2020 alabama workers' compensation prevailing …cpt code:12056-2 $760.83 cpt code:12057-2...

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020 CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE: $620.27 0001U-8 CPT CODE: $101.36 0002U-8 CPT CODE: $110.09 0003U-8 CPT CODE: $41.48 0004U-8 CPT CODE: $2,692.77 0005U-8 CPT CODE: $213.99 0006U-8 CPT CODE: $99.17 0007U-8 CPT CODE: $507.54 0008U-8 CPT CODE: $25.91 0009U-8 CPT CODE: $88.67 0010U-8 CPT CODE: $99.17 0011U-8 CPT CODE: $507.54 0012U-8 CPT CODE: $507.54 0013U-8 CPT CODE: $507.54 0014U-8 CPT CODE: $189.58 0016U-8 CPT CODE: $105.99 0017U-8 CPT CODE: $320.32 00731-4 CPT CODE: $320.32 00732-4 CPT CODE: $20.10 0080U-8 CPT CODE: $354.03 00811-4 CPT CODE: $354.03 00812-4 CPT CODE: $354.03 00813-4 CPT CODE: $84.10 0082U-8 CPT CODE: $677.78 0139U-8 CPT CODE: $23.49 0140U-8 CPT CODE: $23.49 0141U-8 CPT CODE: $23.49 0142U-8 CPT CODE: $90.12 0143U-8 CPT CODE: $90.12 0144U-8 CPT CODE: $90.12 0145U-8 CPT CODE: $90.12 0146U-8 CPT CODE: $90.12 0147U-8 CPT CODE: $90.12 0148U-8 CPT CODE: $90.12 0149U-8 CPT CODE: $90.12 0150U-8 CPT CODE: $23.49 0151U-8 CPT CODE: $23.49 0152U-8 CPT CODE: $4,553.21 0153U-8 CPT CODE: $94.20 0154U-8 CPT CODE: $94.20 0155U-8 CPT CODE: $2,221.22 0156U-8 CPT CODE: $545.43 0157U-8 CPT CODE: $545.43 0158U-8 CPT CODE: $545.43 0159U-8 CPT CODE: $545.43 0160U-8 CPT CODE: $545.43 0161U-8 CPT CODE: $1,090.86 0162U-8 CPT CODE: $50.23 01953-4 CPT CODE: $570.81 01967-4 CPT CODE: $171.25 01968-4 CPT CODE: $96.84 01996-6 CPT CODE: $219.74 0437T-2 CPT CODE: $26.07 0500T-8 CPT CODE: $306.30 09220-I CPT CODE: $45.85 10004-2 CPT CODE: $78.07 10005-2 CPT CODE: $53.23 10006-2 CPT CODE: $100.13 10007-2 CPT CODE: $65.34 10008-2 CPT CODE: $121.73 10009-2 CPT CODE: $88.97 10010-2 CPT CODE: $121.73 10011-2 CPT CODE: $88.97 10012-2 CPT CODE: $75.60 10021-2 CPT CODE: $182.03 10030-2 CPT CODE: $98.28 10035-2 CPT CODE: $49.45 10036-2 CPT CODE: $55.32 10040-2 CPT CODE: $116.60 10060-2 CPT CODE: $189.73 10061-2 CPT CODE: $154.15 10080-2 CPT CODE: $335.95 10081-2 CPT CODE: $110.67 10120-2 CPT CODE: $290.47 10121-2 CPT CODE: $102.76 10140-2 CPT CODE: $94.86 10160-2 CPT CODE: $444.65 10180-2 CPT CODE: $88.91 11000-2 CPT CODE: $61.26 11001-2 CPT CODE: $808.01 11004-2 CPT CODE: $888.24 11005-2 CPT CODE: $1,010.01 11006-2 CPT CODE: $535.81 11008-2 CPT CODE: $307.25 11010-2 CPT CODE: $484.02 11011-2 CPT CODE: $669.39 11012-2 CPT CODE: $316.21 11042-2 CPT CODE: $494.05 11043-2 CPT CODE: $691.69 11044-2 CPT CODE: $49.76 11045-2 CPT CODE: $88.62 11046-2 CPT CODE: $145.03 11047-2 CPT CODE: $64.18 11055-2 CPT CODE: $84.47 11056-2 CPT CODE: $106.43 11057-2 CPT CODE: $41.67 11102-2 CPT CODE: $24.15 11103-2 CPT CODE: $52.33 11104-2 CPT CODE: $28.53 11105-2 CPT CODE: $63.58 11106-2 CPT CODE: $34.06 11107-2 CPT CODE: $102.76 11200-2 CPT CODE: $51.38 11201-2 CPT CODE: $82.28 11300-2 CPT CODE: $118.61 11301-2 CPT CODE: $135.83 11302-2 CPT CODE: $185.59 11303-2 CPT CODE: $93.76 11305-2 CPT CODE: $114.76 11306-2 CPT CODE: $181.77 11307-2 CPT CODE: $227.66 11308-2 CPT CODE: $143.50 11310-2 CPT CODE: $214.28 11311-2 CPT CODE: $262.11 11312-2 CPT CODE: $334.80 11313-2 CPT CODE: $105.56 11400-2 CPT CODE: $151.85 11401-2 CPT CODE: $172.25 11402-2 CPT CODE: $235.21 11403-2 CPT CODE: $287.09 11404-2 CPT CODE: $407.46 11406-2 CPT CODE: $120.38 11420-2 CPT CODE: $146.33 11421-2 CPT CODE: $231.50 11422-2 CPT CODE: $287.09 11423-2 CPT CODE: $342.64 11424-2 CPT CODE: $453.77 11426-2 CPT CODE: $144.46 11440-2 CPT CODE: $183.34 11441-2 CPT CODE: $275.98 11442-2 CPT CODE: $333.39 11443-2 CPT CODE: $425.99 11444-2 CPT CODE: $500.06 11446-2 CPT CODE: $929.75 11450-2 CPT CODE: $1,215.38 11451-2 CPT CODE: $844.55 11462-2 CPT CODE: $1,005.68 11463-2 CPT CODE: $1,035.32 11470-2 CPT CODE: $1,215.38 11471-2 CPT CODE: $229.26 11600-2 CPT CODE: $272.74 11601-2 CPT CODE: $335.95 11602-2 CPT CODE: $395.26 11603-2 CPT CODE: $484.17 11604-2 CPT CODE: $543.46 11606-2 CPT CODE: $231.23 11620-2 CPT CODE: $292.49 11621-2 CPT CODE: $326.07 11622-2 CPT CODE: $395.26 11623-2 CPT CODE: $503.95 11624-2 CPT CODE: $681.81 11626-2 CPT CODE: $272.74 11640-2 Page 1

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Page 1: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $620.270001U-8

