NORTH CAROLINA INDUSTRIAL COMMISSION

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MEDICAL FEE SCHEDULE

Section 2: Commission Assigned Codes


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ABBREVIATIONS: T = time and U = unit.

Code Description Fee Time
ANT01 ANESTHESIA- ANESTHESIOLOGIST (per minute, first sixty minutes) $3.88 T
ANT01 ANESTHESIA- ANESTHESIOLOGIST (per minute, minutes past sixty) $2.05 T
ANT02 CRNA SERVICES FOR ANESTHESIA (per minute, first sixty minutes) $2.55 T
ANT02 CRNA SERVICES FOR ANESTHESIA (per minute, minutes past sixty) $1.05 T
CPM00 CONTINUOUS PASSIVE PURCHASED By Report  
CPM01 CONTINUOUS PASSIVE DAILY    $30.00 U
CPM02 CONTINUOUS PASSIVE WEEKLY   $210.00 U
CPM03 CONTINUOUS PASSIVE MONTHLY  $840.00 U
CR100 COMP REHAB PROGRAM Per Agreement   
CS100 COLD STUDY                  $100.00  
EMG01 HOME RENTAL BIOFEEDBACK-1MO. $100.00  
EV100 EVALUATIONS-PAY PER AGREEMENT Per Agreement   
FA100 FUNCTIONAL ASSESSMENT Per Agreement   
FC100 FUNCTIONAL CAPACITY Per Agreement   
FO999 FULL ORTHODONTIC TRT.       Per Agreement   
FS100 FLOW METER/PER DAY          $100.00  
FS200 FLAP MONITORING/PER DAY     $100.00  
IME01 IME/ONE HOUR                $100.00  
IME02 IME/TWO HOURS               $200.00  
IME03 IME/THREE HOURS OR MORE     $400.00  
NSP01 NEUROMUSCULAR STIMUL PURCHAS $950.00  
NSR01  NEUROMUSCULAR DAILY RENTAL $5.00 U
NSR02 NEUROMUSCULAR RENTAL WEEKLY $35.00 U
NSR03 NEUROMUSCULAR MONTHLY RENTAL $140.00 U
PAN01 PANEL EXAMINATION           Per Agreement   
PSY00 REHAB WITH PSYCH PROGRAM    Per Agreement   
PSY01 CONSULTATION   (PSYCHOLOGIST)             $119.00  
PSY02 RETURN OFFICE VISIT   (PSYCHOLOGIST)       $75.00 T
PSY03 PSYCHOLOGICAL TESTING  (PSYCHOLOGIST)       $75.00 T
PSY04 GROUP THERAPY (PER HOUR)    (PSYCHOLOGIST) $20.00 T
PS100 PENTOTHAL PAIN STUDY        $320.00  
SMT01 SPECIAL SPORT MED. THERAPY  Per Agreement   
TNP01 TENS UNIT PURCHASE          $595.00  
TNP02 TENS UNIT PURCHASE          $565.00  
TNR01 TENS UNIT RENTAL DAILY      $2.75 U
TNR02 TENS UNIT RENTAL WEEKLY     $19.00 U
TNR03 TENS UNIT RENTAL MONTHLY    $76.00 U
WC100 WORK CONDITIONING Per Agreement   
WH100 WORK HARDENING Per Agreement   
YM100 Y MEMBERSHIP                Per Agreement   
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