CPT Codes and Fees: Evaluation & Management, Medicine, Physical Therapy

Evaluation & Management, Medicine, Physical Therapy

Effective January 1, 2015

ABBREVIATIONS: BR = by report (i.e., report is needed to establish fee), CPT = Current Procedural Terminology, FAC = services were performed in a facility setting, FUD = follow-up days (i.e., number of days in global period), NA = no allowance, OFF = services were performed in physician office setting, PC (26) = professional component, PER AGM = per agreement, SC = special consideration (see Guides or contact Industrial Commission), TBA = to be assigned, TC (27) = technical component, Total = total fee, and Units = requires time or number of units.

CPT Code	Total	OFF	FAC	TC (27)	PC (26)	Units Required
90281	BR
90283	BR
90284	BR
90287	BR
90288	BR
90291	BR
90296	BR
90371	BR
90375	BR
90376	BR
90378	BR
90384	BR
90385	BR
90386	BR
90389	BR
90393	BR
90396	BR
90399	BR
90460		$45.96
90461		$23.05
90471	BR
90472	BR
90473	BR
90474	BR
90476	BR
90477	BR
90581	BR
90585	BR
90586	BR
90630	BR
90632	BR
90633	BR
90634	BR
90636	BR
90644	BR
90645	BR
90646	BR
90647	BR
90648	BR
90649	BR
90650	BR
90651	BR
90653	BR
90654	BR
90655	BR
90656	BR
90657	BR
90658	BR
90659	BR
90660	BR
90661	BR
90662	BR
90664	BR
90666	BR
90667	BR
90668	BR
90669	BR
90670	BR
90672	BR
90673	BR
90675	BR
90676	BR
90680	BR
90681	BR
90685	BR
90686	BR
90687	BR
90688	BR
90690	BR
90691	BR
90692	BR
90693	BR
90696	BR
90698	BR
90700	$25.15
90702	$13.67
90703	$12.58
90704	$22.97
90705	$20.78
90706	$21.88
90707	$28.44
90708	$25.15
90710	$34.46
90712	$13.67
90713	$26.26
90714	$24.19
90715	BR
90716	$34.46
90717	$33.37
90719	$20.78
90720	$37.75
90721	BR
90723	BR
90725	$14.77
90727	$20.78
90732	$18.04
90733	$39.93
90734	BR
90735	$16.40
90736	BR
90738	BR
90739	BR
90740	BR
90743	BR
90744	BR
90746	BR
90747	BR
90748	BR
90749	BR
90780	$54.70
90781	$27.35
90782	$5.47
90783	$20.24
90784	$23.51
90785		$7.28	$7.28
90788	$5.47
90791		$230.38	$181.04
90792		$192.13	$187.15
90799	BR
90832		$95.97	$76.05
90833		$64.15	$63.64
90834		$124.65	$114.19
90836		$104.20	$104.20
90837		$182.65	$172.19
90838		$168.25	$167.26
90839	BR
90840	BR
90845	$115.96
90846	$129.07
90847	$146.58
90849	$44.86
90853	$36.64
90863	BR
90865	$175.16
90867	BR
90868	BR
90869		$899.83	$234.24
90870	$129.07
90871	$188.70
90875	$71.19					YES
90876	$110.74					YES
90880	$149.86
90882	$98.45
90885	BR
90887	$95.72
90889	$80.41
90899	BR
90901	$78.00
90911	$124.00
90935	$141.11
90937	$247.76
90939	BR
90940	BR
90945	$132.91
90947	$221.50
90951	$1,922.58
90952	BR
90953	BR
90954	$1,578.58
90955	$893.77
90956	$605.43
90957	$1,267.02
90958	$854.82
90959	$560.96
90960	$561.93
