2018 alabama workers' compensation prevailing rate/maximum ... physicians fee.pdf · cpt...

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2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018 CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE: $241.99 0025T-6 CPT CODE: $241.99 0025T-A CPT CODE: $241.99 0025T-M CPT CODE: $241.99 0025T-N CPT CODE: $159.36 0025T-P CPT CODE: $2,487.59 0099T-2 CPT CODE: $48.05 01953-4 CPT CODE: $545.97 01967-4 CPT CODE: $163.80 01968-4 CPT CODE: $92.62 01996-6 CPT CODE: $283.53 03410-I CPT CODE: $210.17 0437T-2 CPT CODE: $102.07 07210-7 CPT CODE: $102.07 07210-I CPT CODE: $145.53 07220-7 CPT CODE: $145.53 07220-I CPT CODE: $262.72 07230-7 CPT CODE: $262.72 07230-I CPT CODE: $283.53 07240-7 CPT CODE: $283.53 07240-I CPT CODE: $330.78 07241-7 CPT CODE: $330.78 07241-I CPT CODE: $115.29 07250-7 CPT CODE: $115.29 07250-I CPT CODE: $1,483.82 07260-7 CPT CODE: $1,483.82 07260-I CPT CODE: $238.17 07310-7 CPT CODE: $238.17 07310-I CPT CODE: $302.44 07320-I CPT CODE: $292.97 09220-7 CPT CODE: $292.97 09220-I CPT CODE: $239.15 09240-I CPT CODE: $72.31 10021-2 CPT CODE: $72.31 10022-2 CPT CODE: $174.11 10030-2 CPT CODE: $94.00 10035-2 CPT CODE: $47.30 10036-2 CPT CODE: $52.91 10040-2 CPT CODE: $111.52 10060-2 CPT CODE: $181.47 10061-2 CPT CODE: $147.43 10080-2 CPT CODE: $321.33 10081-2 CPT CODE: $105.85 10120-2 CPT CODE: $277.83 10121-2 CPT CODE: $98.29 10140-2 CPT CODE: $90.74 10160-2 CPT CODE: $425.29 10180-2 CPT CODE: $85.04 11000-2 CPT CODE: $58.59 11001-2 CPT CODE: $772.84 11004-2 CPT CODE: $849.58 11005-2 CPT CODE: $966.05 11006-2 CPT CODE: $512.48 11008-2 CPT CODE: $293.88 11010-2 CPT CODE: $462.95 11011-2 CPT CODE: $640.26 11012-2 CPT CODE: $302.44 11042-2 CPT CODE: $472.54 11043-2 CPT CODE: $661.58 11044-2 CPT CODE: $47.59 11045-2 CPT CODE: $84.76 11046-2 CPT CODE: $138.72 11047-2 CPT CODE: $61.39 11055-2 CPT CODE: $80.80 11056-2 CPT CODE: $101.80 11057-2 CPT CODE: $115.29 11100-2 CPT CODE: $58.59 11101-2 CPT CODE: $98.29 11200-2 CPT CODE: $49.14 11201-2 CPT CODE: $78.70 11300-2 CPT CODE: $113.45 11301-2 CPT CODE: $129.92 11302-2 CPT CODE: $177.51 11303-2 CPT CODE: $89.68 11305-2 CPT CODE: $109.77 11306-2 CPT CODE: $173.86 11307-2 CPT CODE: $217.75 11308-2 CPT CODE: $137.25 11310-2 CPT CODE: $204.95 11311-2 CPT CODE: $250.71 11312-2 CPT CODE: $320.23 11313-2 CPT CODE: $100.97 11400-2 CPT CODE: $145.24 11401-2 CPT CODE: $164.75 11402-2 CPT CODE: $224.97 11403-2 CPT CODE: $274.60 11404-2 CPT CODE: $389.72 11406-2 CPT CODE: $115.14 11420-2 CPT CODE: $139.96 11421-2 CPT CODE: $221.43 11422-2 CPT CODE: $274.60 11423-2 CPT CODE: $327.73 11424-2 CPT CODE: $434.02 11426-2 CPT CODE: $138.17 11440-2 CPT CODE: $175.37 11441-2 CPT CODE: $263.97 11442-2 CPT CODE: $318.88 11443-2 CPT CODE: $407.44 11444-2 CPT CODE: $478.30 11446-2 CPT CODE: $889.29 11450-2 CPT CODE: $1,162.47 11451-2 CPT CODE: $807.79 11462-2 CPT CODE: $961.91 11463-2 CPT CODE: $990.26 11470-2 CPT CODE: $1,162.47 11471-2 CPT CODE: $219.28 11600-2 CPT CODE: $260.87 11601-2 CPT CODE: $321.33 11602-2 CPT CODE: $378.05 11603-2 CPT CODE: $463.09 11604-2 CPT CODE: $519.80 11606-2 CPT CODE: $221.17 11620-2 CPT CODE: $279.76 11621-2 CPT CODE: $311.88 11622-2 CPT CODE: $378.05 11623-2 CPT CODE: $482.01 11624-2 CPT CODE: $652.13 11626-2 CPT CODE: $260.87 11640-2 CPT CODE: $292.97 11641-2 CPT CODE: $359.12 11642-2 CPT CODE: $491.46 11643-2 CPT CODE: $519.80 11644-2 CPT CODE: $642.67 11646-2 CPT CODE: $60.76 11720-2 CPT CODE: $105.06 11721-2 CPT CODE: $124.75 11730-2 CPT CODE: $60.46 11732-2 CPT CODE: $88.80 11740-2 CPT CODE: $510.36 11750-2 CPT CODE: $116.05 11755-2 CPT CODE: $120.98 11760-2 CPT CODE: $538.68 11762-2 CPT CODE: $548.14 11765-2 CPT CODE: $812.78 11770-2 CPT CODE: $1,030.15 11771-2 CPT CODE: $1,606.65 11772-2 CPT CODE: $52.91 11900-2 CPT CODE: $153.10 11901-2 CPT CODE: $109.63 11920-2 CPT CODE: $166.32 11921-2 CPT CODE: $253.27 11922-2 CPT CODE: $109.63 11950-2 CPT CODE: $166.32 11951-2 CPT CODE: $253.27 11952-2 CPT CODE: $359.12 11954-2 CPT CODE: $3,666.05 11960-2 CPT CODE: $4,073.38 11970-2 CPT CODE: $4,073.38 11971-2 CPT CODE: $205.76 11980-2 CPT CODE: $244.95 11981-2 CPT CODE: $61.98 11982-2 CPT CODE: $306.93 11983-2 Page 1

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Page 1: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $241.990025T-6