CPT CODE: $101.360002U-8

CPT CODE: $110.090003U-8

CPT CODE: $41.480004U-8

CPT CODE: $2,692.770005U-8

CPT CODE: $213.990006U-8

CPT CODE: $99.170007U-8

CPT CODE: $507.540008U-8

CPT CODE: $25.910009U-8

CPT CODE: $88.670010U-8

CPT CODE: $99.170011U-8

CPT CODE: $507.540012U-8

CPT CODE: $507.540013U-8

CPT CODE: $507.540014U-8

CPT CODE: $189.580016U-8

CPT CODE: $105.990017U-8

CPT CODE: $320.3200731-4

CPT CODE: $320.3200732-4

CPT CODE: $20.100080U-8

CPT CODE: $354.0300811-4

CPT CODE: $354.0300812-4

CPT CODE: $354.0300813-4

CPT CODE: $84.100082U-8

CPT CODE: $677.780139U-8

CPT CODE: $23.490140U-8

CPT CODE: $23.490141U-8

CPT CODE: $23.490142U-8

CPT CODE: $90.120143U-8

CPT CODE: $90.120144U-8

CPT CODE: $90.120145U-8

CPT CODE: $90.120146U-8

CPT CODE: $90.120147U-8

CPT CODE: $90.120148U-8

CPT CODE: $90.120149U-8

CPT CODE: $90.120150U-8

CPT CODE: $23.490151U-8

CPT CODE: $23.490152U-8

CPT CODE: $4,553.210153U-8

CPT CODE: $94.200154U-8

CPT CODE: $94.200155U-8

CPT CODE: $2,221.220156U-8

CPT CODE: $545.430157U-8

CPT CODE: $545.430158U-8

CPT CODE: $545.430159U-8

CPT CODE: $545.430160U-8

CPT CODE: $545.430161U-8

CPT CODE: $1,090.860162U-8

CPT CODE: $50.2301953-4

CPT CODE: $570.8101967-4

CPT CODE: $171.2501968-4

CPT CODE: $96.8401996-6

CPT CODE: $219.740437T-2

CPT CODE: $26.070500T-8

CPT CODE: $306.3009220-I

CPT CODE: $45.8510004-2

CPT CODE: $78.0710005-2

CPT CODE: $53.2310006-2

CPT CODE: $100.1310007-2

CPT CODE: $65.3410008-2

CPT CODE: $121.7310009-2

CPT CODE: $88.9710010-2

CPT CODE: $121.7310011-2

CPT CODE: $88.9710012-2

CPT CODE: $75.6010021-2

CPT CODE: $182.0310030-2

CPT CODE: $98.2810035-2

CPT CODE: $49.4510036-2

CPT CODE: $55.3210040-2

CPT CODE: $116.6010060-2

CPT CODE: $189.7310061-2

CPT CODE: $154.1510080-2

CPT CODE: $335.9510081-2

CPT CODE: $110.6710120-2

CPT CODE: $290.4710121-2

CPT CODE: $102.7610140-2

CPT CODE: $94.8610160-2

CPT CODE: $444.6510180-2

CPT CODE: $88.9111000-2

CPT CODE: $61.2611001-2

CPT CODE: $808.0111004-2

CPT CODE: $888.2411005-2

CPT CODE: $1,010.0111006-2

CPT CODE: $535.8111008-2

CPT CODE: $307.2511010-2

CPT CODE: $484.0211011-2

CPT CODE: $669.3911012-2

CPT CODE: $316.2111042-2

CPT CODE: $494.0511043-2

CPT CODE: $691.6911044-2

CPT CODE: $49.7611045-2

CPT CODE: $88.6211046-2

CPT CODE: $145.0311047-2

CPT CODE: $64.1811055-2

CPT CODE: $84.4711056-2

CPT CODE: $106.4311057-2

CPT CODE: $41.6711102-2

CPT CODE: $24.1511103-2

CPT CODE: $52.3311104-2

CPT CODE: $28.5311105-2

CPT CODE: $63.5811106-2

CPT CODE: $34.0611107-2

CPT CODE: $102.7611200-2

CPT CODE: $51.3811201-2

CPT CODE: $82.2811300-2

CPT CODE: $118.6111301-2

CPT CODE: $135.8311302-2

CPT CODE: $185.5911303-2

CPT CODE: $93.7611305-2

CPT CODE: $114.7611306-2

CPT CODE: $181.7711307-2

CPT CODE: $227.6611308-2

CPT CODE: $143.5011310-2

CPT CODE: $214.2811311-2

CPT CODE: $262.1111312-2

CPT CODE: $334.8011313-2

CPT CODE: $105.5611400-2

CPT CODE: $151.8511401-2

CPT CODE: $172.2511402-2

CPT CODE: $235.2111403-2

CPT CODE: $287.0911404-2

CPT CODE: $407.4611406-2

CPT CODE: $120.3811420-2

CPT CODE: $146.3311421-2

CPT CODE: $231.5011422-2

CPT CODE: $287.0911423-2

CPT CODE: $342.6411424-2

CPT CODE: $453.7711426-2

CPT CODE: $144.4611440-2

CPT CODE: $183.3411441-2

CPT CODE: $275.9811442-2

CPT CODE: $333.3911443-2

CPT CODE: $425.9911444-2

CPT CODE: $500.0611446-2

CPT CODE: $929.7511450-2

CPT CODE: $1,215.3811451-2

CPT CODE: $844.5511462-2

CPT CODE: $1,005.6811463-2

CPT CODE: $1,035.3211470-2

CPT CODE: $1,215.3811471-2

CPT CODE: $229.2611600-2

CPT CODE: $272.7411601-2

CPT CODE: $335.9511602-2

CPT CODE: $395.2611603-2

CPT CODE: $484.1711604-2

CPT CODE: $543.4611606-2

CPT CODE: $231.2311620-2

CPT CODE: $292.4911621-2

CPT CODE: $326.0711622-2

CPT CODE: $395.2611623-2

CPT CODE: $503.9511624-2

CPT CODE: $681.8111626-2

CPT CODE: $272.7411640-2

Page 1

Page 2: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $306.3011641-2

CPT CODE: $375.4611642-2

CPT CODE: $513.8311643-2

CPT CODE: $543.4611644-2

CPT CODE: $671.9211646-2

CPT CODE: $63.5211720-2

CPT CODE: $109.8411721-2

CPT CODE: $130.4211730-2

CPT CODE: $63.2111732-2

CPT CODE: $92.8411740-2

CPT CODE: $533.5911750-2

CPT CODE: $121.3311755-2

CPT CODE: $126.4911760-2

CPT CODE: $563.1911762-2

CPT CODE: $573.0811765-2

CPT CODE: $849.7711770-2

CPT CODE: $1,077.0311771-2

CPT CODE: $1,679.7711772-2

CPT CODE: $55.3211900-2

CPT CODE: $160.0711901-2

CPT CODE: $114.6311920-2

CPT CODE: $173.8911921-2

CPT CODE: $264.7911922-2

CPT CODE: $114.6311950-2

CPT CODE: $173.8911951-2

CPT CODE: $264.7911952-2

CPT CODE: $375.4611954-2

CPT CODE: $3,832.8711960-2

CPT CODE: $4,258.7511970-2

CPT CODE: $4,258.7511971-2

CPT CODE: $215.1311980-2

CPT CODE: $256.1011981-2

CPT CODE: $64.8011982-2

CPT CODE: $320.8911983-2

CPT CODE: $112.6412001-2

CPT CODE: $146.2612002-2

CPT CODE: $193.6612004-2

CPT CODE: $249.0112005-2

CPT CODE: $484.1712006-2

CPT CODE: $523.7012007-2

CPT CODE: $130.4212011-2

CPT CODE: $193.6612013-2

CPT CODE: $247.0212014-2

CPT CODE: $280.6312015-2

CPT CODE: $375.4612016-2

CPT CODE: $503.9512017-2

CPT CODE: $533.5912018-2

CPT CODE: $1,165.9412020-2

CPT CODE: $1,531.5512021-2

CPT CODE: $169.9612031-2

CPT CODE: $235.1512032-2

CPT CODE: $326.0712034-2

CPT CODE: $513.8312035-2

CPT CODE: $622.5012036-2

CPT CODE: $671.9212037-2

CPT CODE: $156.1212041-2

CPT CODE: $231.2312042-2

CPT CODE: $264.7912044-2

CPT CODE: $294.4712045-2

CPT CODE: $444.6512046-2

CPT CODE: $503.9512047-2

CPT CODE: $254.9312051-2

CPT CODE: $326.0712052-2

CPT CODE: $375.4612053-2

CPT CODE: $474.2712054-2

CPT CODE: $523.7012055-2

CPT CODE: $760.8312056-2

CPT CODE: $1,027.6512057-2

CPT CODE: $296.4313100-2

CPT CODE: $345.8413101-2

CPT CODE: $80.8713102-2

CPT CODE: $345.8413120-2

CPT CODE: $533.5913121-2

CPT CODE: $182.7713122-2

CPT CODE: $405.1113131-2

CPT CODE: $830.0213132-2

CPT CODE: $397.8913133-2

CPT CODE: $523.7013151-2

CPT CODE: $889.2813152-2

CPT CODE: $422.1513153-2

CPT CODE: $1,778.6013160-2

CPT CODE: $780.6014000-2

CPT CODE: $1,146.2314001-2

CPT CODE: $770.7314020-2

CPT CODE: $1,403.1414021-2

CPT CODE: $1,086.9414040-2

CPT CODE: $1,462.3814041-2

CPT CODE: $1,324.0714060-2

CPT CODE: $1,926.8014061-2

CPT CODE: $1,871.8014301-2

CPT CODE: $393.6614302-2

CPT CODE: $1,205.4614350-2

CPT CODE: $296.8215002-2

CPT CODE: $149.7715003-2

CPT CODE: $326.5115004-2

CPT CODE: $164.6015005-2

CPT CODE: $254.8515040-2

CPT CODE: $365.5815050-2

CPT CODE: $1,096.7815100-2

CPT CODE: $316.2115101-2

CPT CODE: $811.3715110-2

CPT CODE: $152.9115111-2

CPT CODE: $1,124.0715115-2

CPT CODE: $292.0415116-2

CPT CODE: $1,600.7415120-2

CPT CODE: $622.5015121-2

CPT CODE: $683.2615130-2

CPT CODE: $125.3615131-2

CPT CODE: $1,249.4315135-2

CPT CODE: $170.8115136-2

CPT CODE: $683.2615150-2

CPT CODE: $162.5415151-2

CPT CODE: $199.7515152-2

CPT CODE: $1,000.1015155-2

CPT CODE: $316.8315156-2

CPT CODE: $341.6315157-2

CPT CODE: $830.0215200-2

CPT CODE: $622.5015201-2

CPT CODE: $1,274.6715220-2

CPT CODE: $691.6915221-2

CPT CODE: $1,027.6515240-2

CPT CODE: $938.6815241-2

CPT CODE: $1,788.4515260-2

CPT CODE: $1,077.0315261-2

CPT CODE: $155.1615271-2

CPT CODE: $29.5715272-2

CPT CODE: $318.6415273-2

CPT CODE: $75.6715274-2

CPT CODE: $166.7015275-2

CPT CODE: $36.8015276-2

CPT CODE: $322.9615277-2

CPT CODE: $89.3515278-2

CPT CODE: $2,025.6115570-2

CPT CODE: $2,025.6115572-2

CPT CODE: $2,025.6115574-2

CPT CODE: $2,025.6115576-2

CPT CODE: $879.4115600-2

CPT CODE: $1,126.4615610-2

CPT CODE: $1,877.4015620-2

CPT CODE: $1,877.4015630-2

CPT CODE: $1,887.2915650-2

CPT CODE: $970.6815730-2

CPT CODE: $1,911.8215731-2

CPT CODE: $1,108.4215733-2

CPT CODE: $2,697.5015734-2

CPT CODE: $2,697.5015736-2

CPT CODE: $2,697.5015738-2

CPT CODE: $2,697.5015740-2

CPT CODE: $2,272.6715750-2

CPT CODE: $10,919.5515756-2

CPT CODE: $8,853.0315757-2

CPT CODE: $8,461.7115758-2

Page 2

Page 3: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,272.6715760-2

CPT CODE: $494.8715769-2

CPT CODE: $2,717.3015770-2

CPT CODE: $491.5215771-2

CPT CODE: $146.6515772-2

CPT CODE: $497.0715773-2

CPT CODE: $141.0115774-2

CPT CODE: $63.2115775-2

CPT CODE: $229.2715777-2

CPT CODE: $2,717.3015780-2

CPT CODE: $839.9115781-2

CPT CODE: $582.9815782-2

CPT CODE: $124.5015783-2

CPT CODE: $124.5015786-2

CPT CODE: $110.6715787-2

CPT CODE: $2,715.6615788-2

CPT CODE: $2,715.6615789-2

CPT CODE: $1,073.2015792-2

CPT CODE: $1,073.2015793-2

CPT CODE: $2,272.6715819-2

CPT CODE: $1,610.6015820-2

CPT CODE: $2,312.1715821-2

CPT CODE: $1,827.9815822-2

CPT CODE: $1,827.9815823-2

CPT CODE: $2,272.6715824-2

CPT CODE: $3,399.0915825-2

CPT CODE: $1,827.9815826-2

CPT CODE: $6,610.4415828-2

CPT CODE: $1,827.9815829-2

CPT CODE: $2,558.0915830-2

CPT CODE: $6,610.4415832-2

CPT CODE: $6,610.4415833-2

CPT CODE: $6,610.4415834-2

CPT CODE: $6,610.4415835-2

CPT CODE: $6,610.4415836-2

CPT CODE: $3,142.1915837-2

CPT CODE: $3,142.1915838-2

CPT CODE: $3,142.1915839-2

CPT CODE: $4,406.9415840-2

CPT CODE: $4,406.9415841-2

CPT CODE: $4,406.9415842-2

CPT CODE: $5,355.5715845-2

CPT CODE: $395.3215847-2

CPT CODE: $65.2015850-2

CPT CODE: $65.2015851-2

CPT CODE: $345.8415852-2

CPT CODE: $1,413.0115876-2

CPT CODE: $1,413.0115877-2

CPT CODE: $1,413.0115878-2

CPT CODE: $1,413.0115879-2

CPT CODE: $1,314.1715920-2

CPT CODE: $1,699.5615922-2

CPT CODE: $1,017.7515931-2

CPT CODE: $1,383.3315933-2

CPT CODE: $1,205.4615934-2

CPT CODE: $1,827.9815935-2

CPT CODE: $1,452.5015936-2

CPT CODE: $1,827.9815937-2

CPT CODE: $1,156.0815940-2

CPT CODE: $1,571.0915941-2

CPT CODE: $1,452.5015944-2

CPT CODE: $1,827.9815945-2

CPT CODE: $2,677.7615946-2

CPT CODE: $1,017.7515950-2

CPT CODE: $1,383.3315951-2

CPT CODE: $1,452.5015952-2

CPT CODE: $1,827.9815953-2

CPT CODE: $2,331.9615956-2

CPT CODE: $2,717.3015958-2

CPT CODE: $100.8016000-2

CPT CODE: $96.8416020-2

CPT CODE: $106.7216025-2

CPT CODE: $136.3716030-2

CPT CODE: $316.2116035-2

CPT CODE: $129.4616036-2

CPT CODE: $85.1717000-2

CPT CODE: $37.1717003-3

CPT CODE: $337.8817004-2

CPT CODE: $57.4117110-2

CPT CODE: $77.7117111-2

CPT CODE: $59.2617250-2

CPT CODE: $166.0917260-2

CPT CODE: $201.8717261-2

CPT CODE: $246.3217262-2

CPT CODE: $285.2217263-2

CPT CODE: $351.9017264-2

CPT CODE: $474.1317266-2

CPT CODE: $168.5217270-2

CPT CODE: $214.8217271-2

CPT CODE: $258.8917272-2

CPT CODE: $326.0717273-2

CPT CODE: $395.2617274-2

CPT CODE: $503.9517276-2

CPT CODE: $201.8717280-2

CPT CODE: $205.5217281-2

CPT CODE: $306.3017282-2

CPT CODE: $375.4617283-2

CPT CODE: $474.2717284-2

CPT CODE: $543.4617286-2

CPT CODE: $688.0917311-2

CPT CODE: $315.7217312-2

CPT CODE: $671.9117313-2

CPT CODE: $307.6217314-2

CPT CODE: $70.1617315-2

CPT CODE: $65.2017340-2

CPT CODE: $63.2117360-2

CPT CODE: $118.5917380-2

CPT CODE: $96.8419000-2

CPT CODE: $63.2119001-2

CPT CODE: $523.7019020-2

CPT CODE: $100.8019030-2

CPT CODE: $251.1019081-2

CPT CODE: $121.9819082-2

CPT CODE: $235.8019083-2

CPT CODE: $114.7319084-2

CPT CODE: $275.7519085-2

CPT CODE: $129.0619086-2

CPT CODE: $128.4419100-2

CPT CODE: $681.8119101-2

CPT CODE: $820.1319110-2

CPT CODE: $820.1319112-2

CPT CODE: $780.6019120-2

CPT CODE: $774.5619125-2

CPT CODE: $774.5619126-2

CPT CODE: $252.0319281-2

CPT CODE: $70.9319282-2

CPT CODE: $146.9719283-2

CPT CODE: $71.3819284-2

CPT CODE: $124.6719285-2

CPT CODE: $66.7219286-2

CPT CODE: $196.1319287-2

CPT CODE: $91.5919288-2

CPT CODE: $171.7819294-2

CPT CODE: $984.2319296-2

CPT CODE: $492.8319297-2

CPT CODE: $1,124.6219298-2

CPT CODE: $975.4719300-2

CPT CODE: $871.5919301-2

CPT CODE: $2,427.2219302-2

CPT CODE: $1,261.5019303-2

CPT CODE: $2,440.7119305-2

CPT CODE: $4,356.5819306-2

CPT CODE: $2,433.9619307-2

CPT CODE: $4,673.7619316-2

CPT CODE: $4,673.7619318-2

CPT CODE: $2,588.8719324-2

CPT CODE: $2,588.8719325-2

CPT CODE: $1,363.6019328-2

CPT CODE: $1,086.9419330-2

CPT CODE: $1,215.3819340-2

CPT CODE: $1,798.3319342-2

CPT CODE: $1,995.9919350-2

Page 3

Page 4: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $1,995.9919355-2

CPT CODE: $3,991.9519357-2

CPT CODE: $2,588.8719361-2

CPT CODE: $14,080.5519364-2

CPT CODE: $2,588.8719366-2

CPT CODE: $10,448.7419367-2

CPT CODE: $10,448.7419368-2

CPT CODE: $10,448.7419369-2

CPT CODE: $938.6819370-2

CPT CODE: $938.6819371-2

CPT CODE: $1,205.4619380-2

CPT CODE: $779.6120100-2

CPT CODE: $1,322.3520101-2

CPT CODE: $1,322.3520102-2

CPT CODE: $525.0520103-2

CPT CODE: $870.2020150-2

CPT CODE: $280.6320200-2

CPT CODE: $444.6520205-2

CPT CODE: $187.7320206-2

CPT CODE: $189.7320220-2

CPT CODE: $879.4120225-2

CPT CODE: $691.6920240-2

CPT CODE: $820.1320245-2

CPT CODE: $2,638.2620250-2

CPT CODE: $2,638.2620251-2

CPT CODE: $124.5020500-2

CPT CODE: $124.5020501-2

CPT CODE: $136.3720520-2

CPT CODE: $1,245.0220525-2

CPT CODE: $58.6320526-2

CPT CODE: $67.7320527-2

CPT CODE: $71.1620550-2

CPT CODE: $58.6320551-2

CPT CODE: $87.9520552-2

CPT CODE: $117.2520553-2

CPT CODE: $557.5420555-2

CPT CODE: $49.4520560-2

CPT CODE: $84.9320561-2

CPT CODE: $83.5620600-2

CPT CODE: $85.6020604-2

CPT CODE: $73.1020605-2

CPT CODE: $94.2820606-2

CPT CODE: $75.1120610-2

CPT CODE: $107.6720611-2

CPT CODE: $57.1320612-2

CPT CODE: $622.5020615-2

CPT CODE: $316.2120650-2

CPT CODE: $1,551.3420660-2

CPT CODE: $2,371.4420661-2

CPT CODE: $691.6920662-2

CPT CODE: $691.6920663-2

CPT CODE: $2,268.7720664-2

CPT CODE: $124.5020665-2

CPT CODE: $800.3820670-2

CPT CODE: $1,165.9420680-2

CPT CODE: $2,075.0220690-2

CPT CODE: $3,942.5420692-2

CPT CODE: $1,966.3120693-2

CPT CODE: $948.6120694-2

CPT CODE: $2,142.5620696-2

CPT CODE: $87.8420700-2

CPT CODE: $65.6420701-2

CPT CODE: $146.0920702-2

CPT CODE: $104.8820703-2

CPT CODE: $152.1920704-2

CPT CODE: $125.3520705-2

CPT CODE: $7,628.2120802-2

CPT CODE: $7,628.2120805-2

CPT CODE: $7,628.2120808-2

CPT CODE: $8,240.8420816-2

CPT CODE: $4,090.7720822-2

CPT CODE: $8,112.3920824-2

CPT CODE: $4,090.7720827-2

CPT CODE: $7,183.5520838-2

CPT CODE: $563.1920900-2

CPT CODE: $3,774.5820902-2

CPT CODE: $1,077.0320910-2

CPT CODE: $1,630.3720912-2

CPT CODE: $444.6520920-2

CPT CODE: $879.4120922-2

CPT CODE: $3,774.5820924-2

CPT CODE: $571.0320930-2

CPT CODE: $571.0320931-2

CPT CODE: $748.9020932-2

CPT CODE: $687.1120933-2

CPT CODE: $748.5120934-2

CPT CODE: $571.0320936-2

CPT CODE: $1,884.5520937-2

CPT CODE: $1,884.5520938-2

CPT CODE: $70.9820939-2

CPT CODE: $294.4720950-2

CPT CODE: $7,114.3620955-2

CPT CODE: $6,117.1420956-2

CPT CODE: $6,117.1420957-2

CPT CODE: $7,114.3620962-2

CPT CODE: $9,683.4920969-2

CPT CODE: $9,683.4920970-2

CPT CODE: $8,053.0920972-2

CPT CODE: $8,053.0920973-2

CPT CODE: $1,916.9420974-2

CPT CODE: $1,905.3120975-2

CPT CODE: $2,826.0221010-2

CPT CODE: $523.5921011-2

CPT CODE: $567.3321012-2

CPT CODE: $816.9121013-2

CPT CODE: $877.3721014-2

CPT CODE: $4,476.1621015-2

CPT CODE: $1,761.1721016-2

CPT CODE: $1,363.6021025-2

CPT CODE: $839.9121026-2

CPT CODE: $1,017.7521029-2

CPT CODE: $839.9121030-2

CPT CODE: $760.8321031-2

CPT CODE: $839.9121032-2

CPT CODE: $2,213.3421034-2

CPT CODE: $760.8321040-2

CPT CODE: $2,331.9621044-2

CPT CODE: $2,331.9621045-2

CPT CODE: $1,987.8321046-2

CPT CODE: $2,983.2421047-2

CPT CODE: $1,987.8321048-2

CPT CODE: $3,195.2721049-2

CPT CODE: $2,826.0221050-2

CPT CODE: $2,826.0221060-2

CPT CODE: $1,363.6021070-2

CPT CODE: $1,887.2921100-2

CPT CODE: $1,225.2421110-2

CPT CODE: $124.5021116-2

CPT CODE: $1,551.3421120-2

CPT CODE: $2,312.1721121-2

CPT CODE: $2,312.1721122-2

CPT CODE: $2,312.1721123-2

CPT CODE: $1,531.5521125-2

CPT CODE: $2,144.2221127-2

CPT CODE: $1,432.7721137-2

CPT CODE: $2,144.2221138-2

CPT CODE: $1,432.7721139-2

CPT CODE: $7,384.3621141-2

CPT CODE: $7,828.0721142-2

CPT CODE: $8,271.8221143-2

CPT CODE: $9,041.2121145-2

CPT CODE: $9,495.7321146-2

CPT CODE: $9,960.1721147-2

CPT CODE: $9,495.7321150-2

CPT CODE: $9,495.7321151-2

CPT CODE: $10,464.0721154-2

CPT CODE: $11,096.4621155-2

CPT CODE: $8,171.6821159-2

CPT CODE: $10,315.8721160-2

CPT CODE: $3,468.2721172-2

CPT CODE: $3,468.2721175-2

CPT CODE: $4,772.5621179-2

Page 4

Page 5: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $5,385.2221180-2

CPT CODE: $1,017.7521181-2

CPT CODE: $8,813.9621182-2

CPT CODE: $8,813.9621183-2

CPT CODE: $8,813.9621184-2

CPT CODE: $3,063.1621188-2

CPT CODE: $5,918.7721193-2

CPT CODE: $6,531.4021194-2

CPT CODE: $6,472.1321195-2

CPT CODE: $7,282.3721196-2

CPT CODE: $2,242.9921198-2

CPT CODE: $2,038.5621199-2

CPT CODE: $2,826.0221206-2

CPT CODE: $1,620.4921208-2

CPT CODE: $1,511.8121209-2

CPT CODE: $3,073.0221210-2

CPT CODE: $3,073.0221215-2

CPT CODE: $1,630.3721230-2

CPT CODE: $1,620.4921235-2

CPT CODE: $3,893.1821240-2

CPT CODE: $4,140.1721242-2

CPT CODE: $5,829.8721243-2

CPT CODE: $1,818.1521244-2

CPT CODE: $4,970.1921247-2

CPT CODE: $3,073.0221255-2

CPT CODE: $6,985.9221256-2

CPT CODE: $6,985.9221260-2

CPT CODE: $8,744.7921261-2

CPT CODE: $9,308.0021263-2

CPT CODE: $6,985.9221267-2

CPT CODE: $8,744.7921268-2

CPT CODE: $2,045.4021270-2

CPT CODE: $4,663.8721275-2

CPT CODE: $1,254.9121280-2

CPT CODE: $1,254.9121282-2

CPT CODE: $1,630.3721295-2

CPT CODE: $2,075.0221296-2

CPT CODE: $464.3821310-2

CPT CODE: $251.0021315-2

CPT CODE: $711.4421320-2

CPT CODE: $879.4121325-2

CPT CODE: $2,075.0221330-2

CPT CODE: $3,389.2121335-2

CPT CODE: $841.8021336-2

CPT CODE: $249.0121337-2

CPT CODE: $1,254.9121338-2

CPT CODE: $2,075.0221339-2

CPT CODE: $2,756.8221340-2

CPT CODE: $2,519.6921343-2

CPT CODE: $2,888.7821344-2

CPT CODE: $2,885.2721345-2

CPT CODE: $2,756.8221346-2

CPT CODE: $3,962.2921347-2

CPT CODE: $3,242.7021348-2

CPT CODE: $691.6921355-2

CPT CODE: $1,511.3521356-2

CPT CODE: $1,432.7721360-2

CPT CODE: $3,814.1021365-2

CPT CODE: $4,151.4221366-2

CPT CODE: $2,559.2121385-2

CPT CODE: $2,519.6921386-2

CPT CODE: $3,468.2721387-2

CPT CODE: $3,013.7421390-2

CPT CODE: $3,962.2921395-2

CPT CODE: $938.6821400-2

CPT CODE: $1,887.2921401-2

CPT CODE: $2,519.6921406-2

CPT CODE: $3,043.3721407-2

CPT CODE: $2,946.1621408-2

CPT CODE: $1,699.5621421-2

CPT CODE: $2,569.1021422-2

CPT CODE: $3,185.3221423-2

CPT CODE: $2,075.0221431-2

CPT CODE: $4,159.9521432-2

CPT CODE: $5,721.1521433-2

CPT CODE: $9,436.4421435-2

CPT CODE: $10,273.2921436-2

CPT CODE: $938.6821440-2

CPT CODE: $1,808.2421445-2

CPT CODE: $928.8221450-2

CPT CODE: $987.1621451-2

CPT CODE: $1,870.6221452-2

CPT CODE: $1,887.2921453-2

CPT CODE: $3,596.7121454-2

CPT CODE: $2,450.5121461-2

CPT CODE: $2,687.6521462-2

CPT CODE: $1,887.2921465-2

CPT CODE: $4,515.6521470-2

CPT CODE: $292.4921480-2

CPT CODE: $474.2721485-2

CPT CODE: $1,887.2921490-2

CPT CODE: $1,383.3321497-2

CPT CODE: $513.8321501-2

CPT CODE: $1,324.0721502-2

CPT CODE: $938.6821510-2

CPT CODE: $249.0121550-2

CPT CODE: $756.4421552-2

CPT CODE: $1,246.5821554-2

CPT CODE: $124.5021555-2

CPT CODE: $251.0021556-2

CPT CODE: $4,742.9321557-2

CPT CODE: $2,342.6521558-2

CPT CODE: $1,324.0721600-2

CPT CODE: $2,595.0521601-2

CPT CODE: $3,571.1521602-2

CPT CODE: $2,473.5821603-2

CPT CODE: $1,324.0721610-2

CPT CODE: $3,201.4621615-2

CPT CODE: $4,772.5621616-2

CPT CODE: $3,201.4621620-2

CPT CODE: $2,826.0221627-2

CPT CODE: $4,772.5621630-2

CPT CODE: $6,047.2421632-2

CPT CODE: $1,928.6321685-2

CPT CODE: $1,699.5621700-2

CPT CODE: $2,826.0221705-2

CPT CODE: $1,689.6421720-2

CPT CODE: $1,936.7021725-2

CPT CODE: $5,661.8821740-2

CPT CODE: $1,819.4321742-2

CPT CODE: $1,819.4321743-2

CPT CODE: $3,201.4621750-2

CPT CODE: $666.3421811-2

CPT CODE: $799.4221812-2

CPT CODE: $1,094.5321813-2

CPT CODE: $513.8321820-2

CPT CODE: $1,887.2921825-2

CPT CODE: $249.0121920-2

CPT CODE: $513.8321925-2

CPT CODE: $249.0121930-2

CPT CODE: $791.1821931-2

CPT CODE: $1,135.9521932-2

CPT CODE: $1,253.0121933-2

CPT CODE: $4,742.9321935-2

CPT CODE: $2,435.2721936-2

CPT CODE: $1,288.0122010-2

CPT CODE: $1,288.0122015-2

CPT CODE: $1,758.8422100-2

CPT CODE: $1,758.8422101-2

CPT CODE: $1,758.8422102-2

CPT CODE: $1,014.7522103-2

CPT CODE: $3,912.9022110-2

CPT CODE: $3,912.9022112-2

CPT CODE: $3,912.9022114-2

CPT CODE: $1,014.7522116-2

CPT CODE: $4,176.9722206-2

CPT CODE: $4,122.6422207-2

CPT CODE: $1,023.2322208-2

CPT CODE: $4,772.5622210-2

CPT CODE: $4,772.5622212-2

CPT CODE: $4,772.5622214-2

CPT CODE: $1,196.8322216-2

Page 5

Page 6: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $5,533.4122220-2

CPT CODE: $5,533.4122222-2

CPT CODE: $5,533.4122224-2

CPT CODE: $1,196.8322226-2

CPT CODE: $592.8722310-2

CPT CODE: $1,887.2922315-2

CPT CODE: $1,724.1722318-2

CPT CODE: $2,154.4222319-2

CPT CODE: $4,406.9422325-2

CPT CODE: $4,406.9422326-2

CPT CODE: $4,406.9422327-2

CPT CODE: $1,322.3522328-2

CPT CODE: $513.8322505-2

CPT CODE: $2,018.6622510-2

CPT CODE: $1,997.5322511-2

CPT CODE: $1,115.6822512-2

CPT CODE: $626.3922513-2

CPT CODE: $584.8222514-2

CPT CODE: $262.2322515-2

CPT CODE: $4,378.1622532-2

CPT CODE: $4,178.9422533-2

CPT CODE: $1,007.8522534-2

CPT CODE: $6,047.2422548-2

CPT CODE: $4,654.2822551-2

CPT CODE: $1,536.8922552-2

CPT CODE: $5,742.6522554-2

CPT CODE: $6,847.5922556-2

CPT CODE: $5,464.2222558-2

CPT CODE: $1,324.0722585-2

CPT CODE: $2,939.8522586-2

CPT CODE: $6,047.2422590-2

CPT CODE: $6,047.2422595-2

CPT CODE: $5,357.7922600-2

CPT CODE: $5,227.0822610-2

CPT CODE: $6,518.5822612-2

CPT CODE: $1,322.3522614-2

CPT CODE: $6,847.5922630-2

CPT CODE: $1,322.3522632-2

CPT CODE: $3,741.2622633-2

CPT CODE: $1,164.6422634-2

CPT CODE: $6,412.8322800-2

CPT CODE: $6,798.2022802-2

CPT CODE: $7,389.6522804-2

CPT CODE: $3,371.3222808-2

CPT CODE: $6,412.8322810-2

CPT CODE: $6,798.2022812-2

CPT CODE: $5,689.7022818-2

CPT CODE: $6,833.3722819-2

CPT CODE: $3,260.7822830-2

CPT CODE: $5,355.5622840-2

CPT CODE: $3,424.3522841-2

CPT CODE: $5,371.3622842-2

CPT CODE: $5,337.1822843-2

CPT CODE: $5,798.5922844-2

CPT CODE: $2,125.4422845-2

CPT CODE: $3,053.1222846-2

CPT CODE: $3,487.9922847-2

CPT CODE: $1,322.3522848-2

CPT CODE: $4,723.1722849-2

CPT CODE: $3,428.7522850-2

CPT CODE: $4,873.3722852-2

CPT CODE: $280.4622853-2

CPT CODE: $363.0522854-2

CPT CODE: $2,015.7422855-2

CPT CODE: $672.0022858-2

CPT CODE: $363.0522859-2

CPT CODE: $4,100.6522900-2

CPT CODE: $1,120.5122901-2

CPT CODE: $699.8322902-2

CPT CODE: $742.2922903-2

CPT CODE: $1,757.3122904-2

CPT CODE: $2,278.3222905-2

CPT CODE: $928.8223000-2

CPT CODE: $2,401.0923020-2

CPT CODE: $185.7723030-2

CPT CODE: $247.0223031-2

CPT CODE: $938.6823035-2

CPT CODE: $2,203.4823040-2

CPT CODE: $1,077.0323044-2

CPT CODE: $249.0123065-2

CPT CODE: $513.8323066-2

CPT CODE: $702.4123071-2

CPT CODE: $1,233.7223073-2

CPT CODE: $543.4623075-2

CPT CODE: $1,086.9423076-2

CPT CODE: $4,742.9323077-2

CPT CODE: $2,372.2323078-2

CPT CODE: $2,401.0923100-2

CPT CODE: $1,077.0323101-2

CPT CODE: $3,270.6623105-2

CPT CODE: $1,452.5023106-2

CPT CODE: $2,203.4823107-2

CPT CODE: $1,571.0923120-2

CPT CODE: $1,571.0923125-2

CPT CODE: $1,580.9623130-2

CPT CODE: $1,324.0723140-2

CPT CODE: $1,936.7023145-2

CPT CODE: $1,571.0923146-2

CPT CODE: $3,468.2723150-2

CPT CODE: $5,227.0823155-2

CPT CODE: $4,100.6523156-2

CPT CODE: $1,383.3323170-2

CPT CODE: $1,077.0323172-2

CPT CODE: $2,826.0223174-2

CPT CODE: $1,077.0323180-2

CPT CODE: $1,077.0323182-2

CPT CODE: $2,826.0223184-2

CPT CODE: $1,571.0923190-2

CPT CODE: $1,571.0923195-2

CPT CODE: $3,774.5823200-2

CPT CODE: $5,978.0623210-2

CPT CODE: $2,885.2723220-2

CPT CODE: $126.4923330-2

CPT CODE: $678.3023333-2

CPT CODE: $1,206.1523334-2

CPT CODE: $1,478.5123335-2

CPT CODE: $126.4923350-2

CPT CODE: $4,406.9423395-2

CPT CODE: $4,406.9423397-2

CPT CODE: $2,519.6923400-2

CPT CODE: $1,758.8423405-2

CPT CODE: $2,638.2623406-2

CPT CODE: $2,134.3223410-2

CPT CODE: $3,171.8323412-2

CPT CODE: $859.6423415-2

CPT CODE: $3,592.7623420-2

CPT CODE: $2,638.2623430-2

CPT CODE: $2,638.2623440-2

CPT CODE: $3,616.4623450-2

CPT CODE: $4,100.6523455-2

CPT CODE: $4,406.9423460-2

CPT CODE: $3,962.2923462-2

CPT CODE: $3,774.5823465-2

CPT CODE: $3,774.5823466-2

CPT CODE: $4,268.6623470-2

CPT CODE: $5,345.7023472-2

CPT CODE: $2,850.9923473-2

CPT CODE: $3,579.6823474-2

CPT CODE: $2,203.4823480-2

CPT CODE: $2,638.2623485-2

CPT CODE: $1,887.2923490-2

CPT CODE: $2,776.6023491-2

CPT CODE: $375.4623500-2

CPT CODE: $543.4623505-2

CPT CODE: $1,660.0423515-2

CPT CODE: $251.0023520-2

CPT CODE: $622.5023525-2

CPT CODE: $1,571.0923530-2

CPT CODE: $1,758.8423532-2

CPT CODE: $622.5023540-2

CPT CODE: $760.8323545-2

CPT CODE: $1,788.4523550-2

Page 6

Page 7: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $1,926.8023552-2

CPT CODE: $345.8423570-2

CPT CODE: $760.8323575-2

CPT CODE: $1,887.2923585-2

CPT CODE: $1,007.8623600-2

CPT CODE: $1,561.2323605-2

CPT CODE: $2,776.6023615-2

CPT CODE: $2,888.7823616-2

CPT CODE: $345.8423620-2

CPT CODE: $760.8323625-2

CPT CODE: $1,936.7023630-2

CPT CODE: $711.4423650-2

CPT CODE: $889.2823655-2

CPT CODE: $2,826.0223660-2

CPT CODE: $582.9823665-2

CPT CODE: $2,638.2623670-2

CPT CODE: $879.4123675-2

CPT CODE: $3,705.4223680-2

CPT CODE: $830.0223700-2

CPT CODE: $3,903.0223800-2

CPT CODE: $4,406.9423802-2

CPT CODE: $5,039.3323900-2

CPT CODE: $3,774.5823920-2

CPT CODE: $691.6923921-2

CPT CODE: $185.7723930-2

CPT CODE: $124.5023931-2

CPT CODE: $938.6823935-2

CPT CODE: $2,025.6124000-2

CPT CODE: $2,343.5224006-2

CPT CODE: $251.0024065-2

CPT CODE: $513.8324066-2

CPT CODE: $681.8324071-2

CPT CODE: $1,171.9724073-2

CPT CODE: $642.2724075-2

CPT CODE: $1,175.8624076-2

CPT CODE: $4,742.9324077-2

CPT CODE: $2,185.7024079-2

CPT CODE: $1,195.5924100-2

CPT CODE: $1,768.7224101-2

CPT CODE: $2,193.6224102-2

CPT CODE: $889.2824105-2

CPT CODE: $2,193.6224110-2

CPT CODE: $2,717.3024115-2

CPT CODE: $2,331.9624116-2

CPT CODE: $1,758.8424120-2

CPT CODE: $2,203.4824125-2

CPT CODE: $1,936.7024126-2

CPT CODE: $2,025.6124130-2

CPT CODE: $2,638.2624134-2

CPT CODE: $1,758.8424136-2

CPT CODE: $1,324.0724138-2

CPT CODE: $2,638.2624140-2

CPT CODE: $1,758.8424145-2

CPT CODE: $1,324.0724147-2

CPT CODE: $1,714.6624149-2

CPT CODE: $5,978.0624150-2

CPT CODE: $3,962.2924152-2

CPT CODE: $3,270.6624155-2

CPT CODE: $1,324.0724160-2

CPT CODE: $879.4124164-2

CPT CODE: $116.6024200-2

CPT CODE: $642.2724201-2

CPT CODE: $124.5024220-2

CPT CODE: $546.1324300-2

CPT CODE: $2,588.8724301-2

CPT CODE: $1,324.0724305-2

CPT CODE: $1,077.0324310-2

CPT CODE: $2,717.3024320-2

CPT CODE: $2,638.2624330-2

CPT CODE: $3,468.2724331-2

CPT CODE: $1,201.8224332-2

CPT CODE: $2,203.4824340-2

CPT CODE: $2,490.4624341-2

CPT CODE: $3,082.8924342-2

CPT CODE: $2,238.5524343-2

CPT CODE: $4,415.3524344-2

CPT CODE: $2,238.5524345-2

CPT CODE: $4,415.3524346-2

CPT CODE: $672.6624357-2

CPT CODE: $967.5924358-2

CPT CODE: $1,067.2024359-2

CPT CODE: $4,525.5524360-2

CPT CODE: $3,774.5824361-2

CPT CODE: $3,774.5824362-2

CPT CODE: $5,592.6924363-2

CPT CODE: $1,383.3324365-2

CPT CODE: $2,203.4824366-2

CPT CODE: $3,146.5324370-2

CPT CODE: $3,625.7424371-2

CPT CODE: $2,203.4824400-2

CPT CODE: $2,519.6924410-2

CPT CODE: $3,468.2724420-2

CPT CODE: $3,774.5824430-2

CPT CODE: $4,406.9424435-2

CPT CODE: $2,203.4824470-2

CPT CODE: $1,936.7024495-2

CPT CODE: $2,776.6024498-2

CPT CODE: $770.7324500-2

CPT CODE: $1,126.4624505-2

CPT CODE: $2,776.6024515-2

CPT CODE: $2,659.2224516-2

CPT CODE: $780.6024530-2

CPT CODE: $1,126.4624535-2

CPT CODE: $2,193.6224538-2

CPT CODE: $3,082.8924545-2

CPT CODE: $2,946.1624546-2

CPT CODE: $444.6524560-2

CPT CODE: $879.4124565-2

CPT CODE: $1,511.8124566-2

CPT CODE: $1,936.7024575-2

CPT CODE: $563.1924576-2

CPT CODE: $1,037.5024577-2

CPT CODE: $2,826.0224579-2

CPT CODE: $1,511.8124582-2

CPT CODE: $4,476.1624586-2

CPT CODE: $4,476.1624587-2

CPT CODE: $365.5824600-2

CPT CODE: $760.8324605-2

CPT CODE: $2,203.4824615-2

CPT CODE: $879.4124620-2

CPT CODE: $2,322.0524635-2

CPT CODE: $177.8424640-2

CPT CODE: $760.8324650-2

CPT CODE: $928.8224655-2

CPT CODE: $1,995.9924665-2

CPT CODE: $2,638.2624666-2

CPT CODE: $316.2124670-2

CPT CODE: $691.6924675-2

CPT CODE: $1,610.6024685-2

CPT CODE: $3,527.5324800-2

CPT CODE: $3,962.2924802-2

CPT CODE: $2,203.4824900-2

CPT CODE: $1,936.7024920-2

CPT CODE: $691.6924925-2

CPT CODE: $2,203.4824930-2

CPT CODE: $2,638.2624931-2

CPT CODE: $1,818.1524935-2

CPT CODE: $3,774.5824940-2

CPT CODE: $1,037.5025000-2

CPT CODE: $900.9625001-2

CPT CODE: $928.8225020-2

CPT CODE: $1,936.7025023-2

CPT CODE: $433.5225024-2

CPT CODE: $1,851.2925025-2

CPT CODE: $185.7725028-2

CPT CODE: $124.5025031-2

CPT CODE: $928.8225035-2

CPT CODE: $2,025.6125040-2

CPT CODE: $249.0125065-2

CPT CODE: $513.8325066-2

CPT CODE: $713.9825071-2

CPT CODE: $888.9525073-2

Page 7

Page 8: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $830.0225075-2

CPT CODE: $1,175.8625076-2

CPT CODE: $4,742.9325077-2

CPT CODE: $1,906.5325078-2

CPT CODE: $1,571.0925085-2

CPT CODE: $1,195.5925100-2

CPT CODE: $1,195.5925101-2

CPT CODE: $1,887.2925105-2

CPT CODE: $1,511.8125107-2

CPT CODE: $588.2625109-2

CPT CODE: $760.8325110-2

CPT CODE: $978.2325111-2

CPT CODE: $1,195.5925112-2

CPT CODE: $2,282.5025115-2

CPT CODE: $2,272.6725116-2

CPT CODE: $1,086.9425118-2

CPT CODE: $1,887.2925119-2

CPT CODE: $1,729.1825120-2

CPT CODE: $2,163.9525125-2

CPT CODE: $1,887.2925126-2

CPT CODE: $1,195.5925130-2

CPT CODE: $1,630.3725135-2

CPT CODE: $1,630.3725136-2

CPT CODE: $1,758.8425145-2

CPT CODE: $1,758.8425150-2

CPT CODE: $1,758.8425151-2

CPT CODE: $3,774.5825170-2

CPT CODE: $1,274.6725210-2

CPT CODE: $2,203.4825215-2

CPT CODE: $1,383.3325230-2

CPT CODE: $1,383.3325240-2

CPT CODE: $124.5025246-2

CPT CODE: $820.1325248-2

CPT CODE: $820.1325250-2

CPT CODE: $1,254.9125251-2

CPT CODE: $379.5225259-2

CPT CODE: $1,286.2525260-2

CPT CODE: $1,802.8025263-2

CPT CODE: $2,704.1925265-2

CPT CODE: $1,043.1725270-2

CPT CODE: $1,286.2525272-2

CPT CODE: $1,802.8025274-2

CPT CODE: $1,073.7525275-2

CPT CODE: $1,511.8125280-2

CPT CODE: $1,077.0325290-2

CPT CODE: $1,383.3325295-2

CPT CODE: $2,401.0925300-2

CPT CODE: $2,075.0225301-2

CPT CODE: $2,075.0225310-2

CPT CODE: $2,401.0925312-2

CPT CODE: $2,401.0925315-2

CPT CODE: $3,270.6625316-2

CPT CODE: $3,596.7125320-2

CPT CODE: $3,065.2025332-2

CPT CODE: $3,596.7125335-2

CPT CODE: $2,405.6825337-2

CPT CODE: $1,887.2925350-2

CPT CODE: $2,638.2625355-2

CPT CODE: $2,203.4825360-2

CPT CODE: $3,082.8925365-2

CPT CODE: $3,082.8925370-2

CPT CODE: $3,903.0225375-2

CPT CODE: $2,203.4825390-2

CPT CODE: $2,717.3025391-2

CPT CODE: $3,082.8925392-2

CPT CODE: $3,468.2725393-2

CPT CODE: $1,152.4425394-2

CPT CODE: $2,450.5125400-2

CPT CODE: $2,885.2725405-2

CPT CODE: $3,270.6625415-2

CPT CODE: $3,774.5825420-2

CPT CODE: $2,717.3025425-2

CPT CODE: $3,468.2725426-2

CPT CODE: $809.9525430-2

CPT CODE: $1,780.3325431-2

CPT CODE: $2,717.3025440-2

CPT CODE: $1,630.3725441-2

CPT CODE: $1,620.4925442-2

CPT CODE: $1,887.2925443-2

CPT CODE: $1,887.2925444-2

CPT CODE: $1,887.2925445-2

CPT CODE: $3,962.2925446-2

CPT CODE: $2,806.2225447-2

CPT CODE: $1,887.2925449-2

CPT CODE: $1,324.0725450-2

CPT CODE: $1,887.2925455-2

CPT CODE: $2,203.4825490-2

CPT CODE: $1,936.7025491-2

CPT CODE: $2,964.3625492-2

CPT CODE: $573.0825500-2

CPT CODE: $760.8325505-2

CPT CODE: $2,203.4825515-2

CPT CODE: $1,740.9325520-2

CPT CODE: $2,525.3225525-2

CPT CODE: $2,525.3225526-2

CPT CODE: $484.1725530-2

CPT CODE: $968.3425535-2

CPT CODE: $1,936.7025545-2

CPT CODE: $642.2725560-2

CPT CODE: $1,225.2425565-2

CPT CODE: $2,831.3625574-2

CPT CODE: $3,250.8725575-2

CPT CODE: $711.4425600-2

CPT CODE: $899.1625605-2

CPT CODE: $1,086.1125606-2

CPT CODE: $1,051.0325607-2

CPT CODE: $1,107.6925608-2

CPT CODE: $1,230.4725609-2

CPT CODE: $513.8325622-2

CPT CODE: $978.2325624-2

CPT CODE: $2,005.8825628-2

CPT CODE: $474.2725630-2

CPT CODE: $741.0825635-2

CPT CODE: $1,887.2925645-2

CPT CODE: $444.6525650-2

CPT CODE: $475.1625651-2

CPT CODE: $592.4225652-2

CPT CODE: $760.8325660-2

CPT CODE: $1,936.7025670-2

CPT CODE: $900.9625671-2

CPT CODE: $691.6925675-2

CPT CODE: $1,383.3325676-2

CPT CODE: $1,324.0725680-2

CPT CODE: $1,887.2925685-2

CPT CODE: $1,077.0325690-2

CPT CODE: $1,630.3725695-2

CPT CODE: $2,450.5125800-2

CPT CODE: $3,013.7425805-2

CPT CODE: $3,013.7425810-2

CPT CODE: $2,450.5125820-2

CPT CODE: $2,964.3625825-2

CPT CODE: $2,886.7925830-2

CPT CODE: $1,887.2925900-2

CPT CODE: $1,758.8425905-2

CPT CODE: $691.6925907-2

CPT CODE: $1,936.7025909-2

CPT CODE: $1,887.2925915-2

CPT CODE: $1,887.2925920-2

CPT CODE: $691.6925922-2

CPT CODE: $1,887.2925924-2

CPT CODE: $1,571.0925927-2

CPT CODE: $563.1925929-2

CPT CODE: $1,571.0925931-2

CPT CODE: $126.4926010-2

CPT CODE: $278.6126011-2

CPT CODE: $928.8226020-2

CPT CODE: $800.3826025-2

CPT CODE: $1,571.0926030-2

CPT CODE: $928.8226034-2

CPT CODE: $938.6826035-2

CPT CODE: $1,383.3326037-2

CPT CODE: $563.1926040-2

Page 8

Page 9: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $1,383.3326045-2

CPT CODE: $839.9126055-2

CPT CODE: $563.1926060-2

CPT CODE: $978.2326070-2

CPT CODE: $820.1326075-2

CPT CODE: $780.6026080-2

CPT CODE: $978.2326100-2

CPT CODE: $820.1326105-2

CPT CODE: $691.6926110-2

CPT CODE: $692.1226111-2

CPT CODE: $910.8226113-2

CPT CODE: $622.5026115-2

CPT CODE: $1,086.9426116-2

CPT CODE: $1,324.0726117-2

CPT CODE: $1,786.8926118-2

CPT CODE: $1,709.4326121-2

CPT CODE: $1,709.4326123-2

CPT CODE: $691.6926125-2

CPT CODE: $1,383.3326130-2

CPT CODE: $1,551.3426135-2

CPT CODE: $1,383.3326140-2

CPT CODE: $1,551.3426145-2

CPT CODE: $859.6426160-2

CPT CODE: $820.1326170-2

CPT CODE: $820.1326180-2

CPT CODE: $851.3326185-2

CPT CODE: $1,383.3326200-2

CPT CODE: $1,758.8426205-2

CPT CODE: $1,254.9126210-2

CPT CODE: $1,620.4926215-2

CPT CODE: $1,077.0326230-2

CPT CODE: $820.1326235-2

CPT CODE: $691.6926236-2

CPT CODE: $1,630.3726250-2

CPT CODE: $1,630.3726260-2

CPT CODE: $1,630.3726262-2

CPT CODE: $1,086.9426320-2

CPT CODE: $217.5426340-2

CPT CODE: $79.7426341-2

CPT CODE: $1,590.0926350-2

CPT CODE: $2,785.2426352-2

CPT CODE: $1,802.8026356-2

CPT CODE: $1,802.8026357-2

CPT CODE: $2,785.2426358-2

CPT CODE: $1,661.0226370-2

CPT CODE: $2,126.8926372-2

CPT CODE: $1,671.1626373-2

CPT CODE: $1,671.1626390-2

CPT CODE: $2,258.5526392-2

CPT CODE: $648.2126410-2

CPT CODE: $1,417.9526412-2

CPT CODE: $891.2826415-2

CPT CODE: $1,144.4726416-2

CPT CODE: $708.9526418-2

CPT CODE: $1,417.9526420-2

CPT CODE: $1,661.0226426-2

CPT CODE: $2,258.5526428-2

CPT CODE: $577.3126432-2

CPT CODE: $708.9526433-2

CPT CODE: $840.6226434-2

CPT CODE: $638.0526437-2

CPT CODE: $1,103.9726440-2

CPT CODE: $1,103.9726442-2

CPT CODE: $840.6226445-2

CPT CODE: $1,043.1726449-2

CPT CODE: $840.6226450-2

CPT CODE: $577.3126455-2

CPT CODE: $577.3126460-2

CPT CODE: $1,417.9526471-2

CPT CODE: $1,103.9726474-2

CPT CODE: $1,154.6026476-2

CPT CODE: $1,154.6026477-2

CPT CODE: $1,671.1626478-2

CPT CODE: $1,671.1626479-2

CPT CODE: $1,802.8026480-2

CPT CODE: $2,390.2526483-2

CPT CODE: $2,258.5526485-2

CPT CODE: $2,785.2426489-2

CPT CODE: $2,126.8926490-2

CPT CODE: $2,785.2426492-2

CPT CODE: $2,511.7826494-2

CPT CODE: $2,126.8926496-2

CPT CODE: $2,126.8926497-2

CPT CODE: $2,785.2426498-2

CPT CODE: $2,126.8926499-2

CPT CODE: $1,417.9526500-2

CPT CODE: $1,671.1626502-2

CPT CODE: $1,671.1626508-2

CPT CODE: $2,501.6326510-2

CPT CODE: $1,383.3326516-2

CPT CODE: $2,075.0226517-2

CPT CODE: $2,450.5126518-2

CPT CODE: $1,383.3326520-2

CPT CODE: $1,294.4126525-2

CPT CODE: $1,630.3726530-2

CPT CODE: $1,887.2926531-2

CPT CODE: $1,245.0226535-2

CPT CODE: $1,887.2926536-2

CPT CODE: $1,887.2926540-2

CPT CODE: $2,331.9626541-2

CPT CODE: $1,847.7826542-2

CPT CODE: $1,630.3726545-2

CPT CODE: $1,678.6126546-2

CPT CODE: $1,383.3326548-2

CPT CODE: $5,523.5026550-2

CPT CODE: $6,505.0426551-2

CPT CODE: $6,693.8226553-2

CPT CODE: $6,505.0426554-2

CPT CODE: $5,978.0626555-2

CPT CODE: $4,587.8726556-2

CPT CODE: $1,571.0926560-2

CPT CODE: $2,203.4826561-2

CPT CODE: $2,964.3626562-2

CPT CODE: $1,630.3726565-2

CPT CODE: $1,630.3726567-2

CPT CODE: $2,163.9526568-2

CPT CODE: $2,697.5026580-2

CPT CODE: $1,630.3726587-2

CPT CODE: $1,324.0726590-2

CPT CODE: $2,450.5126591-2

CPT CODE: $1,630.3726593-2

CPT CODE: $2,025.6126596-2

CPT CODE: $262.8026600-2

CPT CODE: $602.7526605-2

CPT CODE: $938.6826607-2

CPT CODE: $908.7526608-2

CPT CODE: $948.6126615-2

CPT CODE: $543.4626641-2

CPT CODE: $543.4626645-2

CPT CODE: $978.2326650-2

CPT CODE: $2,005.8826665-2

CPT CODE: $513.8326670-2

CPT CODE: $563.1926675-2

CPT CODE: $869.5326676-2

CPT CODE: $1,254.9126685-2

CPT CODE: $1,254.9126686-2

CPT CODE: $249.0126700-2

CPT CODE: $513.8326705-2

CPT CODE: $839.9126706-2

CPT CODE: $1,225.2426715-2

CPT CODE: $195.6526720-2

CPT CODE: $464.3826725-2

CPT CODE: $839.9126727-2

CPT CODE: $1,126.4626735-2

CPT CODE: $335.9526740-2

CPT CODE: $484.1726742-2

CPT CODE: $1,393.2126746-2

CPT CODE: $130.4226750-2