90961	$453.67
90962	$328.10
90963	$1,086.05
90964	$906.30
90965	$862.05
90966	$448.87
90967	$38.85
90968	$30.32
90969	$29.58
90970	$15.68
90989	$526.69
90993	$88.05
90997	$218.23
90999	PA
91010	$204.55			$40.91	$163.64
91013	$45.77			$26.00	$19.78
91020	$228.61			$45.72	$182.89
91022	$334.14			$217.14	$117.00
91030	$92.43			$9.24	$83.19
91034	$352.90			$273.70	$79.20
91035	$697.98			$569.46	$128.51
91037	$224.96			$145.75	$79.20
91038	$193.42			$103.66	$89.75
91040	$679.14			$599.92	$79.20
91065	$66.19			$13.24	$52.95
91110	$1,378.53
91111	$1,085.40			$1,004.97	$80.42
91112	$1,745.63			$1,574.56	$171.07
91117		$280.51	$298.66
91120	$670.44			$590.85	$79.60
91122	$210.66			$42.13	$168.53
91132	BR
91133	BR
91200	$67.07			$38.98	$28.09
91299	BR
92002	$82.21
92004	$120.14
92012	$65.63
92014	$83.68
92015	$36.64
92018	$103.92
92019	$93.52
92020	$34.46
92025	$43.61			$18.04	$25.56
92060	$56.98			$9.88	$47.10
92065	$38.60			$8.55	$30.05
92071		$74.14	$66.33
92072		$236.45	$190.94
92081	$35.94			$8.01	$27.93
92082	$49.40			$10.41	$38.99
92083	$71.20			$15.22	$55.98
92100	$61.26
92132	$72.06			$30.03	$42.02
92133	$88.60			$30.03	$58.57
92134	$88.60			$30.03	$58.57
92136	$113.27			$71.26	$42.01
92140	$41.57
92145	$29.28			$12.27	$17.01
92225	$53.59
92226	$47.04
92227		$22.64
92228	$59.55			$24.66	$34.90
92230	$67.28
92235	$128.60			$54.48	$74.12
92240	$132.02			$49.99	$82.03
92250	$45.67			$9.35	$36.32
92260	$54.15
92265	$57.84			$12.29	$45.55
92270	$78.92			$16.56	$62.36
92275	$101.53			$21.36	$80.17
92283	$24.52			$6.40	$18.12
92284	$36.95			$9.35	$27.60
92285	$26.09			$5.88	$20.21
92286	$101.09			$21.36	$79.73
92287	$120.33
92310	$127.98
92311	$102.83
92312	$125.25
92313	$93.52
92314	$75.48
92315	$57.43
92316	$84.23
92317	$43.75
92325	$19.15
92326	$78.76
92341	$51.41
92342	$57.97
92352	$35.00
92353	$46.48
92354	$422.24
92355	$205.65
92358	$47.04
92370	$35.00
92371	$30.08
92499	BR
92502	$138.38
92504	$22.97
92507	$44.86
92508	$22.97
92511	$100.96
92512	$53.59
92516	$43.21
92520	$67.81
92521		$174.32	$174.32
92522		$141.88	$141.88
92523		$294.16	$294.16
92524		$147.10	$147.10
92526	$52.43
92531	$25.15
92532	$36.64
92533	$57.43
92534	$28.44
92540	$185.21			$31.42	$153.80
92541	$56.33			$11.27	$45.06
92542	$49.22			$9.84	$39.38
92543	$62.90			$12.58	$50.32
92544	$38.28			$7.66	$30.62
92545	$32.82			$6.56	$26.26
92546	$42.66			$8.53	$34.13
92547	$27.89			$5.58	$22.31
92548	$119.05			$71.98	$47.07
92551	$16.40
92552	$21.88
92553	$32.82
92555	$18.60
92556	$28.44
92557	$59.08
92558	BR
92559	$48.13
92560	$28.44
92561	$35.55
92562	$20.24
92563	$18.60
92564	$23.51
92565	$19.69
92567	$26.26
92568	$18.60
92570	$61.31	$57.87