CPT CODE: $241.990025T-A

CPT CODE: $241.990025T-M

CPT CODE: $241.990025T-N

CPT CODE: $159.360025T-P

CPT CODE: $2,487.590099T-2

CPT CODE: $48.0501953-4

CPT CODE: $545.9701967-4

CPT CODE: $163.8001968-4

CPT CODE: $92.6201996-6

CPT CODE: $283.5303410-I

CPT CODE: $210.170437T-2

CPT CODE: $102.0707210-7

CPT CODE: $102.0707210-I

CPT CODE: $145.5307220-7

CPT CODE: $145.5307220-I

CPT CODE: $262.7207230-7

CPT CODE: $262.7207230-I

CPT CODE: $283.5307240-7

CPT CODE: $283.5307240-I

CPT CODE: $330.7807241-7

CPT CODE: $330.7807241-I

CPT CODE: $115.2907250-7

CPT CODE: $115.2907250-I

CPT CODE: $1,483.8207260-7

CPT CODE: $1,483.8207260-I

CPT CODE: $238.1707310-7

CPT CODE: $238.1707310-I

CPT CODE: $302.4407320-I

CPT CODE: $292.9709220-7

CPT CODE: $292.9709220-I

CPT CODE: $239.1509240-I

CPT CODE: $72.3110021-2

CPT CODE: $72.3110022-2

CPT CODE: $174.1110030-2

CPT CODE: $94.0010035-2

CPT CODE: $47.3010036-2

CPT CODE: $52.9110040-2

CPT CODE: $111.5210060-2

CPT CODE: $181.4710061-2

CPT CODE: $147.4310080-2

CPT CODE: $321.3310081-2

CPT CODE: $105.8510120-2

CPT CODE: $277.8310121-2

CPT CODE: $98.2910140-2

CPT CODE: $90.7410160-2

CPT CODE: $425.2910180-2

CPT CODE: $85.0411000-2

CPT CODE: $58.5911001-2

CPT CODE: $772.8411004-2

CPT CODE: $849.5811005-2

CPT CODE: $966.0511006-2

CPT CODE: $512.4811008-2

CPT CODE: $293.8811010-2

CPT CODE: $462.9511011-2

CPT CODE: $640.2611012-2

CPT CODE: $302.4411042-2

CPT CODE: $472.5411043-2

CPT CODE: $661.5811044-2

CPT CODE: $47.5911045-2

CPT CODE: $84.7611046-2

CPT CODE: $138.7211047-2

CPT CODE: $61.3911055-2

CPT CODE: $80.8011056-2

CPT CODE: $101.8011057-2

CPT CODE: $115.2911100-2

CPT CODE: $58.5911101-2

CPT CODE: $98.2911200-2

CPT CODE: $49.1411201-2

CPT CODE: $78.7011300-2

CPT CODE: $113.4511301-2

CPT CODE: $129.9211302-2

CPT CODE: $177.5111303-2

CPT CODE: $89.6811305-2

CPT CODE: $109.7711306-2

CPT CODE: $173.8611307-2

CPT CODE: $217.7511308-2

CPT CODE: $137.2511310-2

CPT CODE: $204.9511311-2

CPT CODE: $250.7111312-2

CPT CODE: $320.2311313-2

CPT CODE: $100.9711400-2

CPT CODE: $145.2411401-2

CPT CODE: $164.7511402-2

CPT CODE: $224.9711403-2

CPT CODE: $274.6011404-2

CPT CODE: $389.7211406-2

CPT CODE: $115.1411420-2

CPT CODE: $139.9611421-2

CPT CODE: $221.4311422-2

CPT CODE: $274.6011423-2

CPT CODE: $327.7311424-2

CPT CODE: $434.0211426-2

CPT CODE: $138.1711440-2

CPT CODE: $175.3711441-2

CPT CODE: $263.9711442-2

CPT CODE: $318.8811443-2

CPT CODE: $407.4411444-2

CPT CODE: $478.3011446-2

CPT CODE: $889.2911450-2

CPT CODE: $1,162.4711451-2

CPT CODE: $807.7911462-2

CPT CODE: $961.9111463-2

CPT CODE: $990.2611470-2

CPT CODE: $1,162.4711471-2

CPT CODE: $219.2811600-2

CPT CODE: $260.8711601-2

CPT CODE: $321.3311602-2

CPT CODE: $378.0511603-2

CPT CODE: $463.0911604-2

CPT CODE: $519.8011606-2

CPT CODE: $221.1711620-2

CPT CODE: $279.7611621-2

CPT CODE: $311.8811622-2

CPT CODE: $378.0511623-2

CPT CODE: $482.0111624-2

CPT CODE: $652.1311626-2

CPT CODE: $260.8711640-2

CPT CODE: $292.9711641-2

CPT CODE: $359.1211642-2

CPT CODE: $491.4611643-2

CPT CODE: $519.8011644-2

CPT CODE: $642.6711646-2

CPT CODE: $60.7611720-2

CPT CODE: $105.0611721-2

CPT CODE: $124.7511730-2

CPT CODE: $60.4611732-2

CPT CODE: $88.8011740-2

CPT CODE: $510.3611750-2

CPT CODE: $116.0511755-2

CPT CODE: $120.9811760-2

CPT CODE: $538.6811762-2

CPT CODE: $548.1411765-2

CPT CODE: $812.7811770-2

CPT CODE: $1,030.1511771-2

CPT CODE: $1,606.6511772-2

CPT CODE: $52.9111900-2

CPT CODE: $153.1011901-2

CPT CODE: $109.6311920-2

CPT CODE: $166.3211921-2

CPT CODE: $253.2711922-2

CPT CODE: $109.6311950-2

CPT CODE: $166.3211951-2

CPT CODE: $253.2711952-2

CPT CODE: $359.1211954-2

CPT CODE: $3,666.0511960-2

CPT CODE: $4,073.3811970-2

CPT CODE: $4,073.3811971-2

CPT CODE: $205.7611980-2

CPT CODE: $244.9511981-2

CPT CODE: $61.9811982-2

CPT CODE: $306.9311983-2

Page 1

Page 2: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $107.7412001-2

CPT CODE: $139.9012002-2

CPT CODE: $185.2312004-2

CPT CODE: $238.1712005-2

CPT CODE: $463.0912006-2

CPT CODE: $500.9112007-2

CPT CODE: $124.7512011-2

CPT CODE: $185.2312013-2

CPT CODE: $236.2712014-2

CPT CODE: $268.4212015-2

CPT CODE: $359.1212016-2

CPT CODE: $482.0112017-2

CPT CODE: $510.3612018-2

CPT CODE: $1,115.2012020-2

CPT CODE: $1,464.8912021-2

CPT CODE: $162.5612031-2

CPT CODE: $224.9112032-2

CPT CODE: $311.8812034-2

CPT CODE: $491.4612035-2

CPT CODE: $595.4012036-2

CPT CODE: $642.6712037-2

CPT CODE: $149.3212041-2

CPT CODE: $221.1712042-2

CPT CODE: $253.2712044-2

CPT CODE: $281.6612045-2

CPT CODE: $425.2912046-2

CPT CODE: $482.0112047-2

CPT CODE: $243.8312051-2

CPT CODE: $311.8812052-2

CPT CODE: $359.1212053-2

CPT CODE: $453.6312054-2

CPT CODE: $500.9112055-2

CPT CODE: $727.7112056-2

CPT CODE: $982.9312057-2

CPT CODE: $283.5313100-2

CPT CODE: $330.7813101-2

CPT CODE: $77.3513102-2

CPT CODE: $330.7813120-2

CPT CODE: $510.3613121-2

CPT CODE: $174.8113122-2

CPT CODE: $387.4813131-2

CPT CODE: $793.8913132-2

CPT CODE: $380.5713133-2

CPT CODE: $500.9113151-2

CPT CODE: $850.5813152-2

CPT CODE: $403.7813153-2

CPT CODE: $1,701.1913160-2

CPT CODE: $746.6214000-2

CPT CODE: $1,096.3414001-2

CPT CODE: $737.1814020-2

CPT CODE: $1,342.0714021-2

CPT CODE: $1,039.6314040-2

CPT CODE: $1,398.7314041-2

CPT CODE: $1,266.4314060-2

CPT CODE: $1,842.9314061-2

CPT CODE: $1,790.3314301-2

CPT CODE: $376.5214302-2

CPT CODE: $1,153.0014350-2

CPT CODE: $283.9115002-2

CPT CODE: $143.2415003-2

CPT CODE: $312.3015004-2

CPT CODE: $157.4415005-2

CPT CODE: $243.7615040-2

CPT CODE: $349.6715050-2

CPT CODE: $1,049.0415100-2

CPT CODE: $302.4415101-2

CPT CODE: $776.0615110-2

CPT CODE: $146.2615111-2

CPT CODE: $1,075.1515115-2

CPT CODE: $279.3315116-2

CPT CODE: $1,531.0715120-2

CPT CODE: $595.4015121-2

CPT CODE: $653.5215130-2

CPT CODE: $119.9115131-2

CPT CODE: $1,195.0515135-2

CPT CODE: $163.3815136-2

CPT CODE: $653.5215150-2

CPT CODE: $155.4715151-2

CPT CODE: $191.0515152-2

CPT CODE: $956.5615155-2

CPT CODE: $303.0415156-2

CPT CODE: $326.7615157-2

CPT CODE: $793.8915200-2

CPT CODE: $595.4015201-2

CPT CODE: $1,219.1815220-2

CPT CODE: $661.5815221-2

CPT CODE: $982.9315240-2

CPT CODE: $897.8315241-2

CPT CODE: $1,710.6115260-2

CPT CODE: $1,030.1515261-2

CPT CODE: $148.4015271-2

CPT CODE: $28.2915272-2

CPT CODE: $304.7715273-2

CPT CODE: $72.3815274-2

CPT CODE: $159.4415275-2

CPT CODE: $35.2015276-2

CPT CODE: $308.9115277-2

CPT CODE: $85.4615278-2

CPT CODE: $1,937.4415570-2

CPT CODE: $1,937.4415572-2

CPT CODE: $1,937.4415574-2

CPT CODE: $1,937.4415576-2

CPT CODE: $841.1315600-2

CPT CODE: $1,077.4315610-2

CPT CODE: $1,795.6815620-2

CPT CODE: $1,795.6815630-2

CPT CODE: $1,805.1515650-2

CPT CODE: $1,828.6115731-2

CPT CODE: $2,580.0915734-2

CPT CODE: $2,580.0915736-2

CPT CODE: $2,580.0915738-2

CPT CODE: $2,580.0915740-2

CPT CODE: $2,173.7515750-2

CPT CODE: $10,444.2815756-2

CPT CODE: $8,467.7015757-2

CPT CODE: $8,093.4115758-2

CPT CODE: $2,173.7515760-2

CPT CODE: $2,599.0315770-2

CPT CODE: $60.4615775-2

CPT CODE: $219.3015777-2

CPT CODE: $2,599.0315780-2

CPT CODE: $803.3615781-2

CPT CODE: $557.6015782-2

CPT CODE: $119.0815783-2

CPT CODE: $119.0815786-2

CPT CODE: $105.8515787-2

CPT CODE: $2,597.4615788-2

CPT CODE: $2,597.4615789-2

CPT CODE: $1,026.4915792-2

CPT CODE: $1,026.4915793-2

CPT CODE: $2,173.7515819-2

CPT CODE: $1,540.5015820-2

CPT CODE: $2,211.5415821-2

CPT CODE: $1,748.4115822-2

CPT CODE: $1,748.4115823-2

CPT CODE: $2,173.7515824-2

CPT CODE: $3,251.1515825-2

CPT CODE: $1,748.4115826-2

CPT CODE: $6,322.7215828-2

CPT CODE: $1,748.4115829-2

CPT CODE: $2,446.7515830-2

CPT CODE: $6,322.7215832-2

CPT CODE: $6,322.7215833-2

CPT CODE: $6,322.7215834-2

CPT CODE: $6,322.7215835-2

CPT CODE: $6,322.7215836-2

CPT CODE: $3,005.4215837-2

CPT CODE: $3,005.4215838-2

CPT CODE: $3,005.4215839-2

CPT CODE: $4,215.1315840-2

CPT CODE: $4,215.1315841-2

CPT CODE: $4,215.1315842-2

Page 2

Page 3: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $5,122.4715845-2

CPT CODE: $378.1115847-2

CPT CODE: $62.3615850-2

CPT CODE: $62.3615851-2

CPT CODE: $330.7815852-2

CPT CODE: $1,351.5115876-2

CPT CODE: $1,351.5115877-2

CPT CODE: $1,351.5115878-2

CPT CODE: $1,351.5115879-2

CPT CODE: $1,256.9715920-2

CPT CODE: $1,625.5915922-2

CPT CODE: $973.4515931-2

CPT CODE: $1,323.1215933-2

CPT CODE: $1,153.0015934-2

CPT CODE: $1,748.4115935-2

CPT CODE: $1,389.2815936-2

CPT CODE: $1,748.4115937-2

CPT CODE: $1,105.7615940-2

CPT CODE: $1,502.7215941-2

CPT CODE: $1,389.2815944-2

CPT CODE: $1,748.4115945-2

CPT CODE: $2,561.2215946-2

CPT CODE: $973.4515950-2

CPT CODE: $1,323.1215951-2

CPT CODE: $1,389.2815952-2

CPT CODE: $1,748.4115953-2

CPT CODE: $2,230.4615956-2

CPT CODE: $2,599.0315958-2

CPT CODE: $96.4116000-2

CPT CODE: $92.6216020-2

CPT CODE: $102.0716025-2

CPT CODE: $130.4316030-2

CPT CODE: $302.4416035-2

CPT CODE: $123.8316036-2

CPT CODE: $81.4717000-2

CPT CODE: $35.5417003-3

CPT CODE: $323.1717004-2

CPT CODE: $54.9117110-2

CPT CODE: $74.3217111-2

CPT CODE: $56.6917250-2

CPT CODE: $158.8717260-2

CPT CODE: $193.0817261-2

CPT CODE: $235.6017262-2

CPT CODE: $272.8117263-2

CPT CODE: $336.5917264-2

CPT CODE: $453.4917266-2

CPT CODE: $161.1917270-2

CPT CODE: $205.4717271-2

CPT CODE: $247.6217272-2

CPT CODE: $311.8817273-2

CPT CODE: $378.0517274-2

CPT CODE: $482.0117276-2

CPT CODE: $193.0817280-2

CPT CODE: $196.5717281-2

CPT CODE: $292.9717282-2

CPT CODE: $359.1217283-2

CPT CODE: $453.6317284-2

CPT CODE: $519.8017286-2

CPT CODE: $658.1417311-2

CPT CODE: $301.9717312-2

CPT CODE: $642.6617313-2

CPT CODE: $294.2317314-2

CPT CODE: $67.1017315-2

CPT CODE: $62.3617340-2

CPT CODE: $60.4617360-2

CPT CODE: $113.4217380-2

CPT CODE: $92.6219000-2

CPT CODE: $60.4619001-2

CPT CODE: $500.9119020-2

CPT CODE: $96.4119030-2

CPT CODE: $240.1719081-2

CPT CODE: $116.6819082-2

CPT CODE: $225.5419083-2

CPT CODE: $109.7419084-2

CPT CODE: $263.7519085-2

CPT CODE: $123.4519086-2

CPT CODE: $122.8519100-2

CPT CODE: $652.1319101-2

CPT CODE: $784.4319110-2

CPT CODE: $784.4319112-2

CPT CODE: $746.6219120-2

CPT CODE: $740.8519125-2

CPT CODE: $740.8519126-2

CPT CODE: $4,082.8719260-2

CPT CODE: $5,784.0319271-2

CPT CODE: $5,784.0319272-2

CPT CODE: $241.0619281-2

CPT CODE: $67.8419282-2

CPT CODE: $140.5819283-2

CPT CODE: $68.2719284-2

CPT CODE: $119.2519285-2

CPT CODE: $63.8219286-2

CPT CODE: $187.5919287-2

CPT CODE: $87.6019288-2

CPT CODE: $941.3919296-2

CPT CODE: $471.3719297-2

CPT CODE: $1,075.6719298-2

CPT CODE: $933.0219300-2

CPT CODE: $833.6519301-2

CPT CODE: $2,321.5719302-2

CPT CODE: $1,206.6019303-2

CPT CODE: $1,229.8319304-2

CPT CODE: $2,334.4819305-2

CPT CODE: $4,166.9619306-2

CPT CODE: $2,328.0319307-2

CPT CODE: $4,470.3319316-2

CPT CODE: $4,470.3319318-2

CPT CODE: $2,476.1819324-2

CPT CODE: $2,476.1819325-2

CPT CODE: $1,304.2419328-2

CPT CODE: $1,039.6319330-2

CPT CODE: $1,162.4719340-2

CPT CODE: $1,720.0619342-2

CPT CODE: $1,909.1119350-2

CPT CODE: $1,909.1119355-2

CPT CODE: $3,818.2019357-2

CPT CODE: $2,476.1819361-2

CPT CODE: $13,467.6919364-2

CPT CODE: $2,476.1819366-2

CPT CODE: $9,993.9519367-2

CPT CODE: $9,993.9519368-2

CPT CODE: $9,993.9519369-2

CPT CODE: $897.8319370-2

CPT CODE: $897.8319371-2

CPT CODE: $1,153.0019380-2

CPT CODE: $181.4720005-2

CPT CODE: $745.6820100-2

CPT CODE: $1,264.7920101-2

CPT CODE: $1,264.7920102-2

CPT CODE: $502.2020103-2

CPT CODE: $832.3320150-2

CPT CODE: $268.4220200-2

CPT CODE: $425.2920205-2

CPT CODE: $179.5620206-2

CPT CODE: $181.4720220-2

CPT CODE: $841.1320225-2

CPT CODE: $661.5820240-2

CPT CODE: $784.4320245-2

CPT CODE: $2,523.4320250-2

CPT CODE: $2,523.4320251-2

CPT CODE: $119.0820500-2

CPT CODE: $119.0820501-2

CPT CODE: $130.4320520-2

CPT CODE: $1,190.8420525-2

CPT CODE: $56.0720526-2

CPT CODE: $64.7920527-2

CPT CODE: $68.0620550-2

CPT CODE: $56.0720551-2

CPT CODE: $84.1220552-2

CPT CODE: $112.1520553-2

CPT CODE: $533.2720555-2

CPT CODE: $79.9320600-2

Page 3

Page 4: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $81.8820604-2

CPT CODE: $69.9220605-2

CPT CODE: $90.1820606-2

CPT CODE: $71.8420610-2

CPT CODE: $102.9920611-2

CPT CODE: $54.6520612-2

CPT CODE: $595.4020615-2

CPT CODE: $302.4420650-2

CPT CODE: $1,483.8220660-2

CPT CODE: $2,268.2220661-2

CPT CODE: $661.5820662-2

CPT CODE: $661.5820663-2

CPT CODE: $2,170.0220664-2

CPT CODE: $119.0820665-2

CPT CODE: $765.5520670-2

CPT CODE: $1,115.2020680-2

CPT CODE: $1,984.7020690-2

CPT CODE: $3,770.9420692-2

CPT CODE: $1,880.7220693-2

CPT CODE: $907.3220694-2

CPT CODE: $2,049.3120696-2

CPT CODE: $7,296.2020802-2

CPT CODE: $7,296.2020805-2

CPT CODE: $7,296.2020808-2

CPT CODE: $7,882.1620816-2

CPT CODE: $3,912.7220822-2

CPT CODE: $7,759.3020824-2

CPT CODE: $3,912.7220827-2

CPT CODE: $6,870.8820838-2

CPT CODE: $538.6820900-2

CPT CODE: $3,610.2920902-2

CPT CODE: $1,030.1520910-2

CPT CODE: $1,559.4020912-2

CPT CODE: $425.2920920-2

CPT CODE: $841.1320922-2

CPT CODE: $3,610.2920924-2

CPT CODE: $2,580.0920926-2

CPT CODE: $546.1820930-2

CPT CODE: $546.1820931-2

CPT CODE: $546.1820936-2

CPT CODE: $1,802.5220937-2

CPT CODE: $1,802.5220938-2

CPT CODE: $281.6620950-2

CPT CODE: $6,804.7120955-2

CPT CODE: $5,850.8920956-2

CPT CODE: $5,850.8920957-2

CPT CODE: $6,804.7120962-2

CPT CODE: $9,262.0120969-2

CPT CODE: $9,262.0120970-2

CPT CODE: $7,702.5720972-2

CPT CODE: $7,702.5720973-2

CPT CODE: $1,833.5120974-2

CPT CODE: $1,822.3820975-2

CPT CODE: $2,703.0121010-2

CPT CODE: $500.8021011-2

CPT CODE: $542.6421012-2

CPT CODE: $781.3521013-2

CPT CODE: $839.1821014-2

CPT CODE: $4,281.3321015-2

CPT CODE: $1,684.5121016-2

CPT CODE: $1,304.2421025-2

CPT CODE: $803.3621026-2

CPT CODE: $973.4521029-2

CPT CODE: $803.3621030-2

CPT CODE: $727.7121031-2

CPT CODE: $803.3621032-2

CPT CODE: $2,117.0021034-2

CPT CODE: $727.7121040-2

CPT CODE: $2,230.4621044-2

CPT CODE: $2,230.4621045-2

CPT CODE: $1,901.3121046-2

CPT CODE: $2,853.4021047-2

CPT CODE: $1,901.3121048-2

CPT CODE: $3,056.2021049-2

CPT CODE: $2,703.0121050-2

CPT CODE: $2,703.0121060-2

CPT CODE: $1,304.2421070-2

CPT CODE: $1,805.1521100-2

CPT CODE: $1,171.9121110-2

CPT CODE: $119.0821116-2

CPT CODE: $1,483.8221120-2

CPT CODE: $2,211.5421121-2

CPT CODE: $2,211.5421122-2

CPT CODE: $2,211.5421123-2

CPT CODE: $1,464.8921125-2

CPT CODE: $2,050.8921127-2

CPT CODE: $1,370.4121137-2

CPT CODE: $2,050.8921138-2

CPT CODE: $1,370.4121139-2

CPT CODE: $7,062.9521141-2

CPT CODE: $7,487.3521142-2

CPT CODE: $7,911.7921143-2

CPT CODE: $8,647.6921145-2

CPT CODE: $9,082.4321146-2

CPT CODE: $9,526.6621147-2

CPT CODE: $9,082.4321150-2

CPT CODE: $9,082.4321151-2

CPT CODE: $10,008.6221154-2

CPT CODE: $10,613.4821155-2

CPT CODE: $7,816.0121159-2

CPT CODE: $9,866.8721160-2

CPT CODE: $3,317.3121172-2

CPT CODE: $3,317.3121175-2

CPT CODE: $4,564.8321179-2

CPT CODE: $5,150.8221180-2

CPT CODE: $973.4521181-2

CPT CODE: $8,430.3321182-2

CPT CODE: $8,430.3321183-2

CPT CODE: $8,430.3321184-2

CPT CODE: $2,929.8321188-2

CPT CODE: $5,661.1621193-2

CPT CODE: $6,247.1221194-2

CPT CODE: $6,190.4321195-2

CPT CODE: $6,965.4021196-2

CPT CODE: $2,145.3621198-2

CPT CODE: $1,949.8321199-2

CPT CODE: $2,703.0121206-2

CPT CODE: $1,549.9621208-2

CPT CODE: $1,446.0021209-2

CPT CODE: $2,939.2721210-2

CPT CODE: $2,939.2721215-2

CPT CODE: $1,559.4021230-2

CPT CODE: $1,549.9621235-2

CPT CODE: $3,723.7321240-2

CPT CODE: $3,959.9721242-2

CPT CODE: $5,576.1221243-2

CPT CODE: $1,739.0121244-2

CPT CODE: $4,753.8621247-2

CPT CODE: $2,939.2721255-2

CPT CODE: $6,681.8621256-2

CPT CODE: $6,681.8621260-2

CPT CODE: $8,364.1721261-2

CPT CODE: $8,902.8721263-2

CPT CODE: $6,681.8621267-2

CPT CODE: $8,364.1721268-2

CPT CODE: $1,956.3721270-2

CPT CODE: $4,460.8721275-2

CPT CODE: $1,200.3021280-2

CPT CODE: $1,200.3021282-2

CPT CODE: $1,559.4021295-2

CPT CODE: $1,984.7021296-2

CPT CODE: $444.1721310-2

CPT CODE: $240.0821315-2

CPT CODE: $680.4721320-2

CPT CODE: $841.1321325-2

CPT CODE: $1,984.7021330-2

CPT CODE: $3,241.6921335-2

CPT CODE: $805.1621336-2

CPT CODE: $238.1721337-2

CPT CODE: $1,200.3021338-2

CPT CODE: $1,984.7021339-2

CPT CODE: $2,636.8321340-2

Page 4

Page 5: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,410.0221343-2

CPT CODE: $2,763.0521344-2

CPT CODE: $2,759.6921345-2

CPT CODE: $2,636.8321346-2

CPT CODE: $3,789.8421347-2

CPT CODE: $3,101.5621348-2

CPT CODE: $661.5821355-2

CPT CODE: $1,445.5621356-2

CPT CODE: $1,370.4121360-2

CPT CODE: $3,648.0921365-2

CPT CODE: $3,970.7221366-2

CPT CODE: $2,447.8221385-2

CPT CODE: $2,410.0221386-2

CPT CODE: $3,317.3121387-2

CPT CODE: $2,882.5621390-2

CPT CODE: $3,789.8421395-2

CPT CODE: $897.8321400-2

CPT CODE: $1,805.1521401-2

CPT CODE: $2,410.0221406-2

CPT CODE: $2,910.9121407-2

CPT CODE: $2,817.9321408-2

CPT CODE: $1,625.5921421-2

CPT CODE: $2,457.2821422-2

CPT CODE: $3,046.6721423-2

CPT CODE: $1,984.7021431-2

CPT CODE: $3,978.8821432-2

CPT CODE: $5,472.1421433-2

CPT CODE: $9,025.7221435-2

CPT CODE: $9,826.1421436-2

CPT CODE: $897.8321440-2

CPT CODE: $1,729.5421445-2

CPT CODE: $888.3921450-2

CPT CODE: $944.2021451-2

CPT CODE: $1,789.2021452-2

CPT CODE: $1,805.1521453-2

CPT CODE: $3,440.1721454-2

CPT CODE: $2,343.8621461-2

CPT CODE: $2,570.6721462-2

CPT CODE: $1,805.1521465-2

CPT CODE: $4,319.1121470-2

CPT CODE: $279.7621480-2

CPT CODE: $453.6321485-2

CPT CODE: $1,805.1521490-2

CPT CODE: $1,323.1221497-2

CPT CODE: $491.4621501-2

CPT CODE: $1,266.4321502-2

CPT CODE: $897.8321510-2

CPT CODE: $238.1721550-2

CPT CODE: $723.5121552-2

CPT CODE: $1,192.3221554-2

CPT CODE: $119.0821555-2

CPT CODE: $240.0821556-2

CPT CODE: $4,536.5021557-2

CPT CODE: $2,240.6821558-2

CPT CODE: $1,266.4321600-2

CPT CODE: $1,266.4321610-2

CPT CODE: $3,062.1221615-2

CPT CODE: $4,564.8321616-2

CPT CODE: $3,062.1221620-2

CPT CODE: $2,703.0121627-2

CPT CODE: $4,564.8321630-2

CPT CODE: $5,784.0321632-2

CPT CODE: $1,844.6921685-2

CPT CODE: $1,625.5921700-2

CPT CODE: $2,703.0121705-2

CPT CODE: $1,616.1021720-2

CPT CODE: $1,852.4121725-2

CPT CODE: $5,415.4421740-2

CPT CODE: $1,740.2321742-2

CPT CODE: $1,740.2321743-2

CPT CODE: $3,062.1221750-2

CPT CODE: $637.3421811-2

CPT CODE: $764.6321812-2

CPT CODE: $1,046.8921813-2

CPT CODE: $491.4621820-2

CPT CODE: $1,805.1521825-2

CPT CODE: $238.1721920-2

CPT CODE: $491.4621925-2

CPT CODE: $238.1721930-2

CPT CODE: $756.7421931-2

CPT CODE: $1,086.5021932-2

CPT CODE: $1,198.4821933-2

CPT CODE: $4,536.5021935-2

CPT CODE: $2,329.2821936-2

CPT CODE: $1,231.9422010-2

CPT CODE: $1,231.9422015-2

CPT CODE: $1,682.2922100-2

CPT CODE: $1,682.2922101-2

CPT CODE: $1,682.2922102-2

CPT CODE: $970.5822103-2

CPT CODE: $3,742.5922110-2

CPT CODE: $3,742.5922112-2

CPT CODE: $3,742.5922114-2

CPT CODE: $970.5822116-2

CPT CODE: $3,995.1722206-2

CPT CODE: $3,943.2022207-2

CPT CODE: $978.6922208-2

CPT CODE: $4,564.8322210-2

CPT CODE: $4,564.8322212-2

CPT CODE: $4,564.8322214-2

CPT CODE: $1,144.7422216-2

CPT CODE: $5,292.5722220-2

CPT CODE: $5,292.5722222-2

CPT CODE: $5,292.5722224-2

CPT CODE: $1,144.7422226-2

CPT CODE: $567.0622310-2

CPT CODE: $1,805.1522315-2

CPT CODE: $1,649.1322318-2

CPT CODE: $2,060.6522319-2

CPT CODE: $4,215.1322325-2

CPT CODE: $4,215.1322326-2

CPT CODE: $4,215.1322327-2

CPT CODE: $1,264.7922328-2

CPT CODE: $491.4622505-2

CPT CODE: $1,930.7922510-2

CPT CODE: $1,910.5922511-2

CPT CODE: $1,067.1322512-2

CPT CODE: $599.1322513-2

CPT CODE: $559.3722514-2

CPT CODE: $250.8222515-2

CPT CODE: $4,187.6022532-2

CPT CODE: $3,997.0622533-2

CPT CODE: $963.9822534-2

CPT CODE: $5,784.0322548-2

CPT CODE: $4,451.7022551-2

CPT CODE: $1,470.0022552-2

CPT CODE: $5,492.7022554-2

CPT CODE: $6,549.5522556-2

CPT CODE: $5,226.3922558-2

CPT CODE: $1,266.4322585-2

CPT CODE: $2,811.8922586-2

CPT CODE: $5,784.0322590-2

CPT CODE: $5,784.0322595-2

CPT CODE: $5,124.5922600-2

CPT CODE: $4,999.5722610-2

CPT CODE: $6,234.8522612-2

CPT CODE: $1,264.7922614-2

CPT CODE: $6,549.5522630-2

CPT CODE: $1,264.7922632-2

CPT CODE: $3,578.4322633-2

CPT CODE: $1,113.9522634-2

CPT CODE: $6,133.7122800-2

CPT CODE: $6,502.3122802-2

CPT CODE: $7,068.0122804-2

CPT CODE: $3,224.5822808-2

CPT CODE: $6,133.7122810-2

CPT CODE: $6,502.3122812-2

CPT CODE: $5,442.0622818-2

CPT CODE: $6,535.9422819-2

CPT CODE: $3,118.8522830-2

CPT CODE: $5,122.4622840-2

CPT CODE: $3,275.3122841-2

Page 5

Page 6: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $5,137.5722842-2

CPT CODE: $5,104.8722843-2

CPT CODE: $5,546.2022844-2

CPT CODE: $2,032.9222845-2

CPT CODE: $2,920.2422846-2

CPT CODE: $3,336.1722847-2

CPT CODE: $1,264.7922848-2

CPT CODE: $4,517.6022849-2

CPT CODE: $3,279.5122850-2

CPT CODE: $4,661.2622852-2

CPT CODE: $1,928.0122855-2

CPT CODE: $642.7522858-2

CPT CODE: $3,922.1722900-2

CPT CODE: $1,071.7422901-2

CPT CODE: $669.3722902-2

CPT CODE: $709.9822903-2

CPT CODE: $1,680.8222904-2

CPT CODE: $2,179.1622905-2

CPT CODE: $888.3923000-2

CPT CODE: $2,296.5823020-2

CPT CODE: $177.6823030-2

CPT CODE: $236.2723031-2

CPT CODE: $897.8323035-2

CPT CODE: $2,107.5823040-2

CPT CODE: $1,030.1523044-2

CPT CODE: $238.1723065-2

CPT CODE: $491.4623066-2

CPT CODE: $671.8423071-2

CPT CODE: $1,180.0223073-2

CPT CODE: $519.8023075-2

CPT CODE: $1,039.6323076-2

CPT CODE: $4,536.5023077-2

CPT CODE: $2,268.9823078-2

CPT CODE: $2,296.5823100-2

CPT CODE: $1,030.1523101-2

CPT CODE: $3,128.3023105-2

CPT CODE: $1,389.2823106-2

CPT CODE: $2,107.5823107-2

CPT CODE: $1,502.7223120-2

CPT CODE: $1,502.7223125-2

CPT CODE: $1,512.1523130-2

CPT CODE: $1,266.4323140-2

CPT CODE: $1,852.4123145-2

CPT CODE: $1,502.7223146-2

CPT CODE: $3,317.3123150-2

CPT CODE: $4,999.5723155-2

CPT CODE: $3,922.1723156-2

CPT CODE: $1,323.1223170-2

CPT CODE: $1,030.1523172-2

CPT CODE: $2,703.0123174-2

CPT CODE: $1,030.1523180-2

CPT CODE: $1,030.1523182-2

CPT CODE: $2,703.0123184-2

CPT CODE: $1,502.7223190-2

CPT CODE: $1,502.7223195-2

CPT CODE: $3,610.2923200-2

CPT CODE: $5,717.8723210-2

CPT CODE: $2,759.6923220-2

CPT CODE: $120.9823330-2

CPT CODE: $648.7723333-2

CPT CODE: $1,153.6523334-2

CPT CODE: $1,414.1523335-2

CPT CODE: $120.9823350-2

CPT CODE: $4,215.1323395-2

CPT CODE: $4,215.1323397-2

CPT CODE: $2,410.0223400-2

CPT CODE: $1,682.2923405-2

CPT CODE: $2,523.4323406-2

CPT CODE: $2,041.4223410-2

CPT CODE: $3,033.7823412-2

CPT CODE: $822.2223415-2

CPT CODE: $3,436.3823420-2

CPT CODE: $2,523.4323430-2

CPT CODE: $2,523.4323440-2

CPT CODE: $3,459.0523450-2

CPT CODE: $3,922.1723455-2

CPT CODE: $4,215.1323460-2

CPT CODE: $3,789.8423462-2

CPT CODE: $3,610.2923465-2

CPT CODE: $3,610.2923466-2

CPT CODE: $4,082.8723470-2

CPT CODE: $5,113.0223472-2

CPT CODE: $2,726.9023473-2

CPT CODE: $3,423.8723474-2

CPT CODE: $2,107.5823480-2

CPT CODE: $2,523.4323485-2

CPT CODE: $1,805.1523490-2

CPT CODE: $2,655.7423491-2

CPT CODE: $359.1223500-2

CPT CODE: $519.8023505-2

CPT CODE: $1,587.7923515-2

CPT CODE: $240.0823520-2

CPT CODE: $595.4023525-2

CPT CODE: $1,502.7223530-2

CPT CODE: $1,682.2923532-2

CPT CODE: $595.4023540-2

CPT CODE: $727.7123545-2

CPT CODE: $1,710.6123550-2

CPT CODE: $1,842.9323552-2

CPT CODE: $330.7823570-2

CPT CODE: $727.7123575-2

CPT CODE: $1,805.1523585-2

CPT CODE: $963.9923600-2

CPT CODE: $1,493.2823605-2

CPT CODE: $2,655.7423615-2

CPT CODE: $2,763.0523616-2

CPT CODE: $330.7823620-2

CPT CODE: $727.7123625-2

CPT CODE: $1,852.4123630-2

CPT CODE: $680.4723650-2

CPT CODE: $850.5823655-2

CPT CODE: $2,703.0123660-2

CPT CODE: $557.6023665-2

CPT CODE: $2,523.4323670-2

CPT CODE: $841.1323675-2

CPT CODE: $3,544.1423680-2

CPT CODE: $793.8923700-2

CPT CODE: $3,733.1423800-2

CPT CODE: $4,215.1323802-2

CPT CODE: $4,819.9923900-2

CPT CODE: $3,610.2923920-2

CPT CODE: $661.5823921-2

CPT CODE: $177.6823930-2

CPT CODE: $119.0823931-2

CPT CODE: $897.8323935-2

CPT CODE: $1,937.4424000-2

CPT CODE: $2,241.5224006-2

CPT CODE: $240.0824065-2

CPT CODE: $491.4624066-2

CPT CODE: $652.1524071-2

CPT CODE: $1,120.9624073-2

CPT CODE: $614.3124075-2

CPT CODE: $1,124.6724076-2

CPT CODE: $4,536.5024077-2

CPT CODE: $2,090.5624079-2

CPT CODE: $1,143.5524100-2

CPT CODE: $1,691.7424101-2

CPT CODE: $2,098.1424102-2

CPT CODE: $850.5824105-2

CPT CODE: $2,098.1424110-2

CPT CODE: $2,599.0324115-2

CPT CODE: $2,230.4624116-2

CPT CODE: $1,682.2924120-2

CPT CODE: $2,107.5824125-2

CPT CODE: $1,852.4124126-2

CPT CODE: $1,937.4424130-2

CPT CODE: $2,523.4324134-2

CPT CODE: $1,682.2924136-2

CPT CODE: $1,266.4324138-2

CPT CODE: $2,523.4324140-2

CPT CODE: $1,682.2924145-2

CPT CODE: $1,266.4324147-2

Page 6

Page 7: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $1,640.0324149-2

CPT CODE: $5,717.8724150-2

CPT CODE: $3,789.8424152-2

CPT CODE: $3,128.3024155-2

CPT CODE: $1,266.4324160-2

CPT CODE: $841.1324164-2

CPT CODE: $111.5224200-2

CPT CODE: $614.3124201-2

CPT CODE: $119.0824220-2

CPT CODE: $522.3624300-2

CPT CODE: $2,476.1824301-2

CPT CODE: $1,266.4324305-2

CPT CODE: $1,030.1524310-2

CPT CODE: $2,599.0324320-2

CPT CODE: $2,523.4324330-2

CPT CODE: $3,317.3124331-2

CPT CODE: $1,149.5124332-2

CPT CODE: $2,107.5824340-2

CPT CODE: $2,382.0624341-2

CPT CODE: $2,948.7124342-2

CPT CODE: $2,141.1124343-2

CPT CODE: $4,223.1724344-2

CPT CODE: $2,141.1124345-2

CPT CODE: $4,223.1724346-2

CPT CODE: $841.1324350-2

CPT CODE: $1,020.7024351-2

CPT CODE: $1,266.4324352-2

CPT CODE: $1,266.4324354-2

CPT CODE: $1,776.8224356-2

CPT CODE: $643.3824357-2

CPT CODE: $925.4824358-2

CPT CODE: $1,020.7524359-2

CPT CODE: $4,328.5824360-2

CPT CODE: $3,610.2924361-2

CPT CODE: $3,610.2924362-2

CPT CODE: $5,349.2624363-2

CPT CODE: $1,323.1224365-2

CPT CODE: $2,107.5824366-2

CPT CODE: $3,009.5824370-2

CPT CODE: $3,467.9324371-2

CPT CODE: $2,107.5824400-2

CPT CODE: $2,410.0224410-2

CPT CODE: $3,317.3124420-2

CPT CODE: $3,610.2924430-2

CPT CODE: $4,215.1324435-2

CPT CODE: $2,107.5824470-2

CPT CODE: $1,852.4124495-2

CPT CODE: $2,655.7424498-2

CPT CODE: $737.1824500-2

CPT CODE: $1,077.4324505-2

CPT CODE: $2,655.7424515-2

CPT CODE: $2,543.4724516-2

CPT CODE: $746.6224530-2

CPT CODE: $1,077.4324535-2

CPT CODE: $2,098.1424538-2

CPT CODE: $2,948.7124545-2

CPT CODE: $2,817.9324546-2

CPT CODE: $425.2924560-2

CPT CODE: $841.1324565-2

CPT CODE: $1,446.0024566-2

CPT CODE: $1,852.4124575-2

CPT CODE: $538.6824576-2

CPT CODE: $992.3424577-2

CPT CODE: $2,703.0124579-2

CPT CODE: $1,446.0024582-2

CPT CODE: $4,281.3324586-2

CPT CODE: $4,281.3324587-2

CPT CODE: $349.6724600-2

CPT CODE: $727.7124605-2

CPT CODE: $2,107.5824615-2

CPT CODE: $841.1324620-2

CPT CODE: $2,220.9724635-2

CPT CODE: $170.1024640-2

CPT CODE: $727.7124650-2

CPT CODE: $888.3924655-2

CPT CODE: $1,909.1124665-2

CPT CODE: $2,523.4324666-2

CPT CODE: $302.4424670-2

CPT CODE: $661.5824675-2

CPT CODE: $1,540.5024685-2

CPT CODE: $3,374.0024800-2

CPT CODE: $3,789.8424802-2

CPT CODE: $2,107.5824900-2

CPT CODE: $1,852.4124920-2

CPT CODE: $661.5824925-2

CPT CODE: $2,107.5824930-2

CPT CODE: $2,523.4324931-2

CPT CODE: $1,739.0124935-2

CPT CODE: $3,610.2924940-2

CPT CODE: $992.3425000-2

CPT CODE: $861.7525001-2

CPT CODE: $888.3925020-2

CPT CODE: $1,852.4125023-2

CPT CODE: $414.6525024-2

CPT CODE: $1,770.7225025-2

CPT CODE: $177.6825028-2

CPT CODE: $119.0825031-2

CPT CODE: $888.3925035-2

CPT CODE: $1,937.4425040-2

CPT CODE: $238.1725065-2

CPT CODE: $491.4625066-2

CPT CODE: $682.9125071-2

CPT CODE: $850.2525073-2

CPT CODE: $793.8925075-2

CPT CODE: $1,124.6725076-2

CPT CODE: $4,536.5025077-2

CPT CODE: $1,823.5525078-2

CPT CODE: $1,502.7225085-2

CPT CODE: $1,143.5525100-2

CPT CODE: $1,143.5525101-2

CPT CODE: $1,805.1525105-2

CPT CODE: $1,446.0025107-2

CPT CODE: $562.6525109-2

CPT CODE: $727.7125110-2

CPT CODE: $935.6525111-2

CPT CODE: $1,143.5525112-2

CPT CODE: $2,183.1525115-2

CPT CODE: $2,173.7525116-2

CPT CODE: $1,039.6325118-2

CPT CODE: $1,805.1525119-2

CPT CODE: $1,653.9125120-2

CPT CODE: $2,069.7725125-2

CPT CODE: $1,805.1525126-2

CPT CODE: $1,143.5525130-2

CPT CODE: $1,559.4025135-2

CPT CODE: $1,559.4025136-2

CPT CODE: $1,682.2925145-2

CPT CODE: $1,682.2925150-2

CPT CODE: $1,682.2925151-2

CPT CODE: $3,610.2925170-2

CPT CODE: $1,219.1825210-2

CPT CODE: $2,107.5825215-2

CPT CODE: $1,323.1225230-2

CPT CODE: $1,323.1225240-2

CPT CODE: $119.0825246-2

CPT CODE: $784.4325248-2

CPT CODE: $784.4325250-2

CPT CODE: $1,200.3025251-2

CPT CODE: $363.0025259-2

CPT CODE: $1,230.2625260-2

CPT CODE: $1,724.3425263-2

CPT CODE: $2,586.4925265-2

CPT CODE: $997.7725270-2

CPT CODE: $1,230.2625272-2

CPT CODE: $1,724.3425274-2

CPT CODE: $1,027.0125275-2

CPT CODE: $1,446.0025280-2

CPT CODE: $1,030.1525290-2

CPT CODE: $1,323.1225295-2

CPT CODE: $2,296.5825300-2

CPT CODE: $1,984.7025301-2

CPT CODE: $1,984.7025310-2

Page 7

Page 8: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,296.5825312-2

CPT CODE: $2,296.5825315-2

CPT CODE: $3,128.3025316-2

CPT CODE: $3,440.1725320-2

CPT CODE: $2,931.7925332-2

CPT CODE: $3,440.1725335-2

CPT CODE: $2,300.9725337-2

CPT CODE: $1,805.1525350-2

CPT CODE: $2,523.4325355-2

CPT CODE: $2,107.5825360-2

CPT CODE: $2,948.7125365-2

CPT CODE: $2,948.7125370-2

CPT CODE: $3,733.1425375-2

CPT CODE: $2,107.5825390-2

CPT CODE: $2,599.0325391-2

CPT CODE: $2,948.7125392-2

CPT CODE: $3,317.3125393-2

CPT CODE: $1,102.2825394-2

CPT CODE: $2,343.8625400-2

CPT CODE: $2,759.6925405-2

CPT CODE: $3,128.3025415-2

CPT CODE: $3,610.2925420-2

CPT CODE: $2,599.0325425-2

CPT CODE: $3,317.3125426-2

CPT CODE: $774.7025430-2

CPT CODE: $1,702.8425431-2

CPT CODE: $2,599.0325440-2

CPT CODE: $1,559.4025441-2

CPT CODE: $1,549.9625442-2

CPT CODE: $1,805.1525443-2

CPT CODE: $1,805.1525444-2

CPT CODE: $1,805.1525445-2

CPT CODE: $3,789.8425446-2

CPT CODE: $2,684.0825447-2

CPT CODE: $1,805.1525449-2

CPT CODE: $1,266.4325450-2

CPT CODE: $1,805.1525455-2

CPT CODE: $2,107.5825490-2

CPT CODE: $1,852.4125491-2

CPT CODE: $2,835.3325492-2

CPT CODE: $548.1425500-2

CPT CODE: $727.7125505-2

CPT CODE: $2,107.5825515-2

CPT CODE: $1,665.1525520-2

CPT CODE: $2,415.4025525-2

CPT CODE: $2,415.4025526-2

CPT CODE: $463.0925530-2

CPT CODE: $926.1925535-2

CPT CODE: $1,852.4125545-2

CPT CODE: $614.3125560-2

CPT CODE: $1,171.9125565-2

CPT CODE: $2,708.1225574-2

CPT CODE: $3,109.3825575-2

CPT CODE: $680.4725600-2

CPT CODE: $860.0225605-2

CPT CODE: $1,038.8425606-2

CPT CODE: $1,005.2825607-2

CPT CODE: $1,059.4825608-2

CPT CODE: $1,176.9225609-2

CPT CODE: $491.4625622-2

CPT CODE: $935.6525624-2

CPT CODE: $1,918.5725628-2

CPT CODE: $453.6325630-2

CPT CODE: $708.8225635-2

CPT CODE: $1,805.1525645-2

CPT CODE: $425.2925650-2

CPT CODE: $454.4925651-2

CPT CODE: $566.6325652-2

CPT CODE: $727.7125660-2

CPT CODE: $1,852.4125670-2

CPT CODE: $861.7525671-2

CPT CODE: $661.5825675-2

CPT CODE: $1,323.1225676-2

CPT CODE: $1,266.4325680-2

CPT CODE: $1,805.1525685-2

CPT CODE: $1,030.1525690-2

CPT CODE: $1,559.4025695-2

CPT CODE: $2,343.8625800-2

CPT CODE: $2,882.5625805-2

CPT CODE: $2,882.5625810-2

CPT CODE: $2,343.8625820-2

CPT CODE: $2,835.3325825-2

CPT CODE: $2,761.1525830-2

CPT CODE: $1,805.1525900-2

CPT CODE: $1,682.2925905-2

CPT CODE: $661.5825907-2

CPT CODE: $1,852.4125909-2

CPT CODE: $1,805.1525915-2

CPT CODE: $1,805.1525920-2

CPT CODE: $661.5825922-2

CPT CODE: $1,805.1525924-2

CPT CODE: $1,502.7225927-2

CPT CODE: $538.6825929-2

CPT CODE: $1,502.7225931-2

CPT CODE: $120.9826010-2

CPT CODE: $266.4826011-2

CPT CODE: $888.3926020-2

CPT CODE: $765.5526025-2

CPT CODE: $1,502.7226030-2

CPT CODE: $888.3926034-2

CPT CODE: $897.8326035-2

CPT CODE: $1,323.1226037-2

CPT CODE: $538.6826040-2

CPT CODE: $1,323.1226045-2

CPT CODE: $803.3626055-2

CPT CODE: $538.6826060-2

CPT CODE: $935.6526070-2

CPT CODE: $784.4326075-2

CPT CODE: $746.6226080-2

CPT CODE: $935.6526100-2

CPT CODE: $784.4326105-2

CPT CODE: $661.5826110-2

CPT CODE: $661.9926111-2

CPT CODE: $871.1726113-2

CPT CODE: $595.4026115-2

CPT CODE: $1,039.6326116-2

CPT CODE: $1,266.4326117-2

CPT CODE: $1,709.1226118-2

CPT CODE: $1,635.0226121-2

CPT CODE: $1,635.0226123-2

CPT CODE: $661.5826125-2

CPT CODE: $1,323.1226130-2

CPT CODE: $1,483.8226135-2

CPT CODE: $1,323.1226140-2

CPT CODE: $1,483.8226145-2

CPT CODE: $822.2226160-2

CPT CODE: $784.4326170-2

CPT CODE: $784.4326180-2

CPT CODE: $814.2826185-2

CPT CODE: $1,323.1226200-2

CPT CODE: $1,682.2926205-2

CPT CODE: $1,200.3026210-2

CPT CODE: $1,549.9626215-2

CPT CODE: $1,030.1526230-2

CPT CODE: $784.4326235-2

CPT CODE: $661.5826236-2

CPT CODE: $1,559.4026250-2

CPT CODE: $1,559.4026260-2

CPT CODE: $1,559.4026262-2

CPT CODE: $1,039.6326320-2

CPT CODE: $208.0726340-2

CPT CODE: $76.2726341-2

CPT CODE: $1,520.8826350-2

CPT CODE: $2,664.0126352-2

CPT CODE: $1,724.3426356-2

CPT CODE: $1,724.3426357-2

CPT CODE: $2,664.0126358-2

CPT CODE: $1,588.7326370-2

CPT CODE: $2,034.3226372-2

CPT CODE: $1,598.4326373-2

CPT CODE: $1,598.4326390-2

CPT CODE: $2,160.2426392-2

Page 8

Page 9: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $620.0026410-2

CPT CODE: $1,356.2426412-2

CPT CODE: $852.4826415-2

CPT CODE: $1,094.6626416-2

CPT CODE: $678.0926418-2

CPT CODE: $1,356.2426420-2

CPT CODE: $1,588.7326426-2

CPT CODE: $2,160.2426428-2

CPT CODE: $552.1826432-2

CPT CODE: $678.0926433-2

CPT CODE: $804.0326434-2

CPT CODE: $610.2826437-2

CPT CODE: $1,055.9226440-2

CPT CODE: $1,055.9226442-2

CPT CODE: $804.0326445-2

CPT CODE: $997.7726449-2

CPT CODE: $804.0326450-2

CPT CODE: $552.1826455-2

CPT CODE: $552.1826460-2

CPT CODE: $1,356.2426471-2

CPT CODE: $1,055.9226474-2

CPT CODE: $1,104.3426476-2

CPT CODE: $1,104.3426477-2

CPT CODE: $1,598.4326478-2

CPT CODE: $1,598.4326479-2

CPT CODE: $1,724.3426480-2

CPT CODE: $2,286.2226483-2

CPT CODE: $2,160.2426485-2

CPT CODE: $2,664.0126489-2

CPT CODE: $2,034.3226490-2

CPT CODE: $2,664.0126492-2

CPT CODE: $2,402.4626494-2

CPT CODE: $2,034.3226496-2

CPT CODE: $2,034.3226497-2

CPT CODE: $2,664.0126498-2

CPT CODE: $2,034.3226499-2

CPT CODE: $1,356.2426500-2

CPT CODE: $1,598.4326502-2

CPT CODE: $1,598.4326508-2

CPT CODE: $2,392.7526510-2

CPT CODE: $1,323.1226516-2

CPT CODE: $1,984.7026517-2

CPT CODE: $2,343.8626518-2

CPT CODE: $1,323.1226520-2

CPT CODE: $1,238.0726525-2

CPT CODE: $1,559.4026530-2

CPT CODE: $1,805.1526531-2

CPT CODE: $1,190.8426535-2

CPT CODE: $1,805.1526536-2

CPT CODE: $1,805.1526540-2

CPT CODE: $2,230.4626541-2

CPT CODE: $1,767.3626542-2

CPT CODE: $1,559.4026545-2

CPT CODE: $1,605.5526546-2

CPT CODE: $1,323.1226548-2

CPT CODE: $5,283.0926550-2

CPT CODE: $6,221.9126551-2

CPT CODE: $6,402.4726553-2

CPT CODE: $6,221.9126554-2

CPT CODE: $5,717.8726555-2

CPT CODE: $4,388.1826556-2

CPT CODE: $1,502.7226560-2

CPT CODE: $2,107.5826561-2

CPT CODE: $2,835.3326562-2

CPT CODE: $1,559.4026565-2

CPT CODE: $1,559.4026567-2

CPT CODE: $2,069.7726568-2

CPT CODE: $2,580.0926580-2

CPT CODE: $1,559.4026587-2

CPT CODE: $1,266.4326590-2

CPT CODE: $2,343.8626591-2

CPT CODE: $1,559.4026593-2

CPT CODE: $1,937.4426596-2

CPT CODE: $251.3626600-2

CPT CODE: $576.5126605-2

CPT CODE: $897.8326607-2

CPT CODE: $869.2026608-2

CPT CODE: $907.3226615-2

CPT CODE: $519.8026641-2

CPT CODE: $519.8026645-2

CPT CODE: $935.6526650-2

CPT CODE: $1,918.5726665-2

CPT CODE: $491.4626670-2

CPT CODE: $538.6826675-2

CPT CODE: $831.6826676-2

CPT CODE: $1,200.3026685-2

CPT CODE: $1,200.3026686-2

CPT CODE: $238.1726700-2

CPT CODE: $491.4626705-2

CPT CODE: $803.3626706-2

CPT CODE: $1,171.9126715-2

CPT CODE: $187.1326720-2

CPT CODE: $444.1726725-2

CPT CODE: $803.3626727-2

CPT CODE: $1,077.4326735-2

CPT CODE: $321.3326740-2

CPT CODE: $463.0926742-2

CPT CODE: $1,332.5726746-2

CPT CODE: $124.7526750-2

CPT CODE: $238.1726755-2

CPT CODE: $340.2726756-2

CPT CODE: $529.2526765-2

CPT CODE: $149.3226770-2

CPT CODE: $179.5626775-2

CPT CODE: $340.2726776-2

CPT CODE: $623.8126785-2

CPT CODE: $2,107.5826820-2

CPT CODE: $1,682.2926841-2

CPT CODE: $2,107.5826842-2

CPT CODE: $1,682.2926843-2

CPT CODE: $2,107.5826844-2

CPT CODE: $1,559.4026850-2

CPT CODE: $1,984.7026852-2

CPT CODE: $1,200.3026860-2

CPT CODE: $595.4026861-2

CPT CODE: $1,559.4026862-2

CPT CODE: $784.4326863-2

CPT CODE: $1,049.0426910-2

CPT CODE: $614.3126951-2

CPT CODE: $793.8926952-2

CPT CODE: $177.6826990-2

CPT CODE: $92.6226991-2

CPT CODE: $897.8326992-2

CPT CODE: $538.6827000-2

CPT CODE: $661.5827001-2

CPT CODE: $661.5827003-2

CPT CODE: $1,266.4327005-2

CPT CODE: $1,266.4327006-2

CPT CODE: $1,805.1527025-2

CPT CODE: $1,628.3727027-2

CPT CODE: $2,948.7127030-2

CPT CODE: $2,835.3327033-2

CPT CODE: $3,610.2927035-2

CPT CODE: $3,526.2927036-2

CPT CODE: $238.1727040-2

CPT CODE: $491.4627041-2

CPT CODE: $755.5127043-2

CPT CODE: $1,202.1727045-2

CPT CODE: $774.9927047-2

CPT CODE: $1,115.2027048-2

CPT CODE: $4,536.5027049-2

CPT CODE: $1,266.4327050-2

CPT CODE: $2,939.2727052-2

CPT CODE: $4,215.1327054-2

CPT CODE: $1,792.2327057-2

CPT CODE: $3,258.2827059-2

CPT CODE: $1,030.1527060-2

CPT CODE: $784.4327062-2

CPT CODE: $1,030.1527065-2

CPT CODE: $1,625.5927066-2

CPT CODE: $1,625.5927067-2

CPT CODE: $1,030.1527070-2

Page 9

Page 10: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,703.0127071-2

CPT CODE: $5,717.8727075-2

CPT CODE: $5,717.8727076-2

CPT CODE: $5,717.8727077-2

CPT CODE: $5,717.8727078-2

CPT CODE: $1,417.6427080-2

CPT CODE: $119.0827086-2

