ------- ------- 82105-26 $8.00 ------- ------- ------- ------- ------- ------- 82105-TC $18.00 ------- ------- ------- ------- ------- ------- 82106 $26.00 ------- ------- ------- ------- ------- ------- 82106-26 $8.00 ------- ------- ------- ------- ------- ------- 82106-TC $18.00 ------- ------- ------- ------- ------- ------- 82108 $45.00 ------- ------- ------- ------- ------- ------- 82108-26 $14.00 ------- ------- ------- ------- ------- ------- 82108-TC $32.00 ------- ------- ------- ------- ------- ------- 82120 $9.00 ------- ------- ------- ------- ------- ------- 82120-26 $3.00 ------- ------- ------- ------- ------- ------- 82120-TC $5.00 ------- ------- ------- ------- ------- ------- 82127 $33.00 ------- ------- ------- ------- ------- ------- 82127-26 $11.00 ------- ------- ------- ------- ------- ------- 82127-TC $22.00 ------- ------- ------- ------- ------- ------- 82128 $26.00 ------- ------- ------- ------- ------- ------- 82128-26 $6.00 ------- ------- ------- ------- ------- ------- 82128-TC $19.00 ------- ------- ------- ------- ------- ------- 82131 $57.00 ------- ------- ------- ------- ------- ------- 82131-26 $13.00 ------- ------- ------- ------- ------- ------- 82131-TC $44.00 ------- ------- ------- ------- ------- ------- 82135 $41.00 ------- ------- ------- ------- ------- ------- 82135-26 $13.00 ------- ------- ------- ------- ------- ------- 82135-TC $28.00 ------- ------- ------- ------- ------- ------- 82136 $38.00 ------- ------- ------- ------- ------- ------- 82136-26 $14.00 ------- ------- ------- ------- ------- ------- 82136-TC $23.00 ------- ------- ------- ------- ------- ------- 82139 $38.00 ------- ------- ------- ------- ------- ------- 82139-26 $14.00 ------- ------- ------- ------- ------- ------- 82139-TC $23.00 ------- ------- ------- ------- ------- ------- 82140 $40.00 ------- ------- ------- ------- ------- ------- 82140-26 $12.00 ------- ------- ------- ------- ------- ------- 82140-TC $28.00 ------- ------- ------- ------- ------- ------- 82143 $28.00 ------- ------- ------- ------- ------- ------- 82143-26 $8.00 ------- ------- ------- ------- ------- ------- 82143-TC $19.00 ------- ------- ------- ------- ------- ------- 82145 $35.00 ------- ------- ------- ------- ------- ------- 82145-26 $10.00 ------- ------- ------- ------- ------- ------- 82145-TC $24.00 ------- ------- ------- ------- ------- ------- 82150 $16.00 ------- ------- ------- ------- ------- ------- 82150-26 $5.00 ------- ------- ------- ------- ------- ------- 82150-TC $11.00 ------- ------- ------- ------- ------- ------- 82154 $34.00 ------- ------- ------- ------- ------- ------- 82154-26 $13.00 ------- ------- ------- ------- ------- ------- 82154-TC $20.00 ------- ------- ------- ------- ------- ------- 82157 $57.00 ------- ------- ------- ------- ------- ------- 82157-26 $17.00 ------- ------- ------- ------- ------- ------- 82157-TC $40.00 ------- ------- ------- ------- ------- ------- 82160 $67.00 ------- ------- ------- ------- ------- ------- 82160-26 $21.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 292
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 82160-TC $43.00 ------- ------- ------- ------- ------- ------- 82163 $42.00 ------- ------- ------- ------- ------- ------- 82163-26 $12.00 ------- ------- ------- ------- ------- ------- 82163-TC $31.00 ------- ------- ------- ------- ------- ------- 82164 $32.00 ------- ------- ------- ------- ------- ------- 82164-26 $10.00 ------- ------- ------- ------- ------- ------- 82164-TC $21.00 ------- ------- ------- ------- ------- ------- 82172 $33.00 ------- ------- ------- ------- ------- ------- 82172-26 $10.00 ------- ------- ------- ------- ------- ------- 82172-TC $22.00 ------- ------- ------- ------- ------- ------- 82175 $48.00 ------- ------- ------- ------- ------- ------- 82175-26 $15.00 ------- ------- ------- ------- ------- ------- 82175-TC $33.00 ------- ------- ------- ------- ------- ------- 82180 $25.00 ------- ------- ------- ------- ------- ------- 82180-26 $8.00 ------- ------- ------- ------- ------- ------- 82180-TC $17.00 ------- ------- ------- ------- ------- ------- 82190 $24.00 ------- ------- ------- ------- ------- ------- 82190-26 $8.00 ------- ------- ------- ------- ------- ------- 82190-TC $16.00 ------- ------- ------- ------- ------- ------- 82205 $34.00 ------- ------- ------- ------- ------- ------- 82205-26 $10.00 ------- ------- ------- ------- ------- ------- 82205-TC $23.00 ------- ------- ------- ------- ------- ------- 82232 $43.00 ------- ------- ------- ------- ------- ------- 82232-26 $14.00 ------- ------- ------- ------- ------- ------- 82232-TC $29.00 ------- ------- ------- ------- ------- ------- 82239 $23.00 ------- ------- ------- ------- ------- ------- 82239-26 $8.00 ------- ------- ------- ------- ------- ------- 82239-TC $15.00 ------- ------- ------- ------- ------- ------- 82240 $49.00 ------- ------- ------- ------- ------- ------- 82240-26 $15.00 ------- ------- ------- ------- ------- ------- 82240-TC $34.00 ------- ------- ------- ------- ------- ------- 82247 $10.00 ------- ------- ------- ------- ------- ------- 82247-26 $3.00 ------- ------- ------- ------- ------- ------- 82247-TC $7.00 ------- ------- ------- ------- ------- ------- 82248 $10.00 ------- ------- ------- ------- ------- ------- 82248-26 $3.00 ------- ------- ------- ------- ------- ------- 82248-TC $7.00 ------- ------- ------- ------- ------- ------- 82252 $11.00 ------- ------- ------- ------- ------- ------- 82252-26 $3.00 ------- ------- ------- ------- ------- ------- 82252-TC $7.00 ------- ------- ------- ------- ------- ------- 82261 $38.00 ------- ------- ------- ------- ------- ------- 82261-26 $13.00 ------- ------- ------- ------- ------- ------- 82261-TC $24.00 ------- ------- ------- ------- ------- ------- 82270 $5.00 ------- ------- ------- ------- ------- ------- 82270-26 $2.00 ------- ------- ------- ------- ------- ------- 82270-TC $3.00 ------- ------- ------- ------- ------- ------- 82274 BR ------- ------- ------- ------- ------- ------- 82274-26 BR ------- ------- ------- ------- ------- ------- 82274-TC BR ------- ------- ------- ------- ------- ------- 82286 $12.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 293
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 82286-26 $3.00 ------- ------- ------- ------- ------- ------- 82286-TC $8.00 ------- ------- ------- ------- ------- ------- 82300 $48.00 ------- ------- ------- ------- ------- ------- 82300-26 $15.00 ------- ------- ------- ------- ------- ------- 82300-TC $33.00 ------- ------- ------- ------- ------- ------- 82306 $79.00 ------- ------- ------- ------- ------- ------- 82306-26 $25.00 ------- ------- ------- ------- ------- ------- 82306-TC $52.00 ------- ------- ------- ------- ------- ------- 82307 $57.00 ------- ------- ------- ------- ------- ------- 82307-26 $19.00 ------- ------- ------- ------- ------- ------- 82307-TC $38.00 ------- ------- ------- ------- ------- ------- 82308 $62.00 ------- ------- ------- ------- ------- ------- 82308-26 $18.00 ------- ------- ------- ------- ------- ------- 82308-TC $43.00 ------- ------- ------- ------- ------- ------- 82310 $11.00 ------- ------- ------- ------- ------- ------- 82310-26 $3.00 ------- ------- ------- ------- ------- ------- 82310-TC $7.00 ------- ------- ------- ------- ------- ------- 82330 $37.00 ------- ------- ------- ------- ------- ------- 82330-26 $11.00 ------- ------- ------- ------- ------- ------- 82330-TC $25.00 ------- ------- ------- ------- ------- ------- 82331 $14.00 ------- ------- ------- ------- ------- ------- 82331-26 $4.00 ------- ------- ------- ------- ------- ------- 82331-TC $10.00 ------- ------- ------- ------- ------- ------- 82340 $13.00 ------- ------- ------- ------- ------- ------- 82340-26 $4.00 ------- ------- ------- ------- ------- ------- 82340-TC $8.00 ------- ------- ------- ------- ------- ------- 82355 $31.00 ------- ------- ------- ------- ------- ------- 82355-26 $10.00 ------- ------- ------- ------- ------- ------- 82355-TC $20.00 ------- ------- ------- ------- ------- ------- 82360 $31.00 ------- ------- ------- ------- ------- ------- 82360-26 $10.00 ------- ------- ------- ------- ------- ------- 82360-TC $20.00 ------- ------- ------- ------- ------- ------- 82365 $31.00 ------- ------- ------- ------- ------- ------- 82365-26 $8.00 ------- ------- ------- ------- ------- ------- 82365-TC $21.00 ------- ------- ------- ------- ------- ------- 82370 $22.00 ------- ------- ------- ------- ------- ------- 82370-26 $7.00 ------- ------- ------- ------- ------- ------- 82370-TC $15.00 ------- ------- ------- ------- ------- ------- 82373 $16.00 ------- ------- ------- ------- ------- ------- 82373-26 $5.00 ------- ------- ------- ------- ------- ------- 82373-TC $11.00 ------- ------- ------- ------- ------- ------- 82374 $10.00 ------- ------- ------- ------- ------- ------- 82374-26 $3.00 ------- ------- ------- ------- ------- ------- 82374-TC $6.00 ------- ------- ------- ------- ------- ------- 82375 $26.00 ------- ------- ------- ------- ------- ------- 82375-26 $7.00 ------- ------- ------- ------- ------- ------- 82375-TC $18.00 ------- ------- ------- ------- ------- ------- 82376 $11.00 ------- ------- ------- ------- ------- ------- 82376-26 $3.00 ------- ------- ------- ------- ------- ------- 82376-TC $7.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 294
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 82378 $31.00 ------- ------- ------- ------- ------- ------- 82378-26 $8.00 ------- ------- ------- ------- ------- ------- 82378-TC $21.00 ------- ------- ------- ------- ------- ------- 82379 $38.00 ------- ------- ------- ------- ------- ------- 82379-26 $13.00 ------- ------- ------- ------- ------- ------- 82379-TC $24.00 ------- ------- ------- ------- ------- ------- 82380 $21.00 ------- ------- ------- ------- ------- ------- 82380-26 $6.00 ------- ------- ------- ------- ------- ------- 82380-TC $15.00 ------- ------- ------- ------- ------- ------- 82382 $38.00 ------- ------- ------- ------- ------- ------- 82382-26 $12.00 ------- ------- ------- ------- ------- ------- 82382-TC $25.00 ------- ------- ------- ------- ------- ------- 82383 $62.00 ------- ------- ------- ------- ------- ------- 82383-26 $18.00 ------- ------- ------- ------- ------- ------- 82383-TC $43.00 ------- ------- ------- ------- ------- ------- 82384 $62.00 ------- ------- ------- ------- ------- ------- 82384-26 $18.00 ------- ------- ------- ------- ------- ------- 82384-TC $43.00 ------- ------- ------- ------- ------- ------- 82387 $34.00 ------- ------- ------- ------- ------- ------- 82387-26 $10.00 ------- ------- ------- ------- ------- ------- 82387-TC $23.00 ------- ------- ------- ------- ------- ------- 82390 $24.00 ------- ------- ------- ------- ------- ------- 82390-26 $7.00 ------- ------- ------- ------- ------- ------- 82390-TC $17.00 ------- ------- ------- ------- ------- ------- 82397 $22.00 ------- ------- ------- ------- ------- ------- 82397-26 $7.00 ------- ------- ------- ------- ------- ------- 82397-TC $15.00 ------- ------- ------- ------- ------- ------- 82415 $28.00 ------- ------- ------- ------- ------- ------- 82415-26 $8.00 ------- ------- ------- ------- ------- ------- 82415-TC $19.00 ------- ------- ------- ------- ------- ------- 82435 $8.00 ------- ------- ------- ------- ------- ------- 82435-26 $2.00 ------- ------- ------- ------- ------- ------- 82435-TC $6.00 ------- ------- ------- ------- ------- ------- 82436 $14.00 ------- ------- ------- ------- ------- ------- 82436-26 $4.00 ------- ------- ------- ------- ------- ------- 82436-TC $10.00 ------- ------- ------- ------- ------- ------- 82438 $13.00 ------- ------- ------- ------- ------- ------- 82438-26 $4.00 ------- ------- ------- ------- ------- ------- 82438-TC $8.00 ------- ------- ------- ------- ------- ------- 82441 $16.00 ------- ------- ------- ------- ------- ------- 82441-26 $5.00 ------- ------- ------- ------- ------- ------- 82441-TC $11.00 ------- ------- ------- ------- ------- ------- 82465 $8.00 ------- ------- ------- ------- ------- ------- 82465-26 $2.00 ------- ------- ------- ------- ------- ------- 82465-TC $6.00 ------- ------- ------- ------- ------- ------- 82480 $23.00 ------- ------- ------- ------- ------- ------- 82480-26 $6.00 ------- ------- ------- ------- ------- ------- 82480-TC $17.00 ------- ------- ------- ------- ------- ------- 82482 $23.00 ------- ------- ------- ------- ------- ------- 82482-26 $7.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 295
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 82482-TC $15.00 ------- ------- ------- ------- ------- ------- 82485 $37.00 ------- ------- ------- ------- ------- ------- 82485-26 $8.00 ------- ------- ------- ------- ------- ------- 82485-TC $28.00 ------- ------- ------- ------- ------- ------- 82486 $42.00 ------- ------- ------- ------- ------- ------- 82486-26 $14.00 ------- ------- ------- ------- ------- ------- 82486-TC $27.00 ------- ------- ------- ------- ------- ------- 82487 $43.00 ------- ------- ------- ------- ------- ------- 82487-26 $14.00 ------- ------- ------- ------- ------- ------- 82487-TC $29.00 ------- ------- ------- ------- ------- ------- 82488 $57.00 ------- ------- ------- ------- ------- ------- 82488-26 $19.00 ------- ------- ------- ------- ------- ------- 82488-TC $38.00 ------- ------- ------- ------- ------- ------- 82489 $47.00 ------- ------- ------- ------- ------- ------- 82489-26 $15.00 ------- ------- ------- ------- ------- ------- 82489-TC $32.00 ------- ------- ------- ------- ------- ------- 82491 $58.00 ------- ------- ------- ------- ------- ------- 82491-26 $17.00 ------- ------- ------- ------- ------- ------- 82491-TC $41.00 ------- ------- ------- ------- ------- ------- 82492 $42.00 ------- ------- ------- ------- ------- ------- 82492-26 $13.00 ------- ------- ------- ------- ------- ------- 82492-TC $28.00 ------- ------- ------- ------- ------- ------- 82495 $48.00 ------- ------- ------- ------- ------- ------- 82495-26 $16.00 ------- ------- ------- ------- ------- ------- 82495-TC $32.00 ------- ------- ------- ------- ------- ------- 82507 $55.00 ------- ------- ------- ------- ------- ------- 82507-26 $16.00 ------- ------- ------- ------- ------- ------- 82507-TC $39.00 ------- ------- ------- ------- ------- ------- 82520 $26.00 ------- ------- ------- ------- ------- ------- 82520-26 $8.00 ------- ------- ------- ------- ------- ------- 82520-TC $18.00 ------- ------- ------- ------- ------- ------- 82523 $43.00 ------- ------- ------- ------- ------- ------- 82523-26 $17.00 ------- ------- ------- ------- ------- ------- 82523-TC $25.00 ------- ------- ------- ------- ------- ------- 82525 $34.00 ------- ------- ------- ------- ------- ------- 82525-26 $10.00 ------- ------- ------- ------- ------- ------- 82525-TC $23.00 ------- ------- ------- ------- ------- ------- 82528 $40.00 ------- ------- ------- ------- ------- ------- 82528-26 $13.00 ------- ------- ------- ------- ------- ------- 82528-TC $26.00 ------- ------- ------- ------- ------- ------- 82530 $38.00 ------- ------- ------- ------- ------- ------- 82530-26 $12.00 ------- ------- ------- ------- ------- ------- 82530-TC $25.00 ------- ------- ------- ------- ------- ------- 82533 $35.00 ------- ------- ------- ------- ------- ------- 82533-26 $10.00 ------- ------- ------- ------- ------- ------- 82533-TC $24.00 ------- ------- ------- ------- ------- ------- 82540 $10.00 ------- ------- ------- ------- ------- ------- 82540-26 $3.00 ------- ------- ------- ------- ------- ------- 82540-TC $6.00 ------- ------- ------- ------- ------- ------- 82541 $42.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 296
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 82541-26 $13.00 ------- ------- ------- ------- ------- ------- 82541-TC $28.00 ------- ------- ------- ------- ------- ------- 82542 $42.00 ------- ------- ------- ------- ------- ------- 82542-26 $13.00 ------- ------- ------- ------- ------- ------- 82542-TC $28.00 ------- ------- ------- ------- ------- ------- 82543 $42.00 ------- ------- ------- ------- ------- ------- 82543-26 $13.00 ------- ------- ------- ------- ------- ------- 82543-TC $28.00 ------- ------- ------- ------- ------- ------- 82544 $42.00 ------- ------- ------- ------- ------- ------- 82544-26 $13.00 ------- ------- ------- ------- ------- ------- 82544-TC $28.00 ------- ------- ------- ------- ------- ------- 82550 $16.00 ------- ------- ------- ------- ------- ------- 82550-26 $4.00 ------- ------- ------- ------- ------- ------- 82550-TC $12.00 ------- ------- ------- ------- ------- ------- 82552 $33.00 ------- ------- ------- ------- ------- ------- 82552-26 $10.00 ------- ------- ------- ------- ------- ------- 82552-TC $22.00 ------- ------- ------- ------- ------- ------- 82553 $16.00 ------- ------- ------- ------- ------- ------- 82553-26 $5.00 ------- ------- ------- ------- ------- ------- 82553-TC $11.00 ------- ------- ------- ------- ------- ------- 82554 $19.00 ------- ------- ------- ------- ------- ------- 82554-26 $6.00 ------- ------- ------- ------- ------- ------- 82554-TC $13.00 ------- ------- ------- ------- ------- ------- 82565 $13.00 ------- ------- ------- ------- ------- ------- 82565-26 $2.00 ------- ------- ------- ------- ------- ------- 82565-TC $11.00 ------- ------- ------- ------- ------- ------- 82570 $10.00 ------- ------- ------- ------- ------- ------- 82570-26 $2.00 ------- ------- ------- ------- ------- ------- 82570-TC $7.00 ------- ------- ------- ------- ------- ------- 82575 $25.00 ------- ------- ------- ------- ------- ------- 82575-26 $8.00 ------- ------- ------- ------- ------- ------- 82575-TC $17.00 ------- ------- ------- ------- ------- ------- 82585 $15.00 ------- ------- ------- ------- ------- ------- 82585-26 $3.00 ------- ------- ------- ------- ------- ------- 82585-TC $12.00 ------- ------- ------- ------- ------- ------- 82595 $31.00 ------- ------- ------- ------- ------- ------- 82595-26 $10.00 ------- ------- ------- ------- ------- ------- 82595-TC $21.00 ------- ------- ------- ------- ------- ------- 82600 $40.00 ------- ------- ------- ------- ------- ------- 82600-26 $12.00 ------- ------- ------- ------- ------- ------- 82600-TC $28.00 ------- ------- ------- ------- ------- ------- 82607 $38.00 ------- ------- ------- ------- ------- ------- 82607-26 $10.00 ------- ------- ------- ------- ------- ------- 82607-TC $27.00 ------- ------- ------- ------- ------- ------- 82608 $40.00 ------- ------- ------- ------- ------- ------- 82608-26 $13.00 ------- ------- ------- ------- ------- ------- 82608-TC $26.00 ------- ------- ------- ------- ------- ------- 82615 $17.00 ------- ------- ------- ------- ------- ------- 82615-26 $5.00 ------- ------- ------- ------- ------- ------- 82615-TC $12.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 297
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 82626 $59.00 ------- ------- ------- ------- ------- ------- 82626-26 $19.00 ------- ------- ------- ------- ------- ------- 82626-TC $40.00 ------- ------- ------- ------- ------- ------- 82627 $37.00 ------- ------- ------- ------- ------- ------- 82627-26 $12.00 ------- ------- ------- ------- ------- ------- 82627-TC $24.00 ------- ------- ------- ------- ------- ------- 82633 $81.00 ------- ------- ------- ------- ------- ------- 82633-26 $23.00 ------- ------- ------- ------- ------- ------- 82633-TC $56.00 ------- ------- ------- ------- ------- ------- 82634 $81.00 ------- ------- ------- ------- ------- ------- 82634-26 $23.00 ------- ------- ------- ------- ------- ------- 82634-TC $56.00 ------- ------- ------- ------- ------- ------- 82638 $23.00 ------- ------- ------- ------- ------- ------- 82638-26 $7.00 ------- ------- ------- ------- ------- ------- 82638-TC $16.00 ------- ------- ------- ------- ------- ------- 82646 $37.00 ------- ------- ------- ------- ------- ------- 82646-26 $11.00 ------- ------- ------- ------- ------- ------- 82646-TC $25.00 ------- ------- ------- ------- ------- ------- 82649 $43.00 ------- ------- ------- ------- ------- ------- 82649-26 $17.00 ------- ------- ------- ------- ------- ------- 82649-TC $25.00 ------- ------- ------- ------- ------- ------- 82651 $43.00 ------- ------- ------- ------- ------- ------- 82651-26 $17.00 ------- ------- ------- ------- ------- ------- 82651-TC $25.00 ------- ------- ------- ------- ------- ------- 82652 $89.00 ------- ------- ------- ------- ------- ------- 82652-26 $25.00 ------- ------- ------- ------- ------- ------- 82652-TC $62.00 ------- ------- ------- ------- ------- ------- 82654 $37.00 ------- ------- ------- ------- ------- ------- 82654-26 $11.00 ------- ------- ------- ------- ------- ------- 82654-TC $25.00 ------- ------- ------- ------- ------- ------- 82657 $42.00 ------- ------- ------- ------- ------- ------- 82657-26 $13.00 ------- ------- ------- ------- ------- ------- 82657-TC $28.00 ------- ------- ------- ------- ------- ------- 82658 $42.00 ------- ------- ------- ------- ------- ------- 82658-26 $13.00 ------- ------- ------- ------- ------- ------- 82658-TC $28.00 ------- ------- ------- ------- ------- ------- 82664 $40.00 ------- ------- ------- ------- ------- ------- 82664-26 $13.00 ------- ------- ------- ------- ------- ------- 82664-TC $26.00 ------- ------- ------- ------- ------- ------- 82666 $58.00 ------- ------- ------- ------- ------- ------- 82666-26 $17.00 ------- ------- ------- ------- ------- ------- 82666-TC $41.00 ------- ------- ------- ------- ------- ------- 82668 $45.00 ------- ------- ------- ------- ------- ------- 82668-26 $14.00 ------- ------- ------- ------- ------- ------- 82668-TC $32.00 ------- ------- ------- ------- ------- ------- 82670 $61.00 ------- ------- ------- ------- ------- ------- 82670-26 $18.00 ------- ------- ------- ------- ------- ------- 82670-TC $42.00 ------- ------- ------- ------- ------- ------- 82671 $61.00 ------- ------- ------- ------- ------- ------- 82671-26 $17.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 298
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 82671-TC $43.00 ------- ------- ------- ------- ------- ------- 82672 $57.00 ------- ------- ------- ------- ------- ------- 82672-26 $16.00 ------- ------- ------- ------- ------- ------- 82672-TC $41.00 ------- ------- ------- ------- ------- ------- 82677 $52.00 ------- ------- ------- ------- ------- ------- 82677-26 $17.00 ------- ------- ------- ------- ------- ------- 82677-TC $35.00 ------- ------- ------- ------- ------- ------- 82679 $70.00 ------- ------- ------- ------- ------- ------- 82679-26 $20.00 ------- ------- ------- ------- ------- ------- 82679-TC $48.00 ------- ------- ------- ------- ------- ------- 82690 $53.00 ------- ------- ------- ------- ------- ------- 82690-26 $21.00 ------- ------- ------- ------- ------- ------- 82690-TC $32.00 ------- ------- ------- ------- ------- ------- 82693 $23.00 ------- ------- ------- ------- ------- ------- 82693-26 $7.00 ------- ------- ------- ------- ------- ------- 82693-TC $16.00 ------- ------- ------- ------- ------- ------- 82696 $57.00 ------- ------- ------- ------- ------- ------- 82696-26 $19.00 ------- ------- ------- ------- ------- ------- 82696-TC $38.00 ------- ------- ------- ------- ------- ------- 82705 $14.00 ------- ------- ------- ------- ------- ------- 82705-26 $6.00 ------- ------- ------- ------- ------- ------- 82705-TC $9.00 ------- ------- ------- ------- ------- ------- 82710 $42.00 ------- ------- ------- ------- ------- ------- 82710-26 $13.00 ------- ------- ------- ------- ------- ------- 82710-TC $29.00 ------- ------- ------- ------- ------- ------- 82715 $33.00 ------- ------- ------- ------- ------- ------- 82715-26 $11.00 ------- ------- ------- ------- ------- ------- 82715-TC $21.00 ------- ------- ------- ------- ------- ------- 82725 $28.00 ------- ------- ------- ------- ------- ------- 82725-26 $8.00 ------- ------- ------- ------- ------- ------- 82725-TC $19.00 ------- ------- ------- ------- ------- ------- 82726 $42.00 ------- ------- ------- ------- ------- ------- 82726-26 $13.00 ------- ------- ------- ------- ------- ------- 82726-TC $28.00 ------- ------- ------- ------- ------- ------- 82728 $24.00 ------- ------- ------- ------- ------- ------- 82728-26 $7.00 ------- ------- ------- ------- ------- ------- 82728-TC $17.00 ------- ------- ------- ------- ------- ------- 82735 $36.00 ------- ------- ------- ------- ------- ------- 82735-26 $12.00 ------- ------- ------- ------- ------- ------- 82735-TC $23.00 ------- ------- ------- ------- ------- ------- 82742 $42.00 ------- ------- ------- ------- ------- ------- 82742-26 $13.00 ------- ------- ------- ------- ------- ------- 82742-TC $29.00 ------- ------- ------- ------- ------- ------- 82746 $39.00 ------- ------- ------- ------- ------- ------- 82746-26 $13.00 ------- ------- ------- ------- ------- ------- 82746-TC $25.00 ------- ------- ------- ------- ------- ------- 82747 $29.00 ------- ------- ------- ------- ------- ------- 82747-26 $10.00 ------- ------- ------- ------- ------- ------- 82747-TC $19.00 ------- ------- ------- ------- ------- ------- 82757 $36.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 299
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 82757-26 $11.00 ------- ------- ------- ------- ------- ------- 82757-TC $24.00 ------- ------- ------- ------- ------- ------- 82759 $38.00 ------- ------- ------- ------- ------- ------- 82759-26 $12.00 ------- ------- ------- ------- ------- ------- 82759-TC $25.00 ------- ------- ------- ------- ------- ------- 82760 $26.00 ------- ------- ------- ------- ------- ------- 82760-26 $8.00 ------- ------- ------- ------- ------- ------- 82760-TC $18.00 ------- ------- ------- ------- ------- ------- 82775 $47.00 ------- ------- ------- ------- ------- ------- 82775-26 $14.00 ------- ------- ------- ------- ------- ------- 82775-TC $33.00 ------- ------- ------- ------- ------- ------- 82776 $14.00 ------- ------- ------- ------- ------- ------- 82776-26 $3.00 ------- ------- ------- ------- ------- ------- 82776-TC $11.00 ------- ------- ------- ------- ------- ------- 82784 $15.00 ------- ------- ------- ------- ------- ------- 82784-26 $5.00 ------- ------- ------- ------- ------- ------- 82784-TC $11.00 ------- ------- ------- ------- ------- ------- 82785 $33.00 ------- ------- ------- ------- ------- ------- 82785-26 $11.00 ------- ------- ------- ------- ------- ------- 82785-TC $21.00 ------- ------- ------- ------- ------- ------- 82787 $54.00 ------- ------- ------- ------- ------- ------- 82787-26 $17.00 ------- ------- ------- ------- ------- ------- 82787-TC $37.00 ------- ------- ------- ------- ------- ------- 82800 $22.00 ------- ------- ------- ------- ------- ------- 82800-26 $6.00 ------- ------- ------- ------- ------- ------- 82800-TC $16.00 ------- ------- ------- ------- ------- ------- 82803 $53.00 ------- ------- ------- ------- ------- ------- 82803-26 $16.00 ------- ------- ------- ------- ------- ------- 82803-TC $37.00 ------- ------- ------- ------- ------- ------- 82805 $36.00 ------- ------- ------- ------- ------- ------- 82805-26 $10.00 ------- ------- ------- ------- ------- ------- 82805-TC $24.00 ------- ------- ------- ------- ------- ------- 82810 $28.00 ------- ------- ------- ------- ------- ------- 82810-26 $8.00 ------- ------- ------- ------- ------- ------- 82810-TC $19.00 ------- ------- ------- ------- ------- ------- 82820 $16.00 ------- ------- ------- ------- ------- ------- 82820-26 $5.00 ------- ------- ------- ------- ------- ------- 82820-TC $11.00 ------- ------- ------- ------- ------- ------- 82926 $20.00 ------- ------- ------- ------- ------- ------- 82926-26 $5.00 ------- ------- ------- ------- ------- ------- 82926-TC $15.00 ------- ------- ------- ------- ------- ------- 82928 $12.00 ------- ------- ------- ------- ------- ------- 82928-26 $4.00 ------- ------- ------- ------- ------- ------- 82928-TC $7.00 ------- ------- ------- ------- ------- ------- 82938 $48.00 ------- ------- ------- ------- ------- ------- 82938-26 $16.00 ------- ------- ------- ------- ------- ------- 82938-TC $32.00 ------- ------- ------- ------- ------- ------- 82941 $47.00 ------- ------- ------- ------- ------- ------- 82941-26 $15.00 ------- ------- ------- ------- ------- ------- 82941-TC $32.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 300
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 82943 $38.00 ------- ------- ------- ------- ------- ------- 82943-26 $12.00 ------- ------- ------- ------- ------- ------- 82943-TC $25.00 ------- ------- ------- ------- ------- ------- 82945 $9.00 ------- ------- ------- ------- ------- ------- 82945-26 $3.00 ------- ------- ------- ------- ------- ------- 82945-TC $5.00 ------- ------- ------- ------- ------- ------- 82946 $29.00 ------- ------- ------- ------- ------- ------- 82946-26 $7.00 ------- ------- ------- ------- ------- ------- 82946-TC $21.00 ------- ------- ------- ------- ------- ------- 82947 $11.00 ------- ------- ------- ------- ------- ------- 82947-26 $3.00 ------- ------- ------- ------- ------- ------- 82947-TC $7.00 ------- ------- ------- ------- ------- ------- 82948 $5.00 ------- ------- ------- ------- ------- ------- 82948-26 $3.00 ------- ------- ------- ------- ------- ------- 82948-TC $3.00 ------- ------- ------- ------- ------- ------- 82950 $12.00 ------- ------- ------- ------- ------- ------- 82950-26 $4.00 ------- ------- ------- ------- ------- ------- 82950-TC $7.00 ------- ------- ------- ------- ------- ------- 82951 $22.00 ------- ------- ------- ------- ------- ------- 82951-26 $7.00 ------- ------- ------- ------- ------- ------- 82951-TC $15.00 ------- ------- ------- ------- ------- ------- 82952 $11.00 ------- ------- ------- ------- ------- ------- 82952-26 $3.00 ------- ------- ------- ------- ------- ------- 82952-TC $7.00 ------- ------- ------- ------- ------- ------- 82953 $41.00 ------- ------- ------- ------- ------- ------- 82953-26 $14.00 ------- ------- ------- ------- ------- ------- 82953-TC $26.00 ------- ------- ------- ------- ------- ------- 82955 $25.00 ------- ------- ------- ------- ------- ------- 82955-26 $7.00 ------- ------- ------- ------- ------- ------- 82955-TC $18.00 ------- ------- ------- ------- ------- ------- 82960 $14.00 ------- ------- ------- ------- ------- ------- 82960-26 $4.00 ------- ------- ------- ------- ------- ------- 82960-TC $10.00 ------- ------- ------- ------- ------- ------- 82962 $5.00 ------- ------- ------- ------- ------- ------- 82962-26 $1.00 ------- ------- ------- ------- ------- ------- 82962-TC $4.00 ------- ------- ------- ------- ------- ------- 82963 $54.00 ------- ------- ------- ------- ------- ------- 82963-26 $17.00 ------- ------- ------- ------- ------- ------- 82963-TC $37.00 ------- ------- ------- ------- ------- ------- 82965 $16.00 ------- ------- ------- ------- ------- ------- 82965-26 $5.00 ------- ------- ------- ------- ------- ------- 82965-TC $11.00 ------- ------- ------- ------- ------- ------- 82975 $28.00 ------- ------- ------- ------- ------- ------- 82975-26 $8.00 ------- ------- ------- ------- ------- ------- 82975-TC $19.00 ------- ------- ------- ------- ------- ------- 82977 $16.00 ------- ------- ------- ------- ------- ------- 82977-26 $4.00 ------- ------- ------- ------- ------- ------- 82977-TC $12.00 ------- ------- ------- ------- ------- ------- 82978 $25.00 ------- ------- ------- ------- ------- ------- 82978-26 $7.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 301
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 82978-TC $18.00 ------- ------- ------- ------- ------- ------- 82979 $18.00 ------- ------- ------- ------- ------- ------- 82979-26 $5.00 ------- ------- ------- ------- ------- ------- 82979-TC $13.00 ------- ------- ------- ------- ------- ------- 82980 $15.00 ------- ------- ------- ------- ------- ------- 82980-26 $3.00 ------- ------- ------- ------- ------- ------- 82980-TC $11.00 ------- ------- ------- ------- ------- ------- 82985 $41.00 ------- ------- ------- ------- ------- ------- 82985-26 $12.00 ------- ------- ------- ------- ------- ------- 82985-TC $29.00 ------- ------- ------- ------- ------- ------- 83001 $40.00 ------- ------- ------- ------- ------- ------- 83001-26 $12.00 ------- ------- ------- ------- ------- ------- 83001-TC $28.00 ------- ------- ------- ------- ------- ------- 83002 $42.00 ------- ------- ------- ------- ------- ------- 83002-26 $13.00 ------- ------- ------- ------- ------- ------- 83002-TC $29.00 ------- ------- ------- ------- ------- ------- 83003 $36.00 ------- ------- ------- ------- ------- ------- 83003-26 $10.00 ------- ------- ------- ------- ------- ------- 83003-TC $25.00 ------- ------- ------- ------- ------- ------- 83008 $34.00 ------- ------- ------- ------- ------- ------- 83008-26 $10.00 ------- ------- ------- ------- ------- ------- 83008-TC $23.00 ------- ------- ------- ------- ------- ------- 83010 $26.00 ------- ------- ------- ------- ------- ------- 83010-26 $8.00 ------- ------- ------- ------- ------- ------- 83010-TC $18.00 ------- ------- ------- ------- ------- ------- 83012 $36.00 ------- ------- ------- ------- ------- ------- 83012-26 $14.00 ------- ------- ------- ------- ------- ------- 83012-TC $21.00 ------- ------- ------- ------- ------- ------- 83013 $133.00 ------- ------- ------- ------- ------- ------- 83013-26 $38.00 ------- ------- ------- ------- ------- ------- 83013-TC $94.00 ------- ------- ------- ------- ------- ------- 83014 $19.00 ------- ------- ------- ------- ------- ------- 83014-26 $6.00 ------- ------- ------- ------- ------- ------- 83014-TC $13.00 ------- ------- ------- ------- ------- ------- 83015 $51.00 ------- ------- ------- ------- ------- ------- 83015-26 $15.00 ------- ------- ------- ------- ------- ------- 83015-TC $36.00 ------- ------- ------- ------- ------- ------- 83018 $56.00 ------- ------- ------- ------- ------- ------- 83018-26 $16.00 ------- ------- ------- ------- ------- ------- 83018-TC $40.00 ------- ------- ------- ------- ------- ------- 83020 $24.00 ------- ------- ------- ------- ------- ------- 83020-26 $6.00 $20.00 $20.00 $21.00 $20.00 $20.00 $21.00 83020-TC $18.00 ------- ------- ------- ------- ------- ------- 83021 $39.00 ------- ------- ------- ------- ------- ------- 83021-26 $13.00 ------- ------- ------- ------- ------- ------- 83021-TC $25.00 ------- ------- ------- ------- ------- ------- 83026 $8.00 ------- ------- ------- ------- ------- ------- 83026-26 $5.00 ------- ------- ------- ------- ------- ------- 83026-TC $3.00 ------- ------- ------- ------- ------- ------- 83030 $18.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 302