CPT CODE: $249.0126755-2

CPT CODE: $355.7526756-2

CPT CODE: $553.3326765-2

CPT CODE: $156.1226770-2

Page 9

Page 10: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $187.7326775-2

CPT CODE: $355.7526776-2

CPT CODE: $652.1926785-2

CPT CODE: $2,203.4826820-2

CPT CODE: $1,758.8426841-2

CPT CODE: $2,203.4826842-2

CPT CODE: $1,758.8426843-2

CPT CODE: $2,203.4826844-2

CPT CODE: $1,630.3726850-2

CPT CODE: $2,075.0226852-2

CPT CODE: $1,254.9126860-2

CPT CODE: $622.5026861-2

CPT CODE: $1,630.3726862-2

CPT CODE: $820.1326863-2

CPT CODE: $1,096.7826910-2

CPT CODE: $642.2726951-2

CPT CODE: $830.0226952-2

CPT CODE: $185.7726990-2

CPT CODE: $96.8426991-2

CPT CODE: $938.6826992-2

CPT CODE: $563.1927000-2

CPT CODE: $691.6927001-2

CPT CODE: $691.6927003-2

CPT CODE: $1,324.0727005-2

CPT CODE: $1,324.0727006-2

CPT CODE: $1,887.2927025-2

CPT CODE: $1,702.4827027-2

CPT CODE: $3,082.8927030-2

CPT CODE: $2,964.3627033-2

CPT CODE: $3,774.5827035-2

CPT CODE: $3,686.7527036-2

CPT CODE: $249.0127040-2

CPT CODE: $513.8327041-2

CPT CODE: $789.8927043-2

CPT CODE: $1,256.8727045-2

CPT CODE: $810.2627047-2

CPT CODE: $1,165.9427048-2

CPT CODE: $4,742.9327049-2

CPT CODE: $1,324.0727050-2

CPT CODE: $3,073.0227052-2

CPT CODE: $4,406.9427054-2

CPT CODE: $1,873.7927057-2

CPT CODE: $3,406.5527059-2

CPT CODE: $1,077.0327060-2

CPT CODE: $820.1327062-2

CPT CODE: $1,077.0327065-2

CPT CODE: $1,699.5627066-2

CPT CODE: $1,699.5627067-2

CPT CODE: $1,077.0327070-2

CPT CODE: $2,826.0227071-2

CPT CODE: $5,978.0627075-2

CPT CODE: $5,978.0627076-2

CPT CODE: $5,978.0627077-2

CPT CODE: $5,978.0627078-2

CPT CODE: $1,482.1527080-2

CPT CODE: $124.5027086-2

CPT CODE: $760.8327087-2

CPT CODE: $3,082.8927090-2

CPT CODE: $3,073.0227091-2

CPT CODE: $154.1527093-2

CPT CODE: $154.1527095-2

CPT CODE: $88.9727096-2

CPT CODE: $2,964.3627097-2

CPT CODE: $2,964.3627098-2

CPT CODE: $3,270.6627100-2

CPT CODE: $3,468.2727105-2

CPT CODE: $4,406.9427110-2

CPT CODE: $3,270.6627111-2

CPT CODE: $5,227.0827120-2

CPT CODE: $4,406.9427122-2

CPT CODE: $4,426.7327125-2

CPT CODE: $6,100.5827130-2

CPT CODE: $8,171.6827132-2

CPT CODE: $9,900.8827134-2

CPT CODE: $6,788.3527137-2

CPT CODE: $6,788.3527138-2

CPT CODE: $2,638.2627140-2

CPT CODE: $4,406.9427146-2

CPT CODE: $4,772.5627147-2

CPT CODE: $6,096.6527151-2

CPT CODE: $4,772.5627156-2

CPT CODE: $4,772.5627158-2

CPT CODE: $3,853.6727161-2

CPT CODE: $3,991.9527165-2

CPT CODE: $3,567.0927170-2

CPT CODE: $2,272.6727175-2

CPT CODE: $3,211.3427176-2

CPT CODE: $5,088.7827177-2

CPT CODE: $4,584.8627178-2

CPT CODE: $3,468.2727179-2

CPT CODE: $5,227.0827181-2

CPT CODE: $1,758.8427185-2

CPT CODE: $4,584.8627187-2

CPT CODE: $269.9327197-2

CPT CODE: $475.5427198-2

CPT CODE: $622.5027200-2

CPT CODE: $1,571.0927202-2

CPT CODE: $2,400.9327215-2

CPT CODE: $1,205.2627216-2

CPT CODE: $3,003.5527217-2

CPT CODE: $3,003.5527218-2

CPT CODE: $1,077.0327220-2

CPT CODE: $2,519.6927222-2

CPT CODE: $3,309.6427226-2

CPT CODE: $4,055.7727227-2

CPT CODE: $4,524.4727228-2

CPT CODE: $879.4127230-2

CPT CODE: $2,075.0227232-2

CPT CODE: $4,159.9527235-2

CPT CODE: $4,574.9427236-2

CPT CODE: $879.4127238-2

CPT CODE: $2,075.0227240-2

CPT CODE: $4,110.5327244-2

CPT CODE: $3,787.9327245-2

CPT CODE: $691.6927246-2

CPT CODE: $1,571.0927248-2

CPT CODE: $820.1327250-2

CPT CODE: $1,571.0927252-2

CPT CODE: $3,527.5327253-2

CPT CODE: $4,278.4927254-2

CPT CODE: $2,025.6127256-2

CPT CODE: $1,571.0927257-2

CPT CODE: $3,527.5327258-2

CPT CODE: $4,940.5727259-2

CPT CODE: $820.1327265-2

CPT CODE: $1,571.0927266-2

CPT CODE: $642.9027267-2

CPT CODE: $794.2627268-2

CPT CODE: $3,347.7927269-2

CPT CODE: $513.8327275-2

CPT CODE: $682.7727279-2

CPT CODE: $3,082.8927280-2

CPT CODE: $3,082.8927282-2

CPT CODE: $4,584.8627284-2

CPT CODE: $4,841.7427286-2

CPT CODE: $5,661.8827290-2

CPT CODE: $3,744.9327295-2

CPT CODE: $523.7027301-2

CPT CODE: $928.8227303-2

CPT CODE: $1,077.0327305-2

CPT CODE: $563.1927306-2

CPT CODE: $820.1327307-2

CPT CODE: $2,519.6927310-2

CPT CODE: $249.0127323-2

CPT CODE: $513.8327324-2

CPT CODE: $1,509.7627325-2

CPT CODE: $1,509.7627326-2

CPT CODE: $711.4427327-2

CPT CODE: $889.2827328-2

CPT CODE: $4,742.9327329-2

CPT CODE: $2,154.1027330-2

CPT CODE: $2,322.0527331-2

Page 10

Page 11: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,697.5027332-2

CPT CODE: $3,270.6627333-2

CPT CODE: $2,302.3127334-2

CPT CODE: $3,774.5827335-2

CPT CODE: $703.6927337-2

CPT CODE: $1,269.7427339-2

CPT CODE: $1,017.7527340-2

CPT CODE: $1,887.2927345-2

CPT CODE: $1,328.8827347-2

CPT CODE: $1,986.0927350-2

CPT CODE: $2,134.3227355-2

CPT CODE: $2,707.4227356-2

CPT CODE: $3,270.6627357-2

CPT CODE: $563.1927358-2

CPT CODE: $2,134.3227360-2

CPT CODE: $3,441.2827364-2

CPT CODE: $3,774.5827365-2

CPT CODE: $43.2127369-2

CPT CODE: $820.1327372-2

CPT CODE: $2,203.4827380-2

CPT CODE: $2,203.4827381-2

CPT CODE: $2,638.2627385-2

CPT CODE: $3,468.2727386-2

CPT CODE: $1,077.0327390-2

CPT CODE: $1,571.0927391-2

CPT CODE: $2,401.0927392-2

CPT CODE: $1,324.0727393-2

CPT CODE: $1,758.8427394-2

CPT CODE: $2,638.2627395-2

CPT CODE: $3,270.6627396-2

CPT CODE: $3,774.5827397-2

CPT CODE: $3,468.2727400-2

CPT CODE: $2,569.1027403-2

CPT CODE: $2,905.0527405-2

CPT CODE: $3,201.4627407-2

CPT CODE: $3,744.9327409-2

CPT CODE: $3,552.9427412-2

CPT CODE: $3,561.5427415-2

CPT CODE: $3,712.5827416-2

CPT CODE: $3,715.2827418-2

CPT CODE: $3,270.6627420-2

CPT CODE: $3,270.6627422-2

CPT CODE: $3,270.6627424-2

CPT CODE: $2,756.8227425-2

CPT CODE: $3,379.3327427-2

CPT CODE: $4,327.9327428-2

CPT CODE: $4,505.7827429-2

CPT CODE: $3,270.6627430-2

CPT CODE: $1,827.9827435-2

CPT CODE: $2,786.4627437-2

CPT CODE: $5,167.8227438-2

CPT CODE: $4,100.6527440-2

CPT CODE: $5,533.4127441-2

CPT CODE: $5,414.8527442-2

CPT CODE: $7,302.1327443-2

CPT CODE: $5,414.8527445-2

CPT CODE: $6,165.8427446-2

CPT CODE: $6,153.9427447-2

CPT CODE: $3,142.1927448-2

CPT CODE: $4,090.7727450-2

CPT CODE: $4,406.9427454-2

CPT CODE: $2,519.6927455-2

CPT CODE: $3,082.8927457-2

CPT CODE: $3,468.2727465-2

CPT CODE: $3,774.5827466-2

CPT CODE: $5,088.7827468-2

CPT CODE: $4,406.9427470-2

CPT CODE: $5,088.7827472-2

CPT CODE: $2,826.0227475-2

CPT CODE: $2,826.0227477-2

CPT CODE: $3,468.2727479-2

CPT CODE: $2,401.0927485-2

CPT CODE: $7,252.7527486-2

CPT CODE: $7,302.1327487-2

CPT CODE: $1,254.9127488-2

CPT CODE: $4,159.9527495-2

CPT CODE: $841.8027496-2

CPT CODE: $1,080.9027497-2

CPT CODE: $1,080.9027498-2

CPT CODE: $1,320.0327499-2

CPT CODE: $1,156.0827500-2

CPT CODE: $1,080.9027501-2

CPT CODE: $2,272.6727502-2

CPT CODE: $2,171.3627503-2

CPT CODE: $3,893.1827506-2

CPT CODE: $3,969.6727507-2

CPT CODE: $879.4127508-2

CPT CODE: $1,683.5227509-2

CPT CODE: $1,748.9727510-2

CPT CODE: $3,969.6727511-2

CPT CODE: $3,969.6727513-2

CPT CODE: $3,853.6727514-2

CPT CODE: $691.6927516-2

CPT CODE: $1,571.0927517-2

CPT CODE: $3,270.6627519-2

CPT CODE: $839.9127520-2

CPT CODE: $2,272.6727524-2

CPT CODE: $691.6927530-2

CPT CODE: $1,462.3827532-2

CPT CODE: $2,888.7827535-2

CPT CODE: $3,231.1027536-2

CPT CODE: $1,106.7127538-2

CPT CODE: $3,082.8927540-2

CPT CODE: $1,077.0327550-2

CPT CODE: $1,077.0327552-2

CPT CODE: $3,082.8927556-2

CPT CODE: $3,082.8927557-2

CPT CODE: $2,946.1627558-2

CPT CODE: $464.3827560-2

CPT CODE: $444.6527562-2

CPT CODE: $2,638.2627566-2

CPT CODE: $464.3827570-2

CPT CODE: $3,853.6727580-2

CPT CODE: $3,013.7427590-2

CPT CODE: $2,776.6027591-2

CPT CODE: $2,826.0227592-2

CPT CODE: $691.6927594-2

CPT CODE: $1,017.7527596-2

CPT CODE: $2,717.3027598-2

CPT CODE: $928.8227600-2

CPT CODE: $1,037.5027601-2

CPT CODE: $1,383.3327602-2

CPT CODE: $1,393.2127603-2

CPT CODE: $1,393.2127604-2

CPT CODE: $313.0227605-2

CPT CODE: $563.1927606-2

CPT CODE: $938.6827607-2

CPT CODE: $2,005.8827610-2

CPT CODE: $1,936.7027612-2

CPT CODE: $249.0127613-2

CPT CODE: $513.8327614-2

CPT CODE: $4,742.9327615-2

CPT CODE: $2,675.8427616-2

CPT CODE: $810.2627618-2

CPT CODE: $1,165.9427619-2

CPT CODE: $1,936.7027620-2

CPT CODE: $1,926.8027625-2

CPT CODE: $2,351.7227626-2

CPT CODE: $760.8327630-2

CPT CODE: $695.9827632-2

CPT CODE: $1,141.1027634-2

CPT CODE: $1,936.7027635-2

CPT CODE: $2,727.2027637-2

CPT CODE: $2,826.0227638-2

CPT CODE: $2,351.7227640-2

CPT CODE: $1,383.3327641-2

CPT CODE: $3,300.2727645-2

CPT CODE: $1,739.0927646-2

CPT CODE: $1,383.3327647-2

CPT CODE: $124.5027648-2

CPT CODE: $2,322.0527650-2

CPT CODE: $2,924.8327652-2

Page 11

Page 12: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,816.0927654-2

CPT CODE: $1,324.0727656-2

CPT CODE: $1,383.3327658-2

CPT CODE: $1,571.0927659-2

CPT CODE: $1,383.3327664-2

CPT CODE: $1,758.8427665-2

CPT CODE: $1,324.0727675-2

CPT CODE: $1,324.0727676-2

CPT CODE: $1,027.6527680-2

CPT CODE: $1,324.0727681-2

CPT CODE: $1,482.1527685-2

CPT CODE: $1,758.8427686-2

CPT CODE: $1,571.0927687-2

CPT CODE: $1,758.8427690-2

CPT CODE: $2,193.6227691-2

CPT CODE: $563.1927692-2

CPT CODE: $2,193.6227695-2

CPT CODE: $3,082.8927696-2

CPT CODE: $2,588.8727698-2

CPT CODE: $3,774.5827700-2

CPT CODE: $6,096.6527702-2

CPT CODE: $6,333.8027703-2

CPT CODE: $731.2127704-2

CPT CODE: $2,381.3227705-2

CPT CODE: $1,383.3327707-2

CPT CODE: $3,774.5827709-2

CPT CODE: $3,774.5827712-2

CPT CODE: $5,227.0827715-2

CPT CODE: $3,270.6627720-2

CPT CODE: $3,774.5827722-2

CPT CODE: $3,853.6727724-2

CPT CODE: $3,774.5827725-2

CPT CODE: $2,393.1227726-2

CPT CODE: $2,697.5027727-2

CPT CODE: $2,203.4827730-2

CPT CODE: $1,324.0727732-2

CPT CODE: $2,717.3027734-2

CPT CODE: $3,962.2927740-2

CPT CODE: $4,772.5627742-2

CPT CODE: $3,596.7127745-2

CPT CODE: $1,175.8627750-2

CPT CODE: $1,511.8127752-2

CPT CODE: $2,588.8727756-2

CPT CODE: $2,826.0227758-2

CPT CODE: $3,242.7027759-2

CPT CODE: $889.2827760-2

CPT CODE: $997.9827762-2

CPT CODE: $2,124.4027766-2

CPT CODE: $496.7427767-2

CPT CODE: $623.5127768-2

CPT CODE: $1,459.1627769-2

CPT CODE: $770.7327780-2

CPT CODE: $770.7327781-2

CPT CODE: $1,422.8927784-2

CPT CODE: $681.8127786-2

CPT CODE: $849.7727788-2

CPT CODE: $1,995.9927792-2

CPT CODE: $1,363.6027808-2

CPT CODE: $1,551.3427810-2

CPT CODE: $2,806.2227814-2

CPT CODE: $879.4127816-2

CPT CODE: $1,758.8427818-2

CPT CODE: $2,993.9527822-2

CPT CODE: $3,171.8327823-2

CPT CODE: $841.8027824-2

CPT CODE: $1,683.5227825-2

CPT CODE: $3,003.5527826-2

CPT CODE: $3,003.5527827-2

CPT CODE: $3,127.9027828-2

CPT CODE: $2,037.4527829-2

CPT CODE: $622.5027830-2

CPT CODE: $760.8327831-2

CPT CODE: $1,758.8427832-2

CPT CODE: $622.5027840-2

CPT CODE: $760.8327842-2

CPT CODE: $2,134.3227846-2

CPT CODE: $1,758.8427848-2

CPT CODE: $444.6527860-2

CPT CODE: $3,379.3327870-2

CPT CODE: $3,774.5827871-2

CPT CODE: $2,588.8727880-2

CPT CODE: $2,826.0227881-2

CPT CODE: $1,887.2927882-2

CPT CODE: $563.1927884-2

CPT CODE: $1,254.9127886-2

CPT CODE: $2,193.6227888-2

CPT CODE: $2,588.8727889-2

CPT CODE: $1,023.5027892-2

CPT CODE: $1,023.5027893-2

CPT CODE: $1,320.0327894-2

CPT CODE: $543.4628001-2

CPT CODE: $780.6028002-2

CPT CODE: $810.2628003-2

CPT CODE: $1,254.9128005-2

CPT CODE: $780.6028008-2

CPT CODE: $124.5028010-2

CPT CODE: $316.2128011-2

CPT CODE: $1,294.4128020-2

CPT CODE: $642.2728022-2

CPT CODE: $563.1928024-2

CPT CODE: $1,758.8428035-2

CPT CODE: $801.4728039-2

CPT CODE: $769.3128041-2

CPT CODE: $573.0828043-2

CPT CODE: $760.8328045-2

CPT CODE: $899.1628046-2

CPT CODE: $1,645.3828047-2

CPT CODE: $1,324.0728050-2

CPT CODE: $820.1328052-2

CPT CODE: $563.1928054-2

CPT CODE: $1,119.8428055-2

CPT CODE: $928.8228060-2

CPT CODE: $938.6828062-2

CPT CODE: $1,324.0728070-2

CPT CODE: $820.1328072-2

CPT CODE: $1,156.0828080-2

CPT CODE: $1,383.3328086-2

CPT CODE: $1,077.0328088-2

CPT CODE: $830.0228090-2

CPT CODE: $780.6028092-2

CPT CODE: $1,324.0728100-2

CPT CODE: $1,571.0928102-2

CPT CODE: $1,571.0928103-2

CPT CODE: $1,077.0328104-2

CPT CODE: $1,324.0728106-2

CPT CODE: $1,324.0728107-2

CPT CODE: $997.9828108-2

CPT CODE: $563.1928110-2

CPT CODE: $1,571.0928111-2

CPT CODE: $879.4128112-2

CPT CODE: $879.4128113-2

CPT CODE: $1,739.0928114-2

CPT CODE: $1,571.0928116-2

CPT CODE: $1,077.0328118-2

CPT CODE: $1,165.9428119-2

CPT CODE: $1,324.0728120-2

CPT CODE: $1,294.4128122-2

CPT CODE: $820.1328124-2

CPT CODE: $1,067.1528126-2

CPT CODE: $2,203.4828130-2

CPT CODE: $968.3428140-2

CPT CODE: $879.4128150-2

CPT CODE: $889.2828153-2

CPT CODE: $770.7328160-2

CPT CODE: $1,571.0928171-2

CPT CODE: $1,254.9128173-2

CPT CODE: $820.1328175-2

CPT CODE: $156.1228190-2

CPT CODE: $642.2728192-2

CPT CODE: $1,324.0728193-2

CPT CODE: $1,324.0728200-2

CPT CODE: $1,758.8428202-2

Page 12

Page 13: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $622.5028208-2

CPT CODE: $938.6828210-2

CPT CODE: $1,077.0328220-2

CPT CODE: $1,343.8228222-2

CPT CODE: $622.5028225-2

CPT CODE: $820.1328226-2

CPT CODE: $642.2728230-2

CPT CODE: $316.2128232-2

CPT CODE: $251.0028234-2

CPT CODE: $1,571.0928238-2

CPT CODE: $820.1328240-2

CPT CODE: $948.6128250-2

CPT CODE: $1,887.2928260-2

CPT CODE: $2,025.6128261-2

CPT CODE: $3,033.4928262-2

CPT CODE: $2,401.0928264-2

CPT CODE: $671.9228270-2

CPT CODE: $671.9228272-2

CPT CODE: $780.6028280-2

CPT CODE: $978.2328285-2

CPT CODE: $770.7328286-2

CPT CODE: $563.1928288-2

CPT CODE: $986.6928289-2

CPT CODE: $986.6828291-2

CPT CODE: $1,561.2328292-2

CPT CODE: $593.9328295-2

CPT CODE: $1,946.5728296-2

CPT CODE: $1,867.4828297-2

CPT CODE: $1,887.2928298-2

CPT CODE: $1,571.0928299-2

CPT CODE: $2,075.0228300-2

CPT CODE: $1,936.7028302-2

CPT CODE: $1,758.8428304-2

CPT CODE: $1,936.7028305-2

CPT CODE: $1,580.9628306-2

CPT CODE: $1,739.0928307-2

CPT CODE: $1,254.9128308-2

CPT CODE: $1,936.7028309-2

CPT CODE: $691.6928310-2

CPT CODE: $444.6528312-2

CPT CODE: $820.1328313-2

CPT CODE: $1,165.9428315-2

CPT CODE: $1,195.5928320-2

CPT CODE: $1,027.6528322-2

CPT CODE: $1,077.0328340-2

CPT CODE: $1,511.8128341-2

CPT CODE: $1,077.0328344-2

CPT CODE: $1,571.0928345-2

CPT CODE: $2,697.5028360-2

CPT CODE: $632.3928400-2

CPT CODE: $1,165.9428405-2

CPT CODE: $1,887.2928406-2

CPT CODE: $2,163.9528415-2

CPT CODE: $2,371.4428420-2

CPT CODE: $642.2728430-2

CPT CODE: $1,165.9428435-2

CPT CODE: $1,887.2928436-2

CPT CODE: $2,519.6928445-2

CPT CODE: $2,817.4228446-2

CPT CODE: $503.9528450-2

CPT CODE: $760.8328455-2

CPT CODE: $1,096.7828456-2

CPT CODE: $1,195.5928465-2

CPT CODE: $523.7028470-2

CPT CODE: $671.9228475-2

CPT CODE: $892.7128476-2

CPT CODE: $1,146.2328485-2

CPT CODE: $205.5228490-2

CPT CODE: $326.0728495-2

CPT CODE: $1,096.7828496-2

CPT CODE: $582.9828505-2

CPT CODE: $306.3028510-2

CPT CODE: $306.3028515-2

CPT CODE: $582.9828525-2

CPT CODE: $306.3028530-2

CPT CODE: $660.0028531-2

CPT CODE: $503.9528540-2

CPT CODE: $622.5028545-2

CPT CODE: $691.6928546-2

CPT CODE: $1,571.0928555-2

CPT CODE: $820.1328570-2

CPT CODE: $820.1328575-2

CPT CODE: $717.4228576-2

CPT CODE: $1,887.2928585-2

CPT CODE: $207.4828600-2

CPT CODE: $513.8328605-2

CPT CODE: $691.6928606-2

CPT CODE: $1,254.9128615-2

CPT CODE: $146.2628630-2

CPT CODE: $316.2128635-2

CPT CODE: $306.0928636-2

CPT CODE: $879.4128645-2

CPT CODE: $124.5028660-2

CPT CODE: $185.7728665-2

CPT CODE: $177.9328666-2

CPT CODE: $622.5028675-2

CPT CODE: $4,100.6528705-2

CPT CODE: $2,964.3628715-2

CPT CODE: $2,460.3928725-2

CPT CODE: $2,401.0928730-2

CPT CODE: $1,936.7028735-2

CPT CODE: $1,521.7128737-2

CPT CODE: $879.4128740-2

CPT CODE: $1,571.0928750-2

CPT CODE: $879.4128755-2

CPT CODE: $1,324.0728760-2

CPT CODE: $1,877.4028800-2

CPT CODE: $1,887.2928805-2

CPT CODE: $1,146.2328810-2

CPT CODE: $592.8728820-2

CPT CODE: $622.5028825-2

CPT CODE: $487.6428890-2

CPT CODE: $691.6929000-2

CPT CODE: $691.6929010-2

CPT CODE: $820.1329015-2

CPT CODE: $523.7029035-2

CPT CODE: $820.1329040-2

CPT CODE: $622.5029044-2

CPT CODE: $691.6929046-2

CPT CODE: $124.5029049-2

CPT CODE: $365.5829055-2

CPT CODE: $187.7329058-2

CPT CODE: $251.0029065-2

CPT CODE: $174.3129075-2

CPT CODE: $175.8629085-2

CPT CODE: $57.0829086-2

CPT CODE: $215.3929105-2

CPT CODE: $69.1529125-2

CPT CODE: $96.8429126-2

CPT CODE: $65.2029130-2

CPT CODE: $59.2829131-2

CPT CODE: $75.1129200-2

CPT CODE: $73.1029240-2

CPT CODE: $71.1629260-2

CPT CODE: $51.3829280-2

CPT CODE: $543.4629305-2

CPT CODE: $642.2729325-2

CPT CODE: $274.6829345-2

CPT CODE: $294.4729355-2

CPT CODE: $563.1929358-2

CPT CODE: $306.3029365-2

CPT CODE: $239.1329405-2

CPT CODE: $245.0629425-2

CPT CODE: $296.4329435-2

CPT CODE: $49.3929440-2

CPT CODE: $272.3529445-2

CPT CODE: $106.7229450-2

CPT CODE: $148.2029505-2

CPT CODE: $110.6729515-2

CPT CODE: $187.7329520-2

CPT CODE: $98.8129530-2

CPT CODE: $75.1129540-2

Page 13

Page 14: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $63.2129550-2

CPT CODE: $106.7229580-2

CPT CODE: $146.6629581-2

CPT CODE: $138.1429584-2

CPT CODE: $120.5329700-2

CPT CODE: $71.1629705-2

CPT CODE: $124.5029710-2

CPT CODE: $88.9129720-2

CPT CODE: $120.5329730-2

CPT CODE: $124.5029740-2

CPT CODE: $124.5029750-2

CPT CODE: $1,363.6029800-2

CPT CODE: $2,717.3029804-2

CPT CODE: $1,297.4629805-2

CPT CODE: $3,154.9329806-2

CPT CODE: $3,574.5729807-2

CPT CODE: $3,567.0929819-2

CPT CODE: $2,509.7929820-2

CPT CODE: $3,567.0929821-2

CPT CODE: $2,509.7929822-2

CPT CODE: $3,567.0929823-2

CPT CODE: $1,103.0729824-2

CPT CODE: $3,567.0929825-2

CPT CODE: $3,210.3829826-2

CPT CODE: $2,509.6029827-2

CPT CODE: $1,307.8129828-2

CPT CODE: $1,521.7129830-2

CPT CODE: $3,656.0129834-2

CPT CODE: $2,569.1029835-2

CPT CODE: $3,656.0129836-2

CPT CODE: $2,569.1029837-2

CPT CODE: $3,656.0129838-2

CPT CODE: $1,511.8129840-2

CPT CODE: $2,460.3929843-2

CPT CODE: $2,875.3929844-2

CPT CODE: $3,418.8929845-2

CPT CODE: $3,468.2729846-2

CPT CODE: $2,638.2629847-2

CPT CODE: $1,314.1729848-2

CPT CODE: $2,946.1629850-2

CPT CODE: $2,946.1629851-2

CPT CODE: $2,888.7829855-2

CPT CODE: $2,888.7829856-2

CPT CODE: $1,773.8129860-2

CPT CODE: $4,253.7829861-2

CPT CODE: $3,491.8629862-2

CPT CODE: $3,912.4929863-2

CPT CODE: $4,111.6729866-2

CPT CODE: $3,561.5429867-2

CPT CODE: $3,561.5429868-2

CPT CODE: $1,294.4129870-2

CPT CODE: $2,312.1729871-2

CPT CODE: $1,954.7629873-2

CPT CODE: $3,567.0929874-2

CPT CODE: $2,694.5429875-2

CPT CODE: $3,300.2729876-2

CPT CODE: $2,970.2329877-2

CPT CODE: $3,300.2729879-2

CPT CODE: $3,895.1429880-2

CPT CODE: $2,970.2329881-2

CPT CODE: $3,300.2729882-2

CPT CODE: $4,268.6629883-2

CPT CODE: $3,300.2729884-2

CPT CODE: $3,300.2729885-2

CPT CODE: $2,312.1729886-2

CPT CODE: $3,300.2729887-2

CPT CODE: $5,291.3229888-2

CPT CODE: $5,879.2729889-2

CPT CODE: $3,152.3029891-2

CPT CODE: $3,152.3029892-2

CPT CODE: $736.5529893-2

CPT CODE: $3,567.0929894-2

CPT CODE: $2,509.7929895-2

CPT CODE: $2,509.7929897-2

CPT CODE: $3,567.0929898-2

CPT CODE: $2,874.9929899-2

CPT CODE: $663.3829900-2

CPT CODE: $732.8229901-2

CPT CODE: $833.0829902-2

CPT CODE: $1,275.4829904-2

CPT CODE: $1,469.5129905-2

CPT CODE: $1,469.5129906-2

CPT CODE: $1,199.1529907-2

CPT CODE: $1,938.8129914-2

CPT CODE: $1,975.4629915-2

CPT CODE: $1,975.8429916-2

CPT CODE: $316.2130000-2

CPT CODE: $296.4330020-2

CPT CODE: $185.7730100-2

CPT CODE: $258.8930110-2

CPT CODE: $938.6830115-2

CPT CODE: $889.2830117-2

CPT CODE: $1,452.5030118-2

CPT CODE: $2,272.6730120-2

CPT CODE: $523.7030124-2

CPT CODE: $938.6830125-2

CPT CODE: $622.5030130-2

CPT CODE: $1,511.8130140-2

CPT CODE: $2,401.0930150-2

CPT CODE: $3,596.7130160-2

CPT CODE: $51.3830200-2

CPT CODE: $71.1630210-2

CPT CODE: $2,480.1430220-2

CPT CODE: $104.7330300-2

CPT CODE: $652.1930310-2

CPT CODE: $683.4230320-2

CPT CODE: $2,588.8730400-2

CPT CODE: $3,725.1830410-2

CPT CODE: $4,199.4530420-2

CPT CODE: $563.1930430-2

CPT CODE: $879.4130435-2

CPT CODE: $2,519.6930450-2

CPT CODE: $545.2530460-2

CPT CODE: $1,511.3530462-2

CPT CODE: $1,147.9630465-2

CPT CODE: $3,142.1930520-2

CPT CODE: $2,401.0930540-2

CPT CODE: $4,525.5530545-2

CPT CODE: $124.5030560-2

CPT CODE: $2,272.6730580-2

CPT CODE: $1,294.4130600-2

CPT CODE: $2,480.1430620-2

CPT CODE: $2,569.1030630-2

CPT CODE: $185.7730801-2

CPT CODE: $405.1130802-2

CPT CODE: $128.4430901-2

CPT CODE: $229.2630903-2

CPT CODE: $474.2730905-2

CPT CODE: $444.6530906-2

CPT CODE: $1,571.0930915-2

CPT CODE: $1,620.4930920-2

CPT CODE: $102.7631000-2

CPT CODE: $444.6531002-2

CPT CODE: $928.8231020-2

CPT CODE: $2,242.9931030-2

CPT CODE: $2,588.8731032-2

CPT CODE: $1,660.0431040-2

CPT CODE: $1,660.0431050-2

CPT CODE: $1,827.9831051-2

CPT CODE: $1,758.8431070-2

CPT CODE: $2,885.2731075-2

CPT CODE: $2,826.0231080-2

CPT CODE: $2,826.0231081-2

CPT CODE: $3,774.5831084-2

CPT CODE: $3,774.5831085-2

CPT CODE: $3,774.5831086-2

CPT CODE: $3,774.5831087-2

CPT CODE: $4,090.7731090-2

CPT CODE: $1,452.5031200-2

CPT CODE: $1,768.7231201-2

CPT CODE: $6,096.6531230-2

CPT CODE: $259.4431231-2

Page 14

Page 15: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $699.9231235-2

CPT CODE: $681.2631237-2

CPT CODE: $401.2931238-2

CPT CODE: $2,566.3631239-2

CPT CODE: $1,511.8131240-2

CPT CODE: $471.1731241-2

CPT CODE: $975.5631253-2

CPT CODE: $1,416.1631254-2

CPT CODE: $1,724.8131255-2

CPT CODE: $1,152.8931256-2

CPT CODE: $975.5631257-2

CPT CODE: $975.5631259-2

CPT CODE: $1,216.4531267-2

CPT CODE: $2,559.9831276-2

CPT CODE: $1,735.7831287-2

CPT CODE: $1,735.7831288-2

CPT CODE: $5,142.0431290-2

CPT CODE: $5,142.0431291-2

CPT CODE: $3,975.4831292-2

CPT CODE: $4,348.7631293-2

CPT CODE: $4,974.0531294-2

CPT CODE: $2,645.2931295-2

CPT CODE: $4,921.5931296-2

CPT CODE: $4,867.7531297-2

CPT CODE: $4,584.8631300-2

CPT CODE: $4,584.8631360-2

CPT CODE: $5,019.6231365-2

CPT CODE: $4,584.8631367-2

CPT CODE: $5,355.5731368-2

CPT CODE: $5,661.8831370-2

CPT CODE: $4,584.8631375-2

CPT CODE: $4,584.8631380-2

CPT CODE: $4,584.8631382-2

CPT CODE: $7,687.5231390-2

CPT CODE: $8,685.4731395-2

CPT CODE: $4,525.5531400-2

CPT CODE: $3,527.5331420-2

CPT CODE: $365.5831500-2

CPT CODE: $241.1131502-2

CPT CODE: $185.7731510-2

CPT CODE: $365.5831511-2

CPT CODE: $365.5831512-2

CPT CODE: $365.5831513-2

CPT CODE: $543.4631515-2

CPT CODE: $199.5931520-2

CPT CODE: $652.1931525-2

CPT CODE: $1,165.9431526-2

CPT CODE: $1,452.5031527-2

CPT CODE: $622.5031528-2

CPT CODE: $444.6531529-2

CPT CODE: $1,027.6531530-2

CPT CODE: $928.8231531-2

CPT CODE: $928.8231535-2

CPT CODE: $1,165.9431536-2

CPT CODE: $1,215.3831540-2

CPT CODE: $1,827.9831541-2

CPT CODE: $1,853.8331545-2

CPT CODE: $2,224.8831546-2

CPT CODE: $1,550.5831551-2

CPT CODE: $1,564.3731552-2

CPT CODE: $1,704.5631553-2

CPT CODE: $1,791.6931554-2

CPT CODE: $3,339.8231560-2

CPT CODE: $3,339.8231561-2

CPT CODE: $928.8231570-2

CPT CODE: $928.8231571-2

CPT CODE: $198.6631572-2

CPT CODE: $163.7731573-2

CPT CODE: $163.7731574-2

CPT CODE: $513.8331575-2

CPT CODE: $938.6831576-2

CPT CODE: $1,254.9131577-2

CPT CODE: $938.6831578-2

CPT CODE: $938.6831579-2

CPT CODE: $4,584.8631580-2

CPT CODE: $4,584.8631584-2

CPT CODE: $4,584.8631587-2

CPT CODE: $2,272.6731590-2

CPT CODE: $1,129.6831591-2

CPT CODE: $1,836.9731592-2

CPT CODE: $1,086.9431600-2

CPT CODE: $1,383.3331601-2

CPT CODE: $1,383.3331603-2

CPT CODE: $2,075.0231605-2

CPT CODE: $2,885.2731610-2

CPT CODE: $1,571.0931611-2

CPT CODE: $622.5031612-2

CPT CODE: $711.4431613-2

CPT CODE: $1,432.7731614-2

CPT CODE: $770.7331615-2

CPT CODE: $770.7331622-2

CPT CODE: $715.9531623-2

CPT CODE: $715.9531624-2

CPT CODE: $830.0231625-2

CPT CODE: $630.3631626-2

CPT CODE: $1,289.0331627-2

CPT CODE: $830.0231628-2

CPT CODE: $830.0231629-2

CPT CODE: $711.4431630-2

CPT CODE: $711.4431631-2

CPT CODE: $174.1231632-2

CPT CODE: $218.3931633-2

CPT CODE: $2,371.1331634-2

CPT CODE: $573.0531636-2

CPT CODE: $169.0531637-2

CPT CODE: $573.0531638-2

CPT CODE: $1,037.5031640-2

CPT CODE: $1,373.4631641-2

CPT CODE: $664.4431643-2

CPT CODE: $780.6031645-2

CPT CODE: $780.6031646-2

CPT CODE: $270.9631647-2

CPT CODE: $281.6931648-2

CPT CODE: $90.6231649-2

CPT CODE: $96.2431651-2

CPT CODE: $438.9631652-2

CPT CODE: $293.8531653-2

CPT CODE: $77.0431654-2

CPT CODE: $271.2831660-2

CPT CODE: $286.4931661-2

CPT CODE: $187.7331717-2

CPT CODE: $187.7331720-2

CPT CODE: $251.0031725-2

CPT CODE: $1,434.8231730-2

CPT CODE: $3,142.1931750-2

CPT CODE: $1,571.0931755-2

CPT CODE: $4,723.1731760-2

CPT CODE: $3,191.6031766-2

CPT CODE: $3,191.6031770-2

CPT CODE: $3,191.6031775-2

CPT CODE: $3,191.6031780-2

CPT CODE: $3,191.6031781-2

CPT CODE: $3,191.6031785-2

CPT CODE: $3,191.6031786-2

CPT CODE: $2,272.6731800-2

CPT CODE: $4,584.8631805-2

CPT CODE: $938.6831820-2

CPT CODE: $1,077.0331825-2

CPT CODE: $1,077.0331830-2

CPT CODE: $1,610.6032035-2

CPT CODE: $2,025.6132036-2

CPT CODE: $1,086.8932096-2

CPT CODE: $1,086.8932097-2

CPT CODE: $914.8332098-2

CPT CODE: $3,497.9032100-2

CPT CODE: $2,816.0932110-2

CPT CODE: $2,885.2732120-2

CPT CODE: $2,885.2732124-2

CPT CODE: $4,011.7332140-2

CPT CODE: $4,011.7332141-2

CPT CODE: $2,885.2732150-2

CPT CODE: $3,013.7432151-2

Page 15

Page 16: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,885.2732160-2

CPT CODE: $3,013.7432200-2

CPT CODE: $2,885.2732215-2

CPT CODE: $4,406.9432220-2

CPT CODE: $2,885.2732225-2

CPT CODE: $5,355.5732320-2

CPT CODE: $249.0132400-2

CPT CODE: $249.0132405-2

CPT CODE: $5,167.8232440-2

CPT CODE: $6,765.7832442-2

CPT CODE: $5,167.8232445-2

CPT CODE: $4,901.0432480-2

CPT CODE: $4,899.3832482-2

CPT CODE: $4,899.3832484-2

CPT CODE: $6,495.1932486-2

CPT CODE: $4,899.3832488-2

CPT CODE: $4,134.7432491-2

CPT CODE: $1,341.8432501-2

CPT CODE: $3,974.2032503-2

CPT CODE: $4,701.5432504-2

CPT CODE: $1,725.3032505-2

CPT CODE: $290.5532506-2

CPT CODE: $290.5532507-2

CPT CODE: $4,209.3432540-2

CPT CODE: $525.2032550-2

CPT CODE: $477.3332551-2

CPT CODE: $292.0332552-2

CPT CODE: $769.3132553-2

CPT CODE: $183.0632554-2

CPT CODE: $229.5232555-2

CPT CODE: $321.2432556-2

CPT CODE: $324.7832557-2

CPT CODE: $161.7032560-2

CPT CODE: $131.2232561-2

CPT CODE: $117.7132562-2

CPT CODE: $1,073.2032601-2

CPT CODE: $1,119.8632604-2

CPT CODE: $1,119.8632606-2

CPT CODE: $508.9132607-2

CPT CODE: $625.0432608-2

CPT CODE: $432.2332609-2

CPT CODE: $2,883.6332650-2

CPT CODE: $2,883.6332651-2

CPT CODE: $4,395.4532652-2

CPT CODE: $2,883.6332653-2

CPT CODE: $2,818.3032654-2

CPT CODE: $4,003.4732655-2

CPT CODE: $4,162.1532656-2

CPT CODE: $3,844.8532658-2

CPT CODE: $3,816.8432659-2

CPT CODE: $3,844.8532661-2

CPT CODE: $5,067.3532662-2

CPT CODE: $4,899.3832663-2

CPT CODE: $3,471.5632664-2

CPT CODE: $3,770.1832665-2

CPT CODE: $1,422.1032666-2

CPT CODE: $256.3732667-2

CPT CODE: $257.5032668-2

CPT CODE: $2,190.7432669-2

CPT CODE: $2,615.8732670-2

CPT CODE: $3,578.1432671-2

CPT CODE: $2,481.5532672-2

CPT CODE: $1,921.2932673-2

CPT CODE: $351.7932674-2

CPT CODE: $258.1032701-2

CPT CODE: $3,497.9032800-2

CPT CODE: $1,867.4832810-2

CPT CODE: $3,497.9032815-2

CPT CODE: $2,136.2832820-2

CPT CODE: $9,397.4732851-2

CPT CODE: $9,397.4732852-2

CPT CODE: $11,263.9232853-2

CPT CODE: $11,263.9232854-2

CPT CODE: $3,013.7432900-2

CPT CODE: $2,885.2732905-2

CPT CODE: $4,090.7732906-2

CPT CODE: $3,013.7432940-2

CPT CODE: $444.6532960-2

CPT CODE: $697.1132997-2

CPT CODE: $246.1433016-2

CPT CODE: $255.7333017-2

CPT CODE: $292.6433018-2

CPT CODE: $236.8533019-2

CPT CODE: $3,843.7433020-2

CPT CODE: $3,814.1033025-2

CPT CODE: $6,738.9033030-2

CPT CODE: $9,564.9233031-2

CPT CODE: $3,843.7433050-2

CPT CODE: $8,428.5733120-2

CPT CODE: $4,723.1733130-2

CPT CODE: $5,235.6333140-2

CPT CODE: $2,278.8033202-2

CPT CODE: $2,278.8033203-2

CPT CODE: $2,035.5133206-2

CPT CODE: $2,035.5133207-2

CPT CODE: $3,073.0233208-2

CPT CODE: $879.4133210-2

CPT CODE: $877.2133211-2

CPT CODE: $879.4133212-2

CPT CODE: $877.2133213-2

CPT CODE: $1,213.1733214-2

CPT CODE: $887.1633215-2

CPT CODE: $2,035.5133216-2

CPT CODE: $2,034.4133217-2

CPT CODE: $1,037.5033218-2

CPT CODE: $1,035.8833220-2

CPT CODE: $1,056.6033221-2

CPT CODE: $731.2133222-2

CPT CODE: $727.9133223-2

CPT CODE: $1,076.6233224-2

CPT CODE: $1,076.6233225-2

CPT CODE: $1,033.0233226-2

CPT CODE: $650.6833227-2

CPT CODE: $650.6833228-2

CPT CODE: $650.6833229-2

CPT CODE: $1,275.9233230-2

CPT CODE: $1,275.9233231-2

CPT CODE: $989.2033233-2

CPT CODE: $989.2033234-2

CPT CODE: $989.2033235-2

CPT CODE: $989.2033236-2

CPT CODE: $989.2033237-2

CPT CODE: $1,586.4633238-2

CPT CODE: $877.2133240-2

CPT CODE: $877.2133241-2

CPT CODE: $2,211.7433243-2

CPT CODE: $2,211.7433244-2

CPT CODE: $5,216.6833249-2

CPT CODE: $7,055.1333250-2

CPT CODE: $8,428.5733251-2

CPT CODE: $5,024.4333254-2

CPT CODE: $5,414.3633255-2

CPT CODE: $6,016.1033256-2

CPT CODE: $2,099.4833257-2

CPT CODE: $2,122.7733258-2

CPT CODE: $2,589.7433259-2

CPT CODE: $8,428.5733261-2

CPT CODE: $615.5433262-2

CPT CODE: $615.5433263-2

CPT CODE: $615.5433264-2

CPT CODE: $5,024.4333265-2

CPT CODE: $5,715.2433266-2

CPT CODE: $748.9733270-2

CPT CODE: $588.1233271-2

CPT CODE: $492.9333272-2

CPT CODE: $475.3433273-2

CPT CODE: $92.3633285-2

CPT CODE: $90.6233286-2

CPT CODE: $3,814.1033300-2

CPT CODE: $6,738.9033305-2

CPT CODE: $4,841.7433310-2

CPT CODE: $7,677.6233315-2

Page 16

Page 17: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $3,843.7433320-2

CPT CODE: $6,744.9433321-2

CPT CODE: $6,738.9033322-2

CPT CODE: $6,738.9033330-2

CPT CODE: $9,624.2033335-2

CPT CODE: $1,577.8333361-2

CPT CODE: $1,726.0933362-2

CPT CODE: $1,787.2333363-2

CPT CODE: $1,901.0533364-2

CPT CODE: $2,075.6833365-2

CPT CODE: $2,198.6533366-2

CPT CODE: $729.2833367-2

CPT CODE: $883.7133368-2

CPT CODE: $1,166.9233369-2

CPT CODE: $2,359.3133390-2

CPT CODE: $3,622.8333391-2

CPT CODE: $7,677.6233404-2

CPT CODE: $8,398.9633405-2

CPT CODE: $8,398.9433406-2

CPT CODE: $7,684.4233410-2

CPT CODE: $8,398.9633411-2

CPT CODE: $8,398.9633412-2

CPT CODE: $12,225.1233413-2

CPT CODE: $7,671.0233414-2

CPT CODE: $7,677.6233415-2

CPT CODE: $7,671.0233416-2

CPT CODE: $7,677.6233417-2

CPT CODE: $2,117.2933418-2

CPT CODE: $624.5933419-2

CPT CODE: $5,790.3333420-2

CPT CODE: $8,023.4633422-2

CPT CODE: $8,784.3133425-2

CPT CODE: $8,784.3133426-2

CPT CODE: $8,784.3133427-2

CPT CODE: $9,831.6933430-2

CPT CODE: $3,517.2533440-2

CPT CODE: $8,428.5733460-2

CPT CODE: $8,426.9433463-2

CPT CODE: $8,426.9433464-2

CPT CODE: $9,624.2033465-2

CPT CODE: $10,375.1533468-2

CPT CODE: $6,165.8433470-2

CPT CODE: $6,159.2033471-2

CPT CODE: $7,677.6233474-2

CPT CODE: $7,671.0233475-2

CPT CODE: $8,478.0133476-2

CPT CODE: $1,460.5633477-2

CPT CODE: $9,248.7133478-2

CPT CODE: $5,887.3533496-2

CPT CODE: $6,738.9033500-2

CPT CODE: $6,437.5433501-2

CPT CODE: $4,841.7433502-2

CPT CODE: $6,738.9033503-2

CPT CODE: $9,624.2033504-2

CPT CODE: $9,612.1233505-2

CPT CODE: $9,612.1233506-2

CPT CODE: $6,492.3533507-2

CPT CODE: $7,746.7633510-2

CPT CODE: $7,993.8333511-2

CPT CODE: $8,379.1733512-2

CPT CODE: $8,774.4433513-2

CPT CODE: $9,041.2133514-2

CPT CODE: $9,298.1133516-2

CPT CODE: $344.3733517-2

CPT CODE: $707.8433518-2

CPT CODE: $1,033.0833519-2

CPT CODE: $1,291.3533521-2

CPT CODE: $1,549.6133522-2

CPT CODE: $1,549.6133523-2

CPT CODE: $1,719.3033530-2

CPT CODE: $7,728.8733533-2

CPT CODE: $7,968.0333534-2

CPT CODE: $8,350.6333535-2

CPT CODE: $8,752.3733536-2

CPT CODE: $9,564.9233542-2

CPT CODE: $11,511.4733545-2

CPT CODE: $2,133.3433572-2

CPT CODE: $5,785.9233600-2

CPT CODE: $5,785.9233602-2

CPT CODE: $5,785.9233606-2

CPT CODE: $5,804.6033608-2

CPT CODE: $9,238.8433610-2

CPT CODE: $11,497.2233611-2

CPT CODE: $11,497.2233612-2

CPT CODE: $8,426.9433615-2

CPT CODE: $8,426.9433617-2

CPT CODE: $15,332.7233619-2

CPT CODE: $2,977.0333620-2

CPT CODE: $1,606.6933621-2

CPT CODE: $6,745.7933622-2

CPT CODE: $6,926.6633641-2

CPT CODE: $7,677.6233645-2

CPT CODE: $11,550.9933647-2

CPT CODE: $9,248.7133660-2

CPT CODE: $9,624.2033665-2

CPT CODE: $11,511.4733670-2

CPT CODE: $7,053.6433675-5

CPT CODE: $7,336.9833676-2

CPT CODE: $8,056.1033677-2

CPT CODE: $9,248.7133681-2

CPT CODE: $9,624.2033684-2

CPT CODE: $10,562.8933688-2

CPT CODE: $3,843.7433690-2

CPT CODE: $10,750.6433692-2

CPT CODE: $11,511.4733694-2

CPT CODE: $10,741.3433697-2

CPT CODE: $7,677.6233702-2

CPT CODE: $11,511.4733710-2

CPT CODE: $9,624.2033720-2

CPT CODE: $11,497.2233722-2

CPT CODE: $5,856.9033724-2

CPT CODE: $7,336.9833726-2

CPT CODE: $9,624.2033730-2

CPT CODE: $6,915.1433732-2

CPT CODE: $6,165.8433735-2

CPT CODE: $6,159.2033736-2

CPT CODE: $6,165.8433737-2

CPT CODE: $5,790.3333750-2

CPT CODE: $5,790.3333755-2

CPT CODE: $5,790.3333762-2

CPT CODE: $5,790.3333764-2

CPT CODE: $5,790.3333766-2

CPT CODE: $5,785.9233767-2

CPT CODE: $1,354.1233768-2

CPT CODE: $5,608.5933770-2

CPT CODE: $12,262.4233771-2

CPT CODE: $10,750.6433774-2

CPT CODE: $11,511.4733775-2

CPT CODE: $12,272.3433776-2

CPT CODE: $5,612.4333777-2

CPT CODE: $5,612.4333778-2

CPT CODE: $11,511.4733779-2

CPT CODE: $12,272.3433780-2

CPT CODE: $5,612.4333781-2

CPT CODE: $5,682.3033782-2

CPT CODE: $6,142.8533783-2

CPT CODE: $11,511.4733786-2

CPT CODE: $6,738.9033788-2

CPT CODE: $14,663.8533800-2

CPT CODE: $4,584.8633802-2

CPT CODE: $5,790.3333803-2

CPT CODE: $7,055.1333813-2

CPT CODE: $7,055.1333814-2

CPT CODE: $3,873.4033820-2

CPT CODE: $4,584.8633822-2

CPT CODE: $5,790.3333824-2

CPT CODE: $5,790.3333840-2

CPT CODE: $7,677.6233845-2

CPT CODE: $6,738.9033851-2

CPT CODE: $15,345.3533852-2

CPT CODE: $15,332.7233853-2

CPT CODE: $3,532.5333858-2

Page 17

Page 18: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,535.4533859-2

CPT CODE: $10,741.3433863-2

CPT CODE: $7,862.3833864-2

CPT CODE: $1,074.9333866-2

CPT CODE: $3,395.1233871-2

CPT CODE: $9,564.9233875-2

CPT CODE: $9,564.9233877-2

CPT CODE: $8,428.5733910-2

CPT CODE: $5,790.3333915-2

CPT CODE: $14,535.1233916-2

CPT CODE: $8,426.9433917-2

CPT CODE: $9,612.1233920-2

CPT CODE: $14,520.8233922-2

CPT CODE: $5,010.1233924-2

CPT CODE: $6,991.0133925-2

CPT CODE: $8,225.2933926-2

CPT CODE: $13,191.2833945-2

CPT CODE: $385.8133946-2

CPT CODE: $422.3333947-2

CPT CODE: $298.7133948-2

CPT CODE: $291.1533949-2

CPT CODE: $495.4333951-2

CPT CODE: $483.6733952-2

CPT CODE: $552.3133953-2

CPT CODE: $539.3433954-2

CPT CODE: $1,086.1833955-2

CPT CODE: $1,029.0633956-2

CPT CODE: $321.2933957-2

CPT CODE: $313.5933958-2

CPT CODE: $380.1933959-2

CPT CODE: $361.9633962-2

CPT CODE: $657.4633963-2

CPT CODE: $668.1733964-2

CPT CODE: $317.6533965-2

CPT CODE: $359.6933966-2

CPT CODE: $1,115.4233967-2

CPT CODE: $904.1433968-2

CPT CODE: $396.4933969-2

CPT CODE: $2,312.1733970-2

CPT CODE: $2,035.5133971-2

CPT CODE: $2,314.3633973-2

CPT CODE: $2,034.4133974-2

CPT CODE: $389.2433984-2

CPT CODE: $737.9233985-2

CPT CODE: $703.6433986-2

CPT CODE: $292.0233987-2

CPT CODE: $921.6933988-2

CPT CODE: $604.9833989-2

CPT CODE: $513.0533990-2

CPT CODE: $747.8133991-2

CPT CODE: $244.4533992-2

CPT CODE: $214.6533993-2

CPT CODE: $3,201.4634001-2

CPT CODE: $4,406.9434051-2

CPT CODE: $2,964.3634101-2

CPT CODE: $2,964.3634111-2

CPT CODE: $5,227.0834151-2

CPT CODE: $2,588.8734201-2

CPT CODE: $2,499.9234203-2

CPT CODE: $6,353.5234401-2

CPT CODE: $2,519.6934421-2

CPT CODE: $2,154.1034451-2

CPT CODE: $6,353.5234471-2

CPT CODE: $2,391.2034490-2

CPT CODE: $4,841.7434501-2

CPT CODE: $9,434.8134502-2

CPT CODE: $5,227.0834510-2

CPT CODE: $5,227.0834520-2

CPT CODE: $2,608.6234530-2

CPT CODE: $1,815.1334701-2

CPT CODE: $2,336.6234702-2

CPT CODE: $2,266.9534703-2

CPT CODE: $2,002.8234704-2

CPT CODE: $1,894.9234705-2

CPT CODE: $2,413.9734706-2

CPT CODE: $1,205.4834707-2

CPT CODE: $1,942.4434708-2

CPT CODE: $338.8034709-2

CPT CODE: $924.9934710-2

CPT CODE: $312.6734711-2

CPT CODE: $720.4134712-2

CPT CODE: $135.4734713-2

CPT CODE: $284.9934714-2

CPT CODE: $319.3734715-2

CPT CODE: $395.4934716-2

CPT CODE: $465.1334717-2

CPT CODE: $1,294.4534718-2

CPT CODE: $424.2534808-2

CPT CODE: $639.4934812-2

CPT CODE: $592.7034813-2

CPT CODE: $976.3834820-2

CPT CODE: $941.2834833-2

CPT CODE: $473.6634834-2

CPT CODE: $5,039.3335001-2

CPT CODE: $5,039.3335002-2

CPT CODE: $5,039.3335005-2

CPT CODE: $3,843.7435011-2

CPT CODE: $3,911.6035013-2

CPT CODE: $6,353.5235021-2

CPT CODE: $6,353.5235022-2

CPT CODE: $3,843.7435045-2

CPT CODE: $7,134.1535081-2

CPT CODE: $7,578.8135082-2

CPT CODE: $7,677.6235091-2

CPT CODE: $7,677.6235092-2

CPT CODE: $7,134.1535102-2

CPT CODE: $7,134.1535103-2

CPT CODE: $5,355.5735111-2

CPT CODE: $5,355.5735112-2

CPT CODE: $7,677.6235121-2

CPT CODE: $7,677.6235122-2

CPT CODE: $6,353.5235131-2

CPT CODE: $6,353.5235132-2

CPT CODE: $4,841.7435141-2

CPT CODE: $4,841.7435142-2

CPT CODE: $5,227.0835151-2

CPT CODE: $5,227.0835152-2

CPT CODE: $5,227.0835180-2

CPT CODE: $7,865.3635182-2

CPT CODE: $5,227.0835184-2

CPT CODE: $5,227.0835188-2

CPT CODE: $7,865.3635189-2

CPT CODE: $5,227.0835190-2

CPT CODE: $5,227.0835201-2

CPT CODE: $5,227.0835206-2