92571	$19.15
92572	$4.38
92575	$15.31
92576	$21.88
92577	$35.55
92579	$36.33
92582	$36.10
92583	$44.30
92584	$123.07
92585	$195.26			$97.63	$97.63
92586	$107.06
92587	$82.29			$69.44	$12.85
92588	$113.67			$78.53	$35.14
92589	$26.80
92590	$74.39
92591	$97.36
92592	$27.35
92593	$51.41
92594	$27.35
92595	$51.41
92596	$28.99
92597	$112.33
92601	$191.46
92602	$134.11
92603	$128.69
92604	$87.56
92605	BR
92606	BR
92607	$159.93
92608	$31.14
92609	$86.54
92610	$60.86
92611	$66.27
92612		$255.83	$101.07			YES
92613	BR
92614		$197.93	$101.07			YES
92615	BR
92616		$271.82	$147.90			YES
92617	BR
92618	BR
92620	$65.44
92621	$16.14
92625	$64.33
92626	$123.49
92627	$31.06
92630	BR
92633	BR
92640	$77.67
92700	BR
92920		$809.13	$809.13
92921	BR
92924		$961.81	$961.81
92925	BR
92928		$898.45	$898.45
92929	BR
92933		$1,004.71	$1,004.71
92934	BR
92937		$897.42	$897.42
92938	BR
92941		$1,006.65	$1,006.65
92943		$1,006.65	$1,006.65
92944	BR
92950	$318.32
92953	$70.55
92960	$216.59
92961	$349.35
92970	$368.63
92971	$150.95
92973	$260.70
92974	$273.69
92975	$678.20
92977	$394.34
92978	$359.67			$220.06	$139.61
92979	$221.96			$110.27	$111.69
92986	$1,698.23
92987	$1,733.64
92990	$1,353.67
92992	$3,429.18
92993	$2,402.67
92997	$1,357.01
92998	$524.43
93000	$39.37			$23.62	$15.75
93005	$21.88
93010	$16.95			$0.00	$16.95
93015	$161.89			$80.94	$80.95
93016	$43.75
93017	$82.03
93018	$35.55
93024	$194.70			$77.88	$116.82
93025	$387.21
93040	$21.88			$7.66	$14.22
93041	$7.11
93042	$14.77
93224	$230.81			$138.49	$92.32
93225	$60.70			$60.70	$0.00
93226	$107.20
93227	$63.44
93228	$51.25
93229	BR
93260	$126.89			$40.94	$85.95
93261	$226.43			$135.86	$90.57
93268	$226.43			$135.86	$90.57
93270	$60.70
93271	$117.05
93272	$48.68			$0.00	$48.68
93278	$104.47			$62.68	$41.79
93279	$108.85			$36.94	$71.91
93280	$128.98			$42.64	$86.33
93281	$150.79			$50.00	$100.80
93282	$139.30			$45.18	$94.12
93283	$169.76			$51.38	$118.39
93284	$199.04			$58.24	$140.80
93285	$93.69			$34.88	$58.81
93286	$53.02			$22.93	$30.10
93287	$70.14			$25.94	$44.21
93288	$83.78			$35.56	$48.22
93289	$129.72			$42.64	$87.08
93290	$62.27			$19.76	$42.52
93291	$80.36			$31.66	$48.70
93292	$72.78			$24.56	$48.22
93293	$113.07			$79.41	$33.66
93294	$73.07
93295	$132.11
93296	$69.20
93297	$51.25
93298	$58.81
93299	BR
93303	$300.01			$186.93	$113.08
93304	$164.33			$94.07	$70.26
93306	$509.19			$366.04	$143.15
93307	$336.93			$237.62	$99.31
93308	$162.22			$102.54	$59.68
93312	$339.65			$186.81	$152.84
93313	$85.32			$0.00	$85.32
93314	$271.82			$163.09	$108.73
93315	$385.83			$184.40	$201.43
93316	$79.52
93317	$305.82			$184.40	$121.42
93318	BR
93320	$131.80</