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 83030-26 $6.00 ------- ------- ------- ------- ------- ------- 83030-TC $12.00 ------- ------- ------- ------- ------- ------- 83033 $15.00 ------- ------- ------- ------- ------- ------- 83033-26 $4.00 ------- ------- ------- ------- ------- ------- 83033-TC $11.00 ------- ------- ------- ------- ------- ------- 83036 $15.00 ------- ------- ------- ------- ------- ------- 83036-26 $5.00 ------- ------- ------- ------- ------- ------- 83036-TC $10.00 ------- ------- ------- ------- ------- ------- 83045 $13.00 ------- ------- ------- ------- ------- ------- 83045-26 $4.00 ------- ------- ------- ------- ------- ------- 83045-TC $8.00 ------- ------- ------- ------- ------- ------- 83050 $16.00 ------- ------- ------- ------- ------- ------- 83050-26 $5.00 ------- ------- ------- ------- ------- ------- 83050-TC $11.00 ------- ------- ------- ------- ------- ------- 83051 $16.00 ------- ------- ------- ------- ------- ------- 83051-26 $5.00 ------- ------- ------- ------- ------- ------- 83051-TC $11.00 ------- ------- ------- ------- ------- ------- 83055 $13.00 ------- ------- ------- ------- ------- ------- 83055-26 $4.00 ------- ------- ------- ------- ------- ------- 83055-TC $8.00 ------- ------- ------- ------- ------- ------- 83060 $22.00 ------- ------- ------- ------- ------- ------- 83060-26 $6.00 ------- ------- ------- ------- ------- ------- 83060-TC $16.00 ------- ------- ------- ------- ------- ------- 83065 $18.00 ------- ------- ------- ------- ------- ------- 83065-26 $6.00 ------- ------- ------- ------- ------- ------- 83065-TC $12.00 ------- ------- ------- ------- ------- ------- 83068 $20.00 ------- ------- ------- ------- ------- ------- 83068-26 $5.00 ------- ------- ------- ------- ------- ------- 83068-TC $15.00 ------- ------- ------- ------- ------- ------- 83069 $11.00 ------- ------- ------- ------- ------- ------- 83069-26 $3.00 ------- ------- ------- ------- ------- ------- 83069-TC $7.00 ------- ------- ------- ------- ------- ------- 83070 $13.00 ------- ------- ------- ------- ------- ------- 83070-26 $4.00 ------- ------- ------- ------- ------- ------- 83070-TC $8.00 ------- ------- ------- ------- ------- ------- 83071 $18.00 ------- ------- ------- ------- ------- ------- 83071-26 $5.00 ------- ------- ------- ------- ------- ------- 83071-TC $13.00 ------- ------- ------- ------- ------- ------- 83080 $38.00 ------- ------- ------- ------- ------- ------- 83080-26 $11.00 ------- ------- ------- ------- ------- ------- 83080-TC $26.00 ------- ------- ------- ------- ------- ------- 83088 $59.00 ------- ------- ------- ------- ------- ------- 83088-26 $18.00 ------- ------- ------- ------- ------- ------- 83088-TC $41.00 ------- ------- ------- ------- ------- ------- 83090 $38.00 ------- ------- ------- ------- ------- ------- 83090-26 $13.00 ------- ------- ------- ------- ------- ------- 83090-TC $25.00 ------- ------- ------- ------- ------- ------- 83150 $49.00 ------- ------- ------- ------- ------- ------- 83150-26 $16.00 ------- ------- ------- ------- ------- ------- 83150-TC $33.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 303
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 83491 $37.00 ------- ------- ------- ------- ------- ------- 83491-26 $11.00 ------- ------- ------- ------- ------- ------- 83491-TC $25.00 ------- ------- ------- ------- ------- ------- 83497 $35.00 ------- ------- ------- ------- ------- ------- 83497-26 $11.00 ------- ------- ------- ------- ------- ------- 83497-TC $23.00 ------- ------- ------- ------- ------- ------- 83498 $62.00 ------- ------- ------- ------- ------- ------- 83498-26 $20.00 ------- ------- ------- ------- ------- ------- 83498-TC $41.00 ------- ------- ------- ------- ------- ------- 83499 $51.00 ------- ------- ------- ------- ------- ------- 83499-26 $15.00 ------- ------- ------- ------- ------- ------- 83499-TC $36.00 ------- ------- ------- ------- ------- ------- 83500 $69.00 ------- ------- ------- ------- ------- ------- 83500-26 $21.00 ------- ------- ------- ------- ------- ------- 83500-TC $45.00 ------- ------- ------- ------- ------- ------- 83505 $77.00 ------- ------- ------- ------- ------- ------- 83505-26 $21.00 ------- ------- ------- ------- ------- ------- 83505-TC $54.00 ------- ------- ------- ------- ------- ------- 83516 $26.00 ------- ------- ------- ------- ------- ------- 83516-26 $8.00 ------- ------- ------- ------- ------- ------- 83516-TC $18.00 ------- ------- ------- ------- ------- ------- 83518 $21.00 ------- ------- ------- ------- ------- ------- 83518-26 $7.00 ------- ------- ------- ------- ------- ------- 83518-TC $14.00 ------- ------- ------- ------- ------- ------- 83519 $21.00 ------- ------- ------- ------- ------- ------- 83519-26 $7.00 ------- ------- ------- ------- ------- ------- 83519-TC $14.00 ------- ------- ------- ------- ------- ------- 83520 $20.00 ------- ------- ------- ------- ------- ------- 83520-26 $6.00 ------- ------- ------- ------- ------- ------- 83520-TC $14.00 ------- ------- ------- ------- ------- ------- 83525 $31.00 ------- ------- ------- ------- ------- ------- 83525-26 $8.00 ------- ------- ------- ------- ------- ------- 83525-TC $21.00 ------- ------- ------- ------- ------- ------- 83527 $35.00 ------- ------- ------- ------- ------- ------- 83527-26 $11.00 ------- ------- ------- ------- ------- ------- 83527-TC $23.00 ------- ------- ------- ------- ------- ------- 83528 $43.00 ------- ------- ------- ------- ------- ------- 83528-26 $14.00 ------- ------- ------- ------- ------- ------- 83528-TC $29.00 ------- ------- ------- ------- ------- ------- 83540 $16.00 ------- ------- ------- ------- ------- ------- 83540-26 $3.00 ------- ------- ------- ------- ------- ------- 83540-TC $13.00 ------- ------- ------- ------- ------- ------- 83550 $20.00 ------- ------- ------- ------- ------- ------- 83550-26 $5.00 ------- ------- ------- ------- ------- ------- 83550-TC $15.00 ------- ------- ------- ------- ------- ------- 83570 $23.00 ------- ------- ------- ------- ------- ------- 83570-26 $7.00 ------- ------- ------- ------- ------- ------- 83570-TC $16.00 ------- ------- ------- ------- ------- ------- 83582 $34.00 ------- ------- ------- ------- ------- ------- 83582-26 $8.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 304
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 83582-TC $24.00 ------- ------- ------- ------- ------- ------- 83586 $38.00 ------- ------- ------- ------- ------- ------- 83586-26 $13.00 ------- ------- ------- ------- ------- ------- 83586-TC $24.00 ------- ------- ------- ------- ------- ------- 83593 $59.00 ------- ------- ------- ------- ------- ------- 83593-26 $18.00 ------- ------- ------- ------- ------- ------- 83593-TC $41.00 ------- ------- ------- ------- ------- ------- 83605 $19.00 ------- ------- ------- ------- ------- ------- 83605-26 $6.00 ------- ------- ------- ------- ------- ------- 83605-TC $13.00 ------- ------- ------- ------- ------- ------- 83615 $16.00 ------- ------- ------- ------- ------- ------- 83615-26 $5.00 ------- ------- ------- ------- ------- ------- 83615-TC $11.00 ------- ------- ------- ------- ------- ------- 83625 $23.00 ------- ------- ------- ------- ------- ------- 83625-26 $6.00 ------- ------- ------- ------- ------- ------- 83625-TC $17.00 ------- ------- ------- ------- ------- ------- 83632 $42.00 ------- ------- ------- ------- ------- ------- 83632-26 $14.00 ------- ------- ------- ------- ------- ------- 83632-TC $28.00 ------- ------- ------- ------- ------- ------- 83655 $31.00 ------- ------- ------- ------- ------- ------- 83655-26 $8.00 ------- ------- ------- ------- ------- ------- 83655-TC $21.00 ------- ------- ------- ------- ------- ------- 83670 $18.00 ------- ------- ------- ------- ------- ------- 83670-26 $5.00 ------- ------- ------- ------- ------- ------- 83670-TC $13.00 ------- ------- ------- ------- ------- ------- 83690 $18.00 ------- ------- ------- ------- ------- ------- 83690-26 $6.00 ------- ------- ------- ------- ------- ------- 83690-TC $12.00 ------- ------- ------- ------- ------- ------- 83718 $16.00 ------- ------- ------- ------- ------- ------- 83718-26 $5.00 ------- ------- ------- ------- ------- ------- 83718-TC $11.00 ------- ------- ------- ------- ------- ------- 83719 $42.00 ------- ------- ------- ------- ------- ------- 83719-26 $14.00 ------- ------- ------- ------- ------- ------- 83719-TC $28.00 ------- ------- ------- ------- ------- ------- 83721 $16.00 ------- ------- ------- ------- ------- ------- 83721-26 $5.00 ------- ------- ------- ------- ------- ------- 83721-TC $11.00 ------- ------- ------- ------- ------- ------- 83727 $43.00 ------- ------- ------- ------- ------- ------- 83727-26 $14.00 ------- ------- ------- ------- ------- ------- 83727-TC $29.00 ------- ------- ------- ------- ------- ------- 83735 $15.00 ------- ------- ------- ------- ------- ------- 83735-26 $5.00 ------- ------- ------- ------- ------- ------- 83735-TC $10.00 ------- ------- ------- ------- ------- ------- 83775 $17.00 ------- ------- ------- ------- ------- ------- 83775-26 $5.00 ------- ------- ------- ------- ------- ------- 83775-TC $12.00 ------- ------- ------- ------- ------- ------- 83785 $58.00 ------- ------- ------- ------- ------- ------- 83785-26 $17.00 ------- ------- ------- ------- ------- ------- 83785-TC $41.00 ------- ------- ------- ------- ------- ------- 83788 $39.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 305
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 83788-26 $13.00 ------- ------- ------- ------- ------- ------- 83788-TC $25.00 ------- ------- ------- ------- ------- ------- 83789 $39.00 ------- ------- ------- ------- ------- ------- 83789-26 $13.00 ------- ------- ------- ------- ------- ------- 83789-TC $25.00 ------- ------- ------- ------- ------- ------- 83805 $44.00 ------- ------- ------- ------- ------- ------- 83805-26 $15.00 ------- ------- ------- ------- ------- ------- 83805-TC $29.00 ------- ------- ------- ------- ------- ------- 83825 $34.00 ------- ------- ------- ------- ------- ------- 83825-26 $11.00 ------- ------- ------- ------- ------- ------- 83825-TC $22.00 ------- ------- ------- ------- ------- ------- 83835 $41.00 ------- ------- ------- ------- ------- ------- 83835-26 $12.00 ------- ------- ------- ------- ------- ------- 83835-TC $29.00 ------- ------- ------- ------- ------- ------- 83840 $42.00 ------- ------- ------- ------- ------- ------- 83840-26 $14.00 ------- ------- ------- ------- ------- ------- 83840-TC $28.00 ------- ------- ------- ------- ------- ------- 83857 $26.00 ------- ------- ------- ------- ------- ------- 83857-26 $8.00 ------- ------- ------- ------- ------- ------- 83857-TC $18.00 ------- ------- ------- ------- ------- ------- 83858 $37.00 ------- ------- ------- ------- ------- ------- 83858-26 $12.00 ------- ------- ------- ------- ------- ------- 83858-TC $24.00 ------- ------- ------- ------- ------- ------- 83864 $32.00 ------- ------- ------- ------- ------- ------- 83864-26 $8.00 ------- ------- ------- ------- ------- ------- 83864-TC $22.00 ------- ------- ------- ------- ------- ------- 83866 $26.00 ------- ------- ------- ------- ------- ------- 83866-26 $7.00 ------- ------- ------- ------- ------- ------- 83866-TC $19.00 ------- ------- ------- ------- ------- ------- 83872 $13.00 ------- ------- ------- ------- ------- ------- 83872-26 $4.00 ------- ------- ------- ------- ------- ------- 83872-TC $8.00 ------- ------- ------- ------- ------- ------- 83873 $54.00 ------- ------- ------- ------- ------- ------- 83873-26 $18.00 ------- ------- ------- ------- ------- ------- 83873-TC $36.00 ------- ------- ------- ------- ------- ------- 83874 $25.00 ------- ------- ------- ------- ------- ------- 83874-26 $8.00 ------- ------- ------- ------- ------- ------- 83874-TC $17.00 ------- ------- ------- ------- ------- ------- 83880 BR ------- ------- ------- ------- ------- ------- 83880-26 BR ------- ------- ------- ------- ------- ------- 83880-TC BR ------- ------- ------- ------- ------- ------- 83883 $11.00 ------- ------- ------- ------- ------- ------- 83883-26 $3.00 ------- ------- ------- ------- ------- ------- 83883-TC $7.00 ------- ------- ------- ------- ------- ------- 83885 $45.00 ------- ------- ------- ------- ------- ------- 83885-26 $14.00 ------- ------- ------- ------- ------- ------- 83885-TC $32.00 ------- ------- ------- ------- ------- ------- 83887 $58.00 ------- ------- ------- ------- ------- ------- 83887-26 $17.00 ------- ------- ------- ------- ------- ------- 83887-TC $41.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 306
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 83890 $7.00 ------- ------- ------- ------- ------- ------- 83890-26 $2.00 ------- ------- ------- ------- ------- ------- 83890-TC $5.00 ------- ------- ------- ------- ------- ------- 83891 $7.00 ------- ------- ------- ------- ------- ------- 83891-26 $2.00 ------- ------- ------- ------- ------- ------- 83891-TC $5.00 ------- ------- ------- ------- ------- ------- 83892 $7.00 ------- ------- ------- ------- ------- ------- 83892-26 $2.00 ------- ------- ------- ------- ------- ------- 83892-TC $5.00 ------- ------- ------- ------- ------- ------- 83893 $7.00 ------- ------- ------- ------- ------- ------- 83893-26 $2.00 ------- ------- ------- ------- ------- ------- 83893-TC $5.00 ------- ------- ------- ------- ------- ------- 83894 $7.00 ------- ------- ------- ------- ------- ------- 83894-26 $2.00 ------- ------- ------- ------- ------- ------- 83894-TC $5.00 ------- ------- ------- ------- ------- ------- 83896 $7.00 ------- ------- ------- ------- ------- ------- 83896-26 $2.00 ------- ------- ------- ------- ------- ------- 83896-TC $5.00 ------- ------- ------- ------- ------- ------- 83897 $9.00 ------- ------- ------- ------- ------- ------- 83897-26 $3.00 ------- ------- ------- ------- ------- ------- 83897-TC $5.00 ------- ------- ------- ------- ------- ------- 83898 $43.00 ------- ------- ------- ------- ------- ------- 83898-26 $14.00 ------- ------- ------- ------- ------- ------- 83898-TC $29.00 ------- ------- ------- ------- ------- ------- 83901 $44.00 ------- ------- ------- ------- ------- ------- 83901-26 $14.00 ------- ------- ------- ------- ------- ------- 83901-TC $29.00 ------- ------- ------- ------- ------- ------- 83902 $38.00 ------- ------- ------- ------- ------- ------- 83902-26 $13.00 ------- ------- ------- ------- ------- ------- 83902-TC $24.00 ------- ------- ------- ------- ------- ------- 83903 $44.00 ------- ------- ------- ------- ------- ------- 83903-26 $14.00 ------- ------- ------- ------- ------- ------- 83903-TC $29.00 ------- ------- ------- ------- ------- ------- 83904 $44.00 ------- ------- ------- ------- ------- ------- 83904-26 $14.00 ------- ------- ------- ------- ------- ------- 83904-TC $29.00 ------- ------- ------- ------- ------- ------- 83905 $44.00 ------- ------- ------- ------- ------- ------- 83905-26 $14.00 ------- ------- ------- ------- ------- ------- 83905-TC $29.00 ------- ------- ------- ------- ------- ------- 83906 $44.00 ------- ------- ------- ------- ------- ------- 83906-26 $14.00 ------- ------- ------- ------- ------- ------- 83906-TC $29.00 ------- ------- ------- ------- ------- ------- 83912 $39.00 ------- ------- ------- ------- ------- ------- 83912-26 $11.00 $19.00 $20.00 $20.00 $19.00 $20.00 $20.00 83912-TC $28.00 ------- ------- ------- ------- ------- ------- 83915 $31.00 ------- ------- ------- ------- ------- ------- 83915-26 $10.00 ------- ------- ------- ------- ------- ------- 83915-TC $20.00 ------- ------- ------- ------- ------- ------- 83916 $54.00 ------- ------- ------- ------- ------- ------- 83916-26 $18.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 307
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 83916-TC $36.00 ------- ------- ------- ------- ------- ------- 83918 $41.00 ------- ------- ------- ------- ------- ------- 83918-26 $12.00 ------- ------- ------- ------- ------- ------- 83918-TC $29.00 ------- ------- ------- ------- ------- ------- 83919 $42.00 ------- ------- ------- ------- ------- ------- 83919-26 $12.00 ------- ------- ------- ------- ------- ------- 83919-TC $29.00 ------- ------- ------- ------- ------- ------- 83921 $37.00 ------- ------- ------- ------- ------- ------- 83921-26 $12.00 ------- ------- ------- ------- ------- ------- 83921-TC $25.00 ------- ------- ------- ------- ------- ------- 83925 $13.00 ------- ------- ------- ------- ------- ------- 83925-26 $3.00 ------- ------- ------- ------- ------- ------- 83925-TC $9.00 ------- ------- ------- ------- ------- ------- 83930 $11.00 ------- ------- ------- ------- ------- ------- 83930-26 $3.00 ------- ------- ------- ------- ------- ------- 83930-TC $7.00 ------- ------- ------- ------- ------- ------- 83935 $17.00 ------- ------- ------- ------- ------- ------- 83935-26 $5.00 ------- ------- ------- ------- ------- ------- 83935-TC $12.00 ------- ------- ------- ------- ------- ------- 83937 $29.00 ------- ------- ------- ------- ------- ------- 83937-26 $10.00 ------- ------- ------- ------- ------- ------- 83937-TC $19.00 ------- ------- ------- ------- ------- ------- 83945 $32.00 ------- ------- ------- ------- ------- ------- 83945-26 $11.00 ------- ------- ------- ------- ------- ------- 83945-TC $20.00 ------- ------- ------- ------- ------- ------- 83950 BR ------- ------- ------- ------- ------- ------- 83950-26 BR ------- ------- ------- ------- ------- ------- 83950-TC BR ------- ------- ------- ------- ------- ------- 83970 $94.00 ------- ------- ------- ------- ------- ------- 83970-26 $31.00 ------- ------- ------- ------- ------- ------- 83970-TC $62.00 ------- ------- ------- ------- ------- ------- 83986 $8.00 ------- ------- ------- ------- ------- ------- 83986-26 $3.00 ------- ------- ------- ------- ------- ------- 83986-TC $5.00 ------- ------- ------- ------- ------- ------- 83992 $40.00 ------- ------- ------- ------- ------- ------- 83992-26 $12.00 ------- ------- ------- ------- ------- ------- 83992-TC $28.00 ------- ------- ------- ------- ------- ------- 84022 $41.00 ------- ------- ------- ------- ------- ------- 84022-26 $13.00 ------- ------- ------- ------- ------- ------- 84022-TC $28.00 ------- ------- ------- ------- ------- ------- 84030 $11.00 ------- ------- ------- ------- ------- ------- 84030-26 $3.00 ------- ------- ------- ------- ------- ------- 84030-TC $7.00 ------- ------- ------- ------- ------- ------- 84035 $12.00 ------- ------- ------- ------- ------- ------- 84035-26 $3.00 ------- ------- ------- ------- ------- ------- 84035-TC $8.00 ------- ------- ------- ------- ------- ------- 84060 $20.00 ------- ------- ------- ------- ------- ------- 84060-26 $6.00 ------- ------- ------- ------- ------- ------- 84060-TC $14.00 ------- ------- ------- ------- ------- ------- 84061 $14.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 308
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 84061-26 $4.00 ------- ------- ------- ------- ------- ------- 84061-TC $10.00 ------- ------- ------- ------- ------- ------- 84066 $18.00 ------- ------- ------- ------- ------- ------- 84066-26 $6.00 ------- ------- ------- ------- ------- ------- 84066-TC $12.00 ------- ------- ------- ------- ------- ------- 84075 $12.00 ------- ------- ------- ------- ------- ------- 84075-26 $3.00 ------- ------- ------- ------- ------- ------- 84075-TC $8.00 ------- ------- ------- ------- ------- ------- 84078 $19.00 ------- ------- ------- ------- ------- ------- 84078-26 $5.00 ------- ------- ------- ------- ------- ------- 84078-TC $14.00 ------- ------- ------- ------- ------- ------- 84080 $36.00 ------- ------- ------- ------- ------- ------- 84080-26 $11.00 ------- ------- ------- ------- ------- ------- 84080-TC $24.00 ------- ------- ------- ------- ------- ------- 84081 $45.00 ------- ------- ------- ------- ------- ------- 84081-26 $15.00 ------- ------- ------- ------- ------- ------- 84081-TC $31.00 ------- ------- ------- ------- ------- ------- 84085 $15.00 ------- ------- ------- ------- ------- ------- 84085-26 $5.00 ------- ------- ------- ------- ------- ------- 84085-TC $10.00 ------- ------- ------- ------- ------- ------- 84087 $25.00 ------- ------- ------- ------- ------- ------- 84087-26 $7.00 ------- ------- ------- ------- ------- ------- 84087-TC $18.00 ------- ------- ------- ------- ------- ------- 84100 $11.00 ------- ------- ------- ------- ------- ------- 84100-26 $3.00 ------- ------- ------- ------- ------- ------- 84100-TC $7.00 ------- ------- ------- ------- ------- ------- 84105 $11.00 ------- ------- ------- ------- ------- ------- 84105-26 $3.00 ------- ------- ------- ------- ------- ------- 84105-TC $7.00 ------- ------- ------- ------- ------- ------- 84106 $10.00 ------- ------- ------- ------- ------- ------- 84106-26 $2.00 ------- ------- ------- ------- ------- ------- 84106-TC $7.00 ------- ------- ------- ------- ------- ------- 84110 $21.00 ------- ------- ------- ------- ------- ------- 84110-26 $6.00 ------- ------- ------- ------- ------- ------- 84110-TC $15.00 ------- ------- ------- ------- ------- ------- 84119 $21.00 ------- ------- ------- ------- ------- ------- 84119-26 $6.00 ------- ------- ------- ------- ------- ------- 84119-TC $15.00 ------- ------- ------- ------- ------- ------- 84120 $38.00 ------- ------- ------- ------- ------- ------- 84120-26 $11.00 ------- ------- ------- ------- ------- ------- 84120-TC $26.00 ------- ------- ------- ------- ------- ------- 84126 $71.00 ------- ------- ------- ------- ------- ------- 84126-26 $20.00 ------- ------- ------- ------- ------- ------- 84126-TC $49.00 ------- ------- ------- ------- ------- ------- 84127 $18.00 ------- ------- ------- ------- ------- ------- 84127-26 $6.00 ------- ------- ------- ------- ------- ------- 84127-TC $12.00 ------- ------- ------- ------- ------- ------- 84132 $11.00 ------- ------- ------- ------- ------- ------- 84132-26 $3.00 ------- ------- ------- ------- ------- ------- 84132-TC $7.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 309
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 84133 $11.00 ------- ------- ------- ------- ------- ------- 84133-26 $3.00 ------- ------- ------- ------- ------- ------- 84133-TC $7.00 ------- ------- ------- ------- ------- ------- 84134 $24.00 ------- ------- ------- ------- ------- ------- 84134-26 $7.00 ------- ------- ------- ------- ------- ------- 84134-TC $17.00 ------- ------- ------- ------- ------- ------- 84135 $57.00 ------- ------- ------- ------- ------- ------- 84135-26 $19.00 ------- ------- ------- ------- ------- ------- 84135-TC $38.00 ------- ------- ------- ------- ------- ------- 84138 $56.00 ------- ------- ------- ------- ------- ------- 84138-26 $18.00 ------- ------- ------- ------- ------- ------- 84138-TC $38.00 ------- ------- ------- ------- ------- ------- 84140 $41.00 ------- ------- ------- ------- ------- ------- 84140-26 $8.00 ------- ------- ------- ------- ------- ------- 84140-TC $33.00 ------- ------- ------- ------- ------- ------- 84143 $62.00 ------- ------- ------- ------- ------- ------- 84143-26 $20.00 ------- ------- ------- ------- ------- ------- 84143-TC $41.00 ------- ------- ------- ------- ------- ------- 84144 $38.00 ------- ------- ------- ------- ------- ------- 84144-26 $7.00 ------- ------- ------- ------- ------- ------- 84144-TC $31.00 ------- ------- ------- ------- ------- ------- 84146 $53.00 ------- ------- ------- ------- ------- ------- 84146-26 $17.00 ------- ------- ------- ------- ------- ------- 84146-TC $36.00 ------- ------- ------- ------- ------- ------- 84150 $69.00 ------- ------- ------- ------- ------- ------- 84150-26 $20.00 ------- ------- ------- ------- ------- ------- 84150-TC $47.00 ------- ------- ------- ------- ------- ------- 84152 $42.00 ------- ------- ------- ------- ------- ------- 84152-26 $14.00 ------- ------- ------- ------- ------- ------- 84152-TC $27.00 ------- ------- ------- ------- ------- ------- 84153 $33.00 ------- ------- ------- ------- ------- ------- 84153-26 $11.00 ------- ------- ------- ------- ------- ------- 84153-TC $21.00 ------- ------- ------- ------- ------- ------- 84154 $33.00 ------- ------- ------- ------- ------- ------- 84154-26 $11.00 ------- ------- ------- ------- ------- ------- 84154-TC $21.00 ------- ------- ------- ------- ------- ------- 84155 $12.00 ------- ------- ------- ------- ------- ------- 84155-26 $4.00 ------- ------- ------- ------- ------- ------- 84155-TC $7.00 ------- ------- ------- ------- ------- ------- 84160 $5.00 ------- ------- ------- ------- ------- ------- 84160-26 $2.00 ------- ------- ------- ------- ------- ------- 84160-TC $2.00 ------- ------- ------- ------- ------- ------- 84165 $24.00 ------- ------- ------- ------- ------- ------- 84165-26 $8.00 $20.00 $20.00 $21.00 $20.00 $20.00 $21.00 84165-TC $16.00 ------- ------- ------- ------- ------- ------- 84166 ------- BR BR BR BR BR BR 84166-26 ------- $20.00 $20.00 $21.00 $20.00 $20.00 $21.00 84166-TC ------- BR BR BR BR BR BR 84181 $29.00 ------- ------- ------- ------- ------- ------- 84181-26 $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
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 84181-TC $19.00 ------- ------- ------- ------- ------- ------- 84182 $33.00 ------- ------- ------- ------- ------- ------- 84182-26 $11.00 $21.00 $21.00 $22.00 $21.00 $21.00 $22.00 84182-TC $21.00 ------- ------- ------- ------- ------- ------- 84202 $39.00 ------- ------- ------- ------- ------- ------- 84202-26 $13.00 ------- ------- ------- ------- ------- ------- 84202-TC $25.00 ------- ------- ------- ------- ------- ------- 84203 $16.00 ------- ------- ------- ------- ------- ------- 84203-26 $5.00 ------- ------- ------- ------- ------- ------- 84203-TC $11.00 ------- ------- ------- ------- ------- ------- 84206 $32.00 ------- ------- ------- ------- ------- ------- 84206-26 $10.00 ------- ------- ------- ------- ------- ------- 84206-TC $21.00 ------- ------- ------- ------- ------- ------- 84207 $54.00 ------- ------- ------- ------- ------- ------- 84207-26 $16.00 ------- ------- ------- ------- ------- ------- 84207-TC $38.00 ------- ------- ------- ------- ------- ------- 84210 $24.00 ------- ------- ------- ------- ------- ------- 84210-26 $10.00 ------- ------- ------- ------- ------- ------- 84210-TC $15.00 ------- ------- ------- ------- ------- ------- 84220 $25.00 ------- ------- ------- ------- ------- ------- 84220-26 $8.00 ------- ------- ------- ------- ------- ------- 84220-TC $17.00 ------- ------- ------- ------- ------- ------- 84228 $32.00 ------- ------- ------- ------- ------- ------- 84228-26 $10.00 ------- ------- ------- ------- ------- ------- 84228-TC $21.00 ------- ------- ------- ------- ------- ------- 84233 $116.00 ------- ------- ------- ------- ------- ------- 84233-26 $35.00 ------- ------- ------- ------- ------- ------- 84233-TC $81.00 ------- ------- ------- ------- ------- ------- 84234 $116.00 ------- ------- ------- ------- ------- ------- 84234-26 $35.00 ------- ------- ------- ------- ------- ------- 84234-TC $81.00 ------- ------- ------- ------- ------- ------- 84235 $114.00 ------- ------- ------- ------- ------- ------- 84235-26 $34.00 ------- ------- ------- ------- ------- ------- 84235-TC $80.00 ------- ------- ------- ------- ------- ------- 84238 $97.00 ------- ------- ------- ------- ------- ------- 84238-26 $32.00 ------- ------- ------- ------- ------- ------- 84238-TC $65.00 ------- ------- ------- ------- ------- ------- 84244 $47.00 ------- ------- ------- ------- ------- ------- 84244-26 $15.00 ------- ------- ------- ------- ------- ------- 84244-TC $32.00 ------- ------- ------- ------- ------- ------- 84252 $47.00 ------- ------- ------- ------- ------- ------- 84252-26 $14.00 ------- ------- ------- ------- ------- ------- 84252-TC $33.00 ------- ------- ------- ------- ------- ------- 84255 $58.00 ------- ------- ------- ------- ------- ------- 84255-26 $17.00 ------- ------- ------- ------- ------- ------- 84255-TC $41.00 ------- ------- ------- ------- ------- ------- 84260 $54.00 ------- ------- ------- ------- ------- ------- 84260-26 $16.00 ------- ------- ------- ------- ------- ------- 84260-TC $38.00 ------- ------- ------- ------- ------- ------- 84270 $36.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 311
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 84270-26 $11.00 ------- ------- ------- ------- ------- ------- 84270-TC $24.00 ------- ------- ------- ------- ------- ------- 84275 $37.00 ------- ------- ------- ------- ------- ------- 84275-26 $11.00 ------- ------- ------- ------- ------- ------- 84275-TC $25.00 ------- ------- ------- ------- ------- ------- 84285 $59.00 ------- ------- ------- ------- ------- ------- 84285-26 $17.00 ------- ------- ------- ------- ------- ------- 84285-TC $42.00 ------- ------- ------- ------- ------- ------- 84295 $10.00 ------- ------- ------- ------- ------- ------- 84295-26 $3.00 ------- ------- ------- ------- ------- ------- 84295-TC $6.00 ------- ------- ------- ------- ------- ------- 84300 $10.00 ------- ------- ------- ------- ------- ------- 84300-26 $3.00 ------- ------- ------- ------- ------- ------- 84300-TC $6.00 ------- ------- ------- ------- ------- ------- 84302 BR ------- ------- ------- ------- ------- ------- 84302-26 BR ------- ------- ------- ------- ------- ------- 84302-TC BR ------- ------- ------- ------- ------- ------- 84305 $34.00 ------- ------- ------- ------- ------- ------- 84305-26 $11.00 ------- ------- ------- ------- ------- ------- 84305-TC $22.00 ------- ------- ------- ------- ------- ------- 84307 $26.00 ------- ------- ------- ------- ------- ------- 84307-26 $8.00 ------- ------- ------- ------- ------- ------- 84307-TC $18.00 ------- ------- ------- ------- ------- ------- 84311 $11.00 ------- ------- ------- ------- ------- ------- 84311-26 $3.00 ------- ------- ------- ------- ------- ------- 84311-TC $7.00 ------- ------- ------- ------- ------- ------- 84315 $5.00 ------- ------- ------- ------- ------- ------- 84315-26 $2.00 ------- ------- ------- ------- ------- ------- 84315-TC $3.00 ------- ------- ------- ------- ------- ------- 84375 $37.00 ------- ------- ------- ------- ------- ------- 84375-26 $11.00 ------- ------- ------- ------- ------- ------- 84375-TC $25.00 ------- ------- ------- ------- ------- ------- 84376 $10.00 ------- ------- ------- ------- ------- ------- 84376-26 $3.00 ------- ------- ------- ------- ------- ------- 84376-TC $7.00 ------- ------- ------- ------- ------- ------- 84377 $10.00 ------- ------- ------- ------- ------- ------- 84377-26 $3.00 ------- ------- ------- ------- ------- ------- 84377-TC $7.00 ------- ------- ------- ------- ------- ------- 84378 $25.00 ------- ------- ------- ------- ------- ------- 84378-26 $8.00 ------- ------- ------- ------- ------- ------- 84378-TC $17.00 ------- ------- ------- ------- ------- ------- 84379 $25.00 ------- ------- ------- ------- ------- ------- 84379-26 $8.00 ------- ------- ------- ------- ------- ------- 84379-TC $17.00 ------- ------- ------- ------- ------- ------- 84392 $8.00 ------- ------- ------- ------- ------- ------- 84392-26 $2.00 ------- ------- ------- ------- ------- ------- 84392-TC $6.00 ------- ------- ------- ------- ------- ------- 84402 $72.00 ------- ------- ------- ------- ------- ------- 84402-26 $21.00 ------- ------- ------- ------- ------- ------- 84402-TC $49.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 312
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 84403 $67.00 ------- ------- ------- ------- ------- ------- 84403-26 $19.00 ------- ------- ------- ------- ------- ------- 84403-TC $45.00 ------- ------- ------- ------- ------- ------- 84425 $54.00 ------- ------- ------- ------- ------- ------- 84425-26 $17.00 ------- ------- ------- ------- ------- ------- 84425-TC $37.00 ------- ------- ------- ------- ------- ------- 84430 $31.00 ------- ------- ------- ------- ------- ------- 84430-26 $10.00 ------- ------- ------- ------- ------- ------- 84430-TC $20.00 ------- ------- ------- ------- ------- ------- 84432 $28.00 ------- ------- ------- ------- ------- ------- 84432-26 $8.00 ------- ------- ------- ------- ------- ------- 84432-TC $19.00 ------- ------- ------- ------- ------- ------- 84436 $14.00 ------- ------- ------- ------- ------- ------- 84436-26 $3.00 ------- ------- ------- ------- ------- ------- 84436-TC $11.00 ------- ------- ------- ------- ------- ------- 84437 $13.00 ------- ------- ------- ------- ------- ------- 84437-26 $4.00 ------- ------- ------- ------- ------- ------- 84437-TC $8.00 ------- ------- ------- ------- ------- ------- 84439 $16.00 ------- ------- ------- ------- ------- ------- 84439-26 $4.00 ------- ------- ------- ------- ------- ------- 84439-TC $12.00 ------- ------- ------- ------- ------- ------- 84442 $25.00 ------- ------- ------- ------- ------- ------- 84442-26 $6.00 ------- ------- ------- ------- ------- ------- 84442-TC $19.00 ------- ------- ------- ------- ------- ------- 84443 $32.00 ------- ------- ------- ------- ------- ------- 84443-26 $7.00 ------- ------- ------- ------- ------- ------- 84443-TC $23.00 ------- ------- ------- ------- ------- ------- 84445 $98.00 ------- ------- ------- ------- ------- ------- 84445-26 $29.00 ------- ------- ------- ------- ------- ------- 84445-TC $69.00 ------- ------- ------- ------- ------- ------- 84446 $35.00 ------- ------- ------- ------- ------- ------- 84446-26 $11.00 ------- ------- ------- ------- ------- ------- 84446-TC $23.00 ------- ------- ------- ------- ------- ------- 84449 $38.00 ------- ------- ------- ------- ------- ------- 84449-26 $13.00 ------- ------- ------- ------- ------- ------- 84449-TC $24.00 ------- ------- ------- ------- ------- ------- 84450 $11.00 ------- ------- ------- ------- ------- ------- 84450-26 $3.00 ------- ------- ------- ------- ------- ------- 84450-TC $7.00 ------- ------- ------- ------- ------- ------- 84460 $13.00 ------- ------- ------- ------- ------- ------- 84460-26 $4.00 ------- ------- ------- ------- ------- ------- 84460-TC $8.00 ------- ------- ------- ------- ------- ------- 84466 $22.00 ------- ------- ------- ------- ------- ------- 84466-26 $7.00 ------- ------- ------- ------- ------- ------- 84466-TC $15.00 ------- ------- ------- ------- ------- ------- 84478 $12.00 ------- ------- ------- ------- ------- ------- 84478-26 $3.00 ------- ------- ------- ------- ------- ------- 84478-TC $8.00 ------- ------- ------- ------- ------- ------- 84479 $15.00 ------- ------- ------- ------- ------- ------- 84479-26 $5.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 313