CPT CODE: $2,638.2635207-2

CPT CODE: $7,865.3635211-2

CPT CODE: $7,865.3635216-2

CPT CODE: $7,865.3635221-2

CPT CODE: $5,409.9235226-2

CPT CODE: $6,521.5235231-2

CPT CODE: $6,521.5235236-2

CPT CODE: $9,821.8335241-2

CPT CODE: $9,821.8335246-2

CPT CODE: $9,821.8335251-2

CPT CODE: $5,227.0835256-2

CPT CODE: $5,227.0835261-2

CPT CODE: $5,227.0835266-2

CPT CODE: $7,865.3635271-2

CPT CODE: $7,865.3635276-2

CPT CODE: $7,114.3635281-2

CPT CODE: $5,227.0835286-2

CPT CODE: $4,782.4635301-2

CPT CODE: $3,977.4535302-2

CPT CODE: $4,197.3835303-2

CPT CODE: $4,418.6435304-2

CPT CODE: $4,197.3835305-2

CPT CODE: $839.2135306-2

CPT CODE: $5,790.3335311-2

CPT CODE: $6,096.6535321-2

CPT CODE: $6,353.5235331-2

CPT CODE: $7,677.6235341-2

Page 18

Page 19: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $6,165.8435351-2

CPT CODE: $6,748.7835355-2

CPT CODE: $7,114.3635361-2

CPT CODE: $7,045.2135363-2

CPT CODE: $4,406.9435371-2

CPT CODE: $4,406.9435372-2

CPT CODE: $4,778.0535390-2

CPT CODE: $6,165.8435501-2

CPT CODE: $6,165.8435506-2

CPT CODE: $6,096.6535508-2

CPT CODE: $6,096.6535509-2

CPT CODE: $5,089.4035510-2

CPT CODE: $5,227.0835511-2

CPT CODE: $4,363.4035512-2

CPT CODE: $6,096.6535515-2

CPT CODE: $5,227.0835516-2

CPT CODE: $5,227.0835518-2

CPT CODE: $4,406.9435521-2

CPT CODE: $3,668.3935522-2

CPT CODE: $3,156.3335523-2

CPT CODE: $3,557.7235525-2

CPT CODE: $6,353.5235526-2

CPT CODE: $6,205.3235531-2

CPT CODE: $6,096.6535533-2

CPT CODE: $4,639.9835535-2

CPT CODE: $6,353.5235536-2

CPT CODE: $4,840.9535537-2

CPT CODE: $4,840.9535538-2

CPT CODE: $4,840.9535539-2

CPT CODE: $4,840.9535540-2

CPT CODE: $5,731.0335556-2

CPT CODE: $5,227.0835558-2

CPT CODE: $6,887.1135560-2

CPT CODE: $6,096.6535563-2

CPT CODE: $6,096.6535565-2

CPT CODE: $6,165.8435566-2

CPT CODE: $4,460.2235570-2

CPT CODE: $6,096.6535571-2

CPT CODE: $6,165.8435583-2

CPT CODE: $6,165.8435585-2

CPT CODE: $3,320.0735587-2

CPT CODE: $5,414.8535601-2

CPT CODE: $5,414.8535606-2

CPT CODE: $4,406.9435612-2

CPT CODE: $4,406.9435616-2

CPT CODE: $5,839.7335621-2

CPT CODE: $4,843.4235623-2

CPT CODE: $6,353.5235626-2

CPT CODE: $7,114.3635631-2

CPT CODE: $5,202.5235632-2

CPT CODE: $5,202.5235633-2

CPT CODE: $5,202.5235634-2

CPT CODE: $6,353.5235636-2

CPT CODE: $4,840.9535637-2

CPT CODE: $4,840.9535638-2

CPT CODE: $5,414.8535642-2

CPT CODE: $5,414.8535645-2

CPT CODE: $6,373.3135646-2

CPT CODE: $4,995.4235647-2

CPT CODE: $4,318.0335650-2

CPT CODE: $6,096.6535654-2

CPT CODE: $4,387.2035656-2

CPT CODE: $4,406.9435661-2

CPT CODE: $4,406.9435663-2

CPT CODE: $4,406.9435665-2

CPT CODE: $4,841.7435666-2

CPT CODE: $4,841.7435671-2

CPT CODE: $3,201.4635681-2

CPT CODE: $925.6535685-2

CPT CODE: $1,049.0735686-2

CPT CODE: $5,403.3235691-2

CPT CODE: $5,403.3235693-2

CPT CODE: $5,403.3235694-2

CPT CODE: $5,403.3235695-2

CPT CODE: $593.2035697-2

CPT CODE: $1,936.7035701-2

CPT CODE: $426.0035702-2

CPT CODE: $432.5735703-2

CPT CODE: $1,936.7035800-2

CPT CODE: $2,539.4335820-2

CPT CODE: $2,509.7935840-2

CPT CODE: $1,630.3735860-2

CPT CODE: $2,203.4835870-2

CPT CODE: $2,588.8735875-2

CPT CODE: $2,585.0235876-2

CPT CODE: $2,363.0735879-2

CPT CODE: $2,363.0735881-2

CPT CODE: $2,454.2135883-2

CPT CODE: $2,680.8735884-2

CPT CODE: $2,202.4035901-2

CPT CODE: $2,202.4035903-2

CPT CODE: $2,202.4035905-2

CPT CODE: $2,202.4035907-2

CPT CODE: $102.7636000-2

CPT CODE: $435.0636002-2

CPT CODE: $237.2336005-2

CPT CODE: $407.4636010-2

CPT CODE: $522.2836011-2

CPT CODE: $503.9536012-2

CPT CODE: $407.4636013-2

CPT CODE: $522.2836014-2

CPT CODE: $625.9936015-2

CPT CODE: $444.6536100-2

CPT CODE: $161.1236140-2

CPT CODE: $306.3036160-2

CPT CODE: $335.9536200-2

CPT CODE: $522.2836215-2

CPT CODE: $503.9536216-2

CPT CODE: $625.9936217-2

CPT CODE: $112.6436218-2

CPT CODE: $255.7636221-2

CPT CODE: $347.7736222-2

CPT CODE: $376.0736223-2

CPT CODE: $410.6436224-2

CPT CODE: $374.6836225-2

CPT CODE: $411.4236226-2

CPT CODE: $130.3936227-2

CPT CODE: $266.0436228-2

CPT CODE: $522.2836245-2

CPT CODE: $503.9536246-2

CPT CODE: $625.9936247-2

CPT CODE: $112.6436248-2

CPT CODE: $1,723.1336251-2

CPT CODE: $1,892.7036252-2

CPT CODE: $2,635.5136253-2

CPT CODE: $2,742.3436254-2

CPT CODE: $6,274.5036260-2

CPT CODE: $3,132.2836261-2

CPT CODE: $3,102.6736262-2

CPT CODE: $104.7336400-2

CPT CODE: $128.4436405-2

CPT CODE: $102.7636406-2

CPT CODE: $73.1036410-2

CPT CODE: $7.1236415-2

CPT CODE: $4.5136416-2

CPT CODE: $207.4836420-2

CPT CODE: $128.4436425-2

CPT CODE: $61.2636430-2

CPT CODE: $316.2136440-2

CPT CODE: $1,274.6736450-2

CPT CODE: $1,274.6736455-2

CPT CODE: $118.7536456-2

CPT CODE: $316.2136460-2

CPT CODE: $125.3336465-2

CPT CODE: $159.5936466-2

CPT CODE: $187.7336468-2

CPT CODE: $126.4936470-2

CPT CODE: $187.7336471-2

CPT CODE: $1,888.2136475-2

CPT CODE: $944.1136476-2

CPT CODE: $1,691.9536478-2

CPT CODE: $846.7036479-2

Page 19

Page 20: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $711.4436481-2

CPT CODE: $711.4436500-2

CPT CODE: $187.7336510-2

CPT CODE: $431.5536511-2

CPT CODE: $431.5536512-2

CPT CODE: $431.5536513-2

CPT CODE: $431.5536514-2

CPT CODE: $538.3036516-2

CPT CODE: $503.9536522-2

CPT CODE: $202.1636555-2

CPT CODE: $191.8336556-2

CPT CODE: $700.9236557-2

CPT CODE: $665.5036558-2

CPT CODE: $838.1436560-2

CPT CODE: $804.2136561-2

CPT CODE: $4,871.0136563-2

CPT CODE: $804.2136565-2

CPT CODE: $864.7136566-2

CPT CODE: $147.5636568-2

CPT CODE: $140.1936569-2

CPT CODE: $726.0036570-2

CPT CODE: $689.1136571-2

CPT CODE: $98.8836572-2

CPT CODE: $91.0036573-2

CPT CODE: $138.7036575-2

CPT CODE: $523.8536576-2

CPT CODE: $588.7736578-2

CPT CODE: $104.7736580-2

CPT CODE: $556.3136581-2

CPT CODE: $810.1236582-2

CPT CODE: $817.4936583-2

CPT CODE: $103.2936584-2

CPT CODE: $759.9436585-2

CPT CODE: $776.1736589-2

CPT CODE: $2,434.7736590-2

CPT CODE: $11.6436591-2

CPT CODE: $11.6436592-2

CPT CODE: $41.3936593-2

CPT CODE: $290.7036595-2

CPT CODE: $264.1436596-2

CPT CODE: $95.9236597-2

CPT CODE: $157.0436598-2

CPT CODE: $120.5336600-2

CPT CODE: $272.7436620-2

CPT CODE: $365.5836625-2

CPT CODE: $375.4636640-2

CPT CODE: $306.3036660-2

CPT CODE: $523.7036680-2

CPT CODE: $1,363.6036810-2

CPT CODE: $820.1336815-2

CPT CODE: $1,868.1636818-2

CPT CODE: $2,196.4636819-2

CPT CODE: $1,126.2136820-2

CPT CODE: $2,401.0936821-2

CPT CODE: $739.2136823-2

CPT CODE: $3,843.7436825-2

CPT CODE: $3,231.1036830-2

CPT CODE: $2,247.4836831-2

CPT CODE: $4,110.5336832-2

CPT CODE: $2,247.4836833-2

CPT CODE: $3,206.5236838-2

CPT CODE: $251.0036860-2

CPT CODE: $316.2136861-2

CPT CODE: $120.6136901-2

CPT CODE: $239.4036902-2

CPT CODE: $327.8036903-2

CPT CODE: $377.3636904-2

CPT CODE: $473.5936905-2

CPT CODE: $552.5936906-2

CPT CODE: $137.9236907-2

CPT CODE: $206.6836908-2

CPT CODE: $196.1936909-2

CPT CODE: $6,343.6337140-2

CPT CODE: $6,353.5237145-2

CPT CODE: $6,353.5237160-2

CPT CODE: $6,353.5237180-2

CPT CODE: $6,353.5237181-2

CPT CODE: $1,013.8637187-2

CPT CODE: $727.3437188-2

CPT CODE: $3,129.9337191-2

CPT CODE: $2,107.0737192-2

CPT CODE: $2,011.2637193-2

CPT CODE: $374.3337197-2

CPT CODE: $245.0637200-2

CPT CODE: $767.8737211-2

CPT CODE: $677.8837212-2

CPT CODE: $474.0237213-2

CPT CODE: $277.3337214-2

CPT CODE: $1,290.3437217-2

CPT CODE: $972.3437218-2

CPT CODE: $878.4037220-2

CPT CODE: $2,019.0637221-2

CPT CODE: $398.5337222-2

CPT CODE: $854.6237223-2

CPT CODE: $836.6937224-2

CPT CODE: $1,715.1037225-2

CPT CODE: $1,998.2137226-2

CPT CODE: $2,646.5837227-2

CPT CODE: $1,046.5037228-2

CPT CODE: $2,027.2837229-2

CPT CODE: $2,103.1137230-2

CPT CODE: $2,855.1237231-2

CPT CODE: $318.4637232-2

CPT CODE: $522.4537233-2

CPT CODE: $437.9437234-2

CPT CODE: $621.2537235-2

CPT CODE: $611.6437236-2

CPT CODE: $285.3037237-2

CPT CODE: $428.5137238-2

CPT CODE: $199.1337239-2

CPT CODE: $598.7737241-2

CPT CODE: $668.4637242-2

CPT CODE: $796.9637243-2

CPT CODE: $929.7837244-2

CPT CODE: $392.3837246-2

CPT CODE: $194.5437247-2

CPT CODE: $337.4137248-2

CPT CODE: $165.5237249-2

CPT CODE: $103.5037252-2

CPT CODE: $82.6837253-2

CPT CODE: $323.2937500-2

CPT CODE: $2,272.6737565-2

CPT CODE: $1,630.3737600-2

CPT CODE: $2,272.6737605-2

CPT CODE: $2,826.0237606-2

CPT CODE: $811.9137607-2

CPT CODE: $582.9837609-2

CPT CODE: $2,272.6737615-2

CPT CODE: $2,272.6737616-2

CPT CODE: $2,272.6737617-2

CPT CODE: $2,203.4837618-2

CPT CODE: $1,946.6437619-2

CPT CODE: $1,254.9137650-2

CPT CODE: $2,203.4837660-2

CPT CODE: $1,126.4637700-2

CPT CODE: $1,425.7637718-2

CPT CODE: $1,715.0437722-2

CPT CODE: $2,964.3637735-2

CPT CODE: $2,203.4837760-2

CPT CODE: $991.8637761-2

CPT CODE: $731.9137765-2

CPT CODE: $938.4937766-2

CPT CODE: $760.8337780-2

CPT CODE: $316.2137785-2

CPT CODE: $4,841.7437788-2

CPT CODE: $839.9137790-2

CPT CODE: $3,567.0938100-2

CPT CODE: $3,646.1038101-2

CPT CODE: $1,782.4538102-2

CPT CODE: $3,646.1038115-2

CPT CODE: $2,442.3238120-2

CPT CODE: $405.1138200-2

Page 20

Page 21: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $61.5438220-2

CPT CODE: $105.3738221-2

CPT CODE: $84.2338222-2

CPT CODE: $879.4138230-2

CPT CODE: $523.4538232-2

CPT CODE: $879.4138240-2

CPT CODE: $879.4138241-2

CPT CODE: $52.6338242-2

CPT CODE: $141.7438243-2

CPT CODE: $199.5938300-2

CPT CODE: $1,205.4638305-2

CPT CODE: $1,195.5938308-2

CPT CODE: $2,272.6738380-2

CPT CODE: $2,272.6738381-2

CPT CODE: $2,272.6738382-2

CPT CODE: $899.1638500-2

CPT CODE: $563.1938505-2

CPT CODE: $899.1638510-2

CPT CODE: $800.3838520-2

CPT CODE: $642.2738525-2

CPT CODE: $1,758.8438530-2

CPT CODE: $453.9638531-2

CPT CODE: $879.4138542-2

CPT CODE: $1,571.0938550-2

CPT CODE: $1,531.5538555-2

CPT CODE: $1,887.2938562-2

CPT CODE: $3,527.5338564-2

CPT CODE: $1,509.0738570-2

CPT CODE: $2,519.9638571-2

CPT CODE: $3,031.0738572-2

CPT CODE: $2,106.2238573-2

CPT CODE: $2,717.3038700-2

CPT CODE: $3,774.5838720-2

CPT CODE: $3,774.5838724-2

CPT CODE: $1,679.7738740-2

CPT CODE: $3,260.7838745-2

CPT CODE: $839.9138746-2

CPT CODE: $1,297.1738747-2

CPT CODE: $2,588.8738760-2

CPT CODE: $3,814.1038770-2

CPT CODE: $7,114.3638780-2

CPT CODE: $622.5038790-2

CPT CODE: $465.1238792-2

CPT CODE: $523.7038794-2

CPT CODE: $239.0038900-2

CPT CODE: $2,588.8739000-2

CPT CODE: $3,893.1839010-2

CPT CODE: $5,088.7839200-2

CPT CODE: $5,078.9039220-2

CPT CODE: $346.2839401-2

CPT CODE: $452.0439402-2

CPT CODE: $4,841.7439503-2

CPT CODE: $4,406.9439540-2

CPT CODE: $4,011.7339541-2

CPT CODE: $4,841.7439545-2

CPT CODE: $3,147.5239560-2

CPT CODE: $3,933.5839561-2

CPT CODE: $375.4640490-2

CPT CODE: $1,235.1240500-2

CPT CODE: $1,235.1240510-2

CPT CODE: $899.1640520-2

CPT CODE: $2,796.3440525-2

CPT CODE: $2,816.0940527-2

CPT CODE: $1,571.0940530-2

CPT CODE: $849.7740650-2

CPT CODE: $1,571.0940652-2

CPT CODE: $3,142.1940654-2

CPT CODE: $2,282.5040700-2

CPT CODE: $3,339.8240701-2

CPT CODE: $4,100.6540702-2

CPT CODE: $2,519.6940720-2

CPT CODE: $3,616.4640761-2

CPT CODE: $124.5040800-2

CPT CODE: $345.8440801-2

CPT CODE: $181.8140804-2

CPT CODE: $563.1940805-2

CPT CODE: $124.5040806-2

CPT CODE: $185.7740808-2

CPT CODE: $185.7740810-2

CPT CODE: $365.5840812-2

CPT CODE: $820.1340814-2

CPT CODE: $879.4140816-2

CPT CODE: $395.2640818-2

CPT CODE: $316.2140819-2

CPT CODE: $306.3040820-2

CPT CODE: $249.0140830-2

CPT CODE: $395.2640831-2

CPT CODE: $1,324.0740840-2

CPT CODE: $879.4140842-2

CPT CODE: $1,699.5640843-2

CPT CODE: $2,045.4040844-2

CPT CODE: $3,102.6740845-2

CPT CODE: $235.1541000-2

CPT CODE: $691.6941005-2

CPT CODE: $513.8341006-2

CPT CODE: $691.6941007-2

CPT CODE: $444.6541008-2

CPT CODE: $1,077.0341009-2

CPT CODE: $233.1941010-2

CPT CODE: $1,017.7541015-2

CPT CODE: $1,017.7541016-2

CPT CODE: $1,017.7541017-2

CPT CODE: $1,571.0941018-2

CPT CODE: $264.7941100-2

CPT CODE: $523.7041105-2

CPT CODE: $345.8441108-2

CPT CODE: $280.6341110-2

CPT CODE: $760.8341112-2

CPT CODE: $1,017.7541113-2

CPT CODE: $938.6841114-2

CPT CODE: $464.3841115-2

CPT CODE: $770.7341116-2

CPT CODE: $1,274.6741120-2

CPT CODE: $2,460.3941130-2

CPT CODE: $4,841.7441135-2

CPT CODE: $4,011.7341140-2

CPT CODE: $5,721.1541145-2

CPT CODE: $6,096.6541150-2

CPT CODE: $5,464.2241153-2

CPT CODE: $6,096.6541155-2

CPT CODE: $249.0141250-2

CPT CODE: $365.5841251-2

CPT CODE: $563.1941252-2

CPT CODE: $2,203.4841510-2

CPT CODE: $494.0541520-2

CPT CODE: $258.8941800-I

CPT CODE: $1,037.5041826-I

CPT CODE: $296.4342000-2

CPT CODE: $316.2142100-2

CPT CODE: $268.7742104-2

CPT CODE: $602.7542106-2

CPT CODE: $938.6842107-2

CPT CODE: $1,531.5542120-2

CPT CODE: $306.3042140-2

CPT CODE: $3,527.5342145-2

CPT CODE: $444.6542160-2

CPT CODE: $444.6542180-2

CPT CODE: $2,134.3242182-2

CPT CODE: $3,438.6442200-2

CPT CODE: $4,327.9342205-2

CPT CODE: $4,841.7442210-2

CPT CODE: $2,865.5342215-2

CPT CODE: $3,646.1042220-2

CPT CODE: $3,646.1042225-2

CPT CODE: $3,646.1042226-2

CPT CODE: $3,646.1042227-2

CPT CODE: $3,468.2742235-2

CPT CODE: $2,282.5042260-2

CPT CODE: $233.1942300-2

CPT CODE: $513.8342305-2

CPT CODE: $251.0042310-2

CPT CODE: $691.6942320-2

Page 21

Page 22: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $375.4642330-2

CPT CODE: $1,017.7542335-2

CPT CODE: $1,254.9142340-2

CPT CODE: $563.1942400-2

CPT CODE: $553.3342405-2

CPT CODE: $889.2842408-2

CPT CODE: $770.7342409-2

CPT CODE: $1,333.9442410-2

CPT CODE: $3,161.9742415-2

CPT CODE: $3,853.6742420-2

CPT CODE: $2,826.0242425-2

CPT CODE: $5,187.5642426-2

CPT CODE: $1,620.4942440-2

CPT CODE: $1,195.5942450-2

CPT CODE: $1,571.0942500-2

CPT CODE: $1,363.6042505-2

CPT CODE: $1,571.0942507-2

CPT CODE: $2,391.2042509-2

CPT CODE: $2,391.2042510-2

CPT CODE: $124.5042550-2

CPT CODE: $1,571.0942600-2

CPT CODE: $154.1542650-2

CPT CODE: $245.0642660-2

CPT CODE: $187.7342665-2

CPT CODE: $306.3042700-2

CPT CODE: $523.7042720-2

CPT CODE: $1,274.6742725-2

CPT CODE: $185.7742800-2

CPT CODE: $249.0142804-2

CPT CODE: $405.1142806-2

CPT CODE: $780.6042808-2

CPT CODE: $780.6042809-2

CPT CODE: $1,077.0342810-2

CPT CODE: $2,302.3142815-2

CPT CODE: $1,106.7142820-2

CPT CODE: $1,106.7142821-2

CPT CODE: $1,037.5042825-2

CPT CODE: $1,037.5042826-2

CPT CODE: $681.8142830-2

CPT CODE: $563.1942831-2

CPT CODE: $474.2742835-2

CPT CODE: $563.1942836-2

CPT CODE: $1,511.8142842-2

CPT CODE: $2,648.1442844-2

CPT CODE: $2,648.1442845-2

CPT CODE: $405.1142860-2

CPT CODE: $444.6542870-2

CPT CODE: $4,140.1742890-2

CPT CODE: $5,098.6642892-2

CPT CODE: $4,851.6142894-2

CPT CODE: $2,519.6942900-2

CPT CODE: $3,142.1942950-2

CPT CODE: $4,268.6642953-2

CPT CODE: $3,142.1942955-2

CPT CODE: $335.9542960-2

CPT CODE: $365.5842961-2

CPT CODE: $444.6542962-2

CPT CODE: $444.6542970-2

CPT CODE: $444.6542972-2

CPT CODE: $2,885.2743020-2

CPT CODE: $2,964.3643030-2

CPT CODE: $3,468.2743100-2

CPT CODE: $4,525.5543101-2

CPT CODE: $5,673.7443107-2

CPT CODE: $6,617.8643108-2

CPT CODE: $6,617.8643112-2

CPT CODE: $6,617.8643113-2

CPT CODE: $6,617.8643116-2

CPT CODE: $6,617.8643117-2

CPT CODE: $6,617.8643118-2

CPT CODE: $5,846.2143121-2

CPT CODE: $5,846.2143122-2

CPT CODE: $6,617.8643123-2

CPT CODE: $5,673.7443124-2

CPT CODE: $3,774.5843130-2

CPT CODE: $4,525.5543135-2

CPT CODE: $562.4043180-2

CPT CODE: $636.4143180-4

CPT CODE: $147.1443191-2

CPT CODE: $175.5743192-2

CPT CODE: $209.3343193-2

CPT CODE: $190.6343194-2

CPT CODE: $209.7243195-2

CPT CODE: $228.9843196-2

CPT CODE: $94.0143197-2

CPT CODE: $111.9943198-2

CPT CODE: $652.1943200-2

CPT CODE: $22.5643201-2

CPT CODE: $810.2643202-2

CPT CODE: $1,254.9143204-2

CPT CODE: $1,511.8143205-2

CPT CODE: $483.4143210-2

CPT CODE: $284.3443211-2

CPT CODE: $223.0943212-2

CPT CODE: $315.8343213-2

CPT CODE: $228.4243214-2

CPT CODE: $1,225.2443215-2

CPT CODE: $1,511.8143216-2

CPT CODE: $1,511.8143217-2

CPT CODE: $830.0243220-2

CPT CODE: $602.7543226-2

CPT CODE: $1,511.8143227-2

CPT CODE: $240.6643229-2

CPT CODE: $818.8643231-2

CPT CODE: $859.4143232-2

CPT CODE: $271.2043233-2

CPT CODE: $741.0843235-2

CPT CODE: $932.2743236-2

CPT CODE: $798.3143237-2

CPT CODE: $937.0243238-2

CPT CODE: $830.0243239-2

CPT CODE: $1,469.2643240-2

CPT CODE: $1,511.8143241-2

CPT CODE: $1,402.2043242-2

CPT CODE: $1,482.1543243-2

CPT CODE: $1,483.8243244-2

CPT CODE: $978.2343245-2

CPT CODE: $1,511.8143246-2

CPT CODE: $889.2843247-2

CPT CODE: $951.8843248-2

CPT CODE: $953.2043249-2

CPT CODE: $1,278.5043250-2

CPT CODE: $1,274.6743251-2

CPT CODE: $314.5843253-2

CPT CODE: $326.3943254-2

CPT CODE: $1,175.8643255-2

CPT CODE: $1,511.8143259-2

CPT CODE: $1,245.0243260-2

CPT CODE: $1,250.5043261-2

CPT CODE: $1,887.2943262-2

CPT CODE: $2,203.4843263-2

CPT CODE: $2,638.2643264-2

CPT CODE: $3,478.1643265-2

CPT CODE: $269.9743266-2

CPT CODE: $283.8943270-2

CPT CODE: $264.9743273-2

CPT CODE: $916.1543274-2

CPT CODE: $755.2043275-2

CPT CODE: $953.3443276-2

CPT CODE: $759.9343277-2

CPT CODE: $684.1943278-2

CPT CODE: $2,929.0843279-2

CPT CODE: $2,911.3943280-2

CPT CODE: $2,673.2643281-2

CPT CODE: $3,007.7443282-2

CPT CODE: $286.4643283-2

CPT CODE: $5,039.3343300-2

CPT CODE: $4,327.9343305-2

CPT CODE: $5,414.8543310-2

CPT CODE: $5,721.1543312-2

CPT CODE: $5,185.2043313-2

CPT CODE: $5,479.8443314-2

Page 22

Page 23: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $4,841.7443320-2

CPT CODE: $3,843.7443325-2

CPT CODE: $2,363.4843327-2

CPT CODE: $2,376.1143328-2

CPT CODE: $4,011.7343330-2

CPT CODE: $3,774.5843331-2

CPT CODE: $2,687.0343332-2

CPT CODE: $2,699.6843333-2

CPT CODE: $2,660.5043334-2

CPT CODE: $2,673.1343335-2

CPT CODE: $2,660.7643336-2

CPT CODE: $2,906.2243337-2

CPT CODE: $236.4843338-2

CPT CODE: $4,406.9443340-2

CPT CODE: $4,406.9443341-2

CPT CODE: $2,519.6943351-2

CPT CODE: $2,519.6943352-2

CPT CODE: $5,846.2143360-2

CPT CODE: $6,617.8643361-2

CPT CODE: $4,841.7443400-2

CPT CODE: $3,776.4243405-2

CPT CODE: $3,774.5843410-2

CPT CODE: $4,525.5543415-2

CPT CODE: $2,519.6943420-2

CPT CODE: $4,100.6543425-2

CPT CODE: $233.1943450-2

CPT CODE: $632.3943453-2

CPT CODE: $1,017.7543460-2

CPT CODE: $8,046.3343496-2

CPT CODE: $2,519.6943500-2

CPT CODE: $2,786.4643501-2

CPT CODE: $2,786.9643502-2

CPT CODE: $2,786.4643510-2

CPT CODE: $2,341.8343520-2

CPT CODE: $2,519.6943605-2

CPT CODE: $2,322.0543610-2

CPT CODE: $2,323.7043611-2

CPT CODE: $5,464.2243620-2

CPT CODE: $5,459.3243621-2

CPT CODE: $6,653.8343622-2

CPT CODE: $4,526.1043631-2

CPT CODE: $4,526.1043632-2

CPT CODE: $4,526.1043633-2

CPT CODE: $6,653.8343634-2

CPT CODE: $1,253.8543635-2

CPT CODE: $3,814.1043640-2

CPT CODE: $2,786.4643641-2

CPT CODE: $2,535.7743644-2

CPT CODE: $2,763.5643645-2

CPT CODE: $1,275.0043647-2

CPT CODE: $1,338.4143648-2

CPT CODE: $1,714.4843651-2

CPT CODE: $2,361.4443652-2

CPT CODE: $1,585.0843653-2

CPT CODE: $51.4843752-2

CPT CODE: $97.9543753-2

CPT CODE: $145.3543754-2

CPT CODE: $264.0343755-2

CPT CODE: $364.3543756-2

CPT CODE: $469.4343757-2

CPT CODE: $187.7343761-2

CPT CODE: $39.9943762-2

CPT CODE: $88.0043763-2

CPT CODE: $2,329.4243770-2

CPT CODE: $2,388.6543771-2

CPT CODE: $1,613.1143772-2

CPT CODE: $2,388.6543773-2

CPT CODE: $1,613.1143774-2

CPT CODE: $2,175.4143775-2

CPT CODE: $2,717.3043800-2

CPT CODE: $3,142.1943810-2

CPT CODE: $3,142.1943820-2

CPT CODE: $3,685.6543825-2

CPT CODE: $2,262.7843830-2

CPT CODE: $1,660.0443831-2

CPT CODE: $3,329.9443832-2

CPT CODE: $2,717.3043840-2

CPT CODE: $4,840.1343843-2

CPT CODE: $2,763.5643845-2

CPT CODE: $5,078.9043846-2

CPT CODE: $4,103.2443847-2

CPT CODE: $4,103.2443848-2

CPT CODE: $4,525.5543850-2

CPT CODE: $4,901.0443855-2

CPT CODE: $3,922.8043860-2

CPT CODE: $4,901.0443865-2

CPT CODE: $2,519.6943880-2

CPT CODE: $1,275.0043881-2

CPT CODE: $1,338.4143882-2

CPT CODE: $505.5743886-2

CPT CODE: $495.9143887-2

CPT CODE: $706.6943888-2

CPT CODE: $2,835.8844005-2

CPT CODE: $3,468.2744010-2

CPT CODE: $691.6944015-2

CPT CODE: $3,270.6644020-2

CPT CODE: $2,539.4344021-2

CPT CODE: $3,389.2144025-2

CPT CODE: $2,470.2544050-2

CPT CODE: $2,420.8744055-2

CPT CODE: $335.9544100-2

CPT CODE: $2,697.5044110-2

CPT CODE: $4,100.6544111-2

CPT CODE: $3,636.2444120-2

CPT CODE: $907.7944121-2

CPT CODE: $3,636.2444125-2

CPT CODE: $3,488.1744126-2

CPT CODE: $3,963.3444127-2

CPT CODE: $791.4344128-2

CPT CODE: $2,638.2644130-2

CPT CODE: $1,161.9744139-2

CPT CODE: $3,478.1644140-2

CPT CODE: $4,140.1744141-2

CPT CODE: $3,893.1844143-2

CPT CODE: $3,626.3444144-2

CPT CODE: $3,695.5344145-2

CPT CODE: $5,069.0144146-2

CPT CODE: $5,069.0144147-2

CPT CODE: $5,069.0144150-2

CPT CODE: $4,229.1244151-2

CPT CODE: $6,699.3844155-2

CPT CODE: $8,665.7044156-2

CPT CODE: $4,324.2044157-2

CPT CODE: $5,550.6244158-2

CPT CODE: $3,448.4944160-2

CPT CODE: $1,115.8144180-2

CPT CODE: $1,473.9744186-2

CPT CODE: $1,877.5944187-2

CPT CODE: $2,012.5944188-2

CPT CODE: $3,323.8344202-2

CPT CODE: $791.4344203-2

CPT CODE: $2,599.5444204-2

CPT CODE: $3,005.2844205-2

CPT CODE: $3,314.0644206-6

CPT CODE: $3,136.6244207-2

CPT CODE: $4,300.4644208-2

CPT CODE: $4,300.4644210-2

CPT CODE: $3,898.9844211-2

CPT CODE: $5,694.3544212-2

CPT CODE: $903.6744213-2

CPT CODE: $2,909.3644227-2

CPT CODE: $2,173.8444300-2

CPT CODE: $2,410.9944310-2

CPT CODE: $1,739.0944312-2

CPT CODE: $2,578.9544314-2

CPT CODE: $2,588.8744316-2

CPT CODE: $2,588.8744320-2

CPT CODE: $3,310.1644322-2

CPT CODE: $316.2144340-2

CPT CODE: $1,571.0944345-2

CPT CODE: $4,011.7344346-2

CPT CODE: $1,383.3344360-2

Page 23

Page 24: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $1,511.8144361-2

CPT CODE: $1,511.8144363-2

CPT CODE: $1,511.8144364-2

CPT CODE: $1,511.8144365-2

CPT CODE: $1,511.8144366-2

CPT CODE: $1,511.8144369-2

CPT CODE: $1,335.1244370-2

CPT CODE: $2,055.2644372-2

CPT CODE: $2,055.2644373-2

CPT CODE: $1,381.1444376-2

CPT CODE: $1,511.8144377-2

CPT CODE: $1,511.8144378-2

CPT CODE: $1,335.1244379-2

CPT CODE: $316.2144380-2

CPT CODE: $395.2644382-2

CPT CODE: $240.1444384-2

CPT CODE: $271.7444384-4

CPT CODE: $316.2144385-2

CPT CODE: $395.2644386-2

CPT CODE: $316.2144388-2

CPT CODE: $395.2644389-2

CPT CODE: $395.2644390-2

CPT CODE: $395.2644391-2

CPT CODE: $395.2644392-2

CPT CODE: $391.9644394-2

CPT CODE: $521.4444401-2

CPT CODE: $590.0544401-4

CPT CODE: $374.5844402-2

CPT CODE: $423.8744402-4

CPT CODE: $115.7244500-2

CPT CODE: $2,566.3644602-2

CPT CODE: $3,387.6044603-2

CPT CODE: $2,697.0244604-2

CPT CODE: $3,389.2144605-2

CPT CODE: $2,566.3644615-2

CPT CODE: $2,371.4444620-2

CPT CODE: $3,735.0844625-2

CPT CODE: $3,567.8944626-2

CPT CODE: $2,401.0944640-2

CPT CODE: $3,142.1944650-2

CPT CODE: $3,142.1944660-2

CPT CODE: $3,438.6444661-2

CPT CODE: $4,525.5544680-2

CPT CODE: $3,003.6444700-2

CPT CODE: $285.6944701-2

CPT CODE: $2,519.6944800-2

CPT CODE: $2,272.6744820-2

CPT CODE: $2,272.6744850-2

CPT CODE: $1,383.3344900-2

CPT CODE: $1,600.7444950-2

CPT CODE: $1,936.7044960-2

CPT CODE: $1,467.0244970-2

CPT CODE: $622.5045000-2

CPT CODE: $395.2645005-2

CPT CODE: $1,017.7545020-2

CPT CODE: $691.6945100-2

CPT CODE: $2,519.6945108-2

CPT CODE: $5,632.2245110-2

CPT CODE: $2,826.0245111-2

CPT CODE: $5,414.8545112-2

CPT CODE: $5,410.4545113-2

CPT CODE: $4,327.9345114-2

CPT CODE: $8,277.7645119-2

CPT CODE: $6,096.6545120-2

CPT CODE: $6,699.3845121-2

CPT CODE: $2,832.3245123-2

CPT CODE: $8,861.9945126-2

CPT CODE: $3,270.6645130-2

CPT CODE: $5,721.1545135-2

CPT CODE: $4,981.5545136-2

CPT CODE: $1,126.4645150-2

CPT CODE: $2,519.6945160-2

CPT CODE: $1,002.1545171-2

CPT CODE: $1,456.2745172-2

CPT CODE: $1,624.9545190-2

CPT CODE: $118.5945300-2

CPT CODE: $185.7745303-2

CPT CODE: $245.0645305-2

CPT CODE: $513.8345307-2

CPT CODE: $272.5045308-2

CPT CODE: $272.5045309-2

CPT CODE: $444.6545315-2

CPT CODE: $375.4645317-2

CPT CODE: $523.7045320-2

CPT CODE: $444.6545321-2

CPT CODE: $358.7445327-2

CPT CODE: $193.6645330-2

CPT CODE: $262.8045331-2

CPT CODE: $187.7345332-2

CPT CODE: $375.4645333-2

CPT CODE: $375.4645334-2

CPT CODE: $315.7745335-2

CPT CODE: $879.4145337-2

CPT CODE: $373.2945338-2

CPT CODE: $190.9545340-2

CPT CODE: $458.5645341-2

CPT CODE: $481.9645342-2

CPT CODE: $351.2445346-2

CPT CODE: $397.4545346-4

CPT CODE: $241.1745347-2

CPT CODE: $272.9145347-4

CPT CODE: $1,165.9445378-2

CPT CODE: $1,758.8445379-2

CPT CODE: $1,165.9445380-2

CPT CODE: $1,348.7845381-2

CPT CODE: $1,590.8645382-2

CPT CODE: $1,530.4945384-2

CPT CODE: $1,531.5545385-2

CPT CODE: $463.1245386-2

CPT CODE: $755.3245388-2

CPT CODE: $854.7145388-4

CPT CODE: $478.2345389-2

CPT CODE: $541.1645389-4

CPT CODE: $816.6145391-2

CPT CODE: $863.8745392-2

CPT CODE: $4,384.7145395-2

CPT CODE: $6,749.9445397-2

CPT CODE: $2,159.9845400-2

CPT CODE: $2,717.8945402-2

CPT CODE: $2,045.4045500-2

CPT CODE: $2,065.1045505-2

CPT CODE: $124.5045520-2

CPT CODE: $2,776.6045540-2

CPT CODE: $2,776.6045541-2

CPT CODE: $3,488.0245550-2

CPT CODE: $1,274.6745560-2

CPT CODE: $1,534.2045562-2

CPT CODE: $3,531.3245563-2

CPT CODE: $3,142.1945800-2

CPT CODE: $3,527.5345805-2

CPT CODE: $3,142.1945820-2

CPT CODE: $3,527.5345825-2

CPT CODE: $187.7345900-2

CPT CODE: $268.7745905-2

CPT CODE: $642.2745910-2

CPT CODE: $424.8845915-2

CPT CODE: $195.6145990-2

CPT CODE: $186.6846020-2

CPT CODE: $124.5046030-2

CPT CODE: $523.7046040-2

CPT CODE: $523.7046045-2

CPT CODE: $213.4246050-2

CPT CODE: $1,373.4646060-2

CPT CODE: $563.1946070-2

CPT CODE: $889.2846080-2

CPT CODE: $296.4346083-2

CPT CODE: $1,254.9146200-2

CPT CODE: $187.7346220-2

CPT CODE: $292.4946221-2

CPT CODE: $1,096.7846250-2

CPT CODE: $1,294.4146255-2

CPT CODE: $1,363.6046257-2

Page 24

Page 25: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $1,620.4946258-2

CPT CODE: $2,302.3146260-2

CPT CODE: $2,460.3946261-2

CPT CODE: $2,460.3946262-2

CPT CODE: $759.3546270-2

CPT CODE: $1,660.0446275-2

CPT CODE: $2,005.8846280-2

CPT CODE: $563.1946285-2

CPT CODE: $2,006.2446288-2

CPT CODE: $231.2346320-2

CPT CODE: $75.1146500-2

CPT CODE: $402.2446505-2

CPT CODE: $116.6046600-2

CPT CODE: $187.7346604-2

CPT CODE: $185.7746606-2

CPT CODE: $316.2146608-2

CPT CODE: $247.0246610-2

CPT CODE: $246.3746611-2

CPT CODE: $513.8346612-2

CPT CODE: $254.9346614-2

CPT CODE: $255.7146615-2

CPT CODE: $2,272.6746700-2

CPT CODE: $3,142.1946705-2

CPT CODE: $463.1246706-2

CPT CODE: $771.8746707-2

CPT CODE: $1,693.0046710-2

CPT CODE: $3,526.5046712-2

CPT CODE: $2,776.6046715-2

CPT CODE: $2,776.6046716-2

CPT CODE: $2,569.1046730-2

CPT CODE: $5,039.3346735-2

CPT CODE: $5,661.8846740-2

CPT CODE: $5,655.2946742-2

CPT CODE: $5,655.2946744-2

CPT CODE: $5,655.2946746-2

CPT CODE: $5,922.9346748-2

CPT CODE: $2,213.3446750-2

CPT CODE: $3,013.7446751-2

CPT CODE: $3,013.7446753-2

CPT CODE: $1,324.0746754-2

CPT CODE: $2,519.6946760-2

CPT CODE: $2,786.4646761-2

CPT CODE: $124.5046900-2

CPT CODE: $124.5046910-2

CPT CODE: $175.8646916-2

CPT CODE: $179.8246917-2

CPT CODE: $179.8246922-2

CPT CODE: $1,106.7146924-2

CPT CODE: $290.0946930-2

CPT CODE: $185.7746940-2

CPT CODE: $124.5046942-2

CPT CODE: $148.2046945-2

CPT CODE: $316.2146946-2

CPT CODE: $1,050.1246947-2

CPT CODE: $345.8447000-2

CPT CODE: $345.8447001-2

CPT CODE: $3,142.1947010-2

CPT CODE: $3,150.0547015-2

CPT CODE: $2,065.1047100-2

CPT CODE: $3,853.6747120-2

CPT CODE: $5,879.2747122-2

CPT CODE: $5,879.2747125-2

CPT CODE: $5,879.2747130-2

CPT CODE: $13,191.2847135-2

CPT CODE: $2,588.8747350-2

CPT CODE: $3,527.5347360-2

CPT CODE: $3,008.9047361-2

CPT CODE: $2,681.8647362-2

CPT CODE: $8,789.6447383-2

CPT CODE: $3,774.5847400-2

CPT CODE: $3,685.6547420-2

CPT CODE: $4,584.8647425-2

CPT CODE: $4,327.9347460-2

CPT CODE: $2,460.3947480-2

CPT CODE: $1,017.7547490-2

CPT CODE: $109.0747531-2

CPT CODE: $245.8947532-2

CPT CODE: $347.5647533-2

CPT CODE: $460.9847534-2

CPT CODE: $263.9047535-2

CPT CODE: $168.4647536-2

CPT CODE: $112.4747537-2

CPT CODE: $375.9747538-2

CPT CODE: $508.7047539-2

CPT CODE: $607.7047540-2

CPT CODE: $322.2647541-2

CPT CODE: $147.7747542-2

CPT CODE: $186.3547543-2

CPT CODE: $241.0447544-2

CPT CODE: $513.8347550-2

CPT CODE: $513.8347552-2

CPT CODE: $760.8347553-2

CPT CODE: $2,638.2647554-2

CPT CODE: $760.8347555-2

CPT CODE: $760.8347556-2

CPT CODE: $1,860.0547562-2

CPT CODE: $2,086.4947563-2

CPT CODE: $2,793.3147564-2

CPT CODE: $2,272.4947570-2

CPT CODE: $2,480.1447600-2

CPT CODE: $2,687.6547605-2

CPT CODE: $3,053.2647610-2

CPT CODE: $4,901.0447620-2

CPT CODE: $3,389.2147700-2

CPT CODE: $3,438.6447701-2

CPT CODE: $3,395.1547711-2

CPT CODE: $3,395.1547712-2

CPT CODE: $3,389.2147715-2

CPT CODE: $3,468.2747720-2

CPT CODE: $4,100.6547721-2

CPT CODE: $4,100.6547740-2

CPT CODE: $4,893.0347741-2

CPT CODE: $3,438.6447760-2

CPT CODE: $4,100.6547765-2

CPT CODE: $5,108.5147780-2

CPT CODE: $5,110.9147785-2

CPT CODE: $4,723.1747800-2

CPT CODE: $3,438.6447801-2

CPT CODE: $3,468.2747802-2

CPT CODE: $4,720.5647900-2

CPT CODE: $2,519.6948000-2

CPT CODE: $4,367.4348001-2

CPT CODE: $2,826.0248020-2

CPT CODE: $2,638.2648100-2

CPT CODE: $316.2148102-2

CPT CODE: $2,765.8648105-2

CPT CODE: $3,142.1948120-2

CPT CODE: $3,626.3448140-2

CPT CODE: $4,159.9548145-2

CPT CODE: $5,104.6848146-2

CPT CODE: $3,142.1948148-2

CPT CODE: $5,108.5148150-2

CPT CODE: $5,104.6848152-2

CPT CODE: $5,104.6848153-2

CPT CODE: $5,104.6848154-2

CPT CODE: $5,039.3348155-2

CPT CODE: $13,191.2848160-2

CPT CODE: $201.5748400-2

CPT CODE: $3,142.1948500-2

CPT CODE: $3,142.1948510-2

CPT CODE: $3,448.4948520-2

CPT CODE: $4,327.9348540-2

CPT CODE: $3,639.5248545-2

CPT CODE: $4,386.1048547-2

CPT CODE: $3,347.3848548-2

CPT CODE: $2,213.3449000-2

CPT CODE: $3,142.1949002-2

CPT CODE: $2,519.6949010-2

CPT CODE: $2,065.1049020-2

CPT CODE: $2,460.3949040-2

CPT CODE: $2,065.1049060-2

CPT CODE: $1,974.8449062-2

Page 25

Page 26: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $233.8649082-2

CPT CODE: $440.7249083-2

CPT CODE: $142.9849084-2

CPT CODE: $361.1649180-2

CPT CODE: $140.0149185-2

CPT CODE: $1,710.1149203-2

CPT CODE: $1,874.4049204-2

CPT CODE: $2,146.0549205-2

CPT CODE: $5,661.8849215-2

CPT CODE: $4,446.4749220-2

CPT CODE: $1,452.5049250-2

CPT CODE: $2,065.1049255-2

CPT CODE: $1,067.4949320-2

CPT CODE: $1,334.3849321-2

CPT CODE: $1,384.5249322-2

CPT CODE: $1,509.0749323-2

CPT CODE: $926.9049324-2

CPT CODE: $1,068.5749325-2

CPT CODE: $553.1849326-2

CPT CODE: $230.9449327-2

CPT CODE: $316.2149400-2

CPT CODE: $1,418.0149402-2

CPT CODE: $252.0749405-2

CPT CODE: $252.4649406-2

CPT CODE: $286.6549407-2

CPT CODE: $690.8349411-2

CPT CODE: $143.9249412-2

CPT CODE: $1,963.2349418-2

CPT CODE: $1,239.0249419-2

CPT CODE: $1,215.3849421-2

CPT CODE: $1,216.4549422-2

CPT CODE: $229.7549423-2

CPT CODE: $114.8649424-2

CPT CODE: $1,936.7049425-2

CPT CODE: $899.1649426-2

CPT CODE: $363.4849427-2

CPT CODE: $907.7949428-2

CPT CODE: $907.7949429-2

CPT CODE: $354.8449435-2

CPT CODE: $425.0049436-2

CPT CODE: $798.1449440-2

CPT CODE: $870.5849441-2

CPT CODE: $723.1149442-2

CPT CODE: $571.7649446-2

CPT CODE: $231.5549450-2

CPT CODE: $319.5149451-2

CPT CODE: $498.0349452-2

CPT CODE: $162.9949460-2

CPT CODE: $107.3649465-2

CPT CODE: $1,635.3249491-2

CPT CODE: $2,738.3949492-2

CPT CODE: $1,707.7849495-2

CPT CODE: $2,855.6349496-2

CPT CODE: $1,709.4349500-2

CPT CODE: $2,855.6349501-2

CPT CODE: $1,440.6749505-2

CPT CODE: $2,855.6349507-2

CPT CODE: $1,877.4049520-2

CPT CODE: $2,855.6349521-2

CPT CODE: $1,551.3449525-2

CPT CODE: $2,084.8849540-2

CPT CODE: $1,531.5549550-2

CPT CODE: $1,577.1249553-2

CPT CODE: $2,154.1049555-2

CPT CODE: $1,745.1349557-2

CPT CODE: $1,995.9949560-2

CPT CODE: $1,997.0849561-2

CPT CODE: $2,588.8749565-2

CPT CODE: $938.6849570-2

CPT CODE: $1,679.7749572-2

CPT CODE: $1,245.0249580-2

CPT CODE: $1,250.5049582-2

CPT CODE: $1,763.7849585-2

CPT CODE: $1,763.7849587-2

CPT CODE: $2,005.8849590-2

CPT CODE: $2,203.4849600-2

CPT CODE: $3,468.2749605-2

CPT CODE: $2,203.4849606-2

CPT CODE: $2,776.6049610-2

CPT CODE: $2,776.6049611-2

CPT CODE: $1,433.0449650-2

CPT CODE: $1,586.7049651-2

CPT CODE: $1,512.8949652-2

CPT CODE: $1,888.2549653-2

CPT CODE: $1,735.9849654-2

CPT CODE: $2,090.0249655-2

CPT CODE: $1,742.8249656-2

CPT CODE: $2,516.4049657-2

CPT CODE: $1,027.6549900-2

CPT CODE: $2,745.6749904-2

CPT CODE: $2,582.6649905-2

CPT CODE: $6,329.9849906-2

CPT CODE: $2,569.1050010-2

CPT CODE: $2,114.5450020-2

CPT CODE: $3,142.1950040-2

CPT CODE: $3,142.1950045-2

CPT CODE: $3,142.1950060-2

CPT CODE: $4,406.9450065-2

CPT CODE: $4,406.9450070-2

CPT CODE: $4,604.6050075-2

CPT CODE: $4,051.2550080-2

CPT CODE: $5,108.5150081-2

CPT CODE: $2,519.6950100-2

CPT CODE: $3,142.1950120-2

CPT CODE: $3,142.1950125-2

CPT CODE: $3,102.6750130-2

CPT CODE: $4,406.9450135-2

CPT CODE: $820.1350200-2

CPT CODE: $1,432.7750205-2

CPT CODE: $3,102.6750220-2

CPT CODE: $4,031.4850225-2

CPT CODE: $4,713.2850230-2

CPT CODE: $4,713.2850234-2

CPT CODE: $4,031.4850236-2

CPT CODE: $3,744.9350240-2

CPT CODE: $3,705.4250280-2

CPT CODE: $3,705.4250290-2

CPT CODE: $1,936.7050300-2

CPT CODE: $4,406.9450320-2

CPT CODE: $3,646.1050340-2

CPT CODE: $7,391.1050360-2

CPT CODE: $9,110.3750365-2

CPT CODE: $2,638.2650370-2

CPT CODE: $5,533.4150380-2

CPT CODE: $337.5150382-2

CPT CODE: $304.4450384-2

CPT CODE: $285.8850385-2

CPT CODE: $216.0350386-2

CPT CODE: $121.2350387-2

CPT CODE: $96.4350389-2

CPT CODE: $306.3050390-2

CPT CODE: $194.8450391-2

CPT CODE: $124.5050396-2

CPT CODE: $3,893.1850400-2

CPT CODE: $4,397.0650405-2

CPT CODE: $189.7950430-2

CPT CODE: $74.8550431-2

CPT CODE: $251.1250432-2

CPT CODE: $310.2550433-2

CPT CODE: $237.5150434-2

CPT CODE: $114.8150435-2

CPT CODE: $162.0050436-2

CPT CODE: $271.2050437-2

CPT CODE: $3,142.1950500-2

CPT CODE: $4,100.6550520-2

CPT CODE: $4,406.9450525-2

CPT CODE: $4,406.9450526-2

CPT CODE: $5,148.0350540-2

CPT CODE: $1,384.5250541-2

CPT CODE: $3,144.1450542-2

CPT CODE: $3,183.2450543-2

CPT CODE: $3,194.4450544-2

Page 26

Page 27: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $4,148.8650545-2

CPT CODE: $3,424.0950546-2

CPT CODE: $2,835.3750548-2

CPT CODE: $1,758.8450551-2

CPT CODE: $513.8350553-2

CPT CODE: $513.8350555-2

CPT CODE: $563.1950557-2

CPT CODE: $513.8350561-2

CPT CODE: $1,442.0150562-2

CPT CODE: $251.0050570-2

CPT CODE: $316.2150572-2

CPT CODE: $316.2150574-2

CPT CODE: $2,211.3850575-2

CPT CODE: $316.2150576-2

CPT CODE: $316.2150580-2

CPT CODE: $2,460.3950590-2

CPT CODE: $911.9750593-2

CPT CODE: $3,082.8950600-2

CPT CODE: $1,827.9850605-2

CPT CODE: $179.0850606-2

CPT CODE: $3,646.1050610-2

CPT CODE: $3,339.8250620-2

CPT CODE: $3,646.1050630-2

CPT CODE: $3,646.1050650-2

CPT CODE: $4,100.6550660-2

CPT CODE: $51.3850684-2

CPT CODE: $124.5050686-2

CPT CODE: $124.5050688-2

CPT CODE: $71.1650690-2

CPT CODE: $248.7150693-2

CPT CODE: $321.6550694-2

CPT CODE: $407.8850695-2

CPT CODE: $3,843.7450700-2

CPT CODE: $229.0250705-2

CPT CODE: $213.6950706-2

CPT CODE: $3,646.1050715-2

CPT CODE: $2,885.2750722-2

CPT CODE: $4,723.1750725-2

CPT CODE: $3,491.4350727-2

CPT CODE: $3,491.4350728-2

CPT CODE: $3,774.5850740-2

CPT CODE: $4,406.9450750-2

CPT CODE: $3,488.0250760-2

CPT CODE: $4,100.6550770-2

CPT CODE: $3,488.0250780-2

CPT CODE: $3,606.1950782-2

CPT CODE: $3,606.1950783-2

CPT CODE: $4,051.2550785-2

CPT CODE: $3,774.5850800-2

CPT CODE: $5,533.4150810-2

CPT CODE: $5,533.4150815-2

CPT CODE: $5,533.4150820-2

CPT CODE: $6,887.1150825-2

CPT CODE: $5,533.4150830-2

CPT CODE: $5,533.4150840-2

CPT CODE: $4,367.4350845-2

CPT CODE: $3,389.2150860-2

CPT CODE: $3,646.1050900-2

CPT CODE: $3,646.1050920-2

CPT CODE: $4,406.9450930-2

CPT CODE: $3,646.1050940-2

CPT CODE: $3,238.1050945-2

CPT CODE: $3,852.5150947-2

CPT CODE: $3,077.3350948-2

CPT CODE: $444.6550951-2

CPT CODE: $513.8350953-2

CPT CODE: $513.8350955-2

CPT CODE: $513.8350957-2

CPT CODE: $513.8350961-2

CPT CODE: $187.7350970-2

CPT CODE: $316.2150972-2

CPT CODE: $316.2150974-2

CPT CODE: $316.2150976-2

CPT CODE: $316.2150980-2

CPT CODE: $2,401.0951020-2

CPT CODE: $2,401.0951030-2

CPT CODE: $2,401.0951040-2

CPT CODE: $1,660.0451045-2

CPT CODE: $1,936.7051050-2

CPT CODE: $3,329.9451060-2

CPT CODE: $2,065.1051065-2

CPT CODE: $1,254.9151080-2

CPT CODE: $133.2451100-2

CPT CODE: $42.6951101-2

CPT CODE: $258.7251102-2

CPT CODE: $2,638.2651500-2

CPT CODE: $2,964.3651520-2

CPT CODE: $3,102.6751525-2

CPT CODE: $2,885.2751530-2

CPT CODE: $2,826.0251535-2

CPT CODE: $2,569.1051550-2

CPT CODE: $3,646.1051555-2

CPT CODE: $4,406.9451565-2

CPT CODE: $4,723.1751570-2

CPT CODE: $6,284.3851575-2

CPT CODE: $6,284.3851580-2

CPT CODE: $7,865.3651585-2

CPT CODE: $8,171.6851590-2

CPT CODE: $9,436.4451595-2

CPT CODE: $9,288.2551596-2

CPT CODE: $9,436.4451597-2

CPT CODE: $51.3851600-2

CPT CODE: $102.7651605-2

CPT CODE: $102.7651610-2

CPT CODE: $63.2151700-2

CPT CODE: $12.0351701-2

CPT CODE: $36.0851702-2

CPT CODE: $72.1751703-2

CPT CODE: $124.5051705-2

CPT CODE: $124.5051710-2

CPT CODE: $541.2651715-2