CPT CODE: $727.7127087-2

CPT CODE: $2,948.7127090-2

CPT CODE: $2,939.2727091-2

CPT CODE: $147.4327093-2

CPT CODE: $147.4327095-2

CPT CODE: $85.1027096-2

CPT CODE: $2,835.3327097-2

CPT CODE: $2,835.3327098-2

CPT CODE: $3,128.3027100-2

CPT CODE: $3,317.3127105-2

CPT CODE: $4,215.1327110-2

CPT CODE: $3,128.3027111-2

CPT CODE: $4,999.5727120-2

CPT CODE: $4,215.1327122-2

CPT CODE: $4,234.0527125-2

CPT CODE: $5,835.0527130-2

CPT CODE: $7,816.0127132-2

CPT CODE: $9,469.9427134-2

CPT CODE: $6,492.8927137-2

CPT CODE: $6,492.8927138-2

CPT CODE: $2,523.4327140-2

CPT CODE: $4,215.1327146-2

CPT CODE: $4,564.8327147-2

CPT CODE: $5,831.2927151-2

CPT CODE: $4,564.8327156-2

CPT CODE: $4,564.8327158-2

CPT CODE: $3,685.9427161-2

CPT CODE: $3,818.2027165-2

CPT CODE: $3,411.8327170-2

CPT CODE: $2,173.7527175-2

CPT CODE: $3,071.5727176-2

CPT CODE: $4,867.2927177-2

CPT CODE: $4,385.3027178-2

CPT CODE: $3,317.3127179-2

CPT CODE: $4,999.5727181-2

CPT CODE: $1,682.2927185-2

CPT CODE: $4,385.3027187-2

CPT CODE: $595.4027200-2

CPT CODE: $897.8327201-2

CPT CODE: $1,502.7227202-2

CPT CODE: $2,296.4327215-2

CPT CODE: $1,152.8027216-2

CPT CODE: $2,872.8127217-2

CPT CODE: $2,872.8127218-2

CPT CODE: $1,030.1527220-2

CPT CODE: $2,410.0227222-2

CPT CODE: $3,165.5927226-2

CPT CODE: $3,879.2427227-2

CPT CODE: $4,327.5527228-2

CPT CODE: $841.1327230-2

CPT CODE: $1,984.7027232-2

CPT CODE: $3,978.8827235-2

CPT CODE: $4,375.8127236-2

CPT CODE: $841.1327238-2

CPT CODE: $1,984.7027240-2

CPT CODE: $3,931.6127244-2

CPT CODE: $3,623.0627245-2

CPT CODE: $661.5827246-2

CPT CODE: $1,502.7227248-2

CPT CODE: $784.4327250-2

CPT CODE: $1,502.7227252-2

CPT CODE: $3,374.0027253-2

CPT CODE: $4,092.2727254-2

CPT CODE: $1,937.4427256-2

CPT CODE: $1,502.7227257-2

CPT CODE: $3,374.0027258-2

CPT CODE: $4,725.5327259-2

CPT CODE: $784.4327265-2

CPT CODE: $1,502.7227266-2

CPT CODE: $614.9327267-2

CPT CODE: $759.6927268-2

CPT CODE: $3,202.0727269-2

CPT CODE: $491.4627275-2

CPT CODE: $653.0627279-2

CPT CODE: $2,948.7127280-2

CPT CODE: $2,948.7127282-2

CPT CODE: $4,385.3027284-2

CPT CODE: $4,630.9927286-2

CPT CODE: $5,415.4427290-2

CPT CODE: $3,581.9327295-2

CPT CODE: $500.9127301-2

CPT CODE: $888.3927303-2

CPT CODE: $1,030.1527305-2

CPT CODE: $538.6827306-2

CPT CODE: $784.4327307-2

CPT CODE: $2,410.0227310-2

CPT CODE: $238.1727323-2

CPT CODE: $491.4627324-2

CPT CODE: $1,444.0527325-2

CPT CODE: $1,444.0527326-2

CPT CODE: $680.4727327-2

CPT CODE: $850.5827328-2

CPT CODE: $4,536.5027329-2

CPT CODE: $2,060.3427330-2

CPT CODE: $2,220.9727331-2

CPT CODE: $2,580.0927332-2

CPT CODE: $3,128.3027333-2

CPT CODE: $2,202.1027334-2

CPT CODE: $3,610.2927335-2

CPT CODE: $673.0727337-2

CPT CODE: $1,214.4727339-2

CPT CODE: $973.4527340-2

CPT CODE: $1,805.1527345-2

CPT CODE: $1,271.0427347-2

CPT CODE: $1,899.6427350-2

CPT CODE: $2,041.4227355-2

CPT CODE: $2,589.5827356-2

CPT CODE: $3,128.3027357-2

CPT CODE: $538.6827358-2

CPT CODE: $2,041.4227360-2

CPT CODE: $3,291.5027364-2

CPT CODE: $3,610.2927365-2

CPT CODE: $119.0827370-2

CPT CODE: $784.4327372-2

CPT CODE: $2,107.5827380-2

CPT CODE: $2,107.5827381-2

CPT CODE: $2,523.4327385-2

CPT CODE: $3,317.3127386-2

CPT CODE: $1,030.1527390-2

CPT CODE: $1,502.7227391-2

CPT CODE: $2,296.5827392-2

CPT CODE: $1,266.4327393-2

CPT CODE: $1,682.2927394-2

CPT CODE: $2,523.4327395-2

CPT CODE: $3,128.3027396-2

CPT CODE: $3,610.2927397-2

CPT CODE: $3,317.3127400-2

CPT CODE: $2,457.2827403-2

CPT CODE: $2,778.6127405-2

CPT CODE: $3,062.1227407-2

CPT CODE: $3,581.9327409-2

CPT CODE: $3,398.3027412-2

CPT CODE: $3,406.5327415-2

CPT CODE: $3,550.9927416-2

CPT CODE: $3,553.5727418-2

CPT CODE: $3,128.3027420-2

CPT CODE: $3,128.3027422-2

CPT CODE: $3,128.3027424-2

CPT CODE: $2,636.8327425-2

CPT CODE: $3,232.2427427-2

CPT CODE: $4,139.5527428-2

CPT CODE: $4,309.6627429-2

CPT CODE: $3,128.3027430-2

CPT CODE: $1,748.4127435-2

CPT CODE: $2,665.1827437-2

Page 10

Page 11: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $4,942.8927438-2

CPT CODE: $3,922.1727440-2

CPT CODE: $5,292.5727441-2

CPT CODE: $5,179.1727442-2

CPT CODE: $6,984.3027443-2

CPT CODE: $5,179.1727445-2

CPT CODE: $5,897.4627446-2

CPT CODE: $5,886.0927447-2

CPT CODE: $3,005.4227448-2

CPT CODE: $3,912.7227450-2

CPT CODE: $4,215.1327454-2

CPT CODE: $2,410.0227455-2

CPT CODE: $2,948.7127457-2

CPT CODE: $3,317.3127465-2

CPT CODE: $3,610.2927466-2

CPT CODE: $4,867.2927468-2

CPT CODE: $4,215.1327470-2

CPT CODE: $4,867.2927472-2

CPT CODE: $2,703.0127475-2

CPT CODE: $2,703.0127477-2

CPT CODE: $3,317.3127479-2

CPT CODE: $2,296.5827485-2

CPT CODE: $6,937.0827486-2

CPT CODE: $6,984.3027487-2

CPT CODE: $1,200.3027488-2

CPT CODE: $3,978.8827495-2

CPT CODE: $805.1627496-2

CPT CODE: $1,033.8527497-2

CPT CODE: $1,033.8527498-2

CPT CODE: $1,262.5727499-2

CPT CODE: $1,105.7627500-2

CPT CODE: $1,033.8527501-2

CPT CODE: $2,173.7527502-2

CPT CODE: $2,076.8527503-2

CPT CODE: $3,723.7327506-2

CPT CODE: $3,796.8927507-2

CPT CODE: $841.1327508-2

CPT CODE: $1,610.2427509-2

CPT CODE: $1,672.8527510-2

CPT CODE: $3,796.8927511-2

CPT CODE: $3,796.8927513-2

CPT CODE: $3,685.9427514-2

CPT CODE: $661.5827516-2

CPT CODE: $1,502.7227517-2

CPT CODE: $3,128.3027519-2

CPT CODE: $803.3627520-2

CPT CODE: $2,173.7527524-2

CPT CODE: $661.5827530-2

CPT CODE: $1,398.7327532-2

CPT CODE: $2,763.0527535-2

CPT CODE: $3,090.4727536-2

CPT CODE: $1,058.5427538-2

CPT CODE: $2,948.7127540-2

CPT CODE: $1,030.1527550-2

CPT CODE: $1,030.1527552-2

CPT CODE: $2,948.7127556-2

CPT CODE: $2,948.7127557-2

CPT CODE: $2,817.9327558-2

CPT CODE: $444.1727560-2

CPT CODE: $425.2927562-2

CPT CODE: $2,523.4327566-2

CPT CODE: $444.1727570-2

CPT CODE: $3,685.9427580-2

CPT CODE: $2,882.5627590-2

CPT CODE: $2,655.7427591-2

CPT CODE: $2,703.0127592-2

CPT CODE: $661.5827594-2

CPT CODE: $973.4527596-2

CPT CODE: $2,599.0327598-2

CPT CODE: $888.3927600-2

CPT CODE: $992.3427601-2

CPT CODE: $1,323.1227602-2

CPT CODE: $1,332.5727603-2

CPT CODE: $1,332.5727604-2

CPT CODE: $299.3927605-2

CPT CODE: $538.6827606-2

CPT CODE: $897.8327607-2

CPT CODE: $1,918.5727610-2

CPT CODE: $1,852.4127612-2

CPT CODE: $238.1727613-2

CPT CODE: $491.4627614-2

CPT CODE: $4,536.5027615-2

CPT CODE: $2,559.3727616-2

CPT CODE: $774.9927618-2

CPT CODE: $1,115.2027619-2

CPT CODE: $1,852.4127620-2

CPT CODE: $1,842.9327625-2

CPT CODE: $2,249.3627626-2

CPT CODE: $727.7127630-2

CPT CODE: $665.6827632-2

CPT CODE: $1,091.4227634-2

CPT CODE: $1,852.4127635-2

CPT CODE: $2,608.4927637-2

CPT CODE: $2,703.0127638-2

CPT CODE: $2,249.3627640-2

CPT CODE: $1,323.1227641-2

CPT CODE: $3,156.6327645-2

CPT CODE: $1,663.4027646-2

CPT CODE: $1,323.1227647-2

CPT CODE: $119.0827648-2

CPT CODE: $2,220.9727650-2

CPT CODE: $2,797.5227652-2

CPT CODE: $2,693.5327654-2

CPT CODE: $1,266.4327656-2

CPT CODE: $1,323.1227658-2

CPT CODE: $1,502.7227659-2

CPT CODE: $1,323.1227664-2

CPT CODE: $1,682.2927665-2

CPT CODE: $1,266.4327675-2

CPT CODE: $1,266.4327676-2

CPT CODE: $982.9327680-2

CPT CODE: $1,266.4327681-2

CPT CODE: $1,417.6427685-2

CPT CODE: $1,682.2927686-2

CPT CODE: $1,502.7227687-2

CPT CODE: $1,682.2927690-2

CPT CODE: $2,098.1427691-2

CPT CODE: $538.6827692-2

CPT CODE: $2,098.1427695-2

CPT CODE: $2,948.7127696-2

CPT CODE: $2,476.1827698-2

CPT CODE: $3,610.2927700-2

CPT CODE: $5,831.2927702-2

CPT CODE: $6,058.1227703-2

CPT CODE: $699.3827704-2

CPT CODE: $2,277.6727705-2

CPT CODE: $1,323.1227707-2

CPT CODE: $3,610.2927709-2

CPT CODE: $3,610.2927712-2

CPT CODE: $4,999.5727715-2

CPT CODE: $3,128.3027720-2

CPT CODE: $3,610.2927722-2

CPT CODE: $3,685.9427724-2

CPT CODE: $3,610.2927725-2

CPT CODE: $2,288.9627726-2

CPT CODE: $2,580.0927727-2

CPT CODE: $2,107.5827730-2

CPT CODE: $1,266.4327732-2

CPT CODE: $2,599.0327734-2

CPT CODE: $3,789.8427740-2

CPT CODE: $4,564.8327742-2

CPT CODE: $3,440.1727745-2

CPT CODE: $1,124.6727750-2

CPT CODE: $1,446.0027752-2

CPT CODE: $2,476.1827756-2

CPT CODE: $2,703.0127758-2

CPT CODE: $3,101.5627759-2

CPT CODE: $850.5827760-2

CPT CODE: $954.5427762-2

CPT CODE: $2,031.9427766-2

CPT CODE: $475.1127767-2

CPT CODE: $596.3727768-2

Page 11

Page 12: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $1,395.6527769-2

CPT CODE: $737.1827780-2

CPT CODE: $737.1827781-2

CPT CODE: $1,360.9627784-2

CPT CODE: $652.1327786-2

CPT CODE: $812.7827788-2

CPT CODE: $1,909.1127792-2

CPT CODE: $1,304.2427808-2

CPT CODE: $1,483.8227810-2

CPT CODE: $2,684.0827814-2

CPT CODE: $841.1327816-2

CPT CODE: $1,682.2927818-2

CPT CODE: $2,863.6427822-2

CPT CODE: $3,033.7827823-2

CPT CODE: $805.1627824-2

CPT CODE: $1,610.2427825-2

CPT CODE: $2,872.8127826-2

CPT CODE: $2,872.8127827-2

CPT CODE: $2,991.7627828-2

CPT CODE: $1,948.7727829-2

CPT CODE: $595.4027830-2

CPT CODE: $727.7127831-2

CPT CODE: $1,682.2927832-2

CPT CODE: $595.4027840-2

CPT CODE: $727.7127842-2

CPT CODE: $2,041.4227846-2

CPT CODE: $1,682.2927848-2

CPT CODE: $425.2927860-2

CPT CODE: $3,232.2427870-2

CPT CODE: $3,610.2927871-2

CPT CODE: $2,476.1827880-2

CPT CODE: $2,703.0127881-2

CPT CODE: $1,805.1527882-2

CPT CODE: $538.6827884-2

CPT CODE: $1,200.3027886-2

CPT CODE: $2,098.1427888-2

CPT CODE: $2,476.1827889-2

CPT CODE: $978.9627892-2

CPT CODE: $978.9627893-2

CPT CODE: $1,262.5727894-2

CPT CODE: $519.8028001-2

CPT CODE: $746.6228002-2

CPT CODE: $774.9928003-2

CPT CODE: $1,200.3028005-2

CPT CODE: $746.6228008-2

CPT CODE: $119.0828010-2

CPT CODE: $302.4428011-2

CPT CODE: $1,238.0728020-2

CPT CODE: $614.3128022-2

CPT CODE: $538.6828024-2

CPT CODE: $1,682.2928035-2

CPT CODE: $766.5828039-2

CPT CODE: $735.8228041-2

CPT CODE: $548.1428043-2

CPT CODE: $727.7128045-2

CPT CODE: $860.0228046-2

CPT CODE: $1,573.7728047-2

CPT CODE: $1,266.4328050-2

CPT CODE: $784.4328052-2

CPT CODE: $538.6828054-2

CPT CODE: $1,071.1028055-2

CPT CODE: $888.3928060-2

CPT CODE: $897.8328062-2

CPT CODE: $1,266.4328070-2

CPT CODE: $784.4328072-2

CPT CODE: $1,105.7628080-2

CPT CODE: $1,323.1228086-2

CPT CODE: $1,030.1528088-2

CPT CODE: $793.8928090-2

CPT CODE: $746.6228092-2

CPT CODE: $1,266.4328100-2

CPT CODE: $1,502.7228102-2

CPT CODE: $1,502.7228103-2

CPT CODE: $1,030.1528104-2

CPT CODE: $1,266.4328106-2

CPT CODE: $1,266.4328107-2

CPT CODE: $954.5428108-2

CPT CODE: $538.6828110-2

CPT CODE: $1,502.7228111-2

CPT CODE: $841.1328112-2

CPT CODE: $841.1328113-2

CPT CODE: $1,663.4028114-2

CPT CODE: $1,502.7228116-2

CPT CODE: $1,030.1528118-2

CPT CODE: $1,115.2028119-2

CPT CODE: $1,266.4328120-2

CPT CODE: $1,238.0728122-2

CPT CODE: $784.4328124-2

CPT CODE: $1,020.7028126-2

CPT CODE: $2,107.5828130-2

CPT CODE: $926.1928140-2

CPT CODE: $841.1328150-2

CPT CODE: $850.5828153-2

CPT CODE: $737.1828160-2

CPT CODE: $1,502.7228171-2

CPT CODE: $1,200.3028173-2

CPT CODE: $784.4328175-2

CPT CODE: $149.3228190-2

CPT CODE: $614.3128192-2

CPT CODE: $1,266.4328193-2

CPT CODE: $1,266.4328200-2

CPT CODE: $1,682.2928202-2

CPT CODE: $595.4028208-2

CPT CODE: $897.8328210-2

CPT CODE: $1,030.1528220-2

CPT CODE: $1,285.3328222-2

CPT CODE: $595.4028225-2

CPT CODE: $784.4328226-2

CPT CODE: $614.3128230-2

CPT CODE: $302.4428232-2

CPT CODE: $240.0828234-2

CPT CODE: $1,502.7228238-2

CPT CODE: $784.4328240-2

CPT CODE: $907.3228250-2

CPT CODE: $1,805.1528260-2

CPT CODE: $1,937.4428261-2

CPT CODE: $2,901.4628262-2

CPT CODE: $2,296.5828264-2

CPT CODE: $642.6728270-2

CPT CODE: $642.6728272-2

CPT CODE: $746.6228280-2

CPT CODE: $935.6528285-2

CPT CODE: $737.1828286-2

CPT CODE: $538.6828288-2

CPT CODE: $943.7428289-2

CPT CODE: $1,493.2828292-2

CPT CODE: $1,861.8528296-2

CPT CODE: $1,786.2028297-2

CPT CODE: $1,805.1528298-2

CPT CODE: $1,502.7228299-2

CPT CODE: $1,984.7028300-2

CPT CODE: $1,852.4128302-2

CPT CODE: $1,682.2928304-2

CPT CODE: $1,852.4128305-2

CPT CODE: $1,512.1528306-2

CPT CODE: $1,663.4028307-2

CPT CODE: $1,200.3028308-2

CPT CODE: $1,852.4128309-2

CPT CODE: $661.5828310-2

CPT CODE: $425.2928312-2

CPT CODE: $784.4328313-2

CPT CODE: $1,115.2028315-2

CPT CODE: $1,143.5528320-2

CPT CODE: $982.9328322-2

CPT CODE: $1,030.1528340-2

CPT CODE: $1,446.0028341-2

CPT CODE: $1,030.1528344-2

CPT CODE: $1,502.7228345-2

CPT CODE: $2,580.0928360-2

CPT CODE: $604.8628400-2

CPT CODE: $1,115.2028405-2

CPT CODE: $1,805.1528406-2

Page 12

Page 13: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,069.7728415-2

CPT CODE: $2,268.2228420-2

CPT CODE: $614.3128430-2

CPT CODE: $1,115.2028435-2

CPT CODE: $1,805.1528436-2

CPT CODE: $2,410.0228445-2

CPT CODE: $2,694.7928446-2

CPT CODE: $482.0128450-2

CPT CODE: $727.7128455-2

CPT CODE: $1,049.0428456-2

CPT CODE: $1,143.5528465-2

CPT CODE: $500.9128470-2

CPT CODE: $642.6728475-2

CPT CODE: $853.8528476-2

CPT CODE: $1,096.3428485-2

CPT CODE: $196.5728490-2

CPT CODE: $311.8828495-2

CPT CODE: $1,049.0428496-2

CPT CODE: $557.6028505-2

CPT CODE: $292.9728510-2

CPT CODE: $292.9728515-2

CPT CODE: $557.6028525-2

CPT CODE: $292.9728530-2

CPT CODE: $631.2728531-2

CPT CODE: $482.0128540-2

CPT CODE: $595.4028545-2

CPT CODE: $661.5828546-2

CPT CODE: $1,502.7228555-2

CPT CODE: $784.4328570-2

CPT CODE: $784.4328575-2

CPT CODE: $686.2028576-2

CPT CODE: $1,805.1528585-2

CPT CODE: $198.4628600-2

CPT CODE: $491.4628605-2

CPT CODE: $661.5828606-2

CPT CODE: $1,200.3028615-2

CPT CODE: $139.9028630-2

CPT CODE: $302.4428635-2

CPT CODE: $292.7728636-2

CPT CODE: $841.1328645-2

CPT CODE: $119.0828660-2

CPT CODE: $177.6828665-2

CPT CODE: $170.1828666-2

CPT CODE: $595.4028675-2

CPT CODE: $3,922.1728705-2

CPT CODE: $2,835.3328715-2

CPT CODE: $2,353.3028725-2

CPT CODE: $2,296.5828730-2

CPT CODE: $1,852.4128735-2

CPT CODE: $1,455.4828737-2

CPT CODE: $841.1328740-2

CPT CODE: $1,502.7228750-2

CPT CODE: $841.1328755-2

CPT CODE: $1,266.4328760-2

CPT CODE: $1,795.6828800-2

CPT CODE: $1,805.1528805-2

CPT CODE: $1,096.3428810-2

CPT CODE: $567.0628820-2

CPT CODE: $595.4028825-2

CPT CODE: $466.4228890-2

CPT CODE: $661.5829000-2

CPT CODE: $661.5829010-2

CPT CODE: $784.4329015-2

CPT CODE: $500.9129035-2

CPT CODE: $784.4329040-2

CPT CODE: $595.4029044-2

CPT CODE: $661.5829046-2

CPT CODE: $119.0829049-2

CPT CODE: $349.6729055-2

CPT CODE: $179.5629058-2

CPT CODE: $240.0829065-2

CPT CODE: $166.7329075-2

CPT CODE: $168.2129085-2

CPT CODE: $54.6029086-2

CPT CODE: $206.0229105-2

CPT CODE: $66.1529125-2

CPT CODE: $92.6229126-2

CPT CODE: $62.3629130-2

CPT CODE: $56.7029131-2

CPT CODE: $71.8429200-2

CPT CODE: $69.9229240-2

CPT CODE: $68.0629260-2

CPT CODE: $49.1429280-2

CPT CODE: $519.8029305-2

CPT CODE: $614.3129325-2

CPT CODE: $262.7229345-2

CPT CODE: $281.6629355-2

CPT CODE: $538.6829358-2

CPT CODE: $292.9729365-2

CPT CODE: $228.7229405-2

CPT CODE: $234.3929425-2

CPT CODE: $283.5329435-2

CPT CODE: $47.2429440-2

CPT CODE: $260.5029445-2

CPT CODE: $102.0729450-2

CPT CODE: $141.7529505-2

CPT CODE: $105.8529515-2

CPT CODE: $179.5629520-2

CPT CODE: $94.5129530-2

CPT CODE: $71.8429540-2

CPT CODE: $60.4629550-2

CPT CODE: $102.0729580-2

CPT CODE: $140.2729581-2

CPT CODE: $132.1229584-2

CPT CODE: $115.2929700-2

CPT CODE: $68.0629705-2

CPT CODE: $119.0829710-2

CPT CODE: $85.0429720-2

CPT CODE: $115.2929730-2

CPT CODE: $119.0829740-2

CPT CODE: $119.0829750-2

CPT CODE: $1,304.2429800-2

CPT CODE: $2,599.0329804-2

CPT CODE: $1,240.9929805-2

CPT CODE: $3,017.6129806-2

CPT CODE: $3,418.9829807-2

CPT CODE: $3,411.8329819-2

CPT CODE: $2,400.5529820-2

CPT CODE: $3,411.8329821-2

CPT CODE: $2,400.5529822-2

CPT CODE: $3,411.8329823-2

CPT CODE: $1,055.0629824-2

CPT CODE: $3,411.8329825-2

CPT CODE: $3,070.6529826-2

CPT CODE: $2,400.3729827-2

CPT CODE: $1,250.8929828-2

CPT CODE: $1,455.4829830-2

CPT CODE: $3,496.8829834-2

CPT CODE: $2,457.2829835-2

CPT CODE: $3,496.8829836-2

CPT CODE: $2,457.2829837-2

CPT CODE: $3,496.8829838-2

CPT CODE: $1,446.0029840-2

CPT CODE: $2,353.3029843-2

CPT CODE: $2,750.2429844-2

CPT CODE: $3,270.0729845-2

CPT CODE: $3,317.3129846-2

CPT CODE: $2,523.4329847-2

CPT CODE: $1,256.9729848-2

CPT CODE: $2,817.9329850-2

CPT CODE: $2,817.9329851-2

CPT CODE: $2,763.0529855-2

CPT CODE: $2,763.0529856-2

CPT CODE: $1,696.6029860-2

CPT CODE: $4,068.6329861-2

CPT CODE: $3,339.8829862-2

CPT CODE: $3,742.2029863-2

CPT CODE: $3,932.7129866-2

CPT CODE: $3,406.5329867-2

CPT CODE: $3,406.5329868-2

CPT CODE: $1,238.0729870-2

CPT CODE: $2,211.5429871-2

Page 13

Page 14: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $1,869.6829873-2

CPT CODE: $3,411.8329874-2

CPT CODE: $2,577.2629875-2

CPT CODE: $3,156.6329876-2

CPT CODE: $2,840.9529877-2

CPT CODE: $3,156.6329879-2

CPT CODE: $3,725.6029880-2

CPT CODE: $2,840.9529881-2

CPT CODE: $3,156.6329882-2

CPT CODE: $4,082.8729883-2

CPT CODE: $3,156.6329884-2

CPT CODE: $3,156.6329885-2

CPT CODE: $2,211.5429886-2

CPT CODE: $3,156.6329887-2

CPT CODE: $5,061.0129888-2

CPT CODE: $5,623.3729889-2

CPT CODE: $3,015.1029891-2

CPT CODE: $3,015.1029892-2

CPT CODE: $704.4929893-2

CPT CODE: $3,411.8329894-2

CPT CODE: $2,400.5529895-2

CPT CODE: $2,400.5529897-2

CPT CODE: $3,411.8329898-2

CPT CODE: $2,749.8629899-2

CPT CODE: $634.5129900-2

CPT CODE: $700.9229901-2

CPT CODE: $796.8229902-2

CPT CODE: $1,219.9629904-2

CPT CODE: $1,405.5529905-2

CPT CODE: $1,405.5529906-2

CPT CODE: $1,146.9629907-2

CPT CODE: $1,854.4229914-2

CPT CODE: $1,889.4829915-2

CPT CODE: $1,889.8529916-2

CPT CODE: $302.4430000-2

CPT CODE: $283.5330020-2

CPT CODE: $177.6830100-2

CPT CODE: $247.6230110-2

CPT CODE: $897.8330115-2

CPT CODE: $850.5830117-2

CPT CODE: $1,389.2830118-2

CPT CODE: $2,173.7530120-2

CPT CODE: $500.9130124-2

CPT CODE: $897.8330125-2

CPT CODE: $595.4030130-2

CPT CODE: $1,446.0030140-2

CPT CODE: $2,296.5830150-2

CPT CODE: $3,440.1730160-2

CPT CODE: $49.1430200-2

CPT CODE: $68.0630210-2

CPT CODE: $2,372.2030220-2

CPT CODE: $100.1730300-2

CPT CODE: $623.8130310-2

CPT CODE: $653.6730320-2

CPT CODE: $2,476.1830400-2

CPT CODE: $3,563.0430410-2

CPT CODE: $4,016.6630420-2

CPT CODE: $538.6830430-2

CPT CODE: $841.1330435-2

CPT CODE: $2,410.0230450-2

CPT CODE: $521.5230460-2

CPT CODE: $1,445.5630462-2

CPT CODE: $1,097.9930465-2

CPT CODE: $3,005.4230520-2

CPT CODE: $2,296.5830540-2

CPT CODE: $4,328.5830545-2

CPT CODE: $119.0830560-2

CPT CODE: $2,173.7530580-2

CPT CODE: $1,238.0730600-2

CPT CODE: $2,372.2030620-2

CPT CODE: $2,457.2830630-2

CPT CODE: $177.6830801-2

CPT CODE: $387.4830802-2

CPT CODE: $122.8530901-2

CPT CODE: $219.2830903-2

CPT CODE: $453.6330905-2

CPT CODE: $425.2930906-2

CPT CODE: $1,502.7230915-2

CPT CODE: $1,549.9630920-2

CPT CODE: $98.2931000-2

CPT CODE: $425.2931002-2

CPT CODE: $888.3931020-2

CPT CODE: $2,145.3631030-2

CPT CODE: $2,476.1831032-2

CPT CODE: $1,587.7931040-2

CPT CODE: $1,587.7931050-2

CPT CODE: $1,748.4131051-2

CPT CODE: $1,682.2931070-2

CPT CODE: $2,759.6931075-2

CPT CODE: $2,703.0131080-2

CPT CODE: $2,703.0131081-2

CPT CODE: $3,610.2931084-2

CPT CODE: $3,610.2931085-2

CPT CODE: $3,610.2931086-2

CPT CODE: $3,610.2931087-2

CPT CODE: $3,912.7231090-2

CPT CODE: $1,389.2831200-2

CPT CODE: $1,691.7431201-2

CPT CODE: $5,831.2931230-2

CPT CODE: $248.1531231-2

CPT CODE: $669.4531235-2

CPT CODE: $651.6131237-2

CPT CODE: $383.8331238-2

CPT CODE: $2,454.6631239-2

CPT CODE: $1,446.0031240-2

CPT CODE: $1,354.5231254-2

CPT CODE: $1,649.7331255-2

CPT CODE: $1,102.7131256-2

CPT CODE: $1,163.5031267-2

CPT CODE: $2,448.5531276-2

CPT CODE: $1,660.2231287-2

CPT CODE: $1,660.2231288-2

CPT CODE: $4,918.2331290-2

CPT CODE: $4,918.2331291-2

CPT CODE: $3,802.4531292-2

CPT CODE: $4,159.4831293-2

CPT CODE: $4,757.5531294-2

CPT CODE: $2,530.1531295-2

CPT CODE: $4,707.3831296-2

CPT CODE: $4,655.8831297-2

CPT CODE: $4,385.3031300-2

CPT CODE: $4,385.3031360-2

CPT CODE: $4,801.1431365-2

CPT CODE: $4,385.3031367-2

CPT CODE: $5,122.4731368-2

CPT CODE: $5,415.4431370-2

CPT CODE: $4,385.3031375-2

CPT CODE: $4,385.3031380-2

CPT CODE: $4,385.3031382-2

CPT CODE: $7,352.9231390-2

CPT CODE: $8,307.4331395-2

CPT CODE: $4,328.5831400-2

CPT CODE: $3,374.0031420-2

CPT CODE: $349.6731500-2

CPT CODE: $230.6231502-2

CPT CODE: $177.6831510-2

CPT CODE: $349.6731511-2

CPT CODE: $349.6731512-2

CPT CODE: $349.6731513-2

CPT CODE: $519.8031515-2

CPT CODE: $190.9031520-2

CPT CODE: $623.8131525-2

CPT CODE: $1,115.2031526-2

CPT CODE: $1,389.2831527-2

CPT CODE: $595.4031528-2

CPT CODE: $425.2931529-2

CPT CODE: $982.9331530-2

CPT CODE: $888.3931531-2

CPT CODE: $888.3931535-2

CPT CODE: $1,115.2031536-2

CPT CODE: $1,162.4731540-2

CPT CODE: $1,748.4131541-2

Page 14

Page 15: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $1,773.1431545-2

CPT CODE: $2,128.0531546-2

CPT CODE: $3,194.4531560-2

CPT CODE: $3,194.4531561-2

CPT CODE: $888.3931570-2

CPT CODE: $888.3931571-2

CPT CODE: $491.4631575-2

CPT CODE: $897.8331576-2

CPT CODE: $1,200.3031577-2

CPT CODE: $897.8331578-2

CPT CODE: $897.8331579-2

CPT CODE: $4,385.3031580-2

CPT CODE: $4,385.3031584-2

CPT CODE: $4,385.3031587-2

CPT CODE: $2,173.7531590-2

CPT CODE: $4,385.3031595-2

CPT CODE: $1,039.6331600-2

CPT CODE: $1,323.1231601-2

CPT CODE: $1,323.1231603-2

CPT CODE: $1,984.7031605-2

CPT CODE: $2,759.6931610-2

CPT CODE: $1,502.7231611-2

CPT CODE: $595.4031612-2

CPT CODE: $680.4731613-2

CPT CODE: $1,370.4131614-2

CPT CODE: $737.1831615-2

CPT CODE: $737.1831622-2

CPT CODE: $684.7931623-2

CPT CODE: $684.7931624-2

CPT CODE: $793.8931625-2

CPT CODE: $602.9331626-2

CPT CODE: $1,232.9331627-2

CPT CODE: $793.8931628-2

CPT CODE: $793.8931629-2

CPT CODE: $680.4731630-2

CPT CODE: $680.4731631-2

CPT CODE: $166.5431632-2

CPT CODE: $208.8931633-2

CPT CODE: $2,267.9231634-2

CPT CODE: $548.1131636-2

CPT CODE: $161.6931637-2

CPT CODE: $548.1131638-2

CPT CODE: $992.3431640-2

CPT CODE: $1,313.6831641-2

CPT CODE: $635.5131643-2

CPT CODE: $746.6231645-2

CPT CODE: $746.6231646-2

CPT CODE: $259.1731647-2

CPT CODE: $269.4431648-2

CPT CODE: $86.6831649-2

CPT CODE: $92.0531651-2

CPT CODE: $419.8631652-2

CPT CODE: $281.0631653-2

CPT CODE: $73.6931654-2

CPT CODE: $259.4731660-2

CPT CODE: $274.0231661-2

CPT CODE: $179.5631717-2

CPT CODE: $179.5631720-2

CPT CODE: $240.0831725-2

CPT CODE: $1,372.3731730-2

CPT CODE: $3,005.4231750-2

CPT CODE: $1,502.7231755-2

CPT CODE: $4,517.6031760-2

CPT CODE: $3,052.6831766-2

CPT CODE: $3,052.6831770-2

CPT CODE: $3,052.6831775-2

CPT CODE: $3,052.6831780-2

CPT CODE: $3,052.6831781-2

CPT CODE: $3,052.6831785-2

CPT CODE: $3,052.6831786-2

CPT CODE: $2,173.7531800-2

CPT CODE: $4,385.3031805-2

CPT CODE: $897.8331820-2

CPT CODE: $1,030.1531825-2

CPT CODE: $1,030.1531830-2

CPT CODE: $240.0832000-2

CPT CODE: $623.8132002-2

CPT CODE: $179.5632005-2

CPT CODE: $556.3432019-2

CPT CODE: $623.8132020-2

CPT CODE: $1,540.5032035-2

CPT CODE: $1,937.4432036-2

CPT CODE: $1,039.5832096-2

CPT CODE: $1,039.5832097-2

CPT CODE: $875.0132098-2

CPT CODE: $3,345.6632100-2

CPT CODE: $2,693.5332110-2

CPT CODE: $2,759.6932120-2

CPT CODE: $2,759.6932124-2

CPT CODE: $3,837.1132140-2

CPT CODE: $3,837.1132141-2

CPT CODE: $2,759.6932150-2

CPT CODE: $2,882.5632151-2

CPT CODE: $2,759.6932160-2

CPT CODE: $2,882.5632200-2

CPT CODE: $2,759.6932215-2

CPT CODE: $4,215.1332220-2

CPT CODE: $2,759.6932225-2

CPT CODE: $5,122.4732320-2

CPT CODE: $238.1732400-2

CPT CODE: $238.1732405-2

CPT CODE: $4,942.8932440-2

CPT CODE: $6,471.3032442-2

CPT CODE: $4,942.8932445-2

CPT CODE: $4,687.7232480-2

CPT CODE: $4,686.1432482-2

CPT CODE: $4,686.1432484-2

CPT CODE: $6,212.4832486-2

CPT CODE: $4,686.1432488-2

CPT CODE: $3,954.7832491-2

CPT CODE: $1,283.4332501-2

CPT CODE: $3,801.2332503-2

CPT CODE: $4,496.9132504-2

CPT CODE: $1,650.2032505-2

CPT CODE: $277.9132506-2

CPT CODE: $277.9132507-2

CPT CODE: $4,026.1232540-2

CPT CODE: $502.3332550-2

CPT CODE: $456.5632551-2

CPT CODE: $279.3232552-2

CPT CODE: $735.8232553-2

CPT CODE: $175.0932554-2

CPT CODE: $219.5332555-2

CPT CODE: $307.2632556-2

CPT CODE: $310.6432557-2

CPT CODE: $154.6632560-2

CPT CODE: $125.5132561-2

CPT CODE: $112.5932562-2

CPT CODE: $1,026.4932601-2

CPT CODE: $1,071.1132604-2

CPT CODE: $1,071.1132606-2

CPT CODE: $486.7632607-2

CPT CODE: $597.8432608-2

CPT CODE: $413.4132609-2

CPT CODE: $2,758.1232650-2

CPT CODE: $2,758.1232651-2

CPT CODE: $4,204.1332652-2

CPT CODE: $2,758.1232653-2

CPT CODE: $2,695.6332654-2

CPT CODE: $3,829.2232655-2

CPT CODE: $3,980.9932656-2

CPT CODE: $3,677.5132658-2

CPT CODE: $3,650.7132659-2

CPT CODE: $3,677.5132661-2

CPT CODE: $4,846.7932662-2

CPT CODE: $4,686.1432663-2

CPT CODE: $3,320.4632664-2

CPT CODE: $3,606.0932665-2

CPT CODE: $1,360.2132666-2

CPT CODE: $245.2132667-2

CPT CODE: $246.2932668-2

CPT CODE: $2,095.3932669-2

Page 15

Page 16: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,502.0132670-2

CPT CODE: $3,422.4032671-2

CPT CODE: $2,373.5432672-2

CPT CODE: $1,837.6632673-2

CPT CODE: $336.4832674-2

CPT CODE: $246.8732701-2

CPT CODE: $3,345.6632800-2

CPT CODE: $1,786.2032810-2

CPT CODE: $3,345.6632815-2

CPT CODE: $2,043.3032820-2

CPT CODE: $8,988.4532851-2

CPT CODE: $8,988.4532852-2

CPT CODE: $10,773.6532853-2

CPT CODE: $10,773.6532854-2

CPT CODE: $2,882.5632900-2

CPT CODE: $2,759.6932905-2

CPT CODE: $3,912.7232906-2

CPT CODE: $2,882.5632940-2

CPT CODE: $425.2932960-2

CPT CODE: $666.7732997-2

CPT CODE: $238.1733010-2

CPT CODE: $321.3333015-2

CPT CODE: $3,676.4433020-2

CPT CODE: $3,648.0933025-2

CPT CODE: $6,445.5933030-2

CPT CODE: $9,148.6033031-2

CPT CODE: $3,676.4433050-2

CPT CODE: $8,061.7133120-2

CPT CODE: $4,517.6033130-2

CPT CODE: $5,007.7533140-2

CPT CODE: $2,179.6233202-2

CPT CODE: $2,179.6233203-2

CPT CODE: $1,946.9233206-2

CPT CODE: $1,946.9233207-2

CPT CODE: $2,939.2733208-2

CPT CODE: $841.1333210-2

CPT CODE: $839.0433211-2

CPT CODE: $841.1333212-2

CPT CODE: $839.0433213-2

CPT CODE: $1,160.3733214-2

CPT CODE: $848.5533215-2

CPT CODE: $1,946.9233216-2

CPT CODE: $1,945.8633217-2

CPT CODE: $992.3433218-2

CPT CODE: $990.8033220-2

CPT CODE: $1,010.6133221-2

CPT CODE: $699.3833222-2

CPT CODE: $696.2233223-2

CPT CODE: $1,029.7633224-2

CPT CODE: $1,029.7633225-2

CPT CODE: $988.0533226-2

CPT CODE: $622.3633227-2

CPT CODE: $622.3633228-2

CPT CODE: $622.3633229-2

CPT CODE: $1,220.3833230-2

CPT CODE: $1,220.3833231-2

CPT CODE: $946.1533233-2

CPT CODE: $946.1533234-2

CPT CODE: $946.1533235-2

CPT CODE: $946.1533236-2

CPT CODE: $946.1533237-2

CPT CODE: $1,517.4133238-2

CPT CODE: $839.0433240-2

CPT CODE: $839.0433241-2

CPT CODE: $2,115.4733243-2

CPT CODE: $2,115.4733244-2

CPT CODE: $4,989.6233249-2

CPT CODE: $6,748.0633250-2

CPT CODE: $8,061.7133251-2

CPT CODE: $4,805.7533254-2

CPT CODE: $5,178.7033255-2

CPT CODE: $5,754.2533256-2

CPT CODE: $2,008.1033257-2

CPT CODE: $2,030.3733258-2

CPT CODE: $2,477.0333259-2

CPT CODE: $8,061.7133261-2

CPT CODE: $588.7533262-2

CPT CODE: $588.7533263-2

CPT CODE: $588.7533264-2

CPT CODE: $4,805.7533265-2

CPT CODE: $5,466.4733266-2

CPT CODE: $716.3733270-2

CPT CODE: $562.5233271-2

CPT CODE: $471.4733272-2

CPT CODE: $454.6533273-2

CPT CODE: $411.5133282-2

CPT CODE: $276.9233284-2

CPT CODE: $3,648.0933300-2

CPT CODE: $6,445.5933305-2

CPT CODE: $4,630.9933310-2

CPT CODE: $7,343.4433315-2

CPT CODE: $3,676.4433320-2

CPT CODE: $6,451.3633321-2

CPT CODE: $6,445.5933322-2

CPT CODE: $6,445.5933330-2

CPT CODE: $9,205.3033335-2

CPT CODE: $1,509.1633361-2

CPT CODE: $1,650.9633362-2

CPT CODE: $1,709.4433363-2

CPT CODE: $1,818.3133364-2

CPT CODE: $1,985.3433365-2

CPT CODE: $2,102.9633366-2

CPT CODE: $697.5433367-2

CPT CODE: $845.2533368-2

CPT CODE: $1,116.1333369-2

CPT CODE: $7,343.4433404-2

CPT CODE: $8,033.3933405-2

CPT CODE: $8,033.3833406-2

CPT CODE: $7,349.9533410-2

CPT CODE: $8,033.3933411-2

CPT CODE: $8,033.3933412-2

CPT CODE: $11,693.0133413-2

CPT CODE: $7,337.1333414-2

CPT CODE: $7,343.4433415-2

CPT CODE: $7,337.1333416-2

CPT CODE: $7,343.4433417-2

CPT CODE: $2,025.1433418-2

CPT CODE: $597.4133419-2

CPT CODE: $5,538.3133420-2

CPT CODE: $7,674.2433422-2

CPT CODE: $8,401.9733425-2

CPT CODE: $8,401.9733426-2

CPT CODE: $8,401.9733427-2

CPT CODE: $9,403.7733430-2

CPT CODE: $8,061.7133460-2

CPT CODE: $8,060.1633463-2

CPT CODE: $8,060.1633464-2

CPT CODE: $9,205.3033465-2

CPT CODE: $9,923.5733468-2

CPT CODE: $5,897.4633470-2

CPT CODE: $5,891.1233471-2

CPT CODE: $7,343.4433474-2

CPT CODE: $7,337.1333475-2

CPT CODE: $8,109.0033476-2

CPT CODE: $1,396.9833477-2

CPT CODE: $8,846.1633478-2

CPT CODE: $5,631.1033496-2

CPT CODE: $6,445.5933500-2

CPT CODE: $6,157.3533501-2

CPT CODE: $4,630.9933502-2

CPT CODE: $6,445.5933503-2

CPT CODE: $9,205.3033504-2

CPT CODE: $9,193.7433505-2

CPT CODE: $9,193.7433506-2

CPT CODE: $6,209.7633507-2

CPT CODE: $7,409.5833510-2

CPT CODE: $7,645.9033511-2

CPT CODE: $8,014.4733512-2

CPT CODE: $8,392.5333513-2

CPT CODE: $8,647.6933514-2

CPT CODE: $8,893.4133516-2

CPT CODE: $329.3833517-2

Page 16

Page 17: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $677.0433518-2

CPT CODE: $988.1133519-2

CPT CODE: $1,235.1433521-2

CPT CODE: $1,482.1633522-2

CPT CODE: $1,482.1633523-2

CPT CODE: $1,644.4733530-2

CPT CODE: $7,392.4733533-2

CPT CODE: $7,621.2333534-2

CPT CODE: $7,987.1633535-2

CPT CODE: $8,371.4133536-2

CPT CODE: $9,148.6033542-2

CPT CODE: $11,010.4333545-2

CPT CODE: $2,040.4833572-2

CPT CODE: $5,534.0933600-2

CPT CODE: $5,534.0933602-2

CPT CODE: $5,534.0933606-2

CPT CODE: $5,551.9533608-2

CPT CODE: $8,836.7133610-2

CPT CODE: $10,996.8033611-2

CPT CODE: $10,996.8033612-2

CPT CODE: $8,060.1633615-2

CPT CODE: $8,060.1633617-2

CPT CODE: $14,665.3633619-2

CPT CODE: $2,847.4533620-2

CPT CODE: $1,536.7633621-2

CPT CODE: $6,452.1833622-2

CPT CODE: $6,625.1733641-2

CPT CODE: $7,343.4433645-2

CPT CODE: $11,048.2333647-2

CPT CODE: $8,846.1633660-2

CPT CODE: $9,205.3033665-2

CPT CODE: $11,010.4333670-2

CPT CODE: $6,746.6333675-5

CPT CODE: $7,017.6333676-2

CPT CODE: $7,705.4633677-2

CPT CODE: $8,846.1633681-2

CPT CODE: $9,205.3033684-2

CPT CODE: $10,103.1433688-2

CPT CODE: $3,676.4433690-2

CPT CODE: $10,282.7133692-2

CPT CODE: $11,010.4333694-2

CPT CODE: $10,273.8233697-2

CPT CODE: $7,343.4433702-2

CPT CODE: $11,010.4333710-2

CPT CODE: $9,205.3033720-2

CPT CODE: $10,996.8033722-2

CPT CODE: $5,601.9733724-2

CPT CODE: $7,017.6333726-2

CPT CODE: $9,205.3033730-2

CPT CODE: $6,614.1533732-2

CPT CODE: $5,897.4633735-2

CPT CODE: $5,891.1233736-2

CPT CODE: $5,897.4633737-2

CPT CODE: $5,538.3133750-2

CPT CODE: $5,538.3133755-2

CPT CODE: $5,538.3133762-2

CPT CODE: $5,538.3133764-2

CPT CODE: $5,538.3133766-2

CPT CODE: $5,534.0933767-2

CPT CODE: $1,295.1933768-2

CPT CODE: $5,364.4733770-2

CPT CODE: $11,728.7033771-2

CPT CODE: $10,282.7133774-2

CPT CODE: $11,010.4333775-2

CPT CODE: $11,738.1833776-2

CPT CODE: $5,368.1533777-2

CPT CODE: $5,368.1533778-2

CPT CODE: $11,010.4333779-2

CPT CODE: $11,738.1833780-2

CPT CODE: $5,368.1533781-2

CPT CODE: $5,434.9833782-2

CPT CODE: $5,875.4833783-2

CPT CODE: $11,010.4333786-2

CPT CODE: $6,445.5933788-2

CPT CODE: $14,025.6033800-2

CPT CODE: $4,385.3033802-2

CPT CODE: $5,538.3133803-2

CPT CODE: $6,748.0633813-2

CPT CODE: $6,748.0633814-2

CPT CODE: $3,704.8033820-2

CPT CODE: $4,385.3033822-2

CPT CODE: $5,538.3133824-2

CPT CODE: $5,538.3133840-2

CPT CODE: $7,343.4433845-2

CPT CODE: $6,445.5933851-2

CPT CODE: $14,677.4433852-2

CPT CODE: $14,665.3633853-2

CPT CODE: $10,282.7133860-2

CPT CODE: $10,273.8233863-2

CPT CODE: $7,520.1733864-2

CPT CODE: $14,677.4433870-2

CPT CODE: $9,148.6033875-2

CPT CODE: $9,148.6033877-2

CPT CODE: $8,061.7133910-2

CPT CODE: $5,538.3133915-2

CPT CODE: $13,902.4833916-2

CPT CODE: $8,060.1633917-2

CPT CODE: $9,193.7433920-2

CPT CODE: $13,888.8033922-2

CPT CODE: $4,792.0633924-2

CPT CODE: $6,686.7233925-2

CPT CODE: $7,867.2833926-2

CPT CODE: $12,617.1233945-2

CPT CODE: $369.0233946-2

CPT CODE: $403.9433947-2

CPT CODE: $285.7033948-2

CPT CODE: $278.4733949-2

CPT CODE: $473.8633951-2

CPT CODE: $462.6233952-2

CPT CODE: $528.2733953-2

CPT CODE: $515.8633954-2

CPT CODE: $1,038.9033955-2

CPT CODE: $984.2733956-2

CPT CODE: $307.3133957-2

CPT CODE: $299.9433958-2

CPT CODE: $363.6433959-2

CPT CODE: $346.2133962-2

CPT CODE: $628.8433963-2

CPT CODE: $639.0933964-2

CPT CODE: $303.8333965-2

CPT CODE: $344.0333966-2

CPT CODE: $1,066.8733967-2

CPT CODE: $864.7933968-2

CPT CODE: $379.2433969-2

CPT CODE: $2,211.5433970-2

CPT CODE: $1,946.9233971-2

CPT CODE: $2,213.6333973-2

CPT CODE: $1,945.8633974-2

CPT CODE: $372.3033984-2

CPT CODE: $705.8133985-2

CPT CODE: $673.0233986-2

CPT CODE: $279.3133987-2

CPT CODE: $881.5833988-2

CPT CODE: $578.6533989-2

CPT CODE: $490.7333990-2

CPT CODE: $715.2633991-2

CPT CODE: $233.8133992-2

CPT CODE: $205.3133993-2

CPT CODE: $3,062.1234001-2

CPT CODE: $4,215.1334051-2

CPT CODE: $2,835.3334101-2

CPT CODE: $2,835.3334111-2

CPT CODE: $4,999.5734151-2

CPT CODE: $2,476.1834201-2

CPT CODE: $2,391.1134203-2

CPT CODE: $6,076.9734401-2

CPT CODE: $2,410.0234421-2

CPT CODE: $2,060.3434451-2

CPT CODE: $6,076.9734471-2

CPT CODE: $2,287.1234490-2

CPT CODE: $4,630.9934501-2

CPT CODE: $9,024.1634502-2

Page 17

Page 18: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $4,999.5734510-2

CPT CODE: $4,999.5734520-2

CPT CODE: $2,495.0834530-2

CPT CODE: $405.7834808-2

CPT CODE: $611.6534812-2

CPT CODE: $566.9034813-2

CPT CODE: $933.8934820-2

CPT CODE: $900.3234833-2

CPT CODE: $453.0434834-2

CPT CODE: $4,819.9935001-2

CPT CODE: $4,819.9935002-2

CPT CODE: $4,819.9935005-2

CPT CODE: $3,676.4435011-2

CPT CODE: $3,741.3535013-2

CPT CODE: $6,076.9735021-2

CPT CODE: $6,076.9735022-2

CPT CODE: $3,676.4435045-2

CPT CODE: $6,823.6335081-2

CPT CODE: $7,248.9535082-2

CPT CODE: $7,343.4435091-2

CPT CODE: $7,343.4435092-2

CPT CODE: $6,823.6335102-2

CPT CODE: $6,823.6335103-2

CPT CODE: $5,122.4735111-2

CPT CODE: $5,122.4735112-2

CPT CODE: $7,343.4435121-2

CPT CODE: $7,343.4435122-2

CPT CODE: $6,076.9735131-2

CPT CODE: $6,076.9735132-2

CPT CODE: $4,630.9935141-2

CPT CODE: $4,630.9935142-2

CPT CODE: $4,999.5735151-2

CPT CODE: $4,999.5735152-2

CPT CODE: $4,999.5735180-2

CPT CODE: $7,523.0135182-2

CPT CODE: $4,999.5735184-2

CPT CODE: $4,999.5735188-2

CPT CODE: $7,523.0135189-2

CPT CODE: $4,999.5735190-2

CPT CODE: $4,999.5735201-2

CPT CODE: $4,999.5735206-2

CPT CODE: $2,523.4335207-2

CPT CODE: $7,523.0135211-2

CPT CODE: $7,523.0135216-2

CPT CODE: $7,523.0135221-2

CPT CODE: $5,174.4535226-2

CPT CODE: $6,237.6735231-2

CPT CODE: $6,237.6735236-2

CPT CODE: $9,394.3335241-2

CPT CODE: $9,394.3335246-2

CPT CODE: $9,394.3335251-2

CPT CODE: $4,999.5735256-2

CPT CODE: $4,999.5735261-2

CPT CODE: $4,999.5735266-2

CPT CODE: $7,523.0135271-2

CPT CODE: $7,523.0135276-2

CPT CODE: $6,804.7135281-2

CPT CODE: $4,999.5735286-2

CPT CODE: $4,574.3135301-2

CPT CODE: $3,804.3435302-2

CPT CODE: $4,014.6835303-2

CPT CODE: $4,226.3235304-2

CPT CODE: $4,014.6835305-2

CPT CODE: $802.6835306-2

CPT CODE: $5,538.3135311-2

CPT CODE: $5,831.2935321-2

CPT CODE: $6,076.9735331-2

CPT CODE: $7,343.4435341-2

CPT CODE: $5,897.4635351-2

CPT CODE: $6,455.0435355-2

CPT CODE: $6,804.7135361-2

CPT CODE: $6,738.5635363-2

CPT CODE: $4,215.1335371-2

CPT CODE: $4,215.1335372-2

CPT CODE: $4,570.0935390-2

CPT CODE: $5,897.4635501-2

CPT CODE: $5,897.4635506-2

CPT CODE: $5,831.2935508-2

CPT CODE: $5,831.2935509-2

CPT CODE: $4,867.8935510-2

CPT CODE: $4,999.5735511-2

CPT CODE: $4,173.4835512-2

CPT CODE: $5,831.2935515-2

CPT CODE: $4,999.5735516-2

CPT CODE: $4,999.5735518-2

CPT CODE: $4,215.1335521-2

CPT CODE: $3,508.7235522-2

CPT CODE: $3,018.9635523-2

CPT CODE: $3,402.8635525-2

CPT CODE: $6,076.9735526-2

CPT CODE: $5,935.2435531-2

CPT CODE: $5,831.2935533-2

CPT CODE: $4,438.0235535-2

CPT CODE: $6,076.9735536-2

CPT CODE: $4,630.2435537-2

CPT CODE: $4,630.2435538-2

CPT CODE: $4,630.2435539-2

CPT CODE: $4,630.2435540-2

CPT CODE: $6,076.9735548-2

CPT CODE: $5,481.5935556-2

CPT CODE: $4,999.5735558-2

CPT CODE: $6,587.3535560-2

CPT CODE: $5,831.2935563-2

CPT CODE: $5,831.2935565-2

CPT CODE: $5,897.4635566-2

CPT CODE: $4,266.0935570-2

CPT CODE: $5,831.2935571-2

CPT CODE: $5,897.4635583-2

CPT CODE: $5,897.4635585-2

CPT CODE: $3,175.5635587-2

CPT CODE: $5,179.1735601-2

CPT CODE: $5,179.1735606-2

CPT CODE: $4,215.1335612-2

CPT CODE: $4,215.1335616-2

CPT CODE: $5,585.5635621-2

CPT CODE: $4,632.6135623-2

CPT CODE: $6,076.9735626-2

CPT CODE: $6,804.7135631-2

CPT CODE: $4,976.0735632-2

CPT CODE: $4,976.0735633-2

CPT CODE: $4,976.0735634-2

CPT CODE: $6,076.9735636-2

CPT CODE: $4,630.2435637-2

CPT CODE: $4,630.2435638-2

CPT CODE: $5,179.1735642-2

CPT CODE: $5,179.1735645-2

CPT CODE: $6,095.9135646-2

CPT CODE: $4,778.0035647-2

CPT CODE: $4,130.0935650-2

CPT CODE: $5,831.2935654-2

CPT CODE: $4,196.2435656-2

CPT CODE: $4,215.1335661-2

CPT CODE: $4,215.1335663-2

CPT CODE: $4,215.1335665-2

CPT CODE: $4,630.9935666-2

CPT CODE: $4,630.9935671-2

CPT CODE: $3,062.1235681-2

CPT CODE: $885.3635685-2

CPT CODE: $1,003.4135686-2

CPT CODE: $5,168.1435691-2

CPT CODE: $5,168.1435693-2

CPT CODE: $5,168.1435694-2

CPT CODE: $5,168.1435695-2

CPT CODE: $567.3835697-2

CPT CODE: $1,852.4135701-2

CPT CODE: $1,653.9135721-2

CPT CODE: $1,682.2935741-2

CPT CODE: $1,682.2935761-2

CPT CODE: $1,852.4135800-2

CPT CODE: $2,428.9135820-2

CPT CODE: $2,400.5535840-2

CPT CODE: $1,559.4035860-2

Page 18