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 84479-TC $10.00 ------- ------- ------- ------- ------- ------- 84480 $20.00 ------- ------- ------- ------- ------- ------- 84480-26 $6.00 ------- ------- ------- ------- ------- ------- 84480-TC $14.00 ------- ------- ------- ------- ------- ------- 84481 $33.00 ------- ------- ------- ------- ------- ------- 84481-26 $10.00 ------- ------- ------- ------- ------- ------- 84481-TC $22.00 ------- ------- ------- ------- ------- ------- 84482 $45.00 ------- ------- ------- ------- ------- ------- 84482-26 $15.00 ------- ------- ------- ------- ------- ------- 84482-TC $31.00 ------- ------- ------- ------- ------- ------- 84484 $21.00 ------- ------- ------- ------- ------- ------- 84484-26 $6.00 ------- ------- ------- ------- ------- ------- 84484-TC $15.00 ------- ------- ------- ------- ------- ------- 84485 $15.00 ------- ------- ------- ------- ------- ------- 84485-26 $4.00 ------- ------- ------- ------- ------- ------- 84485-TC $11.00 ------- ------- ------- ------- ------- ------- 84488 $15.00 ------- ------- ------- ------- ------- ------- 84488-26 $4.00 ------- ------- ------- ------- ------- ------- 84488-TC $11.00 ------- ------- ------- ------- ------- ------- 84490 $15.00 ------- ------- ------- ------- ------- ------- 84490-26 $4.00 ------- ------- ------- ------- ------- ------- 84490-TC $11.00 ------- ------- ------- ------- ------- ------- 84510 $26.00 ------- ------- ------- ------- ------- ------- 84510-26 $8.00 ------- ------- ------- ------- ------- ------- 84510-TC $18.00 ------- ------- ------- ------- ------- ------- 84512 $17.00 ------- ------- ------- ------- ------- ------- 84512-26 $5.00 ------- ------- ------- ------- ------- ------- 84512-TC $12.00 ------- ------- ------- ------- ------- ------- 84520 $12.00 ------- ------- ------- ------- ------- ------- 84520-26 $3.00 ------- ------- ------- ------- ------- ------- 84520-TC $8.00 ------- ------- ------- ------- ------- ------- 84525 $7.00 ------- ------- ------- ------- ------- ------- 84525-26 $2.00 ------- ------- ------- ------- ------- ------- 84525-TC $5.00 ------- ------- ------- ------- ------- ------- 84540 $13.00 ------- ------- ------- ------- ------- ------- 84540-26 $4.00 ------- ------- ------- ------- ------- ------- 84540-TC $8.00 ------- ------- ------- ------- ------- ------- 84545 $18.00 ------- ------- ------- ------- ------- ------- 84545-26 $5.00 ------- ------- ------- ------- ------- ------- 84545-TC $13.00 ------- ------- ------- ------- ------- ------- 84550 $12.00 ------- ------- ------- ------- ------- ------- 84550-26 $4.00 ------- ------- ------- ------- ------- ------- 84550-TC $7.00 ------- ------- ------- ------- ------- ------- 84560 $12.00 ------- ------- ------- ------- ------- ------- 84560-26 $3.00 ------- ------- ------- ------- ------- ------- 84560-TC $8.00 ------- ------- ------- ------- ------- ------- 84577 $34.00 ------- ------- ------- ------- ------- ------- 84577-26 $11.00 ------- ------- ------- ------- ------- ------- 84577-TC $22.00 ------- ------- ------- ------- ------- ------- 84578 $7.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 314
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 84578-26 $2.00 ------- ------- ------- ------- ------- ------- 84578-TC $5.00 ------- ------- ------- ------- ------- ------- 84580 $17.00 ------- ------- ------- ------- ------- ------- 84580-26 $5.00 ------- ------- ------- ------- ------- ------- 84580-TC $12.00 ------- ------- ------- ------- ------- ------- 84583 $11.00 ------- ------- ------- ------- ------- ------- 84583-26 $3.00 ------- ------- ------- ------- ------- ------- 84583-TC $7.00 ------- ------- ------- ------- ------- ------- 84585 $36.00 ------- ------- ------- ------- ------- ------- 84585-26 $11.00 ------- ------- ------- ------- ------- ------- 84585-TC $24.00 ------- ------- ------- ------- ------- ------- 84586 $42.00 ------- ------- ------- ------- ------- ------- 84586-26 $14.00 ------- ------- ------- ------- ------- ------- 84586-TC $27.00 ------- ------- ------- ------- ------- ------- 84588 $73.00 ------- ------- ------- ------- ------- ------- 84588-26 $23.00 ------- ------- ------- ------- ------- ------- 84588-TC $47.00 ------- ------- ------- ------- ------- ------- 84590 $33.00 ------- ------- ------- ------- ------- ------- 84590-26 $11.00 ------- ------- ------- ------- ------- ------- 84590-TC $21.00 ------- ------- ------- ------- ------- ------- 84591 $26.00 ------- ------- ------- ------- ------- ------- 84591-26 $9.00 ------- ------- ------- ------- ------- ------- 84591-TC $18.00 ------- ------- ------- ------- ------- ------- 84597 $37.00 ------- ------- ------- ------- ------- ------- 84597-26 $11.00 ------- ------- ------- ------- ------- ------- 84597-TC $25.00 ------- ------- ------- ------- ------- ------- 84600 $43.00 ------- ------- ------- ------- ------- ------- 84600-26 $13.00 ------- ------- ------- ------- ------- ------- 84600-TC $31.00 ------- ------- ------- ------- ------- ------- 84620 $29.00 ------- ------- ------- ------- ------- ------- 84620-26 $8.00 ------- ------- ------- ------- ------- ------- 84620-TC $20.00 ------- ------- ------- ------- ------- ------- 84630 $26.00 ------- ------- ------- ------- ------- ------- 84630-26 $8.00 ------- ------- ------- ------- ------- ------- 84630-TC $18.00 ------- ------- ------- ------- ------- ------- 84681 $52.00 ------- ------- ------- ------- ------- ------- 84681-26 $17.00 ------- ------- ------- ------- ------- ------- 84681-TC $35.00 ------- ------- ------- ------- ------- ------- 84702 $38.00 ------- ------- ------- ------- ------- ------- 84702-26 $11.00 ------- ------- ------- ------- ------- ------- 84702-TC $26.00 ------- ------- ------- ------- ------- ------- 84703 $22.00 ------- ------- ------- ------- ------- ------- 84703-26 $6.00 ------- ------- ------- ------- ------- ------- 84703-TC $15.00 ------- ------- ------- ------- ------- ------- 84830 $17.00 ------- ------- ------- ------- ------- ------- 84830-26 $5.00 ------- ------- ------- ------- ------- ------- 84830-TC $12.00 ------- ------- ------- ------- ------- ------- 84999 BR ------- ------- ------- ------- ------- ------- 84999-26 BR ------- ------- ------- ------- ------- ------- 84999-TC BR ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 315
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 85002 $10.00 ------- ------- ------- ------- ------- ------- 85002-26 $3.00 ------- ------- ------- ------- ------- ------- 85002-TC $6.00 ------- ------- ------- ------- ------- ------- 85004 BR ------- ------- ------- ------- ------- ------- 85004-26 BR ------- ------- ------- ------- ------- ------- 85004-TC BR ------- ------- ------- ------- ------- ------- 85007 $6.00 ------- ------- ------- ------- ------- ------- 85007-26 $3.00 ------- ------- ------- ------- ------- ------- 85007-TC $4.00 ------- ------- ------- ------- ------- ------- 85008 $5.00 ------- ------- ------- ------- ------- ------- 85008-26 $2.00 ------- ------- ------- ------- ------- ------- 85008-TC $3.00 ------- ------- ------- ------- ------- ------- 85009 $8.00 ------- ------- ------- ------- ------- ------- 85009-26 $3.00 ------- ------- ------- ------- ------- ------- 85009-TC $5.00 ------- ------- ------- ------- ------- ------- 85013 $3.00 ------- ------- ------- ------- ------- ------- 85013-26 $1.00 ------- ------- ------- ------- ------- ------- 85013-TC $2.00 ------- ------- ------- ------- ------- ------- 85014 $4.00 ------- ------- ------- ------- ------- ------- 85014-26 $1.00 ------- ------- ------- ------- ------- ------- 85014-TC $3.00 ------- ------- ------- ------- ------- ------- 85018 $5.00 ------- ------- ------- ------- ------- ------- 85018-26 $2.00 ------- ------- ------- ------- ------- ------- 85018-TC $3.00 ------- ------- ------- ------- ------- ------- 85025 $20.00 ------- ------- ------- ------- ------- ------- 85025-26 $6.00 ------- ------- ------- ------- ------- ------- 85025-TC $14.00 ------- ------- ------- ------- ------- ------- 85027 $15.00 ------- ------- ------- ------- ------- ------- 85027-26 $5.00 ------- ------- ------- ------- ------- ------- 85027-TC $10.00 ------- ------- ------- ------- ------- ------- 85032 BR ------- ------- ------- ------- ------- ------- 85032-26 BR ------- ------- ------- ------- ------- ------- 85032-TC BR ------- ------- ------- ------- ------- ------- 85041 $7.00 ------- ------- ------- ------- ------- ------- 85041-26 $3.00 ------- ------- ------- ------- ------- ------- 85041-TC $4.00 ------- ------- ------- ------- ------- ------- 85044 $10.00 ------- ------- ------- ------- ------- ------- 85044-26 $3.00 ------- ------- ------- ------- ------- ------- 85044-TC $6.00 ------- ------- ------- ------- ------- ------- 85045 $6.00 ------- ------- ------- ------- ------- ------- 85045-26 $2.00 ------- ------- ------- ------- ------- ------- 85045-TC $4.00 ------- ------- ------- ------- ------- ------- 85046 $13.00 ------- ------- ------- ------- ------- ------- 85046-26 $4.00 ------- ------- ------- ------- ------- ------- 85046-TC $9.00 ------- ------- ------- ------- ------- ------- 85048 $7.00 ------- ------- ------- ------- ------- ------- 85048-26 $3.00 ------- ------- ------- ------- ------- ------- 85048-TC $4.00 ------- ------- ------- ------- ------- ------- 85049 BR ------- ------- ------- ------- ------- ------- 85049-26 BR ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 316
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 85049-TC BR ------- ------- ------- ------- ------- ------- 85060 $25.00 $24.00 $25.00 $26.00 $24.00 $25.00 $26.00 85060-26 $7.00 ------- ------- ------- ------- ------- ------- 85060-TC $18.00 ------- ------- ------- ------- ------- ------- 85097 $59.00 $99.00 $105.00 $109.00 $51.00 $52.00 $54.00 85097-26 $59.00 ------- ------- ------- ------- ------- ------- 85097-TC BR ------- ------- ------- ------- ------- ------- 85130 $19.00 ------- ------- ------- ------- ------- ------- 85130-26 $6.00 ------- ------- ------- ------- ------- ------- 85130-TC $13.00 ------- ------- ------- ------- ------- ------- 85170 $7.00 ------- ------- ------- ------- ------- ------- 85170-26 $2.00 ------- ------- ------- ------- ------- ------- 85170-TC $5.00 ------- ------- ------- ------- ------- ------- 85175 $10.00 ------- ------- ------- ------- ------- ------- 85175-26 $3.00 ------- ------- ------- ------- ------- ------- 85175-TC $6.00 ------- ------- ------- ------- ------- ------- 85210 $31.00 ------- ------- ------- ------- ------- ------- 85210-26 $8.00 ------- ------- ------- ------- ------- ------- 85210-TC $21.00 ------- ------- ------- ------- ------- ------- 85220 $47.00 ------- ------- ------- ------- ------- ------- 85220-26 $15.00 ------- ------- ------- ------- ------- ------- 85220-TC $32.00 ------- ------- ------- ------- ------- ------- 85230 $47.00 ------- ------- ------- ------- ------- ------- 85230-26 $14.00 ------- ------- ------- ------- ------- ------- 85230-TC $33.00 ------- ------- ------- ------- ------- ------- 85240 $48.00 ------- ------- ------- ------- ------- ------- 85240-26 $15.00 ------- ------- ------- ------- ------- ------- 85240-TC $33.00 ------- ------- ------- ------- ------- ------- 85244 $49.00 ------- ------- ------- ------- ------- ------- 85244-26 $15.00 ------- ------- ------- ------- ------- ------- 85244-TC $34.00 ------- ------- ------- ------- ------- ------- 85245 $54.00 ------- ------- ------- ------- ------- ------- 85245-26 $18.00 ------- ------- ------- ------- ------- ------- 85245-TC $36.00 ------- ------- ------- ------- ------- ------- 85246 $54.00 ------- ------- ------- ------- ------- ------- 85246-26 $18.00 ------- ------- ------- ------- ------- ------- 85246-TC $36.00 ------- ------- ------- ------- ------- ------- 85247 $54.00 ------- ------- ------- ------- ------- ------- 85247-26 $18.00 ------- ------- ------- ------- ------- ------- 85247-TC $36.00 ------- ------- ------- ------- ------- ------- 85250 $49.00 ------- ------- ------- ------- ------- ------- 85250-26 $14.00 ------- ------- ------- ------- ------- ------- 85250-TC $35.00 ------- ------- ------- ------- ------- ------- 85260 $49.00 ------- ------- ------- ------- ------- ------- 85260-26 $14.00 ------- ------- ------- ------- ------- ------- 85260-TC $35.00 ------- ------- ------- ------- ------- ------- 85270 $49.00 ------- ------- ------- ------- ------- ------- 85270-26 $14.00 ------- ------- ------- ------- ------- ------- 85270-TC $35.00 ------- ------- ------- ------- ------- ------- 85280 $49.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 317
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 85280-26 $14.00 ------- ------- ------- ------- ------- ------- 85280-TC $35.00 ------- ------- ------- ------- ------- ------- 85290 $44.00 ------- ------- ------- ------- ------- ------- 85290-26 $13.00 ------- ------- ------- ------- ------- ------- 85290-TC $32.00 ------- ------- ------- ------- ------- ------- 85291 $20.00 ------- ------- ------- ------- ------- ------- 85291-26 $6.00 ------- ------- ------- ------- ------- ------- 85291-TC $14.00 ------- ------- ------- ------- ------- ------- 85292 $51.00 ------- ------- ------- ------- ------- ------- 85292-26 $17.00 ------- ------- ------- ------- ------- ------- 85292-TC $34.00 ------- ------- ------- ------- ------- ------- 85293 $51.00 ------- ------- ------- ------- ------- ------- 85293-26 $17.00 ------- ------- ------- ------- ------- ------- 85293-TC $34.00 ------- ------- ------- ------- ------- ------- 85300 $35.00 ------- ------- ------- ------- ------- ------- 85300-26 $12.00 ------- ------- ------- ------- ------- ------- 85300-TC $23.00 ------- ------- ------- ------- ------- ------- 85301 $29.00 ------- ------- ------- ------- ------- ------- 85301-26 $10.00 ------- ------- ------- ------- ------- ------- 85301-TC $19.00 ------- ------- ------- ------- ------- ------- 85302 $33.00 ------- ------- ------- ------- ------- ------- 85302-26 $11.00 ------- ------- ------- ------- ------- ------- 85302-TC $21.00 ------- ------- ------- ------- ------- ------- 85303 $26.00 ------- ------- ------- ------- ------- ------- 85303-26 $8.00 ------- ------- ------- ------- ------- ------- 85303-TC $18.00 ------- ------- ------- ------- ------- ------- 85305 $21.00 ------- ------- ------- ------- ------- ------- 85305-26 $7.00 ------- ------- ------- ------- ------- ------- 85305-TC $14.00 ------- ------- ------- ------- ------- ------- 85306 $29.00 ------- ------- ------- ------- ------- ------- 85306-26 $10.00 ------- ------- ------- ------- ------- ------- 85306-TC $19.00 ------- ------- ------- ------- ------- ------- 85307 $35.00 ------- ------- ------- ------- ------- ------- 85307-26 $12.00 ------- ------- ------- ------- ------- ------- 85307-TC $23.00 ------- ------- ------- ------- ------- ------- 85335 $21.00 ------- ------- ------- ------- ------- ------- 85335-26 $7.00 ------- ------- ------- ------- ------- ------- 85335-TC $14.00 ------- ------- ------- ------- ------- ------- 85337 $19.00 ------- ------- ------- ------- ------- ------- 85337-26 $6.00 ------- ------- ------- ------- ------- ------- 85337-TC $13.00 ------- ------- ------- ------- ------- ------- 85345 $10.00 ------- ------- ------- ------- ------- ------- 85345-26 $2.00 ------- ------- ------- ------- ------- ------- 85345-TC $7.00 ------- ------- ------- ------- ------- ------- 85347 $8.00 ------- ------- ------- ------- ------- ------- 85347-26 $2.00 ------- ------- ------- ------- ------- ------- 85347-TC $6.00 ------- ------- ------- ------- ------- ------- 85348 $10.00 ------- ------- ------- ------- ------- ------- 85348-26 $3.00 ------- ------- ------- ------- ------- ------- 85348-TC $6.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 318
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 85360 $16.00 ------- ------- ------- ------- ------- ------- 85360-26 $4.00 ------- ------- ------- ------- ------- ------- 85360-TC $12.00 ------- ------- ------- ------- ------- ------- 85362 $18.00 ------- ------- ------- ------- ------- ------- 85362-26 $7.00 ------- ------- ------- ------- ------- ------- 85362-TC $11.00 ------- ------- ------- ------- ------- ------- 85366 $13.00 ------- ------- ------- ------- ------- ------- 85366-26 $3.00 ------- ------- ------- ------- ------- ------- 85366-TC $10.00 ------- ------- ------- ------- ------- ------- 85370 $20.00 ------- ------- ------- ------- ------- ------- 85370-26 $5.00 ------- ------- ------- ------- ------- ------- 85370-TC $15.00 ------- ------- ------- ------- ------- ------- 85378 $13.00 ------- ------- ------- ------- ------- ------- 85378-26 $4.00 ------- ------- ------- ------- ------- ------- 85378-TC $8.00 ------- ------- ------- ------- ------- ------- 85379 $18.00 ------- ------- ------- ------- ------- ------- 85379-26 $6.00 ------- ------- ------- ------- ------- ------- 85379-TC $12.00 ------- ------- ------- ------- ------- ------- 85380 BR ------- ------- ------- ------- ------- ------- 85380-26 BR ------- ------- ------- ------- ------- ------- 85380-TC BR ------- ------- ------- ------- ------- ------- 85384 $11.00 ------- ------- ------- ------- ------- ------- 85384-26 $3.00 ------- ------- ------- ------- ------- ------- 85384-TC $7.00 ------- ------- ------- ------- ------- ------- 85385 $16.00 ------- ------- ------- ------- ------- ------- 85385-26 $5.00 ------- ------- ------- ------- ------- ------- 85385-TC $11.00 ------- ------- ------- ------- ------- ------- 85390 $10.00 ------- ------- ------- ------- ------- ------- 85390-26 $2.00 $20.00 $20.00 $21.00 $20.00 $20.00 $21.00 85390-TC $7.00 ------- ------- ------- ------- ------- ------- 85396 ------- $21.00 $23.00 $24.00 $21.00 $23.00 $24.00 85400 $12.00 ------- ------- ------- ------- ------- ------- 85400-26 $3.00 ------- ------- ------- ------- ------- ------- 85400-TC $8.00 ------- ------- ------- ------- ------- ------- 85410 $12.00 ------- ------- ------- ------- ------- ------- 85410-26 $3.00 ------- ------- ------- ------- ------- ------- 85410-TC $8.00 ------- ------- ------- ------- ------- ------- 85415 $28.00 ------- ------- ------- ------- ------- ------- 85415-26 $10.00 ------- ------- ------- ------- ------- ------- 85415-TC $18.00 ------- ------- ------- ------- ------- ------- 85420 $16.00 ------- ------- ------- ------- ------- ------- 85420-26 $3.00 ------- ------- ------- ------- ------- ------- 85420-TC $13.00 ------- ------- ------- ------- ------- ------- 85421 $39.00 ------- ------- ------- ------- ------- ------- 85421-26 $12.00 ------- ------- ------- ------- ------- ------- 85421-TC $26.00 ------- ------- ------- ------- ------- ------- 85441 $7.00 ------- ------- ------- ------- ------- ------- 85441-26 $2.00 ------- ------- ------- ------- ------- ------- 85441-TC $5.00 ------- ------- ------- ------- ------- ------- 85445 $16.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 319
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 85445-26 $5.00 ------- ------- ------- ------- ------- ------- 85445-TC $11.00 ------- ------- ------- ------- ------- ------- 85460 $15.00 ------- ------- ------- ------- ------- ------- 85460-26 $4.00 ------- ------- ------- ------- ------- ------- 85460-TC $11.00 ------- ------- ------- ------- ------- ------- 85461 $12.00 ------- ------- ------- ------- ------- ------- 85461-26 $3.00 ------- ------- ------- ------- ------- ------- 85461-TC $8.00 ------- ------- ------- ------- ------- ------- 85475 $15.00 ------- ------- ------- ------- ------- ------- 85475-26 $4.00 ------- ------- ------- ------- ------- ------- 85475-TC $11.00 ------- ------- ------- ------- ------- ------- 85520 $22.00 ------- ------- ------- ------- ------- ------- 85520-26 $6.00 ------- ------- ------- ------- ------- ------- 85520-TC $16.00 ------- ------- ------- ------- ------- ------- 85525 $20.00 ------- ------- ------- ------- ------- ------- 85525-26 $6.00 ------- ------- ------- ------- ------- ------- 85525-TC $14.00 ------- ------- ------- ------- ------- ------- 85530 $39.00 ------- ------- ------- ------- ------- ------- 85530-26 $12.00 ------- ------- ------- ------- ------- ------- 85530-TC $26.00 ------- ------- ------- ------- ------- ------- 85536 $14.00 ------- ------- ------- ------- ------- ------- 85536-26 $4.00 ------- ------- ------- ------- ------- ------- 85536-TC $10.00 ------- ------- ------- ------- ------- ------- 85540 $24.00 ------- ------- ------- ------- ------- ------- 85540-26 $7.00 ------- ------- ------- ------- ------- ------- 85540-TC $17.00 ------- ------- ------- ------- ------- ------- 85547 $23.00 ------- ------- ------- ------- ------- ------- 85547-26 $6.00 ------- ------- ------- ------- ------- ------- 85547-TC $17.00 ------- ------- ------- ------- ------- ------- 85549 $45.00 ------- ------- ------- ------- ------- ------- 85549-26 $15.00 ------- ------- ------- ------- ------- ------- 85549-TC $31.00 ------- ------- ------- ------- ------- ------- 85555 $17.00 ------- ------- ------- ------- ------- ------- 85555-26 $5.00 ------- ------- ------- ------- ------- ------- 85555-TC $12.00 ------- ------- ------- ------- ------- ------- 85557 $34.00 ------- ------- ------- ------- ------- ------- 85557-26 $10.00 ------- ------- ------- ------- ------- ------- 85557-TC $23.00 ------- ------- ------- ------- ------- ------- 85576 $21.00 ------- ------- ------- ------- ------- ------- 85576-26 $5.00 $20.00 $21.00 $21.00 $20.00 $21.00 $21.00 85576-TC $16.00 ------- ------- ------- ------- ------- ------- 85597 $32.00 ------- ------- ------- ------- ------- ------- 85597-26 $10.00 ------- ------- ------- ------- ------- ------- 85597-TC $21.00 ------- ------- ------- ------- ------- ------- 85610 $6.00 ------- ------- ------- ------- ------- ------- 85610-26 $3.00 ------- ------- ------- ------- ------- ------- 85610-TC $4.00 ------- ------- ------- ------- ------- ------- 85611 $6.00 ------- ------- ------- ------- ------- ------- 85611-26 $2.00 ------- ------- ------- ------- ------- ------- 85611-TC $4.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 320
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 85612 $22.00 ------- ------- ------- ------- ------- ------- 85612-26 $6.00 ------- ------- ------- ------- ------- ------- 85612-TC $16.00 ------- ------- ------- ------- ------- ------- 85613 $15.00 ------- ------- ------- ------- ------- ------- 85613-26 $4.00 ------- ------- ------- ------- ------- ------- 85613-TC $11.00 ------- ------- ------- ------- ------- ------- 85635 $26.00 ------- ------- ------- ------- ------- ------- 85635-26 $8.00 ------- ------- ------- ------- ------- ------- 85635-TC $18.00 ------- ------- ------- ------- ------- ------- 85651 $8.00 ------- ------- ------- ------- ------- ------- 85651-26 $2.00 ------- ------- ------- ------- ------- ------- 85651-TC $6.00 ------- ------- ------- ------- ------- ------- 85652 $8.00 ------- ------- ------- ------- ------- ------- 85652-26 $2.00 ------- ------- ------- ------- ------- ------- 85652-TC $6.00 ------- ------- ------- ------- ------- ------- 85660 $10.00 ------- ------- ------- ------- ------- ------- 85660-26 $3.00 ------- ------- ------- ------- ------- ------- 85660-TC $6.00 ------- ------- ------- ------- ------- ------- 85670 $13.00 ------- ------- ------- ------- ------- ------- 85670-26 $3.00 ------- ------- ------- ------- ------- ------- 85670-TC $10.00 ------- ------- ------- ------- ------- ------- 85675 $13.00 ------- ------- ------- ------- ------- ------- 85675-26 $4.00 ------- ------- ------- ------- ------- ------- 85675-TC $8.00 ------- ------- ------- ------- ------- ------- 85705 $13.00 ------- ------- ------- ------- ------- ------- 85705-26 $4.00 ------- ------- ------- ------- ------- ------- 85705-TC $8.00 ------- ------- ------- ------- ------- ------- 85730 $11.00 ------- ------- ------- ------- ------- ------- 85730-26 $3.00 ------- ------- ------- ------- ------- ------- 85730-TC $7.00 ------- ------- ------- ------- ------- ------- 85732 $17.00 ------- ------- ------- ------- ------- ------- 85732-26 $5.00 ------- ------- ------- ------- ------- ------- 85732-TC $12.00 ------- ------- ------- ------- ------- ------- 85810 $19.00 ------- ------- ------- ------- ------- ------- 85810-26 $4.00 ------- ------- ------- ------- ------- ------- 85810-TC $15.00 ------- ------- ------- ------- ------- ------- 85999 BR ------- ------- ------- ------- ------- ------- 85999-26 BR ------- ------- ------- ------- ------- ------- 85999-TC BR ------- ------- ------- ------- ------- ------- 86000 $16.00 ------- ------- ------- ------- ------- ------- 86000-26 $5.00 ------- ------- ------- ------- ------- ------- 86000-TC $11.00 ------- ------- ------- ------- ------- ------- 86001 $12.00 ------- ------- ------- ------- ------- ------- 86001-26 $4.00 ------- ------- ------- ------- ------- ------- 86001-TC $8.00 ------- ------- ------- ------- ------- ------- 86003 $6.00 ------- ------- ------- ------- ------- ------- 86003-26 $2.00 ------- ------- ------- ------- ------- ------- 86003-TC $3.00 ------- ------- ------- ------- ------- ------- 86005 $11.00 ------- ------- ------- ------- ------- ------- 86005-26 $4.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 321
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 86005-TC $6.00 ------- ------- ------- ------- ------- ------- 86021 $41.00 ------- ------- ------- ------- ------- ------- 86021-26 $12.00 ------- ------- ------- ------- ------- ------- 86021-TC $29.00 ------- ------- ------- ------- ------- ------- 86022 $57.00 ------- ------- ------- ------- ------- ------- 86022-26 $18.00 ------- ------- ------- ------- ------- ------- 86022-TC $39.00 ------- ------- ------- ------- ------- ------- 86023 $28.00 ------- ------- ------- ------- ------- ------- 86023-26 $10.00 ------- ------- ------- ------- ------- ------- 86023-TC $18.00 ------- ------- ------- ------- ------- ------- 86038 $22.00 ------- ------- ------- ------- ------- ------- 86038-26 $7.00 ------- ------- ------- ------- ------- ------- 86038-TC $15.00 ------- ------- ------- ------- ------- ------- 86039 $19.00 ------- ------- ------- ------- ------- ------- 86039-26 $6.00 ------- ------- ------- ------- ------- ------- 86039-TC $13.00 ------- ------- ------- ------- ------- ------- 86060 $13.00 ------- ------- ------- ------- ------- ------- 86060-26 $3.00 ------- ------- ------- ------- ------- ------- 86060-TC $10.00 ------- ------- ------- ------- ------- ------- 86063 $21.00 ------- ------- ------- ------- ------- ------- 86063-26 $6.00 ------- ------- ------- ------- ------- ------- 86063-TC $15.00 ------- ------- ------- ------- ------- ------- 86077 $91.00 $52.00 $54.00 $55.00 $50.00 $52.00 $53.00 86077-26 $26.00 ------- ------- ------- ------- ------- ------- 86077-TC $64.00 ------- ------- ------- ------- ------- ------- 86078 $91.00 $53.00 $55.00 $57.00 $50.00 $52.00 $54.00 86078-26 $26.00 ------- ------- ------- ------- ------- ------- 86078-TC $64.00 ------- ------- ------- ------- ------- ------- 86079 $79.00 $53.00 $55.00 $57.00 $51.00 $52.00 $54.00 86079-26 $25.00 ------- ------- ------- ------- ------- ------- 86079-TC $52.00 ------- ------- ------- ------- ------- ------- 86140 $14.00 ------- ------- ------- ------- ------- ------- 86140-26 $4.00 ------- ------- ------- ------- ------- ------- 86140-TC $10.00 ------- ------- ------- ------- ------- ------- 86141 BR ------- ------- ------- ------- ------- ------- 86141-26 BR ------- ------- ------- ------- ------- ------- 86141-TC BR ------- ------- ------- ------- ------- ------- 86146 $58.00 ------- ------- ------- ------- ------- ------- 86146-26 $19.00 ------- ------- ------- ------- ------- ------- 86146-TC $39.00 ------- ------- ------- ------- ------- ------- 86147 $53.00 ------- ------- ------- ------- ------- ------- 86147-26 $16.00 ------- ------- ------- ------- ------- ------- 86147-TC $36.00 ------- ------- ------- ------- ------- ------- 86148 $59.00 ------- ------- ------- ------- ------- ------- 86148-26 $21.00 ------- ------- ------- ------- ------- ------- 86148-TC $38.00 ------- ------- ------- ------- ------- ------- 86155 $26.00 ------- ------- ------- ------- ------- ------- 86155-26 $8.00 ------- ------- ------- ------- ------- ------- 86155-TC $18.00 ------- ------- ------- ------- ------- ------- 86156 $11.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 322
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 86156-26 $3.00 ------- ------- ------- ------- ------- ------- 86156-TC $7.00 ------- ------- ------- ------- ------- ------- 86157 $13.00 ------- ------- ------- ------- ------- ------- 86157-26 $4.00 ------- ------- ------- ------- ------- ------- 86157-TC $8.00 ------- ------- ------- ------- ------- ------- 86160 $21.00 ------- ------- ------- ------- ------- ------- 86160-26 $5.00 ------- ------- ------- ------- ------- ------- 86160-TC $16.00 ------- ------- ------- ------- ------- ------- 86161 $21.00 ------- ------- ------- ------- ------- ------- 86161-26 $5.00 ------- ------- ------- ------- ------- ------- 86161-TC $16.00 ------- ------- ------- ------- ------- ------- 86162 $54.00 ------- ------- ------- ------- ------- ------- 86162-26 $18.00 ------- ------- ------- ------- ------- ------- 86162-TC $36.00 ------- ------- ------- ------- ------- ------- 86171 $25.00 ------- ------- ------- ------- ------- ------- 86171-26 $7.00 ------- ------- ------- ------- ------- ------- 86171-TC $18.00 ------- ------- ------- ------- ------- ------- 86185 $19.00 ------- ------- ------- ------- ------- ------- 86185-26 $6.00 ------- ------- ------- ------- ------- ------- 86185-TC $13.00 ------- ------- ------- ------- ------- ------- 86215 $36.00 ------- ------- ------- ------- ------- ------- 86215-26 $12.00 ------- ------- ------- ------- ------- ------- 86215-TC $23.00 ------- ------- ------- ------- ------- ------- 86225 $36.00 ------- ------- ------- ------- ------- ------- 86225-26 $11.00 ------- ------- ------- ------- ------- ------- 86225-TC $24.00 ------- ------- ------- ------- ------- ------- 86226 $24.00 ------- ------- ------- ------- ------- ------- 86226-26 $8.00 ------- ------- ------- ------- ------- ------- 86226-TC $16.00 ------- ------- ------- ------- ------- ------- 86235 $33.00 ------- ------- ------- ------- ------- ------- 86235-26 $10.00 ------- ------- ------- ------- ------- ------- 86235-TC $22.00 ------- ------- ------- ------- ------- ------- 86243 $50.00 ------- ------- ------- ------- ------- ------- 86243-26 $15.00 ------- ------- ------- ------- ------- ------- 86243-TC $35.00 ------- ------- ------- ------- ------- ------- 86255 $25.00 ------- ------- ------- ------- ------- ------- 86255-26 $8.00 $20.00 $20.00 $21.00 $20.00 $20.00 $21.00 86255-TC $17.00 ------- ------- ------- ------- ------- ------- 86256 $25.00 ------- ------- ------- ------- ------- ------- 86256-26 $8.00 $20.00 $21.00 $21.00 $20.00 $21.00 $21.00 86256-TC $17.00 ------- ------- ------- ------- ------- ------- 86277 $41.00 ------- ------- ------- ------- ------- ------- 86277-26 $14.00 ------- ------- ------- ------- ------- ------- 86277-TC $26.00 ------- ------- ------- ------- ------- ------- 86280 $15.00 ------- ------- ------- ------- ------- ------- 86280-26 $3.00 ------- ------- ------- ------- ------- ------- 86280-TC $12.00 ------- ------- ------- ------- ------- ------- 86294 BR ------- ------- ------- ------- ------- ------- 86294-26 BR ------- ------- ------- ------- ------- ------- 86294-TC BR ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 323
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 86300 $47.00 ------- ------- ------- ------- ------- ------- 86300-26 $15.00 ------- ------- ------- ------- ------- ------- 86300-TC $32.00 ------- ------- ------- ------- ------- ------- 86301 $47.00 ------- ------- ------- ------- ------- ------- 86301-26 $15.00 ------- ------- ------- ------- ------- ------- 86301-TC $32.00 ------- ------- ------- ------- ------- ------- 86304 $47.00 ------- ------- ------- ------- ------- ------- 86304-26 $15.00 ------- ------- ------- ------- ------- ------- 86304-TC $32.00 ------- ------- ------- ------- ------- ------- 86308 $8.00 ------- ------- ------- ------- ------- ------- 86308-26 $3.00 ------- ------- ------- ------- ------- ------- 86308-TC $5.00 ------- ------- ------- ------- ------- ------- 86309 $12.00 ------- ------- ------- ------- ------- ------- 86309-26 $3.00 ------- ------- ------- ------- ------- ------- 86309-TC $8.00 ------- ------- ------- ------- ------- ------- 86310 $19.00 ------- ------- ------- ------- ------- ------- 86310-26 $6.00 ------- ------- ------- ------- ------- ------- 86310-TC $13.00 ------- ------- ------- ------- ------- ------- 86316 $37.00 ------- ------- ------- ------- ------- ------- 86316-26 $11.00 ------- ------- ------- ------- ------- ------- 86316-TC $25.00 ------- ------- ------- ------- ------- ------- 86317 $31.00 ------- ------- ------- ------- ------- ------- 86317-26 $10.00 ------- ------- ------- ------- ------- ------- 86317-TC $20.00 ------- ------- ------- ------- ------- ------- 86318 $23.00 ------- ------- ------- ------- ------- ------- 86318-26 $10.00 ------- ------- ------- ------- ------- ------- 86318-TC $14.00 ------- ------- ------- ------- ------- ------- 86320 $49.00 ------- ------- ------- ------- ------- ------- 86320-26 $19.00 $20.00 $21.00 $21.00 $20.00 $21.00 $21.00 86320-TC $29.00 ------- ------- ------- ------- ------- ------- 86325 $49.00 ------- ------- ------- ------- ------- ------- 86325-26 $16.00 $20.00 $20.00 $21.00 $20.00 $20.00 $21.00 86325-TC $33.00 ------- ------- ------- ------- ------- ------- 86327 $62.00 ------- ------- ------- ------- ------- ------- 86327-26 $19.00 $23.00 $23.00 $24.00 $23.00 $23.00 $24.00 86327-TC $42.00 ------- ------- ------- ------- ------- ------- 86329 $37.00 ------- ------- ------- ------- ------- ------- 86329-26 $12.00 ------- ------- ------- ------- ------- ------- 86329-TC $24.00 ------- ------- ------- ------- ------- ------- 86331 $22.00 ------- ------- ------- ------- ------- ------- 86331-26 $6.00 ------- ------- ------- ------- ------- ------- 86331-TC $15.00 ------- ------- ------- ------- ------- ------- 86332 $54.00 ------- ------- ------- ------- ------- ------- 86332-26 $18.00 ------- ------- ------- ------- ------- ------- 86332-TC $36.00 ------- ------- ------- ------- ------- ------- 86334 $65.00 ------- ------- ------- ------- ------- ------- 86334-26 $18.00 $20.00 $20.00 $21.00 $20.00 $20.00 $21.00 86334-TC $45.00 ------- ------- ------- ------- ------- ------- 86335 ------- BR BR BR BR BR BR 86335-26 ------- $20.00 $20.00 $21.00 $20.00 $20.00 $21.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 324