CPT CODE: $100.8051720-2

CPT CODE: $177.8451725-2

CPT CODE: $233.1951726-2

CPT CODE: $531.3151727-2

CPT CODE: $531.3151728-2

CPT CODE: $536.4551729-2

CPT CODE: $116.6051736-2

CPT CODE: $126.4951741-2

CPT CODE: $179.7351784-2

CPT CODE: $335.9551785-2

CPT CODE: $165.9951792-2

CPT CODE: $316.2151797-2

CPT CODE: $136.8351798-2

CPT CODE: $3,646.1051800-2

CPT CODE: $5,533.4151820-2

CPT CODE: $2,697.5051840-2

CPT CODE: $2,816.0951841-2

CPT CODE: $2,331.9651845-2

CPT CODE: $2,519.6951860-2

CPT CODE: $3,646.1051865-2

CPT CODE: $1,511.8151880-2

CPT CODE: $3,942.5451900-2

CPT CODE: $3,646.1051920-2

CPT CODE: $3,646.1051925-2

CPT CODE: $4,406.9451940-2

CPT CODE: $5,533.4151960-2

CPT CODE: $3,646.1051980-2

CPT CODE: $2,138.2351990-2

CPT CODE: $2,752.8751992-2

CPT CODE: $316.2152000-2

CPT CODE: $290.0452001-2

CPT CODE: $543.4652005-2

CPT CODE: $602.7552007-2

CPT CODE: $602.7552010-2

CPT CODE: $671.9252204-2

CPT CODE: $563.1952214-2

CPT CODE: $513.8352224-2

CPT CODE: $1,017.7552234-2

CPT CODE: $1,788.4552235-2

CPT CODE: $2,569.1052240-2

CPT CODE: $523.7052250-2

Page 27

Page 28: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $444.6552260-2

CPT CODE: $268.7752265-2

CPT CODE: $760.8352270-2

CPT CODE: $760.8352275-2

CPT CODE: $1,146.2352276-2

CPT CODE: $1,126.4652277-2

CPT CODE: $563.1952281-2

CPT CODE: $1,064.2852282-2

CPT CODE: $513.8352283-2

CPT CODE: $671.9252285-2

CPT CODE: $367.0052287-2

CPT CODE: $711.4452290-2

CPT CODE: $1,027.6552300-2

CPT CODE: $993.7752301-2

CPT CODE: $1,126.4652305-2

CPT CODE: $582.9852310-2

CPT CODE: $820.1352315-2

CPT CODE: $1,827.9852317-2

CPT CODE: $2,519.6952318-2

CPT CODE: $1,165.9452320-2

CPT CODE: $2,203.4852325-2

CPT CODE: $544.6952327-2

CPT CODE: $889.2852330-2

CPT CODE: $879.4152332-2

CPT CODE: $1,096.7852334-2

CPT CODE: $692.5152341-2

CPT CODE: $761.1452342-2

CPT CODE: $831.3452343-2

CPT CODE: $836.0152344-2

CPT CODE: $920.2352345-2

CPT CODE: $1,002.9152346-2

CPT CODE: $667.5652351-2

CPT CODE: $2,027.6452352-2

CPT CODE: $2,409.7852353-2

CPT CODE: $1,558.1752354-2

CPT CODE: $1,486.4252355-2

CPT CODE: $1,363.1252356-2

CPT CODE: $879.6852400-2

CPT CODE: $808.0152402-2

CPT CODE: $1,438.2652441-2

CPT CODE: $1,103.3852442-2

CPT CODE: $1,966.3152500-2

CPT CODE: $3,092.7852601-2

CPT CODE: $3,646.1052630-2

CPT CODE: $1,827.9852640-2

CPT CODE: $3,095.6052647-2

CPT CODE: $3,095.6052648-2

CPT CODE: $2,085.2552649-2

CPT CODE: $1,254.9152700-2

CPT CODE: $523.7053000-2

CPT CODE: $1,571.0953010-2

CPT CODE: $296.4353020-2

CPT CODE: $124.5053025-2

CPT CODE: $563.1953040-2

CPT CODE: $249.0153060-2

CPT CODE: $760.8353080-2

CPT CODE: $3,646.1053085-2

CPT CODE: $365.5853200-2

CPT CODE: $2,638.2653210-2

CPT CODE: $3,339.8253215-2

CPT CODE: $2,272.6753220-2

CPT CODE: $2,331.9653230-2

CPT CODE: $2,519.6953235-2

CPT CODE: $760.8353240-2

CPT CODE: $2,272.6753250-2

CPT CODE: $185.7753260-2

CPT CODE: $444.6553265-2

CPT CODE: $316.2153270-2

CPT CODE: $563.1953275-2

CPT CODE: $1,827.9853400-2

CPT CODE: $2,134.3253405-2

CPT CODE: $2,885.2753410-2

CPT CODE: $2,845.7253415-2

CPT CODE: $3,646.1053420-2

CPT CODE: $3,646.1053425-2

CPT CODE: $2,163.9553430-2

CPT CODE: $2,198.4353431-2

CPT CODE: $3,646.1053440-2

CPT CODE: $1,827.9853442-2

CPT CODE: $1,672.3453444-2

CPT CODE: $4,268.6653445-2

CPT CODE: $1,485.6753446-2

CPT CODE: $2,134.3253447-2

CPT CODE: $2,042.6053448-2

CPT CODE: $2,134.3253449-2

CPT CODE: $741.0853450-2

CPT CODE: $563.1953460-2

CPT CODE: $1,308.8853500-2

CPT CODE: $2,519.6953502-2

CPT CODE: $1,887.2953505-2

CPT CODE: $2,519.6953510-2

CPT CODE: $3,646.1053515-2

CPT CODE: $820.1353520-2

CPT CODE: $79.0253600-2

CPT CODE: $75.1153601-2

CPT CODE: $268.7753605-2

CPT CODE: $100.8053620-2

CPT CODE: $100.8053621-2

CPT CODE: $67.1753660-2

CPT CODE: $65.2053661-2

CPT CODE: $181.8153665-2

CPT CODE: $1,800.8553850-2

CPT CODE: $771.8753855-2

CPT CODE: $2,877.8853860-2

CPT CODE: $124.5054000-2

CPT CODE: $177.8454001-2

CPT CODE: $251.0054015-2

CPT CODE: $110.6754050-2

CPT CODE: $128.4454055-2

CPT CODE: $118.5954056-2

CPT CODE: $909.0454057-2

CPT CODE: $258.8954060-2

CPT CODE: $375.4654065-2

CPT CODE: $124.5054100-2

CPT CODE: $316.2154105-2

CPT CODE: $1,571.0954110-2

CPT CODE: $2,519.6954111-2

CPT CODE: $3,389.2154112-2

CPT CODE: $938.6854115-2

CPT CODE: $1,887.2954120-2

CPT CODE: $3,774.5854125-2

CPT CODE: $5,414.8554130-2

CPT CODE: $6,541.2854135-2

CPT CODE: $148.2054150-2

CPT CODE: $136.3754160-2

CPT CODE: $731.2154161-2

CPT CODE: $475.1654162-2

CPT CODE: $442.7754163-2

CPT CODE: $379.5254164-2

CPT CODE: $124.5054200-2

CPT CODE: $1,571.0954205-2

CPT CODE: $1,314.1754220-2

CPT CODE: $124.5054230-2

CPT CODE: $80.2354231-2

CPT CODE: $81.0454235-2

CPT CODE: $81.0454240-2

CPT CODE: $88.9154250-2

CPT CODE: $1,571.0954300-2

CPT CODE: $2,638.2654304-2

CPT CODE: $1,571.0954308-2

CPT CODE: $1,571.0954312-2

CPT CODE: $2,638.2654316-2

CPT CODE: $2,638.2654318-2

CPT CODE: $3,033.4954322-2

CPT CODE: $3,132.2854324-2

CPT CODE: $3,132.2854326-2

CPT CODE: $4,189.6154328-2

CPT CODE: $3,962.2954332-2

CPT CODE: $3,962.2954336-2

CPT CODE: $1,827.9854340-2

CPT CODE: $3,132.2854344-2

CPT CODE: $3,596.7154348-2

Page 28

Page 29: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $3,962.2954352-2

CPT CODE: $1,620.4954360-2

CPT CODE: $2,638.2654380-2

CPT CODE: $3,329.9454385-2

CPT CODE: $3,329.9454390-2

CPT CODE: $2,756.8254400-2

CPT CODE: $3,310.1654401-2

CPT CODE: $4,258.7554405-2

CPT CODE: $2,229.2854406-2

CPT CODE: $2,436.0154408-2

CPT CODE: $2,786.2054410-2

CPT CODE: $3,065.4554411-2

CPT CODE: $1,086.1054415-2

CPT CODE: $1,447.0954416-2

CPT CODE: $1,592.1254417-2

CPT CODE: $2,331.9654420-2

CPT CODE: $2,331.9654430-2

CPT CODE: $1,571.0954435-2

CPT CODE: $760.1154437-2

CPT CODE: $1,534.2454438-2

CPT CODE: $1,660.0454440-2

CPT CODE: $187.7354450-2

CPT CODE: $102.7654500-2

CPT CODE: $494.0554505-2

CPT CODE: $851.6254512-2

CPT CODE: $997.9854520-2

CPT CODE: $967.0354522-2

CPT CODE: $2,075.0254530-2

CPT CODE: $2,776.6054535-2

CPT CODE: $1,571.0954550-2

CPT CODE: $2,331.9654560-2

CPT CODE: $1,314.1754600-2

CPT CODE: $760.8354620-2

CPT CODE: $1,758.8454640-2

CPT CODE: $1,745.1354650-2

CPT CODE: $760.8354660-2

CPT CODE: $1,571.0954670-2

CPT CODE: $1,887.2954680-2

CPT CODE: $912.2354690-2

CPT CODE: $1,599.6454692-2

CPT CODE: $484.1754700-2

CPT CODE: $124.5054800-2

CPT CODE: $1,017.7554830-2

CPT CODE: $1,333.9454840-2

CPT CODE: $1,225.2454860-2

CPT CODE: $1,887.2954861-2

CPT CODE: $774.4454865-2

CPT CODE: $1,887.2954900-2

CPT CODE: $2,638.2654901-2

CPT CODE: $104.7355000-2

CPT CODE: $1,254.9155040-2

CPT CODE: $1,788.4555041-2

CPT CODE: $1,126.4655060-2

CPT CODE: $316.2155100-2

CPT CODE: $1,561.2355110-2

CPT CODE: $316.2155120-2

CPT CODE: $1,610.6055150-2

CPT CODE: $2,272.6755175-2

CPT CODE: $2,272.6755180-2

CPT CODE: $582.9855200-2

CPT CODE: $573.0855250-2

CPT CODE: $691.6955300-2

CPT CODE: $1,610.6055400-2

CPT CODE: $1,156.0855500-2

CPT CODE: $1,017.7555520-2

CPT CODE: $1,580.9655530-2

CPT CODE: $1,679.7755535-2

CPT CODE: $1,808.2455540-2

CPT CODE: $1,277.7755550-2

CPT CODE: $622.5055600-2

CPT CODE: $1,630.3755605-2

CPT CODE: $3,774.5855650-2

CPT CODE: $3,774.5855680-2

CPT CODE: $464.3855700-2

CPT CODE: $1,571.0955705-2

CPT CODE: $1,571.0955720-2

CPT CODE: $2,638.2655725-2

CPT CODE: $4,011.7355801-2

CPT CODE: $5,355.5755810-2

CPT CODE: $5,355.5755812-2

CPT CODE: $7,114.3655815-2

CPT CODE: $4,011.7355821-2

CPT CODE: $4,011.7355831-2

CPT CODE: $5,355.5755840-2

CPT CODE: $5,355.5755842-2

CPT CODE: $5,938.5455845-2

CPT CODE: $1,827.9855860-2

CPT CODE: $2,519.6955862-2

CPT CODE: $4,219.2155865-2

CPT CODE: $45.4555870-2

CPT CODE: $1,302.3755873-2

CPT CODE: $1,208.8955875-2

CPT CODE: $267.1555876-2

CPT CODE: $662.3155920-2

CPT CODE: $306.0956405-2

CPT CODE: $179.8256420-2

CPT CODE: $780.6056440-2

CPT CODE: $592.8756441-2

CPT CODE: $143.0256442-2

CPT CODE: $213.4256501-2

CPT CODE: $839.9156515-2

CPT CODE: $306.0956605-2

CPT CODE: $59.3156606-2

CPT CODE: $2,351.7256620-2

CPT CODE: $3,013.7456625-2

CPT CODE: $3,438.6456630-2

CPT CODE: $4,687.0556631-2

CPT CODE: $4,694.0656632-2

CPT CODE: $3,424.4456633-2

CPT CODE: $4,687.0556634-2

CPT CODE: $4,687.0556637-2

CPT CODE: $5,908.9056640-2

CPT CODE: $444.6556700-2

CPT CODE: $879.4156740-2

CPT CODE: $444.6556800-2

CPT CODE: $405.1156805-2

CPT CODE: $927.8656810-2

CPT CODE: $196.9856820-2

CPT CODE: $269.1556821-2

CPT CODE: $602.7557000-2

CPT CODE: $592.8757010-2

CPT CODE: $124.5057020-2

CPT CODE: $399.3057022-2

CPT CODE: $399.3057023-2

CPT CODE: $592.8757061-2

CPT CODE: $691.6957065-2

CPT CODE: $128.4457100-2

CPT CODE: $573.0857105-2

CPT CODE: $1,677.7357106-2

CPT CODE: $2,097.9757107-2

CPT CODE: $2,516.5857109-2

CPT CODE: $2,638.2657110-2

CPT CODE: $3,086.3357111-2

CPT CODE: $3,702.6157112-2

CPT CODE: $2,401.0957120-2

CPT CODE: $622.5057130-2

CPT CODE: $474.2757135-2

CPT CODE: $100.8057150-2

CPT CODE: $626.3557155-2

CPT CODE: $232.5857156-2

CPT CODE: $116.6057160-2

CPT CODE: $73.1057170-2

CPT CODE: $187.7357180-2

CPT CODE: $444.6557200-2

CPT CODE: $484.1757210-2

CPT CODE: $1,571.0957220-2

CPT CODE: $1,571.0957230-2

CPT CODE: $1,245.0257240-2

CPT CODE: $1,037.5057250-2

CPT CODE: $1,294.4157260-2

CPT CODE: $1,729.1857265-2

CPT CODE: $2,331.9657268-2

Page 29

Page 30: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $2,045.4057270-2

CPT CODE: $2,331.9657280-2

CPT CODE: $2,351.7257282-2

CPT CODE: $1,928.3357283-2

CPT CODE: $2,582.8557284-2

CPT CODE: $1,372.4957285-2

CPT CODE: $1,327.3357287-2

CPT CODE: $3,013.7457288-2

CPT CODE: $2,173.8457289-2

CPT CODE: $2,519.6957291-2

CPT CODE: $2,519.6957292-2

CPT CODE: $1,177.8057295-2

CPT CODE: $1,787.6957296-2

CPT CODE: $2,885.2757300-2

CPT CODE: $3,468.2757305-2

CPT CODE: $4,100.6557307-2

CPT CODE: $2,753.6457308-2

CPT CODE: $2,519.6957310-2

CPT CODE: $2,499.9257311-2

CPT CODE: $3,468.2757320-2

CPT CODE: $3,468.2757330-2

CPT CODE: $2,341.8357335-2

CPT CODE: $235.1557400-2

CPT CODE: $251.0057410-2

CPT CODE: $246.8057415-2

CPT CODE: $196.9857420-2

CPT CODE: $269.1557421-2

CPT CODE: $1,961.0757423-2

CPT CODE: $1,950.7757425-2

CPT CODE: $1,488.4357426-2

CPT CODE: $211.4557452-2

CPT CODE: $326.0757454-2

CPT CODE: $221.0357455-2

CPT CODE: $210.5157456-2

CPT CODE: $717.4257460-2

CPT CODE: $750.3357461-2

CPT CODE: $169.9657500-2

CPT CODE: $316.2157505-2

CPT CODE: $165.9957510-2

CPT CODE: $211.4557511-2

CPT CODE: $1,017.7557513-2

CPT CODE: $978.2357520-2

CPT CODE: $980.4257522-2

CPT CODE: $889.2857530-2

CPT CODE: $5,304.5357531-2

CPT CODE: $2,519.6957540-2

CPT CODE: $2,826.0257545-2

CPT CODE: $2,331.9657550-2

CPT CODE: $2,776.6057555-2

CPT CODE: $2,776.6057556-2

CPT CODE: $497.8557558-2

CPT CODE: $839.9157700-2

CPT CODE: $1,126.4657720-2

CPT CODE: $185.7757800-2

CPT CODE: $195.6558100-2

CPT CODE: $77.1458110-2

CPT CODE: $652.1958120-2

CPT CODE: $2,539.4358140-2

CPT CODE: $2,450.5158145-2

CPT CODE: $2,090.0858146-2

CPT CODE: $2,608.6258150-2

CPT CODE: $3,478.1658152-2

CPT CODE: $3,043.3758180-2

CPT CODE: $3,073.0258200-2

CPT CODE: $6,541.2858210-2

CPT CODE: $9,130.1358240-2

CPT CODE: $2,796.3458260-2

CPT CODE: $3,127.9058262-2

CPT CODE: $3,309.6458263-2

CPT CODE: $3,685.6558267-2

CPT CODE: $3,201.4658270-2

CPT CODE: $3,191.6058275-2

CPT CODE: $3,438.6458280-2

CPT CODE: $5,602.5758285-2

CPT CODE: $1,515.6958290-2

CPT CODE: $1,666.0558291-2

CPT CODE: $1,831.4558292-2

CPT CODE: $2,668.9958293-2

CPT CODE: $2,323.1458294-2

CPT CODE: $185.7758300-2

CPT CODE: $73.1058301-2

CPT CODE: $181.8158340-2

CPT CODE: $241.0658345-2

CPT CODE: $683.4558346-2

CPT CODE: $128.4458350-2

CPT CODE: $758.0358353-2

CPT CODE: $800.8558356-2

CPT CODE: $2,065.1058400-2

CPT CODE: $2,964.3658410-2

CPT CODE: $2,045.4058520-2

CPT CODE: $2,816.0958540-2

CPT CODE: $1,928.0258541-2

CPT CODE: $2,021.1158542-2

CPT CODE: $1,928.0258543-2

CPT CODE: $2,021.1158544-2

CPT CODE: $1,287.1358545-2

CPT CODE: $1,287.1358546-2

CPT CODE: $4,985.3158548-2

CPT CODE: $1,792.1058550-2

CPT CODE: $1,666.0558552-2

CPT CODE: $1,515.6958553-2

CPT CODE: $1,666.0558554-2

CPT CODE: $582.2858555-2

CPT CODE: $800.6458558-2

CPT CODE: $1,143.5258559-2

CPT CODE: $1,143.5258560-2

CPT CODE: $1,143.5258561-2

CPT CODE: $944.5858562-2

CPT CODE: $1,310.1358563-2

CPT CODE: $1,549.7158570-2

CPT CODE: $1,672.5958571-2

CPT CODE: $1,549.7158572-2

CPT CODE: $1,672.5958573-2

CPT CODE: $823.3558575-2

CPT CODE: $1,314.1758600-2

CPT CODE: $1,225.2458605-2

CPT CODE: $1,175.8658615-2

CPT CODE: $1,180.7458660-2

CPT CODE: $2,023.4158661-2

CPT CODE: $1,384.5258662-2

CPT CODE: $1,400.7058670-2

CPT CODE: $1,334.3858671-2

CPT CODE: $1,439.5058672-2

CPT CODE: $1,400.7058673-2

CPT CODE: $1,482.1558700-2

CPT CODE: $2,213.3458720-2

CPT CODE: $2,509.7958740-2

CPT CODE: $4,920.7958750-2

CPT CODE: $3,942.5458752-2

CPT CODE: $3,942.5458760-2

CPT CODE: $3,942.5458770-2

CPT CODE: $879.4158800-2

CPT CODE: $2,282.5058805-2

CPT CODE: $879.4158820-2

CPT CODE: $2,272.6758822-2

CPT CODE: $3,942.5458825-2

CPT CODE: $2,065.1058900-2

CPT CODE: $2,045.4058920-2

CPT CODE: $1,887.2958925-2

CPT CODE: $1,926.8058940-2

CPT CODE: $3,280.5158943-2

CPT CODE: $2,717.3058950-2

CPT CODE: $4,229.1258951-2

CPT CODE: $3,912.9058952-2

CPT CODE: $4,193.2158953-2

CPT CODE: $4,469.3658954-2

CPT CODE: $3,393.9258956-2

CPT CODE: $2,968.2458957-2

CPT CODE: $3,306.9058958-2

CPT CODE: $4,446.4758960-2

CPT CODE: $162.0359000-3

CPT CODE: $421.1859001-2

Page 30

Page 31: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $162.0359012-3

CPT CODE: $162.0359015-3

CPT CODE: $134.3859020-3

CPT CODE: $102.7659025-3

CPT CODE: $187.7359030-3

CPT CODE: $21.7659050-3

CPT CODE: $25.3859051-3

CPT CODE: $2,638.2659100-3

CPT CODE: $2,588.8759120-3

CPT CODE: $2,806.2259121-3

CPT CODE: $2,588.8759130-3

CPT CODE: $3,082.8959135-3

CPT CODE: $2,954.4259136-3

CPT CODE: $2,648.1459140-3

CPT CODE: $1,511.8159150-3

CPT CODE: $2,539.4359151-3

CPT CODE: $760.8359160-3

CPT CODE: $415.0059200-3

CPT CODE: $1,017.7559300-3

CPT CODE: $839.9159320-3

CPT CODE: $839.9159325-3

CPT CODE: $2,588.8759350-3

CPT CODE: $3,537.4359400-3

CPT CODE: $2,174.4059409-3

CPT CODE: $2,242.9959410-3

CPT CODE: $625.2959425-3

CPT CODE: $942.5759426-3

CPT CODE: $69.1559430-3

CPT CODE: $3,537.4359510-3

CPT CODE: $2,883.6359514-3

CPT CODE: $2,954.4259515-3

CPT CODE: $1,403.1459525-3

CPT CODE: $3,533.9659610-3

CPT CODE: $2,174.4759612-3

CPT CODE: $2,238.1259614-3

CPT CODE: $3,533.9659618-3

CPT CODE: $2,881.6159620-3

CPT CODE: $2,945.2459622-3

CPT CODE: $770.7359812-3

CPT CODE: $978.2359820-3

CPT CODE: $978.2359821-3

CPT CODE: $1,432.7759830-3

CPT CODE: $642.2759840-3

CPT CODE: $731.2159841-3

CPT CODE: $1,531.5559850-3

CPT CODE: $1,660.0459851-3

CPT CODE: $2,638.2659852-3

CPT CODE: $1,225.5359855-3

CPT CODE: $1,325.3959856-3

CPT CODE: $2,115.1959857-2

CPT CODE: $1,115.6459866-3

CPT CODE: $731.2159870-3

CPT CODE: $805.8359871-3

CPT CODE: $622.5060000-2

CPT CODE: $187.7360100-2

CPT CODE: $1,531.5560200-2

CPT CODE: $2,423.8360210-2

CPT CODE: $2,659.8460212-2

CPT CODE: $2,302.3160220-2

CPT CODE: $2,460.3960225-2

CPT CODE: $2,835.8860240-2

CPT CODE: $3,853.6760252-2

CPT CODE: $5,167.8260254-2

CPT CODE: $3,082.8960260-2

CPT CODE: $4,100.6560270-2

CPT CODE: $3,104.6760271-2

CPT CODE: $2,173.8460280-2

CPT CODE: $2,114.5460281-2

CPT CODE: $156.5260300-2

CPT CODE: $3,250.8760500-2

CPT CODE: $3,231.1060502-2

CPT CODE: $4,100.6560505-2

CPT CODE: $653.6060512-2

CPT CODE: $4,100.6560520-2

CPT CODE: $4,103.2460521-2

CPT CODE: $4,103.2460522-2

CPT CODE: $3,962.2960540-2

CPT CODE: $4,584.8660545-2

CPT CODE: $3,468.2760600-2

CPT CODE: $4,901.0460605-2

CPT CODE: $3,623.0660650-2

CPT CODE: $513.8361000-2

CPT CODE: $444.6561001-2

CPT CODE: $306.3061020-2

CPT CODE: $444.6561026-2

CPT CODE: $251.0061050-2

CPT CODE: $345.8461055-2

CPT CODE: $306.3061070-2

CPT CODE: $1,254.9161105-2

CPT CODE: $4,406.9461107-2

CPT CODE: $3,972.2061108-2

CPT CODE: $1,254.9161120-2

CPT CODE: $3,468.2761140-2

CPT CODE: $4,100.6561150-2

CPT CODE: $365.5861151-2

CPT CODE: $4,140.1761154-2

CPT CODE: $4,406.9461156-2

CPT CODE: $4,426.7361210-2

CPT CODE: $2,203.4861215-2

CPT CODE: $2,272.6761250-2

CPT CODE: $2,776.6061253-2

CPT CODE: $5,908.9061304-2

CPT CODE: $6,748.7861305-2

CPT CODE: $5,385.2261312-2

CPT CODE: $5,385.2261313-2

CPT CODE: $4,841.7461314-2

CPT CODE: $4,841.7461315-2

CPT CODE: $721.7661316-2

CPT CODE: $5,148.0361320-2

CPT CODE: $5,148.0361321-2

CPT CODE: $4,569.6161322-2

CPT CODE: $5,656.7561323-2

CPT CODE: $4,406.9461330-2

CPT CODE: $4,406.9461333-2

CPT CODE: $2,717.3061340-2

CPT CODE: $7,677.6261343-2

CPT CODE: $3,468.2761345-2

CPT CODE: $4,841.7461450-2

CPT CODE: $5,908.9061458-2

CPT CODE: $5,908.9061460-2

CPT CODE: $6,294.2661500-2

CPT CODE: $6,294.2661501-2

CPT CODE: $7,341.6661510-2

CPT CODE: $6,926.6661512-2

CPT CODE: $6,047.2461514-2

CPT CODE: $6,047.2461516-2

CPT CODE: $863.0961517-2

CPT CODE: $7,242.8661518-2

CPT CODE: $7,549.1561519-2

CPT CODE: $7,539.2861520-2

CPT CODE: $7,173.6761521-2

CPT CODE: $6,047.2461522-2

CPT CODE: $6,047.2461524-2

CPT CODE: $6,047.2461526-2

CPT CODE: $8,310.0161530-2

CPT CODE: $4,208.8161531-2

CPT CODE: $8,883.1261533-2

CPT CODE: $6,047.2461534-2

CPT CODE: $5,908.9061535-2

CPT CODE: $6,165.8461536-2

CPT CODE: $5,217.7961537-2

CPT CODE: $6,659.8761538-2

CPT CODE: $6,659.8761539-2

CPT CODE: $5,273.8561540-2

CPT CODE: $8,112.3961541-2

CPT CODE: $8,112.3961543-2

CPT CODE: $5,148.0361544-2

CPT CODE: $7,341.6661545-2

CPT CODE: $5,908.9061546-2

CPT CODE: $6,189.6561548-2

CPT CODE: $3,636.2461550-2

CPT CODE: $5,148.0361552-2

Page 31

Page 32: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $3,468.2761556-2

CPT CODE: $3,468.2761557-2

CPT CODE: $4,772.5661558-2

CPT CODE: $4,772.5661559-2

CPT CODE: $5,780.4361563-2

CPT CODE: $8,221.0861564-2

CPT CODE: $5,740.1661566-2

CPT CODE: $6,314.1761567-2

CPT CODE: $5,908.9061570-2

CPT CODE: $5,908.9061571-2

CPT CODE: $2,134.3261575-2

CPT CODE: $2,134.3261576-2

CPT CODE: $2,053.0661580-2

CPT CODE: $3,816.8461581-2

CPT CODE: $3,359.5761582-2

CPT CODE: $3,406.2261583-2

CPT CODE: $2,165.0761584-2

CPT CODE: $2,603.6961585-2

CPT CODE: $2,102.5761586-2

CPT CODE: $2,874.2661590-2

CPT CODE: $2,361.0361591-2

CPT CODE: $1,913.1061592-2

CPT CODE: $2,361.0361595-2

CPT CODE: $2,827.6561596-2

CPT CODE: $3,686.2361597-2

CPT CODE: $3,648.8861598-2

CPT CODE: $3,359.5761600-2

CPT CODE: $3,359.5761601-2

CPT CODE: $3,359.5761605-2

CPT CODE: $3,359.5761606-2

CPT CODE: $4,488.7761607-2

CPT CODE: $4,488.7761608-2

CPT CODE: $2,267.7361611-2

CPT CODE: $4,376.7761613-2

CPT CODE: $3,686.2361615-2

CPT CODE: $4,526.1061616-2

CPT CODE: $2,510.3461618-2

CPT CODE: $1,689.1261619-2

CPT CODE: $2,676.5261623-2

CPT CODE: $3,497.9061624-2

CPT CODE: $1,057.2761626-2

CPT CODE: $868.6561645-2

CPT CODE: $592.1861650-2

CPT CODE: $252.1061651-2

CPT CODE: $7,015.5661680-2

CPT CODE: $8,171.6861682-2

CPT CODE: $7,015.5661684-2

CPT CODE: $8,171.6861686-2

CPT CODE: $7,015.5661690-2

CPT CODE: $8,171.6861692-2

CPT CODE: $7,202.7961697-2

CPT CODE: $7,202.7961698-2

CPT CODE: $7,015.5661700-2

CPT CODE: $8,171.6861702-2

CPT CODE: $6,985.9261703-2

CPT CODE: $6,985.9261705-2

CPT CODE: $6,985.9261708-2

CPT CODE: $6,985.9261710-2

CPT CODE: $6,985.9261711-2

CPT CODE: $6,610.4461720-2

CPT CODE: $6,610.4461735-2

CPT CODE: $6,610.4461750-2

CPT CODE: $6,610.4461751-2

CPT CODE: $6,313.2161760-2

CPT CODE: $6,610.4461770-2

CPT CODE: $319.7761781-2

CPT CODE: $319.7761782-2

CPT CODE: $319.7761783-2

CPT CODE: $2,717.3061790-2

CPT CODE: $4,268.6661791-2

CPT CODE: $1,544.1261796-2

CPT CODE: $421.8161797-2

CPT CODE: $1,544.1261798-2

CPT CODE: $583.2361799-2

CPT CODE: $299.2361800-2

CPT CODE: $4,387.2061850-2

CPT CODE: $4,841.7461860-2

CPT CODE: $2,158.8361863-2

CPT CODE: $647.8061864-2

CPT CODE: $2,877.4561867-2

CPT CODE: $863.2461868-2

CPT CODE: $1,818.1561880-2

CPT CODE: $1,818.1561885-2

CPT CODE: $1,665.9561886-2

CPT CODE: $1,818.1561888-2

CPT CODE: $3,310.1662000-2

CPT CODE: $4,090.7762005-2

CPT CODE: $4,713.2862010-2

CPT CODE: $5,148.0362100-2

CPT CODE: $4,772.5662115-2

CPT CODE: $4,772.5662117-2

CPT CODE: $4,841.7462120-2

CPT CODE: $4,733.0162121-2

CPT CODE: $3,339.8262140-2

CPT CODE: $4,100.6562141-2

CPT CODE: $3,646.1062142-2

CPT CODE: $3,646.1062143-2

CPT CODE: $4,723.1762145-2

CPT CODE: $3,280.5162146-2

CPT CODE: $3,873.4062147-2

CPT CODE: $765.3662148-2

CPT CODE: $936.7862160-2

CPT CODE: $3,738.0862161-2

CPT CODE: $4,112.4962162-2

CPT CODE: $3,363.6862163-2

CPT CODE: $4,859.8162164-2

CPT CODE: $5,025.2262165-2

CPT CODE: $4,970.1962180-2

CPT CODE: $4,100.6562190-2

CPT CODE: $3,774.5862192-2

CPT CODE: $1,077.0362194-2

CPT CODE: $5,464.2262200-2

CPT CODE: $5,464.2262201-2

CPT CODE: $4,406.9462220-2

CPT CODE: $4,090.7762223-2

CPT CODE: $1,077.0362225-2

CPT CODE: $1,768.7262230-2

CPT CODE: $109.1762252-2

CPT CODE: $1,758.8462256-2

CPT CODE: $2,075.0262258-2

CPT CODE: $1,103.0962263-2

CPT CODE: $717.2562264-2

CPT CODE: $333.4962267-2

CPT CODE: $187.7362268-2

CPT CODE: $187.7362269-2

CPT CODE: $181.8162270-2

CPT CODE: $142.2962272-2

CPT CODE: $484.1762273-2

CPT CODE: $375.4662280-2

CPT CODE: $928.8262281-2

CPT CODE: $375.4662282-2

CPT CODE: $417.9562284-2

CPT CODE: $3,814.1062287-2

CPT CODE: $415.0062290-2

CPT CODE: $415.0062291-2

CPT CODE: $3,685.6562292-2

CPT CODE: $879.4162294-2

CPT CODE: $288.0562302-2

CPT CODE: $298.9862303-2

CPT CODE: $283.7862304-2

CPT CODE: $149.6662305-2

CPT CODE: $263.7362320-2

CPT CODE: $292.3562321-2

CPT CODE: $233.2462322-2

CPT CODE: $265.2062323-2

CPT CODE: $212.4662324-2

CPT CODE: $265.4362325-2

CPT CODE: $221.3562326-2

CPT CODE: $237.8362327-2

CPT CODE: $94.0762328-2

CPT CODE: $116.9662329-2

CPT CODE: $2,238.1262350-2

Page 32

Page 33: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $4,430.2862351-2

CPT CODE: $371.2662355-2

CPT CODE: $5,627.0962360-2

CPT CODE: $5,627.0962361-2

CPT CODE: $5,627.0962362-2

CPT CODE: $2,812.6962365-2

CPT CODE: $40.5662367-2

CPT CODE: $40.5662368-2

CPT CODE: $134.3362369-2

CPT CODE: $141.7762370-2

CPT CODE: $5,108.5163001-2

CPT CODE: $5,286.3963003-2

CPT CODE: $4,387.2063005-2

CPT CODE: $4,387.2063011-2

CPT CODE: $5,424.7063012-2

CPT CODE: $6,284.3863015-2

CPT CODE: $6,284.3863016-2

CPT CODE: $5,404.9663017-2

CPT CODE: $4,496.8763020-2

CPT CODE: $3,810.2063030-2

CPT CODE: $1,043.1763035-2

CPT CODE: $5,236.2463040-2

CPT CODE: $5,305.1263042-2

CPT CODE: $895.2963043-2

CPT CODE: $895.2963044-2

CPT CODE: $5,236.2463045-2

CPT CODE: $5,286.3963046-2

CPT CODE: $4,047.1963047-2

CPT CODE: $915.9863048-2

CPT CODE: $5,343.7463050-2

CPT CODE: $5,852.3363051-2

CPT CODE: $5,286.3963055-2

CPT CODE: $4,387.2063056-2

CPT CODE: $1,017.7563057-2

CPT CODE: $5,464.2263064-2

CPT CODE: $1,254.9163066-2

CPT CODE: $4,402.6763075-2

CPT CODE: $1,077.0363076-2

CPT CODE: $4,772.5663077-2

CPT CODE: $1,067.1563078-2

CPT CODE: $6,294.2663081-2

CPT CODE: $1,571.0963082-2

CPT CODE: $6,294.2663085-2

CPT CODE: $1,571.0963086-2

CPT CODE: $6,294.2663087-2

CPT CODE: $1,571.0963088-2

CPT CODE: $6,294.2663090-2

CPT CODE: $1,571.0963091-2

CPT CODE: $5,511.4363101-2

CPT CODE: $5,511.4363102-2

CPT CODE: $1,373.8063103-2

CPT CODE: $5,464.2263170-2

CPT CODE: $5,671.7763172-2

CPT CODE: $5,671.7763173-2

CPT CODE: $6,659.8763180-2

CPT CODE: $7,677.6263182-2

CPT CODE: $4,841.7463185-2

CPT CODE: $5,839.7363190-2

CPT CODE: $5,464.2263191-2

CPT CODE: $5,464.2263194-2

CPT CODE: $5,464.2263195-2

CPT CODE: $5,464.2263196-2

CPT CODE: $5,464.2263197-2

CPT CODE: $6,985.9263198-2

CPT CODE: $6,985.9263199-2

CPT CODE: $6,393.0563200-2

CPT CODE: $6,659.8763250-2

CPT CODE: $6,659.8763251-2

CPT CODE: $6,659.8763252-2

CPT CODE: $5,671.7763265-2

CPT CODE: $5,898.9763266-2

CPT CODE: $5,148.0363267-2

CPT CODE: $5,148.0363268-2

CPT CODE: $5,908.9063270-2

CPT CODE: $5,898.9763271-2

CPT CODE: $5,148.0363272-2

CPT CODE: $5,148.0363273-2

CPT CODE: $5,908.9063275-2

CPT CODE: $5,898.9763276-2

CPT CODE: $5,148.0363277-2

CPT CODE: $5,148.0363278-2

CPT CODE: $5,908.9063280-2

CPT CODE: $5,898.9763281-2

CPT CODE: $5,148.0363282-2

CPT CODE: $5,148.0363283-2

CPT CODE: $5,908.9063285-2

CPT CODE: $5,898.9763286-2

CPT CODE: $5,898.9763287-2

CPT CODE: $5,898.9763290-2

CPT CODE: $1,110.2963295-2

CPT CODE: $6,294.2663300-2

CPT CODE: $6,165.8463301-2

CPT CODE: $6,294.2663302-2

CPT CODE: $6,294.2663303-2

CPT CODE: $6,294.2663304-2

CPT CODE: $6,294.2663305-2

CPT CODE: $6,294.2663306-2

CPT CODE: $6,294.2663307-2

CPT CODE: $1,571.0963308-2

CPT CODE: $2,717.3063600-2

CPT CODE: $1,017.7563610-2

CPT CODE: $1,544.1263620-2

CPT CODE: $485.0163621-2

CPT CODE: $2,717.3063650-2

CPT CODE: $4,100.6563655-2

CPT CODE: $796.3263661-2

CPT CODE: $1,201.5563662-2

CPT CODE: $1,354.6563663-2

CPT CODE: $1,251.7263664-2

CPT CODE: $3,389.2163685-2

CPT CODE: $3,389.2163688-2

CPT CODE: $3,013.7463700-2

CPT CODE: $3,774.5863702-2

CPT CODE: $4,140.1763704-2

CPT CODE: $3,774.5863706-2

CPT CODE: $5,039.3363707-2

CPT CODE: $6,432.5963709-2

CPT CODE: $5,039.3363710-2

CPT CODE: $4,406.9463740-2

CPT CODE: $3,389.2163741-2

CPT CODE: $1,758.8463744-2

CPT CODE: $1,758.8463746-2

CPT CODE: $71.1664400-2

CPT CODE: $102.7664405-2

CPT CODE: $124.5064408-2

CPT CODE: $124.5064415-2

CPT CODE: $213.5264416-2

CPT CODE: $124.5064417-2

CPT CODE: $124.5064418-2

CPT CODE: $177.8464420-2

CPT CODE: $306.3064421-2

CPT CODE: $185.7764425-2

CPT CODE: $251.0064430-2

CPT CODE: $110.6764435-2

CPT CODE: $124.5064445-2

CPT CODE: $213.5264446-2

CPT CODE: $106.7664447-2

CPT CODE: $2,168.2764448-2

CPT CODE: $209.5464449-2

CPT CODE: $179.8264450-2

CPT CODE: $83.5864451-2

CPT CODE: $82.2464455-2

CPT CODE: $98.6364461-2

CPT CODE: $61.9464462-2

CPT CODE: $97.2964463-2

CPT CODE: $302.4764479-2

CPT CODE: $126.1664480-2

CPT CODE: $262.0164483-2

CPT CODE: $105.1464484-2

CPT CODE: $146.6564486-2

CPT CODE: $179.2264487-2

CPT CODE: $180.7864488-2

Page 33

Page 34: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $249.7864489-2

CPT CODE: $337.0564490-2

CPT CODE: $164.6664491-2

CPT CODE: $144.0864492-2

CPT CODE: $313.9064493-2

CPT CODE: $149.2364494-2

CPT CODE: $129.9364495-2

CPT CODE: $187.7364505-2

CPT CODE: $326.0764510-2

CPT CODE: $317.2564517-2

CPT CODE: $365.5864520-2

CPT CODE: $104.7364530-2

CPT CODE: $2,025.6164553-2

CPT CODE: $2,025.6164555-2

CPT CODE: $1,771.0864561-2

CPT CODE: $216.0364566-2

CPT CODE: $1,135.6164568-2

CPT CODE: $1,001.2464569-2

CPT CODE: $866.5864570-2

CPT CODE: $2,509.7964575-2

CPT CODE: $2,509.7964580-2

CPT CODE: $2,190.7064581-2

CPT CODE: $1,254.9164585-2

CPT CODE: $2,509.7964590-2

CPT CODE: $1,254.9164595-2

CPT CODE: $444.6564600-2

CPT CODE: $563.1964605-2

CPT CODE: $691.6964610-2

CPT CODE: $162.3664611-2

CPT CODE: $1,215.3864612-2

CPT CODE: $210.4964615-2

CPT CODE: $189.9864616-2

CPT CODE: $235.9264617-2

CPT CODE: $251.0064620-2

CPT CODE: $365.5864630-2

CPT CODE: $133.1964632-2

CPT CODE: $490.3964633-2

CPT CODE: $223.6464634-2

CPT CODE: $482.0064635-2

CPT CODE: $201.2764636-2

CPT CODE: $365.5864640-2

CPT CODE: $121.5664642-2

CPT CODE: $81.7464643-2

CPT CODE: $132.8964644-2

CPT CODE: $93.5464645-2

CPT CODE: $131.6364646-2

CPT CODE: $152.0764647-2

CPT CODE: $406.3864650-0

CPT CODE: $406.3864653-2

CPT CODE: $513.8364680-2

CPT CODE: $453.0264681-2

CPT CODE: $820.1364702-2

CPT CODE: $1,156.0864704-2

CPT CODE: $1,748.9764708-2

CPT CODE: $2,075.0264712-2

CPT CODE: $2,519.6964713-2

CPT CODE: $1,748.9764714-2

CPT CODE: $1,748.9764716-2

CPT CODE: $1,936.7064718-2

CPT CODE: $1,195.5964719-2

CPT CODE: $1,182.7664721-2

CPT CODE: $1,729.1864722-2

CPT CODE: $820.1364726-2

CPT CODE: $1,195.5964732-2

CPT CODE: $1,195.5964734-2

CPT CODE: $1,195.5964736-2

CPT CODE: $1,758.8464738-2

CPT CODE: $1,758.8464740-2

CPT CODE: $1,758.8464742-2

CPT CODE: $1,383.3364744-2

CPT CODE: $938.6864746-2

CPT CODE: $2,826.0264755-2

CPT CODE: $2,401.0964760-2

CPT CODE: $1,077.0364763-2

CPT CODE: $1,758.8464766-2

CPT CODE: $2,272.6764771-2

CPT CODE: $3,774.5864772-2

CPT CODE: $513.8364774-2

CPT CODE: $1,887.2964776-2

CPT CODE: $251.0064778-2

CPT CODE: $849.7764782-2

CPT CODE: $1,758.8464784-2

CPT CODE: $1,758.8464786-2

CPT CODE: $1,156.0864787-2

CPT CODE: $849.7764788-2

CPT CODE: $1,571.0964790-2

CPT CODE: $1,571.0964792-2

CPT CODE: $375.4664795-2

CPT CODE: $2,519.6964802-2

CPT CODE: $3,468.2764804-2

CPT CODE: $3,468.2764809-2

CPT CODE: $2,420.8764818-2

CPT CODE: $835.1764820-2

CPT CODE: $910.2264821-2

CPT CODE: $91.0464822-2

CPT CODE: $947.2564823-2

CPT CODE: $830.0264831-2

CPT CODE: $249.0164832-2

CPT CODE: $1,156.0864834-2

CPT CODE: $1,521.7164835-2

CPT CODE: $1,748.9764836-2

CPT CODE: $573.0864837-2

CPT CODE: $1,748.9764840-2

CPT CODE: $2,075.0264856-2

CPT CODE: $1,995.9964857-2

CPT CODE: $1,748.9764858-2

CPT CODE: $573.0864859-2

CPT CODE: $2,401.0964861-2

CPT CODE: $2,401.0964862-2

CPT CODE: $4,406.9464864-2

CPT CODE: $4,406.9464865-2

CPT CODE: $4,406.9464866-2

CPT CODE: $4,406.9464868-2

CPT CODE: $2,075.0264885-2

CPT CODE: $2,075.0264886-2

CPT CODE: $2,075.0264890-2

CPT CODE: $2,075.0264891-2

CPT CODE: $3,142.1964892-2

CPT CODE: $3,142.1964893-2

CPT CODE: $4,041.3764895-2

CPT CODE: $4,041.3764896-2

CPT CODE: $6,234.9864897-2

CPT CODE: $6,234.9864898-2

CPT CODE: $1,571.0964901-2

CPT CODE: $2,075.0264902-2

CPT CODE: $1,857.6864905-2

CPT CODE: $1,857.6864907-2

CPT CODE: $982.2264910-2

CPT CODE: $1,238.5764911-2

CPT CODE: $1,857.6865091-2

CPT CODE: $2,401.0965093-2

CPT CODE: $2,213.3465101-2

CPT CODE: $2,440.6465103-2

CPT CODE: $3,142.1965105-2

CPT CODE: $3,843.7465110-2

CPT CODE: $3,843.7465112-2

CPT CODE: $4,723.1765114-2

CPT CODE: $1,936.7065130-2

CPT CODE: $2,331.9665135-2

CPT CODE: $2,312.1765140-2

CPT CODE: $1,936.7065150-2

CPT CODE: $2,312.1765155-2

CPT CODE: $978.2365175-2

CPT CODE: $94.8665205-2

CPT CODE: $88.9165210-2

CPT CODE: $104.7365220-2

CPT CODE: $110.6765222-2

CPT CODE: $3,389.2165235-2

CPT CODE: $2,025.6165260-2

CPT CODE: $3,142.1965265-2

CPT CODE: $185.7765270-2

CPT CODE: $316.2165272-2

Page 34

Page 35: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $316.2165273-2

CPT CODE: $100.8065275-2

CPT CODE: $1,887.2965280-2

CPT CODE: $2,203.4865285-2

CPT CODE: $1,887.2965286-2

CPT CODE: $760.8365290-2

CPT CODE: $1,017.7565400-2

CPT CODE: $187.7365410-2

CPT CODE: $760.8365420-2

CPT CODE: $770.7365426-2

CPT CODE: $124.5065430-2

CPT CODE: $114.6365435-2

CPT CODE: $187.7365436-2

CPT CODE: $306.3065450-2

CPT CODE: $1,571.0965600-2

CPT CODE: $4,980.0865710-2

CPT CODE: $5,661.8865730-2

CPT CODE: $5,108.5165750-2

CPT CODE: $5,602.5765755-2

CPT CODE: $2,092.3165756-2

CPT CODE: $3,685.6565760-2

CPT CODE: $5,908.9065765-2

CPT CODE: $6,234.9865770-2

CPT CODE: $3,046.6865771-2

CPT CODE: $1,511.8165772-2

CPT CODE: $2,075.0265775-2

CPT CODE: $1,635.5065778-2

CPT CODE: $1,542.5665779-2

CPT CODE: $4,152.3965780-2

CPT CODE: $4,983.1765781-2

CPT CODE: $4,567.0465782-2

CPT CODE: $689.9965785-2

CPT CODE: $187.7365800-2

CPT CODE: $1,571.0965810-2

CPT CODE: $1,017.7565815-2

CPT CODE: $2,272.6765820-2

CPT CODE: $1,422.8965850-2

CPT CODE: $1,472.2965855-2

CPT CODE: $2,228.7465860-2

CPT CODE: $2,331.9665865-2

CPT CODE: $1,936.7065870-2

CPT CODE: $1,936.7065875-2

CPT CODE: $1,936.7065880-2

CPT CODE: $1,936.7065900-2

CPT CODE: $1,294.4165920-2

CPT CODE: $2,203.4865930-2

CPT CODE: $820.1366020-2

CPT CODE: $938.6866030-2

CPT CODE: $2,075.0266130-2

CPT CODE: $2,717.3066150-2

CPT CODE: $2,717.3066155-2

CPT CODE: $2,717.3066160-2

CPT CODE: $2,213.3466170-2

CPT CODE: $2,211.7466172-2

CPT CODE: $1,612.3966174-2

CPT CODE: $1,763.1366175-2

CPT CODE: $1,091.8266179-2

CPT CODE: $2,144.2266180-2

CPT CODE: $1,222.1266183-2

CPT CODE: $760.1466184-2

CPT CODE: $2,144.2266185-2

CPT CODE: $4,723.1766225-2

CPT CODE: $1,679.7766250-2

CPT CODE: $1,017.7566500-2

CPT CODE: $1,017.7566505-2

CPT CODE: $2,213.3466600-2

CPT CODE: $4,327.9366605-2

CPT CODE: $1,936.7066625-2

CPT CODE: $1,936.7066630-2

CPT CODE: $1,936.7066635-2

CPT CODE: $2,114.5466680-2

CPT CODE: $1,245.0266682-2

CPT CODE: $2,104.6966700-2

CPT CODE: $2,104.6966710-2

CPT CODE: $2,104.6966720-2

CPT CODE: $2,104.6966740-2

CPT CODE: $1,205.4666761-2

CPT CODE: $1,195.5966762-2

CPT CODE: $1,551.3466770-2

CPT CODE: $1,403.1466820-2

CPT CODE: $997.9866821-2

CPT CODE: $2,467.8966825-2

CPT CODE: $1,640.2566830-2

CPT CODE: $3,073.0266840-2

CPT CODE: $4,130.2966850-2

CPT CODE: $4,772.5666852-2

CPT CODE: $2,816.0966920-2

CPT CODE: $2,648.1466930-2

CPT CODE: $2,618.4766940-2

CPT CODE: $1,712.5666982-2

CPT CODE: $3,675.7666983-2

CPT CODE: $3,675.7666984-2

CPT CODE: $2,262.7866985-2

CPT CODE: $3,675.7666986-2

CPT CODE: $347.3566990-2

CPT CODE: $2,045.4067005-2

CPT CODE: $2,816.0967010-2

CPT CODE: $1,571.0967015-2

CPT CODE: $2,331.9667025-2

CPT CODE: $1,481.5667027-2

CPT CODE: $523.7067028-2

CPT CODE: $2,065.1067030-2

CPT CODE: $2,065.1067031-2

CPT CODE: $4,169.8467036-2

CPT CODE: $4,584.8667039-2

CPT CODE: $4,792.3267040-2

CPT CODE: $2,823.8967041-2

CPT CODE: $3,233.9567042-2

CPT CODE: $3,393.0767043-2

CPT CODE: $4,199.4567101-2

CPT CODE: $4,199.4567105-2

CPT CODE: $3,853.6767107-2

CPT CODE: $4,891.1267108-2

CPT CODE: $2,213.3467110-2

CPT CODE: $3,971.3067113-2

CPT CODE: $1,887.2967115-2

CPT CODE: $2,203.4867120-2

CPT CODE: $2,203.4867121-2

CPT CODE: $1,709.4367141-2

CPT CODE: $1,966.3167145-2

CPT CODE: $2,371.4467208-2

CPT CODE: $1,966.3167210-2

CPT CODE: $2,450.5167218-2

CPT CODE: $2,230.8767220-2

CPT CODE: $722.1767221-2

CPT CODE: $357.9267225-2

CPT CODE: $2,677.7667227-2

CPT CODE: $1,966.3167228-2

CPT CODE: $1,452.6967229-2

CPT CODE: $3,843.7467250-2

CPT CODE: $4,723.1767255-2

CPT CODE: $1,926.8067311-2

CPT CODE: $1,926.8067312-2

CPT CODE: $2,628.3867314-2

CPT CODE: $2,746.9567316-2

CPT CODE: $2,628.3867318-2

CPT CODE: $2,796.3467320-2

CPT CODE: $2,776.6067331-2

CPT CODE: $1,907.0467332-2

CPT CODE: $2,628.3867334-2

CPT CODE: $563.1967335-2

CPT CODE: $3,280.5167340-2

CPT CODE: $2,628.3867343-2

CPT CODE: $1,383.3367345-2

CPT CODE: $665.1567346-2

CPT CODE: $2,539.4367400-2

CPT CODE: $2,075.0267405-2

CPT CODE: $2,727.2067412-2

CPT CODE: $1,887.2967413-2

CPT CODE: $3,843.7467414-2

CPT CODE: $365.5867415-2

CPT CODE: $4,327.9367420-2

Page 35

Page 36: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $4,327.9367430-2

CPT CODE: $3,843.7467440-2

CPT CODE: $3,843.7467445-2

CPT CODE: $4,327.9367450-2

CPT CODE: $126.4967500-2

CPT CODE: $365.5867505-2

CPT CODE: $108.6967515-2

CPT CODE: $2,717.3067550-2

CPT CODE: $1,383.3367560-2

CPT CODE: $5,908.9067570-2

CPT CODE: $104.7367700-2

CPT CODE: $124.5067710-2

CPT CODE: $124.5067715-2

CPT CODE: $169.9667800-2

CPT CODE: $365.5867801-2

CPT CODE: $375.4667805-2

CPT CODE: $642.2767808-2

CPT CODE: $160.0767810-2

CPT CODE: $92.8467820-2

CPT CODE: $187.7367825-2

CPT CODE: $187.7367830-2

CPT CODE: $187.7367835-2

CPT CODE: $258.8967840-2

CPT CODE: $254.9367850-2

CPT CODE: $306.3067875-2

CPT CODE: $1,254.9167880-2

CPT CODE: $1,254.9167882-2

CPT CODE: $2,104.6967900-2

CPT CODE: $1,808.2467901-2

CPT CODE: $2,569.1067902-2

CPT CODE: $3,102.6767903-2

CPT CODE: $2,569.1067904-2

CPT CODE: $3,142.1967906-2

CPT CODE: $2,065.1067908-2

CPT CODE: $2,065.1067909-2

CPT CODE: $2,331.9667911-2

CPT CODE: $1,950.7767912-2

CPT CODE: $316.2167914-2

CPT CODE: $251.0067915-2

CPT CODE: $1,571.0967916-2

CPT CODE: $1,758.8467917-2

CPT CODE: $316.2167921-2

CPT CODE: $251.0067922-2

CPT CODE: $1,274.6767923-2

CPT CODE: $1,660.0467924-2

CPT CODE: $316.2167930-2

CPT CODE: $533.5967935-2

CPT CODE: $102.7667938-2

CPT CODE: $1,254.9167950-2

CPT CODE: $1,966.3167961-2

CPT CODE: $2,322.0567966-2

CPT CODE: $2,322.0567971-2

CPT CODE: $2,885.2767973-2

CPT CODE: $3,468.2767974-2

CPT CODE: $444.6567975-2

CPT CODE: $126.4968020-2

CPT CODE: $51.3868040-2

CPT CODE: $219.3468100-2

CPT CODE: $316.2168110-2

CPT CODE: $444.6568115-2

CPT CODE: $444.6568130-2

CPT CODE: $124.5068135-2

CPT CODE: $100.8068200-2

CPT CODE: $1,660.0468320-2

CPT CODE: $2,203.4868325-2

CPT CODE: $2,826.0268326-2

CPT CODE: $3,596.7168328-2

CPT CODE: $938.6868330-2

CPT CODE: $1,215.3868335-2

CPT CODE: $1,215.3868340-2

CPT CODE: $938.6868360-2

CPT CODE: $1,936.7068362-2

CPT CODE: $1,047.6868371-2

CPT CODE: $187.7368400-2

CPT CODE: $104.7368420-2

CPT CODE: $124.5068440-2

CPT CODE: $2,331.9668500-2

CPT CODE: $2,331.9668505-2

CPT CODE: $365.5868510-2

CPT CODE: $2,331.9668520-2

CPT CODE: $365.5868525-2

CPT CODE: $365.5868530-2

CPT CODE: $2,519.6968540-2

CPT CODE: $3,735.0868550-2

CPT CODE: $622.5068700-2

CPT CODE: $187.7368705-2

CPT CODE: $2,569.1068720-2

CPT CODE: $2,885.2768745-2

CPT CODE: $2,569.1068750-2

CPT CODE: $152.1668760-2

CPT CODE: $118.6168761-2