Page 19: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,107.5835870-2

CPT CODE: $2,476.1835875-2

CPT CODE: $2,472.5035876-2

CPT CODE: $2,260.2235879-2

CPT CODE: $2,260.2235881-2

CPT CODE: $2,347.3835883-2

CPT CODE: $2,564.1835884-2

CPT CODE: $2,106.5335901-2

CPT CODE: $2,106.5335903-2

CPT CODE: $2,106.5335905-2

CPT CODE: $2,106.5335907-2

CPT CODE: $98.2936000-2

CPT CODE: $416.1236002-2

CPT CODE: $226.9136005-2

CPT CODE: $389.7236010-2

CPT CODE: $499.5536011-2

CPT CODE: $482.0136012-2

CPT CODE: $389.7236013-2

CPT CODE: $499.5536014-2

CPT CODE: $598.7536015-2

CPT CODE: $425.2936100-2

CPT CODE: $154.1136140-2

CPT CODE: $292.9736160-2

CPT CODE: $321.3336200-2

CPT CODE: $499.5536215-2

CPT CODE: $482.0136216-2

CPT CODE: $598.7536217-2

CPT CODE: $107.7436218-2

CPT CODE: $244.6336221-2

CPT CODE: $332.6336222-2

CPT CODE: $359.6936223-2

CPT CODE: $392.7736224-2

CPT CODE: $358.3736225-2

CPT CODE: $393.5136226-2

CPT CODE: $124.7236227-2

CPT CODE: $254.4636228-2

CPT CODE: $499.5536245-2

CPT CODE: $482.0136246-2

CPT CODE: $598.7536247-2

CPT CODE: $107.7436248-2

CPT CODE: $1,648.1336251-2

CPT CODE: $1,810.3236252-2

CPT CODE: $2,520.8036253-2

CPT CODE: $2,622.9736254-2

CPT CODE: $6,001.4036260-2

CPT CODE: $2,995.9536261-2

CPT CODE: $2,967.6236262-2

CPT CODE: $100.1736400-2

CPT CODE: $122.8536405-2

CPT CODE: $98.2936406-2

CPT CODE: $69.9236410-2

CPT CODE: $6.8236415-2

CPT CODE: $4.3136416-2

CPT CODE: $198.4636420-2

CPT CODE: $122.8536425-2

CPT CODE: $58.5936430-2

CPT CODE: $302.4436440-2

CPT CODE: $1,219.1836450-2

CPT CODE: $1,219.1836455-2

CPT CODE: $302.4436460-2

CPT CODE: $179.5636468-2

CPT CODE: $120.9836470-2

CPT CODE: $179.5636471-2

CPT CODE: $1,806.0336475-2

CPT CODE: $903.0136476-2

CPT CODE: $1,618.3136478-2

CPT CODE: $809.8436479-2

CPT CODE: $680.4736481-2

CPT CODE: $680.4736500-2

CPT CODE: $179.5636510-2

CPT CODE: $412.7636511-2

CPT CODE: $412.7636512-2

CPT CODE: $412.7636513-2

CPT CODE: $412.7636514-2

CPT CODE: $514.8736516-2

CPT CODE: $482.0136522-2

CPT CODE: $13.4336540-2

CPT CODE: $44.8736550-2

CPT CODE: $193.3636555-2

CPT CODE: $183.4836556-2

CPT CODE: $670.4136557-2

CPT CODE: $636.5336558-2

CPT CODE: $801.6636560-2

CPT CODE: $769.2136561-2

CPT CODE: $4,659.0036563-2

CPT CODE: $769.2136565-2

CPT CODE: $827.0736566-2

CPT CODE: $141.1336568-2

CPT CODE: $134.0936569-2

CPT CODE: $694.4136570-2

CPT CODE: $659.1236571-2

CPT CODE: $132.6736575-2

CPT CODE: $501.0536576-2

CPT CODE: $563.1436578-2

CPT CODE: $100.2136580-2

CPT CODE: $532.0936581-2

CPT CODE: $774.8636582-2

CPT CODE: $781.9136583-2

CPT CODE: $98.8036584-2

CPT CODE: $726.8636585-2

CPT CODE: $742.3936589-2

CPT CODE: $2,328.8036590-2

CPT CODE: $11.1436591-2

CPT CODE: $11.1436592-2

CPT CODE: $39.5936593-2

CPT CODE: $278.0436595-2

CPT CODE: $252.6436596-2

CPT CODE: $91.7436597-2

CPT CODE: $150.2036598-2

CPT CODE: $115.2936600-2

CPT CODE: $260.8736620-2

CPT CODE: $349.6736625-2

CPT CODE: $359.1236640-2

CPT CODE: $292.9736660-2

CPT CODE: $500.9136680-2

CPT CODE: $1,304.2436810-2

CPT CODE: $784.4336815-2

CPT CODE: $1,786.8536818-2

CPT CODE: $2,100.8636819-2

CPT CODE: $1,077.1936820-2

CPT CODE: $2,296.5836821-2

CPT CODE: $707.0336823-2

CPT CODE: $3,676.4436825-2

CPT CODE: $3,090.4736830-2

CPT CODE: $2,149.6536831-2

CPT CODE: $3,931.6136832-2

CPT CODE: $2,149.6536833-2

CPT CODE: $3,066.9636838-2

CPT CODE: $240.0836860-2

CPT CODE: $302.4436861-2

CPT CODE: $6,067.5237140-2

CPT CODE: $6,076.9737145-2

CPT CODE: $6,076.9737160-2

CPT CODE: $6,076.9737180-2

CPT CODE: $6,076.9737181-2

CPT CODE: $969.7437187-2

CPT CODE: $695.6837188-2

CPT CODE: $2,993.7037191-2

CPT CODE: $2,015.3737192-2

CPT CODE: $1,923.7237193-2

CPT CODE: $358.0337197-2

CPT CODE: $234.3937200-2

CPT CODE: $734.4537211-2

CPT CODE: $648.3837212-2

CPT CODE: $453.3837213-2

CPT CODE: $265.2637214-2

CPT CODE: $1,234.1837217-2

CPT CODE: $930.0237218-2

CPT CODE: $3,981.7937220-2

CPT CODE: $6,508.6137221-2

CPT CODE: $1,163.5537222-2

CPT CODE: $6,463.0137223-2

Page 19

Page 20: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $4,775.3837224-2

CPT CODE: $13,328.5237225-2

CPT CODE: $11,179.7637226-2

CPT CODE: $18,000.2337227-2

CPT CODE: $6,775.7637228-2

CPT CODE: $13,238.4537229-2

CPT CODE: $10,437.9337230-2

CPT CODE: $16,665.6337231-2

CPT CODE: $1,539.0537232-2

CPT CODE: $1,898.5437233-2

CPT CODE: $4,820.4037234-2

CPT CODE: $5,172.1537235-2

CPT CODE: $585.0237236-2

CPT CODE: $272.8937237-2

CPT CODE: $409.8737238-2

CPT CODE: $190.4637239-2

CPT CODE: $572.7137241-2

CPT CODE: $639.3637242-2

CPT CODE: $762.2737243-2

CPT CODE: $889.3237244-2

CPT CODE: $98.9937252-2

CPT CODE: $79.0837253-2

CPT CODE: $309.2237500-2

CPT CODE: $2,173.7537565-2

CPT CODE: $1,559.4037600-2

CPT CODE: $2,173.7537605-2

CPT CODE: $2,703.0137606-2

CPT CODE: $776.5837607-2

CPT CODE: $557.6037609-2

CPT CODE: $2,173.7537615-2

CPT CODE: $2,173.7537616-2

CPT CODE: $2,173.7537617-2

CPT CODE: $2,107.5837618-2

CPT CODE: $1,861.9137619-2

CPT CODE: $1,200.3037650-2

CPT CODE: $2,107.5837660-2

CPT CODE: $1,077.4337700-2

CPT CODE: $1,363.7037718-2

CPT CODE: $1,640.3937722-2

CPT CODE: $2,835.3337735-2

CPT CODE: $2,107.5837760-2

CPT CODE: $948.6937761-2

CPT CODE: $700.0537765-2

CPT CODE: $897.6537766-2

CPT CODE: $727.7137780-2

CPT CODE: $302.4437785-2

CPT CODE: $4,630.9937788-2

CPT CODE: $803.3637790-2

CPT CODE: $3,411.8338100-2

CPT CODE: $3,487.4138101-2

CPT CODE: $1,704.8838102-2

CPT CODE: $3,487.4138115-2

CPT CODE: $2,336.0138120-2

CPT CODE: $387.4838200-2

CPT CODE: $58.8738220-2

CPT CODE: $100.7938221-2

CPT CODE: $841.1338230-2

CPT CODE: $500.6738232-2

CPT CODE: $841.1338240-2

CPT CODE: $841.1338241-2

CPT CODE: $50.3438242-2

CPT CODE: $135.5738243-2

CPT CODE: $190.9038300-2

CPT CODE: $1,153.0038305-2

CPT CODE: $1,143.5538308-2

CPT CODE: $2,173.7538380-2

CPT CODE: $2,173.7538381-2

CPT CODE: $2,173.7538382-2

CPT CODE: $860.0238500-2

CPT CODE: $538.6838505-2

CPT CODE: $860.0238510-2

CPT CODE: $765.5538520-2

CPT CODE: $614.3138525-2

CPT CODE: $1,682.2938530-2

CPT CODE: $841.1338542-2

CPT CODE: $1,502.7238550-2

CPT CODE: $1,464.8938555-2

CPT CODE: $1,805.1538562-2

CPT CODE: $3,374.0038564-2

CPT CODE: $1,443.3838570-2

CPT CODE: $2,410.2838571-2

CPT CODE: $2,899.1438572-2

CPT CODE: $2,599.0338700-2

CPT CODE: $3,610.2938720-2

CPT CODE: $3,610.2938724-2

CPT CODE: $1,606.6538740-2

CPT CODE: $3,118.8538745-2

CPT CODE: $803.3638746-2

CPT CODE: $1,240.7238747-2

CPT CODE: $2,476.1838760-2

CPT CODE: $3,648.0938770-2

CPT CODE: $6,804.7138780-2

CPT CODE: $595.4038790-2

CPT CODE: $444.8838792-2

CPT CODE: $500.9138794-2

CPT CODE: $228.6038900-2

CPT CODE: $2,476.1839000-2

CPT CODE: $3,723.7339010-2

CPT CODE: $4,867.2939200-2

CPT CODE: $4,857.8439220-2

CPT CODE: $331.2039401-2

CPT CODE: $432.3639402-2

CPT CODE: $4,630.9939503-2

CPT CODE: $4,215.1339540-2

CPT CODE: $3,837.1139541-2

CPT CODE: $4,630.9939545-2

CPT CODE: $3,010.5239560-2

CPT CODE: $3,762.3739561-2

CPT CODE: $359.1240490-2

CPT CODE: $1,181.3640500-2

CPT CODE: $1,181.3640510-2

CPT CODE: $860.0240520-2

CPT CODE: $2,674.6340525-2

CPT CODE: $2,693.5340527-2

CPT CODE: $1,502.7240530-2

CPT CODE: $812.7840650-2

CPT CODE: $1,502.7240652-2

CPT CODE: $3,005.4240654-2

CPT CODE: $2,183.1540700-2

CPT CODE: $3,194.4540701-2

CPT CODE: $3,922.1740702-2

CPT CODE: $2,410.0240720-2

CPT CODE: $3,459.0540761-2

CPT CODE: $119.0840800-2

CPT CODE: $330.7840801-2

CPT CODE: $173.9040804-2

CPT CODE: $538.6840805-2

CPT CODE: $119.0840806-2

CPT CODE: $177.6840808-2

CPT CODE: $177.6840810-2

CPT CODE: $349.6740812-2

CPT CODE: $784.4340814-2

CPT CODE: $841.1340816-2

CPT CODE: $378.0540818-2

CPT CODE: $302.4440819-2

CPT CODE: $292.9740820-2

CPT CODE: $238.1740830-2

CPT CODE: $378.0540831-2

CPT CODE: $1,266.4340840-2

CPT CODE: $841.1340842-2

CPT CODE: $1,625.5940843-2

CPT CODE: $1,956.3740844-2

CPT CODE: $2,967.6240845-2

CPT CODE: $224.9141000-2

CPT CODE: $661.5841005-2

CPT CODE: $491.4641006-2

CPT CODE: $661.5841007-2

CPT CODE: $425.2941008-2

CPT CODE: $1,030.1541009-2

CPT CODE: $223.0441010-2

CPT CODE: $973.4541015-2

CPT CODE: $973.4541016-2

Page 20

Page 21: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $973.4541017-2

CPT CODE: $1,502.7241018-2

CPT CODE: $253.2741100-2

CPT CODE: $500.9141105-2

CPT CODE: $330.7841108-2

CPT CODE: $268.4241110-2

CPT CODE: $727.7141112-2

CPT CODE: $973.4541113-2

CPT CODE: $897.8341114-2

CPT CODE: $444.1741115-2

CPT CODE: $737.1841116-2

CPT CODE: $1,219.1841120-2

CPT CODE: $2,353.3041130-2

CPT CODE: $4,630.9941135-2

CPT CODE: $3,837.1141140-2

CPT CODE: $5,472.1441145-2

CPT CODE: $5,831.2941150-2

CPT CODE: $5,226.3941153-2

CPT CODE: $5,831.2941155-2

CPT CODE: $238.1741250-2

CPT CODE: $349.6741251-2

CPT CODE: $538.6841252-2

CPT CODE: $2,107.5841500-2

CPT CODE: $2,107.5841510-2

CPT CODE: $472.5441520-2

CPT CODE: $247.6241800-I

CPT CODE: $992.3441826-I

CPT CODE: $283.5342000-2

CPT CODE: $302.4442100-2

CPT CODE: $257.0742104-2

CPT CODE: $576.5142106-2

CPT CODE: $897.8342107-2

CPT CODE: $1,464.8942120-2

CPT CODE: $292.9742140-2

CPT CODE: $3,374.0042145-2

CPT CODE: $425.2942160-2

CPT CODE: $425.2942180-2

CPT CODE: $2,041.4242182-2

CPT CODE: $3,288.9742200-2

CPT CODE: $4,139.5542205-2

CPT CODE: $4,630.9942210-2

CPT CODE: $2,740.8042215-2

CPT CODE: $3,487.4142220-2

CPT CODE: $3,487.4142225-2

CPT CODE: $3,487.4142226-2

CPT CODE: $3,487.4142227-2

CPT CODE: $3,317.3142235-2

CPT CODE: $2,183.1542260-2

CPT CODE: $223.0442300-2

CPT CODE: $491.4642305-2

CPT CODE: $240.0842310-2

CPT CODE: $661.5842320-2

CPT CODE: $359.1242330-2

CPT CODE: $973.4542335-2

CPT CODE: $1,200.3042340-2

CPT CODE: $538.6842400-2

CPT CODE: $529.2542405-2

CPT CODE: $850.5842408-2

CPT CODE: $737.1842409-2

CPT CODE: $1,275.8842410-2

CPT CODE: $3,024.3442415-2

CPT CODE: $3,685.9442420-2

CPT CODE: $2,703.0142425-2

CPT CODE: $4,961.7742426-2

CPT CODE: $1,549.9642440-2

CPT CODE: $1,143.5542450-2

CPT CODE: $1,502.7242500-2

CPT CODE: $1,304.2442505-2

CPT CODE: $1,502.7242507-2

CPT CODE: $2,287.1242509-2

CPT CODE: $2,287.1242510-2

CPT CODE: $119.0842550-2

CPT CODE: $1,502.7242600-2

CPT CODE: $147.4342650-2

CPT CODE: $234.3942660-2

CPT CODE: $179.5642665-2

CPT CODE: $292.9742700-2

CPT CODE: $500.9142720-2

CPT CODE: $1,219.1842725-2

CPT CODE: $177.6842800-2

CPT CODE: $238.1742804-2

CPT CODE: $387.4842806-2

CPT CODE: $746.6242808-2

CPT CODE: $746.6242809-2

CPT CODE: $1,030.1542810-2

CPT CODE: $2,202.1042815-2

CPT CODE: $1,058.5442820-2

CPT CODE: $1,058.5442821-2

CPT CODE: $992.3442825-2

CPT CODE: $992.3442826-2

CPT CODE: $652.1342830-2

CPT CODE: $538.6842831-2

CPT CODE: $453.6342835-2

CPT CODE: $538.6842836-2

CPT CODE: $1,446.0042842-2

CPT CODE: $2,532.8842844-2

CPT CODE: $2,532.8842845-2

CPT CODE: $387.4842860-2

CPT CODE: $425.2942870-2

CPT CODE: $3,959.9742890-2

CPT CODE: $4,876.7442892-2

CPT CODE: $4,640.4442894-2

CPT CODE: $2,410.0242900-2

CPT CODE: $3,005.4242950-2

CPT CODE: $4,082.8742953-2

CPT CODE: $3,005.4242955-2

CPT CODE: $321.3342960-2

CPT CODE: $349.6742961-2

CPT CODE: $425.2942962-2

CPT CODE: $425.2942970-2

CPT CODE: $425.2942972-2

CPT CODE: $2,759.6943020-2

CPT CODE: $2,835.3343030-2

CPT CODE: $3,317.3143100-2

CPT CODE: $4,328.5843101-2

CPT CODE: $5,426.7943107-2

CPT CODE: $6,329.8143108-2

CPT CODE: $6,329.8143112-2

CPT CODE: $6,329.8143113-2

CPT CODE: $6,329.8143116-2

CPT CODE: $6,329.8143117-2

CPT CODE: $6,329.8143118-2

CPT CODE: $5,591.7543121-2

CPT CODE: $5,591.7543122-2

CPT CODE: $6,329.8143123-2

CPT CODE: $5,426.7943124-2

CPT CODE: $3,610.2943130-2

CPT CODE: $4,328.5843135-2

CPT CODE: $537.9343180-2

CPT CODE: $608.7143180-4

CPT CODE: $140.7343191-2

CPT CODE: $167.9343192-2

CPT CODE: $200.2243193-2

CPT CODE: $182.3343194-2

CPT CODE: $200.5943195-2

CPT CODE: $219.0143196-2

CPT CODE: $89.9343197-2

CPT CODE: $107.1143198-2

CPT CODE: $623.8143200-2

CPT CODE: $21.5743201-2

CPT CODE: $774.9943202-2

CPT CODE: $1,200.3043204-2

CPT CODE: $1,446.0043205-2

CPT CODE: $462.3743210-2

CPT CODE: $271.9743211-2

CPT CODE: $213.3743212-2

CPT CODE: $302.0843213-2

CPT CODE: $218.4743214-2

CPT CODE: $1,171.9143215-2

CPT CODE: $1,446.0043216-2

CPT CODE: $1,446.0043217-2

CPT CODE: $793.8943220-2

Page 21

Page 22: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $576.5143226-2

CPT CODE: $1,446.0043227-2

CPT CODE: $230.1843229-2

CPT CODE: $783.2243231-2

CPT CODE: $822.0143232-2

CPT CODE: $259.4043233-2

CPT CODE: $708.8243235-2

CPT CODE: $891.6943236-2

CPT CODE: $763.5643237-2

CPT CODE: $896.2443238-2

CPT CODE: $793.8943239-2

CPT CODE: $1,405.3143240-2

CPT CODE: $1,446.0043241-2

CPT CODE: $1,341.1643242-2

CPT CODE: $1,417.6443243-2

CPT CODE: $1,419.2443244-2

CPT CODE: $935.6543245-2

CPT CODE: $1,446.0043246-2

CPT CODE: $850.5843247-2

CPT CODE: $910.4543248-2

CPT CODE: $911.7243249-2

CPT CODE: $1,222.8643250-2

CPT CODE: $1,219.1843251-2

CPT CODE: $300.9043253-2

CPT CODE: $312.1843254-2

CPT CODE: $1,124.6743255-2

CPT CODE: $1,446.0043259-2

CPT CODE: $1,190.8443260-2

CPT CODE: $1,196.0843261-2

CPT CODE: $1,805.1543262-2

CPT CODE: $2,107.5843263-2

CPT CODE: $2,523.4343264-2

CPT CODE: $3,326.7743265-2

CPT CODE: $258.2243266-2

CPT CODE: $271.5443270-2

CPT CODE: $253.4343273-2

CPT CODE: $876.2743274-2

CPT CODE: $722.3343275-2

CPT CODE: $911.8543276-2

CPT CODE: $726.8543277-2

CPT CODE: $654.4143278-2

CPT CODE: $2,801.5943279-2

CPT CODE: $2,784.6743280-2

CPT CODE: $2,556.9143281-2

CPT CODE: $2,876.8343282-2

CPT CODE: $273.9943283-2

CPT CODE: $4,819.9943300-2

CPT CODE: $4,139.5543305-2

CPT CODE: $5,179.1743310-2

CPT CODE: $5,472.1443312-2

CPT CODE: $4,959.5143313-2

CPT CODE: $5,241.3343314-2

CPT CODE: $4,630.9943320-2

CPT CODE: $3,676.4443325-2

CPT CODE: $2,260.6143327-2

CPT CODE: $2,272.7043328-2

CPT CODE: $3,837.1143330-2

CPT CODE: $3,610.2943331-2

CPT CODE: $2,570.0843332-2

CPT CODE: $2,582.1743333-2

CPT CODE: $2,544.6943334-2

CPT CODE: $2,556.7843335-2

CPT CODE: $2,544.9543336-2

CPT CODE: $2,779.7243337-2

CPT CODE: $226.1843338-2

CPT CODE: $4,215.1343340-2

CPT CODE: $4,215.1343341-2

CPT CODE: $2,410.0243351-2

CPT CODE: $2,410.0243352-2

CPT CODE: $5,591.7543360-2

CPT CODE: $6,329.8143361-2

CPT CODE: $4,630.9943400-2

CPT CODE: $4,630.9943401-2

CPT CODE: $3,612.0643405-2

CPT CODE: $3,610.2943410-2

CPT CODE: $4,328.5843415-2

CPT CODE: $2,410.0243420-2

CPT CODE: $3,922.1743425-2

CPT CODE: $223.0443450-2

CPT CODE: $604.8643453-2

CPT CODE: $973.4543460-2

CPT CODE: $7,696.1143496-2

CPT CODE: $2,410.0243500-2

CPT CODE: $2,665.1843501-2

CPT CODE: $2,665.6543502-2

CPT CODE: $2,665.1843510-2

CPT CODE: $2,239.9043520-2

CPT CODE: $2,410.0243605-2

CPT CODE: $2,220.9743610-2

CPT CODE: $2,222.5743611-2

CPT CODE: $5,226.3943620-2

CPT CODE: $5,221.7043621-2

CPT CODE: $6,364.2243622-2

CPT CODE: $4,329.1043631-2

CPT CODE: $4,329.1043632-2

CPT CODE: $4,329.1043633-2

CPT CODE: $6,364.2243634-2

CPT CODE: $1,199.2843635-2

CPT CODE: $3,648.0943640-2

CPT CODE: $2,665.1843641-2

CPT CODE: $2,425.4043644-2

CPT CODE: $2,643.2743645-2

CPT CODE: $1,219.5043647-2

CPT CODE: $1,280.1643648-2

CPT CODE: $1,639.8543651-2

CPT CODE: $2,258.6643652-2

CPT CODE: $1,516.0943653-2

CPT CODE: $926.1943750-2

CPT CODE: $49.2343752-2

CPT CODE: $93.6943753-2

CPT CODE: $139.0243754-2

CPT CODE: $252.5443755-2

CPT CODE: $348.4943756-2

CPT CODE: $449.0043757-2

CPT CODE: $179.5643760-2

CPT CODE: $179.5643761-2

CPT CODE: $2,228.0343770-2

CPT CODE: $2,284.6843771-2

CPT CODE: $1,542.8943772-2

CPT CODE: $2,284.6843773-2

CPT CODE: $1,542.8943774-2

CPT CODE: $2,080.7243775-2

CPT CODE: $2,599.0343800-2

CPT CODE: $3,005.4243810-2

CPT CODE: $3,005.4243820-2

CPT CODE: $3,525.2343825-2

CPT CODE: $2,164.3043830-2

CPT CODE: $1,587.7943831-2

CPT CODE: $3,185.0043832-2

CPT CODE: $2,599.0343840-2

CPT CODE: $4,629.4643843-2

CPT CODE: $2,643.2743845-2

CPT CODE: $4,857.8443846-2

CPT CODE: $3,924.6543847-2

CPT CODE: $3,924.6543848-2

CPT CODE: $4,328.5843850-2

CPT CODE: $4,687.7243855-2

CPT CODE: $3,752.0543860-2

CPT CODE: $4,687.7243865-2

CPT CODE: $2,410.0243880-2

CPT CODE: $1,219.5043881-2

CPT CODE: $1,280.1643882-2

CPT CODE: $483.5643886-2

CPT CODE: $474.3343887-2

CPT CODE: $675.9343888-2

CPT CODE: $2,712.4544005-2

CPT CODE: $3,317.3144010-2

CPT CODE: $661.5844015-2

CPT CODE: $3,128.3044020-2

CPT CODE: $2,428.9144021-2

CPT CODE: $3,241.6944025-2

CPT CODE: $2,362.7344050-2

Page 22

Page 23: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,315.5044055-2

CPT CODE: $321.3344100-2

CPT CODE: $2,580.0944110-2

CPT CODE: $3,922.1744111-2

CPT CODE: $3,477.9744120-2

CPT CODE: $868.2844121-2

CPT CODE: $3,477.9744125-2

CPT CODE: $3,336.3544126-2

CPT CODE: $3,790.8344127-2

CPT CODE: $756.9944128-2

CPT CODE: $2,523.4344130-2

CPT CODE: $1,111.4044139-2

CPT CODE: $3,326.7744140-2

CPT CODE: $3,959.9744141-2

CPT CODE: $3,723.7344143-2

CPT CODE: $3,468.5144144-2

CPT CODE: $3,534.6844145-2

CPT CODE: $4,848.3844146-2

CPT CODE: $4,848.3844147-2

CPT CODE: $4,848.3844150-2

CPT CODE: $4,045.0444151-2

CPT CODE: $6,407.7944155-2

CPT CODE: $8,288.5244156-2

CPT CODE: $4,135.9944157-2

CPT CODE: $5,309.0444158-2

CPT CODE: $3,298.4044160-2

CPT CODE: $1,067.2444180-2

CPT CODE: $1,409.8144186-2

CPT CODE: $1,795.8744187-2

CPT CODE: $1,924.9944188-2

CPT CODE: $3,179.1544202-2

CPT CODE: $756.9944203-2

CPT CODE: $2,486.3944204-2

CPT CODE: $2,874.4744205-2

CPT CODE: $3,169.8244206-6

CPT CODE: $3,000.1044207-2

CPT CODE: $4,113.2844208-2

CPT CODE: $4,113.2844210-2

CPT CODE: $3,729.2844211-2

CPT CODE: $5,446.5044212-2

CPT CODE: $864.3344213-2

CPT CODE: $2,782.7344227-2

CPT CODE: $2,079.2344300-2

CPT CODE: $2,306.0544310-2

CPT CODE: $1,663.4044312-2

CPT CODE: $2,466.7144314-2

CPT CODE: $2,476.1844316-2

CPT CODE: $2,476.1844320-2

CPT CODE: $3,166.0944322-2

CPT CODE: $302.4444340-2

CPT CODE: $1,502.7244345-2

CPT CODE: $3,837.1144346-2

CPT CODE: $1,323.1244360-2

CPT CODE: $1,446.0044361-2

CPT CODE: $1,446.0044363-2

CPT CODE: $1,446.0044364-2

CPT CODE: $1,446.0044365-2

CPT CODE: $1,446.0044366-2

CPT CODE: $1,446.0044369-2

CPT CODE: $1,277.0144370-2

CPT CODE: $1,965.8044372-2

CPT CODE: $1,965.8044373-2

CPT CODE: $1,321.0244376-2

CPT CODE: $1,446.0044377-2

CPT CODE: $1,446.0044378-2

CPT CODE: $1,277.0144379-2

CPT CODE: $302.4444380-2

CPT CODE: $378.0544382-2

CPT CODE: $229.6944384-2

CPT CODE: $259.9144384-4

CPT CODE: $302.4444385-2

CPT CODE: $378.0544386-2

CPT CODE: $302.4444388-2

CPT CODE: $378.0544389-2

CPT CODE: $378.0544390-2

CPT CODE: $378.0544391-2

CPT CODE: $378.0544392-2

CPT CODE: $374.9044394-2

CPT CODE: $498.7544401-2

CPT CODE: $564.3644401-4

CPT CODE: $358.2844402-2

CPT CODE: $405.4244402-4

CPT CODE: $110.6944500-2

CPT CODE: $2,454.6644602-2

CPT CODE: $3,240.1644603-2

CPT CODE: $2,579.6344604-2

CPT CODE: $3,241.6944605-2

CPT CODE: $2,454.6644615-2

CPT CODE: $2,268.2244620-2

CPT CODE: $3,572.5144625-2

CPT CODE: $3,412.5944626-2

CPT CODE: $2,296.5844640-2

CPT CODE: $3,005.4244650-2

CPT CODE: $3,005.4244660-2

CPT CODE: $3,288.9744661-2

CPT CODE: $4,328.5844680-2

CPT CODE: $2,872.9044700-2

CPT CODE: $273.2644701-2

CPT CODE: $2,410.0244800-2

CPT CODE: $2,173.7544820-2

CPT CODE: $2,173.7544850-2

CPT CODE: $1,323.1244900-2

CPT CODE: $1,531.0744950-2

CPT CODE: $1,852.4144960-2

CPT CODE: $1,403.1744970-2

CPT CODE: $595.4045000-2

CPT CODE: $378.0545005-2

CPT CODE: $973.4545020-2

CPT CODE: $661.5845100-2

CPT CODE: $2,410.0245108-2

CPT CODE: $5,387.0845110-2

CPT CODE: $2,703.0145111-2

CPT CODE: $5,179.1745112-2

CPT CODE: $5,174.9645113-2

CPT CODE: $4,139.5545114-2

CPT CODE: $7,917.4745119-2

CPT CODE: $5,831.2945120-2

CPT CODE: $6,407.7945121-2

CPT CODE: $2,709.0445123-2

CPT CODE: $8,476.2745126-2

CPT CODE: $3,128.3045130-2

CPT CODE: $5,472.1445135-2

CPT CODE: $4,764.7245136-2

CPT CODE: $1,077.4345150-2

CPT CODE: $2,410.0245160-2

CPT CODE: $958.5345171-2

CPT CODE: $1,392.8945172-2

CPT CODE: $1,554.2345190-2

CPT CODE: $113.4245300-2

CPT CODE: $177.6845303-2

CPT CODE: $234.3945305-2

CPT CODE: $491.4645307-2

CPT CODE: $260.6445308-2

CPT CODE: $260.6445309-2

CPT CODE: $425.2945315-2

CPT CODE: $359.1245317-2

CPT CODE: $500.9145320-2

CPT CODE: $425.2945321-2

CPT CODE: $343.1245327-2

CPT CODE: $185.2345330-2

CPT CODE: $251.3645331-2

CPT CODE: $179.5645332-2

CPT CODE: $359.1245333-2

CPT CODE: $359.1245334-2

CPT CODE: $302.0345335-2

CPT CODE: $841.1345337-2

CPT CODE: $357.0545338-2

CPT CODE: $182.6545340-2

CPT CODE: $438.6045341-2

CPT CODE: $460.9845342-2

CPT CODE: $335.9545346-2

CPT CODE: $380.1545346-4

Page 23

Page 24: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $230.6745347-2

CPT CODE: $261.0245347-4

CPT CODE: $1,115.2045378-2

CPT CODE: $1,682.2945379-2

CPT CODE: $1,115.2045380-2

CPT CODE: $1,290.0845381-2

CPT CODE: $1,521.6145382-2

CPT CODE: $1,463.8745384-2

CPT CODE: $1,464.8945385-2

CPT CODE: $442.9645386-2

CPT CODE: $722.4445388-2

CPT CODE: $817.5045388-4

CPT CODE: $457.4245389-2

CPT CODE: $517.6045389-4

CPT CODE: $781.0645391-2

CPT CODE: $826.2845392-2

CPT CODE: $4,193.8645395-2

CPT CODE: $6,456.1445397-2

CPT CODE: $2,065.9745400-2

CPT CODE: $2,599.5945402-2

CPT CODE: $1,956.3745500-2

CPT CODE: $1,975.2245505-2

CPT CODE: $119.0845520-2

CPT CODE: $2,655.7445540-2

CPT CODE: $2,655.7445541-2

CPT CODE: $3,336.2045550-2

CPT CODE: $1,219.1845560-2

CPT CODE: $1,467.4345562-2

CPT CODE: $3,377.6345563-2

CPT CODE: $3,005.4245800-2

CPT CODE: $3,374.0045805-2

CPT CODE: $3,005.4245820-2

CPT CODE: $3,374.0045825-2

CPT CODE: $179.5645900-2

CPT CODE: $257.0745905-2

CPT CODE: $614.3145910-2

CPT CODE: $406.3945915-2

CPT CODE: $187.1045990-2

CPT CODE: $178.5546020-2

CPT CODE: $119.0846030-2

CPT CODE: $500.9146040-2

CPT CODE: $500.9146045-2

CPT CODE: $204.1346050-2

CPT CODE: $1,313.6846060-2

CPT CODE: $538.6846070-2

CPT CODE: $850.5846080-2

CPT CODE: $283.5346083-2

CPT CODE: $1,200.3046200-2

CPT CODE: $179.5646220-2

CPT CODE: $279.7646221-2

CPT CODE: $1,049.0446250-2

CPT CODE: $1,238.0746255-2

CPT CODE: $1,304.2446257-2

CPT CODE: $1,549.9646258-2

CPT CODE: $2,202.1046260-2

CPT CODE: $2,353.3046261-2

CPT CODE: $2,353.3046262-2

CPT CODE: $726.3046270-2

CPT CODE: $1,587.7946275-2

CPT CODE: $1,918.5746280-2

CPT CODE: $538.6846285-2

CPT CODE: $1,918.9146288-2

CPT CODE: $221.1746320-2

CPT CODE: $71.8446500-2

CPT CODE: $384.7346505-2

CPT CODE: $111.5246600-2

CPT CODE: $179.5646604-2

CPT CODE: $177.6846606-2

CPT CODE: $302.4446608-2

CPT CODE: $236.2746610-2

CPT CODE: $235.6446611-2

CPT CODE: $491.4646612-2

CPT CODE: $243.8346614-2

CPT CODE: $244.5846615-2

CPT CODE: $2,173.7546700-2

CPT CODE: $3,005.4246705-2

CPT CODE: $442.9646706-2

CPT CODE: $738.2846707-2

CPT CODE: $1,619.3146710-2

CPT CODE: $3,373.0146712-2

CPT CODE: $2,655.7446715-2

CPT CODE: $2,655.7446716-2

CPT CODE: $2,457.2846730-2

CPT CODE: $4,819.9946735-2

CPT CODE: $5,415.4446740-2

CPT CODE: $5,409.1446742-2

CPT CODE: $5,409.1446744-2

CPT CODE: $5,409.1446746-2

CPT CODE: $5,665.1446748-2

CPT CODE: $2,117.0046750-2

CPT CODE: $2,882.5646751-2

CPT CODE: $2,882.5646753-2

CPT CODE: $1,266.4346754-2

CPT CODE: $2,410.0246760-2

CPT CODE: $2,665.1846761-2

CPT CODE: $4,479.8246762-2

CPT CODE: $119.0846900-2

CPT CODE: $119.0846910-2

CPT CODE: $168.2146916-2

CPT CODE: $172.0046917-2

CPT CODE: $172.0046922-2

CPT CODE: $1,058.5446924-2

CPT CODE: $277.4646930-2

CPT CODE: $177.6846940-2

CPT CODE: $119.0846942-2

CPT CODE: $141.7546945-2

CPT CODE: $302.4446946-2

CPT CODE: $1,004.4146947-2

CPT CODE: $330.7847000-2

CPT CODE: $330.7847001-2

CPT CODE: $3,005.4247010-2

CPT CODE: $3,012.9547015-2

CPT CODE: $1,975.2247100-2

CPT CODE: $3,685.9447120-2

CPT CODE: $5,623.3747122-2

CPT CODE: $5,623.3747125-2

CPT CODE: $5,623.3747130-2

CPT CODE: $12,617.1247135-2

CPT CODE: $2,476.1847350-2

CPT CODE: $3,374.0047360-2

CPT CODE: $2,877.9447361-2

CPT CODE: $2,565.1347362-2

CPT CODE: $8,407.0747383-2

CPT CODE: $3,610.2947400-2

CPT CODE: $3,525.2347420-2

CPT CODE: $4,385.3047425-2

CPT CODE: $4,139.5547460-2

CPT CODE: $2,353.3047480-2

CPT CODE: $973.4547490-2

CPT CODE: $491.4647530-2

CPT CODE: $104.3247531-2

CPT CODE: $235.1947532-2

CPT CODE: $332.4347533-2

CPT CODE: $440.9247534-2

CPT CODE: $252.4147535-2

CPT CODE: $161.1247536-2

CPT CODE: $107.5747537-2

CPT CODE: $359.6147538-2

CPT CODE: $486.5647539-2

CPT CODE: $581.2547540-2

CPT CODE: $308.2347541-2

CPT CODE: $141.3447542-2

CPT CODE: $178.2447543-2

CPT CODE: $230.5447544-2

CPT CODE: $491.4647550-2

CPT CODE: $491.4647552-2

CPT CODE: $727.7147553-2

CPT CODE: $2,523.4347554-2

CPT CODE: $727.7147555-2

CPT CODE: $727.7147556-2

CPT CODE: $1,779.0947562-2

CPT CODE: $1,995.6747563-2

Page 24

Page 25: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,671.7347564-2

CPT CODE: $2,173.5847570-2

CPT CODE: $2,372.2047600-2

CPT CODE: $2,570.6747605-2

CPT CODE: $2,920.3647610-2

CPT CODE: $4,687.7247620-2

CPT CODE: $3,241.6947700-2

CPT CODE: $3,288.9747701-2

CPT CODE: $3,247.3847711-2

CPT CODE: $3,247.3847712-2

CPT CODE: $3,241.6947715-2

CPT CODE: $2,473.8547719-2

CPT CODE: $3,317.3147720-2

CPT CODE: $3,922.1747721-2

CPT CODE: $3,922.1747740-2

CPT CODE: $4,680.0647741-2

CPT CODE: $3,288.9747760-2

CPT CODE: $3,922.1747765-2

CPT CODE: $4,886.1647780-2

CPT CODE: $4,888.4547785-2

CPT CODE: $4,517.6047800-2

CPT CODE: $3,288.9747801-2

CPT CODE: $3,317.3147802-2

CPT CODE: $4,515.1047900-2

CPT CODE: $2,410.0248000-2

CPT CODE: $4,177.3448001-2

CPT CODE: $2,703.0148020-2

CPT CODE: $2,523.4348100-2

CPT CODE: $302.4448102-2

CPT CODE: $2,645.4848105-2

CPT CODE: $3,005.4248120-2

CPT CODE: $3,468.5148140-2

CPT CODE: $3,978.8848145-2

CPT CODE: $4,882.5048146-2

CPT CODE: $3,005.4248148-2

CPT CODE: $4,886.1648150-2

CPT CODE: $4,882.5048152-2

CPT CODE: $4,882.5048153-2

CPT CODE: $4,882.5048154-2

CPT CODE: $4,819.9948155-2

CPT CODE: $12,617.1248160-2

CPT CODE: $192.8048400-2

CPT CODE: $3,005.4248500-2

CPT CODE: $3,005.4248510-2

CPT CODE: $3,298.4048520-2

CPT CODE: $4,139.5548540-2

CPT CODE: $3,481.1148545-2

CPT CODE: $4,195.2048547-2

CPT CODE: $3,201.6848548-2

CPT CODE: $2,117.0049000-2

CPT CODE: $3,005.4249002-2

CPT CODE: $2,410.0249010-2

CPT CODE: $1,975.2249020-2

CPT CODE: $2,353.3049040-2

CPT CODE: $1,975.2249060-2

CPT CODE: $1,888.8849062-2

CPT CODE: $223.6849082-2

CPT CODE: $421.5449083-2

CPT CODE: $136.7649084-2

CPT CODE: $345.4449180-2

CPT CODE: $133.9149185-2

CPT CODE: $2,031.9449200-2

CPT CODE: $2,457.2849201-2

CPT CODE: $1,635.6849203-2

CPT CODE: $1,792.8249204-2

CPT CODE: $2,052.6449205-2

CPT CODE: $5,415.4449215-2

CPT CODE: $4,252.9449220-2

CPT CODE: $1,389.2849250-2

CPT CODE: $1,975.2249255-2

CPT CODE: $1,021.0349320-2

CPT CODE: $1,276.3049321-2

CPT CODE: $1,324.2649322-2

CPT CODE: $1,443.3849323-2

CPT CODE: $886.5649324-2

CPT CODE: $1,022.0649325-2

CPT CODE: $529.1049326-2

CPT CODE: $220.8949327-2

CPT CODE: $302.4449400-2

CPT CODE: $1,356.2949402-2

CPT CODE: $241.1049405-2

CPT CODE: $241.4749406-2

CPT CODE: $274.1849407-2

CPT CODE: $660.7649411-2

CPT CODE: $137.6549412-2

CPT CODE: $1,877.7849418-2

CPT CODE: $1,185.0949419-2

CPT CODE: $1,162.4749421-2

CPT CODE: $1,163.5049422-2

CPT CODE: $219.7549423-2

CPT CODE: $109.8749424-2

CPT CODE: $1,852.4149425-2

CPT CODE: $860.0249426-2

CPT CODE: $347.6649427-2

CPT CODE: $868.2849428-2

CPT CODE: $868.2849429-2

CPT CODE: $339.4049435-2

CPT CODE: $406.5049436-2

CPT CODE: $763.4049440-2

CPT CODE: $832.6949441-2

CPT CODE: $691.6449442-2

CPT CODE: $546.8849446-2

CPT CODE: $221.4749450-2

CPT CODE: $305.6149451-2

CPT CODE: $476.3549452-2

CPT CODE: $155.9049460-2

CPT CODE: $102.6949465-2

CPT CODE: $1,564.1349491-2

CPT CODE: $2,619.2049492-2

CPT CODE: $1,633.4449495-2

CPT CODE: $2,731.3449496-2

CPT CODE: $1,635.0249500-2

CPT CODE: $2,731.3449501-2

CPT CODE: $1,377.9749505-2

CPT CODE: $2,731.3449507-2

CPT CODE: $1,795.6849520-2

CPT CODE: $2,731.3449521-2

CPT CODE: $1,483.8249525-2

CPT CODE: $1,994.1449540-2

CPT CODE: $1,464.8949550-2

CPT CODE: $1,508.4849553-2

CPT CODE: $2,060.3449555-2

CPT CODE: $1,669.1749557-2

CPT CODE: $1,909.1149560-2

CPT CODE: $1,910.1649561-2

CPT CODE: $2,476.1849565-2

CPT CODE: $897.8349570-2

CPT CODE: $1,606.6549572-2

CPT CODE: $1,190.8449580-2

CPT CODE: $1,196.0849582-2

CPT CODE: $1,687.0249585-2

CPT CODE: $1,687.0249587-2

CPT CODE: $1,918.5749590-2

CPT CODE: $2,107.5849600-2

CPT CODE: $3,317.3149605-2

CPT CODE: $2,107.5849606-2

CPT CODE: $2,655.7449610-2

CPT CODE: $2,655.7449611-2

CPT CODE: $1,370.6649650-2

CPT CODE: $1,517.6449651-2

CPT CODE: $1,447.0449652-2

CPT CODE: $1,806.0749653-2

CPT CODE: $1,660.4249654-2

CPT CODE: $1,999.0549655-2

CPT CODE: $1,666.9749656-2

CPT CODE: $2,406.8749657-2

CPT CODE: $982.9349900-2

CPT CODE: $2,626.1649904-2

CPT CODE: $2,470.2549905-2

CPT CODE: $6,054.4649906-2

CPT CODE: $2,457.2850010-2

CPT CODE: $2,022.5050020-2

Page 25

Page 26: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $282.7850021-2

CPT CODE: $3,005.4250040-2

CPT CODE: $3,005.4250045-2

CPT CODE: $3,005.4250060-2

CPT CODE: $4,215.1350065-2

CPT CODE: $4,215.1350070-2

CPT CODE: $4,404.1950075-2

CPT CODE: $3,874.9250080-2

CPT CODE: $4,886.1650081-2

CPT CODE: $2,410.0250100-2

CPT CODE: $3,005.4250120-2

CPT CODE: $3,005.4250125-2

CPT CODE: $2,967.6250130-2

CPT CODE: $4,215.1350135-2

CPT CODE: $784.4350200-2

CPT CODE: $1,370.4150205-2

CPT CODE: $2,967.6250220-2

CPT CODE: $3,856.0150225-2

CPT CODE: $4,508.1350230-2

CPT CODE: $4,508.1350234-2

CPT CODE: $3,856.0150236-2

CPT CODE: $3,581.9350240-2

CPT CODE: $3,544.1450280-2

CPT CODE: $3,544.1450290-2

CPT CODE: $1,852.4150300-2

CPT CODE: $4,215.1350320-2

CPT CODE: $3,487.4150340-2

CPT CODE: $7,069.4050360-2

CPT CODE: $8,713.8450365-2

CPT CODE: $2,523.4350370-2

CPT CODE: $5,292.5750380-2

CPT CODE: $322.8150382-2

CPT CODE: $291.1950384-2

CPT CODE: $273.4450385-2

CPT CODE: $206.6350386-2

CPT CODE: $115.9550387-2

CPT CODE: $92.2350389-2

CPT CODE: $292.9750390-2

CPT CODE: $186.3650391-2

CPT CODE: $292.9750395-2

CPT CODE: $119.0850396-2

CPT CODE: $3,723.7350400-2

CPT CODE: $4,205.6850405-2

CPT CODE: $181.5350430-2

CPT CODE: $71.6050431-2

CPT CODE: $240.1950432-2

CPT CODE: $296.7450433-2

CPT CODE: $227.1750434-2

CPT CODE: $109.8250435-2

CPT CODE: $3,005.4250500-2

CPT CODE: $3,922.1750520-2

CPT CODE: $4,215.1350525-2

CPT CODE: $4,215.1350526-2

CPT CODE: $4,923.9650540-2

CPT CODE: $1,324.2650541-2

CPT CODE: $3,007.2950542-2

CPT CODE: $3,044.6950543-2

CPT CODE: $3,055.4050544-2

CPT CODE: $3,968.2850545-2

CPT CODE: $3,275.0650546-2

CPT CODE: $2,711.9650548-2

CPT CODE: $1,682.2950551-2

CPT CODE: $491.4650553-2

CPT CODE: $491.4650555-2

CPT CODE: $538.6850557-2

CPT CODE: $491.4650561-2

CPT CODE: $1,379.2450562-2

CPT CODE: $240.0850570-2

CPT CODE: $302.4450572-2

CPT CODE: $302.4450574-2

CPT CODE: $2,115.1350575-2

CPT CODE: $302.4450576-2

CPT CODE: $302.4450580-2

CPT CODE: $2,353.3050590-2

CPT CODE: $872.2850593-2

CPT CODE: $2,948.7150600-2

CPT CODE: $1,748.4150605-2

CPT CODE: $171.2950606-2

CPT CODE: $3,487.4150610-2

CPT CODE: $3,194.4550620-2

CPT CODE: $3,487.4150630-2

CPT CODE: $3,487.4150650-2

CPT CODE: $3,922.1750660-2

CPT CODE: $49.1450684-2

CPT CODE: $119.0850686-2

CPT CODE: $119.0850688-2

CPT CODE: $68.0650690-2

CPT CODE: $237.8950693-2

CPT CODE: $307.6550694-2

CPT CODE: $390.1250695-2

CPT CODE: $3,676.4450700-2

CPT CODE: $219.0550705-2

CPT CODE: $204.4050706-2

CPT CODE: $3,487.4150715-2

CPT CODE: $2,759.6950722-2

CPT CODE: $4,517.6050725-2

CPT CODE: $3,339.4650727-2

CPT CODE: $3,339.4650728-2

CPT CODE: $3,610.2950740-2

CPT CODE: $4,215.1350750-2

CPT CODE: $3,336.2050760-2

CPT CODE: $3,922.1750770-2

CPT CODE: $3,336.2050780-2

CPT CODE: $3,449.2350782-2

CPT CODE: $3,449.2350783-2

CPT CODE: $3,874.9250785-2

CPT CODE: $3,610.2950800-2

CPT CODE: $5,292.5750810-2

CPT CODE: $5,292.5750815-2

CPT CODE: $5,292.5750820-2

CPT CODE: $6,587.3550825-2

CPT CODE: $5,292.5750830-2

CPT CODE: $5,292.5750840-2

CPT CODE: $4,177.3450845-2

CPT CODE: $3,241.6950860-2

CPT CODE: $3,487.4150900-2

CPT CODE: $3,487.4150920-2

CPT CODE: $4,215.1350930-2

CPT CODE: $3,487.4150940-2

CPT CODE: $3,097.1650945-2

CPT CODE: $3,684.8250947-2

CPT CODE: $2,943.3950948-2

CPT CODE: $425.2950951-2

CPT CODE: $491.4650953-2

CPT CODE: $491.4650955-2

CPT CODE: $491.4650957-2

CPT CODE: $491.4650961-2

CPT CODE: $179.5650970-2

CPT CODE: $302.4450972-2

CPT CODE: $302.4450974-2

CPT CODE: $302.4450976-2

CPT CODE: $302.4450980-2

CPT CODE: $172.0051000-2

CPT CODE: $47.2451005-2

CPT CODE: $340.2751010-2

CPT CODE: $2,296.5851020-2

CPT CODE: $2,296.5851030-2

CPT CODE: $2,296.5851040-2

CPT CODE: $1,587.7951045-2

CPT CODE: $1,852.4151050-2

CPT CODE: $3,185.0051060-2

CPT CODE: $1,975.2251065-2

CPT CODE: $1,200.3051080-2

CPT CODE: $127.4451100-2

CPT CODE: $40.8351101-2

CPT CODE: $247.4651102-2

CPT CODE: $2,523.4351500-2

CPT CODE: $2,835.3351520-2

CPT CODE: $2,967.6251525-2

CPT CODE: $2,759.6951530-2

CPT CODE: $2,703.0151535-2

CPT CODE: $2,457.2851550-2

Page 26

Page 27: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $3,487.4151555-2

CPT CODE: $4,215.1351565-2

CPT CODE: $4,517.6051570-2

CPT CODE: $6,010.8551575-2

CPT CODE: $6,010.8551580-2

CPT CODE: $7,523.0151585-2

CPT CODE: $7,816.0151590-2

CPT CODE: $9,025.7251595-2

CPT CODE: $8,883.9751596-2

CPT CODE: $9,025.7251597-2

CPT CODE: $49.1451600-2

CPT CODE: $98.2951605-2

CPT CODE: $98.2951610-2

CPT CODE: $60.4651700-2

CPT CODE: $11.5151701-2

CPT CODE: $34.5151702-2

CPT CODE: $69.0351703-2

CPT CODE: $119.0851705-2

CPT CODE: $119.0851710-2

CPT CODE: $517.7151715-2

CPT CODE: $96.4151720-2

CPT CODE: $170.1051725-2

CPT CODE: $223.0451726-2

CPT CODE: $508.1851727-2

CPT CODE: $508.1851728-2

CPT CODE: $513.1151729-2

CPT CODE: $111.5251736-2

CPT CODE: $120.9851741-2

CPT CODE: $171.9151784-2

CPT CODE: $321.3351785-2

CPT CODE: $158.7751792-2

CPT CODE: $302.4451797-2

CPT CODE: $130.8851798-2

CPT CODE: $3,487.4151800-2

CPT CODE: $5,292.5751820-2

CPT CODE: $2,580.0951840-2

CPT CODE: $2,693.5351841-2

CPT CODE: $2,230.4651845-2

CPT CODE: $2,410.0251860-2

CPT CODE: $3,487.4151865-2

CPT CODE: $1,446.0051880-2

CPT CODE: $3,770.9451900-2

CPT CODE: $3,487.4151920-2

CPT CODE: $3,487.4151925-2

CPT CODE: $4,215.1351940-2

CPT CODE: $5,292.5751960-2

CPT CODE: $3,487.4151980-2

CPT CODE: $2,045.1751990-2

CPT CODE: $2,633.0551992-2

CPT CODE: $302.4452000-2

CPT CODE: $277.4252001-2

CPT CODE: $519.8052005-2

CPT CODE: $576.5152007-2

CPT CODE: $576.5152010-2

CPT CODE: $642.6752204-2

CPT CODE: $538.6852214-2

CPT CODE: $491.4652224-2

CPT CODE: $973.4552234-2

CPT CODE: $1,710.6152235-2

CPT CODE: $2,457.2852240-2

CPT CODE: $500.9152250-2

CPT CODE: $425.2952260-2

CPT CODE: $257.0752265-2

CPT CODE: $727.7152270-2

CPT CODE: $727.7152275-2

CPT CODE: $1,096.3452276-2

CPT CODE: $1,077.4352277-2

CPT CODE: $538.6852281-2

CPT CODE: $1,017.9652282-2

CPT CODE: $491.4652283-2

CPT CODE: $642.6752285-2

CPT CODE: $351.0352287-2

CPT CODE: $680.4752290-2

CPT CODE: $982.9352300-2

CPT CODE: $950.5252301-2

CPT CODE: $1,077.4352305-2

CPT CODE: $557.6052310-2

CPT CODE: $784.4352315-2

CPT CODE: $1,748.4152317-2

CPT CODE: $2,410.0252318-2

CPT CODE: $1,115.2052320-2

CPT CODE: $2,107.5852325-2

CPT CODE: $520.9852327-2

CPT CODE: $850.5852330-2

CPT CODE: $841.1352332-2

CPT CODE: $1,049.0452334-2

CPT CODE: $662.3752341-2

CPT CODE: $728.0152342-2

CPT CODE: $795.1652343-2

CPT CODE: $799.6252344-2

CPT CODE: $880.1852345-2

CPT CODE: $959.2652346-2

CPT CODE: $638.5152351-2

CPT CODE: $1,939.3852352-2

CPT CODE: $2,304.8952353-2

CPT CODE: $1,490.3552354-2

CPT CODE: $1,421.7252355-2

CPT CODE: $1,303.7952356-2

CPT CODE: $841.3952400-2

CPT CODE: $772.8452402-2

CPT CODE: $1,375.6652441-2

CPT CODE: $1,055.3552442-2

CPT CODE: $1,880.7252500-2

CPT CODE: $1,030.1552510-2

CPT CODE: $2,958.1752601-2

CPT CODE: $3,487.4152630-2

CPT CODE: $1,748.4152640-2

CPT CODE: $2,960.8752647-2

CPT CODE: $2,960.8752648-2

CPT CODE: $1,994.4952649-2

CPT CODE: $1,200.3052700-2

CPT CODE: $500.9153000-2

CPT CODE: $1,502.7253010-2

CPT CODE: $283.5353020-2

CPT CODE: $119.0853025-2

CPT CODE: $538.6853040-2

CPT CODE: $238.1753060-2

CPT CODE: $727.7153080-2

CPT CODE: $3,487.4153085-2

CPT CODE: $349.6753200-2

CPT CODE: $2,523.4353210-2

CPT CODE: $3,194.4553215-2

CPT CODE: $2,173.7553220-2

CPT CODE: $2,230.4653230-2

CPT CODE: $2,410.0253235-2

CPT CODE: $727.7153240-2

CPT CODE: $2,173.7553250-2

CPT CODE: $177.6853260-2

CPT CODE: $425.2953265-2

CPT CODE: $302.4453270-2

CPT CODE: $538.6853275-2

CPT CODE: $1,748.4153400-2

CPT CODE: $2,041.4253405-2

CPT CODE: $2,759.6953410-2

CPT CODE: $2,721.8653415-2

CPT CODE: $3,487.4153420-2

CPT CODE: $3,487.4153425-2

CPT CODE: $2,069.7753430-2

CPT CODE: $2,102.7453431-2

CPT CODE: $3,487.4153440-2

CPT CODE: $1,748.4153442-2

CPT CODE: $1,599.5553444-2

CPT CODE: $4,082.8753445-2

CPT CODE: $1,421.0153446-2

CPT CODE: $2,041.4253447-2

CPT CODE: $1,953.7053448-2

CPT CODE: $2,041.4253449-2

CPT CODE: $708.8253450-2

CPT CODE: $538.6853460-2

CPT CODE: $1,251.9153500-2

CPT CODE: $2,410.0253502-2

CPT CODE: $1,805.1553505-2

Page 27

Page 28: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,410.0253510-2

CPT CODE: $3,487.4153515-2

CPT CODE: $784.4353520-2