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 86335-TC ------- BR BR BR BR BR BR 86336 BR ------- ------- ------- ------- ------- ------- 86336-26 BR ------- ------- ------- ------- ------- ------- 86336-TC BR ------- ------- ------- ------- ------- ------- 86337 $54.00 ------- ------- ------- ------- ------- ------- 86337-26 $18.00 ------- ------- ------- ------- ------- ------- 86337-TC $36.00 ------- ------- ------- ------- ------- ------- 86340 $39.00 ------- ------- ------- ------- ------- ------- 86340-26 $13.00 ------- ------- ------- ------- ------- ------- 86340-TC $25.00 ------- ------- ------- ------- ------- ------- 86341 $38.00 ------- ------- ------- ------- ------- ------- 86341-26 $13.00 ------- ------- ------- ------- ------- ------- 86341-TC $24.00 ------- ------- ------- ------- ------- ------- 86343 $33.00 ------- ------- ------- ------- ------- ------- 86343-26 $11.00 ------- ------- ------- ------- ------- ------- 86343-TC $21.00 ------- ------- ------- ------- ------- ------- 86344 $21.00 ------- ------- ------- ------- ------- ------- 86344-26 $7.00 ------- ------- ------- ------- ------- ------- 86344-TC $14.00 ------- ------- ------- ------- ------- ------- 86353 $102.00 ------- ------- ------- ------- ------- ------- 86353-26 $31.00 ------- ------- ------- ------- ------- ------- 86353-TC $72.00 ------- ------- ------- ------- ------- ------- 86359 $61.00 ------- ------- ------- ------- ------- ------- 86359-26 $19.00 ------- ------- ------- ------- ------- ------- 86359-TC $41.00 ------- ------- ------- ------- ------- ------- 86360 $99.00 ------- ------- ------- ------- ------- ------- 86360-26 $33.00 ------- ------- ------- ------- ------- ------- 86360-TC $67.00 ------- ------- ------- ------- ------- ------- 86361 $66.00 ------- ------- ------- ------- ------- ------- 86361-26 $21.00 ------- ------- ------- ------- ------- ------- 86361-TC $43.00 ------- ------- ------- ------- ------- ------- 86376 $35.00 ------- ------- ------- ------- ------- ------- 86376-26 $11.00 ------- ------- ------- ------- ------- ------- 86376-TC $23.00 ------- ------- ------- ------- ------- ------- 86378 $45.00 ------- ------- ------- ------- ------- ------- 86378-26 $15.00 ------- ------- ------- ------- ------- ------- 86378-TC $31.00 ------- ------- ------- ------- ------- ------- 86382 $45.00 ------- ------- ------- ------- ------- ------- 86382-26 $14.00 ------- ------- ------- ------- ------- ------- 86382-TC $32.00 ------- ------- ------- ------- ------- ------- 86384 $24.00 ------- ------- ------- ------- ------- ------- 86384-26 $8.00 ------- ------- ------- ------- ------- ------- 86384-TC $16.00 ------- ------- ------- ------- ------- ------- 86403 $18.00 ------- ------- ------- ------- ------- ------- 86403-26 $3.00 ------- ------- ------- ------- ------- ------- 86403-TC $14.00 ------- ------- ------- ------- ------- ------- 86406 $21.00 ------- ------- ------- ------- ------- ------- 86406-26 $5.00 ------- ------- ------- ------- ------- ------- 86406-TC $16.00 ------- ------- ------- ------- ------- ------- 86430 $13.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 325
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 86430-26 $4.00 ------- ------- ------- ------- ------- ------- 86430-TC $8.00 ------- ------- ------- ------- ------- ------- 86431 $17.00 ------- ------- ------- ------- ------- ------- 86431-26 $6.00 ------- ------- ------- ------- ------- ------- 86431-TC $11.00 ------- ------- ------- ------- ------- ------- 86485 $13.00 ------- ------- ------- ------- ------- ------- 86485-26 $4.00 ------- ------- ------- ------- ------- ------- 86485-TC $8.00 ------- ------- ------- ------- ------- ------- 86486 ------- $6.00 $7.00 $8.00 $6.00 $7.00 $8.00 86490 $17.00 $9.00 $10.00 $12.00 $9.00 $10.00 $12.00 86490-26 $5.00 ------- ------- ------- ------- ------- ------- 86490-TC $12.00 ------- ------- ------- ------- ------- ------- 86510 $13.00 $10.00 $11.00 $12.00 $10.00 $11.00 $12.00 86510-26 $4.00 ------- ------- ------- ------- ------- ------- 86510-TC $8.00 ------- ------- ------- ------- ------- ------- 86580 $13.00 $9.00 $10.00 $11.00 $9.00 $10.00 $11.00 86580-26 $4.00 ------- ------- ------- ------- ------- ------- 86580-TC $8.00 ------- ------- ------- ------- ------- ------- 86590 $18.00 ------- ------- ------- ------- ------- ------- 86590-26 $6.00 ------- ------- ------- ------- ------- ------- 86590-TC $12.00 ------- ------- ------- ------- ------- ------- 86592 $8.00 ------- ------- ------- ------- ------- ------- 86592-26 $2.00 ------- ------- ------- ------- ------- ------- 86592-TC $6.00 ------- ------- ------- ------- ------- ------- 86593 $11.00 ------- ------- ------- ------- ------- ------- 86593-26 $3.00 ------- ------- ------- ------- ------- ------- 86593-TC $7.00 ------- ------- ------- ------- ------- ------- 86602 $17.00 ------- ------- ------- ------- ------- ------- 86602-26 $5.00 ------- ------- ------- ------- ------- ------- 86602-TC $12.00 ------- ------- ------- ------- ------- ------- 86603 $20.00 ------- ------- ------- ------- ------- ------- 86603-26 $6.00 ------- ------- ------- ------- ------- ------- 86603-TC $14.00 ------- ------- ------- ------- ------- ------- 86606 $24.00 ------- ------- ------- ------- ------- ------- 86606-26 $8.00 ------- ------- ------- ------- ------- ------- 86606-TC $16.00 ------- ------- ------- ------- ------- ------- 86609 $20.00 ------- ------- ------- ------- ------- ------- 86609-26 $6.00 ------- ------- ------- ------- ------- ------- 86609-TC $14.00 ------- ------- ------- ------- ------- ------- 86611 $23.00 ------- ------- ------- ------- ------- ------- 86611-26 $8.00 ------- ------- ------- ------- ------- ------- 86611-TC $15.00 ------- ------- ------- ------- ------- ------- 86612 $21.00 ------- ------- ------- ------- ------- ------- 86612-26 $6.00 ------- ------- ------- ------- ------- ------- 86612-TC $15.00 ------- ------- ------- ------- ------- ------- 86615 $21.00 ------- ------- ------- ------- ------- ------- 86615-26 $6.00 ------- ------- ------- ------- ------- ------- 86615-TC $15.00 ------- ------- ------- ------- ------- ------- 86617 $29.00 ------- ------- ------- ------- ------- ------- 86617-26 $10.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 326
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 86617-TC $19.00 ------- ------- ------- ------- ------- ------- 86618 $26.00 ------- ------- ------- ------- ------- ------- 86618-26 $8.00 ------- ------- ------- ------- ------- ------- 86618-TC $18.00 ------- ------- ------- ------- ------- ------- 86619 $21.00 ------- ------- ------- ------- ------- ------- 86619-26 $6.00 ------- ------- ------- ------- ------- ------- 86619-TC $15.00 ------- ------- ------- ------- ------- ------- 86622 $16.00 ------- ------- ------- ------- ------- ------- 86622-26 $5.00 ------- ------- ------- ------- ------- ------- 86622-TC $11.00 ------- ------- ------- ------- ------- ------- 86625 $21.00 ------- ------- ------- ------- ------- ------- 86625-26 $6.00 ------- ------- ------- ------- ------- ------- 86625-TC $15.00 ------- ------- ------- ------- ------- ------- 86628 $20.00 ------- ------- ------- ------- ------- ------- 86628-26 $6.00 ------- ------- ------- ------- ------- ------- 86628-TC $14.00 ------- ------- ------- ------- ------- ------- 86631 $20.00 ------- ------- ------- ------- ------- ------- 86631-26 $6.00 ------- ------- ------- ------- ------- ------- 86631-TC $14.00 ------- ------- ------- ------- ------- ------- 86632 $20.00 ------- ------- ------- ------- ------- ------- 86632-26 $6.00 ------- ------- ------- ------- ------- ------- 86632-TC $14.00 ------- ------- ------- ------- ------- ------- 86635 $18.00 ------- ------- ------- ------- ------- ------- 86635-26 $5.00 ------- ------- ------- ------- ------- ------- 86635-TC $13.00 ------- ------- ------- ------- ------- ------- 86638 $20.00 ------- ------- ------- ------- ------- ------- 86638-26 $6.00 ------- ------- ------- ------- ------- ------- 86638-TC $14.00 ------- ------- ------- ------- ------- ------- 86641 $21.00 ------- ------- ------- ------- ------- ------- 86641-26 $7.00 ------- ------- ------- ------- ------- ------- 86641-TC $14.00 ------- ------- ------- ------- ------- ------- 86644 $22.00 ------- ------- ------- ------- ------- ------- 86644-26 $7.00 ------- ------- ------- ------- ------- ------- 86644-TC $15.00 ------- ------- ------- ------- ------- ------- 86645 $28.00 ------- ------- ------- ------- ------- ------- 86645-26 $10.00 ------- ------- ------- ------- ------- ------- 86645-TC $18.00 ------- ------- ------- ------- ------- ------- 86648 $24.00 ------- ------- ------- ------- ------- ------- 86648-26 $8.00 ------- ------- ------- ------- ------- ------- 86648-TC $16.00 ------- ------- ------- ------- ------- ------- 86651 $21.00 ------- ------- ------- ------- ------- ------- 86651-26 $7.00 ------- ------- ------- ------- ------- ------- 86651-TC $14.00 ------- ------- ------- ------- ------- ------- 86652 $21.00 ------- ------- ------- ------- ------- ------- 86652-26 $7.00 ------- ------- ------- ------- ------- ------- 86652-TC $14.00 ------- ------- ------- ------- ------- ------- 86653 $21.00 ------- ------- ------- ------- ------- ------- 86653-26 $7.00 ------- ------- ------- ------- ------- ------- 86653-TC $14.00 ------- ------- ------- ------- ------- ------- 86654 $21.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 327
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 86654-26 $7.00 ------- ------- ------- ------- ------- ------- 86654-TC $14.00 ------- ------- ------- ------- ------- ------- 86658 $21.00 ------- ------- ------- ------- ------- ------- 86658-26 $7.00 ------- ------- ------- ------- ------- ------- 86658-TC $14.00 ------- ------- ------- ------- ------- ------- 86663 $21.00 ------- ------- ------- ------- ------- ------- 86663-26 $7.00 ------- ------- ------- ------- ------- ------- 86663-TC $14.00 ------- ------- ------- ------- ------- ------- 86664 $53.00 ------- ------- ------- ------- ------- ------- 86664-26 $17.00 ------- ------- ------- ------- ------- ------- 86664-TC $36.00 ------- ------- ------- ------- ------- ------- 86665 $29.00 ------- ------- ------- ------- ------- ------- 86665-26 $10.00 ------- ------- ------- ------- ------- ------- 86665-TC $19.00 ------- ------- ------- ------- ------- ------- 86666 $23.00 ------- ------- ------- ------- ------- ------- 86666-26 $8.00 ------- ------- ------- ------- ------- ------- 86666-TC $15.00 ------- ------- ------- ------- ------- ------- 86668 $17.00 ------- ------- ------- ------- ------- ------- 86668-26 $5.00 ------- ------- ------- ------- ------- ------- 86668-TC $12.00 ------- ------- ------- ------- ------- ------- 86671 $20.00 ------- ------- ------- ------- ------- ------- 86671-26 $6.00 ------- ------- ------- ------- ------- ------- 86671-TC $14.00 ------- ------- ------- ------- ------- ------- 86674 $23.00 ------- ------- ------- ------- ------- ------- 86674-26 $7.00 ------- ------- ------- ------- ------- ------- 86674-TC $16.00 ------- ------- ------- ------- ------- ------- 86677 $24.00 ------- ------- ------- ------- ------- ------- 86677-26 $8.00 ------- ------- ------- ------- ------- ------- 86677-TC $16.00 ------- ------- ------- ------- ------- ------- 86682 $21.00 ------- ------- ------- ------- ------- ------- 86682-26 $7.00 ------- ------- ------- ------- ------- ------- 86682-TC $14.00 ------- ------- ------- ------- ------- ------- 86684 $24.00 ------- ------- ------- ------- ------- ------- 86684-26 $8.00 ------- ------- ------- ------- ------- ------- 86684-TC $16.00 ------- ------- ------- ------- ------- ------- 86687 $22.00 ------- ------- ------- ------- ------- ------- 86687-26 $7.00 ------- ------- ------- ------- ------- ------- 86687-TC $16.00 ------- ------- ------- ------- ------- ------- 86688 $20.00 ------- ------- ------- ------- ------- ------- 86688-26 $7.00 ------- ------- ------- ------- ------- ------- 86688-TC $14.00 ------- ------- ------- ------- ------- ------- 86689 $25.00 ------- ------- ------- ------- ------- ------- 86689-26 $8.00 ------- ------- ------- ------- ------- ------- 86689-TC $17.00 ------- ------- ------- ------- ------- ------- 86692 $22.00 ------- ------- ------- ------- ------- ------- 86692-26 $7.00 ------- ------- ------- ------- ------- ------- 86692-TC $15.00 ------- ------- ------- ------- ------- ------- 86694 $22.00 ------- ------- ------- ------- ------- ------- 86694-26 $7.00 ------- ------- ------- ------- ------- ------- 86694-TC $15.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 328
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 86695 $21.00 ------- ------- ------- ------- ------- ------- 86695-26 $7.00 ------- ------- ------- ------- ------- ------- 86695-TC $14.00 ------- ------- ------- ------- ------- ------- 86696 $44.00 ------- ------- ------- ------- ------- ------- 86696-26 $14.00 ------- ------- ------- ------- ------- ------- 86696-TC $30.00 ------- ------- ------- ------- ------- ------- 86698 $20.00 ------- ------- ------- ------- ------- ------- 86698-26 $6.00 ------- ------- ------- ------- ------- ------- 86698-TC $14.00 ------- ------- ------- ------- ------- ------- 86701 $21.00 ------- ------- ------- ------- ------- ------- 86701-26 $7.00 ------- ------- ------- ------- ------- ------- 86701-TC $15.00 ------- ------- ------- ------- ------- ------- 86702 $21.00 ------- ------- ------- ------- ------- ------- 86702-26 $7.00 ------- ------- ------- ------- ------- ------- 86702-TC $14.00 ------- ------- ------- ------- ------- ------- 86703 $22.00 ------- ------- ------- ------- ------- ------- 86703-26 $7.00 ------- ------- ------- ------- ------- ------- 86703-TC $15.00 ------- ------- ------- ------- ------- ------- 86704 $33.00 ------- ------- ------- ------- ------- ------- 86704-26 $11.00 ------- ------- ------- ------- ------- ------- 86704-TC $21.00 ------- ------- ------- ------- ------- ------- 86705 $35.00 ------- ------- ------- ------- ------- ------- 86705-26 $11.00 ------- ------- ------- ------- ------- ------- 86705-TC $23.00 ------- ------- ------- ------- ------- ------- 86706 $24.00 ------- ------- ------- ------- ------- ------- 86706-26 $8.00 ------- ------- ------- ------- ------- ------- 86706-TC $16.00 ------- ------- ------- ------- ------- ------- 86707 $26.00 ------- ------- ------- ------- ------- ------- 86707-26 $8.00 ------- ------- ------- ------- ------- ------- 86707-TC $18.00 ------- ------- ------- ------- ------- ------- 86708 $32.00 ------- ------- ------- ------- ------- ------- 86708-26 $10.00 ------- ------- ------- ------- ------- ------- 86708-TC $21.00 ------- ------- ------- ------- ------- ------- 86709 $29.00 ------- ------- ------- ------- ------- ------- 86709-26 $10.00 ------- ------- ------- ------- ------- ------- 86709-TC $19.00 ------- ------- ------- ------- ------- ------- 86710 $22.00 ------- ------- ------- ------- ------- ------- 86710-26 $7.00 ------- ------- ------- ------- ------- ------- 86710-TC $15.00 ------- ------- ------- ------- ------- ------- 86713 $23.00 ------- ------- ------- ------- ------- ------- 86713-26 $7.00 ------- ------- ------- ------- ------- ------- 86713-TC $16.00 ------- ------- ------- ------- ------- ------- 86717 $20.00 ------- ------- ------- ------- ------- ------- 86717-26 $6.00 ------- ------- ------- ------- ------- ------- 86717-TC $14.00 ------- ------- ------- ------- ------- ------- 86720 $21.00 ------- ------- ------- ------- ------- ------- 86720-26 $7.00 ------- ------- ------- ------- ------- ------- 86720-TC $14.00 ------- ------- ------- ------- ------- ------- 86723 $21.00 ------- ------- ------- ------- ------- ------- 86723-26 $7.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 329
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 86723-TC $14.00 ------- ------- ------- ------- ------- ------- 86727 $20.00 ------- ------- ------- ------- ------- ------- 86727-26 $6.00 ------- ------- ------- ------- ------- ------- 86727-TC $14.00 ------- ------- ------- ------- ------- ------- 86729 $19.00 ------- ------- ------- ------- ------- ------- 86729-26 $6.00 ------- ------- ------- ------- ------- ------- 86729-TC $13.00 ------- ------- ------- ------- ------- ------- 86732 $21.00 ------- ------- ------- ------- ------- ------- 86732-26 $7.00 ------- ------- ------- ------- ------- ------- 86732-TC $14.00 ------- ------- ------- ------- ------- ------- 86735 $21.00 ------- ------- ------- ------- ------- ------- 86735-26 $7.00 ------- ------- ------- ------- ------- ------- 86735-TC $14.00 ------- ------- ------- ------- ------- ------- 86738 $21.00 ------- ------- ------- ------- ------- ------- 86738-26 $7.00 ------- ------- ------- ------- ------- ------- 86738-TC $14.00 ------- ------- ------- ------- ------- ------- 86741 $21.00 ------- ------- ------- ------- ------- ------- 86741-26 $7.00 ------- ------- ------- ------- ------- ------- 86741-TC $14.00 ------- ------- ------- ------- ------- ------- 86744 $21.00 ------- ------- ------- ------- ------- ------- 86744-26 $7.00 ------- ------- ------- ------- ------- ------- 86744-TC $14.00 ------- ------- ------- ------- ------- ------- 86747 $23.00 ------- ------- ------- ------- ------- ------- 86747-26 $7.00 ------- ------- ------- ------- ------- ------- 86747-TC $16.00 ------- ------- ------- ------- ------- ------- 86750 $21.00 ------- ------- ------- ------- ------- ------- 86750-26 $7.00 ------- ------- ------- ------- ------- ------- 86750-TC $14.00 ------- ------- ------- ------- ------- ------- 86753 $20.00 ------- ------- ------- ------- ------- ------- 86753-26 $6.00 ------- ------- ------- ------- ------- ------- 86753-TC $14.00 ------- ------- ------- ------- ------- ------- 86756 $20.00 ------- ------- ------- ------- ------- ------- 86756-26 $6.00 ------- ------- ------- ------- ------- ------- 86756-TC $14.00 ------- ------- ------- ------- ------- ------- 86757 $44.00 ------- ------- ------- ------- ------- ------- 86757-26 $14.00 ------- ------- ------- ------- ------- ------- 86757-TC $30.00 ------- ------- ------- ------- ------- ------- 86759 $21.00 ------- ------- ------- ------- ------- ------- 86759-26 $7.00 ------- ------- ------- ------- ------- ------- 86759-TC $14.00 ------- ------- ------- ------- ------- ------- 86762 $22.00 ------- ------- ------- ------- ------- ------- 86762-26 $7.00 ------- ------- ------- ------- ------- ------- 86762-TC $15.00 ------- ------- ------- ------- ------- ------- 86765 $20.00 ------- ------- ------- ------- ------- ------- 86765-26 $6.00 ------- ------- ------- ------- ------- ------- 86765-TC $14.00 ------- ------- ------- ------- ------- ------- 86768 $21.00 ------- ------- ------- ------- ------- ------- 86768-26 $7.00 ------- ------- ------- ------- ------- ------- 86768-TC $14.00 ------- ------- ------- ------- ------- ------- 86771 $21.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 330
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 86771-26 $7.00 ------- ------- ------- ------- ------- ------- 86771-TC $14.00 ------- ------- ------- ------- ------- ------- 86774 $23.00 ------- ------- ------- ------- ------- ------- 86774-26 $7.00 ------- ------- ------- ------- ------- ------- 86774-TC $16.00 ------- ------- ------- ------- ------- ------- 86777 $22.00 ------- ------- ------- ------- ------- ------- 86777-26 $7.00 ------- ------- ------- ------- ------- ------- 86777-TC $15.00 ------- ------- ------- ------- ------- ------- 86778 $23.00 ------- ------- ------- ------- ------- ------- 86778-26 $7.00 ------- ------- ------- ------- ------- ------- 86778-TC $16.00 ------- ------- ------- ------- ------- ------- 86781 $22.00 ------- ------- ------- ------- ------- ------- 86781-26 $7.00 ------- ------- ------- ------- ------- ------- 86781-TC $15.00 ------- ------- ------- ------- ------- ------- 86784 $21.00 ------- ------- ------- ------- ------- ------- 86784-26 $7.00 ------- ------- ------- ------- ------- ------- 86784-TC $14.00 ------- ------- ------- ------- ------- ------- 86787 $20.00 ------- ------- ------- ------- ------- ------- 86787-26 $6.00 ------- ------- ------- ------- ------- ------- 86787-TC $14.00 ------- ------- ------- ------- ------- ------- 86790 $21.00 ------- ------- ------- ------- ------- ------- 86790-26 $7.00 ------- ------- ------- ------- ------- ------- 86790-TC $14.00 ------- ------- ------- ------- ------- ------- 86793 $21.00 ------- ------- ------- ------- ------- ------- 86793-26 $7.00 ------- ------- ------- ------- ------- ------- 86793-TC $14.00 ------- ------- ------- ------- ------- ------- 86800 $26.00 ------- ------- ------- ------- ------- ------- 86800-26 $8.00 ------- ------- ------- ------- ------- ------- 86800-TC $18.00 ------- ------- ------- ------- ------- ------- 86803 $24.00 ------- ------- ------- ------- ------- ------- 86803-26 $8.00 ------- ------- ------- ------- ------- ------- 86803-TC $16.00 ------- ------- ------- ------- ------- ------- 86804 $26.00 ------- ------- ------- ------- ------- ------- 86804-26 $8.00 ------- ------- ------- ------- ------- ------- 86804-TC $18.00 ------- ------- ------- ------- ------- ------- 86805 $97.00 ------- ------- ------- ------- ------- ------- 86805-26 $33.00 ------- ------- ------- ------- ------- ------- 86805-TC $64.00 ------- ------- ------- ------- ------- ------- 86806 $87.00 ------- ------- ------- ------- ------- ------- 86806-26 $28.00 ------- ------- ------- ------- ------- ------- 86806-TC $57.00 ------- ------- ------- ------- ------- ------- 86807 $74.00 ------- ------- ------- ------- ------- ------- 86807-26 $21.00 ------- ------- ------- ------- ------- ------- 86807-TC $51.00 ------- ------- ------- ------- ------- ------- 86808 $52.00 ------- ------- ------- ------- ------- ------- 86808-26 $15.00 ------- ------- ------- ------- ------- ------- 86808-TC $37.00 ------- ------- ------- ------- ------- ------- 86812 $108.00 ------- ------- ------- ------- ------- ------- 86812-26 $32.00 ------- ------- ------- ------- ------- ------- 86812-TC $75.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 331
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 86813 $101.00 ------- ------- ------- ------- ------- ------- 86813-26 $29.00 ------- ------- ------- ------- ------- ------- 86813-TC $71.00 ------- ------- ------- ------- ------- ------- 86816 $64.00 ------- ------- ------- ------- ------- ------- 86816-26 $18.00 ------- ------- ------- ------- ------- ------- 86816-TC $44.00 ------- ------- ------- ------- ------- ------- 86817 $134.00 ------- ------- ------- ------- ------- ------- 86817-26 $39.00 ------- ------- ------- ------- ------- ------- 86817-TC $94.00 ------- ------- ------- ------- ------- ------- 86821 $123.00 ------- ------- ------- ------- ------- ------- 86821-26 $36.00 ------- ------- ------- ------- ------- ------- 86821-TC $86.00 ------- ------- ------- ------- ------- ------- 86822 $96.00 ------- ------- ------- ------- ------- ------- 86822-26 $32.00 ------- ------- ------- ------- ------- ------- 86822-TC $64.00 ------- ------- ------- ------- ------- ------- 86849 BR ------- ------- ------- ------- ------- ------- 86849-26 BR ------- ------- ------- ------- ------- ------- 86849-TC BR ------- ------- ------- ------- ------- ------- 86850 $10.00 ------- ------- ------- ------- ------- ------- 86850-26 $3.00 ------- ------- ------- ------- ------- ------- 86850-TC $6.00 ------- ------- ------- ------- ------- ------- 86860 $44.00 ------- ------- ------- ------- ------- ------- 86860-26 $15.00 ------- ------- ------- ------- ------- ------- 86860-TC $29.00 ------- ------- ------- ------- ------- ------- 86870 $17.00 ------- ------- ------- ------- ------- ------- 86870-26 $6.00 ------- ------- ------- ------- ------- ------- 86870-TC $11.00 ------- ------- ------- ------- ------- ------- 86880 $13.00 ------- ------- ------- ------- ------- ------- 86880-26 $4.00 ------- ------- ------- ------- ------- ------- 86880-TC $8.00 ------- ------- ------- ------- ------- ------- 86885 $15.00 ------- ------- ------- ------- ------- ------- 86885-26 $4.00 ------- ------- ------- ------- ------- ------- 86885-TC $11.00 ------- ------- ------- ------- ------- ------- 86886 $14.00 ------- ------- ------- ------- ------- ------- 86886-26 $4.00 ------- ------- ------- ------- ------- ------- 86886-TC $10.00 ------- ------- ------- ------- ------- ------- 86890 $67.00 ------- ------- ------- ------- ------- ------- 86890-26 $11.00 ------- ------- ------- ------- ------- ------- 86890-TC $54.00 ------- ------- ------- ------- ------- ------- 86891 $91.00 ------- ------- ------- ------- ------- ------- 86891-26 $26.00 ------- ------- ------- ------- ------- ------- 86891-TC $64.00 ------- ------- ------- ------- ------- ------- 86900 $10.00 ------- ------- ------- ------- ------- ------- 86900-26 $3.00 ------- ------- ------- ------- ------- ------- 86900-TC $6.00 ------- ------- ------- ------- ------- ------- 86901 $10.00 ------- ------- ------- ------- ------- ------- 86901-26 $3.00 ------- ------- ------- ------- ------- ------- 86901-TC $6.00 ------- ------- ------- ------- ------- ------- 86903 $15.00 ------- ------- ------- ------- ------- ------- 86903-26 $5.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 332
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 86903-TC $10.00 ------- ------- ------- ------- ------- ------- 86904 $19.00 ------- ------- ------- ------- ------- ------- 86904-26 $6.00 ------- ------- ------- ------- ------- ------- 86904-TC $13.00 ------- ------- ------- ------- ------- ------- 86905 $7.00 ------- ------- ------- ------- ------- ------- 86905-26 $1.00 ------- ------- ------- ------- ------- ------- 86905-TC $6.00 ------- ------- ------- ------- ------- ------- 86906 $11.00 ------- ------- ------- ------- ------- ------- 86906-26 $3.00 ------- ------- ------- ------- ------- ------- 86906-TC $7.00 ------- ------- ------- ------- ------- ------- 86910 $83.00 ------- ------- ------- ------- ------- ------- 86910-26 $24.00 ------- ------- ------- ------- ------- ------- 86910-TC $57.00 ------- ------- ------- ------- ------- ------- 86911 $19.00 ------- ------- ------- ------- ------- ------- 86911-26 $6.00 ------- ------- ------- ------- ------- ------- 86911-TC $13.00 ------- ------- ------- ------- ------- ------- 86920 $19.00 ------- ------- ------- ------- ------- ------- 86920-26 $3.00 ------- ------- ------- ------- ------- ------- 86920-TC $15.00 ------- ------- ------- ------- ------- ------- 86921 $23.00 ------- ------- ------- ------- ------- ------- 86921-26 $7.00 ------- ------- ------- ------- ------- ------- 86921-TC $16.00 ------- ------- ------- ------- ------- ------- 86922 $20.00 ------- ------- ------- ------- ------- ------- 86922-26 $6.00 ------- ------- ------- ------- ------- ------- 86922-TC $14.00 ------- ------- ------- ------- ------- ------- 86927 $21.00 ------- ------- ------- ------- ------- ------- 86927-26 $5.00 ------- ------- ------- ------- ------- ------- 86927-TC $16.00 ------- ------- ------- ------- ------- ------- 86930 $155.00 ------- ------- ------- ------- ------- ------- 86930-26 $45.00 ------- ------- ------- ------- ------- ------- 86930-TC $108.00 ------- ------- ------- ------- ------- ------- 86931 $155.00 ------- ------- ------- ------- ------- ------- 86931-26 $45.00 ------- ------- ------- ------- ------- ------- 86931-TC $108.00 ------- ------- ------- ------- ------- ------- 86932 $161.00 ------- ------- ------- ------- ------- ------- 86932-26 $48.00 ------- ------- ------- ------- ------- ------- 86932-TC $111.00 ------- ------- ------- ------- ------- ------- 86940 $18.00 ------- ------- ------- ------- ------- ------- 86940-26 $5.00 ------- ------- ------- ------- ------- ------- 86940-TC $13.00 ------- ------- ------- ------- ------- ------- 86941 $31.00 ------- ------- ------- ------- ------- ------- 86941-26 $8.00 ------- ------- ------- ------- ------- ------- 86941-TC $21.00 ------- ------- ------- ------- ------- ------- 86945 $35.00 ------- ------- ------- ------- ------- ------- 86945-26 $11.00 ------- ------- ------- ------- ------- ------- 86945-TC $23.00 ------- ------- ------- ------- ------- ------- 86950 $99.00 ------- ------- ------- ------- ------- ------- 86950-26 $29.00 ------- ------- ------- ------- ------- ------- 86950-TC $70.00 ------- ------- ------- ------- ------- ------- 86965 $25.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 333
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 86965-26 $7.00 ------- ------- ------- ------- ------- ------- 86965-TC $18.00 ------- ------- ------- ------- ------- ------- 86970 $41.00 ------- ------- ------- ------- ------- ------- 86970-26 $12.00 ------- ------- ------- ------- ------- ------- 86970-TC $29.00 ------- ------- ------- ------- ------- ------- 86971 $20.00 ------- ------- ------- ------- ------- ------- 86971-26 $5.00 ------- ------- ------- ------- ------- ------- 86971-TC $15.00 ------- ------- ------- ------- ------- ------- 86972 $20.00 ------- ------- ------- ------- ------- ------- 86972-26 $6.00 ------- ------- ------- ------- ------- ------- 86972-TC $14.00 ------- ------- ------- ------- ------- ------- 86975 $53.00 ------- ------- ------- ------- ------- ------- 86975-26 $16.00 ------- ------- ------- ------- ------- ------- 86975-TC $37.00 ------- ------- ------- ------- ------- ------- 86976 $53.00 ------- ------- ------- ------- ------- ------- 86976-26 $16.00 ------- ------- ------- ------- ------- ------- 86976-TC $37.00 ------- ------- ------- ------- ------- ------- 86977 $53.00 ------- ------- ------- ------- ------- ------- 86977-26 $16.00 ------- ------- ------- ------- ------- ------- 86977-TC $37.00 ------- ------- ------- ------- ------- ------- 86978 $65.00 ------- ------- ------- ------- ------- ------- 86978-26 $19.00 ------- ------- ------- ------- ------- ------- 86978-TC $44.00 ------- ------- ------- ------- ------- ------- 86985 $35.00 ------- ------- ------- ------- ------- ------- 86985-26 $12.00 ------- ------- ------- ------- ------- ------- 86985-TC $23.00 ------- ------- ------- ------- ------- ------- 86999 BR ------- ------- ------- ------- ------- ------- 86999-26 BR ------- ------- ------- ------- ------- ------- 86999-TC BR ------- ------- ------- ------- ------- ------- 87001 $35.00 ------- ------- ------- ------- ------- ------- 87001-26 $11.00 ------- ------- ------- ------- ------- ------- 87001-TC $23.00 ------- ------- ------- ------- ------- ------- 87003 $40.00 ------- ------- ------- ------- ------- ------- 87003-26 $13.00 ------- ------- ------- ------- ------- ------- 87003-TC $26.00 ------- ------- ------- ------- ------- ------- 87015 $14.00 ------- ------- ------- ------- ------- ------- 87015-26 $5.00 ------- ------- ------- ------- ------- ------- 87015-TC $9.00 ------- ------- ------- ------- ------- ------- 87040 $18.00 ------- ------- ------- ------- ------- ------- 87040-26 $6.00 ------- ------- ------- ------- ------- ------- 87040-TC $12.00 ------- ------- ------- ------- ------- ------- 87045 $18.00 ------- ------- ------- ------- ------- ------- 87045-26 $6.00 ------- ------- ------- ------- ------- ------- 87045-TC $11.00 ------- ------- ------- ------- ------- ------- 87046 $5.00 ------- ------- ------- ------- ------- ------- 87046-26 $2.00 ------- ------- ------- ------- ------- ------- 87046-TC $3.00 ------- ------- ------- ------- ------- ------- 87070 $14.00 ------- ------- ------- ------- ------- ------- 87070-26 $4.00 ------- ------- ------- ------- ------- ------- 87070-TC $10.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 334