CPT CODE: $1,017.7568770-2

CPT CODE: $123.6068801-2

CPT CODE: $242.0268810-2

CPT CODE: $545.8068811-2

CPT CODE: $501.1768815-2

CPT CODE: $579.5268816-2

CPT CODE: $124.5068840-2

CPT CODE: $124.5068850-2

CPT CODE: $120.5369000-2

CPT CODE: $185.7769005-2

CPT CODE: $124.5069020-2

CPT CODE: $156.1269100-2

CPT CODE: $187.7369105-2

CPT CODE: $691.6969110-2

CPT CODE: $1,571.0969120-2

CPT CODE: $1,254.9169140-2

CPT CODE: $187.7369145-2

CPT CODE: $2,519.6969150-2

CPT CODE: $2,519.6969155-2

CPT CODE: $108.6969200-2

CPT CODE: $365.5869205-2

CPT CODE: $13.1669209-2

CPT CODE: $45.4569210-2

CPT CODE: $51.3869220-2

CPT CODE: $187.7369222-2

CPT CODE: $1,660.0469300-2

CPT CODE: $6,007.7169310-2

CPT CODE: $6,007.7169320-2

CPT CODE: $355.7569420-2

CPT CODE: $523.7069421-2

CPT CODE: $148.2069424-2

CPT CODE: $251.0069433-2

CPT CODE: $523.7069436-2

CPT CODE: $2,084.8869440-2

CPT CODE: $2,203.4869450-2

CPT CODE: $1,452.5069501-2

CPT CODE: $3,468.2769502-2

CPT CODE: $4,229.1269505-2

CPT CODE: $4,219.2169511-2

CPT CODE: $4,100.6569530-2

CPT CODE: $3,646.1069535-2

CPT CODE: $365.5869540-2

CPT CODE: $6,047.2469550-2

CPT CODE: $6,047.2469552-2

CPT CODE: $6,047.2469554-2

CPT CODE: $3,843.7469601-2

CPT CODE: $2,816.0969602-2

CPT CODE: $4,723.1769603-2

CPT CODE: $2,737.0769604-2

CPT CODE: $4,723.1769605-2

CPT CODE: $243.0869610-2

CPT CODE: $2,588.8769620-2

CPT CODE: $2,964.3669631-2

CPT CODE: $3,211.3469632-2

CPT CODE: $3,073.0269633-2

CPT CODE: $3,379.3369635-2

CPT CODE: $4,347.7069636-2

CPT CODE: $5,849.6369637-2

CPT CODE: $3,656.0169641-2

CPT CODE: $4,229.1269642-2

CPT CODE: $4,229.1269643-2

Page 36

Page 37: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $4,308.1669644-2

CPT CODE: $4,456.3869645-2

CPT CODE: $6,096.6569646-2

CPT CODE: $2,035.5169650-2

CPT CODE: $2,845.7269660-2

CPT CODE: $4,525.5569661-2

CPT CODE: $1,422.8969662-2

CPT CODE: $4,525.5569666-2

CPT CODE: $4,525.5569667-2

CPT CODE: $4,841.7469670-2

CPT CODE: $4,841.7469676-2

CPT CODE: $1,571.0969700-2

CPT CODE: $4,090.7769710-2

CPT CODE: $2,075.0269711-2

CPT CODE: $5,414.8569720-2

CPT CODE: $5,414.8569725-2

CPT CODE: $6,610.4469740-2

CPT CODE: $6,610.4469745-2

CPT CODE: $3,774.5869801-2

CPT CODE: $3,774.5869805-2

CPT CODE: $3,744.9369806-2

CPT CODE: $4,525.5569905-2

CPT CODE: $4,525.5569910-2

CPT CODE: $5,908.9069915-2

CPT CODE: $6,610.4469930-2

CPT CODE: $5,908.9069950-2

CPT CODE: $5,908.9069955-2

CPT CODE: $5,908.9069960-2

CPT CODE: $5,908.9069970-2

CPT CODE: $582.9870010-5

CPT CODE: $229.2670010-P

CPT CODE: $582.9870015-5

CPT CODE: $229.2670015-P

CPT CODE: $160.0770030-5

CPT CODE: $51.3870030-P

CPT CODE: $94.8670100-5

CPT CODE: $43.4770100-P

CPT CODE: $124.5070110-5

CPT CODE: $59.2870110-P

CPT CODE: $94.8670120-5

CPT CODE: $45.4570120-P

CPT CODE: $104.7370130-5

CPT CODE: $65.2070130-P

CPT CODE: $142.2970134-5

CPT CODE: $65.2070134-P

CPT CODE: $71.1670140-5

CPT CODE: $49.3970140-P

CPT CODE: $124.5070150-5

CPT CODE: $63.2170150-P

CPT CODE: $75.1170160-5

CPT CODE: $43.4770160-P

CPT CODE: $162.0370170-5

CPT CODE: $61.2670170-P

CPT CODE: $96.8470190-5

CPT CODE: $55.3270190-P

CPT CODE: $108.6970200-5

CPT CODE: $61.2670200-P

CPT CODE: $66.6970210-5

CPT CODE: $25.9270210-P

CPT CODE: $116.6870220-5

CPT CODE: $48.1470220-P

CPT CODE: $75.1170240-5

CPT CODE: $35.5670240-P

CPT CODE: $98.8170250-5

CPT CODE: $47.4470250-P

CPT CODE: $148.2070260-5

CPT CODE: $67.1770260-P

CPT CODE: $47.4470300-5

CPT CODE: $13.8170300-P

CPT CODE: $65.2070310-5

CPT CODE: $19.7770310-P

CPT CODE: $88.9170320-5

CPT CODE: $37.5470320-P

CPT CODE: $96.8470328-5

CPT CODE: $45.4570328-P

CPT CODE: $118.5970330-5

CPT CODE: $61.2670330-P

CPT CODE: $181.8170332-5

CPT CODE: $98.8170332-P

CPT CODE: $968.3470336-5

CPT CODE: $335.9570336-P

CPT CODE: $154.1570350-5

CPT CODE: $64.1170350-P

CPT CODE: $75.1170355-5

CPT CODE: $57.3170355-P

CPT CODE: $79.0270360-5

CPT CODE: $41.4870360-P

CPT CODE: $134.3870370-5

CPT CODE: $45.4570370-P

CPT CODE: $75.1170380-5

CPT CODE: $39.5370380-P

CPT CODE: $160.0770390-5

CPT CODE: $51.3870390-P

CPT CODE: $436.7470450-5

CPT CODE: $162.9870450-P

CPT CODE: $484.1770460-5

CPT CODE: $181.4970460-P

CPT CODE: $588.8970470-5

CPT CODE: $220.4070470-P

CPT CODE: $399.4370480-5

CPT CODE: $162.9870480-P

CPT CODE: $464.7470481-5

CPT CODE: $188.9170481-P

CPT CODE: $553.7770482-5

CPT CODE: $225.9570482-P

CPT CODE: $390.3570486-5

CPT CODE: $159.2870486-P

CPT CODE: $453.8970487-5

CPT CODE: $185.2070487-P

CPT CODE: $553.7770488-5

CPT CODE: $272.7470488-P

CPT CODE: $399.4370490-5

CPT CODE: $162.9870490-P

CPT CODE: $464.7470491-5

CPT CODE: $188.9170491-P

CPT CODE: $553.7770492-5

CPT CODE: $225.9570492-P

CPT CODE: $581.7870496-5

CPT CODE: $174.6970496-P

CPT CODE: $594.2670498-5

CPT CODE: $177.8170498-P

CPT CODE: $968.3470540-5

CPT CODE: $335.9570540-P

CPT CODE: $751.7970542-5

CPT CODE: $226.1870542-P

CPT CODE: $996.6770543-5

CPT CODE: $299.4770543-P

CPT CODE: $764.2670544-5

CPT CODE: $229.2870544-P

CPT CODE: $834.4570545-5

CPT CODE: $251.1370545-P

CPT CODE: $1,107.4070546-5

CPT CODE: $332.2270546-P

CPT CODE: $726.8370547-5

CPT CODE: $218.3670547-P

CPT CODE: $792.3370548-5

CPT CODE: $237.0870548-P

CPT CODE: $1,052.8270549-5

CPT CODE: $316.6370549-P

CPT CODE: $968.3470551-5

CPT CODE: $335.9570551-P

CPT CODE: $971.3570552-5

CPT CODE: $335.9570552-P

CPT CODE: $1,289.0870553-5

CPT CODE: $335.9570553-P

CPT CODE: $376.4270554-5

CPT CODE: $256.3570554-P

CPT CODE: $388.5770555-5

CPT CODE: $256.3570555-P

CPT CODE: $295.1370557-P

CPT CODE: $308.4070558-P

CPT CODE: $323.1770559-P

Page 37

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $40.4671045-5

CPT CODE: $15.7371045-P

CPT CODE: $57.3271046-5

CPT CODE: $22.4871046-P

CPT CODE: $83.1771047-5

CPT CODE: $24.7371047-P

CPT CODE: $65.7571048-5

CPT CODE: $24.7371048-P

CPT CODE: $106.7271100-5

CPT CODE: $49.3971100-P

CPT CODE: $126.4971101-5

CPT CODE: $67.1771101-P

CPT CODE: $134.3871110-5

CPT CODE: $69.1571110-P

CPT CODE: $207.4871111-5

CPT CODE: $96.8471111-P

CPT CODE: $104.7371120-5

CPT CODE: $45.4571120-P

CPT CODE: $108.6971130-5

CPT CODE: $43.4771130-P

CPT CODE: $453.8971250-5

CPT CODE: $185.2071250-P

CPT CODE: $535.6071260-5

CPT CODE: $218.5371260-P

CPT CODE: $653.6071270-5

CPT CODE: $266.7171270-P

CPT CODE: $701.8871275-5

CPT CODE: $210.5671275-P

CPT CODE: $968.3471550-5

CPT CODE: $335.9571550-P

CPT CODE: $792.3371551-5

CPT CODE: $237.0871551-P

CPT CODE: $1,052.8271552-5

CPT CODE: $316.6371552-P

CPT CODE: $1,240.9071555-5

CPT CODE: $335.9571555-P

CPT CODE: $71.1672020-5

CPT CODE: $39.5372020-P

CPT CODE: $98.8172040-5

CPT CODE: $40.7472040-P

CPT CODE: $152.1672050-5

CPT CODE: $57.3172050-P

CPT CODE: $171.9372052-5

CPT CODE: $67.1772052-P

CPT CODE: $112.6472070-5

CPT CODE: $45.4572070-P

CPT CODE: $124.5072072-5

CPT CODE: $57.3172072-P

CPT CODE: $154.1572074-5

CPT CODE: $65.2072074-P

CPT CODE: $92.8472080-5

CPT CODE: $49.3972080-P

CPT CODE: $41.0772081-5

CPT CODE: $15.0272081-P

CPT CODE: $65.6472082-5

CPT CODE: $18.2072082-P

CPT CODE: $71.3672083-5

CPT CODE: $19.8672083-P

CPT CODE: $84.9172084-5

CPT CODE: $23.1072084-P

CPT CODE: $128.4472100-5

CPT CODE: $55.3272100-P

CPT CODE: $169.9672110-5

CPT CODE: $71.1672110-P

CPT CODE: $235.2172114-5

CPT CODE: $71.1672114-P

CPT CODE: $169.9672120-5

CPT CODE: $47.4472120-P

CPT CODE: $453.8972125-5

CPT CODE: $185.2072125-P

CPT CODE: $535.6072126-5

CPT CODE: $218.5372126-P

CPT CODE: $653.6072127-5

CPT CODE: $306.3072127-P

CPT CODE: $453.8972128-5

CPT CODE: $185.2072128-P

CPT CODE: $535.6072129-5

CPT CODE: $218.5372129-P

CPT CODE: $653.6072130-5

CPT CODE: $266.7172130-P

CPT CODE: $453.8972131-5

CPT CODE: $185.2072131-P

CPT CODE: $535.6072132-5

CPT CODE: $218.5372132-P

CPT CODE: $653.6072133-5

CPT CODE: $266.7172133-P

CPT CODE: $968.3472141-5

CPT CODE: $335.9572141-P

CPT CODE: $980.4272142-5

CPT CODE: $335.9572142-P

CPT CODE: $968.3472146-5

CPT CODE: $335.9572146-P

CPT CODE: $980.4272147-5

CPT CODE: $335.9572147-P

CPT CODE: $968.3472148-5

CPT CODE: $335.9572148-P

CPT CODE: $980.4272149-5

CPT CODE: $335.9572149-P

CPT CODE: $1,289.0872156-5

CPT CODE: $335.9572156-P

CPT CODE: $1,243.4772157-5

CPT CODE: $335.9572157-P

CPT CODE: $1,289.0872158-5

CPT CODE: $335.9572158-P

CPT CODE: $914.5372159-5

CPT CODE: $335.9572159-P

CPT CODE: $94.8672170-5

CPT CODE: $43.4772170-P

CPT CODE: $128.4472190-5

CPT CODE: $49.3972190-P

CPT CODE: $662.8872191-5

CPT CODE: $199.6572191-P

CPT CODE: $453.8972192-5

CPT CODE: $185.2072192-P

CPT CODE: $517.4672193-5

CPT CODE: $210.8072193-P

CPT CODE: $617.3272194-5

CPT CODE: $251.8672194-P

CPT CODE: $687.8472195-5

CPT CODE: $205.8972195-P

CPT CODE: $968.3472196-5

CPT CODE: $335.9572196-P

CPT CODE: $996.6772197-5

CPT CODE: $299.4772197-P

CPT CODE: $914.5372198-5

CPT CODE: $335.9572198-P

CPT CODE: $108.6972200-5

CPT CODE: $35.5672200-P

CPT CODE: $120.5372202-5

CPT CODE: $43.4772202-P

CPT CODE: $100.8072220-5

CPT CODE: $43.4772220-P

CPT CODE: $484.1772240-5

CPT CODE: $171.9372240-P

CPT CODE: $484.1772255-5

CPT CODE: $177.8472255-P

CPT CODE: $484.1772265-5

CPT CODE: $146.2672265-P

CPT CODE: $721.3172270-5

CPT CODE: $233.1972270-P

CPT CODE: $219.9772275-5

CPT CODE: $66.3372275-P

CPT CODE: $484.1772285-5

CPT CODE: $112.6472285-P

CPT CODE: $484.1772295-5

CPT CODE: $130.4272295-P

CPT CODE: $81.0473000-5

CPT CODE: $39.5373000-P

CPT CODE: $98.8173010-5

CPT CODE: $45.4573010-P

CPT CODE: $81.0473020-5

CPT CODE: $39.5373020-P

Page 38

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $100.8073030-5

CPT CODE: $45.4573030-P

CPT CODE: $326.0773040-5

CPT CODE: $102.7673040-P

CPT CODE: $100.8073050-5

CPT CODE: $47.4473050-P

CPT CODE: $98.8173060-5

CPT CODE: $43.4773060-P

CPT CODE: $94.8673070-5

CPT CODE: $39.5373070-P

CPT CODE: $104.7373080-5

CPT CODE: $45.4573080-P

CPT CODE: $345.8473085-5

CPT CODE: $148.2073085-P

CPT CODE: $94.8673090-5

CPT CODE: $39.5373090-P

CPT CODE: $75.1173092-5

CPT CODE: $33.5973092-P

CPT CODE: $81.0473100-5

CPT CODE: $39.5373100-P

CPT CODE: $102.7673110-5

CPT CODE: $45.4573110-P

CPT CODE: $345.8473115-5

CPT CODE: $148.2073115-P

CPT CODE: $75.1173120-5

CPT CODE: $39.5373120-P

CPT CODE: $96.8473130-5

CPT CODE: $45.4573130-P

CPT CODE: $73.1073140-5

CPT CODE: $37.5473140-P

CPT CODE: $333.9873200-5

CPT CODE: $207.4873200-P

CPT CODE: $371.5373201-5

CPT CODE: $296.4373201-P

CPT CODE: $371.5373202-5

CPT CODE: $296.4373202-P

CPT CODE: $366.5473206-5

CPT CODE: $110.7473206-P

CPT CODE: $650.4173218-5

CPT CODE: $194.9773218-P

CPT CODE: $709.6973219-5

CPT CODE: $213.6973219-P

CPT CODE: $968.3473220-5

CPT CODE: $335.9573220-P

CPT CODE: $968.3473221-5

CPT CODE: $335.9573221-P

CPT CODE: $725.2873222-5

CPT CODE: $218.3673222-P

CPT CODE: $963.9073223-5

CPT CODE: $288.5573223-P

CPT CODE: $914.5373225-5

CPT CODE: $335.9573225-P

CPT CODE: $31.5973501-5

CPT CODE: $10.6973501-P

CPT CODE: $43.5773502-5

CPT CODE: $12.7373502-P

CPT CODE: $54.3973503-5

CPT CODE: $16.1673503-P

CPT CODE: $42.1073521-5

CPT CODE: $13.0973521-P

CPT CODE: $51.5473522-5

CPT CODE: $17.0073522-P

CPT CODE: $59.7373523-5

CPT CODE: $18.2073523-P

CPT CODE: $335.9573525-5

CPT CODE: $148.2073525-P

CPT CODE: $29.2973551-5

CPT CODE: $9.4873551-P

CPT CODE: $33.9573552-5

CPT CODE: $10.6973552-P

CPT CODE: $88.9373560-5

CPT CODE: $35.5973560-P

CPT CODE: $99.6173562-5

CPT CODE: $42.7073562-P

CPT CODE: $120.5373564-5

CPT CODE: $49.3973564-P

CPT CODE: $160.0773565-5

CPT CODE: $59.2873565-P

CPT CODE: $345.8473580-5

CPT CODE: $98.8173580-P

CPT CODE: $96.8473590-5

CPT CODE: $39.5373590-P

CPT CODE: $71.1673592-5

CPT CODE: $33.5973592-P

CPT CODE: $88.9173600-5

CPT CODE: $37.5473600-P

CPT CODE: $102.7673610-5

CPT CODE: $45.4573610-P

CPT CODE: $335.9573615-5

CPT CODE: $148.2073615-P

CPT CODE: $75.1173620-5

CPT CODE: $39.5373620-P

CPT CODE: $102.7673630-5

CPT CODE: $40.7473630-P

CPT CODE: $88.9173650-5

CPT CODE: $39.5373650-P

CPT CODE: $71.1673660-5

CPT CODE: $37.5473660-P

CPT CODE: $395.2673700-5

CPT CODE: $148.1573700-P

CPT CODE: $424.8873701-5

CPT CODE: $159.2873701-P

CPT CODE: $424.8873702-5

CPT CODE: $159.2873702-P

CPT CODE: $366.5473706-5

CPT CODE: $110.7473706-P

CPT CODE: $650.4173718-5

CPT CODE: $194.9773718-P

CPT CODE: $709.6973719-5

CPT CODE: $244.8973719-P

CPT CODE: $968.3473720-5

CPT CODE: $335.9573720-P

CPT CODE: $968.3473721-5

CPT CODE: $335.9573721-P

CPT CODE: $725.2873722-5

CPT CODE: $218.3673722-P

CPT CODE: $959.2473723-5

CPT CODE: $288.5573723-P

CPT CODE: $914.5373725-5

CPT CODE: $335.9573725-P

CPT CODE: $49.4574018-5

CPT CODE: $20.2374018-P

CPT CODE: $77.5574019-5

CPT CODE: $29.2274019-P

CPT CODE: $82.0474021-5

CPT CODE: $34.8474021-P

CPT CODE: $146.2674022-5

CPT CODE: $61.1174022-P

CPT CODE: $453.8974150-5

CPT CODE: $185.2074150-P

CPT CODE: $526.5574160-5

CPT CODE: $214.8274160-P

CPT CODE: $635.4574170-5

CPT CODE: $259.3174170-P

CPT CODE: $322.6874174-5

CPT CODE: $171.9874174-P

CPT CODE: $683.1674175-5

CPT CODE: $204.3374175-P

CPT CODE: $141.4274176-5

CPT CODE: $179.7474176-P

CPT CODE: $221.3574177-5

CPT CODE: $188.5474177-P

CPT CODE: $279.7574178-5

CPT CODE: $208.4274178-P

CPT CODE: $968.3474181-5

CPT CODE: $335.9574181-P

CPT CODE: $792.3374182-5

CPT CODE: $237.0874182-P

CPT CODE: $1,052.8274183-5

CPT CODE: $316.6374183-P

CPT CODE: $914.5374185-5

CPT CODE: $335.9574185-P

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $128.8074190-5

CPT CODE: $57.8874190-P

CPT CODE: $179.8274210-5

CPT CODE: $67.1774210-P

CPT CODE: $163.9974220-5

CPT CODE: $71.1674220-P

CPT CODE: $107.8774221-5

CPT CODE: $36.5474221-P

CPT CODE: $71.3374221-TC

CPT CODE: $146.2674230-5

CPT CODE: $102.7674230-P

CPT CODE: $1,551.3474235-5

CPT CODE: $1,551.3474235-P

CPT CODE: $187.7374240-5

CPT CODE: $70.3974240-P

CPT CODE: $256.9274246-5

CPT CODE: $96.3274246-P

CPT CODE: $82.4174248-5

CPT CODE: $36.5474248-P

CPT CODE: $45.8774248-TC

CPT CODE: $175.8674250-5

CPT CODE: $75.1174250-P

CPT CODE: $175.4474251-5

CPT CODE: $74.6474251-P

CPT CODE: $241.2174261-5

CPT CODE: $192.9774261-P

CPT CODE: $270.8074262-5

CPT CODE: $212.2674262-P

CPT CODE: $241.2174263-5

CPT CODE: $192.9774263-P

CPT CODE: $187.7374270-5

CPT CODE: $70.3974270-P

CPT CODE: $237.1574280-5

CPT CODE: $88.8974280-P

CPT CODE: $251.0074283-5

CPT CODE: $104.7374283-P

CPT CODE: $160.0774290-5

CPT CODE: $63.2174290-P

CPT CODE: $239.1374300-5

CPT CODE: $65.2074300-P

CPT CODE: $116.6074301-5

CPT CODE: $37.5474301-P

CPT CODE: $395.2674328-5

CPT CODE: $126.4974328-P

CPT CODE: $424.8874329-5

CPT CODE: $165.9974329-P

CPT CODE: $235.1574330-5

CPT CODE: $126.4974330-P

CPT CODE: $464.3874340-5

CPT CODE: $126.4974340-P

CPT CODE: $335.9574355-5

CPT CODE: $120.5374355-P

CPT CODE: $142.2974360-5

CPT CODE: $98.8174360-P

CPT CODE: $326.0774363-5

CPT CODE: $98.8174363-P

CPT CODE: $254.9374400-5

CPT CODE: $100.8074400-P

CPT CODE: $245.0674410-5

CPT CODE: $102.7674410-P

CPT CODE: $316.2174415-5

CPT CODE: $116.6074415-P

CPT CODE: $163.9974420-5

CPT CODE: $63.2174420-P

CPT CODE: $203.5274425-5

CPT CODE: $81.0474425-P

CPT CODE: $185.7774430-5

CPT CODE: $61.2674430-P

CPT CODE: $203.5274440-5

CPT CODE: $73.1074440-P

CPT CODE: $203.5274445-5

CPT CODE: $104.7374445-P

CPT CODE: $195.6574450-5

CPT CODE: $61.2674450-P

CPT CODE: $203.5274455-5

CPT CODE: $98.8174455-P

CPT CODE: $173.8974470-5

CPT CODE: $73.1074470-P

CPT CODE: $830.0274485-5

CPT CODE: $345.8474485-P

CPT CODE: $156.1274710-5

CPT CODE: $63.2174710-P

CPT CODE: $225.5574712-5

CPT CODE: $170.4374712-P

CPT CODE: $123.3974713-5

CPT CODE: $100.9374713-P

CPT CODE: $245.0674740-5

CPT CODE: $65.2074740-P

CPT CODE: $216.2174742-5

CPT CODE: $170.2974742-P

CPT CODE: $345.8474775-5

CPT CODE: $112.6474775-P

CPT CODE: $293.6475557-5

CPT CODE: $137.1275557-P

CPT CODE: $425.5975559-5

CPT CODE: $173.3475559-P

CPT CODE: $394.5475561-5

CPT CODE: $151.3575561-P

CPT CODE: $487.6775563-5

CPT CODE: $181.1075563-P

CPT CODE: $434.8375565-5

CPT CODE: $110.6475565-P

CPT CODE: $62.3975571-5

CPT CODE: $50.8175571-P

CPT CODE: $358.2875572-5

CPT CODE: $248.2875572-P

CPT CODE: $358.2875573-5

CPT CODE: $312.6175573-P

CPT CODE: $419.3975574-5

CPT CODE: $330.6275574-P

CPT CODE: $681.8175600-5

CPT CODE: $243.0875600-P

CPT CODE: $948.6175605-5

CPT CODE: $272.7475605-P

CPT CODE: $948.6175625-5

CPT CODE: $179.8275625-P

CPT CODE: $899.1675630-5

CPT CODE: $306.3075630-P

CPT CODE: $717.4775635-5

CPT CODE: $215.2475635-P

CPT CODE: $711.4475705-5

CPT CODE: $294.4775705-P

CPT CODE: $484.1775710-5

CPT CODE: $134.3875710-P

CPT CODE: $721.3175716-5

CPT CODE: $185.7775716-P

CPT CODE: $1,077.0375726-5

CPT CODE: $205.5275726-P

CPT CODE: $948.6175731-5

CPT CODE: $249.0175731-P

CPT CODE: $1,077.0375733-5

CPT CODE: $355.7575733-P

CPT CODE: $721.3175736-5

CPT CODE: $229.2675736-P

CPT CODE: $721.3175741-5

CPT CODE: $229.2675741-P

CPT CODE: $839.9175743-5

CPT CODE: $760.8375743-P

CPT CODE: $721.3175746-5

CPT CODE: $229.2675746-P

CPT CODE: $721.3175756-5

CPT CODE: $136.3775756-P

CPT CODE: $444.6575774-5

CPT CODE: $167.9975774-P

CPT CODE: $592.8775801-5

CPT CODE: $136.3775801-P

CPT CODE: $721.3175803-5

CPT CODE: $229.2675803-P

CPT CODE: $592.8775805-5

CPT CODE: $179.8275805-P

CPT CODE: $721.3175807-5

CPT CODE: $249.0175807-P

Page 40

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $256.3575809-5

CPT CODE: $147.3275809-P

CPT CODE: $592.8775810-5

CPT CODE: $136.3775810-P

CPT CODE: $345.8475820-5

CPT CODE: $94.8675820-P

CPT CODE: $484.1775822-5

CPT CODE: $152.1675822-P

CPT CODE: $484.1775825-5

CPT CODE: $128.4475825-P

CPT CODE: $484.1775827-5

CPT CODE: $136.3775827-P

CPT CODE: $523.7075831-5

CPT CODE: $160.0775831-P

CPT CODE: $592.8775833-5

CPT CODE: $316.2175833-P

CPT CODE: $523.7075840-5

CPT CODE: $205.5275840-P

CPT CODE: $592.8775842-5

CPT CODE: $316.2175842-P

CPT CODE: $721.3175860-5

CPT CODE: $294.4775860-P

CPT CODE: $592.8775870-5

CPT CODE: $229.2675870-P

CPT CODE: $1,067.1575872-5

CPT CODE: $464.3875872-P

CPT CODE: $484.1775880-5

CPT CODE: $136.3775880-P

CPT CODE: $1,077.0375885-5

CPT CODE: $335.9575885-P

CPT CODE: $1,077.0375887-5

CPT CODE: $335.9575887-P

CPT CODE: $1,077.0375889-5

CPT CODE: $335.9575889-P

CPT CODE: $1,077.0375891-5

CPT CODE: $335.9575891-P

CPT CODE: $1,818.1575893-5

CPT CODE: $523.7075893-P

CPT CODE: $652.1975894-5

CPT CODE: $272.7475894-P

CPT CODE: $1,037.5075898-5

CPT CODE: $375.4675898-P

CPT CODE: $409.0075901-5

CPT CODE: $115.7775901-P

CPT CODE: $409.0075902-5

CPT CODE: $115.7775902-P

CPT CODE: $355.7575970-5

CPT CODE: $154.1575970-P

CPT CODE: $316.2175984-5

CPT CODE: $229.2675984-P

CPT CODE: $355.7575989-5

CPT CODE: $152.1675989-P

CPT CODE: $96.8476000-5

CPT CODE: $79.0276000-P

CPT CODE: $223.3176010-5

CPT CODE: $112.6476010-P

CPT CODE: $81.0476080-5

CPT CODE: $61.2676080-P

CPT CODE: $69.1576098-5

CPT CODE: $21.7676098-P

CPT CODE: $235.1576100-5

CPT CODE: $106.7276100-P

CPT CODE: $284.5876101-5

CPT CODE: $175.8676101-P

CPT CODE: $375.4676102-5

CPT CODE: $156.1276102-P

CPT CODE: $264.7976120-5

CPT CODE: $98.8176120-P

CPT CODE: $61.2676125-5

CPT CODE: $31.6276125-P

CPT CODE: $108.6976140-5

CPT CODE: $108.6976140-P

CPT CODE: $173.5776376-5

CPT CODE: $15.1676376-P

CPT CODE: $223.1676377-5

CPT CODE: $56.4976377-P

CPT CODE: $160.0776380-5

CPT CODE: $59.2876380-P

CPT CODE: $405.1176506-5

CPT CODE: $264.7976506-P

CPT CODE: $305.1576510-5

CPT CODE: $161.8876510-P

CPT CODE: $326.0776511-5

CPT CODE: $136.3776511-P

CPT CODE: $245.0676512-5

CPT CODE: $101.8576512-P

CPT CODE: $355.7576513-5

CPT CODE: $148.1576513-P

CPT CODE: $242.0076514-5

CPT CODE: $159.3776514-P

CPT CODE: $316.2176516-5

CPT CODE: $146.2676516-P

CPT CODE: $245.0676519-5

CPT CODE: $128.4476519-P

CPT CODE: $326.0776529-5

CPT CODE: $142.2976529-P

CPT CODE: $223.3176536-5

CPT CODE: $104.7376536-P

CPT CODE: $444.6576604-5

CPT CODE: $128.4476604-P

CPT CODE: $120.0876641-5

CPT CODE: $39.8776641-P

CPT CODE: $98.9576642-5

CPT CODE: $37.1076642-P

CPT CODE: $237.1576700-5

CPT CODE: $88.8976700-P

CPT CODE: $177.8476705-5

CPT CODE: $66.6976705-P

CPT CODE: $143.5876706-5

CPT CODE: $47.6776706-P

CPT CODE: $335.9576770-5

CPT CODE: $169.9676770-P

CPT CODE: $282.6076775-5

CPT CODE: $126.4976775-P

CPT CODE: $249.6076776-5

CPT CODE: $111.9976776-P

CPT CODE: $326.0776800-5

CPT CODE: $148.2076800-P

CPT CODE: $112.7876801-5

CPT CODE: $45.1076801-P

CPT CODE: $84.2076802-5

CPT CODE: $34.5976802-P

CPT CODE: $197.6476805-5

CPT CODE: $74.0776805-P

CPT CODE: $203.5276810-5

CPT CODE: $148.2076810-P

CPT CODE: $330.8076811-5

CPT CODE: $174.4376811-P

CPT CODE: $198.4876812-5

CPT CODE: $105.2676812-P

CPT CODE: $101.2076813-5

CPT CODE: $40.4876813-P

CPT CODE: $75.5676814-5

CPT CODE: $31.0376814-P

CPT CODE: $148.2076815-5

CPT CODE: $55.5876815-P

CPT CODE: $106.7276816-5

CPT CODE: $40.7476816-P

CPT CODE: $127.8176817-5

CPT CODE: $51.1376817-P

CPT CODE: $239.1376818-5

CPT CODE: $142.2976818-P

CPT CODE: $116.9876819-5

CPT CODE: $46.8076819-P

CPT CODE: $110.3276820-5

CPT CODE: $34.3876820-P

CPT CODE: $121.7876821-5

CPT CODE: $47.2776821-P

CPT CODE: $395.2676825-5

CPT CODE: $205.5276825-P

CPT CODE: $296.5476826-5

CPT CODE: $80.3776826-P

Page 41

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $267.8376827-5

CPT CODE: $70.7876827-P

CPT CODE: $296.5476828-5

CPT CODE: $80.3776828-P

CPT CODE: $217.4176830-5

CPT CODE: $169.9676830-P

CPT CODE: $246.6576831-5

CPT CODE: $97.9876831-P

CPT CODE: $270.4276856-5

CPT CODE: $106.7276856-P

CPT CODE: $166.6876857-5

CPT CODE: $45.4576857-P

CPT CODE: $335.9576870-5

CPT CODE: $128.4476870-P

CPT CODE: $500.0676872-5

CPT CODE: $169.9676872-P

CPT CODE: $436.7176873-5

CPT CODE: $155.2776873-P

CPT CODE: $194.6476881-5

CPT CODE: $82.1676881-P

CPT CODE: $50.4176882-5

CPT CODE: $33.7476882-P

CPT CODE: $260.1576885-5

CPT CODE: $113.1876885-P

CPT CODE: $260.1676886-5

CPT CODE: $113.1876886-P

CPT CODE: $484.1776932-5

CPT CODE: $258.8976932-P

CPT CODE: $113.6276937-5

CPT CODE: $41.3176937-P

CPT CODE: $265.6176940-5

CPT CODE: $106.2476940-P

CPT CODE: $212.4476941-5

CPT CODE: $118.0276941-P

CPT CODE: $292.4976942-5

CPT CODE: $128.4476942-P

CPT CODE: $435.7576945-5

CPT CODE: $197.9076945-P

CPT CODE: $213.4276946-5

CPT CODE: $116.6076946-P

CPT CODE: $444.6576948-5

CPT CODE: $197.6476948-P

CPT CODE: $344.7376965-5

CPT CODE: $114.9376965-P

CPT CODE: $185.7776970-5

CPT CODE: $63.2176970-P

CPT CODE: $169.8776975-P

CPT CODE: $340.5376977-5

CPT CODE: $111.3076977-P

CPT CODE: $325.1676998-5

CPT CODE: $148.4276998-P

CPT CODE: $98.4977001-5

CPT CODE: $36.4377001-P

CPT CODE: $98.4977002-5

CPT CODE: $36.4377002-P

CPT CODE: $101.2077003-5

CPT CODE: $39.1377003-P

CPT CODE: $484.3777011-5

CPT CODE: $148.4277011-P

CPT CODE: $510.0077012-5

CPT CODE: $152.4677012-P

CPT CODE: $466.8377013-5

CPT CODE: $205.0877013-P

CPT CODE: $145.7277014-5

CPT CODE: $132.2277014-P

CPT CODE: $827.0677021-5

CPT CODE: $223.9777021-P

CPT CODE: $1,033.5077022-5

CPT CODE: $310.3277022-P

CPT CODE: $126.2677046-5

CPT CODE: $77.7277046-P

CPT CODE: $87.4177046-TC

CPT CODE: $129.8777047-5

CPT CODE: $85.9777047-P

CPT CODE: $86.8877047-TC

CPT CODE: $200.1377048-5

CPT CODE: $112.3877048-P

CPT CODE: $143.9477048-TC

CPT CODE: $204.7177049-5

CPT CODE: $122.9777049-P

CPT CODE: $143.2377049-TC

CPT CODE: $152.0677053-5

CPT CODE: $66.1177053-P

CPT CODE: $208.1877054-5

CPT CODE: $66.1177054-P

CPT CODE: $49.7777061-5

CPT CODE: $27.6977061-P

CPT CODE: $61.4477062-5

CPT CODE: $34.6277062-P

CPT CODE: $63.4977063-5

CPT CODE: $33.2777063-P

CPT CODE: $143.5877065-5

CPT CODE: $45.8377065-P

CPT CODE: $173.4577066-5

CPT CODE: $56.1777066-P

CPT CODE: $164.2577067-5

CPT CODE: $45.8377067-P

CPT CODE: $83.6577072-5

CPT CODE: $48.5777072-P

CPT CODE: $83.6577073-5

CPT CODE: $47.2277073-P

CPT CODE: $148.4277074-5

CPT CODE: $85.0077074-P

CPT CODE: $269.8477075-5

CPT CODE: $99.8477075-P

CPT CODE: $85.0077076-5

CPT CODE: $40.4877076-P

CPT CODE: $76.9177077-5

CPT CODE: $44.5277077-P

CPT CODE: $87.7077078-5

CPT CODE: $68.8177078-P

CPT CODE: $174.0477080-5

CPT CODE: $40.4877080-P

CPT CODE: $87.7077081-5

CPT CODE: $26.9977081-P

CPT CODE: $429.0577084-5

CPT CODE: $290.0877084-P

CPT CODE: $103.3577085-5

CPT CODE: $27.7677085-P

CPT CODE: $41.8177086-5

CPT CODE: $9.7277086-P

CPT CODE: $513.8377261-E

CPT CODE: $513.8377261-P

CPT CODE: $652.1977262-E

CPT CODE: $652.1977262-P

CPT CODE: $780.6077263-E

CPT CODE: $780.6077263-P

CPT CODE: $642.2777280-E

CPT CODE: $195.6577280-P

CPT CODE: $770.7377285-E

CPT CODE: $225.2777285-P

CPT CODE: $810.2677290-E

CPT CODE: $280.6377290-P

CPT CODE: $455.3577293-5

CPT CODE: $114.4977293-P

CPT CODE: $802.5477295-E

CPT CODE: $280.0077295-P

CPT CODE: $294.4777300-E

CPT CODE: $187.7377300-P

CPT CODE: $2,476.1277301-E

CPT CODE: $265.3677301-P

CPT CODE: $169.5577306-5

CPT CODE: $86.4277306-P

CPT CODE: $356.5277307-5

CPT CODE: $191.2177307-P

CPT CODE: $206.4577316-5

CPT CODE: $77.7577316-P

CPT CODE: $270.2377317-5

CPT CODE: $102.1777317-P

CPT CODE: $390.9777318-5

CPT CODE: $161.2477318-P

CPT CODE: $642.2777321-E

Page 42

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $258.8977321-P

CPT CODE: $464.3877331-E

CPT CODE: $199.5977331-P

CPT CODE: $474.2777332-E

CPT CODE: $187.7377332-P

CPT CODE: $533.5977333-E

CPT CODE: $254.9377333-P

CPT CODE: $711.4477334-E

CPT CODE: $326.0777334-P

CPT CODE: $464.3877336-E

CPT CODE: $326.0777336-P

CPT CODE: $774.4577338-E

CPT CODE: $365.3577338-P

CPT CODE: $444.6577370-E

CPT CODE: $268.7777370-P

CPT CODE: $1,380.2377371-E

CPT CODE: $1,048.3377372-E

CPT CODE: $219.3477401-E

CPT CODE: $219.3477402-E

CPT CODE: $296.4377407-E

CPT CODE: $355.7577412-E

CPT CODE: $73.1077417-E

CPT CODE: $41.4877417-P

CPT CODE: $234.1977423-E

CPT CODE: $97.0577427-E

CPT CODE: $97.0577427-P

CPT CODE: $142.6177430-E

CPT CODE: $92.6177431-E

CPT CODE: $92.6177431-P

CPT CODE: $5,748.6377432-E

CPT CODE: $5,748.6377432-P

CPT CODE: $331.3077469-E

CPT CODE: $731.2177470-E

CPT CODE: $294.4777470-P

CPT CODE: $200.5677520-E

CPT CODE: $227.7277522-E

CPT CODE: $273.3677523-E

CPT CODE: $297.9277525-E

CPT CODE: $375.4677600-P

CPT CODE: $978.2377750-E

CPT CODE: $1,017.7577750-P

CPT CODE: $1,837.8977761-E

CPT CODE: $1,225.2477761-P

CPT CODE: $2,144.2277762-E

CPT CODE: $1,452.5077762-P

CPT CODE: $2,351.7277763-E

CPT CODE: $1,620.4977763-P

CPT CODE: $237.7877767-E

CPT CODE: $61.1877767-P

CPT CODE: $371.4377768-E

CPT CODE: $81.1577768-P

CPT CODE: $341.4977770-E

CPT CODE: $113.0377770-P

CPT CODE: $636.9077771-E

CPT CODE: $220.7877771-P

CPT CODE: $969.7277772-E

CPT CODE: $313.0977772-P

CPT CODE: $3,063.1677778-E

CPT CODE: $2,084.8877778-P

CPT CODE: $88.9177789-E

CPT CODE: $88.9177789-P

CPT CODE: $434.7677790-E

CPT CODE: $345.8477790-P

CPT CODE: $87.0878012-5

CPT CODE: $15.4578012-P

CPT CODE: $219.6478013-5

CPT CODE: $30.0178013-P

CPT CODE: $254.5478014-5

CPT CODE: $40.0078014-P

CPT CODE: $375.4678015-5

CPT CODE: $142.2978015-P

CPT CODE: $424.8878016-5

CPT CODE: $152.1678016-P

CPT CODE: $503.9578018-5

CPT CODE: $203.5278018-P

CPT CODE: $94.6978020-5

CPT CODE: $58.1578020-P

CPT CODE: $484.1778070-5

CPT CODE: $156.1278070-P

CPT CODE: $381.3778071-5

CPT CODE: $95.2678071-P

CPT CODE: $97.0378072-P

CPT CODE: $513.8378075-5

CPT CODE: $203.5278075-P

CPT CODE: $582.9878102-5

CPT CODE: $225.2778102-P

CPT CODE: $622.5078103-5

CPT CODE: $171.9378103-P

CPT CODE: $721.3178104-5

CPT CODE: $163.9978104-P

CPT CODE: $116.6078110-5

CPT CODE: $55.3278110-P

CPT CODE: $280.6378111-5

CPT CODE: $73.1078111-P

CPT CODE: $239.1378120-5

CPT CODE: $108.6978120-P

CPT CODE: $345.8478121-5

CPT CODE: $156.1278121-P

CPT CODE: $294.4778122-5

CPT CODE: $112.6478122-P

CPT CODE: $484.1778130-5

CPT CODE: $146.2678130-P

CPT CODE: $484.1778135-5

CPT CODE: $171.9378135-P

CPT CODE: $484.1778140-5

CPT CODE: $156.1278140-P

CPT CODE: $592.8778185-5

CPT CODE: $124.5078185-P

CPT CODE: $523.7078191-5

CPT CODE: $152.1678191-P

CPT CODE: $523.7078195-5

CPT CODE: $116.6078195-P

CPT CODE: $484.1778201-5

CPT CODE: $130.4278201-P

CPT CODE: $760.8378202-5

CPT CODE: $112.6478202-P

CPT CODE: $563.1978215-5

CPT CODE: $160.0778215-P

CPT CODE: $1,254.9178216-5

CPT CODE: $148.2078216-P

CPT CODE: $350.6378226-5

CPT CODE: $59.3278226-P

CPT CODE: $476.9078227-5

CPT CODE: $71.6878227-P

CPT CODE: $278.6178230-5

CPT CODE: $110.6778230-P

CPT CODE: $345.8478231-5

CPT CODE: $110.6778231-P

CPT CODE: $395.2678232-5

CPT CODE: $156.1278232-P

CPT CODE: $199.5978258-5

CPT CODE: $81.0478258-P

CPT CODE: $523.7078261-5

CPT CODE: $223.3178261-P

CPT CODE: $365.5878262-5

CPT CODE: $100.8078262-P

CPT CODE: $395.2678264-5

CPT CODE: $167.9978264-P

CPT CODE: $395.3678265-E

CPT CODE: $54.5878265-P

CPT CODE: $511.1078266-E

CPT CODE: $60.4778266-P

CPT CODE: $258.7978267-5

CPT CODE: $77.6578267-P

CPT CODE: $37.2278268-5

CPT CODE: $11.1678268-P

CPT CODE: $523.7078278-5

CPT CODE: $177.8478278-P

CPT CODE: $316.2178282-5

CPT CODE: $84.9678282-P

CPT CODE: $582.9878290-5

CPT CODE: $116.6078290-P

Page 43

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $592.8778291-5

CPT CODE: $156.1278291-P

CPT CODE: $582.9878300-5

CPT CODE: $162.0378300-P

CPT CODE: $711.4478305-5

CPT CODE: $221.3378305-P

CPT CODE: $691.6978306-5

CPT CODE: $165.9978306-P

CPT CODE: $375.4678315-5

CPT CODE: $144.2778315-P

CPT CODE: $365.5878350-5

CPT CODE: $116.6078350-P

CPT CODE: $365.5878351-5

CPT CODE: $116.6078351-P

CPT CODE: $523.7078414-5

CPT CODE: $207.4878414-P

CPT CODE: $484.1778428-5

CPT CODE: $254.9378428-P

CPT CODE: $931.5078429-5

CPT CODE: $136.4978429-P

CPT CODE: $863.2678429-TC

CPT CODE: $520.2178430-5

CPT CODE: $108.6478430-P

CPT CODE: $465.8978430-TC

CPT CODE: $841.7478431-5

CPT CODE: $135.2778431-P

CPT CODE: $774.1178431-TC

CPT CODE: $1,060.1878432-5

CPT CODE: $140.4178432-P

CPT CODE: $989.9778432-TC

CPT CODE: $1,147.8078433-5

CPT CODE: $174.0178433-P

CPT CODE: $1,060.7978433-TC

CPT CODE: $53.7578434-5

CPT CODE: $32.5578434-P

CPT CODE: $37.4778434-TC

CPT CODE: $355.7578445-5

CPT CODE: $175.8678445-P

CPT CODE: $755.1578451-5

CPT CODE: $194.2678451-P

CPT CODE: $1,125.6678452-5

CPT CODE: $442.5478452-P

CPT CODE: $522.3078453-5

CPT CODE: $141.5178453-P

CPT CODE: $508.1578454-5

CPT CODE: $187.8278454-P

CPT CODE: $431.8678456-5

CPT CODE: $163.3778456-P

CPT CODE: $474.2778457-5

CPT CODE: $177.8478457-P

CPT CODE: $494.0578458-5

CPT CODE: $177.8478458-P

CPT CODE: $652.1978466-5

CPT CODE: $187.7378466-P

CPT CODE: $652.1978468-5

CPT CODE: $187.7378468-P

CPT CODE: $652.1978469-5

CPT CODE: $187.7378469-P

CPT CODE: $573.0878472-5

CPT CODE: $193.6678472-P

CPT CODE: $909.0478473-5

CPT CODE: $365.5878473-P

CPT CODE: $928.8278481-5

CPT CODE: $243.0878481-P

CPT CODE: $1,363.6078483-5

CPT CODE: $395.2678483-P

CPT CODE: $544.8478494-5

CPT CODE: $182.7178494-P

CPT CODE: $468.4478496-5

CPT CODE: $182.7178496-P

CPT CODE: $205.2378579-5

CPT CODE: $28.6678579-P

CPT CODE: $513.8378580-5

CPT CODE: $142.2978580-P

CPT CODE: $379.0378582-5

CPT CODE: $62.2878582-P

CPT CODE: $232.4278597-5

CPT CODE: $43.1278597-P

CPT CODE: $355.7678598-5

CPT CODE: $48.9478598-P

CPT CODE: $563.1978600-5

CPT CODE: $165.9978600-P

CPT CODE: $721.3178601-5

CPT CODE: $205.5278601-P

CPT CODE: $780.6078605-5

CPT CODE: $160.0778605-P

CPT CODE: $909.0478606-5

CPT CODE: $171.9378606-P

CPT CODE: $395.2678610-5

CPT CODE: $73.1078610-P

CPT CODE: $721.3178630-5

CPT CODE: $112.6478630-P

CPT CODE: $355.7578635-5

CPT CODE: $171.9378635-P

CPT CODE: $405.1178645-5

CPT CODE: $156.1278645-P

CPT CODE: $484.1778650-5

CPT CODE: $171.9378650-P

CPT CODE: $278.6178660-5

CPT CODE: $405.1178700-5

CPT CODE: $116.6078700-P

CPT CODE: $642.2778701-5

CPT CODE: $148.2078701-P

CPT CODE: $770.7378707-5

CPT CODE: $175.8678707-P

CPT CODE: $451.0578708-5

CPT CODE: $201.0278708-P

CPT CODE: $758.5178709-5

CPT CODE: $174.0078709-P

CPT CODE: $316.2178725-5

CPT CODE: $160.0778725-P

CPT CODE: $102.7678730-5

CPT CODE: $33.5978730-P

CPT CODE: $294.4778740-5

CPT CODE: $96.8478740-P

CPT CODE: $909.0478761-5

CPT CODE: $223.3178761-P

CPT CODE: $395.2678800-5

CPT CODE: $185.7778800-P

CPT CODE: $592.8778801-5

CPT CODE: $185.7778801-P

CPT CODE: $810.2678802-5

CPT CODE: $185.7778802-P

CPT CODE: $405.1178803-5

CPT CODE: $116.6078803-P

CPT CODE: $996.0478804-E

CPT CODE: $98.8678804-P

CPT CODE: $75.4278808-5

CPT CODE: $75.4278808-P

CPT CODE: $1,687.6478811-5

CPT CODE: $336.6778811-P

CPT CODE: $1,687.6478812-5

CPT CODE: $336.6778812-P

CPT CODE: $1,687.6478813-5

CPT CODE: $336.6778813-P

CPT CODE: $1,901.1178814-5

CPT CODE: $348.1378814-P

CPT CODE: $1,901.1178815-5

CPT CODE: $348.1378815-P

CPT CODE: $1,901.1178816-5

CPT CODE: $348.1378816-P

CPT CODE: $490.0578830-5

CPT CODE: $75.4978830-P

CPT CODE: $414.5678830-TC

CPT CODE: $707.4578831-5

CPT CODE: $92.1078831-P

CPT CODE: $615.3578831-TC

CPT CODE: $919.9278832-5

CPT CODE: $107.2978832-P

CPT CODE: $812.6478832-TC

CPT CODE: $103.2978835-5

CPT CODE: $23.6878835-P

Page 44

Page 45: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $79.6078835-TC

CPT CODE: $660.4579005-E

CPT CODE: $448.4179005-P

CPT CODE: $448.4179101-E

CPT CODE: $179.0879101-P

CPT CODE: $996.0479403-E

CPT CODE: $236.1179403-P

CPT CODE: $441.2579445-E

CPT CODE: $266.4779445-P

CPT CODE: $34.0280047-8

CPT CODE: $12.0280047-P

CPT CODE: $11.6580048-8

CPT CODE: $4.1280048-P

CPT CODE: $41.6880050-8

CPT CODE: $12.6680051-8

CPT CODE: $15.5380053-8

CPT CODE: $5.4780053-P

CPT CODE: $51.9080055-8

CPT CODE: $22.2380061-8

CPT CODE: $12.4780069-8

CPT CODE: $4.3780069-P

CPT CODE: $46.9180074-8

CPT CODE: $14.0780074-P

CPT CODE: $11.3280076-8

CPT CODE: $4.3780076-P

CPT CODE: $88.8280081-8

CPT CODE: $36.0780150-8

CPT CODE: $17.7080155-8

CPT CODE: $51.6780156-8

CPT CODE: $19.6580157-8

CPT CODE: $6.9480157-P

CPT CODE: $57.4180158-8

CPT CODE: $13.5680159-8

CPT CODE: $47.8480162-8

CPT CODE: $15.7380163-8

CPT CODE: $47.8480164-8

CPT CODE: $16.0680165-8

CPT CODE: $51.6780168-8

CPT CODE: $18.0580169-8

CPT CODE: $34.4480170-8

CPT CODE: $14.8680171-8

CPT CODE: $35.8880173-8

CPT CODE: $12.6380173-P

CPT CODE: $14.8680175-8

CPT CODE: $28.7180176-8

CPT CODE: $14.8680177-8

CPT CODE: $16.0880178-8

CPT CODE: $30.0880180-8

CPT CODE: $14.8680183-8

CPT CODE: $31.5780184-8

CPT CODE: $37.7880185-8

CPT CODE: $47.8480186-8

CPT CODE: $31.5780188-8

CPT CODE: $40.2780190-8

CPT CODE: $57.4180192-8

CPT CODE: $29.5080194-8

CPT CODE: $21.0880195-8

CPT CODE: $7.4580195-P

CPT CODE: $30.8980197-8

CPT CODE: $33.8880198-8

CPT CODE: $29.0280199-8

CPT CODE: $53.3580200-8

CPT CODE: $47.8480202-8

CPT CODE: $14.8680203-8

CPT CODE: $68.1180299-8

CPT CODE: $12.8180305-8

CPT CODE: $17.0780306-8

CPT CODE: $68.2880307-8

CPT CODE: $91.4880400-8

CPT CODE: $244.5180402-8

CPT CODE: $244.5180406-8

CPT CODE: $438.6180408-8

CPT CODE: $401.2980410-8

CPT CODE: $1,129.2180412-8

CPT CODE: $192.2580414-8

CPT CODE: $184.7780415-8

CPT CODE: $403.0680416-8

CPT CODE: $134.3680417-8

CPT CODE: $2,221.0780418-8

CPT CODE: $216.4980420-8

CPT CODE: $188.5180422-8

CPT CODE: $201.5780424-8

CPT CODE: $615.9280426-8

CPT CODE: $298.6280428-8

CPT CODE: $345.2980430-8

CPT CODE: $270.6680432-8

CPT CODE: $307.9680434-8

CPT CODE: $447.9580435-8

CPT CODE: $266.9080436-8

CPT CODE: $145.5980438-8

CPT CODE: $194.0980439-8

CPT CODE: $61.0880500-8

CPT CODE: $61.2680500-P

CPT CODE: $103.7080502-8

CPT CODE: $98.8180502-P

CPT CODE: $12.7481000-8

CPT CODE: $11.4081001-8

CPT CODE: $10.3981002-8

CPT CODE: $10.0581003-8

CPT CODE: $13.8181005-8

CPT CODE: $9.8881007-8

CPT CODE: $10.5081015-8

CPT CODE: $19.9881020-8

CPT CODE: $18.1881025-8

CPT CODE: $9.5481050-8

CPT CODE: $141.3481105-8

CPT CODE: $141.3481106-8

CPT CODE: $141.3481107-8

CPT CODE: $141.3481108-8

CPT CODE: $141.3481109-8

CPT CODE: $141.3481110-8

CPT CODE: $141.3481111-8

CPT CODE: $141.3481112-8

CPT CODE: $167.3881120-8

CPT CODE: $251.0981121-8

CPT CODE: $2,165.0981162-8

CPT CODE: $1,322.4281163-8

CPT CODE: $786.3181164-8

CPT CODE: $464.6481165-8

CPT CODE: $321.6781166-8

CPT CODE: $464.6481167-8

CPT CODE: $106.1781170-8

CPT CODE: $100.0881171-8

CPT CODE: $218.0281172-8

CPT CODE: $321.6781173-8

CPT CODE: $167.9981174-8

CPT CODE: $279.7181176-8

CPT CODE: $100.0881177-8

CPT CODE: $100.0881178-8

CPT CODE: $100.0881179-8

CPT CODE: $100.0881180-8

CPT CODE: $100.0881181-8

CPT CODE: $100.0881182-8

CPT CODE: $100.0881183-8

CPT CODE: $100.0881184-8

CPT CODE: $251.1481185-8

CPT CODE: $167.9981186-8

CPT CODE: $100.0881187-8

CPT CODE: $100.0881188-8

CPT CODE: $218.0281189-8

CPT CODE: $167.9581190-8

CPT CODE: $106.1781219-8

CPT CODE: $148.3881230-8

CPT CODE: $148.3881231-8

CPT CODE: $148.3881232-8

CPT CODE: $127.8181233-8

CPT CODE: $100.0881234-8

CPT CODE: $464.6481236-8