CPT CODE: $75.5753600-2

CPT CODE: $71.8453601-2

CPT CODE: $257.0753605-2

CPT CODE: $96.4153620-2

CPT CODE: $96.4153621-2

CPT CODE: $64.2553660-2

CPT CODE: $62.3653661-2

CPT CODE: $173.9053665-2

CPT CODE: $1,722.4653850-2

CPT CODE: $738.2853855-2

CPT CODE: $2,752.6253860-2

CPT CODE: $119.0854000-2

CPT CODE: $170.1054001-2

CPT CODE: $240.0854015-2

CPT CODE: $105.8554050-2

CPT CODE: $122.8554055-2

CPT CODE: $113.4254056-2

CPT CODE: $869.4754057-2

CPT CODE: $247.6254060-2

CPT CODE: $359.1254065-2

CPT CODE: $119.0854100-2

CPT CODE: $302.4454105-2

CPT CODE: $1,502.7254110-2

CPT CODE: $2,410.0254111-2

CPT CODE: $3,241.6954112-2

CPT CODE: $897.8354115-2

CPT CODE: $1,805.1554120-2

CPT CODE: $3,610.2954125-2

CPT CODE: $5,179.1754130-2

CPT CODE: $6,256.5754135-2

CPT CODE: $141.7554150-2

CPT CODE: $130.4354160-2

CPT CODE: $699.3854161-2

CPT CODE: $454.4954162-2

CPT CODE: $423.5054163-2

CPT CODE: $363.0054164-2

CPT CODE: $119.0854200-2

CPT CODE: $1,502.7254205-2

CPT CODE: $1,256.9754220-2

CPT CODE: $119.0854230-2

CPT CODE: $76.7454231-2

CPT CODE: $77.5154235-2

CPT CODE: $77.5154240-2

CPT CODE: $85.0454250-2

CPT CODE: $1,502.7254300-2

CPT CODE: $2,523.4354304-2

CPT CODE: $1,502.7254308-2

CPT CODE: $1,502.7254312-2

CPT CODE: $2,523.4354316-2

CPT CODE: $2,523.4354318-2

CPT CODE: $2,901.4654322-2

CPT CODE: $2,995.9554324-2

CPT CODE: $2,995.9554326-2

CPT CODE: $4,007.2654328-2

CPT CODE: $3,789.8454332-2

CPT CODE: $3,789.8454336-2

CPT CODE: $1,748.4154340-2

CPT CODE: $2,995.9554344-2

CPT CODE: $3,440.1754348-2

CPT CODE: $3,789.8454352-2

CPT CODE: $1,549.9654360-2

CPT CODE: $2,523.4354380-2

CPT CODE: $3,185.0054385-2

CPT CODE: $3,185.0054390-2

CPT CODE: $2,636.8354400-2

CPT CODE: $3,166.0954401-2

CPT CODE: $4,073.3854405-2

CPT CODE: $2,132.2554406-2

CPT CODE: $2,329.9854408-2

CPT CODE: $2,664.9354410-2

CPT CODE: $2,932.0354411-2

CPT CODE: $1,038.8354415-2

CPT CODE: $1,384.1154416-2

CPT CODE: $1,522.8254417-2

CPT CODE: $2,230.4654420-2

CPT CODE: $2,230.4654430-2

CPT CODE: $1,502.7254435-2

CPT CODE: $727.0254437-2

CPT CODE: $1,467.4754438-2

CPT CODE: $1,587.7954440-2

CPT CODE: $179.5654450-2

CPT CODE: $98.2954500-2

CPT CODE: $472.5454505-2

CPT CODE: $814.5554512-2

CPT CODE: $954.5454520-2

CPT CODE: $924.9454522-2

CPT CODE: $1,984.7054530-2

CPT CODE: $2,655.7454535-2

CPT CODE: $1,502.7254550-2

CPT CODE: $2,230.4654560-2

CPT CODE: $1,256.9754600-2

CPT CODE: $727.7154620-2

CPT CODE: $1,682.2954640-2

CPT CODE: $1,669.1754650-2

CPT CODE: $727.7154660-2

CPT CODE: $1,502.7254670-2

CPT CODE: $1,805.1554680-2

CPT CODE: $872.5254690-2

CPT CODE: $1,530.0254692-2

CPT CODE: $463.0954700-2

CPT CODE: $119.0854800-2

CPT CODE: $973.4554830-2

CPT CODE: $1,275.8854840-2

CPT CODE: $1,171.9154860-2

CPT CODE: $1,805.1554861-2

CPT CODE: $740.7454865-2

CPT CODE: $1,805.1554900-2

CPT CODE: $2,523.4354901-2

CPT CODE: $100.1755000-2

CPT CODE: $1,200.3055040-2

CPT CODE: $1,710.6155041-2

CPT CODE: $1,077.4355060-2

CPT CODE: $302.4455100-2

CPT CODE: $1,493.2855110-2

CPT CODE: $302.4455120-2

CPT CODE: $1,540.5055150-2

CPT CODE: $2,173.7555175-2

CPT CODE: $2,173.7555180-2

CPT CODE: $557.6055200-2

CPT CODE: $548.1455250-2

CPT CODE: $661.5855300-2

CPT CODE: $1,540.5055400-2

CPT CODE: $1,105.7655500-2

CPT CODE: $973.4555520-2

CPT CODE: $1,512.1555530-2

CPT CODE: $1,606.6555535-2

CPT CODE: $1,729.5455540-2

CPT CODE: $1,222.1555550-2

CPT CODE: $595.4055600-2

CPT CODE: $1,559.4055605-2

CPT CODE: $3,610.2955650-2

CPT CODE: $3,610.2955680-2

CPT CODE: $444.1755700-2

CPT CODE: $1,502.7255705-2

CPT CODE: $1,502.7255720-2

CPT CODE: $2,523.4355725-2

CPT CODE: $3,837.1155801-2

CPT CODE: $5,122.4755810-2

CPT CODE: $5,122.4755812-2

CPT CODE: $6,804.7155815-2

CPT CODE: $3,837.1155821-2

CPT CODE: $3,837.1155831-2

CPT CODE: $5,122.4755840-2

CPT CODE: $5,122.4755842-2

CPT CODE: $5,680.0655845-2

CPT CODE: $1,748.4155860-2

CPT CODE: $2,410.0255862-2

CPT CODE: $4,035.5755865-2

CPT CODE: $43.4755870-2

Page 28

Page 29: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $1,245.6855873-2

CPT CODE: $1,156.2755875-2

CPT CODE: $255.5255876-2

CPT CODE: $633.4955920-2

CPT CODE: $292.7756405-2

CPT CODE: $172.0056420-2

CPT CODE: $746.6256440-2

CPT CODE: $567.0656441-2

CPT CODE: $136.7956442-2

CPT CODE: $204.1356501-2

CPT CODE: $803.3656515-2

CPT CODE: $292.7756605-2

CPT CODE: $56.7456606-2

CPT CODE: $2,249.3656620-2

CPT CODE: $2,882.5656625-2

CPT CODE: $3,288.9756630-2

CPT CODE: $4,483.0456631-2

CPT CODE: $4,489.7556632-2

CPT CODE: $3,275.3956633-2

CPT CODE: $4,483.0456634-2

CPT CODE: $4,483.0456637-2

CPT CODE: $5,651.7156640-2

CPT CODE: $425.2956700-2

CPT CODE: $841.1356740-2

CPT CODE: $425.2956800-2

CPT CODE: $387.4856805-2

CPT CODE: $887.4756810-2

CPT CODE: $188.4156820-2

CPT CODE: $257.4456821-2

CPT CODE: $576.5157000-2

CPT CODE: $567.0657010-2

CPT CODE: $119.0857020-2

CPT CODE: $381.9157022-2

CPT CODE: $381.9157023-2

CPT CODE: $567.0657061-2

CPT CODE: $661.5857065-2

CPT CODE: $122.8557100-2

CPT CODE: $548.1457105-2

CPT CODE: $1,604.7057106-2

CPT CODE: $2,006.6657107-2

CPT CODE: $2,407.0457109-2

CPT CODE: $2,523.4357110-2

CPT CODE: $2,951.9957111-2

CPT CODE: $3,541.4557112-2

CPT CODE: $2,296.5857120-2

CPT CODE: $595.4057130-2

CPT CODE: $453.6357135-2

CPT CODE: $96.4157150-2

CPT CODE: $599.0957155-2

CPT CODE: $222.4657156-2

CPT CODE: $111.5257160-2

CPT CODE: $69.9257170-2

CPT CODE: $179.5657180-2

CPT CODE: $425.2957200-2

CPT CODE: $463.0957210-2

CPT CODE: $1,502.7257220-2

CPT CODE: $1,502.7257230-2

CPT CODE: $1,190.8457240-2

CPT CODE: $992.3457250-2

CPT CODE: $1,238.0757260-2

CPT CODE: $1,653.9157265-2

CPT CODE: $2,230.4657268-2

CPT CODE: $1,956.3757270-2

CPT CODE: $2,230.4657280-2

CPT CODE: $2,249.3657282-2

CPT CODE: $1,844.4057283-2

CPT CODE: $2,470.4357284-2

CPT CODE: $1,312.7557285-2

CPT CODE: $1,269.5657287-2

CPT CODE: $2,882.5657288-2

CPT CODE: $2,079.2357289-2

CPT CODE: $2,410.0257291-2

CPT CODE: $2,410.0257292-2

CPT CODE: $1,126.5457295-2

CPT CODE: $1,709.8957296-2

CPT CODE: $2,759.6957300-2

CPT CODE: $3,317.3157305-2

CPT CODE: $3,922.1757307-2

CPT CODE: $2,633.7957308-2

CPT CODE: $2,410.0257310-2

CPT CODE: $2,391.1157311-2

CPT CODE: $3,317.3157320-2

CPT CODE: $3,317.3157330-2

CPT CODE: $2,239.9057335-2

CPT CODE: $224.9157400-2

CPT CODE: $240.0857410-2

CPT CODE: $236.0657415-2

CPT CODE: $188.4157420-2

CPT CODE: $257.4457421-2

CPT CODE: $1,875.7157423-2

CPT CODE: $1,865.8657425-2

CPT CODE: $1,423.6557426-2

CPT CODE: $202.2557452-2

CPT CODE: $311.8857454-2

CPT CODE: $211.4157455-2

CPT CODE: $201.3557456-2

CPT CODE: $686.2057460-2

CPT CODE: $717.6757461-2

CPT CODE: $162.5657500-2

CPT CODE: $302.4457505-2

CPT CODE: $158.7757510-2

CPT CODE: $202.2557511-2

CPT CODE: $973.4557513-2

CPT CODE: $935.6557520-2

CPT CODE: $937.7557522-2

CPT CODE: $850.5857530-2

CPT CODE: $5,073.6557531-2

CPT CODE: $2,410.0257540-2

CPT CODE: $2,703.0157545-2

CPT CODE: $2,230.4657550-2

CPT CODE: $2,655.7457555-2

CPT CODE: $2,655.7457556-2

CPT CODE: $476.1957558-2

CPT CODE: $803.3657700-2

CPT CODE: $1,077.4357720-2

CPT CODE: $177.6857800-2

CPT CODE: $187.1358100-2

CPT CODE: $73.7858110-2

CPT CODE: $623.8158120-2

CPT CODE: $2,428.9158140-2

CPT CODE: $2,343.8658145-2

CPT CODE: $1,999.1158146-2

CPT CODE: $2,495.0858150-2

CPT CODE: $3,326.7758152-2

CPT CODE: $2,910.9158180-2

CPT CODE: $2,939.2758200-2

CPT CODE: $6,256.5758210-2

CPT CODE: $8,732.7458240-2

CPT CODE: $2,674.6358260-2

CPT CODE: $2,991.7658262-2

CPT CODE: $3,165.5958263-2

CPT CODE: $3,525.2358267-2

CPT CODE: $3,062.1258270-2

CPT CODE: $3,052.6858275-2

CPT CODE: $3,288.9758280-2

CPT CODE: $5,358.7158285-2

CPT CODE: $1,449.7258290-2

CPT CODE: $1,593.5458291-2

CPT CODE: $1,751.7358292-2

CPT CODE: $2,552.8258293-2

CPT CODE: $2,222.0358294-2

CPT CODE: $177.6858300-2

CPT CODE: $69.9258301-2

CPT CODE: $173.9058340-2

CPT CODE: $230.5758345-2

CPT CODE: $653.7058346-2

CPT CODE: $122.8558350-2

CPT CODE: $725.0458353-2

CPT CODE: $765.9958356-2

CPT CODE: $1,975.2258400-2

CPT CODE: $2,835.3358410-2

CPT CODE: $1,956.3758520-2

Page 29

Page 30: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,693.5358540-2

CPT CODE: $1,844.1058541-2

CPT CODE: $1,933.1458542-2

CPT CODE: $1,844.1058543-2

CPT CODE: $1,933.1458544-2

CPT CODE: $1,231.1158545-2

CPT CODE: $1,231.1158546-2

CPT CODE: $4,768.3258548-2

CPT CODE: $1,714.1058550-2

CPT CODE: $1,593.5458552-2

CPT CODE: $1,449.7258553-2

CPT CODE: $1,593.5458554-2

CPT CODE: $556.9458555-2

CPT CODE: $765.7958558-2

CPT CODE: $1,093.7558559-2

CPT CODE: $1,093.7558560-2

CPT CODE: $1,093.7558561-2

CPT CODE: $903.4758562-2

CPT CODE: $1,253.1058563-2

CPT CODE: $1,482.2658570-2

CPT CODE: $1,599.8058571-2

CPT CODE: $1,482.2658572-2

CPT CODE: $1,599.8058573-2

CPT CODE: $1,256.9758600-2

CPT CODE: $1,171.9158605-2

CPT CODE: $1,124.6758615-2

CPT CODE: $1,129.3458660-2

CPT CODE: $1,935.3558661-2

CPT CODE: $1,324.2658662-2

CPT CODE: $1,339.7458670-2

CPT CODE: $1,276.3058671-2

CPT CODE: $1,376.8558672-2

CPT CODE: $1,339.7458673-2

CPT CODE: $1,417.6458700-2

CPT CODE: $2,117.0058720-2

CPT CODE: $2,400.5558740-2

CPT CODE: $4,706.6258750-2

CPT CODE: $3,770.9458752-2

CPT CODE: $3,770.9458760-2

CPT CODE: $3,770.9458770-2

CPT CODE: $841.1358800-2

CPT CODE: $2,183.1558805-2

CPT CODE: $841.1358820-2

CPT CODE: $2,173.7558822-2

CPT CODE: $3,770.9458825-2

CPT CODE: $1,975.2258900-2

CPT CODE: $1,956.3758920-2

CPT CODE: $1,805.1558925-2

CPT CODE: $1,842.9358940-2

CPT CODE: $3,137.7258943-2

CPT CODE: $2,599.0358950-2

CPT CODE: $4,045.0458951-2

CPT CODE: $3,742.5958952-2

CPT CODE: $4,010.6958953-2

CPT CODE: $4,274.8358954-2

CPT CODE: $3,246.2058956-2

CPT CODE: $2,839.0658957-2

CPT CODE: $3,162.9758958-2

CPT CODE: $4,252.9458960-2

CPT CODE: $154.9859000-3

CPT CODE: $402.8559001-2

CPT CODE: $154.9859012-3

CPT CODE: $154.9859015-3

CPT CODE: $128.5359020-3

CPT CODE: $98.2959025-3

CPT CODE: $179.5659030-3

CPT CODE: $20.8159050-3

CPT CODE: $24.2859051-3

CPT CODE: $2,523.4359100-3

CPT CODE: $2,476.1859120-3

CPT CODE: $2,684.0859121-3

CPT CODE: $2,476.1859130-3

CPT CODE: $2,948.7159135-3

CPT CODE: $2,825.8459136-3

CPT CODE: $2,532.8859140-3

CPT CODE: $1,446.0059150-3

CPT CODE: $2,428.9159151-3

CPT CODE: $727.7159160-3

CPT CODE: $396.9459200-3

CPT CODE: $973.4559300-3

CPT CODE: $803.3659320-3

CPT CODE: $803.3659325-3

CPT CODE: $2,476.1859350-3

CPT CODE: $3,383.4659400-3

CPT CODE: $2,079.7659409-3

CPT CODE: $2,145.3659410-3

CPT CODE: $598.0759425-3

CPT CODE: $901.5459426-3

CPT CODE: $66.1559430-3

CPT CODE: $3,383.4659510-3

CPT CODE: $2,758.1259514-3

CPT CODE: $2,825.8459515-3

CPT CODE: $1,342.0759525-3

CPT CODE: $3,380.1559610-3

CPT CODE: $2,079.8359612-3

CPT CODE: $2,140.7159614-3

CPT CODE: $3,380.1559618-3

CPT CODE: $2,756.1859620-3

CPT CODE: $2,817.0559622-3

CPT CODE: $737.1859812-3

CPT CODE: $935.6559820-3

CPT CODE: $935.6559821-3

CPT CODE: $1,370.4159830-3

CPT CODE: $614.3159840-3

CPT CODE: $699.3859841-3

CPT CODE: $1,464.8959850-3

CPT CODE: $1,587.7959851-3

CPT CODE: $2,523.4359852-3

CPT CODE: $1,172.1959855-3

CPT CODE: $1,267.7059856-3

CPT CODE: $2,023.1259857-2

CPT CODE: $1,067.0859866-3

CPT CODE: $699.3859870-3

CPT CODE: $770.7559871-3

CPT CODE: $595.4060000-2

CPT CODE: $180.5960001-2

CPT CODE: $179.5660100-2

CPT CODE: $1,464.8960200-2

CPT CODE: $2,318.3460210-2

CPT CODE: $2,544.0760212-2

CPT CODE: $2,202.1060220-2

CPT CODE: $2,353.3060225-2

CPT CODE: $2,712.4560240-2

CPT CODE: $3,685.9460252-2

CPT CODE: $4,942.8960254-2

CPT CODE: $2,948.7160260-2

CPT CODE: $3,922.1760270-2

CPT CODE: $2,969.5460271-2

CPT CODE: $2,079.2360280-2

CPT CODE: $2,022.5060281-2

CPT CODE: $149.7160300-2

CPT CODE: $3,109.3860500-2

CPT CODE: $3,090.4760502-2

CPT CODE: $3,922.1760505-2

CPT CODE: $625.1660512-2

CPT CODE: $3,922.1760520-2

CPT CODE: $3,924.6560521-2

CPT CODE: $3,924.6560522-2

CPT CODE: $3,789.8460540-2

CPT CODE: $4,385.3060545-2

CPT CODE: $3,317.3160600-2

CPT CODE: $4,687.7260605-2

CPT CODE: $3,465.3660650-2

CPT CODE: $491.4661000-2

CPT CODE: $425.2961001-2

CPT CODE: $292.9761020-2

CPT CODE: $425.2961026-2

CPT CODE: $240.0861050-2

CPT CODE: $330.7861055-2

CPT CODE: $292.9761070-2

CPT CODE: $1,200.3061105-2

CPT CODE: $4,215.1361107-2

Page 30

Page 31: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $3,799.3061108-2

CPT CODE: $1,200.3061120-2

CPT CODE: $3,317.3161140-2

CPT CODE: $3,922.1761150-2

CPT CODE: $349.6761151-2

CPT CODE: $3,959.9761154-2

CPT CODE: $4,215.1361156-2

CPT CODE: $4,234.0561210-2

CPT CODE: $2,107.5861215-2

CPT CODE: $2,173.7561250-2

CPT CODE: $2,655.7461253-2

CPT CODE: $5,651.7161304-2

CPT CODE: $6,455.0461305-2

CPT CODE: $5,150.8261312-2

CPT CODE: $5,150.8261313-2

CPT CODE: $4,630.9961314-2

CPT CODE: $4,630.9961315-2

CPT CODE: $690.3461316-2

CPT CODE: $4,923.9661320-2

CPT CODE: $4,923.9661321-2

CPT CODE: $4,370.7161322-2

CPT CODE: $5,410.5461323-2

CPT CODE: $4,215.1361330-2

CPT CODE: $4,215.1361332-2

CPT CODE: $4,215.1361333-2

CPT CODE: $2,599.0361340-2

CPT CODE: $7,343.4461343-2

CPT CODE: $3,317.3161345-2

CPT CODE: $4,630.9961450-2

CPT CODE: $5,651.7161458-2

CPT CODE: $5,651.7161460-2

CPT CODE: $6,681.8661480-2

CPT CODE: $6,020.3061500-2

CPT CODE: $6,020.3061501-2

CPT CODE: $7,022.1161510-2

CPT CODE: $6,625.1761512-2

CPT CODE: $5,784.0361514-2

CPT CODE: $5,784.0361516-2

CPT CODE: $825.5361517-2

CPT CODE: $6,927.6261518-2

CPT CODE: $7,220.5761519-2

CPT CODE: $7,211.1361520-2

CPT CODE: $6,861.4461521-2

CPT CODE: $5,784.0361522-2

CPT CODE: $5,784.0361524-2

CPT CODE: $5,784.0361526-2

CPT CODE: $7,948.3261530-2

CPT CODE: $4,025.6261531-2

CPT CODE: $8,496.4861533-2

CPT CODE: $5,784.0361534-2

CPT CODE: $5,651.7161535-2

CPT CODE: $5,897.4661536-2

CPT CODE: $4,990.6961537-2

CPT CODE: $6,370.0061538-2

CPT CODE: $6,370.0061539-2

CPT CODE: $5,044.3161540-2

CPT CODE: $7,759.3061541-2

CPT CODE: $7,759.3061543-2

CPT CODE: $4,923.9661544-2

CPT CODE: $7,022.1161545-2

CPT CODE: $5,651.7161546-2

CPT CODE: $5,920.2561548-2

CPT CODE: $3,477.9761550-2

CPT CODE: $4,923.9661552-2

CPT CODE: $3,317.3161556-2

CPT CODE: $3,317.3161557-2

CPT CODE: $4,564.8361558-2

CPT CODE: $4,564.8361559-2

CPT CODE: $5,528.8461563-2

CPT CODE: $7,863.2661564-2

CPT CODE: $5,490.3161566-2

CPT CODE: $6,039.3561567-2

CPT CODE: $5,651.7161570-2

CPT CODE: $5,651.7161571-2

CPT CODE: $2,041.4261575-2

CPT CODE: $2,041.4261576-2

CPT CODE: $1,963.7061580-2

CPT CODE: $3,650.7161581-2

CPT CODE: $3,213.3561582-2

CPT CODE: $3,257.9661583-2

CPT CODE: $2,070.8361584-2

CPT CODE: $2,490.3661585-2

CPT CODE: $2,011.0661586-2

CPT CODE: $2,749.1661590-2

CPT CODE: $2,258.2761591-2

CPT CODE: $1,829.8361592-2

CPT CODE: $2,258.2761595-2

CPT CODE: $2,704.5861596-2

CPT CODE: $3,525.7861597-2

CPT CODE: $3,490.0561598-2

CPT CODE: $3,213.3561600-2

CPT CODE: $3,213.3561601-2

CPT CODE: $3,213.3561605-2

CPT CODE: $3,213.3561606-2

CPT CODE: $4,293.4061607-2

CPT CODE: $4,293.4061608-2

CPT CODE: $4,186.2861610-2

CPT CODE: $2,169.0261611-2

CPT CODE: $4,186.2861612-2

CPT CODE: $4,186.2861613-2

CPT CODE: $3,525.7861615-2

CPT CODE: $4,329.1061616-2

CPT CODE: $2,401.0761618-2

CPT CODE: $1,615.6061619-2

CPT CODE: $2,560.0261623-2

CPT CODE: $3,345.6661624-2

CPT CODE: $1,011.2561626-2

CPT CODE: $830.8461645-2

CPT CODE: $566.4161650-2

CPT CODE: $241.1361651-2

CPT CODE: $6,710.2161680-2

CPT CODE: $7,816.0161682-2

CPT CODE: $6,710.2161684-2

CPT CODE: $7,816.0161686-2

CPT CODE: $6,710.2161690-2

CPT CODE: $7,816.0161692-2

CPT CODE: $6,889.2961697-2

CPT CODE: $6,889.2961698-2

CPT CODE: $6,710.2161700-2

CPT CODE: $7,816.0161702-2

CPT CODE: $6,681.8661703-2

CPT CODE: $6,681.8661705-2

CPT CODE: $6,681.8661708-2

CPT CODE: $6,681.8661710-2

CPT CODE: $6,681.8661711-2

CPT CODE: $6,322.7261720-2

CPT CODE: $6,322.7261735-2

CPT CODE: $6,322.7261750-2

CPT CODE: $6,322.7261751-2

CPT CODE: $6,038.4361760-2

CPT CODE: $6,322.7261770-2

CPT CODE: $305.8561781-2

CPT CODE: $305.8561782-2

CPT CODE: $305.8561783-2

CPT CODE: $2,599.0361790-2

CPT CODE: $4,082.8761791-2

CPT CODE: $1,476.9061796-2

CPT CODE: $403.4561797-2

CPT CODE: $1,476.9061798-2

CPT CODE: $557.8461799-2

CPT CODE: $286.2161800-2

CPT CODE: $4,196.2461850-2

CPT CODE: $4,630.9961860-2

CPT CODE: $2,064.8661863-2

CPT CODE: $619.6161864-2

CPT CODE: $2,752.2161867-2

CPT CODE: $825.6661868-2

CPT CODE: $1,739.0161880-2

CPT CODE: $1,739.0161885-2

CPT CODE: $1,593.4461886-2

CPT CODE: $1,739.0161888-2

CPT CODE: $3,166.0962000-2

Page 31

Page 32: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $3,912.7262005-2

CPT CODE: $4,508.1362010-2

CPT CODE: $4,923.9662100-2

CPT CODE: $4,564.8362115-2

CPT CODE: $4,564.8362117-2

CPT CODE: $4,630.9962120-2

CPT CODE: $4,527.0162121-2

CPT CODE: $3,194.4562140-2

CPT CODE: $3,922.1762141-2

CPT CODE: $3,487.4162142-2

CPT CODE: $3,487.4162143-2

CPT CODE: $4,517.6062145-2

CPT CODE: $3,137.7262146-2

CPT CODE: $3,704.8062147-2

CPT CODE: $732.0562148-2

CPT CODE: $896.0062160-2

CPT CODE: $3,575.3962161-2

CPT CODE: $3,933.5062162-2

CPT CODE: $3,217.2762163-2

CPT CODE: $4,648.2962164-2

CPT CODE: $4,806.5062165-2

CPT CODE: $4,753.8662180-2

CPT CODE: $3,922.1762190-2

CPT CODE: $3,610.2962192-2

CPT CODE: $1,030.1562194-2

CPT CODE: $5,226.3962200-2

CPT CODE: $5,226.3962201-2

CPT CODE: $4,215.1362220-2

CPT CODE: $3,912.7262223-2

CPT CODE: $1,030.1562225-2

CPT CODE: $1,691.7462230-2

CPT CODE: $104.4362252-2

CPT CODE: $1,682.2962256-2

CPT CODE: $1,984.7062258-2

CPT CODE: $1,055.0862263-2

CPT CODE: $686.0262264-2

CPT CODE: $318.9762267-2

CPT CODE: $179.5662268-2

CPT CODE: $179.5662269-2

CPT CODE: $173.9062270-2

CPT CODE: $136.1062272-2

CPT CODE: $463.0962273-2

CPT CODE: $538.6862279-3

CPT CODE: $359.1262280-2

CPT CODE: $888.3962281-2

CPT CODE: $359.1262282-2

CPT CODE: $399.7662284-2

CPT CODE: $3,648.0962287-2

CPT CODE: $396.9462290-2

CPT CODE: $396.9462291-2

CPT CODE: $3,525.2362292-2

CPT CODE: $841.1362294-2

CPT CODE: $275.5162302-2

CPT CODE: $285.9762303-2

CPT CODE: $271.4362304-2

CPT CODE: $143.1562305-2

CPT CODE: $2,140.7162350-2

CPT CODE: $4,237.4562351-2

CPT CODE: $355.1062355-2

CPT CODE: $5,382.1762360-2

CPT CODE: $5,382.1762361-2

CPT CODE: $5,382.1762362-2

CPT CODE: $2,690.2762365-2

CPT CODE: $38.7962367-2

CPT CODE: $38.7962368-2

CPT CODE: $128.4862369-2

CPT CODE: $135.6062370-2

CPT CODE: $4,886.1663001-2

CPT CODE: $5,056.3063003-2

CPT CODE: $4,196.2463005-2

CPT CODE: $4,196.2463011-2

CPT CODE: $5,188.5963012-2

CPT CODE: $6,010.8563015-2

CPT CODE: $6,010.8563016-2

CPT CODE: $5,169.7163017-2

CPT CODE: $4,301.1463020-2

CPT CODE: $3,644.3763030-2

CPT CODE: $997.7763035-2

CPT CODE: $5,008.3263040-2

CPT CODE: $5,074.2263042-2

CPT CODE: $856.3263043-2

CPT CODE: $856.3263044-2

CPT CODE: $5,008.3263045-2

CPT CODE: $5,056.3063046-2

CPT CODE: $3,871.0463047-2

CPT CODE: $876.1163048-2

CPT CODE: $5,111.1663050-2

CPT CODE: $5,597.6163051-2

CPT CODE: $5,056.3063055-2

CPT CODE: $4,196.2463056-2

CPT CODE: $973.4563057-2

CPT CODE: $5,226.3963064-2

CPT CODE: $1,200.3063066-2

CPT CODE: $4,211.0563075-2

CPT CODE: $1,030.1563076-2

CPT CODE: $4,564.8363077-2

CPT CODE: $1,020.7063078-2

CPT CODE: $6,020.3063081-2

CPT CODE: $1,502.7263082-2

CPT CODE: $6,020.3063085-2

CPT CODE: $1,502.7263086-2

CPT CODE: $6,020.3063087-2

CPT CODE: $1,502.7263088-2

CPT CODE: $6,020.3063090-2

CPT CODE: $1,502.7263091-2

CPT CODE: $5,271.5563101-2

CPT CODE: $5,271.5563102-2

CPT CODE: $1,314.0063103-2

CPT CODE: $5,226.3963170-2

CPT CODE: $5,424.9063172-2

CPT CODE: $5,424.9063173-2

CPT CODE: $6,370.0063180-2

CPT CODE: $7,343.4463182-2

CPT CODE: $4,630.9963185-2

CPT CODE: $5,585.5663190-2

CPT CODE: $5,226.3963191-2

CPT CODE: $5,226.3963194-2

CPT CODE: $5,226.3963195-2

CPT CODE: $5,226.3963196-2

CPT CODE: $5,226.3963197-2

CPT CODE: $6,681.8663198-2

CPT CODE: $6,681.8663199-2

CPT CODE: $6,114.8063200-2

CPT CODE: $6,370.0063250-2

CPT CODE: $6,370.0063251-2

CPT CODE: $6,370.0063252-2

CPT CODE: $5,424.9063265-2

CPT CODE: $5,642.2163266-2

CPT CODE: $4,923.9663267-2

CPT CODE: $4,923.9663268-2

CPT CODE: $5,651.7163270-2

CPT CODE: $5,642.2163271-2

CPT CODE: $4,923.9663272-2

CPT CODE: $4,923.9663273-2

CPT CODE: $5,651.7163275-2

CPT CODE: $5,642.2163276-2

CPT CODE: $4,923.9663277-2

CPT CODE: $4,923.9663278-2

CPT CODE: $5,651.7163280-2

CPT CODE: $5,642.2163281-2

CPT CODE: $4,923.9663282-2

CPT CODE: $4,923.9663283-2

CPT CODE: $5,651.7163285-2

CPT CODE: $5,642.2163286-2

CPT CODE: $5,642.2163287-2

CPT CODE: $5,642.2163290-2

CPT CODE: $1,061.9763295-2

CPT CODE: $6,020.3063300-2

CPT CODE: $5,897.4663301-2

CPT CODE: $6,020.3063302-2

CPT CODE: $6,020.3063303-2

CPT CODE: $6,020.3063304-2

Page 32

Page 33: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $6,020.3063305-2

CPT CODE: $6,020.3063306-2

CPT CODE: $6,020.3063307-2

CPT CODE: $1,502.7263308-2

CPT CODE: $2,599.0363600-2

CPT CODE: $973.4563610-2

CPT CODE: $2,599.0363615-2

CPT CODE: $1,476.9063620-2

CPT CODE: $463.9063621-2

CPT CODE: $2,599.0363650-2

CPT CODE: $3,922.1763655-2

CPT CODE: $761.6663661-2

CPT CODE: $1,149.2663662-2

CPT CODE: $1,295.6863663-2

CPT CODE: $1,197.2563664-2

CPT CODE: $3,241.6963685-2

CPT CODE: $3,241.6963688-2

CPT CODE: $2,882.5663700-2

CPT CODE: $3,610.2963702-2

CPT CODE: $3,959.9763704-2

CPT CODE: $3,610.2963706-2

CPT CODE: $4,819.9963707-2

CPT CODE: $6,152.6163709-2

CPT CODE: $4,819.9963710-2

CPT CODE: $4,215.1363740-2

CPT CODE: $3,241.6963741-2

CPT CODE: $1,682.2963744-2

CPT CODE: $1,682.2963746-2

CPT CODE: $68.0664400-2

CPT CODE: $88.8064402-2

CPT CODE: $98.2964405-2

CPT CODE: $119.0864408-2

CPT CODE: $119.0864410-2

CPT CODE: $100.1764413-2

CPT CODE: $119.0864415-2

CPT CODE: $204.2364416-2

CPT CODE: $119.0864417-2

CPT CODE: $119.0864418-2

CPT CODE: $170.1064420-2

CPT CODE: $292.9764421-2

CPT CODE: $177.6864425-2

CPT CODE: $240.0864430-2

CPT CODE: $105.8564435-2

CPT CODE: $119.0864445-2

CPT CODE: $204.2364446-2

CPT CODE: $102.1164447-2

CPT CODE: $2,073.9064448-2

CPT CODE: $200.4264449-2

CPT CODE: $172.0064450-2

CPT CODE: $78.6564455-2

CPT CODE: $94.3364461-2

CPT CODE: $59.2564462-2

CPT CODE: $93.0664463-2

CPT CODE: $289.3064479-2

CPT CODE: $120.6764480-2

CPT CODE: $250.6164483-2

CPT CODE: $100.5664484-2

CPT CODE: $140.2664486-2

CPT CODE: $171.4264487-2

CPT CODE: $172.9264488-2

CPT CODE: $238.9164489-2

CPT CODE: $322.3864490-2

CPT CODE: $157.5064491-2

CPT CODE: $137.8164492-2

CPT CODE: $300.2364493-2

CPT CODE: $142.7364494-2

CPT CODE: $124.2864495-2

CPT CODE: $179.5664505-2

CPT CODE: $179.5664508-2

CPT CODE: $311.8864510-2

CPT CODE: $303.4564517-2

CPT CODE: $349.6764520-2

CPT CODE: $100.1764530-2

CPT CODE: $111.5264550-2

CPT CODE: $1,937.4464553-2

CPT CODE: $1,937.4464555-2

CPT CODE: $1,693.9964561-2

CPT CODE: $206.6264566-2

CPT CODE: $1,086.1864568-2

CPT CODE: $957.6664569-2

CPT CODE: $828.8664570-2

CPT CODE: $2,400.5564575-2

CPT CODE: $2,400.5564580-2

CPT CODE: $2,095.3664581-2

CPT CODE: $1,200.3064585-2

CPT CODE: $2,400.5564590-2

CPT CODE: $1,200.3064595-2

CPT CODE: $425.2964600-2

CPT CODE: $538.6864605-2

CPT CODE: $661.5864610-2

CPT CODE: $155.3064611-2

CPT CODE: $1,162.4764612-2

CPT CODE: $201.3364615-2

CPT CODE: $181.7164616-2

CPT CODE: $225.6664617-2

CPT CODE: $240.0864620-2

CPT CODE: $349.6764630-2

CPT CODE: $127.4064632-2

CPT CODE: $469.0464633-2

CPT CODE: $213.9064634-2

CPT CODE: $461.0264635-2

CPT CODE: $192.5064636-2

CPT CODE: $349.6764640-2

CPT CODE: $116.2764642-2

CPT CODE: $78.1864643-2

CPT CODE: $127.1064644-2

CPT CODE: $89.4764645-2

CPT CODE: $125.9064646-2

CPT CODE: $145.4564647-2

CPT CODE: $388.6964650-0

CPT CODE: $388.6964653-2

CPT CODE: $491.4664680-2

CPT CODE: $433.2964681-2

CPT CODE: $784.4364702-2

CPT CODE: $1,105.7664704-2

CPT CODE: $1,672.8564708-2

CPT CODE: $1,984.7064712-2

CPT CODE: $2,410.0264713-2

CPT CODE: $1,672.8564714-2

CPT CODE: $1,672.8564716-2

CPT CODE: $1,852.4164718-2

CPT CODE: $1,143.5564719-2

CPT CODE: $1,131.2864721-2

CPT CODE: $1,653.9164722-2

CPT CODE: $784.4364726-2

CPT CODE: $1,143.5564732-2

CPT CODE: $1,143.5564734-2

CPT CODE: $1,143.5564736-2

CPT CODE: $1,682.2964738-2

CPT CODE: $1,682.2964740-2

CPT CODE: $1,682.2964742-2

CPT CODE: $1,323.1264744-2

CPT CODE: $897.8364746-2

CPT CODE: $2,703.0164755-2

CPT CODE: $2,296.5864760-2

CPT CODE: $1,030.1564763-2

CPT CODE: $1,682.2964766-2

CPT CODE: $2,173.7564771-2

CPT CODE: $3,610.2964772-2

CPT CODE: $491.4664774-2

CPT CODE: $1,805.1564776-2

CPT CODE: $240.0864778-2

CPT CODE: $812.7864782-2

CPT CODE: $1,682.2964784-2

CPT CODE: $1,682.2964786-2

CPT CODE: $1,105.7664787-2

CPT CODE: $812.7864788-2

CPT CODE: $1,502.7264790-2

CPT CODE: $1,502.7264792-2

CPT CODE: $359.1264795-2

CPT CODE: $2,410.0264802-2

CPT CODE: $3,317.3164804-2

Page 33

Page 34: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $3,317.3164809-2

CPT CODE: $2,315.5064818-2

CPT CODE: $798.8264820-2

CPT CODE: $870.6164821-2

CPT CODE: $87.0764822-2

CPT CODE: $906.0264823-2

CPT CODE: $793.8964831-2

CPT CODE: $238.1764832-2

CPT CODE: $1,105.7664834-2

CPT CODE: $1,455.4864835-2

CPT CODE: $1,672.8564836-2

CPT CODE: $548.1464837-2

CPT CODE: $1,672.8564840-2

CPT CODE: $1,984.7064856-2

CPT CODE: $1,909.1164857-2

CPT CODE: $1,672.8564858-2

CPT CODE: $548.1464859-2

CPT CODE: $2,296.5864861-2

CPT CODE: $2,296.5864862-2

CPT CODE: $4,215.1364864-2

CPT CODE: $4,215.1364865-2

CPT CODE: $4,215.1364866-2

CPT CODE: $4,215.1364868-2

CPT CODE: $1,984.7064885-2

CPT CODE: $1,984.7064886-2

CPT CODE: $1,984.7064890-2

CPT CODE: $1,984.7064891-2

CPT CODE: $3,005.4264892-2

CPT CODE: $3,005.4264893-2

CPT CODE: $3,865.4764895-2

CPT CODE: $3,865.4764896-2

CPT CODE: $5,963.6064897-2

CPT CODE: $5,963.6064898-2

CPT CODE: $1,502.7264901-2

CPT CODE: $1,984.7064902-2

CPT CODE: $1,776.8264905-2

CPT CODE: $1,776.8264907-2

CPT CODE: $939.4764910-2

CPT CODE: $1,184.6664911-2

CPT CODE: $1,776.8265091-2

CPT CODE: $2,296.5865093-2

CPT CODE: $2,117.0065101-2

CPT CODE: $2,334.4165103-2

CPT CODE: $3,005.4265105-2

CPT CODE: $3,676.4465110-2

CPT CODE: $3,676.4465112-2

CPT CODE: $4,517.6065114-2

CPT CODE: $1,852.4165130-2

CPT CODE: $2,230.4665135-2

CPT CODE: $2,211.5465140-2

CPT CODE: $1,852.4165150-2

CPT CODE: $2,211.5465155-2

CPT CODE: $935.6565175-2

CPT CODE: $90.7465205-2

CPT CODE: $85.0465210-2

CPT CODE: $100.1765220-2

CPT CODE: $105.8565222-2

CPT CODE: $3,241.6965235-2

CPT CODE: $1,937.4465260-2

CPT CODE: $3,005.4265265-2

CPT CODE: $177.6865270-2

CPT CODE: $302.4465272-2

CPT CODE: $302.4465273-2

CPT CODE: $96.4165275-2

CPT CODE: $1,805.1565280-2

CPT CODE: $2,107.5865285-2

CPT CODE: $1,805.1565286-2

CPT CODE: $727.7165290-2

CPT CODE: $973.4565400-2

CPT CODE: $179.5665410-2

CPT CODE: $727.7165420-2

CPT CODE: $737.1865426-2

CPT CODE: $119.0865430-2

CPT CODE: $109.6365435-2

CPT CODE: $179.5665436-2

CPT CODE: $292.9765450-2

CPT CODE: $1,502.7265600-2

CPT CODE: $4,763.3265710-2

CPT CODE: $5,415.4465730-2

CPT CODE: $4,886.1665750-2

CPT CODE: $5,358.7165755-2

CPT CODE: $2,001.2465756-2

CPT CODE: $3,525.2365760-2

CPT CODE: $5,651.7165765-2

CPT CODE: $5,963.6065770-2

CPT CODE: $2,914.0765771-2

CPT CODE: $1,446.0065772-2

CPT CODE: $1,984.7065775-2

CPT CODE: $1,564.3165778-2

CPT CODE: $1,475.4265779-2

CPT CODE: $3,971.6565780-2

CPT CODE: $4,766.2765781-2

CPT CODE: $4,368.2665782-2

CPT CODE: $659.9765785-2

CPT CODE: $179.5665800-2

CPT CODE: $179.5665805-2

CPT CODE: $1,502.7265810-2

CPT CODE: $973.4565815-2

CPT CODE: $2,173.7565820-2

CPT CODE: $1,360.9665850-2

CPT CODE: $1,408.2165855-2

CPT CODE: $2,131.7365860-2

CPT CODE: $2,230.4665865-2

CPT CODE: $1,852.4165870-2

CPT CODE: $1,852.4165875-2

CPT CODE: $1,852.4165880-2

CPT CODE: $1,852.4165900-2

CPT CODE: $1,238.0765920-2

CPT CODE: $2,107.5865930-2

CPT CODE: $784.4366020-2

CPT CODE: $897.8366030-2

CPT CODE: $1,984.7066130-2

CPT CODE: $2,599.0366150-2

CPT CODE: $2,599.0366155-2

CPT CODE: $2,599.0366160-2

CPT CODE: $2,117.0066170-2

CPT CODE: $2,115.4766172-2

CPT CODE: $1,542.2166174-2

CPT CODE: $1,686.3966175-2

CPT CODE: $1,044.2966179-2

CPT CODE: $2,050.8966180-2

CPT CODE: $1,168.9266183-2

CPT CODE: $727.0566184-2

CPT CODE: $2,050.8966185-2

CPT CODE: $3,676.4466220-2

CPT CODE: $4,517.6066225-2

CPT CODE: $1,606.6566250-2

CPT CODE: $973.4566500-2

CPT CODE: $973.4566505-2

CPT CODE: $2,117.0066600-2

CPT CODE: $4,139.5566605-2

CPT CODE: $1,852.4166625-2

CPT CODE: $1,852.4166630-2

CPT CODE: $1,852.4166635-2

CPT CODE: $2,022.5066680-2

CPT CODE: $1,190.8466682-2

CPT CODE: $2,013.0866700-2

CPT CODE: $2,013.0866710-2

CPT CODE: $2,013.0866720-2

CPT CODE: $2,013.0866740-2

CPT CODE: $1,153.0066761-2

CPT CODE: $1,143.5566762-2

CPT CODE: $1,483.8266770-2

CPT CODE: $1,342.0766820-2

CPT CODE: $954.5466821-2

CPT CODE: $2,360.4766825-2

CPT CODE: $1,568.8566830-2

CPT CODE: $2,939.2766840-2

CPT CODE: $3,950.5266850-2

CPT CODE: $4,564.8366852-2

CPT CODE: $2,693.5366920-2

CPT CODE: $2,532.8866930-2

Page 34

Page 35: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,504.5166940-2

CPT CODE: $1,638.0366982-2

CPT CODE: $3,515.7766983-2

CPT CODE: $3,515.7766984-2

CPT CODE: $2,164.3066985-2

CPT CODE: $3,515.7766986-2

CPT CODE: $332.2366990-2

CPT CODE: $1,956.3767005-2

CPT CODE: $2,693.5367010-2

CPT CODE: $1,502.7267015-2

CPT CODE: $2,230.4667025-2

CPT CODE: $1,417.0867027-2

CPT CODE: $500.9167028-2

CPT CODE: $1,975.2267030-2

CPT CODE: $1,975.2267031-2

CPT CODE: $3,988.3567036-2

CPT CODE: $4,186.7967038-2

CPT CODE: $4,385.3067039-2

CPT CODE: $4,583.7367040-2

CPT CODE: $2,700.9867041-2

CPT CODE: $3,093.1967042-2

CPT CODE: $3,245.3867043-2

CPT CODE: $4,016.6667101-2

CPT CODE: $4,016.6667105-2

CPT CODE: $3,685.9467107-2

CPT CODE: $4,678.2367108-2

CPT CODE: $2,117.0067110-2

CPT CODE: $3,798.4467113-2

CPT CODE: $1,805.1567115-2

CPT CODE: $2,107.5867120-2

CPT CODE: $2,107.5867121-2

CPT CODE: $1,635.0267141-2

CPT CODE: $1,880.7267145-2

CPT CODE: $2,268.2267208-2

CPT CODE: $1,880.7267210-2

CPT CODE: $2,343.8667218-2

CPT CODE: $2,133.7767220-2

CPT CODE: $690.7367221-2

CPT CODE: $342.3467225-2

CPT CODE: $2,561.2267227-2

CPT CODE: $1,880.7267228-2

CPT CODE: $1,389.4667229-2

CPT CODE: $3,676.4467250-2

CPT CODE: $4,517.6067255-2

CPT CODE: $1,842.9367311-2

CPT CODE: $1,842.9367312-2

CPT CODE: $2,513.9867314-2

CPT CODE: $2,627.3967316-2

CPT CODE: $2,513.9867318-2

CPT CODE: $2,674.6367320-2

CPT CODE: $2,655.7467331-2

CPT CODE: $1,824.0367332-2

CPT CODE: $2,513.9867334-2

CPT CODE: $538.6867335-2

CPT CODE: $3,137.7267340-2

CPT CODE: $2,513.9867343-2

CPT CODE: $1,323.1267345-2

CPT CODE: $636.2167346-2

CPT CODE: $2,428.9167400-2

CPT CODE: $1,984.7067405-2

CPT CODE: $2,608.4967412-2

CPT CODE: $1,805.1567413-2

CPT CODE: $3,676.4467414-2

CPT CODE: $349.6767415-2

CPT CODE: $4,139.5567420-2

CPT CODE: $4,139.5567430-2

CPT CODE: $3,676.4467440-2

CPT CODE: $3,676.4467445-2

CPT CODE: $4,139.5567450-2

CPT CODE: $120.9867500-2

CPT CODE: $349.6767505-2

CPT CODE: $103.9667515-2

CPT CODE: $2,599.0367550-2

CPT CODE: $1,323.1267560-2

CPT CODE: $5,651.7167570-2

CPT CODE: $100.1767700-2

CPT CODE: $119.0867710-2

CPT CODE: $119.0867715-2

CPT CODE: $162.5667800-2

CPT CODE: $349.6767801-2

CPT CODE: $359.1267805-2

CPT CODE: $614.3167808-2

CPT CODE: $153.1067810-2

CPT CODE: $88.8067820-2

CPT CODE: $179.5667825-2

CPT CODE: $179.5667830-2

CPT CODE: $179.5667835-2

CPT CODE: $247.6267840-2

CPT CODE: $243.8367850-2

CPT CODE: $292.9767875-2

CPT CODE: $1,200.3067880-2

CPT CODE: $1,200.3067882-2

CPT CODE: $2,013.0867900-2

CPT CODE: $1,729.5467901-2

CPT CODE: $2,457.2867902-2

CPT CODE: $2,967.6267903-2

CPT CODE: $2,457.2867904-2

CPT CODE: $3,005.4267906-2

CPT CODE: $1,975.2267908-2

CPT CODE: $1,975.2267909-2

CPT CODE: $2,230.4667911-2

CPT CODE: $1,865.8667912-2

CPT CODE: $302.4467914-2

CPT CODE: $240.0867915-2

CPT CODE: $1,502.7267916-2

CPT CODE: $1,682.2967917-2

CPT CODE: $302.4467921-2

CPT CODE: $240.0867922-2

CPT CODE: $1,219.1867923-2

CPT CODE: $1,587.7967924-2

CPT CODE: $302.4467930-2

CPT CODE: $510.3667935-2

CPT CODE: $98.2967938-2

CPT CODE: $1,200.3067950-2

CPT CODE: $1,880.7267961-2

CPT CODE: $2,220.9767966-2

CPT CODE: $2,220.9767971-2

CPT CODE: $2,759.6967973-2

CPT CODE: $3,317.3167974-2

CPT CODE: $425.2967975-2

CPT CODE: $120.9868020-2

CPT CODE: $49.1468040-2

CPT CODE: $209.8068100-2

CPT CODE: $302.4468110-2

CPT CODE: $425.2968115-2

CPT CODE: $425.2968130-2

CPT CODE: $119.0868135-2

CPT CODE: $96.4168200-2

CPT CODE: $1,587.7968320-2

CPT CODE: $2,107.5868325-2

CPT CODE: $2,703.0168326-2

CPT CODE: $3,440.1768328-2

CPT CODE: $897.8368330-2

CPT CODE: $1,162.4768335-2

CPT CODE: $1,162.4768340-2

CPT CODE: $897.8368360-2

CPT CODE: $1,852.4168362-2

CPT CODE: $1,002.0868371-2

CPT CODE: $179.5668400-2

CPT CODE: $100.1768420-2

CPT CODE: $119.0868440-2

CPT CODE: $2,230.4668500-2

CPT CODE: $2,230.4668505-2

CPT CODE: $349.6768510-2

CPT CODE: $2,230.4668520-2

CPT CODE: $349.6768525-2

CPT CODE: $349.6768530-2

CPT CODE: $2,410.0268540-2

CPT CODE: $3,572.5168550-2

CPT CODE: $595.4068700-2

CPT CODE: $179.5668705-2

CPT CODE: $2,457.2868720-2

Page 35

Page 36: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,759.6968745-2

CPT CODE: $2,457.2868750-2

CPT CODE: $145.5368760-2

CPT CODE: $113.4568761-2

CPT CODE: $973.4568770-2

CPT CODE: $118.2168801-2

CPT CODE: $231.4968810-2

CPT CODE: $522.0468811-2

CPT CODE: $479.3568815-2

CPT CODE: $554.3068816-2

CPT CODE: $119.0868840-2

CPT CODE: $119.0868850-2

CPT CODE: $115.2969000-2

CPT CODE: $177.6869005-2

CPT CODE: $119.0869020-2

CPT CODE: $149.3269100-2

CPT CODE: $179.5669105-2

CPT CODE: $661.5869110-2

CPT CODE: $1,502.7269120-2

CPT CODE: $1,200.3069140-2

CPT CODE: $179.5669145-2

CPT CODE: $2,410.0269150-2

CPT CODE: $2,410.0269155-2

CPT CODE: $103.9669200-2

CPT CODE: $349.6769205-2

CPT CODE: $12.5869209-2

CPT CODE: $43.4769210-2

CPT CODE: $49.1469220-2

CPT CODE: $179.5669222-2

CPT CODE: $1,587.7969300-2

CPT CODE: $5,746.2269310-2

CPT CODE: $5,746.2269320-2

CPT CODE: $340.2769420-2

CPT CODE: $500.9169421-2

CPT CODE: $141.7569424-2

CPT CODE: $240.0869433-2

CPT CODE: $500.9169436-2

CPT CODE: $1,994.1469440-2

CPT CODE: $2,107.5869450-2

CPT CODE: $1,389.2869501-2

CPT CODE: $3,317.3169502-2

CPT CODE: $4,045.0469505-2

CPT CODE: $4,035.5769511-2

CPT CODE: $3,922.1769530-2

CPT CODE: $3,487.4169535-2

CPT CODE: $349.6769540-2

CPT CODE: $5,784.0369550-2

CPT CODE: $5,784.0369552-2

CPT CODE: $5,784.0369554-2

CPT CODE: $3,676.4469601-2

CPT CODE: $2,693.5369602-2

CPT CODE: $4,517.6069603-2

CPT CODE: $2,617.9469604-2

CPT CODE: $4,517.6069605-2

CPT CODE: $232.4969610-2

CPT CODE: $2,476.1869620-2

CPT CODE: $2,835.3369631-2

CPT CODE: $3,071.5769632-2

CPT CODE: $2,939.2769633-2

CPT CODE: $3,232.2469635-2

CPT CODE: $4,158.4769636-2

CPT CODE: $5,595.0269637-2

CPT CODE: $3,496.8869641-2

CPT CODE: $4,045.0469642-2

CPT CODE: $4,045.0469643-2

CPT CODE: $4,120.6469644-2

CPT CODE: $4,262.4169645-2

CPT CODE: $5,831.2969646-2

CPT CODE: $1,946.9269650-2

CPT CODE: $2,721.8669660-2

CPT CODE: $4,328.5869661-2

CPT CODE: $1,360.9669662-2

CPT CODE: $4,328.5869666-2

CPT CODE: $4,328.5869667-2

CPT CODE: $4,630.9969670-2

CPT CODE: $4,630.9969676-2

CPT CODE: $1,502.7269700-2

CPT CODE: $3,912.7269710-2

CPT CODE: $1,984.7069711-2

CPT CODE: $5,179.1769720-2

CPT CODE: $5,179.1769725-2

CPT CODE: $6,322.7269740-2

CPT CODE: $6,322.7269745-2

CPT CODE: $3,610.2969801-2

CPT CODE: $3,610.2969805-2

CPT CODE: $3,581.9369806-2

CPT CODE: $4,328.5869905-2

CPT CODE: $4,328.5869910-2

CPT CODE: $5,651.7169915-2

CPT CODE: $6,322.7269930-2

CPT CODE: $5,651.7169950-2

CPT CODE: $5,651.7169955-2

CPT CODE: $5,651.7169960-2

CPT CODE: $5,651.7169970-2

CPT CODE: $557.6070010-5

CPT CODE: $219.2870010-P

CPT CODE: $557.6070015-5

CPT CODE: $219.2870015-P

CPT CODE: $153.1070030-5

CPT CODE: $49.1470030-P

CPT CODE: $90.7470100-5

CPT CODE: $41.5770100-P

CPT CODE: $119.0870110-5

CPT CODE: $56.7070110-P

CPT CODE: $90.7470120-5

CPT CODE: $43.4770120-P

CPT CODE: $100.1770130-5

CPT CODE: $62.3670130-P

CPT CODE: $136.1070134-5

CPT CODE: $62.3670134-P

CPT CODE: $68.0670140-5

CPT CODE: $47.2470140-P

CPT CODE: $119.0870150-5

CPT CODE: $60.4670150-P

CPT CODE: $71.8470160-5

CPT CODE: $41.5770160-P

CPT CODE: $154.9870170-5

CPT CODE: $58.5970170-P

CPT CODE: $92.6270190-5

CPT CODE: $52.9170190-P

CPT CODE: $103.9670200-5

CPT CODE: $58.5970200-P

CPT CODE: $63.7870210-5

CPT CODE: $24.8070210-P

CPT CODE: $111.6170220-5

CPT CODE: $46.0570220-P

CPT CODE: $71.8470240-5

CPT CODE: $34.0170240-P

CPT CODE: $94.5170250-5

CPT CODE: $45.3770250-P

CPT CODE: $141.7570260-5

CPT CODE: $64.2570260-P

CPT CODE: $45.3770300-5

CPT CODE: $13.2170300-P

CPT CODE: $62.3670310-5

CPT CODE: $18.9170310-P

CPT CODE: $85.0470320-5

CPT CODE: $35.9170320-P

CPT CODE: $92.6270328-5

CPT CODE: $43.4770328-P

CPT CODE: $113.4270330-5

CPT CODE: $58.5970330-P

CPT CODE: $173.9070332-5

CPT CODE: $94.5170332-P

CPT CODE: $926.1970336-5

CPT CODE: $321.3370336-P

CPT CODE: $147.4370350-5

CPT CODE: $61.3270350-P

CPT CODE: $71.8470355-5

CPT CODE: $54.8170355-P

CPT CODE: $75.5770360-5

CPT CODE: $39.6770360-P

Page 36

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2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $128.5370370-5