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 87071 $11.00 ------- ------- ------- ------- ------- ------- 87071-26 $3.00 ------- ------- ------- ------- ------- ------- 87071-TC $8.00 ------- ------- ------- ------- ------- ------- 87073 $11.00 ------- ------- ------- ------- ------- ------- 87073-26 $3.00 ------- ------- ------- ------- ------- ------- 87073-TC $8.00 ------- ------- ------- ------- ------- ------- 87075 $18.00 ------- ------- ------- ------- ------- ------- 87075-26 $6.00 ------- ------- ------- ------- ------- ------- 87075-TC $12.00 ------- ------- ------- ------- ------- ------- 87076 $24.00 ------- ------- ------- ------- ------- ------- 87076-26 $8.00 ------- ------- ------- ------- ------- ------- 87076-TC $16.00 ------- ------- ------- ------- ------- ------- 87077 $16.00 ------- ------- ------- ------- ------- ------- 87077-26 $5.00 ------- ------- ------- ------- ------- ------- 87077-TC $11.00 ------- ------- ------- ------- ------- ------- 87081 $12.00 ------- ------- ------- ------- ------- ------- 87081-26 $3.00 ------- ------- ------- ------- ------- ------- 87081-TC $8.00 ------- ------- ------- ------- ------- ------- 87084 $23.00 ------- ------- ------- ------- ------- ------- 87084-26 $7.00 ------- ------- ------- ------- ------- ------- 87084-TC $16.00 ------- ------- ------- ------- ------- ------- 87086 $14.00 ------- ------- ------- ------- ------- ------- 87086-26 $3.00 ------- ------- ------- ------- ------- ------- 87086-TC $11.00 ------- ------- ------- ------- ------- ------- 87088 $18.00 ------- ------- ------- ------- ------- ------- 87088-26 $6.00 ------- ------- ------- ------- ------- ------- 87088-TC $12.00 ------- ------- ------- ------- ------- ------- 87101 $20.00 ------- ------- ------- ------- ------- ------- 87101-26 $6.00 ------- ------- ------- ------- ------- ------- 87101-TC $14.00 ------- ------- ------- ------- ------- ------- 87102 $20.00 ------- ------- ------- ------- ------- ------- 87102-26 $6.00 ------- ------- ------- ------- ------- ------- 87102-TC $14.00 ------- ------- ------- ------- ------- ------- 87103 $32.00 ------- ------- ------- ------- ------- ------- 87103-26 $11.00 ------- ------- ------- ------- ------- ------- 87103-TC $20.00 ------- ------- ------- ------- ------- ------- 87106 $25.00 ------- ------- ------- ------- ------- ------- 87106-26 $7.00 ------- ------- ------- ------- ------- ------- 87106-TC $18.00 ------- ------- ------- ------- ------- ------- 87107 $23.00 ------- ------- ------- ------- ------- ------- 87107-26 $8.00 ------- ------- ------- ------- ------- ------- 87107-TC $15.00 ------- ------- ------- ------- ------- ------- 87109 $26.00 ------- ------- ------- ------- ------- ------- 87109-26 $8.00 ------- ------- ------- ------- ------- ------- 87109-TC $18.00 ------- ------- ------- ------- ------- ------- 87110 $23.00 ------- ------- ------- ------- ------- ------- 87110-26 $7.00 ------- ------- ------- ------- ------- ------- 87110-TC $15.00 ------- ------- ------- ------- ------- ------- 87116 $15.00 ------- ------- ------- ------- ------- ------- 87116-26 $3.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 335
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 87116-TC $11.00 ------- ------- ------- ------- ------- ------- 87118 $28.00 ------- ------- ------- ------- ------- ------- 87118-26 $9.00 ------- ------- ------- ------- ------- ------- 87118-TC $20.00 ------- ------- ------- ------- ------- ------- 87140 $24.00 ------- ------- ------- ------- ------- ------- 87140-26 $7.00 ------- ------- ------- ------- ------- ------- 87140-TC $17.00 ------- ------- ------- ------- ------- ------- 87143 $34.00 ------- ------- ------- ------- ------- ------- 87143-26 $11.00 ------- ------- ------- ------- ------- ------- 87143-TC $22.00 ------- ------- ------- ------- ------- ------- 87147 $26.00 ------- ------- ------- ------- ------- ------- 87147-26 $8.00 ------- ------- ------- ------- ------- ------- 87147-TC $18.00 ------- ------- ------- ------- ------- ------- 87149 $46.00 ------- ------- ------- ------- ------- ------- 87149-26 $15.00 ------- ------- ------- ------- ------- ------- 87149-TC $31.00 ------- ------- ------- ------- ------- ------- 87152 $12.00 ------- ------- ------- ------- ------- ------- 87152-26 $4.00 ------- ------- ------- ------- ------- ------- 87152-TC $8.00 ------- ------- ------- ------- ------- ------- 87158 $5.00 ------- ------- ------- ------- ------- ------- 87158-26 $1.00 ------- ------- ------- ------- ------- ------- 87158-TC $3.00 ------- ------- ------- ------- ------- ------- 87164 $24.00 ------- ------- ------- ------- ------- ------- 87164-26 $8.00 $19.00 $20.00 $20.00 $19.00 $20.00 $20.00 87164-TC $16.00 ------- ------- ------- ------- ------- ------- 87166 $24.00 ------- ------- ------- ------- ------- ------- 87166-26 $7.00 ------- ------- ------- ------- ------- ------- 87166-TC $17.00 ------- ------- ------- ------- ------- ------- 87168 $10.00 ------- ------- ------- ------- ------- ------- 87168-26 $3.00 ------- ------- ------- ------- ------- ------- 87168-TC $7.00 ------- ------- ------- ------- ------- ------- 87169 $10.00 ------- ------- ------- ------- ------- ------- 87169-26 $3.00 ------- ------- ------- ------- ------- ------- 87169-TC $7.00 ------- ------- ------- ------- ------- ------- 87172 $10.00 ------- ------- ------- ------- ------- ------- 87172-26 $3.00 ------- ------- ------- ------- ------- ------- 87172-TC $7.00 ------- ------- ------- ------- ------- ------- 87176 $16.00 ------- ------- ------- ------- ------- ------- 87176-26 $5.00 ------- ------- ------- ------- ------- ------- 87176-TC $11.00 ------- ------- ------- ------- ------- ------- 87177 $18.00 ------- ------- ------- ------- ------- ------- 87177-26 $6.00 ------- ------- ------- ------- ------- ------- 87177-TC $12.00 ------- ------- ------- ------- ------- ------- 87181 $13.00 ------- ------- ------- ------- ------- ------- 87181-26 $3.00 ------- ------- ------- ------- ------- ------- 87181-TC $8.00 ------- ------- ------- ------- ------- ------- 87184 $13.00 ------- ------- ------- ------- ------- ------- 87184-26 $3.00 ------- ------- ------- ------- ------- ------- 87184-TC $10.00 ------- ------- ------- ------- ------- ------- 87185 $11.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 336
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 87185-26 $3.00 ------- ------- ------- ------- ------- ------- 87185-TC $8.00 ------- ------- ------- ------- ------- ------- 87186 $16.00 ------- ------- ------- ------- ------- ------- 87186-26 $4.00 ------- ------- ------- ------- ------- ------- 87186-TC $12.00 ------- ------- ------- ------- ------- ------- 87187 $20.00 ------- ------- ------- ------- ------- ------- 87187-26 $3.00 ------- ------- ------- ------- ------- ------- 87187-TC $17.00 ------- ------- ------- ------- ------- ------- 87188 $18.00 ------- ------- ------- ------- ------- ------- 87188-26 $5.00 ------- ------- ------- ------- ------- ------- 87188-TC $13.00 ------- ------- ------- ------- ------- ------- 87190 $7.00 ------- ------- ------- ------- ------- ------- 87190-26 $2.00 ------- ------- ------- ------- ------- ------- 87190-TC $5.00 ------- ------- ------- ------- ------- ------- 87197 $29.00 ------- ------- ------- ------- ------- ------- 87197-26 $10.00 ------- ------- ------- ------- ------- ------- 87197-TC $19.00 ------- ------- ------- ------- ------- ------- 87205 $11.00 ------- ------- ------- ------- ------- ------- 87205-26 $3.00 ------- ------- ------- ------- ------- ------- 87205-TC $7.00 ------- ------- ------- ------- ------- ------- 87206 $15.00 ------- ------- ------- ------- ------- ------- 87206-26 $3.00 ------- ------- ------- ------- ------- ------- 87206-TC $12.00 ------- ------- ------- ------- ------- ------- 87207 $10.00 ------- ------- ------- ------- ------- ------- 87207-26 $3.00 $20.00 $21.00 $21.00 $20.00 $21.00 $21.00 87207-TC $6.00 ------- ------- ------- ------- ------- ------- 87210 $8.00 ------- ------- ------- ------- ------- ------- 87210-26 $2.00 ------- ------- ------- ------- ------- ------- 87210-TC $6.00 ------- ------- ------- ------- ------- ------- 87220 $12.00 ------- ------- ------- ------- ------- ------- 87220-26 $4.00 ------- ------- ------- ------- ------- ------- 87220-TC $7.00 ------- ------- ------- ------- ------- ------- 87230 $35.00 ------- ------- ------- ------- ------- ------- 87230-26 $11.00 ------- ------- ------- ------- ------- ------- 87230-TC $23.00 ------- ------- ------- ------- ------- ------- 87250 $33.00 ------- ------- ------- ------- ------- ------- 87250-26 $13.00 ------- ------- ------- ------- ------- ------- 87250-TC $19.00 ------- ------- ------- ------- ------- ------- 87252 $44.00 ------- ------- ------- ------- ------- ------- 87252-26 $14.00 ------- ------- ------- ------- ------- ------- 87252-TC $31.00 ------- ------- ------- ------- ------- ------- 87253 $33.00 ------- ------- ------- ------- ------- ------- 87253-26 $10.00 ------- ------- ------- ------- ------- ------- 87253-TC $22.00 ------- ------- ------- ------- ------- ------- 87254 $11.00 ------- ------- ------- ------- ------- ------- 87254-26 $3.00 ------- ------- ------- ------- ------- ------- 87254-TC $8.00 ------- ------- ------- ------- ------- ------- 87255 BR ------- ------- ------- ------- ------- ------- 87255-26 BR ------- ------- ------- ------- ------- ------- 87255-TC BR ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 337
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 87260 $26.00 ------- ------- ------- ------- ------- ------- 87260-26 $8.00 ------- ------- ------- ------- ------- ------- 87260-TC $18.00 ------- ------- ------- ------- ------- ------- 87265 $26.00 ------- ------- ------- ------- ------- ------- 87265-26 $8.00 ------- ------- ------- ------- ------- ------- 87265-TC $18.00 ------- ------- ------- ------- ------- ------- 87267 BR ------- ------- ------- ------- ------- ------- 87267-26 BR ------- ------- ------- ------- ------- ------- 87267-TC BR ------- ------- ------- ------- ------- ------- 87270 $26.00 ------- ------- ------- ------- ------- ------- 87270-26 $8.00 ------- ------- ------- ------- ------- ------- 87270-TC $18.00 ------- ------- ------- ------- ------- ------- 87271 BR ------- ------- ------- ------- ------- ------- 87271-26 BR ------- ------- ------- ------- ------- ------- 87271-TC BR ------- ------- ------- ------- ------- ------- 87272 $26.00 ------- ------- ------- ------- ------- ------- 87272-26 $8.00 ------- ------- ------- ------- ------- ------- 87272-TC $18.00 ------- ------- ------- ------- ------- ------- 87273 $27.00 ------- ------- ------- ------- ------- ------- 87273-26 $9.00 ------- ------- ------- ------- ------- ------- 87273-TC $19.00 ------- ------- ------- ------- ------- ------- 87274 $26.00 ------- ------- ------- ------- ------- ------- 87274-26 $8.00 ------- ------- ------- ------- ------- ------- 87274-TC $18.00 ------- ------- ------- ------- ------- ------- 87275 $27.00 ------- ------- ------- ------- ------- ------- 87275-26 $9.00 ------- ------- ------- ------- ------- ------- 87275-TC $19.00 ------- ------- ------- ------- ------- ------- 87276 $26.00 ------- ------- ------- ------- ------- ------- 87276-26 $8.00 ------- ------- ------- ------- ------- ------- 87276-TC $18.00 ------- ------- ------- ------- ------- ------- 87277 $27.00 ------- ------- ------- ------- ------- ------- 87277-26 $9.00 ------- ------- ------- ------- ------- ------- 87277-TC $19.00 ------- ------- ------- ------- ------- ------- 87278 $26.00 ------- ------- ------- ------- ------- ------- 87278-26 $8.00 ------- ------- ------- ------- ------- ------- 87278-TC $18.00 ------- ------- ------- ------- ------- ------- 87279 $27.00 ------- ------- ------- ------- ------- ------- 87279-26 $9.00 ------- ------- ------- ------- ------- ------- 87279-TC $19.00 ------- ------- ------- ------- ------- ------- 87280 $26.00 ------- ------- ------- ------- ------- ------- 87280-26 $8.00 ------- ------- ------- ------- ------- ------- 87280-TC $18.00 ------- ------- ------- ------- ------- ------- 87281 $27.00 ------- ------- ------- ------- ------- ------- 87281-26 $9.00 ------- ------- ------- ------- ------- ------- 87281-TC $19.00 ------- ------- ------- ------- ------- ------- 87283 $27.00 ------- ------- ------- ------- ------- ------- 87283-26 $9.00 ------- ------- ------- ------- ------- ------- 87283-TC $19.00 ------- ------- ------- ------- ------- ------- 87285 $26.00 ------- ------- ------- ------- ------- ------- 87285-26 $8.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 338
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 87285-TC $18.00 ------- ------- ------- ------- ------- ------- 87290 $26.00 ------- ------- ------- ------- ------- ------- 87290-26 $8.00 ------- ------- ------- ------- ------- ------- 87290-TC $18.00 ------- ------- ------- ------- ------- ------- 87299 $26.00 ------- ------- ------- ------- ------- ------- 87299-26 $8.00 ------- ------- ------- ------- ------- ------- 87299-TC $18.00 ------- ------- ------- ------- ------- ------- 87300 $13.00 ------- ------- ------- ------- ------- ------- 87300-26 $4.00 ------- ------- ------- ------- ------- ------- 87300-TC $9.00 ------- ------- ------- ------- ------- ------- 87301 $26.00 ------- ------- ------- ------- ------- ------- 87301-26 $8.00 ------- ------- ------- ------- ------- ------- 87301-TC $18.00 ------- ------- ------- ------- ------- ------- 87320 $26.00 ------- ------- ------- ------- ------- ------- 87320-26 $8.00 ------- ------- ------- ------- ------- ------- 87320-TC $18.00 ------- ------- ------- ------- ------- ------- 87324 $26.00 ------- ------- ------- ------- ------- ------- 87324-26 $8.00 ------- ------- ------- ------- ------- ------- 87324-TC $18.00 ------- ------- ------- ------- ------- ------- 87327 $27.00 ------- ------- ------- ------- ------- ------- 87327-26 $9.00 ------- ------- ------- ------- ------- ------- 87327-TC $19.00 ------- ------- ------- ------- ------- ------- 87328 $26.00 ------- ------- ------- ------- ------- ------- 87328-26 $8.00 ------- ------- ------- ------- ------- ------- 87328-TC $18.00 ------- ------- ------- ------- ------- ------- 87332 $26.00 ------- ------- ------- ------- ------- ------- 87332-26 $8.00 ------- ------- ------- ------- ------- ------- 87332-TC $18.00 ------- ------- ------- ------- ------- ------- 87335 $26.00 ------- ------- ------- ------- ------- ------- 87335-26 $8.00 ------- ------- ------- ------- ------- ------- 87335-TC $18.00 ------- ------- ------- ------- ------- ------- 87336 $27.00 ------- ------- ------- ------- ------- ------- 87336-26 $9.00 ------- ------- ------- ------- ------- ------- 87336-TC $19.00 ------- ------- ------- ------- ------- ------- 87337 $27.00 ------- ------- ------- ------- ------- ------- 87337-26 $9.00 ------- ------- ------- ------- ------- ------- 87337-TC $19.00 ------- ------- ------- ------- ------- ------- 87338 $27.00 ------- ------- ------- ------- ------- ------- 87338-26 $7.00 ------- ------- ------- ------- ------- ------- 87338-TC $20.00 ------- ------- ------- ------- ------- ------- 87339 $27.00 ------- ------- ------- ------- ------- ------- 87339-26 $9.00 ------- ------- ------- ------- ------- ------- 87339-TC $19.00 ------- ------- ------- ------- ------- ------- 87340 $20.00 ------- ------- ------- ------- ------- ------- 87340-26 $6.00 ------- ------- ------- ------- ------- ------- 87340-TC $14.00 ------- ------- ------- ------- ------- ------- 87341 $23.00 ------- ------- ------- ------- ------- ------- 87341-26 $8.00 ------- ------- ------- ------- ------- ------- 87341-TC $15.00 ------- ------- ------- ------- ------- ------- 87350 $20.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 339
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 87350-26 $6.00 ------- ------- ------- ------- ------- ------- 87350-TC $14.00 ------- ------- ------- ------- ------- ------- 87380 $35.00 ------- ------- ------- ------- ------- ------- 87380-26 $11.00 ------- ------- ------- ------- ------- ------- 87380-TC $23.00 ------- ------- ------- ------- ------- ------- 87385 $26.00 ------- ------- ------- ------- ------- ------- 87385-26 $8.00 ------- ------- ------- ------- ------- ------- 87385-TC $18.00 ------- ------- ------- ------- ------- ------- 87390 $38.00 ------- ------- ------- ------- ------- ------- 87390-26 $13.00 ------- ------- ------- ------- ------- ------- 87390-TC $24.00 ------- ------- ------- ------- ------- ------- 87391 $38.00 ------- ------- ------- ------- ------- ------- 87391-26 $13.00 ------- ------- ------- ------- ------- ------- 87391-TC $24.00 ------- ------- ------- ------- ------- ------- 87400 $13.00 ------- ------- ------- ------- ------- ------- 87400-26 $4.00 ------- ------- ------- ------- ------- ------- 87400-TC $9.00 ------- ------- ------- ------- ------- ------- 87420 $26.00 ------- ------- ------- ------- ------- ------- 87420-26 $8.00 ------- ------- ------- ------- ------- ------- 87420-TC $18.00 ------- ------- ------- ------- ------- ------- 87425 $26.00 ------- ------- ------- ------- ------- ------- 87425-26 $8.00 ------- ------- ------- ------- ------- ------- 87425-TC $18.00 ------- ------- ------- ------- ------- ------- 87427 $27.00 ------- ------- ------- ------- ------- ------- 87427-26 $9.00 ------- ------- ------- ------- ------- ------- 87427-TC $19.00 ------- ------- ------- ------- ------- ------- 87430 $26.00 ------- ------- ------- ------- ------- ------- 87430-26 $8.00 ------- ------- ------- ------- ------- ------- 87430-TC $18.00 ------- ------- ------- ------- ------- ------- 87449 $26.00 ------- ------- ------- ------- ------- ------- 87449-26 $8.00 ------- ------- ------- ------- ------- ------- 87449-TC $18.00 ------- ------- ------- ------- ------- ------- 87450 $21.00 ------- ------- ------- ------- ------- ------- 87450-26 $6.00 ------- ------- ------- ------- ------- ------- 87450-TC $15.00 ------- ------- ------- ------- ------- ------- 87451 $19.00 ------- ------- ------- ------- ------- ------- 87451-26 $7.00 ------- ------- ------- ------- ------- ------- 87451-TC $12.00 ------- ------- ------- ------- ------- ------- 87470 $42.00 ------- ------- ------- ------- ------- ------- 87470-26 $13.00 ------- ------- ------- ------- ------- ------- 87470-TC $28.00 ------- ------- ------- ------- ------- ------- 87471 $73.00 ------- ------- ------- ------- ------- ------- 87471-26 $23.00 ------- ------- ------- ------- ------- ------- 87471-TC $48.00 ------- ------- ------- ------- ------- ------- 87472 $88.00 ------- ------- ------- ------- ------- ------- 87472-26 $28.00 ------- ------- ------- ------- ------- ------- 87472-TC $58.00 ------- ------- ------- ------- ------- ------- 87475 $40.00 ------- ------- ------- ------- ------- ------- 87475-26 $13.00 ------- ------- ------- ------- ------- ------- 87475-TC $26.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 340
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 87476 $73.00 ------- ------- ------- ------- ------- ------- 87476-26 $23.00 ------- ------- ------- ------- ------- ------- 87476-TC $48.00 ------- ------- ------- ------- ------- ------- 87477 $88.00 ------- ------- ------- ------- ------- ------- 87477-26 $28.00 ------- ------- ------- ------- ------- ------- 87477-TC $58.00 ------- ------- ------- ------- ------- ------- 87480 $42.00 ------- ------- ------- ------- ------- ------- 87480-26 $13.00 ------- ------- ------- ------- ------- ------- 87480-TC $28.00 ------- ------- ------- ------- ------- ------- 87481 $73.00 ------- ------- ------- ------- ------- ------- 87481-26 $23.00 ------- ------- ------- ------- ------- ------- 87481-TC $48.00 ------- ------- ------- ------- ------- ------- 87482 $86.00 ------- ------- ------- ------- ------- ------- 87482-26 $28.00 ------- ------- ------- ------- ------- ------- 87482-TC $56.00 ------- ------- ------- ------- ------- ------- 87485 $42.00 ------- ------- ------- ------- ------- ------- 87485-26 $13.00 ------- ------- ------- ------- ------- ------- 87485-TC $28.00 ------- ------- ------- ------- ------- ------- 87486 $73.00 ------- ------- ------- ------- ------- ------- 87486-26 $23.00 ------- ------- ------- ------- ------- ------- 87486-TC $48.00 ------- ------- ------- ------- ------- ------- 87487 $88.00 ------- ------- ------- ------- ------- ------- 87487-26 $28.00 ------- ------- ------- ------- ------- ------- 87487-TC $58.00 ------- ------- ------- ------- ------- ------- 87490 $42.00 ------- ------- ------- ------- ------- ------- 87490-26 $13.00 ------- ------- ------- ------- ------- ------- 87490-TC $28.00 ------- ------- ------- ------- ------- ------- 87491 $73.00 ------- ------- ------- ------- ------- ------- 87491-26 $23.00 ------- ------- ------- ------- ------- ------- 87491-TC $48.00 ------- ------- ------- ------- ------- ------- 87492 $73.00 ------- ------- ------- ------- ------- ------- 87492-26 $23.00 ------- ------- ------- ------- ------- ------- 87492-TC $48.00 ------- ------- ------- ------- ------- ------- 87495 $42.00 ------- ------- ------- ------- ------- ------- 87495-26 $13.00 ------- ------- ------- ------- ------- ------- 87495-TC $28.00 ------- ------- ------- ------- ------- ------- 87496 $73.00 ------- ------- ------- ------- ------- ------- 87496-26 $23.00 ------- ------- ------- ------- ------- ------- 87496-TC $48.00 ------- ------- ------- ------- ------- ------- 87497 $88.00 ------- ------- ------- ------- ------- ------- 87497-26 $28.00 ------- ------- ------- ------- ------- ------- 87497-TC $58.00 ------- ------- ------- ------- ------- ------- 87510 $42.00 ------- ------- ------- ------- ------- ------- 87510-26 $13.00 ------- ------- ------- ------- ------- ------- 87510-TC $28.00 ------- ------- ------- ------- ------- ------- 87511 $73.00 ------- ------- ------- ------- ------- ------- 87511-26 $23.00 ------- ------- ------- ------- ------- ------- 87511-TC $48.00 ------- ------- ------- ------- ------- ------- 87512 $86.00 ------- ------- ------- ------- ------- ------- 87512-26 $28.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 341
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 87512-TC $56.00 ------- ------- ------- ------- ------- ------- 87515 $42.00 ------- ------- ------- ------- ------- ------- 87515-26 $13.00 ------- ------- ------- ------- ------- ------- 87515-TC $28.00 ------- ------- ------- ------- ------- ------- 87516 $73.00 ------- ------- ------- ------- ------- ------- 87516-26 $23.00 ------- ------- ------- ------- ------- ------- 87516-TC $48.00 ------- ------- ------- ------- ------- ------- 87517 $88.00 ------- ------- ------- ------- ------- ------- 87517-26 $28.00 ------- ------- ------- ------- ------- ------- 87517-TC $58.00 ------- ------- ------- ------- ------- ------- 87520 $42.00 ------- ------- ------- ------- ------- ------- 87520-26 $13.00 ------- ------- ------- ------- ------- ------- 87520-TC $28.00 ------- ------- ------- ------- ------- ------- 87521 $73.00 ------- ------- ------- ------- ------- ------- 87521-26 $23.00 ------- ------- ------- ------- ------- ------- 87521-TC $48.00 ------- ------- ------- ------- ------- ------- 87522 $88.00 ------- ------- ------- ------- ------- ------- 87522-26 $28.00 ------- ------- ------- ------- ------- ------- 87522-TC $58.00 ------- ------- ------- ------- ------- ------- 87525 $42.00 ------- ------- ------- ------- ------- ------- 87525-26 $13.00 ------- ------- ------- ------- ------- ------- 87525-TC $28.00 ------- ------- ------- ------- ------- ------- 87526 $73.00 ------- ------- ------- ------- ------- ------- 87526-26 $23.00 ------- ------- ------- ------- ------- ------- 87526-TC $48.00 ------- ------- ------- ------- ------- ------- 87527 $86.00 ------- ------- ------- ------- ------- ------- 87527-26 $28.00 ------- ------- ------- ------- ------- ------- 87527-TC $56.00 ------- ------- ------- ------- ------- ------- 87528 $42.00 ------- ------- ------- ------- ------- ------- 87528-26 $13.00 ------- ------- ------- ------- ------- ------- 87528-TC $28.00 ------- ------- ------- ------- ------- ------- 87529 $73.00 ------- ------- ------- ------- ------- ------- 87529-26 $23.00 ------- ------- ------- ------- ------- ------- 87529-TC $48.00 ------- ------- ------- ------- ------- ------- 87530 $88.00 ------- ------- ------- ------- ------- ------- 87530-26 $28.00 ------- ------- ------- ------- ------- ------- 87530-TC $58.00 ------- ------- ------- ------- ------- ------- 87531 $42.00 ------- ------- ------- ------- ------- ------- 87531-26 $13.00 ------- ------- ------- ------- ------- ------- 87531-TC $28.00 ------- ------- ------- ------- ------- ------- 87532 $73.00 ------- ------- ------- ------- ------- ------- 87532-26 $23.00 ------- ------- ------- ------- ------- ------- 87532-TC $48.00 ------- ------- ------- ------- ------- ------- 87533 $86.00 ------- ------- ------- ------- ------- ------- 87533-26 $28.00 ------- ------- ------- ------- ------- ------- 87533-TC $56.00 ------- ------- ------- ------- ------- ------- 87534 $42.00 ------- ------- ------- ------- ------- ------- 87534-26 $13.00 ------- ------- ------- ------- ------- ------- 87534-TC $28.00 ------- ------- ------- ------- ------- ------- 87535 $73.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 342
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 87535-26 $23.00 ------- ------- ------- ------- ------- ------- 87535-TC $48.00 ------- ------- ------- ------- ------- ------- 87536 $86.00 ------- ------- ------- ------- ------- ------- 87536-26 $28.00 ------- ------- ------- ------- ------- ------- 87536-TC $56.00 ------- ------- ------- ------- ------- ------- 87537 $42.00 ------- ------- ------- ------- ------- ------- 87537-26 $13.00 ------- ------- ------- ------- ------- ------- 87537-TC $28.00 ------- ------- ------- ------- ------- ------- 87538 $73.00 ------- ------- ------- ------- ------- ------- 87538-26 $23.00 ------- ------- ------- ------- ------- ------- 87538-TC $48.00 ------- ------- ------- ------- ------- ------- 87539 $88.00 ------- ------- ------- ------- ------- ------- 87539-26 $28.00 ------- ------- ------- ------- ------- ------- 87539-TC $58.00 ------- ------- ------- ------- ------- ------- 87540 $42.00 ------- ------- ------- ------- ------- ------- 87540-26 $13.00 ------- ------- ------- ------- ------- ------- 87540-TC $28.00 ------- ------- ------- ------- ------- ------- 87541 $73.00 ------- ------- ------- ------- ------- ------- 87541-26 $23.00 ------- ------- ------- ------- ------- ------- 87541-TC $48.00 ------- ------- ------- ------- ------- ------- 87542 $86.00 ------- ------- ------- ------- ------- ------- 87542-26 $28.00 ------- ------- ------- ------- ------- ------- 87542-TC $56.00 ------- ------- ------- ------- ------- ------- 87550 $42.00 ------- ------- ------- ------- ------- ------- 87550-26 $13.00 ------- ------- ------- ------- ------- ------- 87550-TC $28.00 ------- ------- ------- ------- ------- ------- 87551 $73.00 ------- ------- ------- ------- ------- ------- 87551-26 $23.00 ------- ------- ------- ------- ------- ------- 87551-TC $48.00 ------- ------- ------- ------- ------- ------- 87552 $88.00 ------- ------- ------- ------- ------- ------- 87552-26 $28.00 ------- ------- ------- ------- ------- ------- 87552-TC $58.00 ------- ------- ------- ------- ------- ------- 87555 $42.00 ------- ------- ------- ------- ------- ------- 87555-26 $13.00 ------- ------- ------- ------- ------- ------- 87555-TC $28.00 ------- ------- ------- ------- ------- ------- 87556 $73.00 ------- ------- ------- ------- ------- ------- 87556-26 $23.00 ------- ------- ------- ------- ------- ------- 87556-TC $48.00 ------- ------- ------- ------- ------- ------- 87557 $88.00 ------- ------- ------- ------- ------- ------- 87557-26 $28.00 ------- ------- ------- ------- ------- ------- 87557-TC $58.00 ------- ------- ------- ------- ------- ------- 87560 $42.00 ------- ------- ------- ------- ------- ------- 87560-26 $13.00 ------- ------- ------- ------- ------- ------- 87560-TC $28.00 ------- ------- ------- ------- ------- ------- 87561 $73.00 ------- ------- ------- ------- ------- ------- 87561-26 $23.00 ------- ------- ------- ------- ------- ------- 87561-TC $48.00 ------- ------- ------- ------- ------- ------- 87562 $88.00 ------- ------- ------- ------- ------- ------- 87562-26 $28.00 ------- ------- ------- ------- ------- ------- 87562-TC $58.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 343
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 87580 $42.00 ------- ------- ------- ------- ------- ------- 87580-26 $13.00 ------- ------- ------- ------- ------- ------- 87580-TC $28.00 ------- ------- ------- ------- ------- ------- 87581 $73.00 ------- ------- ------- ------- ------- ------- 87581-26 $23.00 ------- ------- ------- ------- ------- ------- 87581-TC $48.00 ------- ------- ------- ------- ------- ------- 87582 $86.00 ------- ------- ------- ------- ------- ------- 87582-26 $28.00 ------- ------- ------- ------- ------- ------- 87582-TC $56.00 ------- ------- ------- ------- ------- ------- 87590 $42.00 ------- ------- ------- ------- ------- ------- 87590-26 $13.00 ------- ------- ------- ------- ------- ------- 87590-TC $28.00 ------- ------- ------- ------- ------- ------- 87591 $73.00 ------- ------- ------- ------- ------- ------- 87591-26 $23.00 ------- ------- ------- ------- ------- ------- 87591-TC $48.00 ------- ------- ------- ------- ------- ------- 87592 $88.00 ------- ------- ------- ------- ------- ------- 87592-26 $28.00 ------- ------- ------- ------- ------- ------- 87592-TC $58.00 ------- ------- ------- ------- ------- ------- 87620 $42.00 ------- ------- ------- ------- ------- ------- 87620-26 $13.00 ------- ------- ------- ------- ------- ------- 87620-TC $28.00 ------- ------- ------- ------- ------- ------- 87621 $73.00 ------- ------- ------- ------- ------- ------- 87621-26 $23.00 ------- ------- ------- ------- ------- ------- 87621-TC $48.00 ------- ------- ------- ------- ------- ------- 87622 $86.00 ------- ------- ------- ------- ------- ------- 87622-26 $28.00 ------- ------- ------- ------- ------- ------- 87622-TC $56.00 ------- ------- ------- ------- ------- ------- 87650 $42.00 ------- ------- ------- ------- ------- ------- 87650-26 $13.00 ------- ------- ------- ------- ------- ------- 87650-TC $28.00 ------- ------- ------- ------- ------- ------- 87651 $73.00 ------- ------- ------- ------- ------- ------- 87651-26 $23.00 ------- ------- ------- ------- ------- ------- 87651-TC $48.00 ------- ------- ------- ------- ------- ------- 87652 $86.00 ------- ------- ------- ------- ------- ------- 87652-26 $28.00 ------- ------- ------- ------- ------- ------- 87652-TC $56.00 ------- ------- ------- ------- ------- ------- 87797 $42.00 ------- ------- ------- ------- ------- ------- 87797-26 $13.00 ------- ------- ------- ------- ------- ------- 87797-TC $28.00 ------- ------- ------- ------- ------- ------- 87798 $73.00 ------- ------- ------- ------- ------- ------- 87798-26 $23.00 ------- ------- ------- ------- ------- ------- 87798-TC $48.00 ------- ------- ------- ------- ------- ------- 87799 $88.00 ------- ------- ------- ------- ------- ------- 87799-26 $28.00 ------- ------- ------- ------- ------- ------- 87799-TC $58.00 ------- ------- ------- ------- ------- ------- 87800 $46.00 ------- ------- ------- ------- ------- ------- 87800-26 $15.00 ------- ------- ------- ------- ------- ------- 87800-TC $31.00 ------- ------- ------- ------- ------- ------- 87801 $81.00 ------- ------- ------- ------- ------- ------- 87801-26 $26.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 344
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 87801-TC $54.00 ------- ------- ------- ------- ------- ------- 87802 BR ------- ------- ------- ------- ------- ------- 87802-26 BR ------- ------- ------- ------- ------- ------- 87802-TC BR ------- ------- ------- ------- ------- ------- 87803 BR ------- ------- ------- ------- ------- ------- 87803-26 BR ------- ------- ------- ------- ------- ------- 87803-TC BR ------- ------- ------- ------- ------- ------- 87804 BR ------- ------- ------- ------- ------- ------- 87804-26 BR ------- ------- ------- ------- ------- ------- 87804-TC BR ------- ------- ------- ------- ------- ------- 87810 $26.00 ------- ------- ------- ------- ------- ------- 87810-26 $8.00 ------- ------- ------- ------- ------- ------- 87810-TC $18.00 ------- ------- ------- ------- ------- ------- 87850 $26.00 ------- ------- ------- ------- ------- ------- 87850-26 $8.00 ------- ------- ------- ------- ------- ------- 87850-TC $18.00 ------- ------- ------- ------- ------- ------- 87880 $26.00 ------- ------- ------- ------- ------- ------- 87880-26 $8.00 ------- ------- ------- ------- ------- ------- 87880-TC $18.00 ------- ------- ------- ------- ------- ------- 87899 $26.00 ------- ------- ------- ------- ------- ------- 87899-26 $8.00 ------- ------- ------- ------- ------- ------- 87899-TC $18.00 ------- ------- ------- ------- ------- ------- 87901 $594.00 ------- ------- ------- ------- ------- ------- 87901-26 $196.00 ------- ------- ------- ------- ------- ------- 87901-TC $398.00 ------- ------- ------- ------- ------- ------- 87902 BR ------- ------- ------- ------- ------- ------- 87902-26 BR ------- ------- ------- ------- ------- ------- 87902-TC BR ------- ------- ------- ------- ------- ------- 87903 $1,126.00 ------- ------- ------- ------- ------- ------- 87903-26 $371.00 ------- ------- ------- ------- ------- ------- 87903-TC $755.00 ------- ------- ------- ------- ------- ------- 87904 $59.00 ------- ------- ------- ------- ------- ------- 87904-26 $20.00 ------- ------- ------- ------- ------- ------- 87904-TC $39.00 ------- ------- ------- ------- ------- ------- 87999 BR ------- ------- ------- ------- ------- ------- 87999-26 BR ------- ------- ------- ------- ------- ------- 87999-TC BR ------- ------- ------- ------- ------- ------- 88000 $445.00 ------- ------- ------- ------- ------- ------- 88000-26 $445.00 ------- ------- ------- ------- ------- ------- 88000-TC BR ------- ------- ------- ------- ------- ------- 88005 $500.00 ------- ------- ------- ------- ------- ------- 88005-26 $500.00 ------- ------- ------- ------- ------- ------- 88005-TC BR ------- ------- ------- ------- ------- ------- 88007 $556.00 ------- ------- ------- ------- ------- ------- 88007-26 $556.00 ------- ------- ------- ------- ------- ------- 88007-TC BR ------- ------- ------- ------- ------- ------- 88020 $556.00 ------- ------- ------- ------- ------- ------- 88020-26 $556.00 ------- ------- ------- ------- ------- ------- 88020-TC BR ------- ------- ------- ------- ------- ------- 88025 $610.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 345