CPT CODE: $127.8181237-8

CPT CODE: $218.0281239-8

CPT CODE: $148.3881247-8

CPT CODE: $79.0381248-8

Page 45

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $79.0381258-8

CPT CODE: $100.0881271-8

CPT CODE: $218.0281274-8

CPT CODE: $171.7481276-8

CPT CODE: $2,220.6081277-8

CPT CODE: $70.6681283-8

CPT CODE: $100.0881284-8

CPT CODE: $218.0281285-8

CPT CODE: $218.0281286-8

CPT CODE: $167.9981289-8

CPT CODE: $127.8181305-8

CPT CODE: $208.0781306-8

CPT CODE: $497.8681307-8

CPT CODE: $344.6881308-8

CPT CODE: $233.6281309-8

CPT CODE: $100.0881312-8

CPT CODE: $208.0781320-8

CPT CODE: $71.5881327-8

CPT CODE: $148.3881328-8

CPT CODE: $100.0881329-8

CPT CODE: $100.0881333-8

CPT CODE: $279.7181334-8

CPT CODE: $148.3881335-8

CPT CODE: $321.6781336-8

CPT CODE: $167.9581337-8

CPT CODE: $100.0881343-8

CPT CODE: $100.0881344-8

CPT CODE: $167.9981345-8

CPT CODE: $148.3881346-8

CPT CODE: $148.3881361-8

CPT CODE: $79.0381362-8

CPT CODE: $686.3881413-8

CPT CODE: $686.3881414-8

CPT CODE: $686.3881422-8

CPT CODE: $686.3881439-8

CPT CODE: $427.4081443-8

CPT CODE: $676.3281448-8

CPT CODE: $103.9381479-8

CPT CODE: $4,249.3481518-8

CPT CODE: $4,378.0381519-8

CPT CODE: $2,902.5581520-8

CPT CODE: $2,902.5581521-8

CPT CODE: $4,553.2181522-8

CPT CODE: $334.5181528-8

CPT CODE: $515.0981539-8

CPT CODE: $2,902.5581541-8

CPT CODE: $4,553.2181542-8

CPT CODE: $431.9481551-8

CPT CODE: $4,553.2181552-8

CPT CODE: $57.6381596-8

CPT CODE: $9.8882009-8

CPT CODE: $33.5982010-8

CPT CODE: $65.0982013-8

CPT CODE: $36.1282016-8

CPT CODE: $54.7482017-8

CPT CODE: $146.2682024-8

CPT CODE: $96.8482030-8

CPT CODE: $12.2282040-8

CPT CODE: $8.9182042-8

CPT CODE: $17.2382043-8

CPT CODE: $8.6282044-8

CPT CODE: $81.6782045-8

CPT CODE: $28.8082045-P

CPT CODE: $61.2682075-8

CPT CODE: $24.5282085-8

CPT CODE: $146.6982088-8

CPT CODE: $51.6782103-8

CPT CODE: $51.6782104-8

CPT CODE: $51.3582105-8

CPT CODE: $51.3582106-8

CPT CODE: $109.0282107-8

CPT CODE: $38.4582107-P

CPT CODE: $62.1482108-8

CPT CODE: $27.5182120-8

CPT CODE: $9.7082120-P

CPT CODE: $30.9882127-8

CPT CODE: $36.8682128-8

CPT CODE: $196.3082131-8

CPT CODE: $49.6182135-8

CPT CODE: $170.4482136-8

CPT CODE: $170.4482139-8

CPT CODE: $35.5682140-8

CPT CODE: $35.5682143-8

CPT CODE: $17.1982150-8

CPT CODE: $104.5482154-8

CPT CODE: $108.6982157-8

CPT CODE: $84.9682160-8

CPT CODE: $73.1082163-8

CPT CODE: $41.6182164-8

CPT CODE: $49.8082172-8

CPT CODE: $68.8882175-8

CPT CODE: $35.5682180-8

CPT CODE: $28.7182190-8

CPT CODE: $55.5882232-8

CPT CODE: $57.4182239-8

CPT CODE: $71.1682240-8

CPT CODE: $11.1182247-8

CPT CODE: $11.1182248-8

CPT CODE: $13.8182252-8

CPT CODE: $48.1782261-8

CPT CODE: $9.6982270-8

CPT CODE: $7.7182271-8

CPT CODE: $2.7282271-P

CPT CODE: $5.7982272-8

CPT CODE: $2.0382272-P

CPT CODE: $6.4982274-8

CPT CODE: $2.2782274-P

CPT CODE: $73.1082286-8

CPT CODE: $73.9982300-8

CPT CODE: $112.0482306-8

CPT CODE: $102.7682308-8

CPT CODE: $15.1082310-8

CPT CODE: $44.8682330-8

CPT CODE: $25.6882331-8

CPT CODE: $12.4382340-8

CPT CODE: $24.5282355-8

CPT CODE: $26.6982360-8

CPT CODE: $29.6482365-8

CPT CODE: $25.6182370-8

CPT CODE: $9.8382373-8

CPT CODE: $3.4782373-P

CPT CODE: $13.8182374-8

CPT CODE: $27.1782375-8

CPT CODE: $13.8182376-8

CPT CODE: $56.1582378-8

CPT CODE: $54.7482379-8

CPT CODE: $35.1482380-8

CPT CODE: $51.1782382-8

CPT CODE: $90.9182383-8

CPT CODE: $103.3782384-8

CPT CODE: $76.5482387-8

CPT CODE: $24.5282390-8

CPT CODE: $19.0682397-8

CPT CODE: $55.1482415-8

CPT CODE: $8.7982435-8

CPT CODE: $8.7982436-8

CPT CODE: $9.5482438-8

CPT CODE: $19.5582441-8

CPT CODE: $11.8782465-8

CPT CODE: $25.6182480-8

CPT CODE: $37.5482482-8

CPT CODE: $39.9282485-8

CPT CODE: $46.9482495-8

CPT CODE: $77.3982507-8

CPT CODE: $12.0382523-8

CPT CODE: $37.5482525-8

CPT CODE: $86.9682528-8

CPT CODE: $51.6782530-8

CPT CODE: $45.0282533-8

CPT CODE: $18.5382540-8

CPT CODE: $48.0282542-8

CPT CODE: $17.7082550-8

Page 46

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $52.0682552-8

CPT CODE: $50.4382553-8

CPT CODE: $50.4382554-8

CPT CODE: $12.3682565-8

CPT CODE: $9.9882570-8

CPT CODE: $24.8982575-8

CPT CODE: $25.6182585-8

CPT CODE: $17.6082595-8

CPT CODE: $53.3382600-8

CPT CODE: $46.0682607-8

CPT CODE: $69.3882608-8

CPT CODE: $14.3682610-8

CPT CODE: $5.0482610-P

CPT CODE: $26.1882615-8

CPT CODE: $79.0282626-8

CPT CODE: $76.5482627-8

CPT CODE: $102.7682633-8

CPT CODE: $88.9182634-8

CPT CODE: $36.8682638-8

CPT CODE: $28.4882642-8

CPT CODE: $98.8182652-8

CPT CODE: $21.9282656-8

CPT CODE: $7.7482656-P

CPT CODE: $43.7782657-8

CPT CODE: $43.7782658-8

CPT CODE: $61.2682664-8

CPT CODE: $96.6482668-8

CPT CODE: $94.8682670-8

CPT CODE: $68.2882671-8

CPT CODE: $56.0582672-8

CPT CODE: $58.3382677-8

CPT CODE: $49.3982679-8

CPT CODE: $26.7982693-8

CPT CODE: $128.4482696-8

CPT CODE: $16.8082705-8

CPT CODE: $39.5382710-8

CPT CODE: $50.1882715-8

CPT CODE: $50.7982725-8

CPT CODE: $170.4482726-8

CPT CODE: $38.8082728-8

CPT CODE: $44.8682735-8

CPT CODE: $63.2182746-8

CPT CODE: $61.2382747-8

CPT CODE: $52.8682757-8

CPT CODE: $93.2582759-8

CPT CODE: $27.7882760-8

CPT CODE: $53.3382775-8

CPT CODE: $37.5482776-8

CPT CODE: $61.2682784-8

CPT CODE: $43.9882785-8

CPT CODE: $59.4082787-8

CPT CODE: $8.0182800-8

CPT CODE: $39.1082803-8

CPT CODE: $72.8082805-8

CPT CODE: $33.6082810-8

CPT CODE: $7.6582820-8

CPT CODE: $10.7482930-8

CPT CODE: $69.1582938-8

CPT CODE: $69.1582941-8

CPT CODE: $19.7782943-8

CPT CODE: $14.0582945-8

CPT CODE: $4.2082945-P

CPT CODE: $17.7782946-8

CPT CODE: $14.8282947-8

CPT CODE: $7.9182948-8

CPT CODE: $11.0782950-8

CPT CODE: $28.7582951-8

CPT CODE: $18.4882952-8

CPT CODE: $19.1882955-8

CPT CODE: $19.7782960-8

CPT CODE: $7.6582962-8

CPT CODE: $57.3182963-8

CPT CODE: $19.7782965-8

CPT CODE: $14.6482977-8

CPT CODE: $75.1182978-8

CPT CODE: $27.6682979-8

CPT CODE: $43.3882985-8

CPT CODE: $83.0183001-8

CPT CODE: $75.1183002-8

CPT CODE: $77.0483003-8

CPT CODE: $26.0783006-8

CPT CODE: $194.8483009-8

CPT CODE: $68.7783009-P

CPT CODE: $18.3283010-8

CPT CODE: $98.8183012-8

CPT CODE: $38.2183013-8

CPT CODE: $265.7983014-8

CPT CODE: $35.1483015-8

CPT CODE: $71.1683018-8

CPT CODE: $37.3383020-8

CPT CODE: $21.6183021-8

CPT CODE: $8.4283026-8

CPT CODE: $24.0183030-8

CPT CODE: $25.6883033-8

CPT CODE: $26.3783036-8

CPT CODE: $15.5783037-8

CPT CODE: $5.5283037-P

CPT CODE: $15.8083045-8

CPT CODE: $21.7683050-8

CPT CODE: $23.7083051-8

CPT CODE: $61.2683060-8

CPT CODE: $49.3983065-8

CPT CODE: $51.3883068-8

CPT CODE: $5.6383069-8

CPT CODE: $19.7783070-8

CPT CODE: $48.1783080-8

CPT CODE: $126.4983088-8

CPT CODE: $62.2383090-8

CPT CODE: $18.6783090-P

CPT CODE: $35.5683150-8

CPT CODE: $55.3283491-8

CPT CODE: $41.6183497-8

CPT CODE: $79.0283498-8

CPT CODE: $73.4183500-8

CPT CODE: $90.6983505-8

CPT CODE: $32.6783516-8

CPT CODE: $34.4483518-8

CPT CODE: $40.1683519-8

CPT CODE: $34.4483520-8

CPT CODE: $49.3983525-8

CPT CODE: $48.5583527-8

CPT CODE: $57.3183528-8

CPT CODE: $12.7783540-8

CPT CODE: $27.6683550-8

CPT CODE: $61.2683570-8

CPT CODE: $49.1083582-8

CPT CODE: $37.3383586-8

CPT CODE: $126.4983593-8

CPT CODE: $42.7083605-8

CPT CODE: $9.0983615-8

CPT CODE: $51.3883625-8

CPT CODE: $21.9283630-8

CPT CODE: $7.7483630-P

CPT CODE: $33.2183631-8

CPT CODE: $11.1083631-P

CPT CODE: $114.6383632-8

CPT CODE: $35.5683633-8

CPT CODE: $61.1883655-8

CPT CODE: $75.1783661-8

CPT CODE: $72.7883662-8

CPT CODE: $25.2083663-8

CPT CODE: $8.9183663-P

CPT CODE: $12.5983664-8

CPT CODE: $4.4383664-P

CPT CODE: $27.1783670-8

CPT CODE: $14.8283690-8

CPT CODE: $77.0483698-8

CPT CODE: $27.1283698-P

CPT CODE: $20.7983700-8

CPT CODE: $4.8283700-P

CPT CODE: $69.6083701-8

CPT CODE: $10.9683701-P

Page 47

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $78.4883704-8

CPT CODE: $14.0683704-P

CPT CODE: $21.5483718-8

CPT CODE: $26.6983719-8

CPT CODE: $22.9583721-8

CPT CODE: $30.6883722-8

CPT CODE: $63.2183727-8

CPT CODE: $19.8783735-8

CPT CODE: $45.4583775-8

CPT CODE: $41.6183785-8

CPT CODE: $48.0283789-8

CPT CODE: $68.2883825-8

CPT CODE: $53.0683835-8

CPT CODE: $61.2683857-8

CPT CODE: $12.2583861-8

CPT CODE: $148.2083864-8

CPT CODE: $13.8183872-8

CPT CODE: $112.6483873-8

CPT CODE: $98.8183874-8

CPT CODE: $20.9583876-8

CPT CODE: $7.3883876-P

CPT CODE: $24.1183883-8

CPT CODE: $148.2083885-8

CPT CODE: $42.2083915-8

CPT CODE: $75.1183916-8

CPT CODE: $53.7283918-8

CPT CODE: $33.2383919-8

CPT CODE: $38.5283921-8

CPT CODE: $13.5683921-P

CPT CODE: $21.5483930-8

CPT CODE: $19.7783935-8

CPT CODE: $91.4883937-8

CPT CODE: $39.2183945-8

CPT CODE: $124.6683950-8

CPT CODE: $43.9783950-P

CPT CODE: $104.4983951-8

CPT CODE: $36.8683951-P

CPT CODE: $187.7383970-8

CPT CODE: $19.7783986-8

CPT CODE: $16.9883987-8

CPT CODE: $65.2083992-8

CPT CODE: $31.1783993-8

CPT CODE: $10.4283993-P

CPT CODE: $9.8884030-8

CPT CODE: $9.8884035-8

CPT CODE: $17.3884060-8

CPT CODE: $19.7784066-8

CPT CODE: $10.7684075-8

CPT CODE: $12.4384078-8

CPT CODE: $57.6284080-8

CPT CODE: $53.3384081-8

CPT CODE: $29.6484085-8

CPT CODE: $61.2684087-8

CPT CODE: $9.0984100-8

CPT CODE: $10.3984105-8

CPT CODE: $17.7784106-8

CPT CODE: $25.6884110-8

CPT CODE: $69.9684112-8

CPT CODE: $45.4584119-8

CPT CODE: $61.2684120-8

CPT CODE: $126.4984126-8

CPT CODE: $14.8284132-8

CPT CODE: $7.6184133-8

CPT CODE: $38.7484134-8

CPT CODE: $61.1184135-8

CPT CODE: $79.0284138-8

CPT CODE: $76.5484140-8

CPT CODE: $76.5484143-8

CPT CODE: $57.5084144-8

CPT CODE: $52.4984145-8

CPT CODE: $94.8684146-8

CPT CODE: $55.3284150-8

CPT CODE: $31.8284152-8

CPT CODE: $11.2284152-P

CPT CODE: $45.9284153-8

CPT CODE: $39.8784154-8

CPT CODE: $7.2284155-8

CPT CODE: $4.5784156-8

CPT CODE: $1.6384156-P

CPT CODE: $4.5784157-8

CPT CODE: $1.6384157-P

CPT CODE: $12.2284160-8

CPT CODE: $18.3484163-8

CPT CODE: $6.4484163-P

CPT CODE: $29.8384165-8

CPT CODE: $33.5284166-8

CPT CODE: $31.6084166-P

CPT CODE: $75.7384181-8

CPT CODE: $75.7384182-8

CPT CODE: $75.3784202-8

CPT CODE: $20.2384203-8

CPT CODE: $55.3284206-8

CPT CODE: $90.6984207-8

CPT CODE: $29.6484210-8

CPT CODE: $25.6184220-8

CPT CODE: $128.4484228-8

CPT CODE: $187.7384233-8

CPT CODE: $94.8684234-8

CPT CODE: $187.7384235-8

CPT CODE: $177.8484238-8

CPT CODE: $73.1084244-8

CPT CODE: $83.0184252-8

CPT CODE: $70.1784255-8

CPT CODE: $93.8684260-8

CPT CODE: $45.9284270-8

CPT CODE: $65.2084275-8

CPT CODE: $136.3784285-8

CPT CODE: $7.3184295-8

CPT CODE: $10.1884300-8

CPT CODE: $6.6184302-8

CPT CODE: $2.3384302-P

CPT CODE: $42.1184305-8

CPT CODE: $42.1184307-8

CPT CODE: $28.7184311-8

CPT CODE: $5.9284315-8

CPT CODE: $25.6884375-8

CPT CODE: $41.5484376-8

CPT CODE: $41.5484377-8

CPT CODE: $41.5484378-8

CPT CODE: $41.5484379-8

CPT CODE: $45.4584392-8

CPT CODE: $92.6184402-8

CPT CODE: $98.8184403-8

CPT CODE: $60.1984410-8

CPT CODE: $51.1784425-8

CPT CODE: $46.4284430-8

CPT CODE: $20.8484431-8

CPT CODE: $60.2484432-8

CPT CODE: $25.6884436-8

CPT CODE: $13.2484437-8

CPT CODE: $49.3984439-8

CPT CODE: $26.6984442-8

CPT CODE: $47.1384443-8

CPT CODE: $154.1584445-8

CPT CODE: $46.4284446-8

CPT CODE: $46.6784449-8

CPT CODE: $10.3984450-8

CPT CODE: $9.9884460-8

CPT CODE: $59.4084466-8

CPT CODE: $13.8184478-8

CPT CODE: $15.5384479-8

CPT CODE: $61.2684480-8

CPT CODE: $90.9184481-8

CPT CODE: $9.5484482-8

CPT CODE: $30.8984484-8

CPT CODE: $33.1084485-8

CPT CODE: $25.6884488-8

CPT CODE: $26.6984490-8

CPT CODE: $25.6884510-8

CPT CODE: $23.6584512-8

CPT CODE: $7.4084520-8

CPT CODE: $5.3684525-8

Page 48

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $11.5684540-8

CPT CODE: $21.7684545-8

CPT CODE: $7.9184550-8

CPT CODE: $9.0984560-8

CPT CODE: $154.1584577-8

CPT CODE: $6.9184578-8

CPT CODE: $49.3984580-8

CPT CODE: $10.3984583-8

CPT CODE: $48.9184585-8

CPT CODE: $67.1784586-8

CPT CODE: $132.4384588-8

CPT CODE: $30.4584590-8

CPT CODE: $20.4384591-8

CPT CODE: $7.2184591-P

CPT CODE: $61.2684597-8

CPT CODE: $75.1184600-8

CPT CODE: $45.4584620-8

CPT CODE: $23.1484630-8

CPT CODE: $31.1484681-8

CPT CODE: $29.6484702-8

CPT CODE: $18.7684703-8

CPT CODE: $16.5684704-8

CPT CODE: $5.8284704-P

CPT CODE: $8.9185002-8

CPT CODE: $9.7085004-8

CPT CODE: $3.3985004-P

CPT CODE: $11.8785007-8

CPT CODE: $13.0285008-8

CPT CODE: $11.4385009-8

CPT CODE: $9.6885013-8

CPT CODE: $9.9885014-8

CPT CODE: $8.6985018-8

CPT CODE: $28.1685025-8

CPT CODE: $13.8985027-8

CPT CODE: $8.9485032-8

CPT CODE: $2.7485032-P

CPT CODE: $6.6385041-8

CPT CODE: $12.9585044-8

CPT CODE: $13.8185045-8

CPT CODE: $11.6385046-8

CPT CODE: $8.9185048-8

CPT CODE: $8.2785049-8

CPT CODE: $2.4685049-P

CPT CODE: $99.1685055-8

CPT CODE: $34.9785055-P

CPT CODE: $33.5985060-8

CPT CODE: $63.2185060-P

CPT CODE: $130.7385097-8

CPT CODE: $181.8185097-P

CPT CODE: $9.8085170-8

CPT CODE: $19.7785175-8

CPT CODE: $41.2585210-8

CPT CODE: $116.6085220-8

CPT CODE: $73.4185230-8

CPT CODE: $62.2385240-8

CPT CODE: $98.8185244-8

CPT CODE: $95.6385245-8

CPT CODE: $95.6385246-8

CPT CODE: $95.6385247-8

CPT CODE: $73.4185250-8

CPT CODE: $102.9885260-8

CPT CODE: $73.4185270-8

CPT CODE: $73.4185280-8

CPT CODE: $73.4185290-8

CPT CODE: $49.3985291-8

CPT CODE: $17.9685292-8

CPT CODE: $116.6085293-8

CPT CODE: $45.4585300-8

CPT CODE: $21.3185301-8

CPT CODE: $51.3885302-8

CPT CODE: $95.6385303-8

CPT CODE: $53.3385305-8

CPT CODE: $95.6385306-8

CPT CODE: $66.2985307-8

CPT CODE: $23.4085307-P

CPT CODE: $95.6385335-8

CPT CODE: $47.8485337-8

CPT CODE: $12.4385345-8

CPT CODE: $19.7785347-8

CPT CODE: $11.8785348-8

CPT CODE: $55.3285360-8

CPT CODE: $19.7785362-8

CPT CODE: $19.1385366-8

CPT CODE: $19.1385370-8

CPT CODE: $19.1385378-8

CPT CODE: $19.1385379-8

CPT CODE: $12.7885380-8

CPT CODE: $4.5185380-P

CPT CODE: $22.7885384-8

CPT CODE: $22.7885385-8

CPT CODE: $27.6685390-8

CPT CODE: $54.9785397-8

CPT CODE: $19.4085397-P

CPT CODE: $27.6685400-8

CPT CODE: $7.9185410-8

CPT CODE: $95.6385415-8

CPT CODE: $19.7785420-8

CPT CODE: $27.6685421-8

CPT CODE: $11.8785441-8

CPT CODE: $17.7785445-8

CPT CODE: $21.3185460-8

CPT CODE: $19.6185461-8

CPT CODE: $95.6385475-8

CPT CODE: $17.7785520-8

CPT CODE: $44.0185525-8

CPT CODE: $75.1185530-8

CPT CODE: $12.0285536-8

CPT CODE: $27.6685540-8

CPT CODE: $61.2685547-8

CPT CODE: $104.7385549-8

CPT CODE: $13.8185555-8

CPT CODE: $35.1985557-8

CPT CODE: $48.5585576-8

CPT CODE: $44.0185597-8

CPT CODE: $17.3885598-8

CPT CODE: $14.1585610-8

CPT CODE: $8.2185611-8

CPT CODE: $8.5285612-8

CPT CODE: $8.2185613-8

CPT CODE: $29.8385635-8

CPT CODE: $9.2985651-8

CPT CODE: $8.2985652-8

CPT CODE: $11.0785660-8

CPT CODE: $23.5285670-8

CPT CODE: $47.4485675-8

CPT CODE: $17.2385705-8

CPT CODE: $17.3185730-8

CPT CODE: $19.1885732-8

CPT CODE: $20.3885810-8

CPT CODE: $11.0786000-8

CPT CODE: $12.9486001-8

CPT CODE: $4.5786001-P

CPT CODE: $18.0786003-8

CPT CODE: $76.5486005-8

CPT CODE: $20.7486008-8

CPT CODE: $18.6886021-8

CPT CODE: $19.7786022-8

CPT CODE: $26.9586023-8

CPT CODE: $45.4586038-8

CPT CODE: $29.7686039-8

CPT CODE: $20.7486060-8

CPT CODE: $17.3186063-8

CPT CODE: $59.2886077-8

CPT CODE: $17.7786077-P

CPT CODE: $72.0086078-8

CPT CODE: $21.7686078-P

CPT CODE: $51.4886079-8

CPT CODE: $16.9886140-8

CPT CODE: $99.5286146-8

CPT CODE: $35.1086146-P

CPT CODE: $143.5086147-8

CPT CODE: $126.7186148-8

Page 49

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $104.7386155-8

CPT CODE: $17.2386156-8

CPT CODE: $17.2386157-8

CPT CODE: $59.4086160-8

CPT CODE: $59.4086161-8

CPT CODE: $79.0286162-8

CPT CODE: $29.6486171-8

CPT CODE: $22.3286200-8

CPT CODE: $7.8686200-P

CPT CODE: $29.6486215-8

CPT CODE: $46.4286225-8

CPT CODE: $19.0686226-8

CPT CODE: $45.4586235-8

CPT CODE: $38.3186255-8

CPT CODE: $28.7586256-8

CPT CODE: $71.1686277-8

CPT CODE: $35.5686280-8

CPT CODE: $23.8886294-8

CPT CODE: $8.4386294-P

CPT CODE: $31.8286300-8

CPT CODE: $11.2286300-P

CPT CODE: $31.8286301-8

CPT CODE: $11.2286301-P

CPT CODE: $31.8286304-8

CPT CODE: $11.2286304-P

CPT CODE: $26.2586305-8

CPT CODE: $16.7686308-8

CPT CODE: $14.4186309-8

CPT CODE: $29.6486310-8

CPT CODE: $47.4486316-8

CPT CODE: $19.6586317-8

CPT CODE: $35.5686318-8

CPT CODE: $53.3386320-8

CPT CODE: $80.0586325-8

CPT CODE: $16.6986327-8

CPT CODE: $61.3486329-8

CPT CODE: $28.4686331-8

CPT CODE: $45.4586332-8

CPT CODE: $61.2686334-8

CPT CODE: $55.2386335-8

CPT CODE: $31.6086335-P

CPT CODE: $25.0086336-8

CPT CODE: $8.8186336-P

CPT CODE: $114.6386337-8

CPT CODE: $37.5486340-8

CPT CODE: $37.3286341-8

CPT CODE: $92.8486343-8

CPT CODE: $35.5686344-8

CPT CODE: $121.4586352-8

CPT CODE: $199.5986353-8

CPT CODE: $87.9086355-8

CPT CODE: $31.0086355-P

CPT CODE: $86.9286356-8

CPT CODE: $30.6686356-P

CPT CODE: $87.9086357-8

CPT CODE: $31.0086357-P

CPT CODE: $132.5486359-8

CPT CODE: $123.1886360-8

CPT CODE: $133.4586361-8

CPT CODE: $87.9086367-8

CPT CODE: $31.0086367-P

CPT CODE: $35.5686376-8

CPT CODE: $37.5486382-8

CPT CODE: $70.7586384-8

CPT CODE: $25.7986386-8

CPT CODE: $23.7086403-8

CPT CODE: $52.6686406-8

CPT CODE: $15.3286430-8

CPT CODE: $14.8286431-8

CPT CODE: $140.6586480-8

CPT CODE: $49.6086480-P

CPT CODE: $78.5586481-8

CPT CODE: $22.9586485-8

CPT CODE: $14.7186486-8

CPT CODE: $3.8886486-P

CPT CODE: $16.5386490-8

CPT CODE: $19.7786510-8

CPT CODE: $15.8086580-8

CPT CODE: $25.9286590-8

CPT CODE: $11.0786592-8

CPT CODE: $16.6086593-8

CPT CODE: $16.2786602-8

CPT CODE: $133.9186603-8

CPT CODE: $66.9686606-8

CPT CODE: $66.9686609-8

CPT CODE: $12.0286611-8

CPT CODE: $4.2086611-P

CPT CODE: $66.9686612-8

CPT CODE: $53.5786615-8

CPT CODE: $83.5186617-8

CPT CODE: $53.5786618-8

CPT CODE: $53.5786619-8

CPT CODE: $53.9486622-8

CPT CODE: $95.4786625-8

CPT CODE: $57.4186628-8

CPT CODE: $57.4186631-8

CPT CODE: $76.5486632-8

CPT CODE: $66.9686635-8

CPT CODE: $95.6386638-8

CPT CODE: $79.5886641-8

CPT CODE: $57.4186644-8

CPT CODE: $66.9686645-8

CPT CODE: $57.4186648-8

CPT CODE: $57.4186651-8

CPT CODE: $57.4186652-8

CPT CODE: $57.4186653-8

CPT CODE: $57.4186654-8

CPT CODE: $198.9686658-8

CPT CODE: $74.6186663-8

CPT CODE: $63.1286664-8

CPT CODE: $74.6186665-8

CPT CODE: $12.0286666-8

CPT CODE: $4.2086666-P

CPT CODE: $38.2686668-8

CPT CODE: $38.2686671-8

CPT CODE: $38.2686674-8

CPT CODE: $86.1086677-8

CPT CODE: $66.9686682-8

CPT CODE: $86.1086684-8

CPT CODE: $53.3386687-8

CPT CODE: $143.5086688-8

CPT CODE: $86.9686689-8

CPT CODE: $63.1286692-8

CPT CODE: $91.8286694-8

CPT CODE: $76.5486695-8

CPT CODE: $58.3486696-8

CPT CODE: $20.5986696-P

CPT CODE: $66.9686698-8

CPT CODE: $46.5886701-8

CPT CODE: $75.7386702-8

CPT CODE: $120.5386703-8

CPT CODE: $43.9386704-8

CPT CODE: $37.1786705-8

CPT CODE: $38.8686706-8

CPT CODE: $45.6286707-8

CPT CODE: $38.8686708-8

CPT CODE: $32.3786709-8

CPT CODE: $57.4186710-8

CPT CODE: $21.9286711-8

CPT CODE: $55.4986713-8

CPT CODE: $47.8486717-8

CPT CODE: $47.8486720-8

CPT CODE: $86.1086723-8

CPT CODE: $66.9686727-8

CPT CODE: $76.5486732-8

CPT CODE: $66.9686735-8

CPT CODE: $57.4186738-8

CPT CODE: $86.1086741-8

CPT CODE: $76.5486744-8

CPT CODE: $95.6386747-8

CPT CODE: $21.9786750-8

CPT CODE: $66.9686753-8

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $66.9686756-8

CPT CODE: $58.3486757-8

CPT CODE: $20.5986757-P

CPT CODE: $95.6386759-8

CPT CODE: $19.0686762-8

CPT CODE: $86.1086765-8

CPT CODE: $76.5486768-8

CPT CODE: $38.2686771-8

CPT CODE: $114.7686774-8

CPT CODE: $66.9686777-8

CPT CODE: $95.6386778-8

CPT CODE: $16.4686780-8

CPT CODE: $72.7086784-8

CPT CODE: $57.4186787-8

CPT CODE: $40.2086788-8

CPT CODE: $14.1786788-P

CPT CODE: $34.4086789-8

CPT CODE: $12.1486789-P

CPT CODE: $57.4186790-8

CPT CODE: $57.4186793-8

CPT CODE: $19.4886794-8

CPT CODE: $59.2886800-8

CPT CODE: $37.1786803-8

CPT CODE: $60.8286804-8

CPT CODE: $64.3186805-8

CPT CODE: $86.9686806-8

CPT CODE: $132.4386807-8

CPT CODE: $102.7686808-8

CPT CODE: $102.7686812-8

CPT CODE: $157.4286813-8

CPT CODE: $96.5386816-8

CPT CODE: $422.9086817-8

CPT CODE: $328.0586821-8

CPT CODE: $259.3586825-8

CPT CODE: $86.4586826-8

CPT CODE: $60.2486828-8

CPT CODE: $50.2286829-8

CPT CODE: $128.9786830-8

CPT CODE: $110.5586831-8

CPT CODE: $202.6786832-8

CPT CODE: $184.2486833-8

CPT CODE: $571.1486834-8

CPT CODE: $515.8786835-8

CPT CODE: $57.4186849-8

CPT CODE: $11.4886850-8

CPT CODE: $11.4886860-8

CPT CODE: $31.0386870-8

CPT CODE: $15.0186880-8

CPT CODE: $11.2086885-8

CPT CODE: $15.0186886-8

CPT CODE: $135.8386890-8

CPT CODE: $135.8386891-8

CPT CODE: $35.9086900-8

CPT CODE: $19.1386901-8

CPT CODE: $6.5986902-8

CPT CODE: $19.1386904-8

CPT CODE: $17.2386905-8

CPT CODE: $19.1386906-8

CPT CODE: $334.8086910-8

CPT CODE: $19.1386920-8

CPT CODE: $43.0586922-8

CPT CODE: $107.1286927-8

CPT CODE: $8.6986930-8

CPT CODE: $107.1286931-8

CPT CODE: $107.1286932-8

CPT CODE: $17.2386940-8

CPT CODE: $122.4386941-8

CPT CODE: $26.7986965-8

CPT CODE: $47.8486970-8

CPT CODE: $47.8486971-8

CPT CODE: $47.8486972-8

CPT CODE: $47.8486975-8

CPT CODE: $47.8486976-8

CPT CODE: $47.8486977-8

CPT CODE: $47.8486978-8

CPT CODE: $75.1187003-8

CPT CODE: $15.5387015-8

CPT CODE: $43.2087040-8

CPT CODE: $28.2887045-8

CPT CODE: $4.7687046-8

CPT CODE: $1.6787046-P

CPT CODE: $28.6487070-8

CPT CODE: $9.5287071-8

CPT CODE: $3.3387071-P

CPT CODE: $9.5287073-8

CPT CODE: $3.3387073-P

CPT CODE: $31.0587075-8

CPT CODE: $28.1587076-8

CPT CODE: $18.5687077-8

CPT CODE: $6.5687077-P

CPT CODE: $17.7787081-8

CPT CODE: $16.0287084-8

CPT CODE: $25.2087086-8

CPT CODE: $32.6287088-8

CPT CODE: $19.1887101-8

CPT CODE: $26.2887102-8

CPT CODE: $25.6887103-8

CPT CODE: $29.6487106-8

CPT CODE: $19.9787107-8

CPT CODE: $7.0287107-P

CPT CODE: $72.9387109-8

CPT CODE: $28.1587110-8

CPT CODE: $27.6687116-8

CPT CODE: $13.8187118-8

CPT CODE: $39.5387140-8

CPT CODE: $75.1187143-8

CPT CODE: $13.2487147-8

CPT CODE: $70.9787149-8

CPT CODE: $21.2987149-P

CPT CODE: $114.8887150-8

CPT CODE: $20.7587152-8

CPT CODE: $6.2387152-P

CPT CODE: $151.2687153-8

CPT CODE: $51.3887158-8

CPT CODE: $64.8287164-8

CPT CODE: $18.5387166-8

CPT CODE: $7.8187168-8

CPT CODE: $2.3387168-P

CPT CODE: $7.8187169-8

CPT CODE: $2.3387169-P

CPT CODE: $7.8187172-8

CPT CODE: $2.3387172-P

CPT CODE: $23.7087176-8

CPT CODE: $19.6587177-8

CPT CODE: $24.7287181-8

CPT CODE: $17.3187184-8

CPT CODE: $16.5487185-8

CPT CODE: $5.8487185-P

CPT CODE: $29.6487186-8

CPT CODE: $19.9787187-8

CPT CODE: $45.4587188-8

CPT CODE: $11.8787190-8

CPT CODE: $17.7787197-8

CPT CODE: $9.2987205-8

CPT CODE: $33.5987206-8

CPT CODE: $17.9687207-8

CPT CODE: $123.9887209-8

CPT CODE: $83.2787209-P

CPT CODE: $9.8887210-8

CPT CODE: $9.5487220-8

CPT CODE: $51.3887230-8

CPT CODE: $67.0787250-8

CPT CODE: $48.9187252-8

CPT CODE: $29.6487253-8

CPT CODE: $11.2687254-8

CPT CODE: $3.3787254-P

CPT CODE: $25.4187255-8

CPT CODE: $8.9887255-P

CPT CODE: $45.6287260-8

CPT CODE: $45.6287265-8

CPT CODE: $34.5987267-8

CPT CODE: $12.1787267-P

Page 51

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $33.9487269-8

CPT CODE: $11.9687269-P

CPT CODE: $45.6287270-8

CPT CODE: $34.5987271-8

CPT CODE: $12.1787271-P

CPT CODE: $45.6287272-8

CPT CODE: $35.8887273-8

CPT CODE: $12.6387273-P

CPT CODE: $45.6287274-8

CPT CODE: $35.8887275-8

CPT CODE: $12.6387275-P

CPT CODE: $45.6287276-8

CPT CODE: $45.6287278-8

CPT CODE: $35.8887279-8

CPT CODE: $12.6387279-P

CPT CODE: $45.6287280-8

CPT CODE: $35.8887281-8

CPT CODE: $12.6387281-P

CPT CODE: $35.8887283-8

CPT CODE: $12.6387283-P

CPT CODE: $45.6287285-8

CPT CODE: $45.6287290-8

CPT CODE: $45.6287299-8

CPT CODE: $22.3887300-8

CPT CODE: $6.7087300-P

CPT CODE: $91.2187301-8

CPT CODE: $38.7287305-8

CPT CODE: $11.6287305-P

CPT CODE: $45.6287320-8

CPT CODE: $45.6287324-8

CPT CODE: $44.7687327-8

CPT CODE: $13.4387327-P

CPT CODE: $91.2187328-8

CPT CODE: $67.7387329-8

CPT CODE: $23.9087329-P

CPT CODE: $45.6287332-8

CPT CODE: $45.6287335-8

CPT CODE: $44.7687336-8

CPT CODE: $13.4387336-P

CPT CODE: $44.7687337-8

CPT CODE: $13.4387337-P

CPT CODE: $35.8887339-8

CPT CODE: $12.6387339-P

CPT CODE: $32.1187340-8

CPT CODE: $25.2787341-8

CPT CODE: $32.1187350-8

CPT CODE: $49.0187380-8

CPT CODE: $45.6287385-8

CPT CODE: $38.3287389-8

CPT CODE: $45.6287390-8

CPT CODE: $45.6287391-8

CPT CODE: $22.3887400-8

CPT CODE: $6.7087400-P

CPT CODE: $45.6287420-8

CPT CODE: $45.6287425-8

CPT CODE: $35.8887427-8

CPT CODE: $12.6387427-P

CPT CODE: $45.6287430-8

CPT CODE: $45.6287449-8

CPT CODE: $30.4087450-8

CPT CODE: $23.8887451-8

CPT CODE: $8.4387451-P

CPT CODE: $177.3987471-8

CPT CODE: $202.7287472-8

CPT CODE: $118.2687475-8

CPT CODE: $177.3987476-8

CPT CODE: $118.2687480-8

CPT CODE: $177.3987481-8

CPT CODE: $202.7287482-8

CPT CODE: $258.3487483-8

CPT CODE: $118.2687485-8

CPT CODE: $177.3987486-8

CPT CODE: $202.7287487-8

CPT CODE: $118.2687490-8

CPT CODE: $177.3987491-8

CPT CODE: $202.7287492-8

CPT CODE: $114.8887493-8

CPT CODE: $118.2687495-8

CPT CODE: $177.3987496-8

CPT CODE: $202.7287497-8

CPT CODE: $120.4987498-8

CPT CODE: $42.5087498-P

CPT CODE: $115.5287500-8

CPT CODE: $40.7587500-P

CPT CODE: $53.0587501-8

CPT CODE: $91.8087502-8

CPT CODE: $32.7287503-8

CPT CODE: $83.4987505-8

CPT CODE: $134.2687506-8

CPT CODE: $261.1887507-8

CPT CODE: $118.2687510-8

CPT CODE: $177.3987511-8

CPT CODE: $202.7287512-8

CPT CODE: $177.3987516-8

CPT CODE: $202.7287517-8

CPT CODE: $118.2687520-8

CPT CODE: $177.3987521-8

CPT CODE: $202.7287522-8

CPT CODE: $118.2687525-8

CPT CODE: $177.3987526-8

CPT CODE: $202.7287527-8

CPT CODE: $118.2687528-8

CPT CODE: $177.3987529-8

CPT CODE: $202.7287530-8

CPT CODE: $118.2687531-8

CPT CODE: $177.3987532-8

CPT CODE: $202.7287533-8

CPT CODE: $118.2687534-8

CPT CODE: $177.3987535-8

CPT CODE: $202.7287536-8

CPT CODE: $118.2687537-8

CPT CODE: $177.3987538-8

CPT CODE: $202.7287539-8

CPT CODE: $118.2687540-8

CPT CODE: $177.3987541-8

CPT CODE: $202.7287542-8

CPT CODE: $118.2687550-8

CPT CODE: $177.3987551-8

CPT CODE: $202.7287552-8

CPT CODE: $118.2687555-8

CPT CODE: $177.3987556-8

CPT CODE: $202.7287557-8

CPT CODE: $118.2687560-8

CPT CODE: $177.3987561-8

CPT CODE: $202.7287562-8

CPT CODE: $23.4987563-8

CPT CODE: $118.2687580-8

CPT CODE: $177.3987581-8

CPT CODE: $202.7287582-8

CPT CODE: $118.2687590-8

CPT CODE: $177.3987591-8

CPT CODE: $202.7287592-8

CPT CODE: $26.7287623-8

CPT CODE: $26.7287624-8

CPT CODE: $26.7287625-8

CPT CODE: $146.9087631-8

CPT CODE: $269.1787632-8

CPT CODE: $574.8187633-8

CPT CODE: $52.1387634-8

CPT CODE: $120.4987640-8

CPT CODE: $42.5087640-P

CPT CODE: $120.4987641-8

CPT CODE: $42.5087641-P

CPT CODE: $118.2687650-8

CPT CODE: $177.3987651-8

CPT CODE: $202.7287652-8

CPT CODE: $120.4987653-8

CPT CODE: $42.5087653-P

CPT CODE: $87.8087660-8

CPT CODE: $30.9987660-P

CPT CODE: $36.1887661-8

CPT CODE: $30.6387662-8

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $118.2687797-8

CPT CODE: $177.3987798-8

CPT CODE: $202.7287799-8

CPT CODE: $70.9787800-8

CPT CODE: $21.2987800-P

CPT CODE: $113.5487801-8

CPT CODE: $34.0887801-P

CPT CODE: $24.6887802-8

CPT CODE: $12.4987802-P

CPT CODE: $35.5087803-8

CPT CODE: $12.4987803-P

CPT CODE: $28.5487806-8

CPT CODE: $22.9387807-8

CPT CODE: $11.6187807-P

CPT CODE: $21.5987808-8

CPT CODE: $10.9387808-P

CPT CODE: $20.7087809-8

CPT CODE: $10.4887809-P

CPT CODE: $45.6287810-8

CPT CODE: $45.6287850-8

CPT CODE: $45.6287880-8

CPT CODE: $45.6287899-8

CPT CODE: $569.3087901-8

CPT CODE: $170.0287901-P

CPT CODE: $781.4387903-8

CPT CODE: $233.9687903-P

CPT CODE: $32.7787904-8

CPT CODE: $11.6087904-P

CPT CODE: $15.7787905-8

CPT CODE: $5.5887905-P

CPT CODE: $90.1687906-8

CPT CODE: $168.4987910-8

CPT CODE: $168.4987912-8

CPT CODE: $92.8488104-8

CPT CODE: $71.1688104-P

CPT CODE: $81.0488106-8

CPT CODE: $81.0488106-P

CPT CODE: $81.0488108-8

CPT CODE: $71.1688108-P

CPT CODE: $150.5188112-8

CPT CODE: $82.6488112-P

CPT CODE: $645.0188120-8

CPT CODE: $75.9788120-P

CPT CODE: $544.7188121-8

CPT CODE: $67.0988121-P

CPT CODE: $160.0788125-8

CPT CODE: $51.3888125-P

CPT CODE: $102.7688130-8

CPT CODE: $81.0488130-P

CPT CODE: $29.6488140-8

CPT CODE: $81.0488140-P

CPT CODE: $19.4388141-8

CPT CODE: $15.2188141-P

CPT CODE: $31.2688142-8

CPT CODE: $9.2988142-P

CPT CODE: $30.7488143-8

CPT CODE: $14.1488147-8

CPT CODE: $9.9588147-P

CPT CODE: $14.1488148-8

CPT CODE: $9.9588148-P

CPT CODE: $16.8088150-8

CPT CODE: $11.8788150-P

CPT CODE: $14.3688152-8

CPT CODE: $10.1488152-P

CPT CODE: $14.1488153-8

CPT CODE: $9.9588153-P

CPT CODE: $15.4388155-8

CPT CODE: $15.8088155-P

CPT CODE: $63.2188160-8

CPT CODE: $63.2188160-P

CPT CODE: $63.2188161-8

CPT CODE: $25.6888161-P

CPT CODE: $116.6088162-8

CPT CODE: $116.6088162-P

CPT CODE: $14.1488164-8

CPT CODE: $9.9588164-P

CPT CODE: $14.1488165-8

CPT CODE: $9.9588165-P

CPT CODE: $14.1488166-8

CPT CODE: $9.9588166-P

CPT CODE: $14.1488167-8

CPT CODE: $9.9588167-P

CPT CODE: $98.8188172-8

CPT CODE: $98.8188172-P

CPT CODE: $213.4288173-8

CPT CODE: $98.8188173-P

CPT CODE: $37.6088174-8

CPT CODE: $9.0288174-P

CPT CODE: $37.6088175-8

CPT CODE: $9.0288175-P

CPT CODE: $39.7988177-8

CPT CODE: $30.9688177-P

CPT CODE: $335.9588182-8

CPT CODE: $225.2788182-P

CPT CODE: $77.0088184-8

CPT CODE: $77.0088185-8

CPT CODE: $107.8588187-8

CPT CODE: $107.8588187-P

CPT CODE: $134.6088188-8

CPT CODE: $134.6088188-P

CPT CODE: $177.3688189-8

CPT CODE: $177.3688189-P

CPT CODE: $583.4188230-8

CPT CODE: $711.4488233-8

CPT CODE: $711.4488235-8

CPT CODE: $464.3888237-8

CPT CODE: $711.4488239-8

CPT CODE: $711.4488245-8

CPT CODE: $424.8888248-8

CPT CODE: $392.0188249-8

CPT CODE: $264.7988261-8

CPT CODE: $355.7588262-8

CPT CODE: $711.4488263-8

CPT CODE: $332.2288264-8

CPT CODE: $592.8788267-8

CPT CODE: $484.1788269-8

CPT CODE: $38.2188271-8

CPT CODE: $21.6188272-8

CPT CODE: $64.7988273-8

CPT CODE: $166.0988274-8

CPT CODE: $297.3588275-8

CPT CODE: $76.7088280-8

CPT CODE: $116.6088283-8

CPT CODE: $25.6888285-8

CPT CODE: $92.6188289-8

CPT CODE: $63.2188300-8

CPT CODE: $21.7688300-P

CPT CODE: $106.7288302-8

CPT CODE: $94.8688302-P

CPT CODE: $142.2988304-8

CPT CODE: $102.7688304-P

CPT CODE: $195.6588305-8

CPT CODE: $187.7388305-P

CPT CODE: $345.8488307-8

CPT CODE: $345.8488307-P

CPT CODE: $444.6588309-8

CPT CODE: $444.6588309-P

CPT CODE: $55.3288311-8

CPT CODE: $55.3288311-P

CPT CODE: $47.4488312-8

CPT CODE: $47.4488312-P

CPT CODE: $51.3888313-8

CPT CODE: $49.3988313-P

CPT CODE: $21.7688314-8

CPT CODE: $21.7688314-P

CPT CODE: $33.5988319-8

CPT CODE: $33.5988319-P

CPT CODE: $126.4988321-8

CPT CODE: $126.4988321-P

CPT CODE: $175.8688323-8

CPT CODE: $185.7788323-P

CPT CODE: $167.9988325-8

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $167.9988325-P

CPT CODE: $120.5388329-8

CPT CODE: $120.5388329-P

CPT CODE: $217.4188331-8

CPT CODE: $187.7388331-P

CPT CODE: $112.6488332-8

CPT CODE: $100.8088332-P

CPT CODE: $168.0688333-8

CPT CODE: $147.4088333-P

CPT CODE: $89.5488334-8

CPT CODE: $78.5388334-P

CPT CODE: $84.4288341-8

CPT CODE: $39.5788341-P

CPT CODE: $165.9988342-8

CPT CODE: $160.0788342-P

CPT CODE: $126.5988344-8

CPT CODE: $49.2188344-P

CPT CODE: $177.8488346-8

CPT CODE: $100.8088346-P

CPT CODE: $711.4488348-8

CPT CODE: $671.9288348-P

CPT CODE: $84.4288350-8

CPT CODE: $42.5488350-P

CPT CODE: $183.7788355-8

CPT CODE: $183.7788356-8

CPT CODE: $183.7788358-8

CPT CODE: $150.7688360-8

CPT CODE: $88.2688360-P

CPT CODE: $138.7088361-8

CPT CODE: $78.2188361-P

CPT CODE: $53.7588363-8

CPT CODE: $112.5788364-8

CPT CODE: $31.0688364-P

CPT CODE: $316.2188365-8

CPT CODE: $280.3088367-8

CPT CODE: $103.1188367-P

CPT CODE: $256.1588368-8

CPT CODE: $111.7488368-P

CPT CODE: $75.7388371-8

CPT CODE: $267.8388372-8

CPT CODE: $59.8388387-8

CPT CODE: $47.6088387-P

CPT CODE: $35.3888388-8

CPT CODE: $29.5988388-P

CPT CODE: $9.9588720-8

CPT CODE: $2.9988720-P

CPT CODE: $9.9188738-8

CPT CODE: $9.9588740-8

CPT CODE: $2.9988740-P

CPT CODE: $9.9588741-8

CPT CODE: $2.9988741-P

CPT CODE: $233.2289049-8

CPT CODE: $87.5789049-P

CPT CODE: $21.3189050-8

CPT CODE: $15.2189051-8

CPT CODE: $7.0789055-8

CPT CODE: $2.1289055-P

CPT CODE: $17.0989060-8

CPT CODE: $12.8589125-8

CPT CODE: $17.7789160-8

CPT CODE: $12.4389190-8

CPT CODE: $10.1989220-8

CPT CODE: $37.6389230-8

CPT CODE: $15.3289300-8

CPT CODE: $14.9389310-8

CPT CODE: $33.2389320-8

CPT CODE: $26.2189321-8

CPT CODE: $7.8789321-P

CPT CODE: $32.0889322-8

CPT CODE: $9.6389322-P

CPT CODE: $125.4989325-8

CPT CODE: $47.4489330-8

CPT CODE: $34.4189331-8

CPT CODE: $9.5889331-P

CPT CODE: $894.1889337-8

CPT CODE: $1,192.6690371-6

CPT CODE: $1,192.6690371-A

CPT CODE: $1,192.6690371-N

CPT CODE: $1,325.5690375-6

CPT CODE: $1,325.5690375-A

CPT CODE: $1,325.5690375-N

CPT CODE: $1,290.6890376-6

CPT CODE: $1,290.6890376-A

CPT CODE: $1,290.6890376-N

CPT CODE: $197.6790384-6

CPT CODE: $73.0990385-6

CPT CODE: $114.6390389-6

CPT CODE: $114.6390389-A

CPT CODE: $114.6390389-N

CPT CODE: $1,028.2590396-6

CPT CODE: $1,028.2590396-A

CPT CODE: $1,028.2590396-N

CPT CODE: $25.8790460-6

CPT CODE: $25.8790460-A

CPT CODE: $25.8790460-N

CPT CODE: $14.5490461-6

CPT CODE: $14.5490461-A

CPT CODE: $14.5490461-N

CPT CODE: $9.9590471-6

CPT CODE: $9.9590471-A

CPT CODE: $9.9590471-N

CPT CODE: $26.5790472-6

CPT CODE: $26.5790472-A

CPT CODE: $26.5790472-N

CPT CODE: $9.2590473-6

CPT CODE: $9.2590473-A

CPT CODE: $9.2590473-N

CPT CODE: $9.2590474-6

CPT CODE: $9.2590474-A

CPT CODE: $9.2590474-N

CPT CODE: $320.5990586-Q

CPT CODE: $197.8890620-6

CPT CODE: $197.8890620-6

CPT CODE: $142.4990621-6

CPT CODE: $142.4990621-6

CPT CODE: $27.5290630-6

CPT CODE: $107.9990632-6

CPT CODE: $43.1890633-6

CPT CODE: $43.1890634-6

CPT CODE: $39.8790647-6

CPT CODE: $44.8590648-6

CPT CODE: $185.7490651-6

CPT CODE: $22.2790654-2

CPT CODE: $22.1390655-6

CPT CODE: $8.3290657-6

CPT CODE: $8.3290658-6

CPT CODE: $159.3190670-6

CPT CODE: $43.0490673-6

CPT CODE: $27.6290674-6

CPT CODE: $219.2790675-6

CPT CODE: $219.2790675-A

CPT CODE: $219.2790675-N

CPT CODE: $132.8990676-6

CPT CODE: $88.0690680-6

CPT CODE: $157.1790681-6

CPT CODE: $53.2090682-6

CPT CODE: $72.8090696-6

CPT CODE: $52.2590700-A

CPT CODE: $52.2590700-N

CPT CODE: $23.7090702-6

CPT CODE: $23.7090702-A

CPT CODE: $23.7090702-N

CPT CODE: $81.4890707-6

CPT CODE: $81.4890707-A

CPT CODE: $81.4890707-N

CPT CODE: $55.5890713-6

CPT CODE: $55.5890713-A

CPT CODE: $55.5890713-N

CPT CODE: $27.9090714-6

CPT CODE: $27.9090714-A

CPT CODE: $27.9090714-N

CPT CODE: $57.3690715-6

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $57.3690715-A

CPT CODE: $57.3690715-N

CPT CODE: $49.3990732-6

CPT CODE: $49.3990732-A

CPT CODE: $49.3990732-N

CPT CODE: $102.5690734-6

CPT CODE: $295.1690740-6

CPT CODE: $104.9590743-6

CPT CODE: $54.8290744-6

CPT CODE: $125.5390746-6

CPT CODE: $318.2390747-6

CPT CODE: $92.9390748-6

CPT CODE: $25.6290756-6

CPT CODE: $5.9090785-C

CPT CODE: $183.5690791-C

CPT CODE: $194.0490792-C

CPT CODE: $79.4390832-C

CPT CODE: $56.7690833-C

CPT CODE: $107.1990834-C

CPT CODE: $94.0690836-C

CPT CODE: $158.0190837-C

CPT CODE: $138.4190838-C

CPT CODE: $158.0190839-C

CPT CODE: $56.7690840-C

CPT CODE: $187.1790845-B

CPT CODE: $187.1790845-C

CPT CODE: $187.1790845-X

CPT CODE: $159.6290846-B

CPT CODE: $159.6290846-C

CPT CODE: $159.6290846-X

CPT CODE: $190.2890847-B

CPT CODE: $190.2890847-C

CPT CODE: $190.2890847-X

CPT CODE: $106.0690849-B

CPT CODE: $106.0690849-C

CPT CODE: $106.0690849-X

CPT CODE: $85.7990853-B

CPT CODE: $85.7990853-C

CPT CODE: $85.7990853-X

CPT CODE: $73.8390863-C

CPT CODE: $371.4790865-2

CPT CODE: $371.4790865-B

CPT CODE: $371.4790865-C

CPT CODE: $371.4790865-X

CPT CODE: $504.7790869-2

CPT CODE: $293.2390870-B

CPT CODE: $293.2390870-C

CPT CODE: $293.2390870-X

CPT CODE: $126.0890875-C

CPT CODE: $171.0590876-C

CPT CODE: $182.4990880-C

CPT CODE: $219.1590885-C

CPT CODE: $184.0590887-C

CPT CODE: $46.4690912-6

CPT CODE: $25.7990913-6

CPT CODE: $241.1190935-6

CPT CODE: $523.7090937-6

CPT CODE: $241.1190945-6

CPT CODE: $523.7090947-6

CPT CODE: $612.9790951-6

CPT CODE: $612.9790952-6

CPT CODE: $612.9790953-6

CPT CODE: $592.2990954-6

CPT CODE: $592.2990955-6

CPT CODE: $592.2990956-6

CPT CODE: $580.6490957-6

CPT CODE: $580.6490958-6

CPT CODE: $580.6490959-6

CPT CODE: $517.2890960-6

CPT CODE: $517.2890961-6

CPT CODE: $517.2890962-6

CPT CODE: $612.9790963-6

CPT CODE: $592.2990964-6

CPT CODE: $580.6490965-6

CPT CODE: $517.2890966-6

CPT CODE: $21.9890967-6

CPT CODE: $19.4090968-6

CPT CODE: $18.1190969-6

CPT CODE: $18.1190970-6

CPT CODE: $1,363.6090989-6

CPT CODE: $148.2091010-6

CPT CODE: $279.3291013-6

CPT CODE: $107.4491013-P

CPT CODE: $98.8191020-6

CPT CODE: $77.1491022-6

CPT CODE: $61.9991022-P

CPT CODE: $128.4491030-6

CPT CODE: $224.9391034-6

CPT CODE: $157.5991034-P

CPT CODE: $104.5891040-6

CPT CODE: $88.8391040-P