CPT CODE: $43.4770370-P

CPT CODE: $228.7270373-5

CPT CODE: $41.5770373-P

CPT CODE: $71.8470380-5

CPT CODE: $37.8170380-P

CPT CODE: $153.1070390-5

CPT CODE: $49.1470390-P

CPT CODE: $417.7370450-5

CPT CODE: $155.8970450-P

CPT CODE: $463.0970460-5

CPT CODE: $173.5970460-P

CPT CODE: $563.2670470-5

CPT CODE: $210.8070470-P

CPT CODE: $382.0570480-5

CPT CODE: $155.8970480-P

CPT CODE: $444.5170481-5

CPT CODE: $180.6970481-P

CPT CODE: $529.6770482-5

CPT CODE: $216.1270482-P

CPT CODE: $373.3670486-5

CPT CODE: $152.3570486-P

CPT CODE: $434.1470487-5

CPT CODE: $177.1470487-P

CPT CODE: $529.6770488-5

CPT CODE: $260.8770488-P

CPT CODE: $382.0570490-5

CPT CODE: $155.8970490-P

CPT CODE: $444.5170491-5

CPT CODE: $180.6970491-P

CPT CODE: $529.6770492-5

CPT CODE: $216.1270492-P

CPT CODE: $556.4670496-5

CPT CODE: $167.0870496-P

CPT CODE: $568.4070498-5

CPT CODE: $170.0770498-P

CPT CODE: $926.1970540-5

CPT CODE: $321.3370540-P

CPT CODE: $719.0770542-5

CPT CODE: $216.3370542-P

CPT CODE: $953.2970543-5

CPT CODE: $286.4470543-P

CPT CODE: $730.9970544-5

CPT CODE: $219.3170544-P

CPT CODE: $798.1470545-5

CPT CODE: $240.1970545-P

CPT CODE: $1,059.2070546-5

CPT CODE: $317.7670546-P

CPT CODE: $695.1970547-5

CPT CODE: $208.8570547-P

CPT CODE: $757.8570548-5

CPT CODE: $226.7670548-P

CPT CODE: $1,007.0070549-5

CPT CODE: $302.8570549-P

CPT CODE: $926.1970551-5

CPT CODE: $321.3370551-P

CPT CODE: $929.0770552-5

CPT CODE: $321.3370552-P

CPT CODE: $1,232.9770553-5

CPT CODE: $321.3370553-P

CPT CODE: $360.0470554-5

CPT CODE: $245.1970554-P

CPT CODE: $371.6670555-5

CPT CODE: $245.1970555-P

CPT CODE: $282.2870557-P

CPT CODE: $294.9870558-P

CPT CODE: $309.1070559-P

CPT CODE: $102.0771100-5

CPT CODE: $47.2471100-P

CPT CODE: $120.9871101-5

CPT CODE: $64.2571101-P

CPT CODE: $128.5371110-5

CPT CODE: $66.1571110-P

CPT CODE: $198.4671111-5

CPT CODE: $92.6271111-P

CPT CODE: $100.1771120-5

CPT CODE: $43.4771120-P

CPT CODE: $103.9671130-5

CPT CODE: $41.5771130-P

CPT CODE: $434.1471250-5

CPT CODE: $177.1471250-P

CPT CODE: $512.2971260-5

CPT CODE: $209.0271260-P

CPT CODE: $625.1671270-5

CPT CODE: $255.1071270-P

CPT CODE: $671.3371275-5

CPT CODE: $201.4071275-P

CPT CODE: $926.1971550-5

CPT CODE: $321.3371550-P

CPT CODE: $757.8571551-5

CPT CODE: $226.7671551-P

CPT CODE: $1,007.0071552-5

CPT CODE: $302.8571552-P

CPT CODE: $1,186.8971555-5

CPT CODE: $321.3371555-P

CPT CODE: $68.0672020-5

CPT CODE: $37.8172020-P

CPT CODE: $94.5172040-5

CPT CODE: $38.9672040-P

CPT CODE: $145.5372050-5

CPT CODE: $54.8172050-P

CPT CODE: $164.4572052-5

CPT CODE: $64.2572052-P

CPT CODE: $107.7472070-5

CPT CODE: $43.4772070-P

CPT CODE: $119.0872072-5

CPT CODE: $54.8172072-P

CPT CODE: $147.4372074-5

CPT CODE: $62.3672074-P

CPT CODE: $88.8072080-5

CPT CODE: $47.2472080-P

CPT CODE: $39.2972081-5

CPT CODE: $14.3672081-P

CPT CODE: $62.7872082-5

CPT CODE: $17.4172082-P

CPT CODE: $68.2572083-5

CPT CODE: $18.9972083-P

CPT CODE: $81.2272084-5

CPT CODE: $22.0972084-P

CPT CODE: $122.8572100-5

CPT CODE: $52.9172100-P

CPT CODE: $162.5672110-5

CPT CODE: $68.0672110-P

CPT CODE: $224.9772114-5

CPT CODE: $68.0672114-P

CPT CODE: $162.5672120-5

CPT CODE: $45.3772120-P

CPT CODE: $434.1472125-5

CPT CODE: $177.1472125-P

CPT CODE: $512.2972126-5

CPT CODE: $209.0272126-P

CPT CODE: $625.1672127-5

CPT CODE: $292.9772127-P

CPT CODE: $434.1472128-5

CPT CODE: $177.1472128-P

CPT CODE: $512.2972129-5

CPT CODE: $209.0272129-P

CPT CODE: $625.1672130-5

CPT CODE: $255.1072130-P

CPT CODE: $434.1472131-5

CPT CODE: $177.1472131-P

CPT CODE: $512.2972132-5

CPT CODE: $209.0272132-P

CPT CODE: $625.1672133-5

CPT CODE: $255.1072133-P

CPT CODE: $926.1972141-5

CPT CODE: $321.3372141-P

CPT CODE: $937.7572142-5

CPT CODE: $321.3372142-P

CPT CODE: $926.1972146-5

CPT CODE: $321.3372146-P

CPT CODE: $937.7572147-5

Page 37

Page 38: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $321.3372147-P

CPT CODE: $926.1972148-5

CPT CODE: $321.3372148-P

CPT CODE: $937.7572149-5

CPT CODE: $321.3372149-P

CPT CODE: $1,232.9772156-5

CPT CODE: $321.3372156-P

CPT CODE: $1,189.3472157-5

CPT CODE: $321.3372157-P

CPT CODE: $1,232.9772158-5

CPT CODE: $321.3372158-P

CPT CODE: $874.7372159-5

CPT CODE: $321.3372159-P

CPT CODE: $90.7472170-5

CPT CODE: $41.5772170-P

CPT CODE: $122.8572190-5

CPT CODE: $47.2472190-P

CPT CODE: $634.0372191-5

CPT CODE: $190.9672191-P

CPT CODE: $434.1472192-5

CPT CODE: $177.1472192-P

CPT CODE: $494.9472193-5

CPT CODE: $201.6272193-P

CPT CODE: $590.4572194-5

CPT CODE: $240.9072194-P

CPT CODE: $657.9172195-5

CPT CODE: $196.9372195-P

CPT CODE: $926.1972196-5

CPT CODE: $321.3372196-P

CPT CODE: $953.2972197-5

CPT CODE: $286.4472197-P

CPT CODE: $874.7372198-5

CPT CODE: $321.3372198-P

CPT CODE: $103.9672200-5

CPT CODE: $34.0172200-P

CPT CODE: $115.2972202-5

CPT CODE: $41.5772202-P

CPT CODE: $96.4172220-5

CPT CODE: $41.5772220-P

CPT CODE: $463.0972240-5

CPT CODE: $164.4572240-P

CPT CODE: $463.0972255-5

CPT CODE: $170.1072255-P

CPT CODE: $463.0972265-5

CPT CODE: $139.9072265-P

CPT CODE: $689.9172270-5

CPT CODE: $223.0472270-P

CPT CODE: $210.4072275-5

CPT CODE: $63.4472275-P

CPT CODE: $463.0972285-5

CPT CODE: $107.7472285-P

CPT CODE: $463.0972295-5

CPT CODE: $124.7572295-P

CPT CODE: $77.5173000-5

CPT CODE: $37.8173000-P

CPT CODE: $94.5173010-5

CPT CODE: $43.4773010-P

CPT CODE: $77.5173020-5

CPT CODE: $37.8173020-P

CPT CODE: $96.4173030-5

CPT CODE: $43.4773030-P

CPT CODE: $311.8873040-5

CPT CODE: $98.2973040-P

CPT CODE: $96.4173050-5

CPT CODE: $45.3773050-P

CPT CODE: $94.5173060-5

CPT CODE: $41.5773060-P

CPT CODE: $90.7473070-5

CPT CODE: $37.8173070-P

CPT CODE: $100.1773080-5

CPT CODE: $43.4773080-P

CPT CODE: $330.7873085-5

CPT CODE: $141.7573085-P

CPT CODE: $90.7473090-5

CPT CODE: $37.8173090-P

CPT CODE: $71.8473092-5

CPT CODE: $32.1273092-P

CPT CODE: $77.5173100-5

CPT CODE: $37.8173100-P

CPT CODE: $98.2973110-5

CPT CODE: $43.4773110-P

CPT CODE: $330.7873115-5

CPT CODE: $141.7573115-P

CPT CODE: $71.8473120-5

CPT CODE: $37.8173120-P

CPT CODE: $92.6273130-5

CPT CODE: $43.4773130-P

CPT CODE: $69.9273140-5

CPT CODE: $35.9173140-P

CPT CODE: $319.4473200-5

CPT CODE: $198.4673200-P

CPT CODE: $355.3773201-5

CPT CODE: $283.5373201-P

CPT CODE: $355.3773202-5

CPT CODE: $283.5373202-P

CPT CODE: $350.5973206-5

CPT CODE: $105.9273206-P

CPT CODE: $622.1173218-5

CPT CODE: $186.4873218-P

CPT CODE: $678.7973219-5

CPT CODE: $204.3973219-P

CPT CODE: $926.1973220-5

CPT CODE: $321.3373220-P

CPT CODE: $926.1973221-5

CPT CODE: $321.3373221-P

CPT CODE: $693.7173222-5

CPT CODE: $208.8573222-P

CPT CODE: $921.9573223-5

CPT CODE: $275.9973223-P

CPT CODE: $874.7373225-5

CPT CODE: $321.3373225-P

CPT CODE: $30.2173501-5

CPT CODE: $10.2373501-P

CPT CODE: $41.6773502-5

CPT CODE: $12.1773502-P

CPT CODE: $52.0373503-5

CPT CODE: $15.4673503-P

CPT CODE: $40.2673521-5

CPT CODE: $12.5373521-P

CPT CODE: $49.2973522-5

CPT CODE: $16.2673522-P

CPT CODE: $57.1473523-5

CPT CODE: $17.4173523-P

CPT CODE: $321.3373525-5

CPT CODE: $141.7573525-P

CPT CODE: $28.0173551-5

CPT CODE: $9.0773551-P

CPT CODE: $32.4873552-5

CPT CODE: $10.2373552-P

CPT CODE: $85.0673560-5

CPT CODE: $34.0473560-P

CPT CODE: $95.2773562-5

CPT CODE: $40.8473562-P

CPT CODE: $115.2973564-5

CPT CODE: $47.2473564-P

CPT CODE: $153.1073565-5

CPT CODE: $56.7073565-P

CPT CODE: $330.7873580-5

CPT CODE: $94.5173580-P

CPT CODE: $92.6273590-5

CPT CODE: $37.8173590-P

CPT CODE: $68.0673592-5

CPT CODE: $32.1273592-P

CPT CODE: $85.0473600-5

CPT CODE: $35.9173600-P

CPT CODE: $98.2973610-5

CPT CODE: $43.4773610-P

CPT CODE: $321.3373615-5

CPT CODE: $141.7573615-P

CPT CODE: $71.8473620-5

CPT CODE: $37.8173620-P

CPT CODE: $98.2973630-5

Page 38

Page 39: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $38.9673630-P

CPT CODE: $85.0473650-5

CPT CODE: $37.8173650-P

CPT CODE: $68.0673660-5

CPT CODE: $35.9173660-P

CPT CODE: $378.0573700-5

CPT CODE: $141.7073700-P

CPT CODE: $406.3973701-5

CPT CODE: $152.3573701-P

CPT CODE: $406.3973702-5

CPT CODE: $152.3573702-P

CPT CODE: $350.5973706-5

CPT CODE: $105.9273706-P

CPT CODE: $622.1173718-5

CPT CODE: $186.4873718-P

CPT CODE: $678.7973719-5

CPT CODE: $234.2273719-P

CPT CODE: $926.1973720-5

CPT CODE: $321.3373720-P

CPT CODE: $926.1973721-5

CPT CODE: $321.3373721-P

CPT CODE: $693.7173722-5

CPT CODE: $208.8573722-P

CPT CODE: $917.4973723-5

CPT CODE: $275.9973723-P

CPT CODE: $874.7373725-5

CPT CODE: $321.3373725-P

CPT CODE: $139.9074022-5

CPT CODE: $58.4574022-P

CPT CODE: $434.1474150-5

CPT CODE: $177.1474150-P

CPT CODE: $503.6374160-5

CPT CODE: $205.4774160-P

CPT CODE: $607.7974170-5

CPT CODE: $248.0274170-P

CPT CODE: $308.6474174-5

CPT CODE: $164.4974174-P

CPT CODE: $653.4274175-5

CPT CODE: $195.4474175-P

CPT CODE: $135.2774176-5

CPT CODE: $171.9274176-P

CPT CODE: $211.7274177-5

CPT CODE: $180.3374177-P

CPT CODE: $267.5774178-5

CPT CODE: $199.3574178-P

CPT CODE: $926.1974181-5

CPT CODE: $321.3374181-P

CPT CODE: $757.8574182-5

CPT CODE: $226.7674182-P

CPT CODE: $1,007.0074183-5

CPT CODE: $302.8574183-P

CPT CODE: $874.7374185-5

CPT CODE: $321.3374185-P

CPT CODE: $123.1974190-5

CPT CODE: $55.3674190-P

CPT CODE: $172.0074210-5

CPT CODE: $64.2574210-P

CPT CODE: $156.8574220-5

CPT CODE: $68.0674220-P

CPT CODE: $139.9074230-5

CPT CODE: $98.2974230-P

CPT CODE: $1,483.8274235-5

CPT CODE: $1,483.8274235-P

CPT CODE: $179.5674240-5

CPT CODE: $67.3274240-P

CPT CODE: $183.3274241-5

CPT CODE: $69.0874241-P

CPT CODE: $226.8374245-5

CPT CODE: $85.0274245-P

CPT CODE: $245.7374246-5

CPT CODE: $92.1274246-P

CPT CODE: $255.1774247-5

CPT CODE: $95.6674247-P

CPT CODE: $270.3174249-5

CPT CODE: $100.9774249-P

CPT CODE: $168.2174250-5

CPT CODE: $71.8474250-P

CPT CODE: $167.8074251-5

CPT CODE: $71.3974251-P

CPT CODE: $228.7274260-5

CPT CODE: $90.7474260-P

CPT CODE: $230.7174261-5

CPT CODE: $184.5774261-P

CPT CODE: $259.0174262-5

CPT CODE: $203.0374262-P

CPT CODE: $230.7174263-5

CPT CODE: $184.5774263-P

CPT CODE: $179.5674270-5

CPT CODE: $67.3274270-P

CPT CODE: $226.8374280-5

CPT CODE: $85.0274280-P

CPT CODE: $240.0874283-5

CPT CODE: $100.1774283-P

CPT CODE: $153.1074290-5

CPT CODE: $60.4674290-P

CPT CODE: $228.7274300-5

CPT CODE: $62.3674300-P

CPT CODE: $111.5274301-5

CPT CODE: $35.9174301-P

CPT CODE: $170.1074305-5

CPT CODE: $85.0474305-P

CPT CODE: $378.0574328-5

CPT CODE: $120.9874328-P

CPT CODE: $406.3974329-5

CPT CODE: $158.7774329-P

CPT CODE: $224.9174330-5

CPT CODE: $120.9874330-P

CPT CODE: $444.1774340-5

CPT CODE: $120.9874340-P

CPT CODE: $321.3374350-5

CPT CODE: $115.2974350-P

CPT CODE: $321.3374355-5

CPT CODE: $115.2974355-P

CPT CODE: $136.1074360-5

CPT CODE: $94.5174360-P

CPT CODE: $311.8874363-5

CPT CODE: $94.5174363-P

CPT CODE: $243.8374400-5

CPT CODE: $96.4174400-P

CPT CODE: $234.3974410-5

CPT CODE: $98.2974410-P

CPT CODE: $302.4474415-5

CPT CODE: $111.5274415-P

CPT CODE: $156.8574420-5

CPT CODE: $60.4674420-P

CPT CODE: $194.6674425-5

CPT CODE: $77.5174425-P

CPT CODE: $177.6874430-5

CPT CODE: $58.5974430-P

CPT CODE: $194.6674440-5

CPT CODE: $69.9274440-P

CPT CODE: $194.6674445-5

CPT CODE: $100.1774445-P

CPT CODE: $187.1374450-5

CPT CODE: $58.5974450-P

CPT CODE: $194.6674455-5

CPT CODE: $94.5174455-P

CPT CODE: $166.3274470-5

CPT CODE: $69.9274470-P

CPT CODE: $793.8974485-5

CPT CODE: $330.7874485-P

CPT CODE: $149.3274710-5

CPT CODE: $60.4674710-P

CPT CODE: $215.7474712-5

CPT CODE: $163.0174712-P

CPT CODE: $118.0374713-5

CPT CODE: $96.5374713-P

CPT CODE: $234.3974740-5

CPT CODE: $62.3674740-P

CPT CODE: $206.8074742-5

CPT CODE: $162.8874742-P

CPT CODE: $330.7874775-5

Page 39

Page 40: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $107.7474775-P

CPT CODE: $1,007.2175552-5

CPT CODE: $311.8875552-P

CPT CODE: $1,279.0175554-5

CPT CODE: $312.4175554-P

CPT CODE: $868.0275555-5

CPT CODE: $312.4175555-P

CPT CODE: $280.8675557-5

CPT CODE: $131.1575557-P

CPT CODE: $407.0675559-5

CPT CODE: $165.7975559-P

CPT CODE: $377.3775561-5

CPT CODE: $144.7675561-P

CPT CODE: $466.4575563-5

CPT CODE: $173.2275563-P

CPT CODE: $415.9075565-5

CPT CODE: $105.8275565-P

CPT CODE: $59.6875571-5

CPT CODE: $48.6075571-P

CPT CODE: $342.6975572-5

CPT CODE: $237.4875572-P

CPT CODE: $342.6975573-5

CPT CODE: $299.0075573-P

CPT CODE: $401.1375574-5

CPT CODE: $316.2375574-P

CPT CODE: $652.1375600-5

CPT CODE: $232.4975600-P

CPT CODE: $907.3275605-5

CPT CODE: $260.8775605-P

CPT CODE: $907.3275625-5

CPT CODE: $172.0075625-P

CPT CODE: $860.0275630-5

CPT CODE: $292.9775630-P

CPT CODE: $686.2475635-5

CPT CODE: $205.8775635-P

CPT CODE: $680.4775705-5

CPT CODE: $281.6675705-P

CPT CODE: $463.0975710-5

CPT CODE: $128.5375710-P

CPT CODE: $689.9175716-5

CPT CODE: $177.6875716-P

CPT CODE: $1,030.1575726-5

CPT CODE: $196.5775726-P

CPT CODE: $907.3275731-5

CPT CODE: $238.1775731-P

CPT CODE: $1,030.1575733-5

CPT CODE: $340.2775733-P

CPT CODE: $689.9175736-5

CPT CODE: $219.2875736-P

CPT CODE: $689.9175741-5

CPT CODE: $219.2875741-P

CPT CODE: $803.3675743-5

CPT CODE: $727.7175743-P

CPT CODE: $689.9175746-5

CPT CODE: $219.2875746-P

CPT CODE: $689.9175756-5

CPT CODE: $130.4375756-P

CPT CODE: $425.2975774-5

CPT CODE: $160.6775774-P

CPT CODE: $567.0675801-5

CPT CODE: $130.4375801-P

CPT CODE: $689.9175803-5

CPT CODE: $219.2875803-P

CPT CODE: $567.0675805-5

CPT CODE: $172.0075805-P

CPT CODE: $689.9175807-5

CPT CODE: $238.1775807-P

CPT CODE: $245.1975809-5

CPT CODE: $140.9175809-P

CPT CODE: $567.0675810-5

CPT CODE: $130.4375810-P

CPT CODE: $330.7875820-5

CPT CODE: $90.7475820-P

CPT CODE: $463.0975822-5

CPT CODE: $145.5375822-P

CPT CODE: $463.0975825-5

CPT CODE: $122.8575825-P

CPT CODE: $463.0975827-5

CPT CODE: $130.4375827-P

CPT CODE: $500.9175831-5

CPT CODE: $153.1075831-P

CPT CODE: $567.0675833-5

CPT CODE: $302.4475833-P

CPT CODE: $500.9175840-5

CPT CODE: $196.5775840-P

CPT CODE: $567.0675842-5

CPT CODE: $302.4475842-P

CPT CODE: $689.9175860-5

CPT CODE: $281.6675860-P

CPT CODE: $567.0675870-5

CPT CODE: $219.2875870-P

CPT CODE: $1,020.7075872-5

CPT CODE: $444.1775872-P

CPT CODE: $463.0975880-5

CPT CODE: $130.4375880-P

CPT CODE: $1,030.1575885-5

CPT CODE: $321.3375885-P

CPT CODE: $1,030.1575887-5

CPT CODE: $321.3375887-P

CPT CODE: $1,030.1575889-5

CPT CODE: $321.3375889-P

CPT CODE: $1,030.1575891-5

CPT CODE: $321.3375891-P

CPT CODE: $1,739.0175893-5

CPT CODE: $500.9175893-P

CPT CODE: $623.8175894-5

CPT CODE: $260.8775894-P

CPT CODE: $992.3475898-5

CPT CODE: $359.1275898-P

CPT CODE: $391.1975901-5

CPT CODE: $110.7475901-P

CPT CODE: $391.1975902-5

CPT CODE: $110.7475902-P

CPT CODE: $340.2775970-5

CPT CODE: $147.4375970-P

CPT CODE: $302.4475984-5

CPT CODE: $219.2875984-P

CPT CODE: $340.2775989-5

CPT CODE: $145.5375989-P

CPT CODE: $92.6276000-5

CPT CODE: $75.5776000-P

CPT CODE: $444.1776001-5

CPT CODE: $175.7776001-P

CPT CODE: $213.6076010-5

CPT CODE: $107.7476010-P

CPT CODE: $77.5176080-5

CPT CODE: $58.5976080-P

CPT CODE: $66.1576098-5

CPT CODE: $20.8176098-P

CPT CODE: $224.9176100-5

CPT CODE: $102.0776100-P

CPT CODE: $272.1976101-5

CPT CODE: $168.2176101-P

CPT CODE: $359.1276102-5

CPT CODE: $149.3276102-P

CPT CODE: $253.2776120-5

CPT CODE: $94.5176120-P

CPT CODE: $58.5976125-5

CPT CODE: $30.2576125-P

CPT CODE: $103.9676140-5

CPT CODE: $103.9676140-P

CPT CODE: $166.0176376-5

CPT CODE: $14.5076376-P

CPT CODE: $213.4576377-5

CPT CODE: $54.0376377-P

CPT CODE: $153.1076380-5

CPT CODE: $56.7076380-P

CPT CODE: $387.4876506-5

CPT CODE: $253.2776506-P

CPT CODE: $291.8776510-5

CPT CODE: $154.8476510-P

CPT CODE: $311.8876511-5

Page 40

Page 41: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $130.4376511-P

CPT CODE: $234.3976512-5

CPT CODE: $97.4276512-P

CPT CODE: $340.2776513-5

CPT CODE: $141.7076513-P

CPT CODE: $231.4776514-5

CPT CODE: $152.4376514-P

CPT CODE: $302.4476516-5

CPT CODE: $139.9076516-P

CPT CODE: $234.3976519-5

CPT CODE: $122.8576519-P

CPT CODE: $311.8876529-5

CPT CODE: $136.1076529-P

CPT CODE: $213.6076536-5

CPT CODE: $100.1776536-P

CPT CODE: $425.2976604-5

CPT CODE: $122.8576604-P

CPT CODE: $114.8576641-5

CPT CODE: $38.1376641-P

CPT CODE: $94.6576642-5

CPT CODE: $35.4976642-P

CPT CODE: $226.8376700-5

CPT CODE: $85.0276700-P

CPT CODE: $170.1076705-5

CPT CODE: $63.7876705-P

CPT CODE: $321.3376770-5

CPT CODE: $162.5676770-P

CPT CODE: $270.3176775-5

CPT CODE: $120.9876775-P

CPT CODE: $238.7476776-5

CPT CODE: $107.1176776-P

CPT CODE: $311.8876800-5

CPT CODE: $141.7576800-P

CPT CODE: $107.8776801-5

CPT CODE: $43.1476801-P

CPT CODE: $80.5476802-5

CPT CODE: $33.0876802-P

CPT CODE: $189.0576805-5

CPT CODE: $70.8476805-P

CPT CODE: $194.6676810-5

CPT CODE: $141.7576810-P

CPT CODE: $316.4076811-5

CPT CODE: $166.8476811-P

CPT CODE: $189.8476812-5

CPT CODE: $100.6776812-P

CPT CODE: $96.7976813-5

CPT CODE: $38.7176813-P

CPT CODE: $72.2776814-5

CPT CODE: $29.6876814-P

CPT CODE: $141.7576815-5

CPT CODE: $53.1676815-P

CPT CODE: $102.0776816-5

CPT CODE: $38.9676816-P

CPT CODE: $122.2576817-5

CPT CODE: $48.9076817-P

CPT CODE: $228.7276818-5

CPT CODE: $136.1076818-P

CPT CODE: $111.8976819-5

CPT CODE: $44.7676819-P

CPT CODE: $105.5276820-5

CPT CODE: $32.8876820-P

CPT CODE: $116.4776821-5

CPT CODE: $45.2176821-P

CPT CODE: $378.0576825-5

CPT CODE: $196.5776825-P

CPT CODE: $283.6376826-5

CPT CODE: $76.8776826-P

CPT CODE: $256.1776827-5

CPT CODE: $67.7076827-P

CPT CODE: $283.6376828-5

CPT CODE: $76.8776828-P

CPT CODE: $207.9476830-5

CPT CODE: $162.5676830-P

CPT CODE: $235.9176831-5

CPT CODE: $93.7176831-P

CPT CODE: $258.6576856-5

CPT CODE: $102.0776856-P

CPT CODE: $159.4276857-5

CPT CODE: $43.4776857-P

CPT CODE: $321.3376870-5

CPT CODE: $122.8576870-P

CPT CODE: $478.3076872-5

CPT CODE: $162.5676872-P

CPT CODE: $417.7076873-5

CPT CODE: $148.5176873-P

CPT CODE: $260.8776880-5

CPT CODE: $186.1776881-5

CPT CODE: $78.5876881-P

CPT CODE: $48.2176882-5

CPT CODE: $32.2776882-P

CPT CODE: $248.8276885-5

CPT CODE: $108.2676885-P

CPT CODE: $248.8376886-5

CPT CODE: $108.2676886-P

CPT CODE: $463.0976930-5

CPT CODE: $243.8376930-P

CPT CODE: $463.0976932-5

CPT CODE: $247.6276932-P

CPT CODE: $108.6876937-5

CPT CODE: $39.5276937-P

CPT CODE: $254.0576940-5

CPT CODE: $101.6276940-P

CPT CODE: $203.1976941-5

CPT CODE: $112.8876941-P

CPT CODE: $279.7676942-5

CPT CODE: $122.8576942-P

CPT CODE: $416.7876945-5

CPT CODE: $189.2976945-P

CPT CODE: $204.1376946-5

CPT CODE: $111.5276946-P

CPT CODE: $425.2976948-5

CPT CODE: $189.0576948-P

CPT CODE: $329.7376965-5

CPT CODE: $109.9376965-P

CPT CODE: $177.6876970-5

CPT CODE: $60.4676970-P

CPT CODE: $162.4776975-P

CPT CODE: $325.7176977-5

CPT CODE: $106.4676977-P

CPT CODE: $311.0176998-5

CPT CODE: $141.9576998-P

CPT CODE: $94.2177001-5

CPT CODE: $34.8477001-P

CPT CODE: $94.2177002-5

CPT CODE: $34.8477002-P

CPT CODE: $96.7977003-5

CPT CODE: $37.4277003-P

CPT CODE: $463.2877011-5

CPT CODE: $141.9577011-P

CPT CODE: $487.8077012-5

CPT CODE: $145.8277012-P

CPT CODE: $446.5177013-5

CPT CODE: $196.1577013-P

CPT CODE: $139.3777014-5

CPT CODE: $126.4777014-P

CPT CODE: $791.0677021-5

CPT CODE: $214.2277021-P

CPT CODE: $988.5177022-5

CPT CODE: $296.8177022-P

CPT CODE: $145.4477053-5

CPT CODE: $63.2377053-P

CPT CODE: $199.1277054-5

CPT CODE: $63.2377054-P

CPT CODE: $335.5277058-5

CPT CODE: $245.1977058-P

CPT CODE: $414.2477059-5

CPT CODE: $245.1977059-P

CPT CODE: $60.7277063-5

CPT CODE: $31.8277063-P

CPT CODE: $80.0177072-5

CPT CODE: $46.4677072-P

CPT CODE: $80.0177073-5

Page 41

Page 42: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $45.1777073-P

CPT CODE: $141.9577074-5

CPT CODE: $81.3077074-P

CPT CODE: $258.1077075-5

CPT CODE: $95.5077075-P

CPT CODE: $81.3077076-5

CPT CODE: $38.7177076-P

CPT CODE: $73.5677077-5

CPT CODE: $42.5977077-P

CPT CODE: $83.8877078-5

CPT CODE: $65.8177078-P

CPT CODE: $132.9277079-5

CPT CODE: $86.4677079-P

CPT CODE: $166.4777080-5

CPT CODE: $38.7177080-P

CPT CODE: $83.8877081-5

CPT CODE: $25.8177081-P

CPT CODE: $410.3777084-5

CPT CODE: $277.4577084-P

CPT CODE: $98.8677085-5

CPT CODE: $26.5577085-P

CPT CODE: $39.9977086-5

CPT CODE: $9.3077086-P

CPT CODE: $491.4677261-E

CPT CODE: $491.4677261-P

CPT CODE: $623.8177262-E

CPT CODE: $623.8177262-P

CPT CODE: $746.6277263-E

CPT CODE: $746.6277263-P

CPT CODE: $614.3177280-E

CPT CODE: $187.1377280-P

CPT CODE: $737.1877285-E

CPT CODE: $215.4777285-P

CPT CODE: $774.9977290-E

CPT CODE: $268.4277290-P

CPT CODE: $435.5277293-5

CPT CODE: $109.5177293-P

CPT CODE: $767.6277295-E

CPT CODE: $267.8177295-P

CPT CODE: $281.6677300-E

CPT CODE: $179.5677300-P

CPT CODE: $2,368.3577301-E

CPT CODE: $253.8177301-P

CPT CODE: $162.1777306-5

CPT CODE: $82.6677306-P

CPT CODE: $341.0077307-5

CPT CODE: $182.8877307-P

CPT CODE: $197.4777316-5

CPT CODE: $74.3677316-P

CPT CODE: $258.4777317-5

CPT CODE: $97.7277317-P

CPT CODE: $373.9577318-5

CPT CODE: $154.2277318-P

CPT CODE: $614.3177321-E

CPT CODE: $247.6277321-P

CPT CODE: $444.1777331-E

CPT CODE: $190.9077331-P

CPT CODE: $453.6377332-E

CPT CODE: $179.5677332-P

CPT CODE: $510.3677333-E

CPT CODE: $243.8377333-P

CPT CODE: $680.4777334-E

CPT CODE: $311.8877334-P

CPT CODE: $444.1777336-E

CPT CODE: $311.8877336-P

CPT CODE: $740.7477338-E

CPT CODE: $349.4577338-P

CPT CODE: $425.2977370-E

CPT CODE: $257.0777370-P

CPT CODE: $1,320.1677371-E

CPT CODE: $1,002.7077372-E

CPT CODE: $209.8077401-E

CPT CODE: $209.8077402-E

CPT CODE: $283.5377407-E

CPT CODE: $340.2777412-E

CPT CODE: $69.9277417-E

CPT CODE: $39.6777417-P

CPT CODE: $223.9977423-E

CPT CODE: $92.8377427-E

CPT CODE: $92.8377427-P

CPT CODE: $136.4077430-E

CPT CODE: $136.4077430-P

CPT CODE: $88.5877431-E

CPT CODE: $88.5877431-P

CPT CODE: $5,498.4177432-E

CPT CODE: $5,498.4177432-P

CPT CODE: $316.8877469-E

CPT CODE: $699.3877470-E

CPT CODE: $281.6677470-P

CPT CODE: $191.8377520-E

CPT CODE: $217.8177522-E

CPT CODE: $261.4677523-E

CPT CODE: $284.9577525-E

CPT CODE: $359.1277600-P

CPT CODE: $935.6577750-E

CPT CODE: $973.4577750-P

CPT CODE: $1,757.9077761-E

CPT CODE: $1,171.9177761-P

CPT CODE: $2,050.8977762-E

CPT CODE: $1,389.2877762-P

CPT CODE: $2,249.3677763-E

CPT CODE: $1,549.9677763-P

CPT CODE: $227.4277767-E

CPT CODE: $58.5177767-P

CPT CODE: $355.2777768-E

CPT CODE: $77.6277768-P

CPT CODE: $326.6277770-E

CPT CODE: $108.1177770-P

CPT CODE: $609.1877771-E

CPT CODE: $211.1777771-P

CPT CODE: $927.5277772-E

CPT CODE: $299.4777772-P

CPT CODE: $2,324.9677777-E

CPT CODE: $1,549.9677777-P

CPT CODE: $2,929.8377778-E

CPT CODE: $1,994.1477778-P

CPT CODE: $302.6377785-E

CPT CODE: $116.1377785-P

CPT CODE: $907.3277786-E

CPT CODE: $261.5877786-P

CPT CODE: $1,348.3877787-E

CPT CODE: $401.7677787-P

CPT CODE: $85.0477789-E

CPT CODE: $85.0477789-P

CPT CODE: $415.8477790-E

CPT CODE: $330.7877790-P

CPT CODE: $83.2978012-5

CPT CODE: $14.7878012-P

CPT CODE: $210.0878013-5

CPT CODE: $28.7078013-P

CPT CODE: $243.4778014-5

CPT CODE: $38.2678014-P

CPT CODE: $359.1278015-5

CPT CODE: $136.1078015-P

CPT CODE: $406.3978016-5

CPT CODE: $145.5378016-P

CPT CODE: $482.0178018-5

CPT CODE: $194.6678018-P

CPT CODE: $90.5678020-5

CPT CODE: $55.6278020-P

CPT CODE: $463.0978070-5

CPT CODE: $149.3278070-P

CPT CODE: $364.7878071-5

CPT CODE: $91.1278071-P

CPT CODE: $92.8178072-P

CPT CODE: $491.4678075-5

CPT CODE: $194.6678075-P

CPT CODE: $557.6078102-5

CPT CODE: $215.4778102-P

CPT CODE: $595.4078103-5

CPT CODE: $164.4578103-P

CPT CODE: $689.9178104-5

Page 42

Page 43: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $156.8578104-P

CPT CODE: $111.5278110-5

CPT CODE: $52.9178110-P

CPT CODE: $268.4278111-5

CPT CODE: $69.9278111-P

CPT CODE: $228.7278120-5

CPT CODE: $103.9678120-P

CPT CODE: $330.7878121-5

CPT CODE: $149.3278121-P

CPT CODE: $281.6678122-5

CPT CODE: $107.7478122-P

CPT CODE: $463.0978130-5

CPT CODE: $139.9078130-P

CPT CODE: $463.0978135-5

CPT CODE: $164.4578135-P

CPT CODE: $463.0978140-5

CPT CODE: $149.3278140-P

CPT CODE: $567.0678185-5

CPT CODE: $119.0878185-P

CPT CODE: $500.9178191-5

CPT CODE: $145.5378191-P

CPT CODE: $500.9178195-5

CPT CODE: $111.5278195-P

CPT CODE: $463.0978201-5

CPT CODE: $124.7578201-P

CPT CODE: $727.7178202-5

CPT CODE: $107.7478202-P

CPT CODE: $463.0978205-5

CPT CODE: $124.7578205-P

CPT CODE: $675.2578206-5

CPT CODE: $103.2978206-P

CPT CODE: $538.6878215-5

CPT CODE: $153.1078215-P

CPT CODE: $1,200.3078216-5

CPT CODE: $141.7578216-P

CPT CODE: $335.3778226-5

CPT CODE: $56.7478226-P

CPT CODE: $456.1478227-5

CPT CODE: $68.5678227-P

CPT CODE: $266.4878230-5

CPT CODE: $105.8578230-P

CPT CODE: $330.7878231-5

CPT CODE: $105.8578231-P

CPT CODE: $378.0578232-5

CPT CODE: $149.3278232-P

CPT CODE: $190.9078258-5

CPT CODE: $77.5178258-P

CPT CODE: $500.9178261-5

CPT CODE: $213.6078261-P

CPT CODE: $349.6778262-5

CPT CODE: $96.4178262-P

CPT CODE: $378.0578264-5

CPT CODE: $160.6778264-P

CPT CODE: $378.1578265-E

CPT CODE: $52.2078265-P

CPT CODE: $488.8678266-E

CPT CODE: $57.8478266-P

CPT CODE: $247.5278267-5

CPT CODE: $74.2678267-P

CPT CODE: $35.5978268-5

CPT CODE: $10.6878268-P

CPT CODE: $194.6678270-5

CPT CODE: $41.5778270-P

CPT CODE: $194.6678271-5

CPT CODE: $41.5778271-P

CPT CODE: $234.3978272-5

CPT CODE: $43.4778272-P

CPT CODE: $500.9178278-5

CPT CODE: $170.1078278-P

CPT CODE: $302.4478282-5

CPT CODE: $81.2678282-P

CPT CODE: $557.6078290-5

CPT CODE: $111.5278290-P

CPT CODE: $567.0678291-5

CPT CODE: $149.3278291-P

CPT CODE: $557.6078300-5

CPT CODE: $154.9878300-P

CPT CODE: $680.4778305-5

CPT CODE: $211.7078305-P

CPT CODE: $661.5878306-5

CPT CODE: $158.7778306-P

CPT CODE: $359.1278315-5

CPT CODE: $138.0078315-P

CPT CODE: $557.6078320-5

CPT CODE: $102.0778320-P

CPT CODE: $349.6778350-5

CPT CODE: $111.5278350-P

CPT CODE: $349.6778351-5

CPT CODE: $111.5278351-P

CPT CODE: $500.9178414-5

CPT CODE: $198.4678414-P

CPT CODE: $463.0978428-5

CPT CODE: $243.8378428-P

CPT CODE: $340.2778445-5

CPT CODE: $168.2178445-P

CPT CODE: $722.2878451-5

CPT CODE: $185.8078451-P

CPT CODE: $1,076.6678452-5

CPT CODE: $423.2878452-P

CPT CODE: $499.5778453-5

CPT CODE: $135.3578453-P

CPT CODE: $486.0378454-5

CPT CODE: $179.6578454-P

CPT CODE: $413.0678456-5

CPT CODE: $156.2678456-P

CPT CODE: $453.6378457-5

CPT CODE: $170.1078457-P

CPT CODE: $472.5478458-5

CPT CODE: $170.1078458-P

CPT CODE: $623.8178466-5

CPT CODE: $179.5678466-P

CPT CODE: $623.8178468-5

CPT CODE: $179.5678468-P

CPT CODE: $623.8178469-5

CPT CODE: $179.5678469-P

CPT CODE: $548.1478472-5

CPT CODE: $185.2378472-P

CPT CODE: $869.4778473-5

CPT CODE: $349.6778473-P

CPT CODE: $888.3978481-5

CPT CODE: $232.4978481-P

CPT CODE: $1,304.2478483-5

CPT CODE: $378.0578483-P

CPT CODE: $521.1278494-5

CPT CODE: $174.7578494-P

CPT CODE: $448.0578496-5

CPT CODE: $174.7578496-P

CPT CODE: $196.3078579-5

CPT CODE: $27.4278579-P

CPT CODE: $491.4678580-5

CPT CODE: $136.1078580-P

CPT CODE: $362.5378582-5

CPT CODE: $59.5778582-P

CPT CODE: $222.3078597-5

CPT CODE: $41.2578597-P

CPT CODE: $340.2778598-5

CPT CODE: $46.8178598-P

CPT CODE: $538.6878600-5

CPT CODE: $158.7778600-P

CPT CODE: $689.9178601-5

CPT CODE: $196.5778601-P

CPT CODE: $746.6278605-5

CPT CODE: $153.1078605-P

CPT CODE: $869.4778606-5

CPT CODE: $164.4578606-P

CPT CODE: $746.6278607-5

CPT CODE: $153.1078607-P

CPT CODE: $378.0578610-5

CPT CODE: $69.9278610-P

CPT CODE: $378.0578615-5

CPT CODE: $69.9278615-P

CPT CODE: $689.9178630-5

Page 43

Page 44: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $107.7478630-P

CPT CODE: $340.2778635-5

CPT CODE: $164.4578635-P

CPT CODE: $387.4878645-5

CPT CODE: $149.3278645-P

CPT CODE: $685.9678647-5

CPT CODE: $109.4378647-P

CPT CODE: $463.0978650-5

CPT CODE: $164.4578650-P

CPT CODE: $266.4878660-5

CPT CODE: $387.4878700-5

CPT CODE: $111.5278700-P

CPT CODE: $614.3178701-5

CPT CODE: $141.7578701-P

CPT CODE: $737.1878707-5

CPT CODE: $168.2178707-P

CPT CODE: $431.4278708-5

CPT CODE: $192.2778708-P

CPT CODE: $725.5078709-5

CPT CODE: $166.4378709-P

CPT CODE: $689.9178710-5

CPT CODE: $107.7478710-P

CPT CODE: $302.4478725-5

CPT CODE: $153.1078725-P

CPT CODE: $98.2978730-5

CPT CODE: $32.1278730-P

CPT CODE: $281.6678740-5

CPT CODE: $92.6278740-P

CPT CODE: $869.4778761-5

CPT CODE: $213.6078761-P

CPT CODE: $378.0578800-5

CPT CODE: $177.6878800-P

CPT CODE: $567.0678801-5

CPT CODE: $177.6878801-P

CPT CODE: $774.9978802-5

CPT CODE: $177.6878802-P

CPT CODE: $387.4878803-5

CPT CODE: $111.5278803-P

CPT CODE: $952.6978804-E

CPT CODE: $94.5678804-P

CPT CODE: $359.1278805-5

CPT CODE: $100.1778805-P

CPT CODE: $793.8978806-5

CPT CODE: $160.6778806-P

CPT CODE: $383.8378807-5

CPT CODE: $112.4778807-P

CPT CODE: $72.1478808-5

CPT CODE: $72.1478808-P

CPT CODE: $1,614.1978811-5

CPT CODE: $322.0278811-P

CPT CODE: $1,614.1978812-5

CPT CODE: $322.0278812-P

CPT CODE: $1,614.1978813-5

CPT CODE: $322.0278813-P

CPT CODE: $1,818.3778814-5

CPT CODE: $332.9778814-P

CPT CODE: $1,818.3778815-5

CPT CODE: $332.9778815-P

CPT CODE: $1,818.3778816-5

CPT CODE: $332.9778816-P

CPT CODE: $631.7079005-E

CPT CODE: $428.8979005-P

CPT CODE: $428.8979101-E

CPT CODE: $171.2979101-P

CPT CODE: $952.6979403-E

CPT CODE: $225.8379403-P

CPT CODE: $422.0479445-E

CPT CODE: $254.8879445-P

CPT CODE: $32.5480047-8

CPT CODE: $11.4980047-P

CPT CODE: $11.1480048-8

CPT CODE: $3.9580048-P

CPT CODE: $39.8680050-8

CPT CODE: $12.1180051-8

CPT CODE: $14.8680053-8

CPT CODE: $5.2380053-P

CPT CODE: $49.6480055-8

CPT CODE: $21.2780061-8

CPT CODE: $11.9380069-8

CPT CODE: $4.1880069-P

CPT CODE: $44.8780074-8

CPT CODE: $13.4680074-P

CPT CODE: $10.8380076-8

CPT CODE: $4.1880076-P

CPT CODE: $84.9580081-8

CPT CODE: $34.5080150-8

CPT CODE: $16.9280155-8

CPT CODE: $49.4280156-8

CPT CODE: $18.8080157-8

CPT CODE: $6.6380157-P

CPT CODE: $54.9180158-8

CPT CODE: $12.9880159-8

CPT CODE: $45.7580162-8

CPT CODE: $15.0580163-8

CPT CODE: $45.7580164-8

CPT CODE: $15.3680165-8

CPT CODE: $49.4280168-8

CPT CODE: $17.2680169-8

CPT CODE: $32.9580170-8

CPT CODE: $14.2280171-8

CPT CODE: $34.3280173-8

CPT CODE: $12.0880173-P

CPT CODE: $14.2280175-8

CPT CODE: $27.4580176-8

CPT CODE: $14.2280177-8

CPT CODE: $15.3880178-8

CPT CODE: $28.7780180-8

CPT CODE: $14.2280183-8

CPT CODE: $30.2080184-8

CPT CODE: $36.1380185-8

CPT CODE: $45.7580186-8

CPT CODE: $30.2080188-8

CPT CODE: $38.5180190-8

CPT CODE: $54.9180192-8

CPT CODE: $28.2180194-8

CPT CODE: $20.1680195-8

CPT CODE: $7.1280195-P

CPT CODE: $29.5580197-8

CPT CODE: $32.4180198-8

CPT CODE: $27.7680199-8

CPT CODE: $51.0280200-8

CPT CODE: $45.7580202-8

CPT CODE: $14.2280203-8

CPT CODE: $65.1480299-8

CPT CODE: $87.5080400-8

CPT CODE: $233.8780402-8

CPT CODE: $233.8780406-8

CPT CODE: $419.5280408-8

CPT CODE: $383.8380410-8

CPT CODE: $1,080.0680412-8

CPT CODE: $183.8880414-8

CPT CODE: $176.7380415-8

CPT CODE: $385.5280416-8

CPT CODE: $128.5180417-8

CPT CODE: $2,124.3980418-8

CPT CODE: $207.0680420-8

CPT CODE: $180.3180422-8

CPT CODE: $192.8080424-8

CPT CODE: $589.1180426-8

CPT CODE: $285.6380428-8

CPT CODE: $330.2780430-8

CPT CODE: $258.8780432-8

CPT CODE: $294.5680434-8

CPT CODE: $428.4580435-8

CPT CODE: $255.2880436-8

CPT CODE: $139.2680438-8

CPT CODE: $185.6580439-8

CPT CODE: $58.4380500-8

CPT CODE: $58.5980500-P

CPT CODE: $99.1980502-8

CPT CODE: $94.5180502-P

CPT CODE: $12.1881000-8

Page 44

Page 45: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $10.9081001-8

CPT CODE: $9.9481002-8

CPT CODE: $9.6181003-8

CPT CODE: $13.2181005-8

CPT CODE: $9.4581007-8

CPT CODE: $10.0481015-8

CPT CODE: $19.1181020-8

CPT CODE: $17.3981025-8

CPT CODE: $9.1381050-8

CPT CODE: $2,070.8581162-8

CPT CODE: $101.5481170-8

CPT CODE: $101.5481219-8

CPT CODE: $164.2781276-8

CPT CODE: $99.4181479-8

CPT CODE: $4,187.4781519-8

CPT CODE: $319.9581528-8

CPT CODE: $9.4582009-8

CPT CODE: $32.1282010-8

CPT CODE: $62.2682013-8

CPT CODE: $34.5582016-8

CPT CODE: $52.3682017-8

CPT CODE: $139.9082024-8

CPT CODE: $92.6282030-8

CPT CODE: $11.6982040-8

CPT CODE: $8.5282042-8

CPT CODE: $16.4782043-8

CPT CODE: $8.2582044-8

CPT CODE: $78.1182045-8

CPT CODE: $27.5482045-P

CPT CODE: $58.5982075-8

CPT CODE: $23.4682085-8

CPT CODE: $140.3082088-8

CPT CODE: $49.4282103-8

CPT CODE: $49.4282104-8

CPT CODE: $49.1282105-8

CPT CODE: $49.1282106-8

CPT CODE: $104.2782107-8

CPT CODE: $36.7882107-P

CPT CODE: $59.4382108-8

CPT CODE: $26.3182120-8

CPT CODE: $9.2882120-P

CPT CODE: $29.6282127-8

CPT CODE: $35.2582128-8

CPT CODE: $187.7682131-8

CPT CODE: $47.4582135-8

CPT CODE: $163.0282136-8

CPT CODE: $163.0282139-8

CPT CODE: $34.0182140-8

CPT CODE: $34.0182143-8

CPT CODE: $16.4482150-8

CPT CODE: $99.9982154-8

CPT CODE: $103.9682157-8

CPT CODE: $81.2682160-8

CPT CODE: $69.9282163-8

CPT CODE: $39.8082164-8

CPT CODE: $47.6382172-8

CPT CODE: $65.8882175-8

CPT CODE: $34.0182180-8

CPT CODE: $27.4582190-8

CPT CODE: $53.1682232-8

CPT CODE: $54.9182239-8

CPT CODE: $68.0682240-8

CPT CODE: $10.6382247-8

CPT CODE: $10.6382248-8

CPT CODE: $13.2182252-8

CPT CODE: $46.0782261-8

CPT CODE: $9.2782270-8

CPT CODE: $7.3882271-8

CPT CODE: $2.6082271-P

CPT CODE: $5.5482272-8

CPT CODE: $1.9482272-P

CPT CODE: $6.2082274-8

CPT CODE: $2.1782274-P

CPT CODE: $69.9282286-8

CPT CODE: $70.7782300-8

CPT CODE: $107.1682306-8

CPT CODE: $98.2982308-8

CPT CODE: $14.4482310-8

CPT CODE: $42.9182330-8

CPT CODE: $24.5682331-8

CPT CODE: $11.8982340-8

CPT CODE: $23.4682355-8

CPT CODE: $25.5382360-8

CPT CODE: $28.3582365-8

CPT CODE: $24.4982370-8

CPT CODE: $9.4082373-8

CPT CODE: $3.3282373-P

CPT CODE: $13.2182374-8

CPT CODE: $25.9882375-8

CPT CODE: $13.2182376-8

CPT CODE: $53.7182378-8

CPT CODE: $52.3682379-8

CPT CODE: $33.6182380-8

CPT CODE: $48.9482382-8

CPT CODE: $86.9682383-8

CPT CODE: $98.8782384-8

CPT CODE: $73.2182387-8

CPT CODE: $23.4682390-8

CPT CODE: $18.2382397-8

CPT CODE: $52.7482415-8

CPT CODE: $8.4182435-8

CPT CODE: $8.4182436-8

CPT CODE: $9.1382438-8

CPT CODE: $18.7082441-8

CPT CODE: $11.3582465-8

CPT CODE: $24.4982480-8

CPT CODE: $35.9182482-8

CPT CODE: $38.1882485-8

CPT CODE: $23.8082486-8

CPT CODE: $79.4082488-8

CPT CODE: $23.0782491-8

CPT CODE: $45.9382492-8

CPT CODE: $44.9082495-8

CPT CODE: $74.0282507-8

CPT CODE: $11.5182523-8

CPT CODE: $35.9182525-8

CPT CODE: $83.1782528-8

CPT CODE: $49.4282530-8

CPT CODE: $43.0682533-8

CPT CODE: $17.7282540-8

CPT CODE: $45.9382541-8

CPT CODE: $45.9382542-8

CPT CODE: $45.9382543-8

CPT CODE: $16.9382550-8

CPT CODE: $49.8082552-8

CPT CODE: $48.2482553-8

CPT CODE: $48.2482554-8

CPT CODE: $11.8282565-8

CPT CODE: $9.5582570-8

CPT CODE: $23.8082575-8

CPT CODE: $24.4982585-8

CPT CODE: $16.8382595-8

CPT CODE: $51.0182600-8

CPT CODE: $44.0582607-8

CPT CODE: $66.3682608-8

CPT CODE: $13.7382610-8

CPT CODE: $4.8382610-P

CPT CODE: $25.0482615-8

CPT CODE: $75.5782626-8

CPT CODE: $73.2182627-8

CPT CODE: $98.2982633-8

CPT CODE: $85.0482634-8

CPT CODE: $35.2582638-8

CPT CODE: $94.5182652-8

CPT CODE: $20.9782656-8

CPT CODE: $7.4082656-P

CPT CODE: $41.8782657-8

CPT CODE: $41.8782658-8

CPT CODE: $58.5982664-8

CPT CODE: $92.4482668-8

CPT CODE: $90.7482670-8

CPT CODE: $65.3082671-8

Page 45

Page 46: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $53.6182672-8

CPT CODE: $55.7982677-8

CPT CODE: $47.2482679-8

CPT CODE: $25.6382693-8

CPT CODE: $122.8582696-8

CPT CODE: $16.0782705-8

CPT CODE: $37.8182710-8

CPT CODE: $48.0082715-8

CPT CODE: $48.5982725-8

CPT CODE: $163.0282726-8

CPT CODE: $37.1182728-8

CPT CODE: $42.9182735-8

CPT CODE: $60.4682746-8

CPT CODE: $58.5682747-8

CPT CODE: $50.5682757-8

CPT CODE: $89.1982759-8

CPT CODE: $26.5782760-8

CPT CODE: $51.0182775-8

CPT CODE: $35.9182776-8

CPT CODE: $58.5982784-8

CPT CODE: $42.0682785-8

CPT CODE: $56.8182787-8

CPT CODE: $7.6682800-8

CPT CODE: $37.3982803-8

CPT CODE: $69.6382805-8

CPT CODE: $32.1482810-8

CPT CODE: $7.3282820-8

CPT CODE: $10.2882930-8

CPT CODE: $66.1582938-8

CPT CODE: $66.1582941-8

CPT CODE: $18.9182943-8

CPT CODE: $13.4382945-8

CPT CODE: $4.0282945-P

CPT CODE: $17.0082946-8

CPT CODE: $14.1882947-8

CPT CODE: $7.5682948-8

CPT CODE: $10.5982950-8

CPT CODE: $27.4982951-8

CPT CODE: $17.6782952-8

CPT CODE: $18.3582955-8

CPT CODE: $18.9182960-8

CPT CODE: $7.3282962-8

CPT CODE: $54.8182963-8

CPT CODE: $18.9182965-8

CPT CODE: $14.0082977-8

CPT CODE: $71.8482978-8

CPT CODE: $26.4682979-8

CPT CODE: $41.4982985-8

CPT CODE: $79.4083001-8

CPT CODE: $71.8483002-8

CPT CODE: $73.6983003-8

CPT CODE: $24.9483006-8

CPT CODE: $186.3683009-8

CPT CODE: $65.7783009-P

CPT CODE: $17.5383010-8

CPT CODE: $94.5183012-8

CPT CODE: $36.5583013-8

CPT CODE: $254.2183014-8

CPT CODE: $33.6183015-8

CPT CODE: $68.0683018-8

CPT CODE: $35.7083020-8

CPT CODE: $20.6683021-8

CPT CODE: $8.0583026-8

CPT CODE: $22.9783030-8

CPT CODE: $24.5683033-8

CPT CODE: $25.2283036-8

CPT CODE: $14.8983037-8

CPT CODE: $5.2883037-P

CPT CODE: $15.1183045-8

CPT CODE: $20.8183050-8

CPT CODE: $22.6883051-8

CPT CODE: $58.5983060-8

CPT CODE: $47.2483065-8

CPT CODE: $49.1483068-8

CPT CODE: $5.3883069-8

CPT CODE: $18.9183070-8

CPT CODE: $46.0783080-8

CPT CODE: $120.9883088-8

CPT CODE: $59.5283090-8

CPT CODE: $17.8683090-P

CPT CODE: $34.0183150-8

CPT CODE: $52.9183491-8

CPT CODE: $39.8083497-8

CPT CODE: $75.5783498-8

CPT CODE: $70.2283500-8

CPT CODE: $86.7483505-8

CPT CODE: $31.2583516-8

CPT CODE: $32.9583518-8

CPT CODE: $38.4183519-8

CPT CODE: $32.9583520-8

CPT CODE: $47.2483525-8

CPT CODE: $46.4483527-8

CPT CODE: $54.8183528-8

CPT CODE: $12.2183540-8

CPT CODE: $26.4683550-8

CPT CODE: $58.5983570-8

CPT CODE: $46.9783582-8

CPT CODE: $35.7083586-8

CPT CODE: $120.9883593-8

CPT CODE: $40.8483605-8

CPT CODE: $8.7083615-8

CPT CODE: $49.1483625-8

CPT CODE: $20.9783630-8

CPT CODE: $7.4083630-P

CPT CODE: $31.7683631-8

CPT CODE: $10.6183631-P

CPT CODE: $109.6383632-8

CPT CODE: $34.0183633-8

CPT CODE: $58.5183655-8

CPT CODE: $71.9083661-8

CPT CODE: $69.6083662-8

CPT CODE: $24.1083663-8

CPT CODE: $8.5283663-P

CPT CODE: $12.0583664-8

CPT CODE: $4.2483664-P

CPT CODE: $25.9883670-8

CPT CODE: $14.1883690-8

CPT CODE: $73.6983698-8

CPT CODE: $25.9483698-P

CPT CODE: $19.8883700-8

CPT CODE: $4.6183700-P

CPT CODE: $66.5883701-8

CPT CODE: $10.4883701-P

CPT CODE: $75.0783704-8

CPT CODE: $13.4583704-P

CPT CODE: $20.6083718-8

CPT CODE: $25.5383719-8

CPT CODE: $21.9583721-8

CPT CODE: $60.4683727-8

CPT CODE: $19.0083735-8

CPT CODE: $43.4783775-8

CPT CODE: $39.8083785-8

CPT CODE: $20.0483788-8

CPT CODE: $45.9383789-8

CPT CODE: $65.3083825-8

CPT CODE: $50.7583835-8

CPT CODE: $58.5983857-8

CPT CODE: $11.7183861-8

CPT CODE: $141.7583864-8

CPT CODE: $13.2183872-8

CPT CODE: $107.7483873-8

CPT CODE: $94.5183874-8

CPT CODE: $20.0483876-8

CPT CODE: $7.0583876-P

CPT CODE: $23.0783883-8

CPT CODE: $141.7583885-8

CPT CODE: $40.3683915-8

CPT CODE: $71.8483916-8

CPT CODE: $51.3883918-8

CPT CODE: $31.7883919-8

CPT CODE: $36.8483921-8

CPT CODE: $12.9883921-P

Page 46

Page 47: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $20.6083930-8

CPT CODE: $18.9183935-8

CPT CODE: $87.5083937-8

CPT CODE: $37.5183945-8

CPT CODE: $119.2383950-8

CPT CODE: $42.0583950-P

CPT CODE: $99.9483951-8

CPT CODE: $35.2583951-P

CPT CODE: $179.5683970-8

CPT CODE: $18.9183986-8

CPT CODE: $16.2483987-8

CPT CODE: $62.3683992-8

CPT CODE: $29.8283993-8

CPT CODE: $9.9783993-P

CPT CODE: $9.4584030-8

CPT CODE: $9.4584035-8

CPT CODE: $16.6284060-8

CPT CODE: $18.9184066-8

CPT CODE: $10.3084075-8

CPT CODE: $11.8984078-8

CPT CODE: $55.1184080-8

CPT CODE: $51.0184081-8

CPT CODE: $28.3584085-8

CPT CODE: $58.5984087-8

CPT CODE: $8.7084100-8

CPT CODE: $9.9484105-8

CPT CODE: $17.0084106-8

CPT CODE: $24.5684110-8

CPT CODE: $66.9284112-8

CPT CODE: $43.4784119-8

CPT CODE: $58.5984120-8

CPT CODE: $120.9884126-8

CPT CODE: $14.1884132-8

CPT CODE: $7.2884133-8

CPT CODE: $37.0584134-8

CPT CODE: $58.4584135-8

CPT CODE: $75.5784138-8

CPT CODE: $73.2184140-8

CPT CODE: $73.2184143-8

CPT CODE: $55.0084144-8

CPT CODE: $50.2084145-8

CPT CODE: $90.7484146-8

CPT CODE: $52.9184150-8

CPT CODE: $30.4384152-8

CPT CODE: $10.7484152-P

CPT CODE: $43.9384153-8

CPT CODE: $38.1384154-8

CPT CODE: $6.9184155-8

CPT CODE: $4.3884156-8

CPT CODE: $1.5684156-P

CPT CODE: $4.3884157-8

CPT CODE: $1.5684157-P

CPT CODE: $11.6984160-8

CPT CODE: $17.5484163-8

CPT CODE: $6.1784163-P

CPT CODE: $28.5384165-8

CPT CODE: $32.0684166-8

CPT CODE: $30.2384166-P

CPT CODE: $72.4484181-8

CPT CODE: $72.4484182-8

CPT CODE: $72.0984202-8

CPT CODE: $19.3584203-8

CPT CODE: $52.9184206-8

CPT CODE: $86.7484207-8

CPT CODE: $28.3584210-8

CPT CODE: $24.4984220-8

CPT CODE: $122.8584228-8

CPT CODE: $179.5684233-8

CPT CODE: $90.7484234-8

CPT CODE: $179.5684235-8

CPT CODE: $170.1084238-8

CPT CODE: $69.9284244-8

CPT CODE: $79.4084252-8

CPT CODE: $67.1284255-8

CPT CODE: $89.7884260-8

CPT CODE: $43.9384270-8

CPT CODE: $62.3684275-8

CPT CODE: $130.4384285-8

CPT CODE: $7.0084295-8

CPT CODE: $9.7384300-8

CPT CODE: $6.3284302-8

CPT CODE: $2.2384302-P

CPT CODE: $40.2884305-8

CPT CODE: $40.2884307-8

CPT CODE: $27.4584311-8

CPT CODE: $5.6684315-8

CPT CODE: $24.5684375-8

CPT CODE: $39.7484376-8

CPT CODE: $39.7484377-8

CPT CODE: $39.7484378-8

CPT CODE: $39.7484379-8

CPT CODE: $43.4784392-8

CPT CODE: $88.5884402-8

CPT CODE: $94.5184403-8

CPT CODE: $48.9484425-8

CPT CODE: $44.4184430-8

CPT CODE: $19.9484431-8

CPT CODE: $57.6284432-8

CPT CODE: $24.5684436-8

CPT CODE: $12.6684437-8

CPT CODE: $47.2484439-8

CPT CODE: $25.5384442-8

CPT CODE: $45.0884443-8

CPT CODE: $147.4384445-8

CPT CODE: $44.4184446-8

CPT CODE: $44.6484449-8

CPT CODE: $9.9484450-8

CPT CODE: $9.5584460-8

CPT CODE: $56.8184466-8

CPT CODE: $13.2184478-8

CPT CODE: $14.8684479-8

CPT CODE: $58.5984480-8

CPT CODE: $86.9684481-8

CPT CODE: $9.1384482-8

CPT CODE: $29.5584484-8

CPT CODE: $31.6684485-8

CPT CODE: $24.5684488-8

CPT CODE: $25.5384490-8

CPT CODE: $24.5684510-8

CPT CODE: $22.6384512-8

CPT CODE: $7.0784520-8

CPT CODE: $5.1284525-8

CPT CODE: $11.0684540-8

CPT CODE: $20.8184545-8

CPT CODE: $7.5684550-8

CPT CODE: $8.7084560-8

CPT CODE: $147.4384577-8

CPT CODE: $6.6184578-8

CPT CODE: $47.2484580-8

CPT CODE: $9.9484583-8

CPT CODE: $46.7884585-8

CPT CODE: $64.2584586-8

CPT CODE: $126.6684588-8

CPT CODE: $29.1384590-8

CPT CODE: $19.5484591-8

CPT CODE: $6.9084591-P

CPT CODE: $58.5984597-8

CPT CODE: $71.8484600-8

CPT CODE: $43.4784620-8

CPT CODE: $22.1484630-8

CPT CODE: $29.7884681-8

CPT CODE: $28.3584702-8

CPT CODE: $17.9484703-8

CPT CODE: $15.8484704-8

CPT CODE: $5.5784704-P

CPT CODE: $8.5285002-8

CPT CODE: $9.2885004-8

CPT CODE: $3.2485004-P

CPT CODE: $11.3585007-8

CPT CODE: $12.4585008-8

CPT CODE: $10.9385009-8

CPT CODE: $9.2585013-8

Page 47

Page 48: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $9.5585014-8

CPT CODE: $8.3185018-8

CPT CODE: $26.9485025-8

CPT CODE: $13.2985027-8

CPT CODE: $8.5685032-8

CPT CODE: $2.6285032-P

CPT CODE: $6.3485041-8

CPT CODE: $12.3985044-8

CPT CODE: $13.2185045-8

CPT CODE: $11.1385046-8

CPT CODE: $8.5285048-8

CPT CODE: $7.9185049-8

CPT CODE: $2.3585049-P

CPT CODE: $94.8485055-8

CPT CODE: $33.4585055-P

CPT CODE: $32.1285060-8

CPT CODE: $60.4685060-P

CPT CODE: $125.0485097-8

CPT CODE: $173.9085097-P

CPT CODE: $9.3885170-8

CPT CODE: $18.9185175-8

CPT CODE: $39.4585210-8

CPT CODE: $111.5285220-8

CPT CODE: $70.2285230-8

CPT CODE: $59.5285240-8

CPT CODE: $94.5185244-8

CPT CODE: $91.4785245-8

CPT CODE: $91.4785246-8

CPT CODE: $91.4785247-8

CPT CODE: $70.2285250-8

CPT CODE: $98.4985260-8

CPT CODE: $70.2285270-8

CPT CODE: $70.2285280-8

CPT CODE: $70.2285290-8

CPT CODE: $47.2485291-8

CPT CODE: $17.1885292-8

CPT CODE: $111.5285293-8

CPT CODE: $43.4785300-8

CPT CODE: $20.3885301-8

CPT CODE: $49.1485302-8

CPT CODE: $91.4785303-8

CPT CODE: $51.0185305-8

CPT CODE: $91.4785306-8

CPT CODE: $63.4085307-8

CPT CODE: $22.3885307-P

CPT CODE: $91.4785335-8

CPT CODE: $45.7585337-8

CPT CODE: $11.8985345-8

CPT CODE: $18.9185347-8

CPT CODE: $11.3585348-8

CPT CODE: $52.9185360-8

CPT CODE: $18.9185362-8

CPT CODE: $18.3085366-8

CPT CODE: $18.3085370-8

CPT CODE: $18.3085378-8

CPT CODE: $18.3085379-8

CPT CODE: $12.2285380-8

CPT CODE: $4.3185380-P

CPT CODE: $21.7985384-8

CPT CODE: $21.7985385-8

CPT CODE: $26.4685390-8

CPT CODE: $52.5785397-8

CPT CODE: $18.5585397-P

CPT CODE: $26.4685400-8

CPT CODE: $7.5685410-8

CPT CODE: $91.4785415-8

CPT CODE: $18.9185420-8

CPT CODE: $26.4685421-8

CPT CODE: $11.3585441-8

CPT CODE: $17.0085445-8

CPT CODE: $20.3885460-8

CPT CODE: $18.7585461-8

CPT CODE: $91.4785475-8

CPT CODE: $17.0085520-8

CPT CODE: $42.0985525-8

CPT CODE: $71.8485530-8

CPT CODE: $11.5085536-8

CPT CODE: $26.4685540-8

CPT CODE: $58.5985547-8

CPT CODE: $100.1785549-8

CPT CODE: $13.2185555-8

CPT CODE: $33.6685557-8

CPT CODE: $46.4485576-8

CPT CODE: $42.0985597-8

CPT CODE: $16.6285598-8

CPT CODE: $13.5385610-8

CPT CODE: $7.8685611-8

CPT CODE: $8.1585612-8

CPT CODE: $7.8685613-8

CPT CODE: $28.5385635-8

CPT CODE: $8.8985651-8

CPT CODE: $7.9385652-8

CPT CODE: $10.5985660-8

CPT CODE: $22.4985670-8

CPT CODE: $45.3785675-8

CPT CODE: $16.4785705-8

CPT CODE: $16.5685730-8

CPT CODE: $18.3585732-8

CPT CODE: $19.4985810-8

CPT CODE: $10.5986000-8

CPT CODE: $12.3886001-8

CPT CODE: $4.3886001-P

CPT CODE: $17.2886003-8

CPT CODE: $73.2186005-8

CPT CODE: $17.8786021-8

CPT CODE: $18.9186022-8

CPT CODE: $25.7886023-8

CPT CODE: $43.4786038-8

CPT CODE: $28.4686039-8

CPT CODE: $19.8386060-8

CPT CODE: $16.5686063-8

CPT CODE: $87.4386064-8

CPT CODE: $30.8486064-P

CPT CODE: $56.7086077-8

CPT CODE: $17.0086077-P

CPT CODE: $68.8786078-8

CPT CODE: $20.8186078-P

CPT CODE: $49.2386079-8

CPT CODE: $16.2486140-8

CPT CODE: $95.1886146-8

CPT CODE: $33.5786146-P

CPT CODE: $137.2586147-8

CPT CODE: $121.1986148-8

CPT CODE: $100.1786155-8

CPT CODE: $16.4786156-8

CPT CODE: $16.4786157-8

CPT CODE: $56.8186160-8

CPT CODE: $56.8186161-8

CPT CODE: $75.5786162-8

CPT CODE: $28.3586171-8

CPT CODE: $21.3586200-8

CPT CODE: $7.5186200-P

CPT CODE: $28.3586215-8

CPT CODE: $44.4186225-8

CPT CODE: $18.2386226-8

CPT CODE: $43.4786235-8

CPT CODE: $36.6586255-8

CPT CODE: $27.4986256-8

CPT CODE: $68.0686277-8

CPT CODE: $34.0186280-8

CPT CODE: $22.8386294-8

CPT CODE: $8.0786294-P

CPT CODE: $30.4386300-8

CPT CODE: $10.7486300-P

CPT CODE: $30.4386301-8

CPT CODE: $10.7486301-P

CPT CODE: $30.4386304-8

CPT CODE: $10.7486304-P

CPT CODE: $25.1186305-8

CPT CODE: $16.0386308-8

CPT CODE: $13.7986309-8

CPT CODE: $28.3586310-8

Page 48

Page 49: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $45.3786316-8

CPT CODE: $18.8086317-8

CPT CODE: $34.0186318-8

CPT CODE: $51.0186320-8

CPT CODE: $76.5786325-8

CPT CODE: $15.9686327-8

CPT CODE: $58.6786329-8

CPT CODE: $27.2286331-8

CPT CODE: $43.4786332-8

CPT CODE: $58.5986334-8

CPT CODE: $52.8386335-8

CPT CODE: $30.2386335-P

CPT CODE: $23.9186336-8

CPT CODE: $8.4286336-P

CPT CODE: $109.6386337-8

CPT CODE: $35.9186340-8

CPT CODE: $35.6986341-8

CPT CODE: $88.8086343-8

CPT CODE: $34.0186344-8

CPT CODE: $116.1686352-8

CPT CODE: $190.9086353-8

CPT CODE: $84.0786355-8

CPT CODE: $29.6586355-P

CPT CODE: $83.1586356-8

CPT CODE: $29.3286356-P

CPT CODE: $84.0786357-8

CPT CODE: $29.6586357-P

CPT CODE: $126.7786359-8

CPT CODE: $117.8286360-8

CPT CODE: $127.6486361-8

CPT CODE: $84.0786367-8

CPT CODE: $29.6586367-P

CPT CODE: $34.0186376-8

CPT CODE: $35.9186382-8

CPT CODE: $67.6786384-8

CPT CODE: $24.6686386-8

CPT CODE: $22.6886403-8

CPT CODE: $50.3786406-8

CPT CODE: $14.6686430-8

CPT CODE: $14.1886431-8

CPT CODE: $134.5386480-8

CPT CODE: $47.4386480-P

CPT CODE: $75.1286481-8

CPT CODE: $21.9586485-8

CPT CODE: $14.0786486-8

CPT CODE: $3.7186486-P

CPT CODE: $15.8186490-8

CPT CODE: $18.9186510-8

CPT CODE: $15.1186580-8

CPT CODE: $21.9586586-8

CPT CODE: $30.8486587-P

CPT CODE: $24.8086590-8

CPT CODE: $10.5986592-8

CPT CODE: $15.8886593-8

CPT CODE: $15.5586602-8

CPT CODE: $128.0886603-8

CPT CODE: $64.0486606-8

CPT CODE: $64.0486609-8

CPT CODE: $11.5086611-8

CPT CODE: $4.0286611-P

CPT CODE: $64.0486612-8

CPT CODE: $51.2486615-8

CPT CODE: $79.8886617-8

CPT CODE: $51.2486618-8

CPT CODE: $51.2486619-8

CPT CODE: $51.6086622-8

CPT CODE: $91.3186625-8

CPT CODE: $54.9186628-8

CPT CODE: $54.9186631-8

CPT CODE: $73.2186632-8

CPT CODE: $64.0486635-8

CPT CODE: $91.4786638-8

CPT CODE: $76.1186641-8

CPT CODE: $54.9186644-8

CPT CODE: $64.0486645-8

CPT CODE: $54.9186648-8

CPT CODE: $54.9186651-8

CPT CODE: $54.9186652-8

CPT CODE: $54.9186653-8

CPT CODE: $54.9186654-8

CPT CODE: $190.3186658-8

CPT CODE: $71.3686663-8

CPT CODE: $60.3886664-8

CPT CODE: $71.3686665-8

CPT CODE: $11.5086666-8

CPT CODE: $4.0286666-P

CPT CODE: $36.6086668-8

CPT CODE: $36.6086671-8

CPT CODE: $36.6086674-8

CPT CODE: $82.3586677-8

CPT CODE: $64.0486682-8

CPT CODE: $6.2886683-8

CPT CODE: $2.1986683-P

CPT CODE: $82.3586684-8

CPT CODE: $51.0186687-8

CPT CODE: $137.2586688-8

CPT CODE: $83.1786689-8

CPT CODE: $60.3886692-8

CPT CODE: $87.8386694-8

CPT CODE: $73.2186695-8

CPT CODE: $55.8086696-8

CPT CODE: $19.7086696-P

CPT CODE: $64.0486698-8

CPT CODE: $44.5586701-8

CPT CODE: $72.4486702-8

CPT CODE: $115.2986703-8

CPT CODE: $42.0286704-8

CPT CODE: $35.5486705-8

CPT CODE: $37.1786706-8

CPT CODE: $43.6386707-8

CPT CODE: $37.1786708-8

CPT CODE: $30.9686709-8

CPT CODE: $54.9186710-8

CPT CODE: $20.9786711-8

CPT CODE: $53.0786713-8

CPT CODE: $45.7586717-8

CPT CODE: $45.7586720-8

CPT CODE: $82.3586723-8

CPT CODE: $64.0486727-8

CPT CODE: $73.2186732-8

CPT CODE: $64.0486735-8

CPT CODE: $54.9186738-8

CPT CODE: $82.3586741-8

CPT CODE: $73.2186744-8

CPT CODE: $91.4786747-8

CPT CODE: $21.0286750-8

CPT CODE: $64.0486753-8

CPT CODE: $64.0486756-8

CPT CODE: $55.8086757-8

CPT CODE: $19.7086757-P

CPT CODE: $91.4786759-8

CPT CODE: $18.2386762-8

CPT CODE: $82.3586765-8

CPT CODE: $73.2186768-8

CPT CODE: $36.6086771-8

CPT CODE: $109.7786774-8

CPT CODE: $64.0486777-8

CPT CODE: $91.4786778-8

CPT CODE: $15.7586780-8

CPT CODE: $69.5486784-8

CPT CODE: $54.9186787-8

CPT CODE: $38.4686788-8

CPT CODE: $13.5586788-P

CPT CODE: $32.9186789-8

CPT CODE: $11.6186789-P

CPT CODE: $54.9186790-8

CPT CODE: $54.9186793-8

CPT CODE: $56.7086800-8

CPT CODE: $35.5486803-8

CPT CODE: $58.1786804-8

CPT CODE: $61.5086805-8

CPT CODE: $83.1786806-8

Page 49

Page 50: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $126.6686807-8

CPT CODE: $98.2986808-8

CPT CODE: $98.2986812-8

CPT CODE: $150.5786813-8

CPT CODE: $92.3386816-8

CPT CODE: $404.4986817-8

CPT CODE: $313.7786821-8

CPT CODE: $248.0686825-8

CPT CODE: $82.6986826-8

CPT CODE: $57.6286828-8

CPT CODE: $48.0386829-8

CPT CODE: $123.3586830-8

CPT CODE: $105.7386831-8

CPT CODE: $193.8486832-8

CPT CODE: $176.2286833-8

CPT CODE: $546.2886834-8

CPT CODE: $493.4286835-8

CPT CODE: $54.9186849-8

CPT CODE: $10.9886850-8

CPT CODE: $10.9886860-8

CPT CODE: $29.6786870-8

CPT CODE: $14.3586880-8

CPT CODE: $10.7186885-8

CPT CODE: $14.3586886-8

CPT CODE: $129.9286890-8

CPT CODE: $129.9286891-8

CPT CODE: $34.3386900-8

CPT CODE: $18.3086901-8

CPT CODE: $6.3086902-8

CPT CODE: $18.3086904-8

CPT CODE: $16.4786905-8

CPT CODE: $18.3086906-8

CPT CODE: $320.2386910-8

CPT CODE: $18.3086920-8

CPT CODE: $41.1786922-8

CPT CODE: $102.4586927-8

CPT CODE: $8.3186930-8

CPT CODE: $102.4586931-8

CPT CODE: $102.4586932-8

CPT CODE: $16.4786940-8

CPT CODE: $117.1086941-8

CPT CODE: $25.6386965-8

CPT CODE: $45.7586970-8

CPT CODE: $45.7586971-8

CPT CODE: $45.7586972-8

CPT CODE: $45.7586975-8

CPT CODE: $45.7586976-8

CPT CODE: $45.7586977-8

CPT CODE: $45.7586978-8

CPT CODE: $71.8487003-8

CPT CODE: $14.8687015-8

CPT CODE: $41.3287040-8

CPT CODE: $27.0587045-8

CPT CODE: $4.5587046-8

CPT CODE: $1.5987046-P

CPT CODE: $27.3987070-8

CPT CODE: $9.1187071-8

CPT CODE: $3.1987071-P

CPT CODE: $9.1187073-8

CPT CODE: $3.1987073-P

CPT CODE: $29.7087075-8

CPT CODE: $26.9387076-8

CPT CODE: $17.7587077-8

CPT CODE: $6.2887077-P

CPT CODE: $17.0087081-8

CPT CODE: $15.3287084-8

CPT CODE: $24.1087086-8

CPT CODE: $31.2187088-8

CPT CODE: $18.3587101-8

CPT CODE: $25.1487102-8

CPT CODE: $24.5687103-8

CPT CODE: $28.3587106-8

CPT CODE: $19.1087107-8

CPT CODE: $6.7287107-P

CPT CODE: $69.7587109-8

CPT CODE: $26.9387110-8

CPT CODE: $26.4687116-8

CPT CODE: $13.2187118-8

CPT CODE: $37.8187140-8

CPT CODE: $71.8487143-8

CPT CODE: $12.6687147-8

CPT CODE: $67.8887149-8

CPT CODE: $20.3687149-P

CPT CODE: $109.8887150-8

CPT CODE: $19.8487152-8

CPT CODE: $5.9687152-P

CPT CODE: $144.6887153-8

CPT CODE: $49.1487158-8

CPT CODE: $61.9987164-8

CPT CODE: $17.7287166-8

CPT CODE: $7.4687168-8

CPT CODE: $2.2387168-P

CPT CODE: $7.4687169-8

CPT CODE: $2.2387169-P

CPT CODE: $7.4687172-8

CPT CODE: $2.2387172-P

CPT CODE: $22.6887176-8

CPT CODE: $18.8087177-8

CPT CODE: $23.6487181-8

CPT CODE: $16.5687184-8

CPT CODE: $15.8287185-8

CPT CODE: $5.5987185-P

CPT CODE: $28.3587186-8

CPT CODE: $19.1087187-8

CPT CODE: $43.4787188-8

CPT CODE: $11.3587190-8

CPT CODE: $17.0087197-8

CPT CODE: $33.9587198-8

CPT CODE: $11.9587198-P

CPT CODE: $33.9587199-8

CPT CODE: $11.9587199-P

CPT CODE: $8.8987205-8

CPT CODE: $32.1287206-8

CPT CODE: $17.1887207-8

CPT CODE: $118.5887209-8

CPT CODE: $79.6487209-P

CPT CODE: $9.4587210-8

CPT CODE: $9.1387220-8

CPT CODE: $49.1487230-8

CPT CODE: $64.1587250-8

CPT CODE: $46.7887252-8

CPT CODE: $28.3587253-8

CPT CODE: $10.7787254-8

CPT CODE: $3.2287254-P

CPT CODE: $24.3187255-8

CPT CODE: $8.5987255-P

CPT CODE: $43.6387260-8

CPT CODE: $43.6387265-8

CPT CODE: $33.0887267-8

CPT CODE: $11.6487267-P

CPT CODE: $32.4787269-8

CPT CODE: $11.4487269-P

CPT CODE: $43.6387270-8

CPT CODE: $33.0887271-8

CPT CODE: $11.6487271-P

CPT CODE: $43.6387272-8

CPT CODE: $34.3287273-8

CPT CODE: $12.0887273-P

CPT CODE: $43.6387274-8

CPT CODE: $34.3287275-8

CPT CODE: $12.0887275-P

CPT CODE: $43.6387276-8

CPT CODE: $43.6387278-8

CPT CODE: $34.3287279-8

CPT CODE: $12.0887279-P

CPT CODE: $43.6387280-8

CPT CODE: $34.3287281-8

CPT CODE: $12.0887281-P

CPT CODE: $34.3287283-8

CPT CODE: $12.0887283-P

CPT CODE: $43.6387285-8

CPT CODE: $43.6387290-8

Page 50

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2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $43.6387299-8