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 88025-26 $610.00 ------- ------- ------- ------- ------- ------- 88025-TC BR ------- ------- ------- ------- ------- ------- 88027 $666.00 ------- ------- ------- ------- ------- ------- 88027-26 $666.00 ------- ------- ------- ------- ------- ------- 88027-TC BR ------- ------- ------- ------- ------- ------- 88036 $477.00 ------- ------- ------- ------- ------- ------- 88036-26 $477.00 ------- ------- ------- ------- ------- ------- 88036-TC BR ------- ------- ------- ------- ------- ------- 88037 $389.00 ------- ------- ------- ------- ------- ------- 88037-26 $389.00 ------- ------- ------- ------- ------- ------- 88037-TC BR ------- ------- ------- ------- ------- ------- 88040 $1,445.00 ------- ------- ------- ------- ------- ------- 88040-26 $1,445.00 ------- ------- ------- ------- ------- ------- 88040-TC BR ------- ------- ------- ------- ------- ------- 88045 BR ------- ------- ------- ------- ------- ------- 88045-26 BR ------- ------- ------- ------- ------- ------- 88045-TC BR ------- ------- ------- ------- ------- ------- 88099 BR ------- ------- ------- ------- ------- ------- 88099-26 BR ------- ------- ------- ------- ------- ------- 88099-TC BR ------- ------- ------- ------- ------- ------- 88104 $49.00 $63.00 $67.00 $70.00 $63.00 $67.00 $70.00 88104-26 $37.00 $30.00 $31.00 $32.00 $30.00 $31.00 $32.00 88104-TC $10.00 $33.00 $36.00 $39.00 $33.00 $36.00 $39.00 88106 $54.00 $80.00 $84.00 $89.00 $80.00 $84.00 $89.00 88106-26 $16.00 $30.00 $31.00 $32.00 $30.00 $31.00 $32.00 88106-TC $38.00 $50.00 $54.00 $57.00 $50.00 $54.00 $57.00 88107 $74.00 $101.00 $107.00 $112.00 $101.00 $107.00 $112.00 88107-26 $57.00 $41.00 $42.00 $44.00 $41.00 $42.00 $44.00 88107-TC $15.00 $60.00 $64.00 $68.00 $60.00 $64.00 $68.00 88108 $59.00 $76.00 $80.00 $85.00 $76.00 $80.00 $85.00 88108-26 $47.00 $30.00 $31.00 $32.00 $30.00 $31.00 $32.00 88108-TC $11.00 $46.00 $50.00 $53.00 $46.00 $50.00 $53.00 88112 ------- $114.00 $119.00 $124.00 $114.00 $119.00 $124.00 88112-26 ------- $61.00 $62.00 $64.00 $61.00 $62.00 $64.00 88112-TC ------- $53.00 $57.00 $61.00 $53.00 $57.00 $61.00 88125 $70.00 $20.00 $21.00 $23.00 $20.00 $21.00 $23.00 88125-26 $20.00 $13.00 $14.00 $14.00 $13.00 $14.00 $14.00 88125-TC $48.00 $7.00 $8.00 $8.00 $7.00 $8.00 $8.00 88130 $25.00 ------- ------- ------- ------- ------- ------- 88130-26 $7.00 ------- ------- ------- ------- ------- ------- 88130-TC $18.00 ------- ------- ------- ------- ------- ------- 88140 $18.00 ------- ------- ------- ------- ------- ------- 88140-26 $5.00 ------- ------- ------- ------- ------- ------- 88140-TC $13.00 ------- ------- ------- ------- ------- ------- 88141 $33.00 $27.00 $28.00 $29.00 $27.00 $28.00 $29.00 88141-26 NC BR BR BR BR BR BR 88141-TC NC BR BR BR BR BR BR 88142 $82.00 ------- ------- ------- ------- ------- ------- 88142-26 $21.00 ------- ------- ------- ------- ------- ------- 88142-TC $59.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 346
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 88143 $94.00 ------- ------- ------- ------- ------- ------- 88143-26 $33.00 ------- ------- ------- ------- ------- ------- 88143-TC $59.00 ------- ------- ------- ------- ------- ------- 88147 $82.00 ------- ------- ------- ------- ------- ------- 88147-26 NC BR BR BR BR BR BR 88147-TC $82.00 ------- ------- ------- ------- ------- ------- 88148 $104.00 ------- ------- ------- ------- ------- ------- 88148-26 $21.00 ------- ------- ------- ------- ------- ------- 88148-TC $82.00 ------- ------- ------- ------- ------- ------- 88150 $13.00 ------- ------- ------- ------- ------- ------- 88150-26 $3.00 ------- ------- ------- ------- ------- ------- 88150-TC $9.00 ------- ------- ------- ------- ------- ------- 88152 $46.00 ------- ------- ------- ------- ------- ------- 88152-26 $8.00 ------- ------- ------- ------- ------- ------- 88152-TC $38.00 ------- ------- ------- ------- ------- ------- 88153 $82.00 ------- ------- ------- ------- ------- ------- 88153-26 $21.00 ------- ------- ------- ------- ------- ------- 88153-TC $59.00 ------- ------- ------- ------- ------- ------- 88154 $104.00 ------- ------- ------- ------- ------- ------- 88154-26 $21.00 ------- ------- ------- ------- ------- ------- 88154-TC $82.00 ------- ------- ------- ------- ------- ------- 88155 $14.00 ------- ------- ------- ------- ------- ------- 88155-26 $3.00 ------- ------- ------- ------- ------- ------- 88155-TC $10.00 ------- ------- ------- ------- ------- ------- 88160 $45.00 $55.00 $58.00 $62.00 $55.00 $58.00 $62.00 88160-26 $14.00 $26.00 $27.00 $28.00 $26.00 $27.00 $28.00 88160-TC $24.00 $29.00 $31.00 $33.00 $29.00 $31.00 $33.00 88161 $64.00 $60.00 $64.00 $67.00 $60.00 $64.00 $67.00 88161-26 $19.00 $27.00 $28.00 $29.00 $27.00 $28.00 $29.00 88161-TC $37.00 $33.00 $36.00 $39.00 $33.00 $36.00 $39.00 88162 $77.00 $82.00 $87.00 $91.00 $82.00 $87.00 $91.00 88162-26 $22.00 $41.00 $42.00 $44.00 $41.00 $42.00 $44.00 88162-TC $53.00 $41.00 $45.00 $48.00 $41.00 $45.00 $48.00 88164 $54.00 ------- ------- ------- ------- ------- ------- 88164-26 $21.00 ------- ------- ------- ------- ------- ------- 88164-TC $33.00 ------- ------- ------- ------- ------- ------- 88165 $72.00 ------- ------- ------- ------- ------- ------- 88165-26 $33.00 ------- ------- ------- ------- ------- ------- 88165-TC $38.00 ------- ------- ------- ------- ------- ------- 88166 $82.00 ------- ------- ------- ------- ------- ------- 88166-26 $21.00 ------- ------- ------- ------- ------- ------- 88166-TC $59.00 ------- ------- ------- ------- ------- ------- 88167 $87.00 ------- ------- ------- ------- ------- ------- 88167-26 $26.00 ------- ------- ------- ------- ------- ------- 88167-TC $59.00 ------- ------- ------- ------- ------- ------- 88172 $70.00 $55.00 $58.00 $61.00 $55.00 $58.00 $61.00 88172-26 $54.00 $32.00 $33.00 $34.00 $32.00 $33.00 $34.00 88172-TC $14.00 $23.00 $25.00 $27.00 $23.00 $25.00 $27.00 88173 $95.00 $140.00 $148.00 $155.00 $140.00 $148.00 $155.00 88173-26 $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
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 88173-TC $26.00 $67.00 $72.00 $77.00 $67.00 $72.00 $77.00 88174 BR ------- ------- ------- ------- ------- ------- 88174-26 BR ------- ------- ------- ------- ------- ------- 88174-TC BR ------- ------- ------- ------- ------- ------- 88175 BR ------- ------- ------- ------- ------- ------- 88175-26 BR ------- ------- ------- ------- ------- ------- 88175-TC BR ------- ------- ------- ------- ------- ------- 88182 $88.00 $111.00 $118.00 $125.00 $111.00 $118.00 $125.00 88182-26 $33.00 $39.00 $41.00 $42.00 $39.00 $41.00 $42.00 88182-TC $54.00 $72.00 $77.00 $83.00 $72.00 $77.00 $83.00 88184 ------- $75.00 $81.00 $86.00 $75.00 $81.00 $86.00 88185 ------- $43.00 $47.00 $50.00 $43.00 $47.00 $50.00 88187 ------- $67.00 $69.00 $70.00 $67.00 $69.00 $70.00 88188 ------- $83.00 $85.00 $86.00 $83.00 $85.00 $86.00 88189 ------- $107.00 $109.00 $110.00 $107.00 $109.00 $110.00 88199 BR ------- ------- ------- ------- ------- ------- 88199-26 BR ------- ------- ------- ------- ------- ------- 88199-TC BR ------- ------- ------- ------- ------- ------- 88233 $243.00 ------- ------- ------- ------- ------- ------- 88233-26 $73.00 ------- ------- ------- ------- ------- ------- 88233-TC $170.00 ------- ------- ------- ------- ------- ------- 88235 $256.00 ------- ------- ------- ------- ------- ------- 88235-26 $76.00 ------- ------- ------- ------- ------- ------- 88235-TC $177.00 ------- ------- ------- ------- ------- ------- 88240 $21.00 ------- ------- ------- ------- ------- ------- 88240-26 $6.00 ------- ------- ------- ------- ------- ------- 88240-TC $15.00 ------- ------- ------- ------- ------- ------- 88241 $21.00 ------- ------- ------- ------- ------- ------- 88241-26 $6.00 ------- ------- ------- ------- ------- ------- 88241-TC $15.00 ------- ------- ------- ------- ------- ------- 88300 $24.00 $24.00 $26.00 $28.00 $24.00 $26.00 $28.00 88300-26 $19.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 88300-TC $5.00 $19.00 $21.00 $22.00 $19.00 $21.00 $22.00 88302 $53.00 $52.00 $56.00 $59.00 $52.00 $56.00 $59.00 88302-26 $42.00 $7.00 $8.00 $8.00 $7.00 $8.00 $8.00 88302-TC $11.00 $45.00 $48.00 $52.00 $45.00 $48.00 $52.00 88304 $70.00 $64.00 $69.00 $73.00 $64.00 $69.00 $73.00 88304-26 $54.00 $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 88304-TC $14.00 $53.00 $57.00 $61.00 $53.00 $57.00 $61.00 88305 $108.00 $109.00 $116.00 $123.00 $109.00 $116.00 $123.00 88305-26 $86.00 $40.00 $41.00 $43.00 $40.00 $41.00 $43.00 88305-TC $21.00 $70.00 $75.00 $80.00 $70.00 $75.00 $80.00 88307 $210.00 $215.00 $228.00 $240.00 $215.00 $228.00 $240.00 88307-26 $168.00 $85.00 $88.00 $91.00 $85.00 $88.00 $91.00 88307-TC $41.00 $130.00 $140.00 $149.00 $130.00 $140.00 $149.00 88309 $322.00 $319.00 $337.00 $354.00 $319.00 $337.00 $354.00 88309-26 $258.00 $144.00 $148.00 $152.00 $144.00 $148.00 $152.00 88309-TC $64.00 $176.00 $189.00 $201.00 $176.00 $189.00 $201.00 88311 $23.00 $19.00 $20.00 $21.00 $19.00 $20.00 $21.00 88311-26 $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
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 88311-TC $4.00 $7.00 $7.00 $8.00 $7.00 $7.00 $8.00 88312 $23.00 $97.00 $102.00 $108.00 $97.00 $102.00 $108.00 88312-26 $7.00 $28.00 $29.00 $30.00 $28.00 $29.00 $30.00 88312-TC $16.00 $68.00 $73.00 $77.00 $68.00 $73.00 $77.00 88313 $23.00 $73.00 $78.00 $82.00 $73.00 $78.00 $82.00 88313-26 $7.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 88313-TC $16.00 $60.00 $65.00 $69.00 $60.00 $65.00 $69.00 88314 $21.00 $98.00 $105.00 $110.00 $98.00 $105.00 $110.00 88314-26 $6.00 $24.00 $25.00 $26.00 $24.00 $25.00 $26.00 88314-TC $15.00 $74.00 $79.00 $84.00 $74.00 $79.00 $84.00 88318 $33.00 $108.00 $115.00 $121.00 $108.00 $115.00 $121.00 88318-26 $14.00 $23.00 $23.00 $24.00 $23.00 $23.00 $24.00 88318-TC $18.00 $85.00 $91.00 $97.00 $85.00 $91.00 $97.00 88319 $26.00 $153.00 $163.00 $172.00 $153.00 $163.00 $172.00 88319-26 $13.00 $28.00 $29.00 $30.00 $28.00 $29.00 $30.00 88319-TC $14.00 $124.00 $133.00 $141.00 $124.00 $133.00 $141.00 88321 $43.00 $93.00 $96.00 $99.00 $83.00 $86.00 $89.00 88321-26 $43.00 ------- ------- ------- ------- ------- ------- 88321-TC NC BR BR BR BR BR BR 88323 $61.00 $150.00 $157.00 $164.00 $150.00 $157.00 $164.00 88323-26 $61.00 $91.00 $93.00 $96.00 $91.00 $93.00 $96.00 88323-TC NC $59.00 $64.00 $68.00 $59.00 $64.00 $68.00 88325 $54.00 $201.00 $210.00 $219.00 $129.00 $132.00 $136.00 88325-26 $54.00 ------- ------- ------- ------- ------- ------- 88325-TC NC BR BR BR BR BR BR 88329 $51.00 $52.00 $54.00 $56.00 $35.00 $36.00 $38.00 88329-26 $51.00 ------- ------- ------- ------- ------- ------- 88329-TC NC BR BR BR BR BR BR 88331 $102.00 $95.00 $99.00 $105.00 $95.00 $99.00 $105.00 88331-26 $70.00 $64.00 $66.00 $68.00 $64.00 $66.00 $68.00 88331-TC $33.00 $31.00 $34.00 $36.00 $31.00 $34.00 $36.00 88332 $53.00 $43.00 $45.00 $47.00 $43.00 $45.00 $47.00 88332-26 $36.00 $32.00 $33.00 $34.00 $32.00 $33.00 $34.00 88332-TC $17.00 $11.00 $12.00 $13.00 $11.00 $12.00 $13.00 88333 ------- $97.00 $101.00 $107.00 $97.00 $101.00 $107.00 88333-26 ------- $65.00 $67.00 $69.00 $65.00 $67.00 $69.00 88333-TC ------- $32.00 $35.00 $38.00 $32.00 $35.00 $38.00 88334 ------- $56.00 $59.00 $62.00 $56.00 $59.00 $62.00 88334-26 ------- $37.00 $39.00 $40.00 $37.00 $39.00 $40.00 88334-TC ------- $19.00 $21.00 $22.00 $19.00 $21.00 $22.00 88342 $53.00 $102.00 $108.00 $113.00 $102.00 $108.00 $113.00 88342-26 $36.00 $45.00 $46.00 $48.00 $45.00 $46.00 $48.00 88342-TC $17.00 $57.00 $62.00 $66.00 $57.00 $62.00 $66.00 88346 $96.00 $103.00 $109.00 $115.00 $103.00 $109.00 $115.00 88346-26 $66.00 $45.00 $47.00 $48.00 $45.00 $47.00 $48.00 88346-TC $28.00 $58.00 $63.00 $67.00 $58.00 $63.00 $67.00 88347 $133.00 $86.00 $90.00 $95.00 $86.00 $90.00 $95.00 88347-26 $99.00 $44.00 $46.00 $47.00 $44.00 $46.00 $47.00 88347-TC $33.00 $41.00 $45.00 $48.00 $41.00 $45.00 $48.00 88348 $191.00 $606.00 $647.00 $683.00 $606.00 $647.00 $683.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 349
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 88348-26 $145.00 $80.00 $83.00 $86.00 $80.00 $83.00 $86.00 88348-TC $44.00 $526.00 $564.00 $597.00 $526.00 $564.00 $597.00 88349 $191.00 $288.00 $308.00 $326.00 $288.00 $308.00 $326.00 88349-26 $145.00 $41.00 $42.00 $44.00 $41.00 $42.00 $44.00 88349-TC $44.00 $247.00 $266.00 $282.00 $247.00 $266.00 $282.00 88355 $108.00 $312.00 $331.00 $349.00 $312.00 $331.00 $349.00 88355-26 $80.00 $95.00 $98.00 $102.00 $95.00 $98.00 $102.00 88355-TC $26.00 $217.00 $233.00 $247.00 $217.00 $233.00 $247.00 88356 $108.00 $311.00 $328.00 $345.00 $311.00 $328.00 $345.00 88356-26 $80.00 $155.00 $160.00 $166.00 $155.00 $160.00 $166.00 88356-TC $26.00 $156.00 $168.00 $179.00 $156.00 $168.00 $179.00 88358 $108.00 $84.00 $90.00 $97.00 $84.00 $90.00 $97.00 88358-26 $80.00 $52.00 $55.00 $59.00 $52.00 $55.00 $59.00 88358-TC $26.00 $31.00 $35.00 $39.00 $31.00 $35.00 $39.00 88360 ------- $123.00 $131.00 $138.00 $123.00 $131.00 $138.00 88360-26 ------- $59.00 $61.00 $64.00 $59.00 $61.00 $64.00 88360-TC ------- $64.00 $69.00 $74.00 $64.00 $69.00 $74.00 88361 ------- $168.00 $180.00 $192.00 $168.00 $180.00 $192.00 88361-26 ------- $65.00 $68.00 $72.00 $65.00 $68.00 $72.00 88361-TC ------- $104.00 $112.00 $120.00 $104.00 $112.00 $120.00 88362 BR $280.00 $296.00 $312.00 $280.00 $296.00 $312.00 88362-26 BR $115.00 $119.00 $123.00 $115.00 $119.00 $123.00 88362-TC BR $165.00 $177.00 $189.00 $165.00 $177.00 $189.00 88365 $24.00 $155.00 $163.00 $171.00 $155.00 $163.00 $171.00 88365-26 $24.00 $62.00 $64.00 $66.00 $62.00 $64.00 $66.00 88365-TC BR $93.00 $100.00 $106.00 $93.00 $100.00 $106.00 88367 ------- $236.00 $251.00 $265.00 $236.00 $251.00 $265.00 88367-26 ------- $66.00 $69.00 $71.00 $66.00 $69.00 $71.00 88367-TC ------- $169.00 $182.00 $194.00 $169.00 $182.00 $194.00 88368 ------- $204.00 $217.00 $229.00 $204.00 $217.00 $229.00 88368-26 ------- $72.00 $75.00 $77.00 $72.00 $75.00 $77.00 88368-TC ------- $132.00 $142.00 $151.00 $132.00 $142.00 $151.00 88371 $34.00 ------- ------- ------- ------- ------- ------- 88371-26 $10.00 $19.00 $20.00 $20.00 $19.00 $20.00 $20.00 88371-TC $23.00 ------- ------- ------- ------- ------- ------- 88372 $38.00 ------- ------- ------- ------- ------- ------- 88372-26 $11.00 $20.00 $21.00 $21.00 $20.00 $21.00 $21.00 88372-TC $26.00 ------- ------- ------- ------- ------- ------- 88380 BR $171.00 $181.00 $191.00 $171.00 $181.00 $191.00 88380-26 BR $79.00 $81.00 $84.00 $79.00 $81.00 $84.00 88380-TC BR $92.00 $100.00 $107.00 $92.00 $100.00 $107.00 88381 ------- $224.00 $238.00 $251.00 $224.00 $238.00 $251.00 88381-26 ------- $60.00 $62.00 $65.00 $60.00 $62.00 $65.00 88381-TC ------- $164.00 $176.00 $186.00 $164.00 $176.00 $186.00 88385 ------- $507.00 $541.00 $571.00 $507.00 $541.00 $571.00 88385-26 ------- $77.00 $80.00 $83.00 $77.00 $80.00 $83.00 88385-TC ------- $430.00 $462.00 $489.00 $430.00 $462.00 $489.00 88386 ------- $521.00 $556.00 $587.00 $521.00 $556.00 $587.00 88386-26 ------- $97.00 $101.00 $104.00 $97.00 $101.00 $104.00 88386-TC ------- $424.00 $455.00 $482.00 $424.00 $455.00 $482.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 350
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 88399 BR ------- ------- ------- ------- ------- ------- 88399-26 BR ------- ------- ------- ------- ------- ------- 88399-TC BR ------- ------- ------- ------- ------- ------- 89049 ------- $195.00 $206.00 $216.00 $64.00 $66.00 $69.00 89050 $10.00 ------- ------- ------- ------- ------- ------- 89050-26 $3.00 ------- ------- ------- ------- ------- ------- 89050-TC $6.00 ------- ------- ------- ------- ------- ------- 89051 $13.00 ------- ------- ------- ------- ------- ------- 89051-26 $4.00 ------- ------- ------- ------- ------- ------- 89051-TC $8.00 ------- ------- ------- ------- ------- ------- 89055 BR ------- ------- ------- ------- ------- ------- 89055-26 BR ------- ------- ------- ------- ------- ------- 89055-TC BR ------- ------- ------- ------- ------- ------- 89060 $13.00 ------- ------- ------- ------- ------- ------- 89060-26 $5.00 $20.00 $21.00 $21.00 $20.00 $21.00 $21.00 89060-TC $8.00 ------- ------- ------- ------- ------- ------- 89100 $51.00 $215.00 $230.00 $242.00 $39.00 $40.00 $42.00 89100-26 $15.00 ------- ------- ------- ------- ------- ------- 89100-TC $36.00 ------- ------- ------- ------- ------- ------- 89105 $65.00 $218.00 $232.00 $244.00 $32.00 $34.00 $35.00 89105-26 $19.00 ------- ------- ------- ------- ------- ------- 89105-TC $44.00 ------- ------- ------- ------- ------- ------- 89125 $14.00 ------- ------- ------- ------- ------- ------- 89125-26 $4.00 ------- ------- ------- ------- ------- ------- 89125-TC $10.00 ------- ------- ------- ------- ------- ------- 89130 $44.00 $181.00 $193.00 $203.00 $28.00 $29.00 $30.00 89130-26 $13.00 ------- ------- ------- ------- ------- ------- 89130-TC $32.00 ------- ------- ------- ------- ------- ------- 89132 $20.00 $203.00 $217.00 $229.00 $16.00 $17.00 $18.00 89132-26 $6.00 ------- ------- ------- ------- ------- ------- 89132-TC $14.00 ------- ------- ------- ------- ------- ------- 89135 $37.00 $242.00 $258.00 $272.00 $50.00 $52.00 $54.00 89135-26 $11.00 ------- ------- ------- ------- ------- ------- 89135-TC $25.00 ------- ------- ------- ------- ------- ------- 89136 $43.00 $159.00 $170.00 $179.00 $15.00 $16.00 $17.00 89136-26 $14.00 ------- ------- ------- ------- ------- ------- 89136-TC $29.00 ------- ------- ------- ------- ------- ------- 89140 $50.00 $200.00 $213.00 $223.00 $51.00 $53.00 $55.00 89140-26 $16.00 ------- ------- ------- ------- ------- ------- 89140-TC $34.00 ------- ------- ------- ------- ------- ------- 89141 $56.00 $213.00 $227.00 $238.00 $49.00 $51.00 $53.00 89141-26 $19.00 ------- ------- ------- ------- ------- ------- 89141-TC $37.00 ------- ------- ------- ------- ------- ------- 89160 $6.00 ------- ------- ------- ------- ------- ------- 89160-26 $2.00 ------- ------- ------- ------- ------- ------- 89160-TC $4.00 ------- ------- ------- ------- ------- ------- 89190 $10.00 ------- ------- ------- ------- ------- ------- 89190-26 $3.00 ------- ------- ------- ------- ------- ------- 89190-TC $6.00 ------- ------- ------- ------- ------- ------- 89220 ------- $17.00 $18.00 $20.00 $17.00 $18.00 $20.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 351
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Pathology & Laboratory CPT Code 2003 MRA 89230 ------- $5.00 $5.00 $6.00 $5.00 $5.00 $6.00 G0124 ------- $27.00 $28.00 $29.00 $27.00 $28.00 $29.00 G0141 ------- $27.00 $28.00 $29.00 $27.00 $28.00 $29.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 352
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 90471 $4.00 $22.00 $23.00 $24.00 $22.00 $23.00 $24.00 90472 $4.00 $11.00 $12.00 $12.00 $9.00 $10.00 $10.00 90473 BR $14.00 $15.00 $15.00 $9.00 $10.00 $10.00 90474 BR $10.00 $10.00 $11.00 $8.00 $8.00 $9.00 90632 BR ------- ------- ------- ------- ------- ------- 90636 BR ------- ------- ------- ------- ------- ------- 90675 BR ------- ------- ------- ------- ------- ------- 90703 BR ------- ------- ------- ------- ------- ------- 90718 BR ------- ------- ------- ------- ------- ------- 90746 BR ------- ------- ------- ------- ------- ------- 90749 BR ------- ------- ------- ------- ------- ------- 90801 $140.00 $159.00 $164.00 $169.00 $137.00 $140.00 $144.00 90802 $143.00 $169.00 $174.00 $180.00 $148.00 $152.00 $156.00 90804 $62.00 $67.00 $69.00 $71.00 $58.00 $60.00 $62.00 90805 $68.00 $74.00 $76.00 $78.00 $66.00 $67.00 $69.00 90806 $94.00 $95.00 $98.00 $100.00 $89.00 $91.00 $94.00 90807 $101.00 $105.00 $108.00 $111.00 $97.00 $99.00 $102.00 90808 $144.00 $141.00 $144.00 $148.00 $134.00 $137.00 $141.00 90809 $149.00 $150.00 $154.00 $158.00 $142.00 $145.00 $149.00 90810 $69.00 $72.00 $74.00 $76.00 $64.00 $66.00 $68.00 90811 $77.00 $82.00 $85.00 $87.00 $71.00 $73.00 $75.00 90812 $101.00 $103.00 $106.00 $109.00 $94.00 $96.00 $99.00 90813 $107.00 $113.00 $117.00 $120.00 $102.00 $105.00 $107.00 90814 $143.00 $148.00 $152.00 $156.00 $140.00 $143.00 $147.00 90815 $149.00 $157.00 $161.00 $166.00 $146.00 $150.00 $153.00 90816 $64.00 $63.00 $65.00 $67.00 $63.00 $65.00 $67.00 90817 $70.00 $70.00 $71.00 $73.00 $70.00 $71.00 $73.00 90818 $96.00 $94.00 $96.00 $99.00 $94.00 $96.00 $99.00 90819 $102.00 $101.00 $103.00 $106.00 $101.00 $103.00 $106.00 90821 $144.00 $139.00 $143.00 $147.00 $139.00 $143.00 $147.00 90822 $149.00 $146.00 $150.00 $154.00 $146.00 $150.00 $154.00 90823 $73.00 $68.00 $70.00 $72.00 $68.00 $70.00 $72.00 90824 $78.00 $76.00 $78.00 $80.00 $76.00 $78.00 $80.00 90826 $103.00 $100.00 $103.00 $106.00 $100.00 $103.00 $106.00 90827 $107.00 $105.00 $108.00 $111.00 $105.00 $108.00 $111.00 90828 $146.00 $145.00 $149.00 $153.00 $145.00 $149.00 $153.00 90829 $150.00 $151.00 $154.00 $158.00 $151.00 $154.00 $158.00 90845 $85.00 $88.00 $90.00 $92.00 $86.00 $88.00 $90.00 90846 $93.00 $93.00 $95.00 $98.00 $91.00 $93.00 $96.00 90847 $110.00 $115.00 $119.00 $122.00 $110.00 $112.00 $115.00 90849 $32.00 $35.00 $36.00 $37.00 $32.00 $33.00 $34.00 90853 $32.00 $33.00 $34.00 $34.00 $31.00 $31.00 $32.00 90857 $31.00 $37.00 $38.00 $39.00 $33.00 $34.00 $34.00 90862 $50.00 $56.00 $58.00 $60.00 $48.00 $49.00 $50.00 90865 $143.00 $162.00 $168.00 $174.00 $142.00 $147.00 $152.00 90870 $94.00 $148.00 $154.00 $160.00 $91.00 $93.00 $96.00 90875 $74.00 $75.00 $78.00 $80.00 $61.00 $63.00 $65.00 90876 $112.00 $109.00 $113.00 $116.00 $96.00 $98.00 $101.00 90880 $112.00 $116.00 $119.00 $122.00 $105.00 $108.00 $110.00 90882 $104.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 353
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 90885 $49.00 $49.00 $50.00 $51.00 $49.00 $50.00 $51.00 90887 $77.00 $85.00 $88.00 $90.00 $75.00 $77.00 $79.00 90889 BR ------- ------- ------- ------- ------- ------- 90899 BR ------- ------- ------- ------- ------- ------- 90901 $46.00 $38.00 $40.00 $42.00 $21.00 $22.00 $23.00 90911 $82.00 $94.00 $99.00 $105.00 $48.00 $50.00 $53.00 90935 $76.00 $71.00 $73.00 $76.00 $71.00 $73.00 $76.00 90937 $226.00 $116.00 $120.00 $124.00 $116.00 $120.00 $124.00 90940 BR ------- ------- ------- ------- ------- ------- 90945 $80.00 $74.00 $77.00 $79.00 $74.00 $77.00 $79.00 90947 $125.00 $119.00 $123.00 $127.00 $119.00 $123.00 $127.00 90997 $115.00 $94.00 $97.00 $100.00 $94.00 $97.00 $100.00 90999 BR ------- ------- ------- ------- ------- ------- 91000 $43.00 $78.00 $82.00 $86.00 $78.00 $82.00 $86.00 91000-26 $40.00 $38.00 $39.00 $41.00 $38.00 $39.00 $41.00 91000-TC $2.00 $39.00 $42.00 $45.00 $39.00 $42.00 $45.00 91010 $116.00 $212.00 $226.00 $239.00 $212.00 $226.00 $239.00 91010-26 $76.00 $69.00 $72.00 $75.00 $69.00 $72.00 $75.00 91010-TC $32.00 $143.00 $154.00 $164.00 $143.00 $154.00 $164.00 91011 $141.00 $271.00 $289.00 $305.00 $271.00 $289.00 $305.00 91011-26 $89.00 $84.00 $87.00 $91.00 $84.00 $87.00 $91.00 91011-TC $39.00 $187.00 $202.00 $214.00 $187.00 $202.00 $214.00 91012 $143.00 $282.00 $300.00 $317.00 $282.00 $300.00 $317.00 91012-26 $95.00 $81.00 $84.00 $87.00 $81.00 $84.00 $87.00 91012-TC $45.00 $201.00 $216.00 $230.00 $201.00 $216.00 $230.00 91020 $60.00 $245.00 $260.00 $275.00 $245.00 $260.00 $275.00 91020-26 $49.00 $79.00 $82.00 $86.00 $79.00 $82.00 $86.00 91020-TC $9.00 $165.00 $178.00 $190.00 $165.00 $178.00 $190.00 91022 ------- $209.00 $222.00 $235.00 $209.00 $222.00 $235.00 91022-26 ------- $80.00 $83.00 $86.00 $80.00 $83.00 $86.00 91022-TC ------- $129.00 $140.00 $149.00 $129.00 $140.00 $149.00 91030 $57.00 $142.00 $151.00 $159.00 $142.00 $151.00 $159.00 91030-26 $47.00 $51.00 $52.00 $54.00 $51.00 $52.00 $54.00 91030-TC $8.00 $92.00 $98.00 $104.00 $92.00 $98.00 $104.00 91034 ------- $227.00 $243.00 $257.00 $227.00 $243.00 $257.00 91034-26 ------- $54.00 $57.00 $59.00 $54.00 $57.00 $59.00 91034-TC ------- $173.00 $186.00 $198.00 $173.00 $186.00 $198.00 91035 ------- $502.00 $535.00 $565.00 $502.00 $535.00 $565.00 91035-26 ------- $87.00 $90.00 $93.00 $87.00 $90.00 $93.00 91035-TC ------- $415.00 $445.00 $471.00 $415.00 $445.00 $471.00 91037 ------- $169.00 $180.00 $191.00 $169.00 $180.00 $191.00 91037-26 ------- $55.00 $57.00 $60.00 $55.00 $57.00 $60.00 91037-TC ------- $114.00 $123.00 $131.00 $114.00 $123.00 $131.00 91038 ------- $147.00 $157.00 $166.00 $147.00 $157.00 $166.00 91038-26 ------- $62.00 $65.00 $67.00 $62.00 $65.00 $67.00 91038-TC ------- $85.00 $92.00 $99.00 $85.00 $92.00 $99.00 91040 ------- $413.00 $442.00 $468.00 $413.00 $442.00 $468.00 91040-26 ------- $52.00 $54.00 $56.00 $52.00 $54.00 $56.00 91040-TC ------- $362.00 $389.00 $411.00 $362.00 $389.00 $411.00 91052 $67.00 $138.00 $146.00 $154.00 $138.00 $146.00 $154.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 354
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 91052-26 $52.00 $44.00 $45.00 $47.00 $44.00 $45.00 $47.00 91052-TC $12.00 $94.00 $101.00 $107.00 $94.00 $101.00 $107.00 91055 $63.00 $147.00 $157.00 $165.00 $147.00 $157.00 $165.00 91055-26 $46.00 $49.00 $51.00 $53.00 $49.00 $51.00 $53.00 91055-TC $11.00 $99.00 $106.00 $112.00 $99.00 $106.00 $112.00 91065 $34.00 $64.00 $69.00 $73.00 $64.00 $69.00 $73.00 91065-26 $23.00 $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 91065-TC $14.00 $53.00 $58.00 $61.00 $53.00 $58.00 $61.00 91105 $35.00 $90.00 $96.00 $101.00 $19.00 $20.00 $21.00 91110 ------- $985.00 $1,049.00 $1,103.00 $985.00 $1,049.00 $1,103.00 91110-26 ------- $198.00 $204.00 $210.00 $198.00 $204.00 $210.00 91110-TC ------- $788.00 $845.00 $893.00 $788.00 $845.00 $893.00 91111 ------- $780.00 $833.00 $878.00 $780.00 $833.00 $878.00 91111-26 ------- $56.00 $58.00 $60.00 $56.00 $58.00 $60.00 91111-TC ------- $723.00 $775.00 $818.00 $723.00 $775.00 $818.00 91120 ------- $433.00 $463.00 $489.00 $433.00 $463.00 $489.00 91120-26 ------- $52.00 $54.00 $57.00 $52.00 $54.00 $57.00 91120-TC ------- $381.00 $408.00 $432.00 $381.00 $408.00 $432.00 91122 $169.00 $263.00 $280.00 $298.00 $263.00 $280.00 $298.00 91122-26 $122.00 $97.00 $102.00 $107.00 $97.00 $102.00 $107.00 91122-TC $37.00 $166.00 $179.00 $191.00 $166.00 $179.00 $191.00 91123 BR ------- ------- ------- ------- ------- ------- 91132 BR ------- ------- ------- ------- ------- ------- 91132-26 $28.00 $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 91132-TC BR ------- ------- ------- ------- ------- ------- 91133 BR ------- ------- ------- ------- ------- ------- 91133-26 $34.00 $37.00 $39.00 $40.00 $37.00 $39.00 $40.00 91133-TC BR ------- ------- ------- ------- ------- ------- 91299 BR ------- ------- ------- ------- ------- ------- 91299-26 BR ------- ------- ------- ------- ------- ------- 91299-TC BR ------- ------- ------- ------- ------- ------- 92002 $63.00 $71.00 $74.00 $77.00 $45.00 $47.00 $48.00 92004 $98.00 $134.00 $139.00 $144.00 $94.00 $96.00 $99.00 92012 $53.00 $75.00 $78.00 $81.00 $47.00 $48.00 $50.00 92014 $75.00 $109.00 $113.00 $117.00 $72.00 $74.00 $76.00 92015 $34.00 $45.00 $48.00 $50.00 $19.00 $20.00 $20.00 92018 $80.00 $134.00 $138.00 $143.00 $134.00 $138.00 $143.00 92019 $70.00 $68.00 $70.00 $72.00 $68.00 $70.00 $72.00 92020 $31.00 $26.00 $27.00 $28.00 $20.00 $21.00 $21.00 92025 ------- $33.00 $35.00 $37.00 $33.00 $35.00 $37.00 92025-26 ------- $18.00 $19.00 $19.00 $18.00 $19.00 $19.00 92025-TC ------- $15.00 $16.00 $18.00 $15.00 $16.00 $18.00 92060 $40.00 $57.00 $60.00 $62.00 $57.00 $60.00 $62.00 92060-26 $32.00 $37.00 $38.00 $39.00 $37.00 $38.00 $39.00 92060-TC $7.00 $20.00 $21.00 $23.00 $20.00 $21.00 $23.00 92065 $34.00 $42.00 $44.00 $47.00 $42.00 $44.00 $47.00 92065-26 $19.00 $19.00 $20.00 $20.00 $19.00 $20.00 $20.00 92065-TC $6.00 $23.00 $25.00 $26.00 $23.00 $25.00 $26.00 92070 $66.00 $66.00 $69.00 $72.00 $38.00 $39.00 $40.00 92081 $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
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 92081-26 $19.00 $19.00 $20.00 $20.00 $19.00 $20.00 $20.00 92081-TC $6.00 $33.00 $35.00 $38.00 $33.00 $35.00 $38.00 92082 $48.00 $67.00 $71.00 $75.00 $67.00 $71.00 $75.00 92082-26 $24.00 $23.00 $24.00 $25.00 $23.00 $24.00 $25.00 92082-TC $9.00 $44.00 $48.00 $50.00 $44.00 $48.00 $50.00 92083 $59.00 $77.00 $82.00 $86.00 $77.00 $82.00 $86.00 92083-26 $31.00 $27.00 $27.00 $28.00 $27.00 $27.00 $28.00 92083-TC $14.00 $51.00 $55.00 $58.00 $51.00 $55.00 $58.00 92100 $40.00 $86.00 $90.00 $93.00 $48.00 $49.00 $50.00 92120 $32.00 $71.00 $74.00 $77.00 $42.00 $43.00 $44.00 92130 $56.00 $79.00 $83.00 $87.00 $44.00 $45.00 $46.00 92135 $69.00 $45.00 $48.00 $50.00 $45.00 $48.00 $50.00 92135-26 $18.00 $19.00 $19.00 $20.00 $19.00 $19.00 $20.00 92135-TC $49.00 $27.00 $29.00 $30.00 $27.00 $29.00 $30.00 92136 $93.00 $86.00 $91.00 $97.00 $86.00 $91.00 $97.00 92136-26 $29.00 $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 92136-TC $63.00 $56.00 $61.00 $66.00 $56.00 $61.00 $66.00 92140 $38.00 $56.00 $59.00 $61.00 $26.00 $27.00 $28.00 92225 $45.00 $23.00 $24.00 $25.00 $20.00 $21.00 $21.00 92226 $39.00 $21.00 $22.00 $23.00 $18.00 $18.00 $19.00 92230 $58.00 $67.00 $70.00 $73.00 $31.00 $32.00 $33.00 92235 $104.00 $131.00 $139.00 $147.00 $131.00 $139.00 $147.00 92235-26 $46.00 $44.00 $45.00 $47.00 $44.00 $45.00 $47.00 92235-TC $53.00 $87.00 $94.00 $100.00 $87.00 $94.00 $100.00 92240 $132.00 $204.00 $217.00 $228.00 $204.00 $217.00 $228.00 92240-26 $60.00 $60.00 $62.00 $64.00 $60.00 $62.00 $64.00 92240-TC $67.00 $144.00 $155.00 $164.00 $144.00 $155.00 $164.00 92250 $40.00 $73.00 $77.00 $81.00 $73.00 $77.00 $81.00 92250-26 $24.00 $23.00 $24.00 $25.00 $23.00 $24.00 $25.00 92250-TC $7.00 $50.00 $53.00 $57.00 $50.00 $53.00 $57.00 92260 $20.00 $18.00 $18.00 $19.00 $11.00 $12.00 $12.00 92265 $53.00 $82.00 $87.00 $92.00 $82.00 $87.00 $92.00 92265-26 $37.00 $42.00 $44.00 $46.00 $42.00 $44.00 $46.00 92265-TC $10.00 $40.00 $43.00 $46.00 $40.00 $43.00 $46.00 92270 $64.00 $89.00 $94.00 $98.00 $89.00 $94.00 $98.00 92270-26 $45.00 $43.00 $44.00 $46.00 $43.00 $44.00 $46.00 92270-TC $19.00 $46.00 $50.00 $53.00 $46.00 $50.00 $53.00 92275 $80.00 $126.00 $133.00 $140.00 $126.00 $133.00 $140.00 92275-26 $56.00 $54.00 $56.00 $58.00 $54.00 $56.00 $58.00 92275-TC $17.00 $72.00 $77.00 $82.00 $72.00 $77.00 $82.00 92283 $24.00 $43.00 $46.00 $49.00 $43.00 $46.00 $49.00 92283-26 $10.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 92283-TC $5.00 $34.00 $37.00 $39.00 $34.00 $37.00 $39.00 92284 $192.00 $69.00 $74.00 $78.00 $69.00 $74.00 $78.00 92284-26 $151.00 $12.00 $13.00 $13.00 $12.00 $13.00 $13.00 92284-TC $46.00 $57.00 $61.00 $65.00 $57.00 $61.00 $65.00 92285 $26.00 $44.00 $47.00 $49.00 $44.00 $47.00 $49.00 92285-26 $12.00 $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 92285-TC $6.00 $32.00 $35.00 $37.00 $32.00 $35.00 $37.00 92286 $91.00 $127.00 $135.00 $142.00 $127.00 $135.00 $142.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 356
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 92286-26 $53.00 $35.00 $36.00 $38.00 $35.00 $36.00 $38.00 92286-TC $29.00 $92.00 $99.00 $105.00 $92.00 $99.00 $105.00 92287 $99.00 $115.00 $121.00 $127.00 $42.00 $44.00 $45.00 92310 $86.00 $88.00 $92.00 $96.00 $60.00 $62.00 $64.00 92311 $78.00 $88.00 $92.00 $96.00 $55.00 $56.00 $58.00 92312 $89.00 $98.00 $102.00 $106.00 $65.00 $67.00 $69.00 92313 $70.00 $84.00 $88.00 $91.00 $47.00 $48.00 $50.00 92314 $54.00 $67.00 $70.00 $73.00 $34.00 $35.00 $36.00 92315 $44.00 $60.00 $63.00 $66.00 $23.00 $23.00 $24.00 92316 $59.00 $76.00 $80.00 $84.00 $37.00 $38.00 $39.00 92317 $39.00 $61.00 $65.00 $68.00 $22.00 $23.00 $24.00 92325 $14.00 $25.00 $27.00 $29.00 $25.00 $27.00 $29.00 92326 $44.00 $50.00 $55.00 $59.00 $50.00 $55.00 $59.00 92340 $32.00 $37.00 $39.00 $40.00 $19.00 $19.00 $20.00 92341 $43.00 $41.00 $43.00 $45.00 $23.00 $24.00 $25.00 92342 $43.00 $45.00 $47.00 $48.00 $27.00 $28.00 $28.00 92352 $31.00 $39.00 $41.00 $42.00 $19.00 $19.00 $20.00 92353 $38.00 $46.00 $48.00 $50.00 $26.00 $26.00 $27.00 92354 $221.00 $186.00 $201.00 $215.00 $186.00 $201.00 $215.00 92355 $107.00 $94.00 $101.00 $107.00 $94.00 $101.00 $107.00 92358 $24.00 $27.00 $29.00 $32.00 $27.00 $29.00 $32.00 92370 $35.00 $31.00 $33.00 $35.00 $17.00 $18.00 $18.00 92371 $18.00 $18.00 $20.00 $21.00 $18.00 $20.00 $21.00 92499 BR ------- ------- ------- ------- ------- ------- 92499-26 BR ------- ------- ------- ------- ------- ------- 92499-TC BR ------- ------- ------- ------- ------- ------- 92502 $101.00 $98.00 $102.00 $106.00 $98.00 $102.00 $106.00 92504 $24.00 $29.00 $31.00 $32.00 $10.00 $10.00 $11.00 92506 $63.00 $153.00 $163.00 $171.00 $47.00 $49.00 $50.00 92507 $40.00 $66.00 $70.00 $73.00 $28.00 $29.00 $30.00 92508 $42.00 $31.00 $33.00 $34.00 $15.00 $15.00 $16.00 92511 $81.00 $159.00 $169.00 $177.00 $61.00 $64.00 $66.00 92512 $46.00 $63.00 $67.00 $70.00 $28.00 $29.00 $30.00 92516 $36.00 $64.00 $68.00 $71.00 $24.00 $24.00 $25.00 92520 $47.00 $58.00 $60.00 $63.00 $42.00 $43.00 $45.00 92526 $48.00 $87.00 $92.00 $96.00 $28.00 $29.00 $30.00 92531 $10.00 ------- ------- ------- ------- ------- ------- 92532 $14.00 ------- ------- ------- ------- ------- ------- 92533 $41.00 ------- ------- ------- ------- ------- ------- 92534 BR ------- ------- ------- ------- ------- ------- 92541 $37.00 $60.00 $64.00 $68.00 $60.00 $64.00 $68.00 92541-26 $25.00 $22.00 $23.00 $24.00 $22.00 $23.00 $24.00 92541-TC $9.00 $38.00 $41.00 $44.00 $38.00 $41.00 $44.00 92542 $33.00 $62.00 $66.00 $70.00 $62.00 $66.00 $70.00 92542-26 $20.00 $18.00 $18.00 $19.00 $18.00 $18.00 $19.00 92542-TC $10.00 $44.00 $47.00 $51.00 $44.00 $47.00 $51.00 92543 $28.00 $29.00 $31.00 $33.00 $29.00 $31.00 $33.00 92543-26 $19.00 $6.00 $6.00 $7.00 $6.00 $6.00 $7.00 92543-TC $10.00 $23.00 $25.00 $26.00 $23.00 $25.00 $26.00 92544 $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
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 92544-26 $16.00 $14.00 $15.00 $15.00 $14.00 $15.00 $15.00 92544-TC $8.00 $35.00 $38.00 $41.00 $35.00 $38.00 $41.00 92545 $22.00 $46.00 $49.00 $52.00 $46.00 $49.00 $52.00 92545-26 $14.00 $13.00 $13.00 $14.00 $13.00 $13.00 $14.00 92545-TC $8.00 $33.00 $36.00 $38.00 $33.00 $36.00 $38.00 92546 $29.00 $87.00 $93.00 $99.00 $87.00 $93.00 $99.00 92546-26 $17.00 $15.00 $16.00 $16.00 $15.00 $16.00 $16.00 92546-TC $9.00 $72.00 $77.00 $82.00 $72.00 $77.00 $82.00 92547 $21.00 $7.00 $9.00 $11.00 $7.00 $9.00 $11.00 92548 $92.00 $106.00 $114.00 $123.00 $106.00 $114.00 $123.00 92548-26 $30.00 $28.00 $28.00 $30.00 $28.00 $28.00 $30.00 92548-TC $59.00 $78.00 $86.00 $94.00 $78.00 $86.00 $94.00 92551 $17.00 $10.00 $11.00 $12.00 $10.00 $11.00 $12.00 92552 $16.00 $23.00 $25.00 $28.00 $23.00 $25.00 $28.00 92553 $24.00 $32.00 $35.00 $38.00 $32.00 $35.00 $38.00 92555 $14.00 $18.00 $20.00 $22.00 $18.00 $20.00 $22.00 92556 $21.00 $25.00 $28.00 $31.00 $25.00 $28.00 $31.00 92557 $46.00 $59.00 $63.00 $69.00 $57.00 $61.00 $66.00 92560 $23.00 ------- ------- ------- ------- ------- ------- 92561 $27.00 $32.00 $35.00 $38.00 $32.00 $35.00 $38.00 92562 $15.00 $23.00 $25.00 $27.00 $23.00 $25.00 $27.00 92563 $14.00 $21.00 $23.00 $25.00 $21.00 $23.00 $25.00 92564 $17.00 $22.00 $24.00 $27.00 $22.00 $24.00 $27.00 92565 $15.00 $15.00 $17.00 $19.00 $15.00 $17.00 $19.00 92567 $20.00 $24.00 $26.00 $29.00 $23.00 $25.00 $27.00 92568 $14.00 $23.00 $24.00 $26.00 $23.00 $24.00 $26.00 92569 $15.00 $19.00 $21.00 $23.00 $19.00 $21.00 $23.00 92571 $14.00 $19.00 $21.00 $23.00 $19.00 $21.00 $23.00 92572 $3.00 $14.00 $15.00 $16.00 $14.00 $15.00 $16.00 92575 $11.00 $30.00 $32.00 $35.00 $30.00 $32.00 $35.00 92576 $17.00 $23.00 $26.00 $28.00 $23.00 $26.00 $28.00 92577 $28.00 $24.00 $26.00 $30.00 $24.00 $26.00 $30.00 92579 $28.00 $51.00 $54.00 $57.00 $49.00 $51.00 $54.00 92582 $28.00 $41.00 $45.00 $49.00 $41.00 $45.00 $49.00 92583 $34.00 $37.00 $41.00 $45.00 $37.00 $41.00 $45.00 92584 $94.00 $88.00 $98.00 $109.00 $88.00 $98.00 $109.00 92585 $114.00 $111.00 $120.00 $130.00 $111.00 $120.00 $130.00 92585-26 $52.00 $27.00 $28.00 $30.00 $27.00 $28.00 $30.00 92585-TC $70.00 $83.00 $91.00 $100.00 $83.00 $91.00 $100.00 92586 $70.00 $73.00 $81.00 $89.00 $73.00 $81.00 $89.00 92587 $58.00 $52.00 $57.00 $63.00 $52.00 $57.00 $63.00 92587-26 $8.00 $7.00 $8.00 $8.00 $7.00 $8.00 $8.00 92587-TC $49.00 $45.00 $49.00 $55.00 $45.00 $49.00 $55.00 92588 $78.00 $76.00 $83.00 $90.00 $76.00 $83.00 $90.00 92588-26 $20.00 $20.00 $20.00 $21.00 $20.00 $20.00 $21.00 92588-TC $57.00 $57.00 $63.00 $70.00 $57.00 $63.00 $70.00 92590 $41.00 ------- ------- ------- ------- ------- ------- 92591 BR ------- ------- ------- ------- ------- ------- 92592 BR ------- ------- ------- ------- ------- ------- 92593 BR ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 358
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 92594 BR ------- ------- ------- ------- ------- ------- 92595 BR ------- ------- ------- ------- ------- ------- 92596 $22.00 $35.00 $39.00 $42.00 $35.00 $39.00 $42.00 92597 $96.00 $106.00 $112.00 $117.00 $48.00 $50.00 $52.00 92603 $88.00 $153.00 $159.00 $165.00 $144.00 $149.00 $155.00 92604 $60.00 $92.00 $96.00 $101.00 $85.00 $89.00 $93.00 92605 BR ------- ------- ------- ------- ------- ------- 92606 BR ------- ------- ------- ------- ------- ------- 92607 $109.00 $155.00 $166.00 $177.00 $155.00 $166.00 $177.00 92608 $22.00 $31.00 $34.00 $38.00 $31.00 $34.00 $38.00 92609 $59.00 $82.00 $88.00 $94.00 $82.00 $88.00 $94.00 92610 $42.00 $106.00 $115.00 $123.00 $106.00 $115.00 $123.00 92611 $46.00 $111.00 $120.00 $128.00 $111.00 $120.00 $128.00 92612 $173.00 $162.00 $171.00 $178.00 $71.00 $73.00 $75.00 92613 BR $42.00 $44.00 $46.00 $42.00 $44.00 $46.00 92614 $134.00 $146.00 $154.00 $161.00 $71.00 $73.00 $75.00 92615 BR $37.00 $39.00 $41.00 $37.00 $39.00 $41.00 92616 $183.00 $202.00 $212.00 $222.00 $105.00 $108.00 $112.00 92617 BR $46.00 $48.00 $51.00 $46.00 $48.00 $51.00 92620 ------- $64.00 $70.00 $75.00 $64.00 $70.00 $75.00 92621 ------- $17.00 $19.00 $22.00 $17.00 $19.00 $22.00 92625 ------- $64.00 $69.00 $75.00 $64.00 $69.00 $75.00 92626 ------- $86.00 $93.00 $100.00 $86.00 $93.00 $100.00 92627 ------- $21.00 $23.00 $24.00 $21.00 $23.00 $24.00 92640 ------- $53.00 $57.00 $61.00 $53.00 $57.00 $61.00 92700 BR ------- ------- ------- ------- ------- ------- 92950 $203.00 $303.00 $319.00 $337.00 $192.00 $200.00 $210.00 92953 $35.00 $12.00 $13.00 $14.00 $12.00 $13.00 $14.00 92960 $162.00 $297.00 $313.00 $328.00 $139.00 $144.00 $149.00 92961 $239.00 $276.00 $288.00 $302.00 $276.00 $288.00 $302.00 92970 $201.00 $189.00 $196.00 $203.00 $189.00 $196.00 $203.00 92971 $100.00 $107.00 $111.00 $115.00 $107.00 $111.00 $115.00 92973 $174.00 $195.00 $204.00 $215.00 $195.00 $204.00 $215.00 92974 $197.00 $179.00 $187.00 $197.00 $179.00 $187.00 $197.00 92975 $400.00 $429.00 $449.00 $472.00 $429.00 $449.00 $472.00 92977 $302.00 $221.00 $244.00 $269.00 $221.00 $244.00 $269.00 92978 $269.00 ------- ------- ------- ------- ------- ------- 92978-26 $95.00 $103.00 $107.00 $111.00 $103.00 $107.00 $111.00 92978-TC $170.00 ------- ------- ------- ------- ------- ------- 92979 $163.00 ------- ------- ------- ------- ------- ------- 92979-26 $76.00 $83.00 $86.00 $90.00 $83.00 $86.00 $90.00 92979-TC $86.00 ------- ------- ------- ------- ------- ------- 92980 $952.00 $889.00 $930.00 $978.00 $889.00 $930.00 $978.00 92981 $268.00 $247.00 $258.00 $272.00 $247.00 $258.00 $272.00 92982 $705.00 $659.00 $689.00 $725.00 $659.00 $689.00 $725.00 92984 $191.00 $177.00 $185.00 $194.00 $177.00 $185.00 $194.00 92986 $1,222.00 $1,465.00 $1,533.00 $1,611.00 $1,465.00 $1,533.00 $1,611.00 92987 $1,271.00 $1,519.00 $1,590.00 $1,672.00 $1,519.00 $1,590.00 $1,672.00 92990 $974.00 $1,158.00 $1,212.00 $1,274.00 $1,158.00 $1,212.00 $1,274.00 92992 BR ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 359
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 92993 BR ------- ------- ------- ------- ------- ------- 92995 $776.00 $725.00 $758.00 $798.00 $725.00 $758.00 $798.00 92996 $210.00 $186.00 $192.00 $199.00 $186.00 $192.00 $199.00 92997 $765.00 $672.00 $694.00 $719.00 $672.00 $694.00 $719.00 92998 $331.00 $340.00 $353.00 $368.00 $340.00 $353.00 $368.00 93000 $26.00 $25.00 $26.00 $28.00 $25.00 $26.00 $28.00 93005 $16.00 $15.00 $17.00 $18.00 $15.00 $17.00 $18.00 93010 $12.00 $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 93012 $90.00 $211.00 $229.00 $246.00 $211.00 $229.00 $246.00 93014 $28.00 $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 93015 $104.00 $113.00 $121.00 $130.00 $113.00 $121.00 $130.00 93016 $25.00 $26.00 $27.00 $28.00 $26.00 $27.00 $28.00 93017 $63.00 $70.00 $77.00 $84.00 $70.00 $77.00 $84.00 93018 $54.00 $17.00 $17.00 $18.00 $17.00 $17.00 $18.00 93024 $111.00 $128.00 $136.00 $145.00 $128.00 $136.00 $145.00 93024-26 $71.00 $66.00 $68.00 $70.00 $66.00 $68.00 $70.00 93024-TC $42.00 $63.00 $68.00 $74.00 $63.00 $68.00 $74.00 93025 $277.00 $263.00 $282.00 $300.00 $263.00 $282.00 $300.00 93025-26 ------- $43.00 $44.00 $46.00 $43.00 $44.00 $46.00 93025-TC ------- $220.00 $237.00 $253.00 $220.00 $237.00 $253.00 93040 $14.00 $15.00 $16.00 $17.00 $15.00 $16.00 $17.00 93041 $31.00 $7.00 $7.00 $8.00 $7.00 $7.00 $8.00 93042 $9.00 $8.00 $9.00 $9.00 $8.00 $9.00 $9.00 93224 $159.00 $151.00 $164.00 $178.00 $151.00 $164.00 $178.00 93225 $46.00 $46.00 $51.00 $56.00 $46.00 $51.00 $56.00 93226 $83.00 $75.00 $83.00 $91.00 $75.00 $83.00 $91.00 93227 $50.00 $30.00 $31.00 $32.00 $30.00 $31.00 $32.00 93230 $168.00 $157.00 $171.00 $186.00 $157.00 $171.00 $186.00 93231 $57.00 $51.00 $56.00 $62.00 $51.00 $56.00 $62.00 93232 $82.00 $78.00 $85.00 $93.00 $78.00 $85.00 $93.00 93233 $55.00 $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 93235 $123.00 ------- ------- ------- ------- ------- ------- 93236 $97.00 ------- ------- ------- ------- ------- ------- 93237 $28.00 $25.00 $26.00 $27.00 $25.00 $26.00 $27.00 93268 $109.00 $296.00 $320.00 $344.00 $296.00 $320.00 $344.00 93270 $46.00 $35.00 $39.00 $43.00 $35.00 $39.00 $43.00 93271 $90.00 $233.00 $252.00 $271.00 $233.00 $252.00 $271.00 93272 $28.00 $28.00 $29.00 $30.00 $28.00 $29.00 $30.00 93278 $58.00 $53.00 $58.00 $64.00 $53.00 $58.00 $64.00 93278-26 $24.00 $14.00 $14.00 $15.00 $14.00 $14.00 $15.00 93278-TC $44.00 $39.00 $44.00 $49.00 $39.00 $44.00 $49.00 93303 $215.00 $238.00 $255.00 $274.00 $238.00 $255.00 $274.00 93303-26 $70.00 $70.00 $72.00 $74.00 $70.00 $72.00 $74.00 93303-TC $144.00 $168.00 $183.00 $200.00 $168.00 $183.00 $200.00 93304 $114.00 $142.00 $152.00 $163.00 $142.00 $152.00 $163.00 93304-26 $43.00 $40.00 $41.00 $43.00 $40.00 $41.00 $43.00 93304-TC $73.00 $102.00 $111.00 $120.00 $102.00 $111.00 $120.00 93307 $196.00 $206.00 $222.00 $240.00 $206.00 $222.00 $240.00 93307-26 $56.00 $52.00 $53.00 $55.00 $52.00 $53.00 $55.00 93307-TC $144.00 $154.00 $169.00 $184.00 $154.00 $169.00 $184.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 360
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 93308 $118.00 $122.00 $132.00 $142.00 $122.00 $132.00 $142.00 93308-26 $46.00 $30.00 $31.00 $32.00 $30.00 $31.00 $32.00 93308-TC $75.00 $93.00 $101.00 $110.00 $93.00 $101.00 $110.00 93312 $322.00 $339.00 $363.00 $388.00 $339.00 $363.00 $388.00 93312-26 $140.00 $121.00 $125.00 $129.00 $121.00 $125.00 $129.00 93312-TC $182.00 $218.00 $238.00 $259.00 $218.00 $238.00 $259.00 93313 $76.00 $46.00 $47.00 $50.00 $46.00 $47.00 $50.00 93314 $212.00 $292.00 $314.00 $338.00 $292.00 $314.00 $338.00 93314-26 $65.00 $69.00 $71.00 $73.00 $69.00 $71.00 $73.00 93314-TC $144.00 $223.00 $243.00 $264.00 $223.00 $243.00 $264.00 93315 $287.00 $616.00 $678.00 $747.00 $616.00 $678.00 $747.00 93315-26 $144.00 $154.00 $159.00 $164.00 $154.00 $159.00 $164.00 93315-TC $141.00 $565.00 $622.00 $685.00 $565.00 $622.00 $685.00 93316 $78.00 $48.00 $50.00 $52.00 $48.00 $50.00 $52.00 93317 $236.00 ------- ------- ------- ------- ------- ------- 93317-26 $95.00 $96.00 $100.00 $104.00 $96.00 $100.00 $104.00 93317-TC $141.00 ------- ------- ------- ------- ------- ------- 93318 BR $600.00 $662.00 $731.00 $600.00 $662.00 $731.00 93318-26 $114.00 $116.00 $121.00 $127.00 $116.00 $121.00 $127.00 93318-TC BR $565.00 $622.00 $685.00 $565.00 $622.00 $685.00 93320 $86.00 $91.00 $99.00 $107.00 $91.00 $99.00 $107.00 93320-26 $30.00 $21.00 $22.00 $23.00 $21.00 $22.00 $23.00 93320-TC $65.00 $70.00 $77.00 $85.00 $70.00 $77.00 $85.00 93321 $50.00 $46.00 $50.00 $55.00 $46.00 $50.00 $55.00 93321-26 $10.00 $9.00 $9.00 $10.00 $9.00 $9.00 $10.00 93321-TC $42.00 $37.00 $41.00 $45.00 $37.00 $41.00 $45.00 93325 $114.00 $87.00 $96.00 $107.00 $87.00 $96.00 $107.00 93325-26 $4.00 $4.00 $5.00 $5.00 $4.00 $5.00 $5.00 93325-TC $110.00 $83.00 $92.00 $102.00 $83.00 $92.00 $102.00 93350 $216.00 $211.00 $225.00 $239.00 $211.00 $225.00 $239.00 93350-26 $77.00 $83.00 $86.00 $89.00 $83.00 $86.00 $89.00 93350-TC $66.00 $128.00 $139.00 $150.00 $128.00 $139.00 $150.00 93501 $674.00 $913.00 $990.00 $1,071.00 $913.00 $990.00 $1,071.00 93501-26 $160.00 $178.00 $186.00 $196.00 $178.00 $186.00 $196.00 93501-TC $634.00 $735.00 $804.00 $876.00 $735.00 $804.00 $876.00 93503 $187.00 $120.00 $124.00 $130.00 $120.00 $124.00 $130.00 93505 $318.00 $672.00 $716.00 $759.00 $672.00 $716.00 $759.00 93505-26 $248.00 $258.00 $269.00 $283.00 $258.00 $269.00 $283.00 93505-TC $74.00 $415.00 $447.00 $476.00 $415.00 $447.00 $476.00 93508 $698.00 $1,064.00 $1,144.00 $1,222.00 $1,064.00 $1,144.00 $1,222.00 93508-26 $232.00 $252.00 $263.00 $277.00 $252.00 $263.00 $277.00 93508-TC $469.00 $812.00 $880.00 $945.00 $812.00 $880.00 $945.00 93510 $1,628.00 $1,643.00 $1,790.00 $1,948.00 $1,643.00 $1,790.00 $1,948.00 93510-26 $247.00 $265.00 $278.00 $292.00 $265.00 $278.00 $292.00 93510-TC $1,388.00 $1,378.00 $1,512.00 $1,656.00 $1,378.00 $1,512.00 $1,656.00 93511 $1,629.00 ------- ------- ------- ------- ------- ------- 93511-26 $270.00 $307.00 $321.00 $338.00 $307.00 $321.00 $338.00 93511-TC $1,350.00 ------- ------- ------- ------- ------- ------- 93514 $2,208.00 ------- ------- ------- ------- ------- ------- 93514-26 $525.00 $410.00 $428.00 $450.00 $410.00 $428.00 $450.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 361
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 93514-TC $1,683.00 ------- ------- ------- ------- ------- ------- 93524 $2,150.00 ------- ------- ------- ------- ------- ------- 93524-26 $392.00 $422.00 $441.00 $464.00 $422.00 $441.00 $464.00 93524-TC $1,766.00 ------- ------- ------- ------- ------- ------- 93526 $2,147.00 $2,126.00 $2,316.00 $2,522.00 $2,126.00 $2,316.00 $2,522.00 93526-26 $363.00 $364.00 $381.00 $401.00 $364.00 $381.00 $401.00 93526-TC $1,815.00 $1,762.00 $1,935.00 $2,121.00 $1,762.00 $1,935.00 $2,121.00 93527 $2,186.00 ------- ------- ------- ------- ------- ------- 93527-26 $451.00 $441.00 $461.00 $485.00 $441.00 $461.00 $485.00 93527-TC $1,766.00 ------- ------- ------- ------- ------- ------- 93528 $2,266.00 ------- ------- ------- ------- ------- ------- 93528-26 $482.00 $537.00 $561.00 $590.00 $537.00 $561.00 $590.00 93528-TC $1,766.00 ------- ------- ------- ------- ------- ------- 93529 $2,032.00 ------- ------- ------- ------- ------- ------- 93529-26 $262.00 $293.00 $306.00 $322.00 $293.00 $306.00 $322.00 93529-TC $1,766.00 ------- ------- ------- ------- ------- ------- 93530 $872.00 ------- ------- ------- ------- ------- ------- 93530-26 $250.00 $248.00 $259.00 $273.00 $248.00 $259.00 $273.00 93530-TC $634.00 ------- ------- ------- ------- ------- ------- 93531 $2,268.00 ------- ------- ------- ------- ------- ------- 93531-26 $467.00 $484.00 $506.00 $532.00 $484.00 $506.00 $532.00 93531-TC $1,815.00 ------- ------- ------- ------- ------- ------- 93532 $2,317.00 ------- ------- ------- ------- ------- ------- 93532-26 $569.00 $567.00 $592.00 $622.00 $567.00 $592.00 $622.00 93532-TC $1,766.00 ------- ------- ------- ------- ------- ------- 93533 $2,131.00 ------- ------- ------- ------- ------- ------- 93533-26 $352.00 $393.00 $411.00 $432.00 $393.00 $411.00 $432.00 93533-TC $1,766.00 ------- ------- ------- ------- ------- ------- 93539 $45.00 $67.00 $71.00 $74.00 $23.00 $23.00 $24.00 93540 $49.00 $189.00 $201.00 $212.00 $24.00 $25.00 $26.00 93541 $38.00 $17.00 $17.00 $18.00 $17.00 $17.00 $18.00 93542 $38.00 $116.00 $123.00 $130.00 $17.00 $17.00 $18.00 93543 $213.00 $65.00 $69.00 $73.00 $17.00 $17.00 $18.00 93544 $30.00 $48.00 $51.00 $53.00 $15.00 $15.00 $16.00 93545 $240.00 $133.00 $142.00 $149.00 $23.00 $23.00 $24.00 93555 $278.00 $194.00 $211.00 $231.00 $194.00 $211.00 $231.00 93555-26 $42.00 $46.00 $48.00 $50.00 $46.00 $48.00 $50.00 93555-TC $234.00 $148.00 $163.00 $181.00 $148.00 $163.00 $181.00 93556 $414.00 $282.00 $308.00 $338.00 $282.00 $308.00 $338.00 93556-26 $44.00 $47.00 $49.00 $51.00 $47.00 $49.00 $51.00 93556-TC $368.00 $235.00 $259.00 $287.00 $235.00 $259.00 $287.00 93561 $59.00 ------- ------- ------- ------- ------- ------- 93561-26 $47.00 $26.00 $26.00 $27.00 $26.00 $26.00 $27.00 93561-TC $20.00 ------- ------- ------- ------- ------- ------- 93562 $46.00 ------- ------- ------- ------- ------- ------- 93562-26 $33.00 $8.00 $8.00 $9.00 $8.00 $8.00 $9.00 93562-TC $13.00 ------- ------- ------- ------- ------- ------- 93571 $270.00 ------- ------- ------- ------- ------- ------- 93571-26 $93.00 $103.00 $106.00 $110.00 $103.00 $106.00 $110.00 93571-TC $170.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 362
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 93572 $222.00 ------- ------- ------- ------- ------- ------- 93572-26 $74.00 $80.00 $83.00 $85.00 $80.00 $83.00 $85.00 93572-TC $155.00 ------- ------- ------- ------- ------- ------- 93580 $974.00 $1,071.00 $1,119.00 $1,177.00 $1,071.00 $1,119.00 $1,177.00 93581 $1,303.00 $1,419.00 $1,482.00 $1,560.00 $1,419.00 $1,482.00 $1,560.00 93600 $198.00 ------- ------- ------- ------- ------- ------- 93600-26 $129.00 $126.00 $132.00 $139.00 $126.00 $132.00 $139.00 93600-TC $73.00 ------- ------- ------- ------- ------- ------- 93602 $159.00 ------- ------- ------- ------- ------- ------- 93602-26 $119.00 $125.00 $131.00 $139.00 $125.00 $131.00 $139.00 93602-TC $42.00 ------- ------- ------- ------- ------- ------- 93603 $187.00 ------- ------- ------- ------- ------- ------- 93603-26 $127.00 $126.00 $132.00 $140.00 $126.00 $132.00 $140.00 93603-TC $63.00 ------- ------- ------- ------- ------- ------- 93609 $578.00 ------- ------- ------- ------- ------- ------- 93609-26 $481.00 $296.00 $309.00 $325.00 $296.00 $309.00 $325.00 93609-TC $101.00 ------- ------- ------- ------- ------- ------- 93610 $214.00 ------- ------- ------- ------- ------- ------- 93610-26 $166.00 $178.00 $186.00 $197.00 $178.00 $186.00 $197.00 93610-TC $52.00 ------- ------- ------- ------- ------- ------- 93612 $224.00 ------- ------- ------- ------- ------- ------- 93612-26 $167.00 $178.00 $186.00 $197.00 $178.00 $186.00 $197.00 93612-TC $61.00 ------- ------- ------- ------- ------- ------- 93613 $377.00 $415.00 $434.00 $457.00 $415.00 $434.00 $457.00 93615 $62.00 ------- ------- ------- ------- ------- ------- 93615-26 $49.00 $54.00 $56.00 $58.00 $54.00 $56.00 $58.00 93615-TC $12.00 ------- ------- ------- ------- ------- ------- 93616 $94.00 ------- ------- ------- ------- ------- ------- 93616-26 $82.00 $74.00 $77.00 $81.00 $74.00 $77.00 $81.00 93616-TC $12.00 ------- ------- ------- ------- ------- ------- 93618 $399.00 ------- ------- ------- ------- ------- ------- 93618-26 $258.00 $253.00 $264.00 $278.00 $253.00 $264.00 $278.00 93618-TC $148.00 ------- ------- ------- ------- ------- ------- 93619 $717.00 ------- ------- ------- ------- ------- ------- 93619-26 $444.00 $440.00 $460.00 $484.00 $440.00 $460.00 $484.00 93619-TC $290.00 ------- ------- ------- ------- ------- ------- 93620 $358.00 ------- ------- ------- ------- ------- ------- 93620-26 $272.00 $691.00 $722.00 $760.00 $691.00 $722.00 $760.00 93620-TC $91.00 ------- ------- ------- ------- ------- ------- 93621 BR ------- ------- ------- ------- ------- ------- 93621-26 $769.00 $125.00 $130.00 $137.00 $125.00 $130.00 $137.00 93621-TC BR ------- ------- ------- ------- ------- ------- 93622 BR ------- ------- ------- ------- ------- ------- 93622-26 $771.00 $183.00 $191.00 $201.00 $183.00 $191.00 $201.00 93622-TC BR ------- ------- ------- ------- ------- ------- 93623 BR ------- ------- ------- ------- ------- ------- 93623-26 $167.00 $169.00 $176.00 $185.00 $169.00 $176.00 $185.00 93623-TC BR ------- ------- ------- ------- ------- ------- 93624 $333.00 ------- ------- ------- ------- ------- ------- 93624-26 $256.00 $292.00 $305.00 $321.00 $292.00 $305.00 $321.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 363
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 93624-TC $74.00 ------- ------- ------- ------- ------- ------- 93631 $651.00 ------- ------- ------- ------- ------- ------- 93631-26 $420.00 $449.00 $476.00 $512.00 $449.00 $476.00 $512.00 93631-TC $239.00 ------- ------- ------- ------- ------- ------- 93640 $467.00 ------- ------- ------- ------- ------- ------- 93640-26 $230.00 $207.00 $216.00 $227.00 $207.00 $216.00 $227.00 93640-TC $269.00 ------- ------- ------- ------- ------- ------- 93641 $613.00 ------- ------- ------- ------- ------- ------- 93641-26 $360.00 $350.00 $366.00 $385.00 $350.00 $366.00 $385.00 93641-TC $269.00 ------- ------- ------- ------- ------- ------- 93642 $549.00 ------- ------- ------- ------- ------- ------- 93642-26 $295.00 $284.00 $294.00 $304.00 $284.00 $294.00 $304.00 93642-TC $269.00 $261.00 $286.00 $312.00 $261.00 $286.00 $312.00 93650 $639.00 $634.00 $663.00 $697.00 $634.00 $663.00 $697.00 93651 $985.00 $961.00 $1,004.00 $1,056.00 $961.00 $1,004.00 $1,056.00 93652 $1,044.00 $1,047.00 $1,094.00 $1,151.00 $1,047.00 $1,094.00 $1,151.00 93660 $162.00 $181.00 $190.00 $199.00 $181.00 $190.00 $199.00 93660-26 $103.00 $107.00 $110.00 $114.00 $107.00 $110.00 $114.00 93660-TC $61.00 $74.00 $80.00 $85.00 $74.00 $80.00 $85.00 93662 BR ------- ------- ------- ------- ------- ------- 93662-26 $158.00 $160.00 $165.00 $171.00 $160.00 $165.00 $171.00 93662-TC BR ------- ------- ------- ------- ------- ------- 93668 BR $17.00 $18.00 $19.00 $17.00 $18.00 $19.00 93701 $36.00 $41.00 $43.00 $46.00 $41.00 $43.00 $46.00 93701-26 $9.00 $10.00 $10.00 $11.00 $10.00 $10.00 $11.00 93701-TC $27.00 $31.00 $33.00 $35.00 $31.00 $33.00 $35.00 93720 $43.00 $49.00 $53.00 $57.00 $49.00 $53.00 $57.00 93721 $27.00 $40.00 $44.00 $48.00 $40.00 $44.00 $48.00 93722 $24.00 $9.00 $9.00 $10.00 $9.00 $9.00 $10.00 93724 $411.00 $383.00 $404.00 $426.00 $383.00 $404.00 $426.00 93724-26 $259.00 $273.00 $282.00 $292.00 $273.00 $282.00 $292.00 93724-TC $148.00 $110.00 $122.00 $135.00 $110.00 $122.00 $135.00 93740 $17.00 $11.00 $12.00 $13.00 $11.00 $12.00 $13.00 93740-26 $12.00 $8.00 $8.00 $9.00 $8.00 $8.00 $9.00 93740-TC $5.00 $3.00 $4.00 $4.00 $3.00 $4.00 $4.00 93770 NC NC NC NC NC NC NC 93770-26 NC NC NC NC NC NC NC 93770-TC NC NC NC NC NC NC NC 93784 NC NC NC NC NC NC NC 93786 NC NC NC NC NC NC NC 93788 NC NC NC NC NC NC NC 93790 NC NC NC NC NC NC NC 93797 $17.00 $19.00 $21.00 $22.00 $10.00 $11.00 $11.00 93798 $38.00 $29.00 $30.00 $32.00 $16.00 $16.00 $17.00 93799 BR ------- ------- ------- ------- ------- ------- 93799-26 BR ------- ------- ------- ------- ------- ------- 93799-TC BR ------- ------- ------- ------- ------- ------- 93875 $55.00 $111.00 $120.00 $130.00 $111.00 $120.00 $130.00 93875-26 $17.00 $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 93875-TC $42.00 $100.00 $109.00 $118.00 $100.00 $109.00 $118.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 364
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 93880 $176.00 $194.00 $211.00 $228.00 $194.00 $211.00 $228.00 93880-26 $31.00 $33.00 $34.00 $36.00 $33.00 $34.00 $36.00 93880-TC $144.00 $162.00 $177.00 $192.00 $162.00 $177.00 $192.00 93882 $117.00 $181.00 $197.00 $214.00 $181.00 $197.00 $214.00 93882-26 $21.00 $22.00 $23.00 $25.00 $22.00 $23.00 $25.00 93882-TC $95.00 $159.00 $173.00 $189.00 $159.00 $173.00 $189.00 93886 $215.00 $212.00 $229.00 $248.00 $212.00 $229.00 $248.00 93886-26 $50.00 $51.00 $53.00 $56.00 $51.00 $53.00 $56.00 93886-TC $162.00 $161.00 $176.00 $192.00 $161.00 $176.00 $192.00 93888 $142.00 $99.00 $107.00 $115.00 $99.00 $107.00 $115.00 93888-26 $33.00 $34.00 $36.00 $38.00 $34.00 $36.00 $38.00 93888-TC $109.00 $65.00 $71.00 $77.00 $65.00 $71.00 $77.00 93890 ------- $158.00 $170.00 $183.00 $158.00 $170.00 $183.00 93890-26 ------- $55.00 $57.00 $60.00 $55.00 $57.00 $60.00 93890-TC ------- $103.00 $113.00 $124.00 $103.00 $113.00 $124.00 93892 ------- $164.00 $176.00 $189.00 $164.00 $176.00 $189.00 93892-26 ------- $61.00 $64.00 $66.00 $61.00 $64.00 $66.00 93892-TC ------- $103.00 $112.00 $123.00 $103.00 $112.00 $123.00 93893 ------- $164.00 $176.00 $189.00 $164.00 $176.00 $189.00 93893-26 ------- $61.00 $64.00 $66.00 $61.00 $64.00 $66.00 93893-TC ------- $103.00 $112.00 $123.00 $103.00 $112.00 $123.00 93922 $60.00 $132.00 $144.00 $155.00 $132.00 $144.00 $155.00 93922-26 $16.00 $14.00 $14.00 $15.00 $14.00 $14.00 $15.00 93922-TC $44.00 $119.00 $129.00 $140.00 $119.00 $129.00 $140.00 93923 $112.00 $204.00 $221.00 $239.00 $204.00 $221.00 $239.00 93923-26 $28.00 $25.00 $26.00 $28.00 $25.00 $26.00 $28.00 93923-TC $85.00 $179.00 $195.00 $212.00 $179.00 $195.00 $212.00 93924 $122.00 $248.00 $269.00 $290.00 $248.00 $269.00 $290.00 93924-26 $31.00 $28.00 $30.00 $32.00 $28.00 $30.00 $32.00 93924-TC $92.00 $219.00 $239.00 $259.00 $219.00 $239.00 $259.00 93925 $175.00 $191.00 $207.00 $223.00 $191.00 $207.00 $223.00 93925-26 $31.00 $31.00 $33.00 $34.00 $31.00 $33.00 $34.00 93925-TC $144.00 $160.00 $174.00 $189.00 $160.00 $174.00 $189.00 93926 $117.00 $123.00 $133.00 $144.00 $123.00 $133.00 $144.00 93926-26 $21.00 $21.00 $23.00 $24.00 $21.00 $23.00 $24.00 93926-TC $96.00 $102.00 $111.00 $120.00 $102.00 $111.00 $120.00 93930 $174.00 $187.00 $203.00 $221.00 $187.00 $203.00 $221.00 93930-26 $26.00 $26.00 $27.00 $28.00 $26.00 $27.00 $28.00 93930-TC $150.00 $161.00 $177.00 $193.00 $161.00 $177.00 $193.00 93931 $118.00 $120.00 $130.00 $141.00 $120.00 $130.00 $141.00 93931-26 $17.00 $17.00 $18.00 $19.00 $17.00 $18.00 $19.00 93931-TC $101.00 $102.00 $112.00 $122.00 $102.00 $112.00 $122.00 93965 $63.00 $136.00 $146.00 $158.00 $136.00 $146.00 $158.00 93965-26 $26.00 $19.00 $19.00 $20.00 $19.00 $19.00 $20.00 93965-TC $42.00 $117.00 $127.00 $137.00 $117.00 $127.00 $137.00 93970 $189.00 $200.00 $218.00 $237.00 $200.00 $218.00 $237.00 93970-26 $36.00 $38.00 $39.00 $42.00 $38.00 $39.00 $42.00 93970-TC $154.00 $162.00 $178.00 $195.00 $162.00 $178.00 $195.00 93971 $121.00 $127.00 $138.00 $150.00 $127.00 $138.00 $150.00 93971-26 $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
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 93971-TC $96.00 $103.00 $113.00 $124.00 $103.00 $113.00 $124.00 93975 $277.00 $260.00 $279.00 $300.00 $260.00 $279.00 $300.00 93975-26 $89.00 $99.00 $103.00 $108.00 $99.00 $103.00 $108.00 93975-TC $181.00 $161.00 $176.00 $192.00 $161.00 $176.00 $192.00 93976 $184.00 $227.00 $245.00 $265.00 $227.00 $245.00 $265.00 93976-26 $59.00 $64.00 $66.00 $69.00 $64.00 $66.00 $69.00 93976-TC $121.00 $163.00 $179.00 $196.00 $163.00 $179.00 $196.00 93978 $177.00 $199.00 $216.00 $236.00 $199.00 $216.00 $236.00 93978-26 $34.00 $36.00 $38.00 $40.00 $36.00 $38.00 $40.00 93978-TC $143.00 $162.00 $178.00 $195.00 $162.00 $178.00 $195.00 93979 $122.00 $127.00 $138.00 $149.00 $127.00 $138.00 $149.00 93979-26 $23.00 $24.00 $25.00 $26.00 $24.00 $25.00 $26.00 93979-TC $98.00 $103.00 $112.00 $123.00 $103.00 $112.00 $123.00 93980 $183.00 $196.00 $214.00 $234.00 $196.00 $214.00 $234.00 93980-26 $65.00 $68.00 $71.00 $74.00 $68.00 $71.00 $74.00 93980-TC $105.00 $128.00 $143.00 $160.00 $128.00 $143.00 $160.00 93981 $148.00 $149.00 $164.00 $181.00 $149.00 $164.00 $181.00 93981-26 $25.00 $23.00 $24.00 $25.00 $23.00 $24.00 $25.00 93981-TC $124.00 $126.00 $140.00 $155.00 $126.00 $140.00 $155.00 93982 ------- $43.00 $45.00 $48.00 $43.00 $45.00 $48.00 93990 $110.00 $116.00 $126.00 $136.00 $116.00 $126.00 $136.00 93990-26 $14.00 $14.00 $15.00 $16.00 $14.00 $15.00 $16.00 93990-TC $96.00 $102.00 $111.00 $120.00 $102.00 $111.00 $120.00 94002 ------- $92.00 $95.00 $99.00 $92.00 $95.00 $99.00 94003 ------- $67.00 $69.00 $72.00 $67.00 $69.00 $72.00 94004 ------- $48.00 $50.00 $52.00 $48.00 $50.00 $52.00 94005 ------- $87.00 $90.00 $93.00 $87.00 $90.00 $93.00 94010 $30.00 $36.00 $39.00 $41.00 $36.00 $39.00 $41.00 94010-26 $12.00 $9.00 $9.00 $10.00 $9.00 $9.00 $10.00 94010-TC $16.00 $27.00 $29.00 $32.00 $27.00 $29.00 $32.00 94014 $39.00 $52.00 $55.00 $57.00 $52.00 $55.00 $57.00 94015 $14.00 $25.00 $27.00 $29.00 $25.00 $27.00 $29.00 94016 $26.00 $26.00 $27.00 $28.00 $26.00 $27.00 $28.00 94060 $57.00 $62.00 $67.00 $72.00 $62.00 $67.00 $72.00 94060-26 $18.00 $15.00 $15.00 $16.00 $15.00 $15.00 $16.00 94060-TC $36.00 $47.00 $52.00 $56.00 $47.00 $52.00 $56.00 94070 $32.00 $66.00 $71.00 $77.00 $66.00 $71.00 $77.00 94070-26 $11.00 $30.00 $31.00 $33.00 $30.00 $31.00 $33.00 94070-TC $19.00 $35.00 $39.00 $44.00 $35.00 $39.00 $44.00 94150 $8.00 $22.00 $24.00 $26.00 $22.00 $24.00 $26.00 94150-26 $6.00 $4.00 $4.00 $5.00 $4.00 $4.00 $5.00 94150-TC $3.00 $18.00 $20.00 $21.00 $18.00 $20.00 $21.00 94200 $17.00 $25.00 $26.00 $28.00 $25.00 $26.00 $28.00 94200-26 $7.00 $6.00 $6.00 $7.00 $6.00 $6.00 $7.00 94200-TC $9.00 $19.00 $20.00 $22.00 $19.00 $20.00 $22.00 94240 $43.00 $42.00 $46.00 $49.00 $42.00 $46.00 $49.00 94240-26 $15.00 $13.00 $13.00 $14.00 $13.00 $13.00 $14.00 94240-TC $26.00 $29.00 $32.00 $35.00 $29.00 $32.00 $35.00 94250 $12.00 $28.00 $30.00 $32.00 $28.00 $30.00 $32.00 94250-26 $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
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 94250-TC $5.00 $22.00 $24.00 $26.00 $22.00 $24.00 $26.00 94260 $27.00 $34.00 $36.00 $40.00 $34.00 $36.00 $40.00 94260-26 $8.00 $6.00 $7.00 $7.00 $6.00 $7.00 $7.00 94260-TC $18.00 $27.00 $30.00 $32.00 $27.00 $30.00 $32.00 94350 $36.00 $40.00 $43.00 $46.00 $40.00 $43.00 $46.00 94350-26 $14.00 $13.00 $13.00 $14.00 $13.00 $13.00 $14.00 94350-TC $20.00 $27.00 $29.00 $32.00 $27.00 $29.00 $32.00 94360 $37.00 $46.00 $50.00 $54.00 $46.00 $50.00 $54.00 94360-26 $11.00 $13.00 $13.00 $14.00 $13.00 $13.00 $14.00 94360-TC $26.00 $33.00 $36.00 $40.00 $33.00 $36.00 $40.00 94370 $33.00 $37.00 $40.00 $42.00 $37.00 $40.00 $42.00 94370-26 $18.00 $13.00 $13.00 $14.00 $13.00 $13.00 $14.00 94370-TC $12.00 $24.00 $26.00 $28.00 $24.00 $26.00 $28.00 94375 $34.00 $39.00 $42.00 $44.00 $39.00 $42.00 $44.00 94375-26 $16.00 $15.00 $15.00 $16.00 $15.00 $15.00 $16.00 94375-TC $17.00 $24.00 $26.00 $28.00 $24.00 $26.00 $28.00 94400 $40.00 $57.00 $62.00 $67.00 $57.00 $62.00 $67.00 94400-26 $24.00 $21.00 $22.00 $23.00 $21.00 $22.00 $23.00 94400-TC $14.00 $36.00 $40.00 $44.00 $36.00 $40.00 $44.00 94450 $37.00 $53.00 $57.00 $60.00 $53.00 $57.00 $60.00 94450-26 $20.00 $20.00 $21.00 $21.00 $20.00 $21.00 $21.00 94450-TC $15.00 $33.00 $36.00 $39.00 $33.00 $36.00 $39.00 94452 ------- $59.00 $63.00 $66.00 $59.00 $63.00 $66.00 94452-26 ------- $16.00 $16.00 $17.00 $16.00 $16.00 $17.00 94452-TC ------- $43.00 $46.00 $49.00 $43.00 $46.00 $49.00 94453 ------- $80.00 $85.00 $90.00 $80.00 $85.00 $90.00 94453-26 ------- $20.00 $21.00 $22.00 $20.00 $21.00 $22.00 94453-TC ------- $60.00 $64.00 $68.00 $60.00 $64.00 $68.00 94610 ------- $72.00 $78.00 $87.00 $72.00 $78.00 $87.00 94620 $91.00 $96.00 $103.00 $111.00 $96.00 $103.00 $111.00 94620-26 $38.00 $32.00 $34.00 $35.00 $32.00 $34.00 $35.00 94620-TC $54.00 $64.00 $70.00 $76.00 $64.00 $70.00 $76.00 94621 $122.00 $168.00 $179.00 $190.00 $168.00 $179.00 $190.00 94621-26 $71.00 $73.00 $76.00 $79.00 $73.00 $76.00 $79.00 94621-TC $52.00 $95.00 $103.00 $111.00 $95.00 $103.00 $111.00 94640 $19.00 $15.00 $16.00 $17.00 $15.00 $16.00 $17.00 94642 BR ------- ------- ------- ------- ------- ------- 94644 ------- $39.00 $42.00 $45.00 $39.00 $42.00 $45.00 94645 ------- $15.00 $16.00 $18.00 $15.00 $16.00 $18.00 94660 $54.00 $59.00 $62.00 $65.00 $39.00 $40.00 $42.00 94662 $38.00 $38.00 $39.00 $41.00 $38.00 $39.00 $41.00 94664 $18.00 $17.00 $18.00 $21.00 $17.00 $18.00 $21.00 94667 $23.00 $24.00 $26.00 $29.00 $24.00 $26.00 $29.00 94668 $16.00 $20.00 $22.00 $24.00 $20.00 $22.00 $24.00 94680 $47.00 $71.00 $77.00 $82.00 $71.00 $77.00 $82.00 94680-26 $23.00 $13.00 $13.00 $14.00 $13.00 $13.00 $14.00 94680-TC $22.00 $58.00 $63.00 $68.00 $58.00 $63.00 $68.00 94681 $60.00 $86.00 $94.00 $102.00 $86.00 $94.00 $102.00 94681-26 $12.00 $10.00 $10.00 $11.00 $10.00 $10.00 $11.00 94681-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
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 94690 $24.00 $65.00 $71.00 $76.00 $65.00 $71.00 $76.00 94690-26 $4.00 $4.00 $4.00 $5.00 $4.00 $4.00 $5.00 94690-TC $20.00 $61.00 $66.00 $71.00 $61.00 $66.00 $71.00 94720 $49.00 $56.00 $61.00 $65.00 $56.00 $61.00 $65.00 94720-26 $15.00 $13.00 $13.00 $14.00 $13.00 $13.00 $14.00 94720-TC $31.00 $43.00 $47.00 $52.00 $43.00 $47.00 $52.00 94725 $79.00 $94.00 $102.00 $110.00 $94.00 $102.00 $110.00 94725-26 $14.00 $13.00 $13.00 $14.00 $13.00 $13.00 $14.00 94725-TC $64.00 $81.00 $89.00 $97.00 $81.00 $89.00 $97.00 94750 $37.00 $72.00 $78.00 $83.00 $72.00 $78.00 $83.00 94750-26 $14.00 $11.00 $12.00 $12.00 $11.00 $12.00 $12.00 94750-TC $21.00 $61.00 $66.00 $71.00 $61.00 $66.00 $71.00 94760 $9.00 $3.00 $4.00 $4.00 $3.00 $4.00 $4.00 94761 $20.00 $7.00 $9.00 $11.00 $7.00 $9.00 $11.00 94762 $30.00 $32.00 $36.00 $41.00 $32.00 $36.00 $41.00 94770 $21.00 $41.00 $45.00 $49.00 $41.00 $45.00 $49.00 94770-26 $9.00 $8.00 $8.00 $8.00 $8.00 $8.00 $8.00 94770-TC $12.00 $33.00 $37.00 $41.00 $33.00 $37.00 $41.00 94799 BR ------- ------- ------- ------- ------- ------- 94799-26 BR ------- ------- ------- ------- ------- ------- 94799-TC BR ------- ------- ------- ------- ------- ------- 95004 $3.00 $6.00 $7.00 $7.00 $6.00 $7.00 $7.00 95010 $11.00 $19.00 $20.00 $21.00 $19.00 $20.00 $21.00 95012 ------- $20.00 $21.00 $23.00 $20.00 $21.00 $23.00 95015 $11.00 $13.00 $14.00 $15.00 $13.00 $14.00 $15.00 95024 $3.00 $7.00 $8.00 $9.00 $7.00 $8.00 $9.00 95027 $5.00 $6.00 $6.00 $7.00 $6.00 $6.00 $7.00 95028 $8.00 $11.00 $12.00 $13.00 $11.00 $12.00 $13.00 95044 $7.00 $8.00 $8.00 $9.00 $8.00 $8.00 $9.00 95052 $9.00 $8.00 $9.00 $10.00 $8.00 $9.00 $10.00 95056 $6.00 $29.00 $31.00 $33.00 $29.00 $31.00 $33.00 95060 $13.00 $22.00 $24.00 $26.00 $22.00 $24.00 $26.00 95065 $7.00 $18.00 $20.00 $21.00 $18.00 $20.00 $21.00 95070 $82.00 $62.00 $67.00 $71.00 $62.00 $67.00 $71.00 95071 $105.00 $78.00 $84.00 $89.00 $78.00 $84.00 $89.00 95075 $82.00 $67.00 $69.00 $72.00 $50.00 $51.00 $53.00 95115 $10.00 $13.00 $15.00 $16.00 $13.00 $15.00 $16.00 95117 $9.00 $17.00 $18.00 $20.00 $17.00 $18.00 $20.00 95120 BR ------- ------- ------- ------- ------- ------- 95125 BR ------- ------- ------- ------- ------- ------- 95130 BR ------- ------- ------- ------- ------- ------- 95131 BR ------- ------- ------- ------- ------- ------- 95132 BR ------- ------- ------- ------- ------- ------- 95133 BR ------- ------- ------- ------- ------- ------- 95134 BR ------- ------- ------- ------- ------- ------- 95144 $9.00 $12.00 $13.00 $13.00 $4.00 $4.00 $4.00 95145 $17.00 $16.00 $17.00 $18.00 $4.00 $4.00 $4.00 95146 $24.00 $25.00 $26.00 $28.00 $4.00 $4.00 $4.00 95147 $33.00 $24.00 $26.00 $27.00 $4.00 $4.00 $4.00 95148 $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
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 95149 $36.00 $44.00 $47.00 $50.00 $4.00 $4.00 $4.00 95165 $7.00 $12.00 $13.00 $13.00 $4.00 $4.00 $4.00 95170 $13.00 $9.00 $10.00 $11.00 $4.00 $4.00 $4.00 95180 $103.00 $149.00 $155.00 $161.00 $110.00 $113.00 $116.00 95199 BR ------- ------- ------- ------- ------- ------- 95250 $114.00 $150.00 $161.00 $170.00 $150.00 $161.00 $170.00 95251 ------- $41.00 $42.00 $43.00 $41.00 $42.00 $43.00 95805 $334.00 $573.00 $616.00 $657.00 $573.00 $616.00 $657.00 95805-26 $94.00 $98.00 $101.00 $105.00 $98.00 $101.00 $105.00 95805-TC $237.00 $475.00 $514.00 $551.00 $475.00 $514.00 $551.00 95806 $232.00 $228.00 $246.00 $267.00 $228.00 $246.00 $267.00 95806-26 $109.00 $86.00 $89.00 $93.00 $86.00 $89.00 $93.00 95806-TC $137.00 $142.00 $157.00 $174.00 $142.00 $157.00 $174.00 95807 $367.00 $567.00 $610.00 $654.00 $567.00 $610.00 $654.00 95807-26 $98.00 $85.00 $88.00 $91.00 $85.00 $88.00 $91.00 95807-TC $256.00 $482.00 $523.00 $563.00 $482.00 $523.00 $563.00 95808 $456.00 $700.00 $752.00 $802.00 $700.00 $752.00 $802.00 95808-26 $149.00 $138.00 $142.00 $148.00 $138.00 $142.00 $148.00 95808-TC $256.00 $563.00 $610.00 $654.00 $563.00 $610.00 $654.00 95810 $521.00 $858.00 $919.00 $978.00 $858.00 $919.00 $978.00 95810-26 $183.00 $181.00 $188.00 $195.00 $181.00 $188.00 $195.00 95810-TC $256.00 $676.00 $731.00 $782.00 $676.00 $731.00 $782.00 95811 $644.00 $942.00 $1,008.00 $1,072.00 $942.00 $1,008.00 $1,072.00 95811-26 $196.00 $195.00 $201.00 $210.00 $195.00 $201.00 $210.00 95811-TC $423.00 $747.00 $807.00 $862.00 $747.00 $807.00 $862.00 95812 $137.00 $246.00 $263.00 $280.00 $246.00 $263.00 $280.00 95812-26 $58.00 $58.00 $61.00 $63.00 $58.00 $61.00 $63.00 95812-TC $68.00 $187.00 $202.00 $216.00 $187.00 $202.00 $216.00 95813 $177.00 $303.00 $323.00 $342.00 $303.00 $323.00 $342.00 95813-26 $89.00 $92.00 $96.00 $100.00 $92.00 $96.00 $100.00 95813-TC $68.00 $210.00 $227.00 $242.00 $210.00 $227.00 $242.00 95816 $133.00 $226.00 $242.00 $257.00 $226.00 $242.00 $257.00 95816-26 $54.00 $58.00 $61.00 $63.00 $58.00 $61.00 $63.00 95816-TC $78.00 $168.00 $181.00 $194.00 $168.00 $181.00 $194.00 95819 $115.00 $229.00 $245.00 $260.00 $229.00 $245.00 $260.00 95819-26 $58.00 $58.00 $61.00 $63.00 $58.00 $61.00 $63.00 95819-TC $56.00 $170.00 $184.00 $197.00 $170.00 $184.00 $197.00 95822 $120.00 $250.00 $268.00 $286.00 $250.00 $268.00 $286.00 95822-26 $58.00 $58.00 $61.00 $63.00 $58.00 $61.00 $63.00 95822-TC $63.00 $192.00 $208.00 $222.00 $192.00 $208.00 $222.00 95824 $51.00 ------- ------- ------- ------- ------- ------- 95824-26 $41.00 $40.00 $41.00 $43.00 $40.00 $41.00 $43.00 95824-TC $10.00 ------- ------- ------- ------- ------- ------- 95827 $145.00 $331.00 $355.00 $377.00 $331.00 $355.00 $377.00 95827-26 $59.00 $57.00 $59.00 $61.00 $57.00 $59.00 $61.00 95827-TC $86.00 $274.00 $296.00 $316.00 $274.00 $296.00 $316.00 95829 $328.00 $1,355.00 $1,443.00 $1,523.00 $1,355.00 $1,443.00 $1,523.00 95829-26 $291.00 $339.00 $354.00 $374.00 $339.00 $354.00 $374.00 95829-TC $6.00 $1,016.00 $1,089.00 $1,150.00 $1,016.00 $1,089.00 $1,150.00 95830 $133.00 $193.00 $204.00 $214.00 $92.00 $96.00 $101.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 369