CPT CODE: $21.4187300-8

CPT CODE: $6.4187300-P

CPT CODE: $87.2487301-8

CPT CODE: $37.0487305-8

CPT CODE: $11.1187305-P

CPT CODE: $43.6387320-8

CPT CODE: $43.6387324-8

CPT CODE: $42.8187327-8

CPT CODE: $12.8487327-P

CPT CODE: $87.2487328-8

CPT CODE: $64.7987329-8

CPT CODE: $22.8687329-P

CPT CODE: $43.6387332-8

CPT CODE: $43.6387335-8

CPT CODE: $42.8187336-8

CPT CODE: $12.8487336-P

CPT CODE: $42.8187337-8

CPT CODE: $12.8487337-P

CPT CODE: $34.3287339-8

CPT CODE: $12.0887339-P

CPT CODE: $30.7287340-8

CPT CODE: $24.1787341-8

CPT CODE: $30.7287350-8

CPT CODE: $46.8887380-8

CPT CODE: $43.6387385-8

CPT CODE: $36.6687389-8

CPT CODE: $43.6387390-8

CPT CODE: $43.6387391-8

CPT CODE: $21.4187400-8

CPT CODE: $6.4187400-P

CPT CODE: $43.6387420-8

CPT CODE: $43.6387425-8

CPT CODE: $34.3287427-8

CPT CODE: $12.0887427-P

CPT CODE: $43.6387430-8

CPT CODE: $43.6387449-8

CPT CODE: $29.0887450-8

CPT CODE: $22.8387451-8

CPT CODE: $8.0787451-P

CPT CODE: $169.6787471-8

CPT CODE: $193.9087472-8

CPT CODE: $113.1287475-8

CPT CODE: $169.6787476-8

CPT CODE: $113.1287480-8

CPT CODE: $169.6787481-8

CPT CODE: $193.9087482-8

CPT CODE: $113.1287485-8

CPT CODE: $169.6787486-8

CPT CODE: $193.9087487-8

CPT CODE: $113.1287490-8

CPT CODE: $169.6787491-8

CPT CODE: $193.9087492-8

CPT CODE: $109.8887493-8

CPT CODE: $113.1287495-8

CPT CODE: $169.6787496-8

CPT CODE: $193.9087497-8

CPT CODE: $115.2487498-8

CPT CODE: $40.6587498-P

CPT CODE: $110.4987500-8

CPT CODE: $38.9787500-P

CPT CODE: $50.7487501-8

CPT CODE: $87.8187502-8

CPT CODE: $31.2987503-8

CPT CODE: $79.8587505-8

CPT CODE: $128.4187506-8

CPT CODE: $249.8287507-8

CPT CODE: $113.1287510-8

CPT CODE: $169.6787511-8

CPT CODE: $193.9087512-8

CPT CODE: $169.6787516-8

CPT CODE: $193.9087517-8

CPT CODE: $113.1287520-8

CPT CODE: $169.6787521-8

CPT CODE: $193.9087522-8

CPT CODE: $113.1287525-8

CPT CODE: $169.6787526-8

CPT CODE: $193.9087527-8

CPT CODE: $113.1287528-8

CPT CODE: $169.6787529-8

CPT CODE: $193.9087530-8

CPT CODE: $113.1287531-8

CPT CODE: $169.6787532-8

CPT CODE: $193.9087533-8

CPT CODE: $113.1287534-8

CPT CODE: $169.6787535-8

CPT CODE: $193.9087536-8

CPT CODE: $113.1287537-8

CPT CODE: $169.6787538-8

CPT CODE: $193.9087539-8

CPT CODE: $113.1287540-8

CPT CODE: $169.6787541-8

CPT CODE: $193.9087542-8

CPT CODE: $113.1287550-8

CPT CODE: $169.6787551-8

CPT CODE: $193.9087552-8

CPT CODE: $113.1287555-8

CPT CODE: $169.6787556-8

CPT CODE: $193.9087557-8

CPT CODE: $113.1287560-8

CPT CODE: $169.6787561-8

CPT CODE: $193.9087562-8

CPT CODE: $113.1287580-8

CPT CODE: $169.6787581-8

CPT CODE: $193.9087582-8

CPT CODE: $113.1287590-8

CPT CODE: $169.6787591-8

CPT CODE: $193.9087592-8

CPT CODE: $25.5687623-8

CPT CODE: $25.5687624-8

CPT CODE: $25.5687625-8

CPT CODE: $140.5187631-8

CPT CODE: $257.4587632-8

CPT CODE: $549.8087633-8

CPT CODE: $115.2487640-8

CPT CODE: $40.6587640-P

CPT CODE: $115.2487641-8

CPT CODE: $40.6587641-P

CPT CODE: $113.1287650-8

CPT CODE: $169.6787651-8

CPT CODE: $193.9087652-8

CPT CODE: $115.2487653-8

CPT CODE: $40.6587653-P

CPT CODE: $83.9887660-8

CPT CODE: $29.6487660-P

CPT CODE: $34.6187661-8

CPT CODE: $113.1287797-8

CPT CODE: $169.6787798-8

CPT CODE: $193.9087799-8

CPT CODE: $67.8887800-8

CPT CODE: $20.3687800-P

CPT CODE: $108.6187801-8

CPT CODE: $32.5987801-P

CPT CODE: $23.6187802-8

CPT CODE: $11.9587802-P

CPT CODE: $33.9587803-8

CPT CODE: $11.9587803-P

CPT CODE: $27.3087806-8

CPT CODE: $21.9387807-8

CPT CODE: $11.1087807-P

CPT CODE: $20.6587808-8

CPT CODE: $10.4587808-P

CPT CODE: $19.8087809-8

CPT CODE: $10.0287809-P

CPT CODE: $43.6387810-8

CPT CODE: $43.6387850-8

CPT CODE: $43.6387880-8

CPT CODE: $43.6387899-8

CPT CODE: $544.5287901-8

CPT CODE: $162.6287901-P

CPT CODE: $747.4287903-8

CPT CODE: $223.7887903-P

Page 51

Page 52: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $31.3487904-8

CPT CODE: $11.0987904-P

CPT CODE: $15.0987905-8

CPT CODE: $5.3387905-P

CPT CODE: $86.2387906-8

CPT CODE: $161.1587910-8

CPT CODE: $161.1587912-8

CPT CODE: $88.8088104-8

CPT CODE: $68.0688104-P

CPT CODE: $77.5188106-8

CPT CODE: $77.5188106-P

CPT CODE: $77.5188108-8

CPT CODE: $68.0688108-P

CPT CODE: $143.9788112-8

CPT CODE: $79.0488112-P

CPT CODE: $616.9488120-8

CPT CODE: $72.6688120-P

CPT CODE: $521.0088121-8

CPT CODE: $64.1788121-P

CPT CODE: $153.1088125-8

CPT CODE: $49.1488125-P

CPT CODE: $98.2988130-8

CPT CODE: $77.5188130-P

CPT CODE: $28.3588140-8

CPT CODE: $77.5188140-P

CPT CODE: $18.5888141-8

CPT CODE: $14.5588141-P

CPT CODE: $29.9188142-8

CPT CODE: $8.8988142-P

CPT CODE: $29.4088143-8

CPT CODE: $13.5288147-8

CPT CODE: $9.5288147-P

CPT CODE: $13.5288148-8

CPT CODE: $9.5288148-P

CPT CODE: $16.0788150-8

CPT CODE: $11.3588150-P

CPT CODE: $13.7488152-8

CPT CODE: $9.6988152-P

CPT CODE: $13.5288153-8

CPT CODE: $9.5288153-P

CPT CODE: $14.7688155-8

CPT CODE: $15.1188155-P

CPT CODE: $60.4688160-8

CPT CODE: $60.4688160-P

CPT CODE: $60.4688161-8

CPT CODE: $24.5688161-P

CPT CODE: $111.5288162-8

CPT CODE: $111.5288162-P

CPT CODE: $13.5288164-8

CPT CODE: $9.5288164-P

CPT CODE: $13.5288165-8

CPT CODE: $9.5288165-P

CPT CODE: $13.5288166-8

CPT CODE: $9.5288166-P

CPT CODE: $13.5288167-8

CPT CODE: $9.5288167-P

CPT CODE: $94.5188172-8

CPT CODE: $94.5188172-P

CPT CODE: $204.1388173-8

CPT CODE: $94.5188173-P

CPT CODE: $35.9688174-8

CPT CODE: $8.6388174-P

CPT CODE: $35.9688175-8

CPT CODE: $8.6388175-P

CPT CODE: $38.0688177-8

CPT CODE: $29.6188177-P

CPT CODE: $321.3388182-8

CPT CODE: $215.4788182-P

CPT CODE: $73.6588184-8

CPT CODE: $73.6588185-8

CPT CODE: $103.1688187-8

CPT CODE: $103.1688187-P

CPT CODE: $128.7488188-8

CPT CODE: $128.7488188-P

CPT CODE: $169.6488189-8

CPT CODE: $169.6488189-P

CPT CODE: $558.0288230-8

CPT CODE: $680.4788233-8

CPT CODE: $680.4788235-8

CPT CODE: $444.1788237-8

CPT CODE: $680.4788239-8

CPT CODE: $680.4788245-8

CPT CODE: $406.3988248-8

CPT CODE: $374.9588249-8

CPT CODE: $253.2788261-8

CPT CODE: $340.2788262-8

CPT CODE: $680.4788263-8

CPT CODE: $317.7688264-8

CPT CODE: $567.0688267-8

CPT CODE: $463.0988269-8

CPT CODE: $36.5588271-8

CPT CODE: $20.6688272-8

CPT CODE: $61.9788273-8

CPT CODE: $158.8788274-8

CPT CODE: $284.4088275-8

CPT CODE: $73.3788280-8

CPT CODE: $111.5288283-8

CPT CODE: $24.5688285-8

CPT CODE: $88.5888289-8

CPT CODE: $60.4688300-8

CPT CODE: $20.8188300-P

CPT CODE: $102.0788302-8

CPT CODE: $90.7488302-P

CPT CODE: $136.1088304-8

CPT CODE: $98.2988304-P

CPT CODE: $187.1388305-8

CPT CODE: $179.5688305-P

CPT CODE: $330.7888307-8

CPT CODE: $330.7888307-P

CPT CODE: $425.2988309-8

CPT CODE: $425.2988309-P

CPT CODE: $52.9188311-8

CPT CODE: $52.9188311-P

CPT CODE: $45.3788312-8

CPT CODE: $45.3788312-P

CPT CODE: $49.1488313-8

CPT CODE: $47.2488313-P

CPT CODE: $20.8188314-8

CPT CODE: $20.8188314-P

CPT CODE: $32.1288319-8

CPT CODE: $32.1288319-P

CPT CODE: $120.9888321-8

CPT CODE: $120.9888321-P

CPT CODE: $168.2188323-8

CPT CODE: $177.6888323-P

CPT CODE: $160.6788325-8

CPT CODE: $160.6788325-P

CPT CODE: $115.2988329-8

CPT CODE: $115.2988329-P

CPT CODE: $207.9488331-8

CPT CODE: $179.5688331-P

CPT CODE: $107.7488332-8

CPT CODE: $96.4188332-P

CPT CODE: $160.7488333-8

CPT CODE: $140.9988333-P

CPT CODE: $85.6588334-8

CPT CODE: $75.1188334-P

CPT CODE: $80.7488341-8

CPT CODE: $37.8588341-P

CPT CODE: $158.7788342-8

CPT CODE: $153.1088342-P

CPT CODE: $121.0888344-8

CPT CODE: $47.0688344-P

CPT CODE: $170.1088346-8

CPT CODE: $96.4188346-P

CPT CODE: $170.1088347-8

CPT CODE: $96.4188347-P

CPT CODE: $680.4788348-8

CPT CODE: $642.6788348-P

CPT CODE: $80.7488350-8

CPT CODE: $40.6988350-P

CPT CODE: $175.7788355-8

Page 52

Page 53: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $175.7788356-8

CPT CODE: $175.7788358-8

CPT CODE: $144.2088360-8

CPT CODE: $84.4288360-P

CPT CODE: $132.6788361-8

CPT CODE: $74.8088361-P

CPT CODE: $51.4188363-8

CPT CODE: $107.6788364-8

CPT CODE: $29.7188364-P

CPT CODE: $302.4488365-8

CPT CODE: $268.1088367-8

CPT CODE: $98.6288367-P

CPT CODE: $245.0088368-8

CPT CODE: $106.8888368-P

CPT CODE: $72.4488371-8

CPT CODE: $256.1788372-8

CPT CODE: $57.2288387-8

CPT CODE: $45.5388387-P

CPT CODE: $33.8488388-8

CPT CODE: $28.3088388-P

CPT CODE: $9.5288720-8

CPT CODE: $2.8688720-P

CPT CODE: $9.4888738-8

CPT CODE: $9.5288740-8

CPT CODE: $2.8688740-P

CPT CODE: $9.5288741-8

CPT CODE: $2.8688741-P

CPT CODE: $223.0789049-8

CPT CODE: $83.7689049-P

CPT CODE: $20.3889050-8

CPT CODE: $14.5589051-8

CPT CODE: $6.7789055-8

CPT CODE: $2.0289055-P

CPT CODE: $16.3589060-8

CPT CODE: $12.2989125-8

CPT CODE: $17.0089160-8

CPT CODE: $11.8989190-8

CPT CODE: $9.7489220-8

CPT CODE: $35.9989230-8

CPT CODE: $16.7989235-8

CPT CODE: $14.6689300-8

CPT CODE: $14.2889310-8

CPT CODE: $31.7889320-8

CPT CODE: $25.0689321-8

CPT CODE: $7.5389321-P

CPT CODE: $30.6889322-8

CPT CODE: $9.2189322-P

CPT CODE: $120.0389325-8

CPT CODE: $45.3789330-8

CPT CODE: $32.9189331-8

CPT CODE: $9.1689331-P

CPT CODE: $855.2789337-8

CPT CODE: $18.9189355-8

CPT CODE: $1,140.7690371-6

CPT CODE: $1,140.7690371-A

CPT CODE: $1,140.7690371-N

CPT CODE: $1,267.8790375-6

CPT CODE: $1,267.8790375-A

CPT CODE: $1,267.8790375-N

CPT CODE: $1,234.5190376-6

CPT CODE: $1,234.5190376-A

CPT CODE: $1,234.5190376-N

CPT CODE: $189.0790384-6

CPT CODE: $69.9190385-6

CPT CODE: $109.6390389-6

CPT CODE: $109.6390389-A

CPT CODE: $109.6390389-N

CPT CODE: $983.4990396-6

CPT CODE: $983.4990396-A

CPT CODE: $983.4990396-N

CPT CODE: $24.7590460-6

CPT CODE: $24.7590460-A

CPT CODE: $24.7590460-N

CPT CODE: $13.9090461-6

CPT CODE: $13.9090461-A

CPT CODE: $13.9090461-N

CPT CODE: $9.5290471-6

CPT CODE: $9.5290471-A

CPT CODE: $9.5290471-N

CPT CODE: $25.4190472-6

CPT CODE: $25.4190472-A

CPT CODE: $25.4190472-N

CPT CODE: $8.8590473-6

CPT CODE: $8.8590473-A

CPT CODE: $8.8590473-N

CPT CODE: $8.8590474-6

CPT CODE: $8.8590474-A

CPT CODE: $8.8590474-N

CPT CODE: $306.6390586-Q

CPT CODE: $189.2790620-6

CPT CODE: $189.2790620-6

CPT CODE: $136.2990621-6

CPT CODE: $136.2990621-6

CPT CODE: $26.3290630-6

CPT CODE: $103.2990632-6

CPT CODE: $41.3090633-6

CPT CODE: $41.3090634-6

CPT CODE: $41.3090645-6

CPT CODE: $39.7490646-6

CPT CODE: $38.1390647-6

CPT CODE: $42.9090648-6

CPT CODE: $177.6590651-6

CPT CODE: $21.3090654-2

CPT CODE: $21.1790655-6

CPT CODE: $7.9590657-6

CPT CODE: $7.9590658-6

CPT CODE: $22.2590669-6

CPT CODE: $152.3790670-6

CPT CODE: $41.1690673-6

CPT CODE: $209.7290675-6

CPT CODE: $209.7290675-A

CPT CODE: $209.7290675-N

CPT CODE: $127.1090676-6

CPT CODE: $84.2390680-6

CPT CODE: $150.3390681-6

CPT CODE: $69.6390696-6

CPT CODE: $49.9890700-A

CPT CODE: $49.9890700-N

CPT CODE: $22.6890702-6

CPT CODE: $22.6890702-A

CPT CODE: $22.6890702-N

CPT CODE: $22.6890703-6

CPT CODE: $22.6890703-A

CPT CODE: $22.6890703-N

CPT CODE: $41.5790704-6

CPT CODE: $41.5790704-A

CPT CODE: $41.5790704-N

CPT CODE: $43.4790705-6

CPT CODE: $43.4790705-A

CPT CODE: $43.4790705-N

CPT CODE: $43.4790706-6

CPT CODE: $43.4790706-A

CPT CODE: $43.4790706-N

CPT CODE: $77.9490707-6

CPT CODE: $77.9490707-A

CPT CODE: $77.9490707-N

CPT CODE: $58.4590708-6

CPT CODE: $58.4590708-A

CPT CODE: $58.4590708-N

CPT CODE: $41.5790712-6

CPT CODE: $41.5790712-A

CPT CODE: $41.5790712-N

CPT CODE: $53.1690713-6

CPT CODE: $53.1690713-A

CPT CODE: $53.1690713-N

CPT CODE: $26.6890714-6

CPT CODE: $26.6890714-A

CPT CODE: $26.6890714-N

CPT CODE: $54.8690715-6

CPT CODE: $54.8690715-A

CPT CODE: $54.8690715-N

CPT CODE: $20.8190719-6

Page 53

Page 54: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $71.3990720-A

CPT CODE: $71.3990720-N

CPT CODE: $47.2490732-6

CPT CODE: $47.2490732-A

CPT CODE: $47.2490732-N

CPT CODE: $98.0990734-6

CPT CODE: $99.9990735-A

CPT CODE: $99.9990735-N

CPT CODE: $282.3090740-6

CPT CODE: $100.3890743-6

CPT CODE: $52.4390744-6

CPT CODE: $120.0790746-6

CPT CODE: $304.3890747-6

CPT CODE: $88.8890748-6

CPT CODE: $5.6590785-C

CPT CODE: $175.5790791-C

CPT CODE: $185.6090792-C

CPT CODE: $75.9790832-C

CPT CODE: $54.2990833-C

CPT CODE: $102.5290834-C

CPT CODE: $89.9790836-C

CPT CODE: $151.1390837-C

CPT CODE: $132.3990838-C

CPT CODE: $151.1390839-C

CPT CODE: $54.2990840-C

CPT CODE: $179.0290845-B

CPT CODE: $179.0290845-C

CPT CODE: $179.0290845-X

CPT CODE: $152.6790846-B

CPT CODE: $152.6790846-C

CPT CODE: $152.6790846-X

CPT CODE: $182.0090847-B

CPT CODE: $182.0090847-C

CPT CODE: $182.0090847-X

CPT CODE: $101.4590849-B

CPT CODE: $101.4590849-C

CPT CODE: $101.4590849-X

CPT CODE: $82.0690853-B

CPT CODE: $82.0690853-C

CPT CODE: $82.0690853-X

CPT CODE: $70.6190863-C

CPT CODE: $355.3190865-2

CPT CODE: $355.3190865-B

CPT CODE: $355.3190865-C

CPT CODE: $355.3190865-X

CPT CODE: $482.8090869-2

CPT CODE: $280.4790870-B

CPT CODE: $280.4790870-C

CPT CODE: $280.4790870-X

CPT CODE: $120.5990875-C

CPT CODE: $163.6090876-C

CPT CODE: $174.5590880-C

CPT CODE: $209.6190885-C

CPT CODE: $176.0490887-C

CPT CODE: $230.6290935-6

CPT CODE: $500.9190937-6

CPT CODE: $230.6290945-6

CPT CODE: $500.9190947-6

CPT CODE: $586.2990951-6

CPT CODE: $586.2990952-6

CPT CODE: $586.2990953-6

CPT CODE: $566.5090954-6

CPT CODE: $566.5090955-6

CPT CODE: $566.5090956-6

CPT CODE: $555.3790957-6

CPT CODE: $555.3790958-6

CPT CODE: $555.3790959-6

CPT CODE: $494.7690960-6

CPT CODE: $494.7690961-6

CPT CODE: $494.7690962-6

CPT CODE: $586.2990963-6

CPT CODE: $566.5090964-6

CPT CODE: $555.3790965-6

CPT CODE: $494.7690966-6

CPT CODE: $21.0390967-6

CPT CODE: $18.5590968-6

CPT CODE: $17.3290969-6

CPT CODE: $17.3290970-6

CPT CODE: $1,304.2490989-6

CPT CODE: $132.3191000-6

CPT CODE: $141.7591010-6

CPT CODE: $267.1691013-6

CPT CODE: $102.7591013-P

CPT CODE: $94.5191020-6

CPT CODE: $73.7891022-6

CPT CODE: $59.3091022-P

CPT CODE: $122.8591030-6

CPT CODE: $215.1491034-6

CPT CODE: $150.7391034-P

CPT CODE: $100.0391040-6

CPT CODE: $84.9691040-P

CPT CODE: $60.4691065-6

CPT CODE: $968.2291110-5

CPT CODE: $172.1991110-P

CPT CODE: $1,187.4991112-6

CPT CODE: $119.5191112-P

CPT CODE: $206.3591117-6

CPT CODE: $184.9991120-6

CPT CODE: $123.3391120-P

CPT CODE: $153.1091122-6

CPT CODE: $36.9791200-6

CPT CODE: $14.8391200-P

CPT CODE: $105.8592002-6

CPT CODE: $105.8592002-A

CPT CODE: $105.8592002-M

CPT CODE: $105.8592002-N

CPT CODE: $107.7492004-6

CPT CODE: $107.7492004-A

CPT CODE: $107.7492004-M

CPT CODE: $107.7492004-N

CPT CODE: $69.9292012-6

CPT CODE: $69.9292012-A

CPT CODE: $69.9292012-M

CPT CODE: $69.9292012-N

CPT CODE: $100.1792014-6

CPT CODE: $100.1792014-A

CPT CODE: $100.1792014-M

CPT CODE: $100.1792014-N

CPT CODE: $491.4692018-6

CPT CODE: $491.4692018-A

CPT CODE: $491.4692018-M

CPT CODE: $491.4692018-N

CPT CODE: $453.6392019-6

CPT CODE: $453.6392019-A

CPT CODE: $453.6392019-M

CPT CODE: $453.6392019-N

CPT CODE: $52.9192020-6

CPT CODE: $52.9192020-A

CPT CODE: $52.9192020-M

CPT CODE: $52.9192020-N

CPT CODE: $105.8292025-6

CPT CODE: $54.8192060-6

CPT CODE: $54.8192060-A

CPT CODE: $54.8192060-M

CPT CODE: $54.8192060-N

CPT CODE: $45.3792065-6

CPT CODE: $45.3792065-A

CPT CODE: $45.3792065-M

CPT CODE: $45.3792065-N

CPT CODE: $42.8892071-2

CPT CODE: $136.7692072-2

CPT CODE: $60.4692081-6

CPT CODE: $60.4692081-A

CPT CODE: $60.4692081-M

CPT CODE: $60.4692081-N

CPT CODE: $69.9292082-6

CPT CODE: $69.9292082-A

CPT CODE: $69.9292082-M

CPT CODE: $69.9292082-N

CPT CODE: $168.2192083-6

CPT CODE: $168.2192083-A

CPT CODE: $168.2192083-M

Page 54

Page 55: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $168.2192083-N

CPT CODE: $45.3792100-6

CPT CODE: $45.3792100-A

CPT CODE: $45.3792100-M

CPT CODE: $45.3792100-N

CPT CODE: $59.2492132-6

CPT CODE: $25.9992132-P

CPT CODE: $59.2492133-6

CPT CODE: $25.9992133-P

CPT CODE: $59.2492134-6

CPT CODE: $25.9992134-P

CPT CODE: $162.4792136-6

CPT CODE: $162.4792136-A

CPT CODE: $162.4792136-M

CPT CODE: $162.4792136-N

CPT CODE: $76.4492136-P

CPT CODE: $52.9192140-6

CPT CODE: $52.9192140-A

CPT CODE: $52.9192140-M

CPT CODE: $52.9192140-N

CPT CODE: $16.0592145-6

CPT CODE: $8.8192145-P

CPT CODE: $68.0692225-6

CPT CODE: $68.0692225-A

CPT CODE: $68.0692225-M

CPT CODE: $68.0692225-N

CPT CODE: $45.3792226-6

CPT CODE: $45.3792226-A

CPT CODE: $45.3792226-M

CPT CODE: $45.3792226-N

CPT CODE: $58.0392227-A

CPT CODE: $58.0392227-N

CPT CODE: $58.0392227-P

CPT CODE: $58.0392228-A

CPT CODE: $58.0392228-N

CPT CODE: $58.0392228-P

CPT CODE: $130.4392230-6

CPT CODE: $130.4392230-A

CPT CODE: $130.4392230-M

CPT CODE: $130.4392230-N

CPT CODE: $378.0592235-6

CPT CODE: $378.0592235-A

CPT CODE: $378.0592235-M

CPT CODE: $378.0592235-N

CPT CODE: $369.3992240-6

CPT CODE: $90.7492250-6

CPT CODE: $90.7492250-A

CPT CODE: $90.7492250-M

CPT CODE: $90.7492250-N

CPT CODE: $68.0692260-6

CPT CODE: $68.0692260-A

CPT CODE: $68.0692260-M

CPT CODE: $68.0692260-N

CPT CODE: $47.2492265-6

CPT CODE: $47.2492265-A

CPT CODE: $47.2492265-M

CPT CODE: $47.2492265-N

CPT CODE: $194.6692270-6

CPT CODE: $194.6692270-A

CPT CODE: $194.6692270-M

CPT CODE: $194.6692270-N

CPT CODE: $211.7092275-6

CPT CODE: $211.7092275-M

CPT CODE: $187.1392284-6

CPT CODE: $187.1392284-A

CPT CODE: $187.1392284-M

CPT CODE: $187.1392284-N

CPT CODE: $71.8492285-6

CPT CODE: $71.8492285-M

CPT CODE: $283.5392286-6

CPT CODE: $283.5392286-A

CPT CODE: $283.5392286-M

CPT CODE: $283.5392286-N

CPT CODE: $359.1292310-6

CPT CODE: $359.1292310-M

CPT CODE: $77.5192352-6

CPT CODE: $77.5192352-M

CPT CODE: $77.5192353-6

CPT CODE: $77.5192353-M

CPT CODE: $47.2492502-6

CPT CODE: $154.9892502-M

CPT CODE: $213.6092504-6

CPT CODE: $124.7592507-6

CPT CODE: $207.9492511-6

CPT CODE: $122.8592512-6

CPT CODE: $77.5192516-6

CPT CODE: $83.7492521-6

CPT CODE: $70.6292522-6

CPT CODE: $141.2492523-6

CPT CODE: $70.8892524-6

CPT CODE: $41.5792531-6

CPT CODE: $64.2592532-6

CPT CODE: $58.5992533-6

CPT CODE: $64.2592534-6

CPT CODE: $42.5992537-6

CPT CODE: $34.2392537-P

CPT CODE: $45.5492538-6

CPT CODE: $161.1992540-6

CPT CODE: $75.0692540-P

CPT CODE: $215.4792541-6

CPT CODE: $202.2592542-6

CPT CODE: $202.2592543-6

CPT CODE: $60.4692544-6

CPT CODE: $62.3692545-6

CPT CODE: $268.4292546-6

CPT CODE: $35.9192547-6

CPT CODE: $35.0792550-6

CPT CODE: $47.2492551-6

CPT CODE: $47.2492551-V

CPT CODE: $45.3792552-6

CPT CODE: $45.3792552-V

CPT CODE: $60.4692553-6

CPT CODE: $60.4692553-V

CPT CODE: $32.1292555-6

CPT CODE: $32.1292555-V

CPT CODE: $43.4792556-6

CPT CODE: $43.4792556-V

CPT CODE: $88.8092557-6

CPT CODE: $88.8092557-V

CPT CODE: $33.6192558-2

CPT CODE: $10.9992558-P

CPT CODE: $20.8192559-6

CPT CODE: $20.8192559-V

CPT CODE: $39.6792560-6

CPT CODE: $39.6792560-V

CPT CODE: $34.0192561-6

CPT CODE: $34.0192561-V

CPT CODE: $13.2192562-6

CPT CODE: $13.2192562-V

CPT CODE: $13.2192563-6

CPT CODE: $13.2192563-V

CPT CODE: $13.2192564-6

CPT CODE: $13.2192564-V

CPT CODE: $22.6892565-6

CPT CODE: $22.6892565-V

CPT CODE: $49.1492567-6

CPT CODE: $49.1492567-V

CPT CODE: $37.8192568-6

CPT CODE: $37.8192568-V

CPT CODE: $86.1392570-6

CPT CODE: $86.1392570-V

CPT CODE: $62.3692571-6

CPT CODE: $62.3692571-V

CPT CODE: $39.6792572-6

CPT CODE: $39.6792572-V

CPT CODE: $20.8192573-6

CPT CODE: $20.8192573-V

CPT CODE: $43.4792575-6

CPT CODE: $43.4792575-V

CPT CODE: $43.4792576-6

CPT CODE: $43.4792576-V

CPT CODE: $22.6892577-6

Page 55

Page 56: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $22.6892577-V

CPT CODE: $140.3492579-6

CPT CODE: $49.1492582-6

CPT CODE: $141.7592583-6

CPT CODE: $211.7092584-6

CPT CODE: $321.3392585-6

CPT CODE: $38.2092587-6

CPT CODE: $62.5192588-6

CPT CODE: $106.4292601-6

CPT CODE: $106.4292602-6

CPT CODE: $96.3692603-6

CPT CODE: $96.3692604-6

CPT CODE: $106.4292605-6

CPT CODE: $106.4292606-6

CPT CODE: $106.4292607-6

CPT CODE: $53.2292608-6

CPT CODE: $106.4292609-6

CPT CODE: $106.4292610-6

CPT CODE: $130.8892611-6

CPT CODE: $149.5892612-6

CPT CODE: $60.4092613-P

CPT CODE: $168.2792614-6

CPT CODE: $67.5992615-P

CPT CODE: $43.1492616-6

CPT CODE: $74.7992617-P

CPT CODE: $33.4592618-2

CPT CODE: $49.3392620-6

CPT CODE: $12.3392621-6

CPT CODE: $43.8592625-6

CPT CODE: $25.0492626-6

CPT CODE: $25.0492627-6

CPT CODE: $171.2992630-6

CPT CODE: $171.2992633-6

CPT CODE: $1,250.4192920-6

CPT CODE: $408.9292921-6

CPT CODE: $1,528.7892924-6

CPT CODE: $280.1592925-6

CPT CODE: $1,256.1492928-6

CPT CODE: $571.5992929-6

CPT CODE: $1,677.4892933-6

CPT CODE: $280.1592934-6

CPT CODE: $1,457.9092937-6

CPT CODE: $280.1592938-6

CPT CODE: $1,677.4892941-6

CPT CODE: $1,677.4892943-6

CPT CODE: $280.1592944-6

CPT CODE: $292.9792950-6

CPT CODE: $292.9792950-A

CPT CODE: $359.1292953-6

CPT CODE: $349.6792960-6

CPT CODE: $349.6792960-A

CPT CODE: $464.1192961-6

CPT CODE: $287.7592961-P

CPT CODE: $1,158.3592973-6

CPT CODE: $472.2092974-6

CPT CODE: $5,472.1492986-6

CPT CODE: $5,027.1092987-6

CPT CODE: $5,472.1492990-6

CPT CODE: $2,945.5692992-6

CPT CODE: $5,891.1292993-6

CPT CODE: $2,609.5392997-6

CPT CODE: $1,268.4292998-6

CPT CODE: $88.8093000-6

CPT CODE: $88.8093000-A

CPT CODE: $88.8093000-N

CPT CODE: $71.8493005-6

CPT CODE: $71.8493005-A

CPT CODE: $71.8493005-N

CPT CODE: $26.4693010-6

CPT CODE: $37.8193010-A

CPT CODE: $37.8193010-N

CPT CODE: $321.3393015-6

CPT CODE: $100.9793016-6

CPT CODE: $96.4193017-6

CPT CODE: $185.2393018-6

CPT CODE: $803.3693024-6

CPT CODE: $803.3693024-A

CPT CODE: $803.3693024-N

CPT CODE: $54.8193040-6

CPT CODE: $13.2193041-6

CPT CODE: $18.9193042-6

CPT CODE: $510.3693224-6

CPT CODE: $119.0893225-6

CPT CODE: $204.1393226-6

CPT CODE: $187.1393227-6

CPT CODE: $68.6093260-6

CPT CODE: $44.5793260-P

CPT CODE: $58.1093261-6

CPT CODE: $41.7993261-P

CPT CODE: $281.5993268-6

CPT CODE: $71.2293270-6

CPT CODE: $138.9393271-6

CPT CODE: $57.3193272-6

CPT CODE: $164.4593278-6

CPT CODE: $77.5193278-P

CPT CODE: $66.8993279-6

CPT CODE: $43.1693279-P

CPT CODE: $78.9893280-6

CPT CODE: $51.7993280-P

CPT CODE: $92.3693281-6

CPT CODE: $60.4293281-P

CPT CODE: $85.4593282-6

CPT CODE: $56.5493282-P

CPT CODE: $104.0193283-6

CPT CODE: $71.2193283-P

CPT CODE: $121.7093284-6

CPT CODE: $84.5993284-P

CPT CODE: $57.8393285-6

CPT CODE: $35.3993285-P

CPT CODE: $32.8093286-6

CPT CODE: $18.1293286-P

CPT CODE: $43.1693287-6

CPT CODE: $26.3293287-P

CPT CODE: $51.7993288-6

CPT CODE: $28.9293288-P

CPT CODE: $79.4193289-6

CPT CODE: $52.2293289-P

CPT CODE: $38.4193290-6

CPT CODE: $25.4793290-P

CPT CODE: $49.6293291-6

CPT CODE: $29.3593291-P

CPT CODE: $44.8993292-6

CPT CODE: $28.9293292-P

CPT CODE: $71.6493293-6

CPT CODE: $20.2993293-P

CPT CODE: $44.0293294-6

CPT CODE: $79.4193295-6

CPT CODE: $43.5993296-6

CPT CODE: $30.6493297-6

CPT CODE: $35.3993298-6

CPT CODE: $545.0293303-6

CPT CODE: $246.2693303-P

CPT CODE: $359.5393304-6

CPT CODE: $95.2393304-P

CPT CODE: $320.2293306-6

CPT CODE: $320.2293306-A

CPT CODE: $320.2293306-N

CPT CODE: $85.8893306-P

CPT CODE: $444.1793307-6

CPT CODE: $444.1793307-A

CPT CODE: $444.1793307-N

CPT CODE: $196.5793307-P

CPT CODE: $281.6693308-6

CPT CODE: $281.6693308-A

CPT CODE: $281.6693308-N

CPT CODE: $77.5193308-P

CPT CODE: $982.9393312-6

CPT CODE: $595.4093312-P

CPT CODE: $161.0493313-6

CPT CODE: $161.0493313-P

CPT CODE: $177.5193314-6

CPT CODE: $177.5193314-P

Page 56

Page 57: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $1,231.2693315-6

CPT CODE: $750.2693315-P

CPT CODE: $201.9393316-6

CPT CODE: $200.3093316-P

CPT CODE: $226.5493317-6

CPT CODE: $224.9193317-P

CPT CODE: $257.0793320-6

CPT CODE: $257.0793320-A

CPT CODE: $257.0793320-N

CPT CODE: $68.0693320-P

CPT CODE: $281.6693321-6

CPT CODE: $77.5193321-P

CPT CODE: $746.6293350-6

CPT CODE: $331.4493351-6

CPT CODE: $46.1793352-6

CPT CODE: $244.6493355-6

CPT CODE: $936.8893451-6

CPT CODE: $495.6493451-P

CPT CODE: $1,470.0093452-6

CPT CODE: $563.9493452-P

CPT CODE: $1,849.5993453-6

CPT CODE: $939.9093453-P

CPT CODE: $1,512.3193454-6

CPT CODE: $704.7893454-P

CPT CODE: $2,104.6693455-6

CPT CODE: $866.7793455-P

CPT CODE: $1,897.3493456-6

CPT CODE: $923.5893456-P

CPT CODE: $2,489.6993457-6

CPT CODE: $1,085.5793457-P

CPT CODE: $1,916.0893458-6

CPT CODE: $767.0393458-P

CPT CODE: $2,508.4393459-6

CPT CODE: $925.4093459-P

CPT CODE: $2,295.6693460-6

CPT CODE: $1,143.0093460-P

CPT CODE: $2,888.0293461-6

CPT CODE: $1,304.9993461-P

CPT CODE: $407.3993462-6

CPT CODE: $154.5793463-6

CPT CODE: $366.9393464-6

CPT CODE: $136.0693464-P

CPT CODE: $765.5593503-6

CPT CODE: $759.3793503-P

CPT CODE: $765.5593505-6

CPT CODE: $765.5593505-P

CPT CODE: $744.8993530-6

CPT CODE: $1,250.6293531-6

CPT CODE: $1,200.5593532-6

CPT CODE: $1,250.6293533-6

CPT CODE: $642.6793561-6

CPT CODE: $642.6793561-P

CPT CODE: $158.7793562-6

CPT CODE: $158.7793562-P

CPT CODE: $446.0893563-6

CPT CODE: $805.1193564-6

CPT CODE: $309.4793565-6

CPT CODE: $365.0893566-6

CPT CODE: $305.2493567-6

CPT CODE: $238.7593568-6

CPT CODE: $2,506.8093580-6

CPT CODE: $738.8793582-6

CPT CODE: $822.3893583-6

CPT CODE: $311.8893600-6

CPT CODE: $311.8893600-P

CPT CODE: $349.6793602-6

CPT CODE: $349.6793602-P

CPT CODE: $359.1293603-6

CPT CODE: $359.1293603-P

CPT CODE: $519.8093610-6

CPT CODE: $519.8093610-P

CPT CODE: $359.1293612-6

CPT CODE: $359.1293612-P

CPT CODE: $359.1293618-6

CPT CODE: $359.1293618-P

CPT CODE: $1,901.2493619-6

CPT CODE: $758.7293619-P

CPT CODE: $2,296.5893620-6

CPT CODE: $2,296.5893620-P

CPT CODE: $2,655.7493621-6

CPT CODE: $2,655.7493621-P

CPT CODE: $2,655.7493622-6

CPT CODE: $2,655.7493622-P

CPT CODE: $359.1293623-6

CPT CODE: $359.1293623-P

CPT CODE: $708.8293624-6

CPT CODE: $708.8293624-P

CPT CODE: $3,714.2593631-6

CPT CODE: $3,714.2593631-P

CPT CODE: $359.1293640-6

CPT CODE: $359.1293640-P

CPT CODE: $357.0593641-6

CPT CODE: $142.8393641-P

CPT CODE: $357.0593642-6

CPT CODE: $142.8393642-P

CPT CODE: $311.3293644-6

CPT CODE: $193.2293644-P

CPT CODE: $5,179.1793650-6

CPT CODE: $5,179.1793650-P

CPT CODE: $2,014.8993653-6

CPT CODE: $2,421.9093654-6

CPT CODE: $459.4393655-6

CPT CODE: $2,421.9093656-6

CPT CODE: $459.6393657-6

CPT CODE: $240.0893660-6

CPT CODE: $240.0893660-P

CPT CODE: $112.9893702-6

CPT CODE: $108.9193724-6

CPT CODE: $42.8493724-P

CPT CODE: $95.9293745-6

CPT CODE: $34.2693745-P

CPT CODE: $7.5693770-6

CPT CODE: $614.3193880-6

CPT CODE: $279.7693880-P

CPT CODE: $206.0293882-6

CPT CODE: $94.5193882-P

CPT CODE: $290.5393886-6

CPT CODE: $139.9093886-P

CPT CODE: $79.4093888-6

CPT CODE: $47.2493888-P

CPT CODE: $303.4793922-6

CPT CODE: $166.0493922-P

CPT CODE: $303.4793923-6

CPT CODE: $166.0493923-P

CPT CODE: $321.3393924-6

CPT CODE: $167.8093924-P

CPT CODE: $321.3393925-6

CPT CODE: $168.2193925-P

CPT CODE: $107.7493926-6

CPT CODE: $56.7093926-P

CPT CODE: $251.5793930-6

CPT CODE: $160.6793930-P

CPT CODE: $71.8493931-6

CPT CODE: $54.8193931-P

CPT CODE: $281.6693970-6

CPT CODE: $139.9093970-P

CPT CODE: $94.5193971-6

CPT CODE: $47.1393971-P

CPT CODE: $614.3193975-6

CPT CODE: $279.7693975-P

CPT CODE: $206.0293976-6

CPT CODE: $94.5193976-P

CPT CODE: $614.3193978-6

CPT CODE: $139.9093978-P

CPT CODE: $206.0293979-6

CPT CODE: $47.2493979-P

CPT CODE: $283.6393980-6

CPT CODE: $139.0493980-P

CPT CODE: $95.1693981-6

CPT CODE: $47.5893981-P

CPT CODE: $71.2293990-6

CPT CODE: $163.8994002-6

Page 57

Page 58: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $163.8994002-A

CPT CODE: $163.8994002-N

CPT CODE: $55.4994003-6

CPT CODE: $55.4994003-A

CPT CODE: $55.4994003-N

CPT CODE: $163.8994004-6

CPT CODE: $163.8994004-A

CPT CODE: $163.8994004-N

CPT CODE: $100.1794010-6

CPT CODE: $100.1794010-A

CPT CODE: $100.1794010-N

CPT CODE: $54.8194010-P

CPT CODE: $129.2094011-6

CPT CODE: $199.3494012-6

CPT CODE: $42.4594013-6

CPT CODE: $252.6494014-6

CPT CODE: $66.7494015-6

CPT CODE: $54.0394016-6

CPT CODE: $130.4394060-6

CPT CODE: $130.4394060-A

CPT CODE: $130.4394060-N

CPT CODE: $81.2694060-P

CPT CODE: $292.9794070-6

CPT CODE: $292.9794070-A

CPT CODE: $292.9794070-N

CPT CODE: $68.0694070-P

CPT CODE: $58.5994150-6

CPT CODE: $58.5994150-A

CPT CODE: $58.5994150-N

CPT CODE: $69.9294200-6

CPT CODE: $69.9294200-A

CPT CODE: $69.9294200-N

CPT CODE: $52.9194250-6

CPT CODE: $52.9194250-A

CPT CODE: $52.9194250-N

CPT CODE: $60.4694375-6

CPT CODE: $60.4694375-A

CPT CODE: $60.4694375-N

CPT CODE: $24.5694375-P

CPT CODE: $98.2994400-6

CPT CODE: $98.2994400-A

CPT CODE: $98.2994400-N

CPT CODE: $78.7294610-6

CPT CODE: $78.7294610-A

CPT CODE: $78.7294610-N

CPT CODE: $254.2194621-6

CPT CODE: $47.2494640-6

CPT CODE: $47.2494640-A

CPT CODE: $47.2494640-N

CPT CODE: $302.4494642-6

CPT CODE: $302.4494642-A

CPT CODE: $302.4494642-N

CPT CODE: $42.5994644-6

CPT CODE: $42.5994644-A

CPT CODE: $42.5994644-N

CPT CODE: $14.2094644-P

CPT CODE: $16.7894645-6

CPT CODE: $16.7894645-A

CPT CODE: $16.7894645-N

CPT CODE: $5.1694645-P

CPT CODE: $202.2594660-6

CPT CODE: $202.2594660-A

CPT CODE: $202.2594660-N

CPT CODE: $37.8194664-6

CPT CODE: $37.8194664-A

CPT CODE: $37.8194664-N

CPT CODE: $52.9194667-6

CPT CODE: $52.9194667-A

CPT CODE: $52.9194667-N

CPT CODE: $33.4194669-6

CPT CODE: $66.1594680-6

CPT CODE: $66.1594680-A

CPT CODE: $66.1594680-N

CPT CODE: $119.0894681-6

CPT CODE: $119.0894681-A

CPT CODE: $119.0894681-N

CPT CODE: $66.1594690-6

CPT CODE: $66.1594690-A

CPT CODE: $66.1594690-N

CPT CODE: $82.7494726-6

CPT CODE: $19.9594726-P

CPT CODE: $65.3394727-6

CPT CODE: $19.9594727-P

CPT CODE: $65.3394728-6

CPT CODE: $19.9594728-P

CPT CODE: $81.9494729-6

CPT CODE: $62.3694750-6

CPT CODE: $62.3694750-A

CPT CODE: $62.3694750-N

CPT CODE: $557.6094772-6

CPT CODE: $213.6094772-P

CPT CODE: $58.1894780-6

CPT CODE: $22.6094781-6

CPT CODE: $6.7995000-6*

CPT CODE: $5.6695004-6*

CPT CODE: $85.2495017-6

CPT CODE: $29.5395018-6

CPT CODE: $15.5595024-6*

CPT CODE: $6.7995027-6*

CPT CODE: $20.8995028-6*

CPT CODE: $8.9295044-6

CPT CODE: $22.6895060-6

CPT CODE: $20.8195065-6

CPT CODE: $141.7595070-6

CPT CODE: $121.7295076-6

CPT CODE: $87.0695079-6

CPT CODE: $9.4595115-6

CPT CODE: $9.4595117-6

CPT CODE: $13.2195120-6

CPT CODE: $20.8195125-6

CPT CODE: $49.1495130-6

CPT CODE: $32.1295131-6

CPT CODE: $41.5795132-6

CPT CODE: $43.4795133-6

CPT CODE: $43.4795134-6

CPT CODE: $60.6995144-6

CPT CODE: $35.9195145-6

CPT CODE: $20.8195146-6

CPT CODE: $43.4795147-6

CPT CODE: $45.3795148-6

CPT CODE: $41.5795149-6

CPT CODE: $107.1195165-6

CPT CODE: $77.5195170-6

CPT CODE: $52.9195180-6

CPT CODE: $25.0495251-6

CPT CODE: $1,066.0295782-6

CPT CODE: $292.5795782-P

CPT CODE: $1,116.4595783-6

CPT CODE: $305.0095783-P

CPT CODE: $1,613.2395800-6

CPT CODE: $81.7895800-P

CPT CODE: $2,723.4295801-6

CPT CODE: $72.9295801-P

CPT CODE: $765.5595805-6

CPT CODE: $303.4795805-P

CPT CODE: $887.0995806-6

CPT CODE: $1,213.9495807-6

CPT CODE: $482.0195807-P

CPT CODE: $1,213.9495808-6

CPT CODE: $482.0195808-P

CPT CODE: $1,213.9495810-6

CPT CODE: $482.0195810-P

CPT CODE: $985.6595811-6

CPT CODE: $463.7495811-P

CPT CODE: $230.9795812-6

CPT CODE: $230.9795813-6

CPT CODE: $156.8595816-6

CPT CODE: $234.3995819-6

CPT CODE: $128.5395819-P

CPT CODE: $228.7295822-6

CPT CODE: $172.0095824-6

CPT CODE: $292.9795827-6

Page 58

Page 59: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $292.9795827-A

CPT CODE: $292.9795827-N

CPT CODE: $262.7295829-P

CPT CODE: $1,606.6595830-6

CPT CODE: $3,869.2695830-A

CPT CODE: $3,869.2695830-N

CPT CODE: $47.2495831-6

CPT CODE: $49.1495832-6

CPT CODE: $58.5995833-6

CPT CODE: $168.2195834-6

CPT CODE: $66.1595851-6

CPT CODE: $35.9195852-6

CPT CODE: $107.7495857-6

CPT CODE: $251.3695860-6

CPT CODE: $160.6795860-P

CPT CODE: $330.7895861-6

CPT CODE: $223.0495861-P

CPT CODE: $463.0995863-6

CPT CODE: $330.7895863-P

CPT CODE: $604.8695864-6

CPT CODE: $349.6795864-P

CPT CODE: $250.3495865-6

CPT CODE: $129.1295865-P

CPT CODE: $180.5295866-6

CPT CODE: $92.2395866-P

CPT CODE: $111.5295867-6

CPT CODE: $158.7795868-6

CPT CODE: $145.5395869-6

CPT CODE: $137.3595870-6

CPT CODE: $145.5395872-6

CPT CODE: $92.6295872-P

CPT CODE: $100.1495873-6

CPT CODE: $51.3995873-P

CPT CODE: $100.1495874-6

CPT CODE: $51.3995874-P

CPT CODE: $47.4895885-6

CPT CODE: $15.3195885-P

CPT CODE: $75.4795886-6

CPT CODE: $40.8395886-P

CPT CODE: $67.0395887-6

CPT CODE: $32.0995887-P

CPT CODE: $102.1395905-6

CPT CODE: $3.8795905-P

CPT CODE: $97.6195907-6

CPT CODE: $55.5495907-P

CPT CODE: $120.5695908-6

CPT CODE: $69.7295908-P

CPT CODE: $144.3995909-6

CPT CODE: $83.3995909-P

CPT CODE: $190.1595910-6

CPT CODE: $111.4195910-P

CPT CODE: $230.1895911-6

CPT CODE: $138.9295911-P

CPT CODE: $270.2095912-6

CPT CODE: $166.9595912-P

CPT CODE: $313.2195913-6

CPT CODE: $197.7895913-P

CPT CODE: $52.5395921-6

CPT CODE: $18.0595921-P

CPT CODE: $52.5395922-6

CPT CODE: $18.0595922-P

CPT CODE: $52.5395923-6

CPT CODE: $18.0595923-P

CPT CODE: $97.7195924-6

CPT CODE: $55.5795924-P

CPT CODE: $181.4795925-6

CPT CODE: $60.8895926-6

CPT CODE: $60.8895927-6

CPT CODE: $98.6795928-6

CPT CODE: $98.6795928-P

CPT CODE: $98.6795929-6

CPT CODE: $98.6795929-P

CPT CODE: $268.8695930-6

CPT CODE: $109.9395930-P

CPT CODE: $272.1995933-6

CPT CODE: $109.9395933-P

CPT CODE: $132.3195937-6

CPT CODE: $211.8695938-6

CPT CODE: $70.4195938-P

CPT CODE: $391.7395939-6

CPT CODE: $141.2895939-P

CPT CODE: $35.8895940-6

CPT CODE: $784.4395950-6

CPT CODE: $330.7895950-P

CPT CODE: $330.7895951-P

CPT CODE: $741.0795953-6

CPT CODE: $329.3895953-P

CPT CODE: $223.0495955-6

CPT CODE: $223.0495955-A

CPT CODE: $223.0495955-N

CPT CODE: $283.6395956-6

CPT CODE: $375.1095956-P

CPT CODE: $215.4795958-P

CPT CODE: $247.6295961-6

CPT CODE: $98.1995961-P

CPT CODE: $247.6295962-6

CPT CODE: $98.1995962-P

CPT CODE: $92.1495970-6

CPT CODE: $92.1495971-6

CPT CODE: $92.1495972-6

CPT CODE: $92.1495973-6

CPT CODE: $92.1495974-6

CPT CODE: $92.1495975-6

CPT CODE: $123.3395978-6

CPT CODE: $97.2995979-6

CPT CODE: $69.0395990-6

CPT CODE: $69.0395990-Q

CPT CODE: $84.6895991-6

CPT CODE: $84.6895991-Q

CPT CODE: $247.3895992-6

CPT CODE: $169.9796101-6

CPT CODE: $169.9796101-C

CPT CODE: $85.6596102-6

CPT CODE: $85.6596102-C

CPT CODE: $42.1696103-6

CPT CODE: $42.1696103-C

CPT CODE: $197.9296105-6

CPT CODE: $197.9296105-C

CPT CODE: $173.0596110-6

CPT CODE: $173.0596110-C

CPT CODE: $155.1696111-6

CPT CODE: $155.1696111-C

CPT CODE: $77.7496116-6

CPT CODE: $77.7496116-C

CPT CODE: $140.9996118-6

CPT CODE: $140.9996118-C

CPT CODE: $71.1596119-6

CPT CODE: $71.1596119-C

CPT CODE: $56.6696120-6

CPT CODE: $56.6696120-C

CPT CODE: $159.6196125-6

CPT CODE: $159.6196125-C

CPT CODE: $5.1896127-6

CPT CODE: $72.9896360-6

CPT CODE: $23.5096361-6

CPT CODE: $89.0696365-6

CPT CODE: $30.9296366-6

CPT CODE: $49.4896367-6

CPT CODE: $29.6996368-6

CPT CODE: $189.8796369-6

CPT CODE: $19.7996370-6

CPT CODE: $87.8296371-6

CPT CODE: $21.0396372-6

CPT CODE: $21.0396372-A

CPT CODE: $21.0396372-C

CPT CODE: $21.0396372-N

CPT CODE: $66.7996374-6

CPT CODE: $30.9296375-6

CPT CODE: $64.5796401-6

CPT CODE: $64.5796401-Q

CPT CODE: $44.8096402-6

CPT CODE: $44.8096402-Q

Page 59

Page 60: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $62.4796405-Q

CPT CODE: $137.4696406-Q

CPT CODE: $150.2096409-6

CPT CODE: $150.2096409-Q

CPT CODE: $88.2896411-6

CPT CODE: $88.2896411-Q

CPT CODE: $212.1496413-6

CPT CODE: $212.1496413-Q

CPT CODE: $48.7696415-6

CPT CODE: $48.7696415-Q

CPT CODE: $227.9596416-6

CPT CODE: $227.9596416-Q

CPT CODE: $104.1096417-6

CPT CODE: $104.1096417-Q

CPT CODE: $92.6296420-Q

CPT CODE: $149.3296422-Q

CPT CODE: $43.4796423-Q

CPT CODE: $102.0796425-Q

CPT CODE: $260.8796440-Q

CPT CODE: $442.4596446-Q

CPT CODE: $260.8796450-Q

CPT CODE: $188.4296521-Q

CPT CODE: $135.7296522-6

CPT CODE: $135.7296522-Q

CPT CODE: $34.2696523-6

CPT CODE: $34.2696523-Q

CPT CODE: $91.4796542-Q

CPT CODE: $32.5796900-6

CPT CODE: $53.7196910-6

CPT CODE: $54.9696912-6

CPT CODE: $173.0596913-6

CPT CODE: $188.4196920-6

CPT CODE: $202.7896921-6

CPT CODE: $268.9596922-6

CPT CODE: $46.2698925-6

CPT CODE: $55.2098926-6

CPT CODE: $69.6398927-6

CPT CODE: $98.1998928-6

CPT CODE: $141.0698929-6

CPT CODE: $130.4399002-6

CPT CODE: $19.7799051-6

CPT CODE: $270.3199078-6

CPT CODE: $270.3199078-A

CPT CODE: $270.3199078-N

CPT CODE: $79.9099080-6

CPT CODE: $184.0999170-6