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 95831 $26.00 $28.00 $29.00 $31.00 $15.00 $16.00 $16.00 95832 $21.00 $26.00 $27.00 $29.00 $16.00 $17.00 $18.00 95833 $34.00 $40.00 $42.00 $43.00 $25.00 $26.00 $27.00 95834 $44.00 $47.00 $49.00 $51.00 $33.00 $34.00 $36.00 95851 $18.00 $19.00 $20.00 $21.00 $9.00 $9.00 $10.00 95852 $14.00 $15.00 $16.00 $16.00 $6.00 $7.00 $7.00 95857 $40.00 $44.00 $46.00 $48.00 $28.00 $29.00 $30.00 95860 $73.00 $91.00 $96.00 $101.00 $91.00 $96.00 $101.00 95860-26 $53.00 $53.00 $55.00 $58.00 $53.00 $55.00 $58.00 95860-TC $15.00 $37.00 $40.00 $43.00 $37.00 $40.00 $43.00 95861 $113.00 $125.00 $132.00 $140.00 $125.00 $132.00 $140.00 95861-26 $86.00 $85.00 $88.00 $91.00 $85.00 $88.00 $91.00 95861-TC $28.00 $41.00 $44.00 $48.00 $41.00 $44.00 $48.00 95863 $138.00 $150.00 $158.00 $167.00 $150.00 $158.00 $167.00 95863-26 $102.00 $101.00 $105.00 $109.00 $101.00 $105.00 $109.00 95863-TC $35.00 $48.00 $53.00 $57.00 $48.00 $53.00 $57.00 95864 $177.00 $181.00 $192.00 $204.00 $181.00 $192.00 $204.00 95864-26 $114.00 $108.00 $112.00 $116.00 $108.00 $112.00 $116.00 95864-TC $67.00 $73.00 $80.00 $87.00 $73.00 $80.00 $87.00 95865 ------- $120.00 $127.00 $133.00 $120.00 $127.00 $133.00 95865-26 ------- $88.00 $91.00 $95.00 $88.00 $91.00 $95.00 95865-TC ------- $33.00 $36.00 $38.00 $33.00 $36.00 $38.00 95866 ------- $93.00 $98.00 $103.00 $93.00 $98.00 $103.00 95866-26 ------- $69.00 $72.00 $75.00 $69.00 $72.00 $75.00 95866-TC ------- $24.00 $26.00 $28.00 $24.00 $26.00 $28.00 95867 $66.00 $75.00 $79.00 $83.00 $75.00 $79.00 $83.00 95867-26 $43.00 $43.00 $44.00 $46.00 $43.00 $44.00 $46.00 95867-TC $21.00 $32.00 $35.00 $38.00 $32.00 $35.00 $38.00 95868 $96.00 $103.00 $109.00 $115.00 $103.00 $109.00 $115.00 95868-26 $71.00 $64.00 $66.00 $69.00 $64.00 $66.00 $69.00 95868-TC $26.00 $39.00 $42.00 $46.00 $39.00 $42.00 $46.00 95869 $29.00 $44.00 $47.00 $49.00 $44.00 $47.00 $49.00 95869-26 $21.00 $21.00 $21.00 $22.00 $21.00 $21.00 $22.00 95869-TC $8.00 $23.00 $25.00 $27.00 $23.00 $25.00 $27.00 95870 $29.00 $43.00 $46.00 $49.00 $43.00 $46.00 $49.00 95870-26 $21.00 $21.00 $21.00 $22.00 $21.00 $21.00 $22.00 95870-TC $8.00 $22.00 $24.00 $26.00 $22.00 $24.00 $26.00 95872 $104.00 $171.00 $177.00 $185.00 $171.00 $177.00 $185.00 95872-26 $81.00 $141.00 $145.00 $149.00 $141.00 $145.00 $149.00 95872-TC $22.00 $30.00 $33.00 $36.00 $30.00 $33.00 $36.00 95873 ------- $43.00 $46.00 $49.00 $43.00 $46.00 $49.00 95873-26 ------- $21.00 $22.00 $23.00 $21.00 $22.00 $23.00 95873-TC ------- $22.00 $24.00 $26.00 $22.00 $24.00 $26.00 95874 ------- $43.00 $45.00 $48.00 $43.00 $45.00 $48.00 95874-26 ------- $21.00 $22.00 $23.00 $21.00 $22.00 $23.00 95874-TC ------- $22.00 $24.00 $25.00 $22.00 $24.00 $25.00 95875 $43.00 $105.00 $111.00 $118.00 $105.00 $111.00 $118.00 95875-26 $34.00 $61.00 $63.00 $65.00 $61.00 $63.00 $65.00 95875-TC $7.00 $44.00 $48.00 $52.00 $44.00 $48.00 $52.00 95900 $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
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 95900-26 $24.00 $23.00 $24.00 $25.00 $23.00 $24.00 $25.00 95900-TC $10.00 $38.00 $41.00 $44.00 $38.00 $41.00 $44.00 95903 $43.00 $69.00 $73.00 $77.00 $69.00 $73.00 $77.00 95903-26 $33.00 $33.00 $34.00 $35.00 $33.00 $34.00 $35.00 95903-TC $9.00 $36.00 $39.00 $41.00 $36.00 $39.00 $41.00 95904 $31.00 $53.00 $57.00 $60.00 $53.00 $57.00 $60.00 95904-26 $20.00 $19.00 $20.00 $21.00 $19.00 $20.00 $21.00 95904-TC $8.00 $34.00 $37.00 $40.00 $34.00 $37.00 $40.00 95920 $168.00 $170.00 $181.00 $192.00 $170.00 $181.00 $192.00 95920-26 $118.00 $119.00 $124.00 $131.00 $119.00 $124.00 $131.00 95920-TC $48.00 $52.00 $57.00 $62.00 $52.00 $57.00 $62.00 95921 $61.00 $74.00 $78.00 $82.00 $74.00 $78.00 $82.00 95921-26 $46.00 $47.00 $49.00 $50.00 $47.00 $49.00 $50.00 95921-TC $14.00 $27.00 $29.00 $31.00 $27.00 $29.00 $31.00 95922 $65.00 $87.00 $91.00 $96.00 $87.00 $91.00 $96.00 95922-26 $50.00 $52.00 $54.00 $56.00 $52.00 $54.00 $56.00 95922-TC $14.00 $35.00 $38.00 $40.00 $35.00 $38.00 $40.00 95923 $105.00 $121.00 $129.00 $136.00 $121.00 $129.00 $136.00 95923-26 $47.00 $49.00 $51.00 $53.00 $49.00 $51.00 $53.00 95923-TC $57.00 $73.00 $78.00 $83.00 $73.00 $78.00 $83.00 95925 $94.00 $109.00 $117.00 $125.00 $109.00 $117.00 $125.00 95925-26 $53.00 $30.00 $31.00 $33.00 $30.00 $31.00 $33.00 95925-TC $41.00 $79.00 $85.00 $92.00 $79.00 $85.00 $92.00 95926 $66.00 $107.00 $115.00 $122.00 $107.00 $115.00 $122.00 95926-26 $34.00 $29.00 $31.00 $32.00 $29.00 $31.00 $32.00 95926-TC $34.00 $78.00 $84.00 $90.00 $78.00 $84.00 $90.00 95927 $67.00 $111.00 $119.00 $127.00 $111.00 $119.00 $127.00 95927-26 $34.00 $31.00 $32.00 $34.00 $31.00 $32.00 $34.00 95927-TC $34.00 $80.00 $87.00 $93.00 $80.00 $87.00 $93.00 95928 ------- $198.00 $209.00 $220.00 $198.00 $209.00 $220.00 95928-26 ------- $80.00 $83.00 $86.00 $80.00 $83.00 $86.00 95928-TC ------- $117.00 $126.00 $134.00 $117.00 $126.00 $134.00 95929 ------- $208.00 $220.00 $231.00 $208.00 $220.00 $231.00 95929-26 ------- $81.00 $83.00 $87.00 $81.00 $83.00 $87.00 95929-TC ------- $127.00 $137.00 $145.00 $127.00 $137.00 $145.00 95930 $44.00 $111.00 $119.00 $125.00 $111.00 $119.00 $125.00 95930-26 $25.00 $19.00 $20.00 $21.00 $19.00 $20.00 $21.00 95930-TC $11.00 $92.00 $98.00 $104.00 $92.00 $98.00 $104.00 95933 $62.00 $70.00 $75.00 $81.00 $70.00 $75.00 $81.00 95933-26 $33.00 $33.00 $34.00 $36.00 $33.00 $34.00 $36.00 95933-TC $30.00 $37.00 $41.00 $45.00 $37.00 $41.00 $45.00 95934 $36.00 $46.00 $49.00 $52.00 $46.00 $49.00 $52.00 95934-26 $28.00 $28.00 $28.00 $30.00 $28.00 $28.00 $30.00 95934-TC $8.00 $19.00 $21.00 $22.00 $19.00 $21.00 $22.00 95936 $39.00 $44.00 $46.00 $49.00 $44.00 $46.00 $49.00 95936-26 $30.00 $30.00 $31.00 $32.00 $30.00 $31.00 $32.00 95936-TC $8.00 $14.00 $15.00 $16.00 $14.00 $15.00 $16.00 95937 $40.00 $60.00 $64.00 $69.00 $60.00 $64.00 $69.00 95937-26 $31.00 $38.00 $40.00 $43.00 $38.00 $40.00 $43.00 95937-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
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 95950 $265.00 $261.00 $284.00 $310.00 $261.00 $284.00 $310.00 95950-26 $84.00 $82.00 $85.00 $88.00 $82.00 $85.00 $88.00 95950-TC $177.00 $180.00 $199.00 $222.00 $180.00 $199.00 $222.00 95951 $34.00 ------- ------- ------- ------- ------- ------- 95951-26 $14.00 $324.00 $336.00 $351.00 $324.00 $336.00 $351.00 95951-TC $20.00 ------- ------- ------- ------- ------- ------- 95953 $411.00 $451.00 $484.00 $520.00 $451.00 $484.00 $520.00 95953-26 $165.00 $176.00 $183.00 $190.00 $176.00 $183.00 $190.00 95953-TC $240.00 $275.00 $301.00 $329.00 $275.00 $301.00 $329.00 95954 $208.00 $271.00 $287.00 $303.00 $271.00 $287.00 $303.00 95954-26 $134.00 $127.00 $132.00 $138.00 $127.00 $132.00 $138.00 95954-TC $23.00 $144.00 $155.00 $165.00 $144.00 $155.00 $165.00 95955 $130.00 $151.00 $162.00 $175.00 $151.00 $162.00 $175.00 95955-26 $59.00 $53.00 $55.00 $57.00 $53.00 $55.00 $57.00 95955-TC $74.00 $98.00 $107.00 $118.00 $98.00 $107.00 $118.00 95956 $541.00 $773.00 $829.00 $884.00 $773.00 $829.00 $884.00 95956-26 $166.00 $166.00 $172.00 $180.00 $166.00 $172.00 $180.00 95956-TC $314.00 $607.00 $657.00 $704.00 $607.00 $657.00 $704.00 95957 $171.00 $252.00 $268.00 $285.00 $252.00 $268.00 $285.00 95957-26 $104.00 $107.00 $111.00 $116.00 $107.00 $111.00 $116.00 95957-TC $64.00 $145.00 $157.00 $169.00 $145.00 $157.00 $169.00 95958 $296.00 $378.00 $399.00 $421.00 $378.00 $399.00 $421.00 95958-26 $230.00 $228.00 $236.00 $246.00 $228.00 $236.00 $246.00 95958-TC $66.00 $150.00 $163.00 $175.00 $150.00 $163.00 $175.00 95961 $216.00 $256.00 $275.00 $298.00 $256.00 $275.00 $298.00 95961-26 $166.00 $183.00 $196.00 $213.00 $183.00 $196.00 $213.00 95961-TC $48.00 $73.00 $79.00 $85.00 $73.00 $79.00 $85.00 95962 $227.00 $239.00 $254.00 $271.00 $239.00 $254.00 $271.00 95962-26 $176.00 $184.00 $193.00 $206.00 $184.00 $193.00 $206.00 95962-TC $48.00 $55.00 $60.00 $66.00 $55.00 $60.00 $66.00 95965 BR ------- ------- ------- ------- ------- ------- 95965-26 $420.00 $438.00 $455.00 $476.00 $438.00 $455.00 $476.00 95965-TC BR ------- ------- ------- ------- ------- ------- 95966 BR ------- ------- ------- ------- ------- ------- 95966-26 $210.00 $216.00 $224.00 $233.00 $216.00 $224.00 $233.00 95966-TC BR ------- ------- ------- ------- ------- ------- 95967 BR ------- ------- ------- ------- ------- ------- 95967-26 $184.00 $181.00 $188.00 $195.00 $181.00 $188.00 $195.00 95967-TC BR ------- ------- ------- ------- ------- ------- 95970 $22.00 $53.00 $56.00 $59.00 $24.00 $25.00 $26.00 95971 $39.00 $58.00 $61.00 $65.00 $41.00 $43.00 $46.00 95972 $78.00 $110.00 $116.00 $124.00 $82.00 $86.00 $92.00 95973 $47.00 $60.00 $63.00 $66.00 $49.00 $51.00 $54.00 95974 $155.00 $182.00 $190.00 $198.00 $161.00 $168.00 $175.00 95975 $88.00 $102.00 $107.00 $112.00 $94.00 $98.00 $103.00 95978 ------- $215.00 $224.00 $234.00 $186.00 $193.00 $201.00 95979 ------- $97.00 $101.00 $105.00 $88.00 $91.00 $95.00 95980 ------- $44.00 $46.00 $48.00 $44.00 $46.00 $48.00 95981 ------- $29.00 $31.00 $33.00 $17.00 $18.00 $18.00 95982 ------- $45.00 $48.00 $50.00 $34.00 $36.00 $38.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 372
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 95990 $57.00 $65.00 $71.00 $76.00 $65.00 $71.00 $76.00 95991 ------- $93.00 $99.00 $104.00 $39.00 $41.00 $43.00 95999 BR ------- ------- ------- ------- ------- ------- 96000 $93.00 $92.00 $96.00 $100.00 $92.00 $96.00 $100.00 96001 $111.00 $109.00 $113.00 $118.00 $109.00 $113.00 $118.00 96002 $21.00 $21.00 $22.00 $23.00 $21.00 $22.00 $23.00 96003 $20.00 $19.00 $20.00 $21.00 $19.00 $20.00 $21.00 96004 $97.00 $117.00 $121.00 $126.00 $117.00 $121.00 $126.00 96020 ------- BR BR BR BR BR BR 96020-26 ------- $179.00 $186.00 $193.00 $179.00 $186.00 $193.00 96020-TC ------- BR BR BR BR BR BR 96040 ------- $39.00 $42.00 $45.00 $39.00 $42.00 $45.00 96101 ------- $91.00 $94.00 $97.00 $91.00 $93.00 $96.00 96102 ------- $54.00 $56.00 $59.00 $24.00 $25.00 $25.00 96103 ------- $42.00 $44.00 $46.00 $26.00 $26.00 $27.00 96105 $68.00 $78.00 $87.00 $96.00 $78.00 $87.00 $96.00 96110 $88.00 $18.00 $22.00 $28.00 $18.00 $22.00 $28.00 96111 $68.00 $141.00 $147.00 $155.00 $139.00 $145.00 $152.00 96116 ------- $107.00 $112.00 $119.00 $100.00 $105.00 $112.00 96118 ------- $124.00 $130.00 $138.00 $99.00 $104.00 $110.00 96119 ------- $81.00 $88.00 $97.00 $37.00 $41.00 $47.00 96120 ------- $68.00 $71.00 $75.00 $25.00 $26.00 $27.00 96125 ------- $103.00 $108.00 $115.00 $87.00 $92.00 $97.00 96150 ------- $25.00 $25.00 $26.00 $24.00 $25.00 $25.00 96151 ------- $24.00 $24.00 $25.00 $23.00 $24.00 $24.00 96152 ------- $23.00 $23.00 $24.00 $23.00 $23.00 $24.00 96153 ------- $6.00 $6.00 $6.00 $5.00 $5.00 $6.00 96154 ------- $22.00 $23.00 $24.00 $22.00 $23.00 $23.00 96155 ------- $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 96401 ------- $67.00 $72.00 $76.00 $67.00 $72.00 $76.00 96402 ------- $43.00 $45.00 $48.00 $43.00 $45.00 $48.00 96405 $57.00 $141.00 $150.00 $158.00 $31.00 $32.00 $33.00 96406 $86.00 $161.00 $171.00 $180.00 $43.00 $45.00 $46.00 96409 ------- $125.00 $134.00 $142.00 $125.00 $134.00 $142.00 96411 ------- $72.00 $78.00 $83.00 $72.00 $78.00 $83.00 96413 ------- $169.00 $182.00 $193.00 $169.00 $182.00 $193.00 96415 ------- $39.00 $43.00 $47.00 $39.00 $43.00 $47.00 96416 ------- $183.00 $197.00 $209.00 $183.00 $197.00 $209.00 96417 ------- $84.00 $91.00 $97.00 $84.00 $91.00 $97.00 96420 $46.00 $118.00 $127.00 $136.00 $118.00 $127.00 $136.00 96422 $46.00 $194.00 $209.00 $222.00 $194.00 $209.00 $222.00 96423 $17.00 $84.00 $90.00 $95.00 $84.00 $90.00 $95.00 96425 $54.00 $191.00 $205.00 $218.00 $191.00 $205.00 $218.00 96440 $156.00 $367.00 $389.00 $410.00 $141.00 $148.00 $156.00 96445 $157.00 $354.00 $376.00 $396.00 $132.00 $138.00 $145.00 96450 $134.00 $297.00 $315.00 $332.00 $104.00 $109.00 $114.00 96521 ------- $147.00 $158.00 $168.00 $147.00 $158.00 $168.00 96522 ------- $118.00 $126.00 $135.00 $118.00 $126.00 $135.00 96523 ------- $29.00 $31.00 $33.00 $29.00 $31.00 $33.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 373
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 96542 $126.00 $185.00 $197.00 $209.00 $51.00 $54.00 $57.00 96549 BR ------- ------- ------- ------- ------- ------- 96567 $62.00 $114.00 $123.00 $131.00 $114.00 $123.00 $131.00 96570 $69.00 $62.00 $66.00 $70.00 $62.00 $66.00 $70.00 96571 $38.00 $29.00 $31.00 $32.00 $29.00 $31.00 $32.00 96900 $17.00 $21.00 $23.00 $24.00 $21.00 $23.00 $24.00 96902 $24.00 $22.00 $22.00 $23.00 $21.00 $21.00 $22.00 96904 ------- $75.00 $81.00 $85.00 $75.00 $81.00 $85.00 96910 $21.00 $61.00 $66.00 $71.00 $61.00 $66.00 $71.00 96912 $24.00 $78.00 $85.00 $91.00 $78.00 $85.00 $91.00 96913 $53.00 $107.00 $116.00 $125.00 $107.00 $116.00 $125.00 96920 $152.00 $164.00 $173.00 $180.00 $66.00 $68.00 $69.00 96921 $155.00 $162.00 $171.00 $178.00 $66.00 $68.00 $71.00 96922 $214.00 $239.00 $252.00 $262.00 $113.00 $116.00 $119.00 96999 BR ------- ------- ------- ------- ------- ------- 97001 $62.00 $75.00 $78.00 $81.00 $75.00 $78.00 $81.00 97002 $29.00 $40.00 $42.00 $43.00 $40.00 $42.00 $43.00 97003 $62.00 $80.00 $84.00 $88.00 $80.00 $84.00 $88.00 97004 $29.00 $47.00 $50.00 $52.00 $47.00 $50.00 $52.00 97005 NC BR BR BR BR BR BR 97006 NC BR BR BR BR BR BR 97010 $10.00 $5.00 $5.00 $6.00 $5.00 $5.00 $6.00 97012 $16.00 $15.00 $16.00 $17.00 $15.00 $16.00 $17.00 97014 $14.00 $14.00 $15.00 $16.00 $14.00 $15.00 $16.00 97016 $15.00 $16.00 $16.00 $17.00 $16.00 $16.00 $17.00 97018 $10.00 $8.00 $8.00 $9.00 $8.00 $8.00 $9.00 97022 $15.00 $18.00 $18.00 $19.00 $18.00 $18.00 $19.00 97024 $10.00 $5.00 $6.00 $6.00 $5.00 $6.00 $6.00 97026 $9.00 $5.00 $5.00 $6.00 $5.00 $5.00 $6.00 97028 $10.00 $7.00 $7.00 $8.00 $7.00 $7.00 $8.00 97032 $16.00 $17.00 $18.00 $18.00 $17.00 $18.00 $18.00 97033 $16.00 $24.00 $26.00 $27.00 $24.00 $26.00 $27.00 97034 $13.00 $15.00 $16.00 $16.00 $15.00 $16.00 $16.00 97035 $11.00 $12.00 $13.00 $13.00 $12.00 $13.00 $13.00 97036 $19.00 $26.00 $27.00 $28.00 $26.00 $27.00 $28.00 97039 $15.00 ------- ------- ------- ------- ------- ------- 97110 $22.00 $29.00 $31.00 $32.00 $29.00 $31.00 $32.00 97112 $23.00 $30.00 $31.00 $33.00 $30.00 $31.00 $33.00 97113 $24.00 $35.00 $37.00 $38.00 $35.00 $37.00 $38.00 97116 $21.00 $25.00 $26.00 $27.00 $25.00 $26.00 $27.00 97124 $19.00 $23.00 $24.00 $25.00 $23.00 $24.00 $25.00 97139 $15.00 ------- ------- ------- ------- ------- ------- 97140 $26.00 $27.00 $28.00 $29.00 $27.00 $28.00 $29.00 97150 $18.00 $19.00 $19.00 $20.00 $19.00 $19.00 $20.00 97260 $23.00 ------- ------- ------- ------- ------- ------- 97261 $17.00 ------- ------- ------- ------- ------- ------- 97530 $22.00 $31.00 $32.00 $33.00 $31.00 $32.00 $33.00 97532 $22.00 $25.00 $26.00 $27.00 $25.00 $26.00 $27.00 97533 $24.00 $27.00 $28.00 $29.00 $27.00 $28.00 $29.00 97535 $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
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 97537 $23.00 $28.00 $29.00 $30.00 $28.00 $29.00 $30.00 97542 $17.00 $28.00 $29.00 $30.00 $28.00 $29.00 $30.00 97545 $83.00 ------- ------- ------- ------- ------- ------- 97546 $41.00 ------- ------- ------- ------- ------- ------- 97597 ------- $59.00 $63.00 $66.00 $40.00 $42.00 $44.00 97598 ------- $73.00 $77.00 $81.00 $51.00 $54.00 $56.00 97602 BR ------- ------- ------- ------- ------- ------- 97605 ------- $36.00 $37.00 $39.00 $28.00 $29.00 $30.00 97606 ------- $39.00 $41.00 $42.00 $31.00 $32.00 $34.00 97750 BR BR BR BR BR BR BR 97752 $48.00 ------- ------- ------- ------- ------- ------- 97755 ------- $35.00 $36.00 $38.00 $35.00 $36.00 $38.00 97760 ------- $34.00 $35.00 $37.00 $34.00 $35.00 $37.00 97761 ------- $30.00 $31.00 $32.00 $30.00 $31.00 $32.00 97762 ------- $33.00 $35.00 $37.00 $33.00 $35.00 $37.00 97799 BR ------- ------- ------- ------- ------- ------- 97802 $26.00 $29.00 $30.00 $31.00 $29.00 $30.00 $31.00 97803 $17.00 $26.00 $27.00 $28.00 $25.00 $26.00 $27.00 97804 $7.00 $15.00 $16.00 $16.00 $15.00 $15.00 $16.00 97810 ------- $37.00 $38.00 $40.00 $31.00 $32.00 $34.00 97811 ------- $28.00 $29.00 $31.00 $26.00 $27.00 $28.00 97813 ------- $39.00 $40.00 $42.00 $34.00 $35.00 $36.00 97814 ------- $31.00 $33.00 $34.00 $29.00 $30.00 $31.00 97850 $54.00 ------- ------- ------- ------- ------- ------- 97851 $26.00 ------- ------- ------- ------- ------- ------- 97852 $54.00 ------- ------- ------- ------- ------- ------- 97853 $26.00 ------- ------- ------- ------- ------- ------- 98925 NC NC NC NC NC NC NC 98926 $32.00 $41.00 $43.00 $45.00 $34.00 $35.00 $37.00 98927 NC NC NC NC NC NC NC 98928 $23.00 $62.00 $65.00 $67.00 $52.00 $54.00 $56.00 98929 NC NC NC NC NC NC NC 98940 NC NC NC NC NC NC NC 98941 $32.00 $36.00 $37.00 $38.00 $31.00 $32.00 $33.00 98942 NC NC NC NC NC NC NC 98943 $23.00 $24.00 $24.00 $25.00 $20.00 $21.00 $22.00 98960 ------- $23.00 $25.00 $27.00 $23.00 $25.00 $27.00 98961 ------- $12.00 $13.00 $14.00 $12.00 $13.00 $14.00 98962 ------- $8.00 $9.00 $10.00 $8.00 $9.00 $10.00 98966 ------- $13.00 $14.00 $14.00 $12.00 $13.00 $13.00 98967 ------- $25.00 $26.00 $27.00 $24.00 $25.00 $26.00 98968 ------- $37.00 $39.00 $40.00 $36.00 $37.00 $39.00 99000 $6.00 ------- ------- ------- ------- ------- ------- 99001 $4.00 ------- ------- ------- ------- ------- ------- 99002 $35.00 ------- ------- ------- ------- ------- ------- 99026 BR ------- ------- ------- ------- ------- ------- 99027 BR ------- ------- ------- ------- ------- ------- 99070 BR ------- ------- ------- ------- ------- ------- 99071 NC NC NC NC NC NC NC 99075 See 440.13 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 375
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA 99078 NC NC NC NC NC NC NC 99080 BR ------- ------- ------- ------- ------- ------- 99082 BR ------- ------- ------- ------- ------- ------- 99090 BR ------- ------- ------- ------- ------- ------- 99091 BR $53.00 $54.00 $56.00 $53.00 $54.00 $56.00 99172 BR ------- ------- ------- ------- ------- ------- 99173 BR $3.00 $3.00 $4.00 $3.00 $3.00 $4.00 99175 $53.00 $40.00 $45.00 $50.00 $40.00 $45.00 $50.00 99183 $123.00 $211.00 $222.00 $234.00 $122.00 $127.00 $133.00 99185 $23.00 $48.00 $52.00 $56.00 $48.00 $52.00 $56.00 99186 $78.00 $95.00 $109.00 $127.00 $95.00 $109.00 $127.00 99190 BR ------- ------- ------- ------- ------- ------- 99191 BR ------- ------- ------- ------- ------- ------- 99192 BR ------- ------- ------- ------- ------- ------- 99195 $16.00 $60.00 $65.00 $69.00 $60.00 $65.00 $69.00 99199 NC NC NC NC NC NC NC G0101 ------- $38.00 $39.00 $41.00 $38.00 $39.00 $41.00 G0102 ------- $21.00 $22.00 $23.00 $9.00 $10.00 $10.00 G0104 ------- $135.00 $143.00 $151.00 $63.00 $66.00 $70.00 G0105 ------- $401.00 $425.00 $448.00 $220.00 $230.00 $243.00 G0105-53 ------- $135.00 $143.00 $151.00 $63.00 $66.00 $70.00 G0106 ------- $194.00 $208.00 $222.00 $194.00 $208.00 $222.00 G0106-26 ------- $52.00 $54.00 $56.00 $52.00 $54.00 $56.00 G0106-TC ------- $142.00 $155.00 $166.00 $142.00 $155.00 $166.00 G0108 ------- $29.00 $31.00 $33.00 $29.00 $31.00 $33.00 G0109 ------- $16.00 $18.00 $19.00 $16.00 $18.00 $19.00 G0117 ------- $46.00 $49.00 $51.00 $46.00 $49.00 $51.00 G0118 ------- $31.00 $33.00 $35.00 $31.00 $33.00 $35.00 G0120 ------- $191.00 $204.00 $218.00 $191.00 $204.00 $218.00 G0120-26 ------- $52.00 $54.00 $56.00 $52.00 $54.00 $56.00 G0120-TC ------- $139.00 $151.00 $162.00 $139.00 $151.00 $162.00 G0121 ------- $401.00 $425.00 $448.00 $220.00 $230.00 $243.00 G0121-53 ------- $135.00 $143.00 $151.00 $63.00 $66.00 $70.00 G0122 ------- $209.00 $224.00 $239.00 $209.00 $224.00 $239.00 G0122-26 ------- $51.00 $53.00 $55.00 $51.00 $53.00 $55.00 G0122-TC ------- $158.00 $171.00 $184.00 $158.00 $171.00 $184.00 G0128 ------- $4.00 $5.00 $5.00 $4.00 $5.00 $5.00 G0166 ------- $162.00 $173.00 $183.00 $162.00 $173.00 $183.00 G0179 ------- $47.00 $50.00 $52.00 $47.00 $50.00 $52.00 G0180 ------- $62.00 $65.00 $68.00 $62.00 $65.00 $68.00 G0181 ------- $113.00 $117.00 $122.00 $113.00 $117.00 $122.00 G0182 ------- $117.00 $122.00 $127.00 $117.00 $122.00 $127.00 G0237 ------- $15.00 $16.00 $17.00 $15.00 $16.00 $17.00 G0238 ------- $15.00 $17.00 $18.00 $15.00 $17.00 $18.00 G0239 ------- $14.00 $15.00 $16.00 $14.00 $15.00 $16.00 G0248 ------- $197.00 $212.00 $223.00 $197.00 $212.00 $223.00 G0249 ------- $145.00 $156.00 $164.00 $145.00 $156.00 $164.00 G0250 ------- $10.00 $10.00 $11.00 $10.00 $10.00 $11.00 G0268 ------- $49.00 $52.00 $54.00 $33.00 $34.00 $35.00 G0270 ------- $26.00 $27.00 $28.00 $25.00 $26.00 $27.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 376
Medicine CPT Code Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition 2003 MRA G0271 ------- $15.00 $16.00 $16.00 $15.00 $15.00 $16.00 G0281 ------- $12.00 $13.00 $13.00 $12.00 $13.00 $13.00 G0283 ------- $12.00 $13.00 $13.00 $12.00 $13.00 $13.00 G0308 ------- $773.00 $802.00 $831.00 $773.00 $802.00 $831.00 G0309 ------- $635.00 $658.00 $682.00 $635.00 $658.00 $682.00 G0310 ------- $497.00 $515.00 $533.00 $497.00 $515.00 $533.00 G0311 ------- $542.00 $561.00 $581.00 $542.00 $561.00 $581.00 G0312 ------- $447.00 $462.00 $479.00 $447.00 $462.00 $479.00 G0313 ------- $351.00 $362.00 $375.00 $351.00 $362.00 $375.00 G0314 ------- $475.00 $492.00 $509.00 $475.00 $492.00 $509.00 G0315 ------- $392.00 $405.00 $419.00 $392.00 $405.00 $419.00 G0316 ------- $305.00 $314.00 $325.00 $305.00 $314.00 $325.00 G0317 ------- $299.00 $309.00 $321.00 $299.00 $309.00 $321.00 G0318 ------- $245.00 $254.00 $263.00 $245.00 $254.00 $263.00 G0319 ------- $192.00 $198.00 $205.00 $192.00 $198.00 $205.00 G0320 ------- $606.00 $627.00 $649.00 $606.00 $627.00 $649.00 G0321 ------- $433.00 $447.00 $463.00 $433.00 $447.00 $463.00 G0322 ------- $375.00 $387.00 $400.00 $375.00 $387.00 $400.00 G0323 ------- $234.00 $242.00 $250.00 $234.00 $242.00 $250.00 G0324 ------- $21.00 $22.00 $23.00 $21.00 $22.00 $23.00 G0325 ------- $13.00 $13.00 $14.00 $13.00 $13.00 $14.00 G0326 ------- $15.00 $16.00 $16.00 $15.00 $16.00 $16.00 G0327 ------- $8.00 $9.00 $9.00 $8.00 $9.00 $9.00 G0329 ------- $9.00 $9.00 $10.00 $9.00 $9.00 $10.00 G0332 ------- $77.00 $83.00 $87.00 $77.00 $83.00 $87.00 G0366 ------- $25.00 $26.00 $28.00 $25.00 $26.00 $28.00 G0367 ------- $15.00 $17.00 $18.00 $15.00 $17.00 $18.00 G9041 ------- $25.00 $26.00 $26.00 $25.00 $26.00 $26.00 G9042 ------- $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 G9043 ------- $11.00 $11.00 $12.00 $11.00 $11.00 $12.00 G9044 ------- $9.00 $10.00 $11.00 $9.00 $10.00 $11.00 P3001 ------- $27.00 $28.00 $29.00 $27.00 $28.00 $29.00 Q0035 ------- $23.00 $24.00 $26.00 $23.00 $24.00 $26.00 Q0035-26 ------- $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 Q0091 ------- $43.00 $45.00 $48.00 $20.00 $21.00 $21.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 377
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Evaluation and Management CPT Code 2003 MRA 99201 $35.00 $39.00 $41.00 $43.00 $25.00 $26.00 $27.00 99202 $58.00 $67.00 $70.00 $74.00 $47.00 $49.00 $51.00 99203 $58.00 $99.00 $104.00 $109.00 $73.00 $76.00 $80.00 99204 $84.00 $151.00 $158.00 $165.00 $120.00 $125.00 $130.00 99205 $84.00 $190.00 $198.00 $207.00 $156.00 $162.00 $169.00 99211 $19.00 $21.00 $22.00 $23.00 $9.00 $10.00 $10.00 99212 $31.00 $40.00 $42.00 $45.00 $25.00 $26.00 $27.00 99213 $40.00 $64.00 $67.00 $70.00 $46.00 $47.00 $49.00 99214 $40.00 $97.00 $101.00 $105.00 $72.00 $74.00 $77.00 99215 $65.00 $132.00 $137.00 $143.00 $103.00 $107.00 $111.00 99217 $65.00 $71.00 $74.00 $77.00 $71.00 $74.00 $77.00 99218 $65.00 $67.00 $70.00 $72.00 $67.00 $70.00 $72.00 99219 $109.00 $111.00 $114.00 $119.00 $111.00 $114.00 $119.00 99220 $152.00 $155.00 $161.00 $167.00 $155.00 $161.00 $167.00 99221 $66.00 $94.00 $96.00 $100.00 $94.00 $96.00 $100.00 99222 $109.00 $129.00 $133.00 $138.00 $129.00 $133.00 $138.00 99223 $152.00 $189.00 $194.00 $201.00 $189.00 $194.00 $201.00 99231 $33.00 $39.00 $40.00 $42.00 $39.00 $40.00 $42.00 99232 $54.00 $69.00 $71.00 $73.00 $69.00 $71.00 $73.00 99233 $77.00 $99.00 $102.00 $105.00 $99.00 $102.00 $105.00 99234 $129.00 $135.00 $140.00 $146.00 $135.00 $140.00 $146.00 99235 $173.00 $178.00 $184.00 $191.00 $178.00 $184.00 $191.00 99236 $213.00 $221.00 $228.00 $237.00 $221.00 $228.00 $237.00 99238 $66.00 $71.00 $73.00 $76.00 $71.00 $73.00 $76.00 99239 $88.00 $102.00 $105.00 $109.00 $102.00 $105.00 $109.00 99241 $54.00 $52.00 $55.00 $58.00 $35.00 $37.00 $39.00 99242 $88.00 $97.00 $102.00 $108.00 $74.00 $77.00 $82.00 99243 $117.00 $133.00 $140.00 $147.00 $103.00 $108.00 $113.00 99244 $163.00 $195.00 $204.00 $213.00 $161.00 $167.00 $174.00 99245 $212.00 $241.00 $252.00 $264.00 $202.00 $210.00 $219.00 99251 $54.00 $51.00 $52.00 $55.00 $51.00 $52.00 $55.00 99252 $70.00 $81.00 $84.00 $88.00 $81.00 $84.00 $88.00 99253 $96.00 $120.00 $124.00 $129.00 $120.00 $124.00 $129.00 99254 $138.00 $172.00 $178.00 $184.00 $172.00 $178.00 $184.00 99255 $190.00 $212.00 $220.00 $229.00 $212.00 $220.00 $229.00 99281 $18.00 $22.00 $22.00 $23.00 $22.00 $22.00 $23.00 99282 $28.00 $41.00 $42.00 $43.00 $41.00 $42.00 $43.00 99283 $60.00 $66.00 $69.00 $72.00 $66.00 $69.00 $72.00 99284 $94.00 $121.00 $126.00 $131.00 $121.00 $126.00 $131.00 99285 $103.00 $182.00 $188.00 $197.00 $182.00 $188.00 $197.00 99288 BR ------- ------- ------- ------- ------- ------- 99291 $192.00 $274.00 $285.00 $297.00 $226.00 $233.00 $242.00 99292 $95.00 $123.00 $128.00 $133.00 $113.00 $117.00 $122.00 99304 ------- $83.00 $86.00 $89.00 $83.00 $86.00 $89.00 99305 ------- $116.00 $119.00 $123.00 $116.00 $119.00 $123.00 99306 ------- $149.00 $153.00 $158.00 $149.00 $153.00 $158.00 99307 ------- $41.00 $43.00 $44.00 $41.00 $43.00 $44.00 99308 ------- $63.00 $65.00 $68.00 $63.00 $65.00 $68.00 99309 ------- $85.00 $88.00 $91.00 $85.00 $88.00 $91.00 99310 ------- $124.00 $128.00 $132.00 $124.00 $128.00 $132.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 378
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Evaluation and Management CPT Code 2003 MRA 99315 $60.00 $62.00 $64.00 $67.00 $62.00 $64.00 $67.00 99316 $77.00 $81.00 $83.00 $87.00 $81.00 $83.00 $87.00 99318 ------- $87.00 $90.00 $92.00 $87.00 $90.00 $92.00 99324 ------- $58.00 $61.00 $63.00 $58.00 $61.00 $63.00 99325 ------- $85.00 $88.00 $92.00 $85.00 $88.00 $92.00 99326 ------- $138.00 $142.00 $147.00 $138.00 $142.00 $147.00 99327 ------- $179.00 $184.00 $191.00 $179.00 $184.00 $191.00 99328 ------- $211.00 $218.00 $226.00 $211.00 $218.00 $226.00 99334 ------- $58.00 $60.00 $63.00 $58.00 $60.00 $63.00 99335 ------- $90.00 $93.00 $96.00 $90.00 $93.00 $96.00 99336 ------- $128.00 $132.00 $136.00 $128.00 $132.00 $136.00 99337 ------- $183.00 $189.00 $195.00 $183.00 $189.00 $195.00 99339 ------- $73.00 $75.00 $79.00 $73.00 $75.00 $79.00 99340 ------- $101.00 $105.00 $109.00 $101.00 $105.00 $109.00 99341 $59.00 $58.00 $60.00 $63.00 $58.00 $60.00 $63.00 99342 $85.00 $85.00 $88.00 $92.00 $85.00 $88.00 $92.00 99343 $109.00 $134.00 $139.00 $144.00 $134.00 $139.00 $144.00 99344 $160.00 $176.00 $181.00 $188.00 $176.00 $181.00 $188.00 99345 $193.00 $211.00 $218.00 $226.00 $211.00 $218.00 $226.00 99347 $46.00 $55.00 $57.00 $60.00 $55.00 $57.00 $60.00 99348 $71.00 $84.00 $86.00 $89.00 $84.00 $86.00 $89.00 99349 $107.00 $122.00 $126.00 $131.00 $122.00 $126.00 $131.00 99350 $156.00 $171.00 $177.00 $183.00 $171.00 $177.00 $183.00 99354 $106.00 $98.00 $102.00 $106.00 $93.00 $96.00 $100.00 99355 $104.00 $96.00 $100.00 $103.00 $91.00 $94.00 $97.00 99356 $87.00 $90.00 $93.00 $96.00 $90.00 $93.00 $96.00 99357 $88.00 $90.00 $93.00 $97.00 $90.00 $93.00 $97.00 99358 BR $103.00 $106.00 $110.00 $103.00 $106.00 $110.00 99359 BR $50.00 $51.00 $53.00 $50.00 $51.00 $53.00 99360 BR $59.00 $60.00 $62.00 $59.00 $60.00 $62.00 99363 ------- $116.00 $121.00 $126.00 $80.00 $83.00 $86.00 99364 ------- $40.00 $42.00 $44.00 $31.00 $32.00 $34.00 99366 ------- $42.00 $44.00 $46.00 $41.00 $43.00 $45.00 99367 ------- $54.00 $55.00 $57.00 $54.00 $55.00 $57.00 99368 ------- $35.00 $36.00 $37.00 $35.00 $36.00 $37.00 99374 $75.00 $68.00 $71.00 $74.00 $57.00 $59.00 $61.00 99375 $75.00 $113.00 $118.00 $123.00 $106.00 $110.00 $115.00 99377 $75.00 $68.00 $71.00 $74.00 $57.00 $59.00 $61.00 99378 $104.00 $121.00 $126.00 $132.00 $114.00 $119.00 $124.00 99379 $75.00 $67.00 $70.00 $73.00 $56.00 $58.00 $60.00 99380 $104.00 $102.00 $105.00 $109.00 $88.00 $91.00 $94.00 99406 ------- $13.00 $14.00 $14.00 $13.00 $13.00 $13.00 99407 ------- $26.00 $27.00 $28.00 $25.00 $26.00 $26.00 99408 ------- $32.00 $33.00 $33.00 $30.00 $31.00 $32.00 99409 ------- $63.00 $65.00 $66.00 $61.00 $63.00 $64.00 99441 ------- $14.00 $15.00 $15.00 $13.00 $13.00 $14.00 99442 ------- $25.00 $26.00 $27.00 $24.00 $25.00 $26.00 99443 ------- $37.00 $39.00 $40.00 $36.00 $37.00 $39.00 99450 NC NC NC NC NC NC NC 99455 $90.00 ------- ------- ------- ------- ------- ------- CPT only 2008 American Medical Association. All rights reserved. Part C, 379
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2008 Edition Evaluation and Management CPT Code 2003 MRA 99456 BR ------- ------- ------- ------- ------- ------- 99457 BR ------- ------- ------- ------- ------- ------- 99499 BR ------- ------- ------- ------- ------- ------- 99600 BR ------- ------- ------- ------- ------- ------- G0245 ------- $67.00 $70.00 $73.00 $47.00 $48.00 $50.00 G0246 ------- $40.00 $42.00 $43.00 $24.00 $25.00 $26.00 G0337 ------- $71.00 $74.00 $78.00 $71.00 $74.00 $78.00 G0344 ------- $100.00 $105.00 $110.00 $73.00 $77.00 $81.00 G0368 ------- $9.00 $10.00 $10.00 $9.00 $10.00 $10.00 G0372 ------- $16.00 $16.00 $17.00 $9.00 $9.00 $10.00 G0396 ------- $32.00 $33.00 $33.00 $30.00 $31.00 $32.00 G0397 ------- $63.00 $65.00 $66.00 $61.00 $62.00 $64.00 M0064 ------- $39.00 $41.00 $42.00 $18.00 $18.00 $19.00 CPT only 2008 American Medical Association. All rights reserved. Part C, 380
Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition APPENDIX A DEFINITIONS 381
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.440.02 (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.440.02 (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.440.13 (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.440.13 (1) (l), F.S. 382
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.458.347, F.S., or s.459.022, 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.440.13, F.S. (24) Physician means a physician as defined in s.440.13, 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
Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition APPENDIX B OFFICIAL SOURCE OF REFERENCES DIRECTORY OFFICIAL S 384
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. 2009 Relative Value Guide: A Guide for Anesthesia Values American Society of Anesthesiologists 520 N. Northwest Highway Park Ridge, Il. 60068-2573 (847) 825-5586 Web Site: www.asahq.org/ Complete Global Service Data for Orthopaedic Surgery, Vol. 1 & 2 American Academy of Orthopaedic Surgeons 6300 North River Road Rosemont, Illinois 60018-4262 (847) 823-7186 (800) 626-6726 (847) 823-8125 Fax (800) 823-8025 Fax Web site: www.aaos.org/ 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 60611-2678 (312) 440-2653 (800) 621-8099 (312) 440-7494 Fax Web site: www.ada.org ADA Order Department American Dental Association Post Office Box 776 St. Charles, Illinois 60174 (800) 947-4746 (888) 476-1880 Fax Web site: www.adacatalog.org/ Drug Topics Red Book Medical Economics Company, Inc. Five Paragon Drive Montvale, New Jersey 07645-1742 (201) 358-7200 (800) 232-7379 (201) 722-2680 Fax Web site: www.pdr.net. 385
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 60610 (312) 464-5000 (312) 464-4184 Fax Web site: www.ama-assn.org AMA Order Department P.O. Box 930876 Atlanta, Georgia 31193-0876 (800) 621 8335 (800) 262-3211 (312) 464-5600 Fax For questions regarding the use of CPT codes, please contact the American Medical Association CPT Information and Education Services at 1-800-634-6922. 1996 Florida Uniform Permanent Impairment Rating Schedule Florida Workers Compensation Institute P. O. Box 200 Tallahassee, Florida 32302 (850) 425-8156 (850) 222-9766 Fax Web site: www.fwciweb.org National Correct Coding Initiative Coding Policy Manual for Medicare Services (Coding Policy Manual) Visit http://www.cms.hhs.gov/nationalcorrectcodinited/ 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 46082-0907 Attention: Niles R. Rosen, M.D., Medical Director and Linda S. Dietz, RHIA, CCS, CCS-P, Coding Specialist (317) 571-1745 Fax 386
Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition APPENDIX C MODIFIERS 387
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 -2009 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 - 2009, when the service is medically necessary. (1) The guidelines in the CPT -2009 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
Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition APPENDIX D WORKERS COMPENSATION UNIQUE CODES 389
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 17 97260 Manipulation of spine by a physician other than an Page 28 osteopathic or chiropractic physician. 97261 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. 97750 Functional capacity evaluation (FCE) with written report. Page 32 97752 Muscle testing manually or by automated equipment with Page 29 written report. 97850 Physical reconditioning assessment; per hour. Page 23 97851 Physical reconditioning assessment; additional thirty (30) Page 23 minutes. 97852 Physical reconditioning program; per hour. Page 30 97853 Physical reconditioning program; additional thirty (30) minutes. Page 30 99457 Consensus Independent Medical Examination (CIME). Page 20 390
Florida Workers Compensation Health Care Provider Reimbursement Manual, 2008 Edition COMPENSATION UN APPENDIX E MEDICARE LOCALITY MAP 391
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