CPT CODE: $129.8099175-6

CPT CODE: $129.8099175-A

CPT CODE: $129.8099175-B

CPT CODE: $129.8099175-C

CPT CODE: $129.8099175-N

CPT CODE: $129.8099175-R

CPT CODE: $33.8899177-6

CPT CODE: $73.2199183-6

CPT CODE: $73.2199183-A

CPT CODE: $248.7899184-6

CPT CODE: $22.2199188-6

CPT CODE: $66.1599195-6

CPT CODE: $66.1599195-A

CPT CODE: $63.9399201-6

CPT CODE: $63.9399201-A

CPT CODE: $69.1199201-C

CPT CODE: $63.9399201-N

CPT CODE: $63.9399201-Q

CPT CODE: $79.4499202-6

CPT CODE: $79.4499202-A

CPT CODE: $87.0799202-C

CPT CODE: $79.4499202-N

CPT CODE: $79.4499202-Q

CPT CODE: $112.3799203-6

CPT CODE: $112.3799203-A

CPT CODE: $119.2899203-C

CPT CODE: $112.3799203-N

CPT CODE: $112.3799203-Q

CPT CODE: $161.1999204-6

CPT CODE: $161.1999204-A

CPT CODE: $174.1299204-C

CPT CODE: $161.1999204-N

CPT CODE: $161.1999204-Q

CPT CODE: $240.2799205-6

CPT CODE: $240.2799205-A

CPT CODE: $240.2799205-C

CPT CODE: $240.2799205-N

CPT CODE: $240.2799205-Q

CPT CODE: $44.5599211-6

CPT CODE: $44.5599211-A

CPT CODE: $44.5599211-C

CPT CODE: $44.5599211-N

CPT CODE: $44.5599211-Q

CPT CODE: $60.0499212-6

CPT CODE: $60.0499212-A

CPT CODE: $60.0499212-C

CPT CODE: $60.0499212-N

CPT CODE: $60.0499212-Q

CPT CODE: $69.7599213-6

CPT CODE: $69.7599213-A

CPT CODE: $69.7599213-C

CPT CODE: $69.7599213-N

CPT CODE: $69.7599213-Q

CPT CODE: $91.0599214-6

CPT CODE: $91.0599214-A

CPT CODE: $91.0599214-C

CPT CODE: $91.0599214-N

CPT CODE: $91.0599214-Q

CPT CODE: $133.6699215-6

CPT CODE: $133.6699215-A

CPT CODE: $133.6699215-C

CPT CODE: $133.6699215-N

CPT CODE: $133.6699215-Q

CPT CODE: $105.3399217-6

CPT CODE: $124.4399218-6

CPT CODE: $124.4399218-A

CPT CODE: $159.2099219-6

CPT CODE: $159.2099219-A

CPT CODE: $234.2199220-6

CPT CODE: $234.2199220-A

CPT CODE: $124.7599221-6

CPT CODE: $124.7599221-B

CPT CODE: $124.7599221-C

CPT CODE: $124.7599221-N

CPT CODE: $158.7799222-6

CPT CODE: $158.7799222-B

CPT CODE: $158.7799222-C

CPT CODE: $158.7799222-N

CPT CODE: $234.3999223-6

CPT CODE: $234.3999223-B

CPT CODE: $234.3999223-C

CPT CODE: $234.3999223-N

CPT CODE: $34.4599224-6

CPT CODE: $34.4599224-A

CPT CODE: $34.4599224-C

CPT CODE: $34.4599224-N

CPT CODE: $34.4599224-Q

CPT CODE: $34.4599224-X

CPT CODE: $61.6599225-6

CPT CODE: $61.6599225-A

CPT CODE: $61.6599225-C

CPT CODE: $61.6599225-N

CPT CODE: $61.6599225-Q

CPT CODE: $61.6599225-X

CPT CODE: $91.8799226-6

CPT CODE: $91.8799226-A

CPT CODE: $91.8799226-C

CPT CODE: $91.8799226-N

CPT CODE: $91.8799226-Q

CPT CODE: $91.8799226-X

CPT CODE: $66.1599231-6

CPT CODE: $66.1599231-B

CPT CODE: $66.1599231-C

CPT CODE: $66.1599231-E

CPT CODE: $66.1599231-N

CPT CODE: $85.0499232-6

Page 60

Page 61: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $85.0499232-B

CPT CODE: $85.0499232-C

CPT CODE: $85.0499232-E

CPT CODE: $85.0499232-N

CPT CODE: $113.4299233-6

CPT CODE: $113.4299233-B

CPT CODE: $113.4299233-C

CPT CODE: $113.4299233-E

CPT CODE: $113.4299233-N

CPT CODE: $187.4399234-6

CPT CODE: $187.4399234-A

CPT CODE: $187.4399234-C

CPT CODE: $187.4399234-N

CPT CODE: $187.4399234-Q

CPT CODE: $214.9299235-6

CPT CODE: $214.9299235-A

CPT CODE: $214.9299235-C

CPT CODE: $214.9299235-N

CPT CODE: $214.9299235-Q

CPT CODE: $282.7899236-6

CPT CODE: $282.7899236-A

CPT CODE: $282.7899236-C

CPT CODE: $282.7899236-N

CPT CODE: $282.7899236-Q

CPT CODE: $103.9699238-6

CPT CODE: $103.9699238-B

CPT CODE: $103.9699238-C

CPT CODE: $103.9699238-E

CPT CODE: $103.9699238-N

CPT CODE: $106.5299239-6

CPT CODE: $106.5299239-C

CPT CODE: $106.5299239-D

CPT CODE: $106.5299239-E

CPT CODE: $106.5299239-N

CPT CODE: $127.9099241-9

CPT CODE: $127.9099241-A

CPT CODE: $127.9099241-N

CPT CODE: $158.8699242-9

CPT CODE: $158.8699242-A

CPT CODE: $158.8699242-N

CPT CODE: $184.0399243-9

CPT CODE: $184.0399243-A

CPT CODE: $184.0399243-N

CPT CODE: $240.2799244-9

CPT CODE: $240.2799244-A

CPT CODE: $240.2799244-N

CPT CODE: $265.4299245-9

CPT CODE: $265.4299245-A

CPT CODE: $265.4299245-N

CPT CODE: $124.7599251-9

CPT CODE: $124.7599251-A

CPT CODE: $124.7599251-N

CPT CODE: $154.9899252-9

CPT CODE: $154.9899252-A

CPT CODE: $154.9899252-N

CPT CODE: $179.5699253-9

CPT CODE: $179.5699253-A

CPT CODE: $179.5699253-N

CPT CODE: $234.3999254-9

CPT CODE: $234.3999254-A

CPT CODE: $234.3999254-N

CPT CODE: $268.4299255-9

CPT CODE: $268.4299255-A

CPT CODE: $268.4299255-N

CPT CODE: $60.4699281-6

CPT CODE: $60.4699281-A

CPT CODE: $60.4699281-C

CPT CODE: $60.4699281-N

CPT CODE: $81.2699282-6

CPT CODE: $81.2699282-A

CPT CODE: $81.2699282-C

CPT CODE: $81.2699282-N

CPT CODE: $100.1799283-6

CPT CODE: $100.1799283-A

CPT CODE: $100.1799283-C

CPT CODE: $100.1799283-N

CPT CODE: $122.8599284-6

CPT CODE: $122.8599284-C

CPT CODE: $122.8599284-N

CPT CODE: $183.3299285-6

CPT CODE: $183.3299285-A

CPT CODE: $183.3299285-C

CPT CODE: $183.3299285-N

CPT CODE: $240.0899291-6

CPT CODE: $240.0899291-A

CPT CODE: $240.0899291-B

CPT CODE: $240.0899291-C

CPT CODE: $240.0899291-N

CPT CODE: $179.5699292-6

CPT CODE: $179.5699292-A

CPT CODE: $179.5699292-B

CPT CODE: $179.5699292-C

CPT CODE: $179.5699292-N

CPT CODE: $89.6099304-6

CPT CODE: $89.6099304-A

CPT CODE: $89.6099304-C

CPT CODE: $89.6099304-N

CPT CODE: $119.9199305-6

CPT CODE: $119.9199305-A

CPT CODE: $119.9199305-C

CPT CODE: $119.9199305-N

CPT CODE: $150.2099306-6

CPT CODE: $150.2099306-A

CPT CODE: $150.2099306-C

CPT CODE: $150.2099306-N

CPT CODE: $39.5399307-6

CPT CODE: $39.5399307-A

CPT CODE: $39.5399307-C

CPT CODE: $39.5399307-N

CPT CODE: $65.8899308-6

CPT CODE: $65.8899308-A

CPT CODE: $65.8899308-C

CPT CODE: $65.8899308-N

CPT CODE: $92.2399309-6

CPT CODE: $92.2399309-A

CPT CODE: $92.2399309-C

CPT CODE: $92.2399309-N

CPT CODE: $114.6499310-6

CPT CODE: $114.6499310-A

CPT CODE: $114.6499310-C

CPT CODE: $114.6499310-N

CPT CODE: $92.1199315-6

CPT CODE: $92.1199315-A

CPT CODE: $92.1199315-B

CPT CODE: $92.1199315-C

CPT CODE: $92.1199315-N

CPT CODE: $92.1199316-6

CPT CODE: $92.1199316-A

CPT CODE: $92.1199316-B

CPT CODE: $92.1199316-C

CPT CODE: $92.1199316-N

CPT CODE: $76.4299318-6

CPT CODE: $76.4299318-A

CPT CODE: $76.4299318-C

CPT CODE: $76.4299318-N

CPT CODE: $64.5799324-6

CPT CODE: $64.5799324-A

CPT CODE: $64.5799324-C

CPT CODE: $64.5799324-N

CPT CODE: $96.1999325-6

CPT CODE: $96.1999325-A

CPT CODE: $96.1999325-C

CPT CODE: $96.1999325-N

CPT CODE: $140.9999326-6

CPT CODE: $140.9999326-A

CPT CODE: $140.9999326-C

CPT CODE: $140.9999326-N

CPT CODE: $188.4299327-6

CPT CODE: $188.4299327-A

CPT CODE: $188.4299327-C

CPT CODE: $188.4299327-N

CPT CODE: $235.8599328-6

Page 61

Page 62: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $235.8599328-A

CPT CODE: $235.8599328-C

CPT CODE: $235.8599328-N

CPT CODE: $42.1699334-6

CPT CODE: $42.1699334-A

CPT CODE: $42.1699334-C

CPT CODE: $42.1699334-N

CPT CODE: $69.8499335-6

CPT CODE: $69.8499335-A

CPT CODE: $69.8499335-C

CPT CODE: $69.8499335-N

CPT CODE: $110.6899336-6

CPT CODE: $110.6899336-A

CPT CODE: $110.6899336-C

CPT CODE: $110.6899336-N

CPT CODE: $166.0199337-6

CPT CODE: $166.0199337-A

CPT CODE: $166.0199337-C

CPT CODE: $166.0199337-N

CPT CODE: $92.6299341-6

CPT CODE: $92.6299341-A

CPT CODE: $92.6299341-C

CPT CODE: $92.6299341-N

CPT CODE: $105.8599342-6

CPT CODE: $105.8599342-A

CPT CODE: $105.8599342-C

CPT CODE: $105.8599342-N

CPT CODE: $154.9899343-6

CPT CODE: $154.9899343-A

CPT CODE: $154.9899343-C

CPT CODE: $154.9899343-N

CPT CODE: $221.3799344-6

CPT CODE: $221.3799344-A

CPT CODE: $221.3799344-C

CPT CODE: $221.3799344-N

CPT CODE: $276.3199345-6

CPT CODE: $276.3199345-A

CPT CODE: $276.3199345-C

CPT CODE: $276.3199345-N

CPT CODE: $63.0299347-6

CPT CODE: $63.0299347-A

CPT CODE: $63.0299347-C

CPT CODE: $63.0299347-N

CPT CODE: $85.6499348-6

CPT CODE: $85.6499348-A

CPT CODE: $85.6499348-C

CPT CODE: $85.6499348-N

CPT CODE: $114.7399349-6

CPT CODE: $114.7399349-A

CPT CODE: $114.7399349-C

CPT CODE: $114.7399349-N

CPT CODE: $137.3599350-6

CPT CODE: $137.3599350-A

CPT CODE: $137.3599350-C

CPT CODE: $137.3599350-N

CPT CODE: $248.1599354-6

CPT CODE: $248.1599354-A

CPT CODE: $248.1599354-C

CPT CODE: $248.1599354-E

CPT CODE: $248.1599354-N

CPT CODE: $119.6299355-A

CPT CODE: $119.6299355-C

CPT CODE: $119.6299355-E

CPT CODE: $119.6299355-N

CPT CODE: $248.1599356-6

CPT CODE: $248.1599356-E

CPT CODE: $119.6299357-6

CPT CODE: $319.5899358-6

CPT CODE: $159.7899359-6

CPT CODE: $79.9099367-6

CPT CODE: $79.9099368-6

CPT CODE: $56.7099381-6

CPT CODE: $58.5999382-6

CPT CODE: $65.5699383-6

CPT CODE: $54.8199391-6

CPT CODE: $60.4699392-6

CPT CODE: $60.4699393-6

CPT CODE: $69.9299394-6

CPT CODE: $8.7499415-6

CPT CODE: $0.6099416-6

CPT CODE: $154.6199460-6

CPT CODE: $77.9399462-6

CPT CODE: $232.5499463-6

CPT CODE: $184.3099464-6

CPT CODE: $170.6999465-6

CPT CODE: $170.6999465-A

CPT CODE: $170.6999465-N

CPT CODE: $218.9399466-6

CPT CODE: $218.9399466-A

CPT CODE: $218.9399466-C

CPT CODE: $218.9399466-N

CPT CODE: $132.3599467-6

CPT CODE: $132.3599467-A

CPT CODE: $132.3599467-C

CPT CODE: $132.3599467-N

CPT CODE: $573.9299468-6

CPT CODE: $435.3999469-6

CPT CODE: $573.9299471-6

CPT CODE: $418.0799472-6

CPT CODE: $395.6599475-6

CPT CODE: $346.6399476-6

CPT CODE: $371.1899477-6

CPT CODE: $160.8099478-6

CPT CODE: $148.4399479-6

CPT CODE: $142.2499480-6

CPT CODE: $69.9999485-6

CPT CODE: $37.8999486-6

CPT CODE: $43.2599490-6

CPT CODE: $129.9599495-6

CPT CODE: $183.2699496-6

CPT CODE: $1,142.36A9507-G

CPT CODE: $3,448.40A9523-Q

CPT CODE: $1,045.44A9600-6

CPT CODE: $1,045.44A9600-E

CPT CODE: $1,045.44A9600-Q

CPT CODE: $177.74G0104-2

CPT CODE: $830.52G0105-2

CPT CODE: $239.14G0106-P

CPT CODE: $57.56G0117-6

CPT CODE: $57.56G0117-A

CPT CODE: $57.56G0117-M

CPT CODE: $57.56G0117-N

CPT CODE: $57.56G0117-P

CPT CODE: $908.09G0120-P

CPT CODE: $830.52G0121-2

CPT CODE: $61.39G0122-P

CPT CODE: $325.71G0130-5

CPT CODE: $106.46G0130-P

CPT CODE: $13.52G0141-8

CPT CODE: $29.40G0143-8

CPT CODE: $29.40G0144-8

CPT CODE: $29.40G0145-8

CPT CODE: $13.52G0147-8

CPT CODE: $13.52G0148-8

CPT CODE: $103.29G0202-5

CPT CODE: $48.71G0202-P

CPT CODE: $103.29G0204-5

CPT CODE: $48.71G0204-P

CPT CODE: $2,316.70G0219-5

CPT CODE: $346.77G0219-P

CPT CODE: $71.91G0245-6

CPT CODE: $50.34G0246-6

CPT CODE: $71.91G0247-6

CPT CODE: $1,694.21G0252-6

CPT CODE: $337.97G0252-P

CPT CODE: $2,155.88G0256-E

CPT CODE: $1,498.61G0256-P

CPT CODE: $195.59G0257-6

CPT CODE: $79.10G0259-2

CPT CODE: $2,155.88G0261-E

CPT CODE: $1,498.61G0261-P

CPT CODE: $38.83G0268-2

Page 62

Page 63: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $230.12G0274-P

CPT CODE: $870.12G0275-5

CPT CODE: $405.57G0275-P

CPT CODE: $46.28G0277-6

CPT CODE: $582.47G0278-5

CPT CODE: $185.53G0278-P

CPT CODE: $60.72G0279-5

CPT CODE: $34.21G0279-P

CPT CODE: $33.08G0283-D

CPT CODE: $33.08G0283-N

CPT CODE: $478.92G0288-5

CPT CODE: $107.87G0288-P

CPT CODE: $1,697.08G0289-2

CPT CODE: $100.74G0297-5

CPT CODE: $28.48G0297-P

CPT CODE: $18.35G0306-8

CPT CODE: $5.50G0306-P

CPT CODE: $9.11G0307-8

CPT CODE: $3.17G0307-P

CPT CODE: $26.85G0328-6

CPT CODE: $76.74G0365-6

CPT CODE: $39.74G0365-P

CPT CODE: $35.58G0372-6

CPT CODE: $163.89G0389-5

CPT CODE: $74.85G0389-P

CPT CODE: $44.45G0406-6

CPT CODE: $44.45G0406-9

CPT CODE: $44.45G0406-A

CPT CODE: $44.45G0406-N

CPT CODE: $79.84G0407-6

CPT CODE: $79.84G0407-9

CPT CODE: $79.84G0407-A

CPT CODE: $79.84G0407-N

CPT CODE: $114.36G0408-6

CPT CODE: $114.36G0408-9

CPT CODE: $114.36G0408-A

CPT CODE: $114.36G0408-N

CPT CODE: $10.35G0409-6

CPT CODE: $1,685.90G0412-2

CPT CODE: $1,144.14G0413-2

CPT CODE: $2,426.81G0414-2

CPT CODE: $2,517.10G0415-2

CPT CODE: $715.07G0416-8

CPT CODE: $223.04G0416-P

CPT CODE: $145.20G0420-6

CPT CODE: $145.20G0420-X

CPT CODE: $32.61G0421-6

CPT CODE: $32.61G0421-C

CPT CODE: $32.61G0421-X

CPT CODE: $82.44G0422-6

CPT CODE: $82.44G0423-6

CPT CODE: $38.76G0424-6

CPT CODE: $134.12G0425-6

CPT CODE: $134.12G0425-9

CPT CODE: $134.12G0425-A

CPT CODE: $134.12G0425-N

CPT CODE: $182.11G0426-6

CPT CODE: $182.11G0426-9

CPT CODE: $182.11G0426-A

CPT CODE: $182.11G0426-N

CPT CODE: $267.01G0427-6

CPT CODE: $267.01G0427-9

CPT CODE: $267.01G0427-A

CPT CODE: $267.01G0427-N

CPT CODE: $18.91G0436-C

CPT CODE: $18.91G0436-X

CPT CODE: $36.27G0437-C

CPT CODE: $36.27G0437-X

CPT CODE: $125.72G0438-6

CPT CODE: $114.84G0439-6

CPT CODE: $269.62G0440-2

CPT CODE: $70.12G0441-2

CPT CODE: $22.25G0452-P

CPT CODE: $29.71G0453-6

CPT CODE: $135.11G0455-6

CPT CODE: $106.06G0461-8

CPT CODE: $101.55G0461-P

CPT CODE: $82.02G0462-8

CPT CODE: $41.33G0462-P

CPT CODE: $13.05G0473-6

CPT CODE: $15.55G0475-8

CPT CODE: $25.56G0476-8

CPT CODE: $66.60G0480-8

CPT CODE: $66.60G0481-8

CPT CODE: $66.60G0482-8

CPT CODE: $66.60G0483-8

CPT CODE: $159.95G6001-6

CPT CODE: $72.20G6001-P

CPT CODE: $164.39G6002-6

CPT CODE: $48.87G6002-P

CPT CODE: $188.83G6003-6

CPT CODE: $188.83G6004-6

CPT CODE: $188.83G6005-6

CPT CODE: $188.83G6006-6

CPT CODE: $266.24G6007-6

CPT CODE: $198.82G6008-6

CPT CODE: $198.82G6009-6

CPT CODE: $198.82G6010-6

CPT CODE: $284.75G6011-6

CPT CODE: $235.54G6012-6

CPT CODE: $265.50G6013-6

CPT CODE: $265.13G6014-6

CPT CODE: $964.12G6015-6

CPT CODE: $964.12G6016-6

CPT CODE: $20.92G9141-6

CPT CODE:

J$48.23J0120-6

CPT CODE:

J$48.23J0120-Q

CPT CODE:

J$24.69J0129-6

CPT CODE:

J$24.69J0129-Q

CPT CODE:

J$945.35J0130-6

CPT CODE:

J$0.47J0133-6

CPT CODE:

J$0.47J0133-Q

CPT CODE:

J$113.53J0152-6

CPT CODE:

J$113.53J0152-Q

CPT CODE:

J$0.91J0153-6

CPT CODE:

J$0.11J0171-6

CPT CODE:

J$0.11J0171-Q

CPT CODE:

J$1,107.59J0178-6

CPT CODE:

J$166.27J0180-6

CPT CODE:

J$166.27J0180-Q

CPT CODE:

J$19.65J0190-6

CPT CODE:

J$19.65J0190-Q

CPT CODE:

J$28.62J0200-6

CPT CODE:

J$28.62J0200-Q

CPT CODE:

J$1,955.59J0202-6

CPT CODE:

J$69.63J0205-6

CPT CODE:

J$69.63J0205-Q

CPT CODE:

J$575.24J0207-6

CPT CODE:

J$575.24J0207-Q

CPT CODE:

J$19.65J0210-6

CPT CODE:

J$19.65J0210-Q

CPT CODE:

J$39.80J0215-6

CPT CODE:

J$39.80J0215-Q

CPT CODE:

J$154.04J0220-6

CPT CODE:

J$154.04J0220-Q

CPT CODE:

J$182.35J0256-6

CPT CODE:

J$182.35J0256-Q

CPT CODE:

J$33.37J0275-6

CPT CODE:

J$4.25J0278-6

CPT CODE:

J$4.25J0278-Q

CPT CODE:

J$19.65J0280-6

CPT CODE:

J$19.65J0280-Q

CPT CODE:

J$26.82J0282-6

CPT CODE:

J$26.82J0282-Q

CPT CODE:

J$52.45J0285-6

CPT CODE:

J$52.45J0285-Q

CPT CODE:

J$33.08J0287-6

CPT CODE:

J$33.08J0287-Q

CPT CODE:

J$23.01J0288-6

CPT CODE:

J$23.01J0288-Q

CPT CODE:

J$54.22J0289-6

CPT CODE:

J$54.22J0289-Q

Page 63

Page 64: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE:

J$19.65J0290-6

CPT CODE:

J$19.65J0290-Q

CPT CODE:

J$19.65J0300-6

CPT CODE:

J$19.65J0300-Q

CPT CODE:

J$19.65J0330-6

CPT CODE:

J$19.65J0330-Q

CPT CODE:

J$2.90J0348-6

CPT CODE:

J$2.90J0348-Q

CPT CODE:

J$19.65J0360-6

CPT CODE:

J$19.65J0360-Q

CPT CODE:

J$4.71J0364-6

CPT CODE:

J$4.71J0364-Q

CPT CODE:

J$3.91J0365-6

CPT CODE:

J$3.91J0365-Q

CPT CODE:

J$19.65J0380-6

CPT CODE:

J$19.65J0380-Q

CPT CODE:

J$40.74J0390-6

CPT CODE:

J$40.74J0390-Q

CPT CODE:

J$336.82J0395-6

CPT CODE:

J$336.82J0395-Q

CPT CODE:

J$0.43J0400-6

CPT CODE:

J$0.43J0400-Q

CPT CODE:

J$4.34J0401-6

CPT CODE:

J$36.66J0456-6

CPT CODE:

J$36.66J0456-Q

CPT CODE:

J$0.02J0461-6

CPT CODE:

J$0.02J0461-Q

CPT CODE:

J$62.47J0470-6

CPT CODE:

J$62.47J0470-Q

CPT CODE:

J$386.19J0475-6

CPT CODE:

J$386.19J0475-Q

CPT CODE:

J$136.64J0476-6

CPT CODE:

J$136.64J0476-Q

CPT CODE:

J$2,450.40J0480-6

CPT CODE:

J$2,450.40J0480-Q

CPT CODE:

J$4.42J0485-6

CPT CODE:

J$19.65J0500-6

CPT CODE:

J$19.65J0500-Q

CPT CODE:

J$19.65J0515-6

CPT CODE:

J$19.65J0515-Q

CPT CODE:

J$19.65J0520-6

CPT CODE:

J$19.65J0520-Q

CPT CODE:

J$4.84J0558-6

CPT CODE:

J$4.84J0558-Q

CPT CODE:

J$0.12J0559-6

CPT CODE:

J$0.12J0559-Q

CPT CODE:

J$6.69J0561-6

CPT CODE:

J$6.69J0561-Q

CPT CODE:

J$2.59J0583-6

CPT CODE:

J$2.59J0583-Q

CPT CODE:

J$6.63J0585-6

CPT CODE:

J$6.63J0585-Q

CPT CODE:

J$8.70J0586-6

CPT CODE:

J$8.70J0586-Q

CPT CODE:

J$13.64J0587-6

CPT CODE:

J$13.64J0587-Q

CPT CODE:

J$1.43J0592-6

CPT CODE:

J$1.43J0592-Q

CPT CODE:

J$12.85J0594-Q

CPT CODE:

J$11.42J0595-6

CPT CODE:

J$11.42J0595-Q

CPT CODE:

J$36.74J0596-6

CPT CODE:

J$44.06J0597-6

CPT CODE:

J$44.06J0597-Q

CPT CODE:

J$52.39J0598-6

CPT CODE:

J$52.39J0598-Q

CPT CODE:

J$70.84J0600-6

CPT CODE:

J$70.84J0600-Q

CPT CODE:

J$60.69J0610-6

CPT CODE:

J$60.69J0610-Q

CPT CODE:

J$19.65J0620-6

CPT CODE:

J$19.65J0620-Q

CPT CODE:

J$89.28J0630-6

CPT CODE:

J$89.28J0630-Q

CPT CODE:

J$20.92J0636-6

CPT CODE:

J$20.92J0636-Q

CPT CODE:

J$47.65J0637-6

CPT CODE:

J$47.65J0637-Q

CPT CODE:

J$109.00J0638-6

CPT CODE:

J$109.00J0638-Q

CPT CODE:

J$42.84J0640-Q

CPT CODE:

J$1.62J0641-6

CPT CODE:

J$1.62J0641-Q

CPT CODE:

J$19.65J0670-6

CPT CODE:

J$19.65J0670-Q

CPT CODE:

J$19.65J0690-6

CPT CODE:

J$19.65J0690-Q

CPT CODE:

J$11.80J0692-6

CPT CODE:

J$11.80J0692-Q

CPT CODE:

J$19.65J0694-6

CPT CODE:

J$2,443.06J0695-6

CPT CODE:

J$19.65J0696-6

CPT CODE:

J$19.65J0696-Q

CPT CODE:

J$19.65J0697-6

CPT CODE:

J$19.65J0697-Q

CPT CODE:

J$19.65J0698-6

CPT CODE:

J$19.65J0698-Q

CPT CODE:

J$7.18J0702-6

CPT CODE:

J$7.18J0702-Q

CPT CODE:

J$4.74J0706-6

CPT CODE:

J$4.74J0706-Q

CPT CODE:

J$19.65J0710-6

CPT CODE:

J$19.65J0710-Q

CPT CODE:

J$335.55J0714-6

CPT CODE:

J$6.03J0717-6

CPT CODE:

J$4.81J0718-6

CPT CODE:

J$4.81J0718-Q

CPT CODE:

J$19.65J0720-6

CPT CODE:

J$19.65J0720-Q

CPT CODE:

J$19.65J0725-6

CPT CODE:

J$19.65J0725-Q

CPT CODE:

J$92.11J0735-6

CPT CODE:

J$92.11J0735-Q

CPT CODE:

J$1,257.11J0740-3

CPT CODE:

J$1,292.64J0740-6

CPT CODE:

J$1,292.64J0740-Q

CPT CODE:

J$19.65J0743-6

CPT CODE:

J$19.65J0743-Q

CPT CODE:

J$23.03J0744-6

CPT CODE:

J$23.03J0744-Q

CPT CODE:

J$19.65J0745-6

CPT CODE:

J$19.65J0745-Q

CPT CODE:

J$19.65J0760-6

CPT CODE:

J$19.65J0760-Q

CPT CODE:

J$66.06J0770-6

CPT CODE:

J$66.06J0770-Q

CPT CODE:

J$47.15J0775-6

CPT CODE:

J$47.15J0775-Q

CPT CODE:

J$19.65J0780-6

CPT CODE:

J$19.65J0780-Q

CPT CODE:

J$6.82J0795-6

CPT CODE:

J$6.82J0795-Q

CPT CODE:

J$46.44J0800-6

CPT CODE:

J$46.44J0800-Q

CPT CODE:

J$147.55J0833-6

CPT CODE:

J$147.55J0833-Q

CPT CODE:

J$141.62J0834-6

CPT CODE:

J$141.62J0834-Q

CPT CODE:

J$1,754.30J0875-6

CPT CODE:

J$0.47J0878-6

CPT CODE:

J$0.47J0878-Q

CPT CODE:

J$6.08J0881-6

CPT CODE:

J$6.08J0881-Q

CPT CODE:

J$6.08J0882-6

CPT CODE:

J$6.08J0882-Q

CPT CODE:

J$16.47J0885-6

CPT CODE:

J$16.47J0885-Q

CPT CODE:

J$16.47J0886-6

CPT CODE:

J$16.47J0886-Q

CPT CODE:

J$12.95J0890-6

CPT CODE:

J$32.91J0894-Q

CPT CODE:

J$19.65J0895-6

Page 64

Page 65: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE:

J$19.65J0945-6

CPT CODE:

J$19.65J0945-Q

CPT CODE:

J$19.65J1000-6

CPT CODE:

J$19.65J1000-Q

CPT CODE:

J$19.65J1020-6

CPT CODE:

J$19.65J1020-Q

CPT CODE:

J$19.65J1030-6

CPT CODE:

J$19.65J1030-Q

CPT CODE:

J$19.65J1040-6

CPT CODE:

J$19.65J1040-Q

CPT CODE:

J$0.40J1050-6

CPT CODE:

J$7.38J1051-6

CPT CODE:

J$7.38J1051-Q

CPT CODE:

J$36.82J1056-6

CPT CODE:

J$0.03J1071-6

CPT CODE:

J$1.43J1094-6

CPT CODE:

J$1.43J1094-Q

CPT CODE:

J$19.65J1100-6

CPT CODE:

J$19.65J1100-Q

CPT CODE:

J$19.65J1110-6

CPT CODE:

J$19.65J1110-Q

CPT CODE:

J$74.40J1120-6

CPT CODE:

J$74.40J1120-Q

CPT CODE:

J$19.65J1160-6

CPT CODE:

J$19.65J1160-Q

CPT CODE:

J$790.55J1162-6

CPT CODE:

J$790.55J1162-Q

CPT CODE:

J$19.65J1165-6

CPT CODE:

J$19.65J1165-Q

CPT CODE:

J$19.65J1170-6

CPT CODE:

J$19.65J1170-Q

CPT CODE:

J$19.65J1180-6

CPT CODE:

J$19.65J1180-Q

CPT CODE:

J$19.65J1200-6

CPT CODE:

J$19.65J1200-Q

CPT CODE:

J$19.65J1205-6

CPT CODE:

J$19.65J1205-Q

CPT CODE:

J$83.91J1212-6

CPT CODE:

J$83.91J1212-Q

CPT CODE:

J$19.65J1230-6

CPT CODE:

J$19.65J1230-Q

CPT CODE:

J$19.65J1240-6

CPT CODE:

J$19.65J1240-Q

CPT CODE:

J$58.45J1245-6

CPT CODE:

J$3.17J1260-6

CPT CODE:

J$3.17J1260-Q

CPT CODE:

J$1.01J1267-6

CPT CODE:

J$1.01J1267-Q

CPT CODE:

J$16.33J1270-6

CPT CODE:

J$16.33J1270-Q

CPT CODE:

J$338.29J1290-6

CPT CODE:

J$338.29J1290-Q

CPT CODE:

J$231.62J1300-6

CPT CODE:

J$231.62J1300-Q

CPT CODE:

J$19.65J1320-6

CPT CODE:

J$19.65J1320-Q

CPT CODE:

J$251.49J1322-6

CPT CODE:

J$29.08J1325-6

CPT CODE:

J$29.08J1325-Q

CPT CODE:

J$18.75J1327-6

CPT CODE:

J$18.75J1327-Q

CPT CODE:

J$17.77J1330-Q

CPT CODE:

J$35.27J1335-6

CPT CODE:

J$35.27J1335-Q

CPT CODE:

J$19.65J1380-6

CPT CODE:

J$19.65J1380-Q

CPT CODE:

J$72.63J1410-6

CPT CODE:

J$72.63J1410-Q

CPT CODE:

J$110.35J1430-6

CPT CODE:

J$110.35J1430-Q

CPT CODE:

J$19.65J1435-6

CPT CODE:

J$19.65J1435-Q

CPT CODE:

J$124.96J1436-6

CPT CODE:

J$124.96J1436-Q

CPT CODE:

J$218.89J1438-6

CPT CODE:

J$218.89J1438-Q

CPT CODE:

J$1.18J1439-6

CPT CODE:

J$276.74J1440-Q

CPT CODE:

J$444.53J1441-Q

CPT CODE:

J$1.16J1442-6

CPT CODE:

J$7.24J1443-6

CPT CODE:

J$4.76J1446-6

CPT CODE:

J$1.69J1447-6

CPT CODE:

J$132.44J1450-6

CPT CODE:

J$132.44J1450-Q

CPT CODE:

J$18.24J1451-6

CPT CODE:

J$18.24J1451-Q

CPT CODE:

J$1,491.83J1452-6

CPT CODE:

J$1,491.83J1452-Q

CPT CODE:

J$2.35J1453-6

CPT CODE:

J$2.35J1453-Q

CPT CODE:

J$19.65J1455-6

CPT CODE:

J$19.65J1455-Q

CPT CODE:

J$1.97J1457-6

CPT CODE:

J$1.97J1457-Q

CPT CODE:

J$467.67J1458-6

CPT CODE:

J$467.67J1458-Q

CPT CODE:

J$56.14J1459-6

CPT CODE:

J$56.14J1459-Q

CPT CODE:

J$19.65J1460-6

CPT CODE:

J$19.65J1460-Q

CPT CODE:

J$71.74J1556-6

CPT CODE:

J$19.65J1560-6

CPT CODE:

J$19.65J1560-Q

CPT CODE:

J$57.26J1561-6

CPT CODE:

J$57.26J1561-Q

CPT CODE:

J$45.66J1566-6

CPT CODE:

J$45.66J1566-Q

CPT CODE:

J$55.79J1567-6

CPT CODE:

J$55.79J1567-Q

CPT CODE:

J$69.63J1570-6

CPT CODE:

J$69.63J1570-Q

CPT CODE:

J$51.86J1575-6

CPT CODE:

J$19.65J1580-6

CPT CODE:

J$19.65J1580-Q

CPT CODE:

J$1.48J1590-6

CPT CODE:

J$1.48J1590-Q

CPT CODE:

J$19.65J1600-6

CPT CODE:

J$19.65J1600-Q

CPT CODE:

J$27.51J1602-6

CPT CODE:

J$29.08J1626-6

CPT CODE:

J$29.08J1626-Q

CPT CODE:

J$19.65J1630-6

CPT CODE:

J$19.65J1630-Q

CPT CODE:

J$64.25J1631-6

CPT CODE:

J$64.25J1631-Q

CPT CODE:

J$10.77J1640-6

CPT CODE:

J$10.77J1640-Q

CPT CODE:

J$12.51J1652-6

CPT CODE:

J$12.51J1652-Q

CPT CODE:

J$6.20J1655-6

CPT CODE:

J$6.20J1655-Q

CPT CODE:

J$118.61J1670-6

CPT CODE:

J$118.61J1670-Q

CPT CODE:

J$83.15J1680-6

CPT CODE:

J$83.15J1680-Q

CPT CODE:

J$19.65J1700-6

CPT CODE:

J$19.65J1700-Q

CPT CODE:

J$19.65J1710-6

CPT CODE:

J$19.65J1710-Q

CPT CODE:

J$19.65J1720-6

CPT CODE:

J$19.65J1720-Q

CPT CODE:

J$184.53J1740-6

CPT CODE:

J$184.53J1740-Q

CPT CODE:

J$1.57J1741-6

CPT CODE:

J$279.55J1742-6

CPT CODE:

J$279.55J1742-Q

CPT CODE:

J$94.56J1745-6

CPT CODE:

J$94.56J1745-Q

CPT CODE:

J$0.99J1756-6

CPT CODE:

J$0.99J1756-Q

CPT CODE:

J$47.74J1786-6

Page 65

Page 66: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE:

J$47.74J1786-Q

CPT CODE:

J$19.65J1790-6

CPT CODE:

J$19.65J1790-Q

CPT CODE:

J$19.65J1800-6

CPT CODE:

J$19.65J1800-Q

CPT CODE:

J$19.65J1810-6

CPT CODE:

J$19.65J1810-Q

CPT CODE:

J$0.17J1815-6

CPT CODE:

J$0.17J1815-Q

CPT CODE:

J$1.74J1817-6

CPT CODE:

J$1.74J1817-Q

CPT CODE:

J$987.89J1826-6

CPT CODE:

J$987.89J1826-Q

CPT CODE:

J$280.81J1833-6

CPT CODE:

J$1,363.98J1835-6

CPT CODE:

J$1,363.98J1835-Q

CPT CODE:

J$19.65J1840-6

CPT CODE:

J$19.65J1840-Q

CPT CODE:

J$19.65J1850-6

CPT CODE:

J$19.65J1850-Q

CPT CODE:

J$19.65J1885-6

CPT CODE:

J$19.65J1885-Q

CPT CODE:

J$19.65J1890-6

CPT CODE:

J$19.65J1890-Q

CPT CODE:

J$32.18J1930-6

CPT CODE:

J$32.18J1930-Q

CPT CODE:

J$35.27J1931-6

CPT CODE:

J$35.27J1931-Q

CPT CODE:

J$19.65J1940-6

CPT CODE:

J$19.65J1940-Q

CPT CODE:

J$237.83J1945-6

CPT CODE:

J$237.83J1945-Q

CPT CODE:

J$0.77J1953-6

CPT CODE:

J$0.77J1953-Q

CPT CODE:

J$34.96J1956-6

CPT CODE:

J$34.96J1956-Q

CPT CODE:

J$19.65J1960-6

CPT CODE:

J$19.65J1960-Q

CPT CODE:

J$19.65J1980-6

CPT CODE:

J$19.65J1980-Q

CPT CODE:

J$19.65J1990-6

CPT CODE:

J$19.65J1990-Q

CPT CODE:

J$19.65J2010-6

CPT CODE:

J$19.65J2010-Q

CPT CODE:

J$56.22J2020-6

CPT CODE:

J$56.22J2020-Q

CPT CODE:

J$19.65J2060-6

CPT CODE:

J$19.65J2060-Q

CPT CODE:

J$19.65J2150-6

CPT CODE:

J$19.65J2150-Q

CPT CODE:

J$19.65J2160-6

CPT CODE:

J$19.65J2160-Q

CPT CODE:

J$19.65J2175-6

CPT CODE:

J$19.65J2175-Q

CPT CODE:

J$19.65J2180-6

CPT CODE:

J$19.65J2180-Q

CPT CODE:

J$7.75J2185-6

CPT CODE:

J$7.75J2185-Q

CPT CODE:

J$19.65J2210-6

CPT CODE:

J$19.65J2210-Q

CPT CODE:

J$0.46J2212-6

CPT CODE:

J$2.57J2248-6

CPT CODE:

J$2.57J2248-Q

CPT CODE:

J$19.65J2270-6

CPT CODE:

J$19.65J2270-Q

CPT CODE:

J$9.39J2274-6

CPT CODE:

J$9.19J2278-6

CPT CODE:

J$9.19J2278-Q

CPT CODE:

J$15.44J2280-6

CPT CODE:

J$15.44J2280-Q

CPT CODE:

J$19.65J2320-6

CPT CODE:

J$19.65J2320-Q

CPT CODE:

J$46.55J2325-6

CPT CODE:

J$46.55J2325-Q

CPT CODE:

J$123.40J2353-6

CPT CODE:

J$123.40J2353-Q

CPT CODE:

J$6.77J2354-6

CPT CODE:

J$6.77J2354-Q

CPT CODE:

J$419.43J2355-6

CPT CODE:

J$419.43J2355-Q

CPT CODE:

J$21.54J2357-6

CPT CODE:

J$21.54J2357-Q

CPT CODE:

J$3.84J2358-6

CPT CODE:

J$3.84J2358-Q

CPT CODE:

J$19.65J2360-6

CPT CODE:

J$19.65J2360-Q

CPT CODE:

J$19.65J2370-6

CPT CODE:

J$19.65J2370-Q

CPT CODE:

J$44.28J2400-6

CPT CODE:

J$44.28J2400-Q

CPT CODE:

J$10.71J2405-6

CPT CODE:

J$10.71J2405-Q

CPT CODE:

J$3,414.41J2407-6

CPT CODE:

J$19.65J2410-6

CPT CODE:

J$19.65J2410-Q

CPT CODE:

J$18.11J2425-6

CPT CODE:

J$18.11J2425-Q

CPT CODE:

J$9.19J2426-6

CPT CODE:

J$9.19J2426-Q

CPT CODE:

J$19.65J2460-6

CPT CODE:

J$19.65J2460-Q

CPT CODE:

J$46.61J2469-6

CPT CODE:

J$46.61J2469-Q

CPT CODE:

J$7.60J2501-6

CPT CODE:

J$7.60J2501-Q

CPT CODE:

J$12,679.46J2502-6

CPT CODE:

J$1,415.88J2503-6

CPT CODE:

J$1,415.88J2503-Q

CPT CODE:

J$258.25J2504-6

CPT CODE:

J$258.25J2504-Q

CPT CODE:

J$4,163.60J2505-6

CPT CODE:

J$4,163.60J2505-Q

CPT CODE:

J$19.65J2510-6

CPT CODE:

J$19.65J2510-Q

CPT CODE:

J$20.95J2513-6

CPT CODE:

J$20.95J2513-Q

CPT CODE:

J$19.65J2515-6

CPT CODE:

J$19.65J2515-Q

CPT CODE:

J$19.65J2540-6

CPT CODE:

J$19.65J2540-Q

CPT CODE:

J$8.49J2543-6

CPT CODE:

J$8.49J2543-Q

CPT CODE:

J$1,118.51J2547-6

CPT CODE:

J$19.65J2550-6

CPT CODE:

J$19.65J2550-Q

CPT CODE:

J$19.65J2560-6

CPT CODE:

J$19.65J2560-Q

CPT CODE:

J$343.19J2562-6

CPT CODE:

J$343.19J2562-Q

CPT CODE:

J$19.65J2590-6

CPT CODE:

J$19.65J2590-Q

CPT CODE:

J$19.65J2650-6

CPT CODE:

J$19.65J2650-Q

CPT CODE:

J$47.83J2680-6

CPT CODE:

J$47.83J2680-Q

CPT CODE:

J$19.65J2690-6

CPT CODE:

J$19.65J2690-Q

CPT CODE:

J$19.65J2700-6

CPT CODE:

J$19.65J2700-Q

CPT CODE:

J$19.65J2710-6

CPT CODE:

J$19.65J2710-Q

CPT CODE:

J$19.65J2720-6

CPT CODE:

J$19.65J2720-Q

CPT CODE:

J$62.47J2730-6

CPT CODE:

J$62.47J2730-Q

CPT CODE:

J$60.69J2760-6

CPT CODE:

J$60.69J2760-Q

CPT CODE:

J$19.65J2765-6

CPT CODE:

J$19.65J2765-Q

CPT CODE:

J$160.27J2770-6

CPT CODE:

J$160.27J2770-Q

CPT CODE:

J$2.39J2780-6

Page 66

Page 67: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE:

J$2.39J2780-Q

CPT CODE:

J$525.75J2783-6

CPT CODE:

J$525.75J2783-Q

CPT CODE:

J$70.39J2785-6

CPT CODE:

J$70.39J2785-Q

CPT CODE:

J$54.37J2788-6

CPT CODE:

J$54.37J2788-Q

CPT CODE:

J$124.96J2790-6

CPT CODE:

J$36.55J2792-6

CPT CODE:

J$36.55J2792-Q

CPT CODE:

J$7.48J2794-6

CPT CODE:

J$7.48J2794-C

CPT CODE:

J$7.48J2794-Q

CPT CODE:

J$7.48J2794-X

CPT CODE:

J$1.49J2795-6

CPT CODE:

J$1.49J2795-Q

CPT CODE:

J$55.49J2796-6

CPT CODE:

J$55.49J2796-Q

CPT CODE:

J$19.65J2800-6

CPT CODE:

J$19.65J2800-Q

CPT CODE:

J$208.88J2820-Q

CPT CODE:

J$98.08J2860-6

CPT CODE:

J$19.65J2910-6

CPT CODE:

J$19.65J2910-Q

CPT CODE:

J$12.37J2916-6

CPT CODE:

J$12.37J2916-Q

CPT CODE:

J$19.65J2920-6

CPT CODE:

J$19.65J2920-Q

CPT CODE:

J$19.65J2930-6

CPT CODE:

J$19.65J2930-Q

CPT CODE:

J$65.08J2940-6

CPT CODE:

J$65.08J2940-Q

CPT CODE:

J$65.08J2941-6

CPT CODE:

J$65.08J2941-Q

CPT CODE:

J$19.65J2950-6

CPT CODE:

J$19.65J2950-Q

CPT CODE:

J$2,051.28J2993-6

CPT CODE:

J$41.01J2997-6

CPT CODE:

J$41.01J2997-Q

CPT CODE:

J$19.65J3000-6

CPT CODE:

J$19.65J3000-Q

CPT CODE:

J$19.65J3010-6

CPT CODE:

J$19.65J3010-Q

CPT CODE:

J$35.65J3060-6

CPT CODE:

J$19.65J3070-6

CPT CODE:

J$19.65J3070-Q

CPT CODE:

J$1.39J3090-6

CPT CODE:

J$3.00J3095-6

CPT CODE:

J$3.00J3095-Q

CPT CODE:

J$74.34J3101-6

CPT CODE:

J$74.34J3101-Q

CPT CODE:

J$19.65J3105-6

CPT CODE:

J$19.65J3105-Q

CPT CODE:

J$0.06J3121-6

CPT CODE:

J$1.32J3145-6

CPT CODE:

J$19.65J3230-6

CPT CODE:

J$19.65J3230-Q

CPT CODE:

J$348.13J3240-6

CPT CODE:

J$348.13J3240-Q

CPT CODE:

J$1.46J3243-6

CPT CODE:

J$1.46J3243-Q

CPT CODE:

J$13.59J3246-6

CPT CODE:

J$13.59J3246-Q

CPT CODE:

J$19.65J3250-6

CPT CODE:

J$19.65J3250-Q

CPT CODE:

J$19.65J3260-6

CPT CODE:

J$19.65J3260-Q

CPT CODE:

J$4.09J3262-6

CPT CODE:

J$4.09J3262-Q

CPT CODE:

J$19.65J3280-6

CPT CODE:

J$19.65J3280-Q

CPT CODE:

J$85.65J3285-6

CPT CODE:

J$4.80J3300-6

CPT CODE:

J$4.80J3300-Q

CPT CODE:

J$19.65J3301-6

CPT CODE:

J$19.65J3301-Q

CPT CODE:

J$19.65J3302-6

CPT CODE:

J$19.65J3302-Q

CPT CODE:

J$19.65J3303-6

CPT CODE:

J$19.65J3303-Q

CPT CODE:

J$19.65J3310-6

CPT CODE:

J$19.65J3310-Q

CPT CODE:

J$597.20J3315-6

CPT CODE:

J$597.20J3315-Q

CPT CODE:

J$42.52J3320-6

CPT CODE:

J$42.52J3320-Q

CPT CODE:

J$133.89J3350-6

CPT CODE:

J$133.89J3350-Q

CPT CODE:

J$138.76J3357-6

CPT CODE:

J$138.76J3357-Q

CPT CODE:

J$19.65J3360-6

CPT CODE:

J$19.65J3360-Q

CPT CODE:

J$104.52J3364-6

CPT CODE:

J$104.52J3364-Q

CPT CODE:

J$49.98J3370-6

CPT CODE:

J$49.98J3370-Q

CPT CODE:

J$18.92J3380-6

CPT CODE:

J$406.37J3385-6

CPT CODE:

J$406.37J3385-Q

CPT CODE:

J$13.89J3396-6

CPT CODE:

J$13.89J3396-Q

CPT CODE:

J$19.65J3400-6

CPT CODE:

J$19.65J3400-Q

CPT CODE:

J$19.65J3410-6

CPT CODE:

J$19.65J3410-Q

CPT CODE:

J$1.41J3411-6

CPT CODE:

J$1.41J3411-Q

CPT CODE:

J$1.41J3415-6

CPT CODE:

J$1.41J3415-Q

CPT CODE:

J$19.65J3420-6

CPT CODE:

J$19.65J3420-Q

CPT CODE:

J$19.65J3430-6

CPT CODE:

J$19.65J3430-Q

CPT CODE:

J$7.42J3465-6

CPT CODE:

J$7.42J3465-Q

CPT CODE:

J$19.65J3470-6

CPT CODE:

J$19.65J3470-Q

CPT CODE:

J$0.18J3471-6

CPT CODE:

J$0.18J3471-Q

CPT CODE:

J$214.11J3472-6

CPT CODE:

J$214.11J3472-Q

CPT CODE:

J$0.62J3473-6

CPT CODE:

J$0.62J3473-Q

CPT CODE:

J$1.49J3485-6

CPT CODE:

J$1.49J3485-Q

CPT CODE:

J$30.89J3486-6

CPT CODE:

J$30.89J3486-Q

CPT CODE:

J$329.16J3487-6

CPT CODE:

J$329.16J3487-Q

CPT CODE:

J$250.89J3489-6

CPT CODE:

J$2.31J7121-6

CPT CODE:

J$1.08J7178-6

CPT CODE:

J$6.08J7188-6

CPT CODE:

J$2.03J7189-6

CPT CODE:

J$2.03J7189-Q

CPT CODE:

J$2.13J7205-6

CPT CODE:

J$732.25J7297-6

CPT CODE:

J$954.28J7298-6

CPT CODE:

J$777.78J7301-6

CPT CODE:

J$582.87J7302-6

CPT CODE:

J$582.87J7302-Q

CPT CODE:

J$156.79J7308-6

CPT CODE:

J$156.79J7308-Q

CPT CODE:

J$99.37J7309-6

CPT CODE:

J$99.37J7309-Q

CPT CODE:

J$228.11J7312-6

CPT CODE:

J$228.11J7312-Q

CPT CODE:

J$545.32J7313-6

CPT CODE:

J$429.86J7315-6

CPT CODE:

J$1,181.05J7316-6

CPT CODE:

J$152.49J7321-6

CPT CODE:

J$161.02J7323-6

Page 67

Page 68: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE:

J$274.87J7324-6

CPT CODE:

J$19.71J7325-6

CPT CODE:

J$1,081.25J7327-6

CPT CODE:

J$3.14J7336-6

CPT CODE:

J$504.96J7511-6

CPT CODE:

J$504.96J7511-Q

CPT CODE:

J$732.44J7513-6

CPT CODE:

J$362.24J7513-Q

CPT CODE:

J$51.06J7516-6

CPT CODE:

J$51.06J7516-Q

CPT CODE:

J$98.19J9000-Q

CPT CODE:

J$482.23J9001-Q

CPT CODE:

J$633.31J9002-6

CPT CODE:

J$771.27J9010-6

CPT CODE:

J$771.27J9010-Q

CPT CODE:

J$392.76J9019-6

CPT CODE:

J$99.99J9020-Q

CPT CODE:

J$5.42J9025-Q

CPT CODE:

J$155.65J9027-Q

CPT CODE:

J$299.91J9031-Q

CPT CODE:

J$35.49J9032-6

CPT CODE:

J$23.66J9033-Q

CPT CODE:

J$89.50J9035-Q

CPT CODE:

J$106.93J9039-6

CPT CODE:

J$523.09J9040-Q

CPT CODE:

J$42.64J9041-Q

CPT CODE:

J$116.29J9042-6

CPT CODE:

J$173.59J9045-Q

CPT CODE:

J$33.05J9047-6

CPT CODE:

J$151.75J9050-Q

CPT CODE:

J$74.99J9055-Q

CPT CODE:

J$72.63J9060-Q

CPT CODE:

J$10.71J9070-Q

CPT CODE:

J$566.63J9098-Q

CPT CODE:

J$14.28J9100-Q

CPT CODE:

J$23.20J9120-Q

CPT CODE:

J$26.78J9130-Q

CPT CODE:

J$144.63J9150-Q

CPT CODE:

J$109.63J9151-Q

CPT CODE:

J$4.68J9155-Q

CPT CODE:

J$1,491.65J9160-Q

CPT CODE:

J$24.99J9165-Q

CPT CODE:

J$23.53J9171-Q

CPT CODE:

J$4.95J9175-6

CPT CODE:

J$4.95J9175-Q

CPT CODE:

J$40.18J9178-Q

CPT CODE:

J$28.55J9181-Q

CPT CODE:

J$333.86J9185-Q

CPT CODE:

J$5.37J9190-Q

CPT CODE:

J$232.08J9200-Q

CPT CODE:

J$142.20J9201-Q

CPT CODE:

J$800.72J9202-Q

CPT CODE:

J$182.60J9206-Q

CPT CODE:

J$78.88J9207-Q

CPT CODE:

J$233.82J9208-Q

CPT CODE:

J$61.99J9209-Q

CPT CODE:

J$444.53J9211-Q

CPT CODE:

J$7.95J9212-Q

CPT CODE:

J$57.12J9213-Q

CPT CODE:

J$19.65J9214-Q

CPT CODE:

J$15.95J9215-Q

CPT CODE:

J$274.93J9216-Q

CPT CODE:

J$912.26J9217-Q

CPT CODE:

J$44.28J9218-Q

CPT CODE:

J$6,640.60J9225-Q

CPT CODE:

J$21.41J9230-Q

CPT CODE:

J$17.86J9250-Q

CPT CODE:

J$30.35J9260-Q

CPT CODE:

J$2.85J9262-6

CPT CODE:

J$13.34J9263-Q

CPT CODE:

J$11.90J9264-Q

CPT CODE:

J$0.18J9267-6

CPT CODE:

J$2,827.74J9268-Q

CPT CODE:

J$148.19J9270-Q

CPT CODE:

J$50.82J9271-6

CPT CODE:

J$244.58J9280-Q

CPT CODE:

J$1,210.36J9293-Q

CPT CODE:

J$28.23J9299-6

CPT CODE:

J$60.25J9301-6

CPT CODE:

J$57.44J9302-Q

CPT CODE:

J$63.45J9305-Q

CPT CODE:

J$11.61J9306-6

CPT CODE:

J$204.00J9307-Q

CPT CODE:

J$60.05J9308-6

CPT CODE:

J$737.21J9310-Q

CPT CODE:

J$275.62J9315-Q

CPT CODE:

J$134.63J9320-Q

CPT CODE:

J$5.85J9328-Q

CPT CODE:

J$59.17J9330-Q

CPT CODE:

J$164.75J9340-Q

CPT CODE:

J$33.97J9351-Q

CPT CODE:

J$33.17J9354-6

CPT CODE:

J$75.56J9355-Q

CPT CODE:

J$654.75J9357-Q

CPT CODE:

J$30.35J9360-Q

CPT CODE:

J$64.25J9370-Q

CPT CODE:

J$2,332.20J9371-6

CPT CODE:

J$126.61J9395-Q

CPT CODE:

J$17.69J9400-6

CPT CODE:

J$4,159.09J9600-Q

CPT CODE: $85.59P9045-6

CPT CODE: $85.59P9045-Q

CPT CODE: $38.55P9046-6

CPT CODE: $38.55P9046-Q

CPT CODE: $115.47P9047-6

CPT CODE: $115.47P9047-Q

CPT CODE: $129.11P9048-6

CPT CODE: $129.11P9048-Q

CPT CODE: $12.71P9612-6

CPT CODE: $9.45P9615-6

CPT CODE: $1.04Q0138-6

CPT CODE: $1.04Q0138-Q

CPT CODE: $1.04Q0139-6

CPT CODE: $1.04Q0139-Q

CPT CODE: $118.08Q3025-6

CPT CODE: $39.97Q3026-6

CPT CODE: $56.45Q3031-6

CPT CODE: $1.64Q4081-6

CPT CODE: $1.64Q4081-Q

CPT CODE: $1.08Q5101-6

CPT CODE: $1.03Q9945-5

CPT CODE: $1.03Q9945-G

CPT CODE: $0.54Q9946-5

CPT CODE: $0.54Q9946-G

CPT CODE: $0.39Q9947-5

CPT CODE: $0.39Q9947-G

CPT CODE: $1.09Q9948-5

CPT CODE: $1.09Q9948-G

CPT CODE: $0.50Q9949-5

CPT CODE: $0.50Q9949-G

CPT CODE: $0.47Q9950-5

CPT CODE: $0.47Q9950-G

CPT CODE: $0.51Q9965-5

CPT CODE: $0.51Q9965-G

CPT CODE: $0.59Q9966-5

CPT CODE: $0.59Q9966-G

CPT CODE: $0.61Q9967-5

CPT CODE: $0.61Q9967-G

CPT CODE: $109.50S0107-6

CPT CODE: $109.50S0107-Q

CPT CODE: $321.33S0147-6

CPT CODE: $321.33S0147-Q

CPT CODE: $10.61S0156-6

CPT CODE: $10.61S0156-Q

CPT CODE: $31.24S0164-6

CPT CODE: $31.24S0164-Q

CPT CODE: $7.31S0166-6

CPT CODE: $7.31S0166-Q

CPT CODE: $4.45S0167-6

CPT CODE: $4.45S0167-Q

CPT CODE: $759.29S0180-6

CPT CODE: $759.29S0180-Q

Page 68

Page 69: 2018 Alabama Workers' Compensation Prevailing Rate/Maximum ... Physicians Fee.pdf · cpt code:15572-2 $1,937.44 cpt code:15574-2 $1,937.44 cpt code:15576-2 $1,937.44 cpt code:15600-2

2018 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective January 1, 2018

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $99.07S0195-6

CPT CODE: $32.95S0265-6

CPT CODE: $43.25S0311-6

CPT CODE: $64.72S0390-6

CPT CODE: $4,550.92S2068-2

CPT CODE: $1,486.23S2075-2

CPT CODE: $931.54S2076-2

CPT CODE: $1,906.54S2078-2

CPT CODE: $2,984.33S2079-2

CPT CODE: $65.77S2083-2

CPT CODE: $2,328.80S2095-2

CPT CODE: $1,332.08S2114-2

CPT CODE: $1,438.80S2117-2

CPT CODE: $4,449.15S2118-2

CPT CODE: $282.28S2225-2

CPT CODE: $2,063.48S2325-2

CPT CODE: $56.45S3000-6

CPT CODE: $56.45S3000-A

CPT CODE: $56.45S3000-M

CPT CODE: $56.45S3000-N

CPT CODE: $5,448.51S3865-8

CPT CODE: $885.94S3866-8

CPT CODE: $0.20S5550-6

CPT CODE: $0.20S5550-Q

CPT CODE: $0.45S5551-6

CPT CODE: $0.45S5551Q

CPT CODE: $40.28S8945-D

CPT CODE: $40.28S8945-N

CPT CODE: $634.03S9015-6

CPT CODE: $52.22S9015-P

CPT CODE: $704.14S9025-6

CPT CODE: $2,170.26S9034-2

CPT CODE: $657.49S9055-6

Page 69