CPT CODE: $63.2191065-6

CPT CODE: $1,012.2891110-5

CPT CODE: $180.0391110-P

CPT CODE: $1,241.5291112-6

CPT CODE: $124.9591112-P

CPT CODE: $215.7491117-6

CPT CODE: $193.4191120-6

CPT CODE: $128.9491120-P

CPT CODE: $160.0791122-6

CPT CODE: $38.6591200-6

CPT CODE: $15.5091200-P

CPT CODE: $110.6792002-6

CPT CODE: $110.6792002-A

CPT CODE: $110.6792002-M

CPT CODE: $110.6792002-N

CPT CODE: $112.6492004-6

CPT CODE: $112.6492004-A

CPT CODE: $112.6492004-M

CPT CODE: $112.6492004-N

CPT CODE: $73.1092012-6

CPT CODE: $73.1092012-A

CPT CODE: $73.1092012-M

CPT CODE: $73.1092012-N

CPT CODE: $104.7392014-6

CPT CODE: $104.7392014-A

CPT CODE: $104.7392014-M

CPT CODE: $104.7392014-N

CPT CODE: $513.8392018-6

CPT CODE: $513.8392018-A

CPT CODE: $513.8392018-M

CPT CODE: $513.8392018-N

CPT CODE: $474.2792019-6

CPT CODE: $474.2792019-A

CPT CODE: $474.2792019-M

CPT CODE: $474.2792019-N

CPT CODE: $55.3292020-6

CPT CODE: $55.3292020-A

CPT CODE: $55.3292020-M

CPT CODE: $55.3292020-N

CPT CODE: $110.6492025-6

CPT CODE: $57.3192060-6

CPT CODE: $57.3192060-A

CPT CODE: $57.3192060-M

CPT CODE: $57.3192060-N

CPT CODE: $47.4492065-6

CPT CODE: $47.4492065-A

CPT CODE: $47.4492065-M

CPT CODE: $47.4492065-N

CPT CODE: $44.8392071-2

CPT CODE: $142.9892072-2

CPT CODE: $63.2192081-6

CPT CODE: $63.2192081-A

CPT CODE: $63.2192081-M

CPT CODE: $63.2192081-N

CPT CODE: $73.1092082-6

CPT CODE: $73.1092082-A

CPT CODE: $73.1092082-M

CPT CODE: $73.1092082-N

CPT CODE: $175.8692083-6

CPT CODE: $175.8692083-A

CPT CODE: $175.8692083-M

Page 55

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $175.8692083-N

CPT CODE: $47.4492100-6

CPT CODE: $47.4492100-A

CPT CODE: $47.4492100-M

CPT CODE: $47.4492100-N

CPT CODE: $61.9392132-6

CPT CODE: $27.1792132-P

CPT CODE: $61.9392133-6

CPT CODE: $27.1792133-P

CPT CODE: $61.9392134-6

CPT CODE: $27.1792134-P

CPT CODE: $169.8792136-6

CPT CODE: $169.8792136-A

CPT CODE: $169.8792136-M

CPT CODE: $169.8792136-N

CPT CODE: $79.9392136-P

CPT CODE: $16.7892145-6

CPT CODE: $9.2292145-P

CPT CODE: $23.7792201-6

CPT CODE: $15.3892202-6

CPT CODE: $60.6692227-A

CPT CODE: $60.6692227-N

CPT CODE: $60.6692227-P

CPT CODE: $60.6692228-A

CPT CODE: $60.6692228-N

CPT CODE: $60.6692228-P

CPT CODE: $136.3792230-6

CPT CODE: $136.3792230-A

CPT CODE: $136.3792230-M

CPT CODE: $136.3792230-N

CPT CODE: $395.2692235-6

CPT CODE: $395.2692235-A

CPT CODE: $395.2692235-M

CPT CODE: $395.2692235-N

CPT CODE: $386.2092240-6

CPT CODE: $308.9192242-6

CPT CODE: $94.8692250-6

CPT CODE: $94.8692250-A

CPT CODE: $94.8692250-M

CPT CODE: $94.8692250-N

CPT CODE: $71.1692260-6

CPT CODE: $71.1692260-A

CPT CODE: $71.1692260-M

CPT CODE: $71.1692260-N

CPT CODE: $49.3992265-6

CPT CODE: $49.3992265-A

CPT CODE: $49.3992265-M

CPT CODE: $49.3992265-N

CPT CODE: $203.5292270-6

CPT CODE: $203.5292270-A

CPT CODE: $203.5292270-M

CPT CODE: $203.5292270-N

CPT CODE: $136.0392273-5

CPT CODE: $40.2392273-P

CPT CODE: $95.7892273-TC

CPT CODE: $92.6492274-5

CPT CODE: $35.6692274-P

CPT CODE: $56.9992274-TC

CPT CODE: $195.6592284-6

CPT CODE: $195.6592284-A

CPT CODE: $195.6592284-M

CPT CODE: $195.6592284-N

CPT CODE: $75.1192285-6

CPT CODE: $75.1192285-M

CPT CODE: $296.4392286-6

CPT CODE: $296.4392286-A

CPT CODE: $296.4392286-M

CPT CODE: $296.4392286-N

CPT CODE: $375.4692310-6

CPT CODE: $375.4692310-M

CPT CODE: $81.0492352-6

CPT CODE: $81.0492352-M

CPT CODE: $81.0492353-6

CPT CODE: $81.0492353-M

CPT CODE: $49.3992502-6

CPT CODE: $162.0392502-M

CPT CODE: $223.3192504-6

CPT CODE: $130.4292507-6

CPT CODE: $217.4192511-6

CPT CODE: $128.4492512-6

CPT CODE: $81.0492516-6

CPT CODE: $87.5592521-6

CPT CODE: $73.8392522-6

CPT CODE: $147.6792523-6

CPT CODE: $74.1192524-6

CPT CODE: $43.4792531-6

CPT CODE: $67.1792532-6

CPT CODE: $61.2692533-6

CPT CODE: $67.1792534-6

CPT CODE: $44.5292537-6

CPT CODE: $35.7992537-P

CPT CODE: $47.6192538-6

CPT CODE: $168.5392540-6

CPT CODE: $78.4792540-P

CPT CODE: $225.2792541-6

CPT CODE: $211.4592542-6

CPT CODE: $63.2192544-6

CPT CODE: $65.2092545-6

CPT CODE: $280.6392546-6

CPT CODE: $37.5492547-6

CPT CODE: $65.1192549-5

CPT CODE: $47.2592549-P

CPT CODE: $17.8792549-TC

CPT CODE: $36.6692550-6

CPT CODE: $49.3992551-6

CPT CODE: $49.3992551-V

CPT CODE: $47.4492552-6

CPT CODE: $47.4492552-V

CPT CODE: $63.2192553-6

CPT CODE: $63.2192553-V

CPT CODE: $33.5992555-6

CPT CODE: $33.5992555-V

CPT CODE: $45.4592556-6

CPT CODE: $45.4592556-V

CPT CODE: $92.8492557-6

CPT CODE: $92.8492557-V

CPT CODE: $35.1492558-2

CPT CODE: $11.4992558-P

CPT CODE: $21.7692559-6

CPT CODE: $21.7692559-V

CPT CODE: $41.4892560-6

CPT CODE: $41.4892560-V

CPT CODE: $35.5692561-6

CPT CODE: $35.5692561-V

CPT CODE: $13.8192562-6

CPT CODE: $13.8192562-V

CPT CODE: $13.8192563-6

CPT CODE: $13.8192563-V

CPT CODE: $13.8192564-6

CPT CODE: $13.8192564-V

CPT CODE: $23.7092565-6

CPT CODE: $23.7092565-V

CPT CODE: $51.3892567-6

CPT CODE: $51.3892567-V

CPT CODE: $39.5392568-6

CPT CODE: $39.5392568-V

CPT CODE: $90.0592570-6

CPT CODE: $90.0592570-V

CPT CODE: $65.2092571-6

CPT CODE: $65.2092571-V

CPT CODE: $41.4892572-6

CPT CODE: $41.4892572-V

CPT CODE: $45.4592575-6

CPT CODE: $45.4592575-V

CPT CODE: $45.4592576-6

CPT CODE: $45.4592576-V

CPT CODE: $23.7092577-6

CPT CODE: $23.7092577-V

CPT CODE: $146.7392579-6

CPT CODE: $51.3892582-6

CPT CODE: $148.2092583-6

CPT CODE: $221.3392584-6

Page 56

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $335.9592585-6

CPT CODE: $39.9492587-6

CPT CODE: $65.3592588-6

CPT CODE: $111.2692601-6

CPT CODE: $111.2692602-6

CPT CODE: $100.7592603-6

CPT CODE: $100.7592604-6

CPT CODE: $111.2692605-6

CPT CODE: $111.2692606-6

CPT CODE: $111.2692607-6

CPT CODE: $55.6492608-6

CPT CODE: $111.2692609-6

CPT CODE: $111.2692610-6

CPT CODE: $136.8392611-6

CPT CODE: $156.3992612-6

CPT CODE: $63.1592613-P

CPT CODE: $175.9392614-6

CPT CODE: $70.6792615-P

CPT CODE: $45.1092616-6

CPT CODE: $78.2092617-P

CPT CODE: $34.9792618-2

CPT CODE: $51.5892620-6

CPT CODE: $12.8992621-6

CPT CODE: $45.8592625-6

CPT CODE: $26.1892626-6

CPT CODE: $26.1892627-6

CPT CODE: $179.0892630-6

CPT CODE: $179.0892633-6

CPT CODE: $1,307.3192920-6

CPT CODE: $427.5392921-6

CPT CODE: $1,598.3592924-6

CPT CODE: $292.9092925-6

CPT CODE: $1,313.3092928-6

CPT CODE: $597.6092929-6

CPT CODE: $1,753.8292933-6

CPT CODE: $292.9092934-6

CPT CODE: $1,524.2492937-6

CPT CODE: $292.9092938-6

CPT CODE: $1,753.8292941-6

CPT CODE: $1,753.8292943-6

CPT CODE: $292.9092944-6

CPT CODE: $306.3092950-6

CPT CODE: $306.3092950-A

CPT CODE: $375.4692953-6

CPT CODE: $365.5892960-6

CPT CODE: $365.5892960-A

CPT CODE: $485.2392961-6

CPT CODE: $300.8492961-P

CPT CODE: $1,211.0792973-6

CPT CODE: $493.6892974-6

CPT CODE: $5,721.1592986-6

CPT CODE: $5,255.8792987-6

CPT CODE: $5,721.1592990-6

CPT CODE: $3,079.6092992-6

CPT CODE: $6,159.2092993-6

CPT CODE: $2,728.2892997-6

CPT CODE: $1,326.1492998-6

CPT CODE: $92.8493000-6

CPT CODE: $92.8493000-A

CPT CODE: $92.8493000-N

CPT CODE: $75.1193005-6

CPT CODE: $75.1193005-A

CPT CODE: $75.1193005-N

CPT CODE: $27.6693010-6

CPT CODE: $39.5393010-A

CPT CODE: $39.5393010-N

CPT CODE: $335.9593015-6

CPT CODE: $105.5693016-6

CPT CODE: $100.8093017-6

CPT CODE: $193.6693018-6

CPT CODE: $839.9193024-6

CPT CODE: $839.9193024-A

CPT CODE: $839.9193024-N

CPT CODE: $57.3193040-6

CPT CODE: $13.8193041-6

CPT CODE: $19.7793042-6

CPT CODE: $533.5993224-6

CPT CODE: $124.5093225-6

CPT CODE: $213.4293226-6

CPT CODE: $195.6593227-6

CPT CODE: $71.7293260-6

CPT CODE: $46.6093260-P

CPT CODE: $60.7593261-6

CPT CODE: $43.6993261-P

CPT CODE: $294.4193268-6

CPT CODE: $74.4693270-6

CPT CODE: $145.2593271-6

CPT CODE: $59.9293272-6

CPT CODE: $171.9393278-6

CPT CODE: $81.0493278-P

CPT CODE: $69.9393279-6

CPT CODE: $45.1293279-P

CPT CODE: $82.5793280-6

CPT CODE: $54.1593280-P

CPT CODE: $96.5693281-6

CPT CODE: $63.1793281-P

CPT CODE: $89.3393282-6

CPT CODE: $59.1193282-P

CPT CODE: $108.7493283-6

CPT CODE: $74.4593283-P

CPT CODE: $127.2493284-6

CPT CODE: $88.4493284-P

CPT CODE: $60.4693285-6

CPT CODE: $37.0093285-P

CPT CODE: $34.2993286-6

CPT CODE: $18.9593286-P

CPT CODE: $45.1293287-6

CPT CODE: $27.5293287-P

CPT CODE: $54.1593288-6

CPT CODE: $30.2493288-P

CPT CODE: $83.0393289-6

CPT CODE: $54.6093289-P

CPT CODE: $40.1593290-6

CPT CODE: $26.6393290-P

CPT CODE: $51.8993291-6

CPT CODE: $30.6993291-P

CPT CODE: $46.9393292-6

CPT CODE: $30.2493292-P

CPT CODE: $74.9093293-6

CPT CODE: $21.2193293-P

CPT CODE: $46.0293294-6

CPT CODE: $83.0393295-6

CPT CODE: $45.5793296-6

CPT CODE: $32.0393297-6

CPT CODE: $37.0093298-6

CPT CODE: $569.8393303-6

CPT CODE: $257.4793303-P

CPT CODE: $375.8993304-6

CPT CODE: $99.5793304-P

CPT CODE: $334.8093306-6

CPT CODE: $334.8093306-A

CPT CODE: $334.8093306-N

CPT CODE: $89.7993306-P

CPT CODE: $464.3893307-6

CPT CODE: $464.3893307-A

CPT CODE: $464.3893307-N

CPT CODE: $205.5293307-P

CPT CODE: $294.4793308-6

CPT CODE: $294.4793308-A

CPT CODE: $294.4793308-N

CPT CODE: $81.0493308-P

CPT CODE: $1,027.6593312-6

CPT CODE: $622.5093312-P

CPT CODE: $168.3793313-6

CPT CODE: $168.3793313-P

CPT CODE: $185.5993314-6

CPT CODE: $185.5993314-P

CPT CODE: $1,287.2993315-6

CPT CODE: $784.4193315-P

CPT CODE: $211.1293316-6

CPT CODE: $209.4193316-P

CPT CODE: $236.8493317-6

Page 57

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $235.1593317-P

CPT CODE: $268.7793320-6

CPT CODE: $268.7793320-A

CPT CODE: $268.7793320-N

CPT CODE: $71.1693320-P

CPT CODE: $294.4793321-6

CPT CODE: $81.0493321-P

CPT CODE: $780.6093350-6

CPT CODE: $346.5293351-6

CPT CODE: $48.2893352-6

CPT CODE: $255.7793355-6

CPT CODE: $12.4893356-5

CPT CODE: $979.5193451-6

CPT CODE: $518.2093451-P

CPT CODE: $1,536.8993452-6

CPT CODE: $589.6193452-P

CPT CODE: $1,933.7693453-6

CPT CODE: $982.6793453-P

CPT CODE: $1,581.1393454-6

CPT CODE: $736.8593454-P

CPT CODE: $2,200.4393455-6

CPT CODE: $906.2193455-P

CPT CODE: $1,983.6893456-6

CPT CODE: $965.6193456-P

CPT CODE: $2,602.9893457-6

CPT CODE: $1,134.9893457-P

CPT CODE: $2,003.2793458-6

CPT CODE: $801.9493458-P

CPT CODE: $2,622.5793459-6

CPT CODE: $967.5193459-P

CPT CODE: $2,400.1393460-6

CPT CODE: $1,195.0193460-P

CPT CODE: $3,019.4493461-6

CPT CODE: $1,364.3893461-P

CPT CODE: $425.9493462-6

CPT CODE: $161.6193463-6

CPT CODE: $383.6393464-6

CPT CODE: $142.2693464-P

CPT CODE: $800.3893503-6

CPT CODE: $793.9293503-P

CPT CODE: $800.3893505-6

CPT CODE: $800.3893505-P

CPT CODE: $778.7993530-6

CPT CODE: $1,307.5493531-6

CPT CODE: $1,255.1993532-6

CPT CODE: $1,307.5493533-6

CPT CODE: $671.9293561-6

CPT CODE: $671.9293561-P

CPT CODE: $165.9993562-6

CPT CODE: $165.9993562-P

CPT CODE: $466.3893563-6

CPT CODE: $841.7693564-6

CPT CODE: $323.5593565-6

CPT CODE: $381.6993566-6

CPT CODE: $319.1493567-6

CPT CODE: $249.6293568-6

CPT CODE: $2,620.8793580-6

CPT CODE: $772.4993582-6

CPT CODE: $859.8193583-6

CPT CODE: $1,300.4993590-6

CPT CODE: $1,079.1993591-6

CPT CODE: $475.5793592-6

CPT CODE: $326.0793600-6

CPT CODE: $326.0793600-P

CPT CODE: $365.5893602-6

CPT CODE: $365.5893602-P

CPT CODE: $375.4693603-6

CPT CODE: $375.4693603-P

CPT CODE: $543.4693610-6

CPT CODE: $543.4693610-P

CPT CODE: $375.4693612-6

CPT CODE: $375.4693612-P

CPT CODE: $375.4693618-6

CPT CODE: $375.4693618-P

CPT CODE: $1,987.7593619-6

CPT CODE: $793.2493619-P

CPT CODE: $2,401.0993620-6

CPT CODE: $2,401.0993620-P

CPT CODE: $2,776.6093621-6

CPT CODE: $2,776.6093621-P

CPT CODE: $2,776.6093622-6

CPT CODE: $2,776.6093622-P

CPT CODE: $375.4693623-6

CPT CODE: $375.4693623-P

CPT CODE: $741.0893624-6

CPT CODE: $741.0893624-P

CPT CODE: $3,883.2893631-6

CPT CODE: $3,883.2893631-P

CPT CODE: $375.4693640-6

CPT CODE: $375.4693640-P

CPT CODE: $373.2993641-6

CPT CODE: $149.3393641-P

CPT CODE: $373.2993642-6

CPT CODE: $149.3393642-P

CPT CODE: $325.4993644-6

CPT CODE: $202.0193644-P

CPT CODE: $5,414.8593650-6

CPT CODE: $5,414.8593650-P

CPT CODE: $2,106.5893653-6

CPT CODE: $2,532.1193654-6

CPT CODE: $480.3393655-6

CPT CODE: $2,532.1193656-6

CPT CODE: $480.5493657-6

CPT CODE: $251.0093660-6

CPT CODE: $251.0093660-P

CPT CODE: $118.1393702-6

CPT CODE: $113.8793724-6

CPT CODE: $44.7993724-P

CPT CODE: $100.2893745-6

CPT CODE: $35.8293745-P

CPT CODE: $7.9193770-6

CPT CODE: $54.7793792-6

CPT CODE: $12.7493793-6

CPT CODE: $642.2793880-6

CPT CODE: $292.4993880-P

CPT CODE: $215.3993882-6

CPT CODE: $98.8193882-P

CPT CODE: $303.7593886-6

CPT CODE: $146.2693886-P

CPT CODE: $83.0193888-6

CPT CODE: $49.3993888-P

CPT CODE: $317.2893922-6

CPT CODE: $173.5993922-P

CPT CODE: $317.2893923-6

CPT CODE: $173.5993923-P

CPT CODE: $335.9593924-6

CPT CODE: $175.4493924-P

CPT CODE: $335.9593925-6

CPT CODE: $175.8693925-P

CPT CODE: $112.6493926-6

CPT CODE: $59.2893926-P

CPT CODE: $263.0193930-6

CPT CODE: $167.9993930-P

CPT CODE: $75.1193931-6

CPT CODE: $57.3193931-P

CPT CODE: $294.4793970-6

CPT CODE: $146.2693970-P

CPT CODE: $98.8193971-6

CPT CODE: $49.2793971-P

CPT CODE: $642.2793975-6

CPT CODE: $292.4993975-P

CPT CODE: $215.3993976-6

CPT CODE: $98.8193976-P

CPT CODE: $642.2793978-6

CPT CODE: $146.2693978-P

CPT CODE: $215.3993979-6

CPT CODE: $49.3993979-P

CPT CODE: $296.5493980-6

CPT CODE: $145.3793980-P

CPT CODE: $99.4993981-6

CPT CODE: $49.7593981-P

CPT CODE: $261.8493985-5

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $40.2893985-P

CPT CODE: $221.5693985-TC

CPT CODE: $132.9193986-5

CPT CODE: $25.7993986-P

CPT CODE: $107.1293986-TC

CPT CODE: $74.4693990-6

CPT CODE: $171.3594002-6

CPT CODE: $171.3594002-A

CPT CODE: $171.3594002-N

CPT CODE: $58.0194003-6

CPT CODE: $58.0194003-A

CPT CODE: $58.0194003-N

CPT CODE: $171.3594004-6

CPT CODE: $171.3594004-A

CPT CODE: $171.3594004-N

CPT CODE: $104.7394010-6

CPT CODE: $104.7394010-A

CPT CODE: $104.7394010-N

CPT CODE: $57.3194010-P

CPT CODE: $135.0894011-6

CPT CODE: $208.4194012-6

CPT CODE: $44.3994013-6

CPT CODE: $264.1494014-6

CPT CODE: $69.7794015-6

CPT CODE: $56.4994016-6

CPT CODE: $136.3794060-6

CPT CODE: $136.3794060-A

CPT CODE: $136.3794060-N

CPT CODE: $84.9694060-P

CPT CODE: $306.3094070-6

CPT CODE: $306.3094070-A

CPT CODE: $306.3094070-N

CPT CODE: $71.1694070-P

CPT CODE: $61.2694150-6

CPT CODE: $61.2694150-A

CPT CODE: $61.2694150-N

CPT CODE: $73.1094200-6

CPT CODE: $73.1094200-A

CPT CODE: $73.1094200-N

CPT CODE: $55.3294250-6

CPT CODE: $55.3294250-A

CPT CODE: $55.3294250-N

CPT CODE: $63.2194375-6

CPT CODE: $63.2194375-A

CPT CODE: $63.2194375-N

CPT CODE: $25.6894375-P

CPT CODE: $102.7694400-6

CPT CODE: $102.7694400-A

CPT CODE: $102.7694400-N

CPT CODE: $82.3094610-6

CPT CODE: $82.3094610-A

CPT CODE: $82.3094610-N

CPT CODE: $151.7394617-6

CPT CODE: $48.8994617-Q

CPT CODE: $54.6294618-6

CPT CODE: $17.6094618-Q

CPT CODE: $265.7994621-6

CPT CODE: $49.3994640-6

CPT CODE: $49.3994640-A

CPT CODE: $49.3994640-N

CPT CODE: $316.2194642-6

CPT CODE: $316.2194642-A

CPT CODE: $316.2194642-N

CPT CODE: $44.5294644-6

CPT CODE: $44.5294644-A

CPT CODE: $44.5294644-N

CPT CODE: $14.8494644-P

CPT CODE: $17.5494645-6

CPT CODE: $17.5494645-A

CPT CODE: $17.5494645-N

CPT CODE: $5.4094645-P

CPT CODE: $211.4594660-6

CPT CODE: $211.4594660-A

CPT CODE: $211.4594660-N

CPT CODE: $39.5394664-6

CPT CODE: $39.5394664-A

CPT CODE: $39.5394664-N

CPT CODE: $55.3294667-6

CPT CODE: $55.3294667-A

CPT CODE: $55.3294667-N

CPT CODE: $34.9394669-6

CPT CODE: $69.1594680-6

CPT CODE: $69.1594680-A

CPT CODE: $69.1594680-N

CPT CODE: $124.5094681-6

CPT CODE: $124.5094681-A

CPT CODE: $124.5094681-N

CPT CODE: $69.1594690-6

CPT CODE: $69.1594690-A

CPT CODE: $69.1594690-N

CPT CODE: $86.5094726-6

CPT CODE: $20.8594726-P

CPT CODE: $68.3194727-6

CPT CODE: $20.8594727-P

CPT CODE: $68.3194728-6

CPT CODE: $20.8594728-P

CPT CODE: $85.6794729-6

CPT CODE: $65.2094750-6

CPT CODE: $65.2094750-A

CPT CODE: $65.2094750-N

CPT CODE: $582.9894772-6

CPT CODE: $223.3194772-P

CPT CODE: $60.8394780-6

CPT CODE: $23.6394781-6

CPT CODE: $7.1095000-6*

CPT CODE: $5.9295004-6*

CPT CODE: $89.1295017-6

CPT CODE: $30.8795018-6

CPT CODE: $16.2795024-6*

CPT CODE: $7.1095027-6*

CPT CODE: $21.8495028-6*

CPT CODE: $9.3395044-6

CPT CODE: $23.7095060-6

CPT CODE: $21.7695065-6

CPT CODE: $148.2095070-6

CPT CODE: $127.2595076-6

CPT CODE: $91.0295079-6

CPT CODE: $9.8895115-6

CPT CODE: $9.8895117-6

CPT CODE: $13.8195120-6

CPT CODE: $21.7695125-6

CPT CODE: $51.3895130-6

CPT CODE: $33.5995131-6

CPT CODE: $43.4795132-6

CPT CODE: $45.4595133-6

CPT CODE: $45.4595134-6

CPT CODE: $63.4695144-6

CPT CODE: $37.5495145-6

CPT CODE: $21.7695146-6

CPT CODE: $45.4595147-6

CPT CODE: $47.4495148-6

CPT CODE: $43.4795149-6

CPT CODE: $111.9995165-6

CPT CODE: $81.0495170-6

CPT CODE: $55.3295180-6

CPT CODE: $55.6995249-6

CPT CODE: $26.1895251-6

CPT CODE: $106.6295717-6

CPT CODE: $139.4595718-6

CPT CODE: $164.8995719-6

CPT CODE: $215.8995720-6

CPT CODE: $216.5895721-6

CPT CODE: $263.3695722-6

CPT CODE: $267.8995723-6

CPT CODE: $335.8695724-6

CPT CODE: $304.7995725-6

CPT CODE: $424.3695726-6

CPT CODE: $1,114.5395782-6

CPT CODE: $305.8995782-P

CPT CODE: $1,167.2595783-6

CPT CODE: $318.8895783-P

CPT CODE: $1,686.6495800-6

Page 59

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $85.5095800-P

CPT CODE: $2,847.3695801-6

CPT CODE: $76.2495801-P

CPT CODE: $800.3895805-6

CPT CODE: $317.2895805-P

CPT CODE: $927.4695806-6

CPT CODE: $1,269.1895807-6

CPT CODE: $503.9595807-P

CPT CODE: $1,269.1895808-6

CPT CODE: $503.9595808-P

CPT CODE: $1,269.1895810-6

CPT CODE: $503.9595810-P

CPT CODE: $1,030.5095811-6

CPT CODE: $484.8495811-P

CPT CODE: $241.4995812-6

CPT CODE: $241.4995813-6

CPT CODE: $163.9995816-6

CPT CODE: $245.0695819-6

CPT CODE: $134.3895819-P

CPT CODE: $239.1395822-6

CPT CODE: $179.8295824-6

CPT CODE: $274.6895829-P

CPT CODE: $1,679.7795830-6

CPT CODE: $4,045.3395830-A

CPT CODE: $4,045.3395830-N

CPT CODE: $114.3495836-6

CPT CODE: $69.1595851-6

CPT CODE: $37.5495852-6

CPT CODE: $112.6495857-6

CPT CODE: $262.8095860-6

CPT CODE: $167.9995860-P

CPT CODE: $345.8495861-6

CPT CODE: $233.1995861-P

CPT CODE: $484.1795863-6

CPT CODE: $345.8495863-P

CPT CODE: $632.3995864-6

CPT CODE: $365.5895864-P

CPT CODE: $261.7395865-6

CPT CODE: $135.0095865-P

CPT CODE: $188.7395866-6

CPT CODE: $96.4395866-P

CPT CODE: $116.6095867-6

CPT CODE: $165.9995868-6

CPT CODE: $152.1695869-6

CPT CODE: $143.6095870-6

CPT CODE: $152.1695872-6

CPT CODE: $96.8495872-P

CPT CODE: $104.6995873-6

CPT CODE: $53.7395873-P

CPT CODE: $104.6995874-6

CPT CODE: $53.7395874-P

CPT CODE: $49.6595885-6

CPT CODE: $16.0195885-P

CPT CODE: $78.9095886-6

CPT CODE: $42.6995886-P

CPT CODE: $70.0995887-6

CPT CODE: $33.5595887-P

CPT CODE: $106.7895905-6

CPT CODE: $4.0595905-P

CPT CODE: $102.0595907-6

CPT CODE: $58.0895907-P

CPT CODE: $126.0595908-6

CPT CODE: $72.8995908-P

CPT CODE: $150.9595909-6

CPT CODE: $87.1895909-P

CPT CODE: $198.8095910-6

CPT CODE: $116.4995910-P

CPT CODE: $240.6695911-6

CPT CODE: $145.2595911-P

CPT CODE: $282.5095912-6

CPT CODE: $174.5495912-P

CPT CODE: $327.4695913-6

CPT CODE: $206.7995913-P

CPT CODE: $54.9295921-6

CPT CODE: $18.8795921-P

CPT CODE: $54.9295922-6

CPT CODE: $18.8795922-P

CPT CODE: $54.9295923-6

CPT CODE: $18.8795923-P

CPT CODE: $102.1695924-6

CPT CODE: $58.1095924-P

CPT CODE: $189.7395925-6

CPT CODE: $63.6595926-6

CPT CODE: $63.6595927-6

CPT CODE: $103.1695928-6

CPT CODE: $103.1695928-P

CPT CODE: $103.1695929-6

CPT CODE: $103.1695929-P

CPT CODE: $281.1095930-6

CPT CODE: $114.9395930-P

CPT CODE: $284.5895933-6

CPT CODE: $114.9395933-P

CPT CODE: $138.3395937-6

CPT CODE: $221.5095938-6

CPT CODE: $73.6295938-P

CPT CODE: $409.5695939-6

CPT CODE: $147.7095939-P

CPT CODE: $37.5195940-6

CPT CODE: $233.1995955-6

CPT CODE: $233.1995955-A

CPT CODE: $233.1995955-N

CPT CODE: $225.2795958-P

CPT CODE: $258.8995961-6

CPT CODE: $102.6695961-P

CPT CODE: $258.8995962-6

CPT CODE: $102.6695962-P

CPT CODE: $96.3495970-6

CPT CODE: $96.3495971-6

CPT CODE: $96.3495972-6

CPT CODE: $96.3495973-6

CPT CODE: $42.2995976-6

CPT CODE: $56.4395977-6

CPT CODE: $53.1995983-6

CPT CODE: $46.6795984-6

CPT CODE: $72.1795990-6

CPT CODE: $72.1795990-Q

CPT CODE: $88.5395991-6

CPT CODE: $88.5395991-Q

CPT CODE: $258.6395992-6

CPT CODE: $206.9296105-6

CPT CODE: $206.9296105-C

CPT CODE: $180.9396110-6

CPT CODE: $180.9396110-C

CPT CODE: $136.2896112-6

CPT CODE: $62.1696113-6

CPT CODE: $81.2896116-6

CPT CODE: $81.2896116-C

CPT CODE: $84.1596121-6

CPT CODE: $166.8796125-6

CPT CODE: $166.8796125-C

CPT CODE: $5.4196127-6

CPT CODE: $118.9396130-6

CPT CODE: $90.6896131-6

CPT CODE: $116.9896132-6

CPT CODE: $89.6396133-6

CPT CODE: $26.6296136-6

CPT CODE: $21.0996137-6

CPT CODE: $37.9496139-6

CPT CODE: $1.9596146-6

CPT CODE: $93.7696156-6

CPT CODE: $64.0396158-6

CPT CODE: $22.0796159-6

CPT CODE: $12.9896160-6

CPT CODE: $4.7696161-6

CPT CODE: $9.3396164-6

CPT CODE: $4.1796165-6

CPT CODE: $68.4796167-6

CPT CODE: $24.3396168-6

CPT CODE: $29.0396170-6

CPT CODE: $14.5196171-6

CPT CODE: $76.3096360-6

CPT CODE: $24.5796361-6

Page 60

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $93.1196365-6

CPT CODE: $32.3396366-6

CPT CODE: $51.7396367-6

CPT CODE: $31.0496368-6

CPT CODE: $198.5096369-6

CPT CODE: $20.7096370-6

CPT CODE: $91.8196371-6

CPT CODE: $21.9896372-6

CPT CODE: $21.9896372-A

CPT CODE: $21.9896372-C

CPT CODE: $21.9896372-N

CPT CODE: $69.8396374-6

CPT CODE: $32.3396375-6

CPT CODE: $19.5396377-6

CPT CODE: $67.5196401-6

CPT CODE: $67.5196401-Q

CPT CODE: $46.8396402-6

CPT CODE: $46.8396402-Q

CPT CODE: $65.3296405-Q

CPT CODE: $143.7196406-Q

CPT CODE: $157.0496409-6

CPT CODE: $157.0496409-Q

CPT CODE: $92.3196411-6

CPT CODE: $92.3196411-Q

CPT CODE: $221.7996413-6

CPT CODE: $221.7996413-Q

CPT CODE: $50.9896415-6

CPT CODE: $50.9896415-Q

CPT CODE: $238.3296416-6

CPT CODE: $238.3296416-Q

CPT CODE: $108.8496417-6

CPT CODE: $108.8496417-Q

CPT CODE: $96.8496420-Q

CPT CODE: $156.1296422-Q

CPT CODE: $45.4596423-Q

CPT CODE: $106.7296425-Q

CPT CODE: $272.7496440-Q

CPT CODE: $462.5896446-Q

CPT CODE: $272.7496450-Q

CPT CODE: $197.0096521-Q

CPT CODE: $141.8996522-6

CPT CODE: $141.8996522-Q

CPT CODE: $35.8296523-6

CPT CODE: $35.8296523-Q

CPT CODE: $95.6396542-Q

CPT CODE: $194.6296573-Q

CPT CODE: $252.0296574-6

CPT CODE: $34.0596900-6

CPT CODE: $56.1596910-6

CPT CODE: $57.4696912-6

CPT CODE: $180.9396913-6

CPT CODE: $196.9896920-6

CPT CODE: $212.0296921-6

CPT CODE: $281.1896922-6

CPT CODE: $50.7497763-6

CPT CODE: $48.3698925-6

CPT CODE: $57.7298926-6

CPT CODE: $72.8098927-6

CPT CODE: $102.6698928-6

CPT CODE: $147.4898929-6

CPT CODE: $136.3799002-6

CPT CODE: $20.6699051-6

CPT CODE: $282.6099078-6

CPT CODE: $282.6099078-A

CPT CODE: $282.6099078-N

CPT CODE: $83.5499080-6

CPT CODE: $26.1599151-6

CPT CODE: $13.6999152-6

CPT CODE: $11.2199153-6

CPT CODE: $102.6999155-6

CPT CODE: $84.2499156-6

CPT CODE: $63.9199157-6

CPT CODE: $192.4799170-6

CPT CODE: $135.7099175-6

CPT CODE: $135.7099175-A

CPT CODE: $135.7099175-B

CPT CODE: $135.7099175-C

CPT CODE: $135.7099175-N

CPT CODE: $135.7099175-R

CPT CODE: $35.4299177-6

CPT CODE: $76.5499183-6

CPT CODE: $76.5499183-A

CPT CODE: $260.1199184-6

CPT CODE: $23.2299188-6

CPT CODE: $69.1599195-6

CPT CODE: $69.1599195-A

CPT CODE: $66.8499201-6

CPT CODE: $66.8499201-A

CPT CODE: $72.2699201-C

CPT CODE: $66.8499201-N

CPT CODE: $66.8499201-Q

CPT CODE: $83.0599202-6

CPT CODE: $83.0599202-A

CPT CODE: $91.0499202-C

CPT CODE: $83.0599202-N

CPT CODE: $83.0599202-Q

CPT CODE: $117.4899203-6

CPT CODE: $117.4899203-A

CPT CODE: $124.7199203-C

CPT CODE: $117.4899203-N

CPT CODE: $117.4899203-Q

CPT CODE: $168.5299204-6

CPT CODE: $168.5299204-A

CPT CODE: $182.0499204-C

CPT CODE: $168.5299204-N

CPT CODE: $168.5299204-Q

CPT CODE: $251.2099205-6

CPT CODE: $251.2099205-A

CPT CODE: $251.2099205-C

CPT CODE: $251.2099205-N

CPT CODE: $251.2099205-Q

CPT CODE: $46.5899211-6

CPT CODE: $46.5899211-A

CPT CODE: $46.5899211-C

CPT CODE: $46.5899211-N

CPT CODE: $46.5899211-Q

CPT CODE: $62.7899212-6

CPT CODE: $62.7899212-A

CPT CODE: $62.7899212-C

CPT CODE: $62.7899212-N

CPT CODE: $62.7899212-Q

CPT CODE: $72.9399213-6

CPT CODE: $72.9399213-A

CPT CODE: $72.9399213-C

CPT CODE: $72.9399213-N

CPT CODE: $72.9399213-Q

CPT CODE: $95.2099214-6

CPT CODE: $95.2099214-A

CPT CODE: $95.2099214-C

CPT CODE: $95.2099214-N

CPT CODE: $95.2099214-Q

CPT CODE: $139.7499215-6

CPT CODE: $139.7499215-A

CPT CODE: $139.7499215-C

CPT CODE: $139.7499215-N

CPT CODE: $139.7499215-Q

CPT CODE: $110.1399217-6

CPT CODE: $130.0999218-6

CPT CODE: $130.0999218-A

CPT CODE: $166.4499219-6

CPT CODE: $166.4499219-A

CPT CODE: $244.8799220-6

CPT CODE: $244.8799220-A

CPT CODE: $130.4299221-6

CPT CODE: $130.4299221-B

CPT CODE: $130.4299221-C

CPT CODE: $130.4299221-N

CPT CODE: $165.9999222-6

CPT CODE: $165.9999222-B

CPT CODE: $165.9999222-C

CPT CODE: $165.9999222-N

CPT CODE: $245.0699223-6

Page 61

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $245.0699223-B

CPT CODE: $245.0699223-C

CPT CODE: $245.0699223-N

CPT CODE: $36.0299224-6

CPT CODE: $36.0299224-A

CPT CODE: $36.0299224-C

CPT CODE: $36.0299224-N

CPT CODE: $36.0299224-Q

CPT CODE: $36.0299224-X

CPT CODE: $64.4699225-6

CPT CODE: $64.4699225-A

CPT CODE: $64.4699225-C

CPT CODE: $64.4699225-N

CPT CODE: $64.4699225-Q

CPT CODE: $64.4699225-X

CPT CODE: $96.0699226-6

CPT CODE: $96.0699226-A

CPT CODE: $96.0699226-C

CPT CODE: $96.0699226-N

CPT CODE: $96.0699226-Q

CPT CODE: $96.0699226-X

CPT CODE: $69.1599231-6

CPT CODE: $69.1599231-B

CPT CODE: $69.1599231-C

CPT CODE: $69.1599231-E

CPT CODE: $69.1599231-N

CPT CODE: $88.9199232-6

CPT CODE: $88.9199232-B

CPT CODE: $88.9199232-C

CPT CODE: $88.9199232-E

CPT CODE: $88.9199232-N

CPT CODE: $118.5999233-6

CPT CODE: $118.5999233-B

CPT CODE: $118.5999233-C

CPT CODE: $118.5999233-E

CPT CODE: $118.5999233-N

CPT CODE: $195.9699234-6

CPT CODE: $195.9699234-A

CPT CODE: $195.9699234-C

CPT CODE: $195.9699234-N

CPT CODE: $195.9699234-Q

CPT CODE: $224.7099235-6

CPT CODE: $224.7099235-A

CPT CODE: $224.7099235-C

CPT CODE: $224.7099235-N

CPT CODE: $224.7099235-Q

CPT CODE: $295.6599236-6

CPT CODE: $295.6599236-A

CPT CODE: $295.6599236-C

CPT CODE: $295.6599236-N

CPT CODE: $295.6599236-Q

CPT CODE: $108.6999238-6

CPT CODE: $108.6999238-B

CPT CODE: $108.6999238-C

CPT CODE: $108.6999238-E

CPT CODE: $108.6999238-N

CPT CODE: $111.3799239-6

CPT CODE: $111.3799239-C

CPT CODE: $111.3799239-D

CPT CODE: $111.3799239-E

CPT CODE: $111.3799239-N

CPT CODE: $133.7299241-9

CPT CODE: $133.7299241-A

CPT CODE: $133.7299241-N

CPT CODE: $166.0899242-9

CPT CODE: $166.0899242-A

CPT CODE: $166.0899242-N

CPT CODE: $192.4199243-9

CPT CODE: $192.4199243-A

CPT CODE: $192.4199243-N

CPT CODE: $251.2099244-9

CPT CODE: $251.2099244-A

CPT CODE: $251.2099244-N

CPT CODE: $277.5099245-9

CPT CODE: $277.5099245-A

CPT CODE: $277.5099245-N

CPT CODE: $130.4299251-9

CPT CODE: $130.4299251-A

CPT CODE: $130.4299251-N

CPT CODE: $162.0399252-9

CPT CODE: $162.0399252-A

CPT CODE: $162.0399252-N

CPT CODE: $187.7399253-9

CPT CODE: $187.7399253-A

CPT CODE: $187.7399253-N

CPT CODE: $245.0699254-9

CPT CODE: $245.0699254-A

CPT CODE: $245.0699254-N

CPT CODE: $280.6399255-9

CPT CODE: $280.6399255-A

CPT CODE: $280.6399255-N

CPT CODE: $63.2199281-6

CPT CODE: $63.2199281-A

CPT CODE: $63.2199281-C

CPT CODE: $63.2199281-N

CPT CODE: $84.9699282-6

CPT CODE: $84.9699282-A

CPT CODE: $84.9699282-C

CPT CODE: $84.9699282-N

CPT CODE: $104.7399283-6

CPT CODE: $104.7399283-A

CPT CODE: $104.7399283-C

CPT CODE: $104.7399283-N

CPT CODE: $128.4499284-6

CPT CODE: $128.4499284-C

CPT CODE: $128.4499284-N

CPT CODE: $191.6699285-6

CPT CODE: $191.6699285-A

CPT CODE: $191.6699285-C

CPT CODE: $191.6699285-N

CPT CODE: $251.0099291-6

CPT CODE: $251.0099291-A

CPT CODE: $251.0099291-B

CPT CODE: $251.0099291-C

CPT CODE: $251.0099291-N

CPT CODE: $187.7399292-6

CPT CODE: $187.7399292-A

CPT CODE: $187.7399292-B

CPT CODE: $187.7399292-C

CPT CODE: $187.7399292-N

CPT CODE: $93.6899304-6

CPT CODE: $93.6899304-A

CPT CODE: $93.6899304-C

CPT CODE: $93.6899304-N

CPT CODE: $125.3699305-6

CPT CODE: $125.3699305-A

CPT CODE: $125.3699305-C

CPT CODE: $125.3699305-N

CPT CODE: $157.0499306-6

CPT CODE: $157.0499306-A

CPT CODE: $157.0499306-C

CPT CODE: $157.0499306-N

CPT CODE: $41.3399307-6

CPT CODE: $41.3399307-A

CPT CODE: $41.3399307-C

CPT CODE: $41.3399307-N

CPT CODE: $68.8899308-6

CPT CODE: $68.8899308-A

CPT CODE: $68.8899308-C

CPT CODE: $68.8899308-N

CPT CODE: $96.4399309-6

CPT CODE: $96.4399309-A

CPT CODE: $96.4399309-C

CPT CODE: $96.4399309-N

CPT CODE: $119.8599310-6

CPT CODE: $119.8599310-A

CPT CODE: $119.8599310-C

CPT CODE: $119.8599310-N

CPT CODE: $96.2999315-6

CPT CODE: $96.2999315-A

CPT CODE: $96.2999315-B

CPT CODE: $96.2999315-C

Page 62

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $96.2999315-N

CPT CODE: $96.2999316-6

CPT CODE: $96.2999316-A

CPT CODE: $96.2999316-B

CPT CODE: $96.2999316-C

CPT CODE: $96.2999316-N

CPT CODE: $79.9099318-6

CPT CODE: $79.9099318-A

CPT CODE: $79.9099318-C

CPT CODE: $79.9099318-N

CPT CODE: $67.5199324-6

CPT CODE: $67.5199324-A

CPT CODE: $67.5199324-C

CPT CODE: $67.5199324-N

CPT CODE: $100.5799325-6

CPT CODE: $100.5799325-A

CPT CODE: $100.5799325-C

CPT CODE: $100.5799325-N

CPT CODE: $147.4099326-6

CPT CODE: $147.4099326-A

CPT CODE: $147.4099326-C

CPT CODE: $147.4099326-N

CPT CODE: $197.0099327-6

CPT CODE: $197.0099327-A

CPT CODE: $197.0099327-C

CPT CODE: $197.0099327-N

CPT CODE: $246.5899328-6

CPT CODE: $246.5899328-A

CPT CODE: $246.5899328-C

CPT CODE: $246.5899328-N

CPT CODE: $44.0899334-6

CPT CODE: $44.0899334-A

CPT CODE: $44.0899334-C

CPT CODE: $44.0899334-N

CPT CODE: $73.0199335-6

CPT CODE: $73.0199335-A

CPT CODE: $73.0199335-C

CPT CODE: $73.0199335-N

CPT CODE: $115.7199336-6

CPT CODE: $115.7199336-A

CPT CODE: $115.7199336-C

CPT CODE: $115.7199336-N

CPT CODE: $173.5799337-6

CPT CODE: $173.5799337-A

CPT CODE: $173.5799337-C

CPT CODE: $173.5799337-N

CPT CODE: $96.8499341-6

CPT CODE: $96.8499341-A

CPT CODE: $96.8499341-C

CPT CODE: $96.8499341-N

CPT CODE: $110.6799342-6

CPT CODE: $110.6799342-A

CPT CODE: $110.6799342-C

CPT CODE: $110.6799342-N

CPT CODE: $162.0399343-6

CPT CODE: $162.0399343-A

CPT CODE: $162.0399343-C

CPT CODE: $162.0399343-N

CPT CODE: $231.4499344-6

CPT CODE: $231.4499344-A

CPT CODE: $231.4499344-C

CPT CODE: $231.4499344-N

CPT CODE: $288.8899345-6

CPT CODE: $288.8899345-A

CPT CODE: $288.8899345-C

CPT CODE: $288.8899345-N

CPT CODE: $65.8999347-6

CPT CODE: $65.8999347-A

CPT CODE: $65.8999347-C

CPT CODE: $65.8999347-N

CPT CODE: $89.5399348-6

CPT CODE: $89.5399348-A

CPT CODE: $89.5399348-C

CPT CODE: $89.5399348-N

CPT CODE: $119.9699349-6

CPT CODE: $119.9699349-A

CPT CODE: $119.9699349-C

CPT CODE: $119.9699349-N

CPT CODE: $143.6099350-6

CPT CODE: $143.6099350-A

CPT CODE: $143.6099350-C

CPT CODE: $143.6099350-N

CPT CODE: $259.4499354-6

CPT CODE: $259.4499354-A

CPT CODE: $259.4499354-C

CPT CODE: $259.4499354-E

CPT CODE: $259.4499354-N

CPT CODE: $125.0799355-A

CPT CODE: $125.0799355-C

CPT CODE: $125.0799355-E

CPT CODE: $125.0799355-N

CPT CODE: $259.4499356-6

CPT CODE: $259.4499356-E

CPT CODE: $125.0799357-6

CPT CODE: $334.1299358-6

CPT CODE: $167.0699359-6

CPT CODE: $83.5499367-6

CPT CODE: $83.5499368-6

CPT CODE: $59.2899381-6

CPT CODE: $61.2699382-6

CPT CODE: $68.5499383-6

CPT CODE: $57.3199391-6

CPT CODE: $63.2199392-6

CPT CODE: $63.2199393-6

CPT CODE: $73.1099394-6

CPT CODE: $9.1499415-6

CPT CODE: $0.6299416-6

CPT CODE: $161.6599460-6

CPT CODE: $81.4799462-6

CPT CODE: $243.1299463-6

CPT CODE: $192.6899464-6

CPT CODE: $178.4699465-6

CPT CODE: $178.4699465-A

CPT CODE: $178.4699465-N

CPT CODE: $228.9099466-6

CPT CODE: $228.9099466-A

CPT CODE: $228.9099466-C

CPT CODE: $228.9099466-N

CPT CODE: $138.3799467-6

CPT CODE: $138.3799467-A

CPT CODE: $138.3799467-C

CPT CODE: $138.3799467-N

CPT CODE: $600.0499468-6

CPT CODE: $455.2099469-6

CPT CODE: $600.0499471-6

CPT CODE: $437.1099472-6

CPT CODE: $10.6299473-6

CPT CODE: $9.2299474-6

CPT CODE: $413.6599475-6

CPT CODE: $362.4199476-6

CPT CODE: $388.0899477-6

CPT CODE: $168.1199478-6

CPT CODE: $155.1899479-6

CPT CODE: $148.7199480-6

CPT CODE: $188.1399483-6

CPT CODE: $34.3299484-C

CPT CODE: $50.1699484-NF

CPT CODE: $73.1899485-6

CPT CODE: $39.6199486-6

CPT CODE: $45.2299490-6

CPT CODE: $87.0999491-6

CPT CODE: $94.7499492-C

CPT CODE: $165.6799492-NF

CPT CODE: $85.6599493-C

CPT CODE: $132.8299493-NF

CPT CODE: $45.7299494-C

CPT CODE: $68.7799494-NF

CPT CODE: $135.8699495-6

CPT CODE: $191.6099496-6

CPT CODE: $1,194.34A9507-G

CPT CODE: $324.65A9590-6

CPT CODE: $1,093.00A9600-6

Page 63

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEE CPT CODE MAX FEECPT CODE: $1,093.00A9600-E

CPT CODE: $1,093.00A9600-Q

CPT CODE: $185.83G0104-2

CPT CODE: $868.31G0105-2

CPT CODE: $250.02G0106-P

CPT CODE: $60.17G0117-6

CPT CODE: $60.17G0117-A

CPT CODE: $60.17G0117-M

CPT CODE: $60.17G0117-N

CPT CODE: $60.17G0117-P

CPT CODE: $949.42G0120-P

CPT CODE: $868.31G0121-2

CPT CODE: $64.18G0122-P

CPT CODE: $340.53G0130-5

CPT CODE: $111.30G0130-P

CPT CODE: $14.14G0141-8

CPT CODE: $30.74G0143-8

CPT CODE: $30.74G0144-8

CPT CODE: $30.74G0145-8

CPT CODE: $14.14G0147-8

CPT CODE: $14.14G0148-8

CPT CODE: $107.99G0202-5

CPT CODE: $50.92G0202-P

CPT CODE: $107.99G0204-5

CPT CODE: $50.92G0204-P

CPT CODE: $2,422.13G0219-5

CPT CODE: $362.55G0219-P

CPT CODE: $75.18G0245-6

CPT CODE: $52.63G0246-6

CPT CODE: $75.18G0247-6

CPT CODE: $1,771.30G0252-6

CPT CODE: $353.35G0252-P

CPT CODE: $204.49G0257-6

CPT CODE: $82.70G0259-2

CPT CODE: $40.59G0268-2

CPT CODE: $48.39G0277-6

CPT CODE: $608.97G0278-5

CPT CODE: $193.97G0278-P

CPT CODE: $63.49G0279-5

CPT CODE: $35.76G0279-P

CPT CODE: $34.59G0283-D

CPT CODE: $34.59G0283-N

CPT CODE: $500.72G0288-5

CPT CODE: $112.78G0288-P

CPT CODE: $1,774.31G0289-2

CPT CODE: $105.33G0297-5

CPT CODE: $29.78G0297-P

CPT CODE: $19.18G0306-8

CPT CODE: $5.75G0306-P

CPT CODE: $9.52G0307-8

CPT CODE: $3.31G0307-P

CPT CODE: $28.08G0328-6

CPT CODE: $37.20G0372-6

CPT CODE: $46.47G0406-6

CPT CODE: $46.47G0406-9

CPT CODE: $46.47G0406-A

CPT CODE: $46.47G0406-N

CPT CODE: $83.48G0407-6

CPT CODE: $83.48G0407-9

CPT CODE: $83.48G0407-A

CPT CODE: $83.48G0407-N

CPT CODE: $119.57G0408-6

CPT CODE: $119.57G0408-9

CPT CODE: $119.57G0408-A

CPT CODE: $119.57G0408-N

CPT CODE: $10.82G0409-6

CPT CODE: $1,762.62G0412-2

CPT CODE: $1,196.20G0413-2

CPT CODE: $2,537.24G0414-2

CPT CODE: $2,631.65G0415-2

CPT CODE: $747.61G0416-8

CPT CODE: $233.19G0416-P

CPT CODE: $151.80G0420-6

CPT CODE: $151.80G0420-X

CPT CODE: $34.09G0421-6

CPT CODE: $34.09G0421-C

CPT CODE: $34.09G0421-X

CPT CODE: $86.20G0422-6

CPT CODE: $86.20G0423-6

CPT CODE: $40.52G0424-6

CPT CODE: $140.22G0425-6

CPT CODE: $140.22G0425-9

CPT CODE: $140.22G0425-A

CPT CODE: $140.22G0425-N

CPT CODE: $190.40G0426-6

CPT CODE: $190.40G0426-9

CPT CODE: $190.40G0426-A

CPT CODE: $190.40G0426-N

CPT CODE: $279.17G0427-6

CPT CODE: $279.17G0427-9

CPT CODE: $279.17G0427-A

CPT CODE: $279.17G0427-N

CPT CODE: $131.45G0438-6

CPT CODE: $120.07G0439-6

CPT CODE: $23.26G0452-P

CPT CODE: $31.06G0453-6

CPT CODE: $141.27G0455-6

CPT CODE: $13.65G0473-6

CPT CODE: $16.26G0475-8

CPT CODE: $26.72G0476-8

CPT CODE: $69.63G0480-8

CPT CODE: $69.63G0481-8

CPT CODE: $69.63G0482-8

CPT CODE: $69.63G0483-8

CPT CODE: $6.05G0500-6

CPT CODE: $113.80G0516-6

CPT CODE: $129.77G0517-6

CPT CODE: $210.11G0518-6

CPT CODE: $68.28G0659-8

CPT CODE: $17.71G2011-X

CPT CODE: $36.93G2066-G

CPT CODE: $167.22G6001-6

CPT CODE: $75.49G6001-P

CPT CODE: $171.87G6002-6

CPT CODE: $51.10G6002-P

CPT CODE: $197.42G6003-6

CPT CODE: $197.42G6004-6

CPT CODE: $197.42G6005-6

CPT CODE: $197.42G6006-6

CPT CODE: $278.36G6007-6

CPT CODE: $207.87G6008-6

CPT CODE: $207.87G6009-6

CPT CODE: $207.87G6010-6

CPT CODE: $297.70G6011-6

CPT CODE: $246.26G6012-6

CPT CODE: $277.58G6013-6

CPT CODE: $277.20G6014-6

CPT CODE: $1,007.99G6015-6

CPT CODE: $1,007.99G6016-6

CPT CODE:

J$50.42J0120-6

CPT CODE:

J$50.42J0120-Q

CPT CODE:

J$25.81J0129-6

CPT CODE:

J$25.81J0129-Q

CPT CODE:

J$988.37J0130-6

CPT CODE:

J$0.49J0133-6

CPT CODE:

J$0.49J0133-Q

CPT CODE:

J$0.95J0153-6

CPT CODE:

J$0.11J0171-6

CPT CODE:

J$0.11J0171-Q

CPT CODE:

J$1,158.00J0178-6

CPT CODE:

J$331.45J0179-6

CPT CODE:

J$173.84J0180-6

CPT CODE:

J$173.84J0180-Q

CPT CODE:

J$2.72J0185-6

CPT CODE:

J$20.54J0190-6

CPT CODE:

J$20.54J0190-Q

CPT CODE:

J$29.92J0200-6

CPT CODE:

J$29.92J0200-Q

CPT CODE:

J$2,044.59J0202-6

CPT CODE:

J$72.80J0205-6

CPT CODE:

J$72.80J0205-Q

CPT CODE:

J$601.41J0207-6

Page 64

Page 65: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

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

J$601.41J0207-Q

CPT CODE:

J$20.54J0210-6

CPT CODE:

J$20.54J0210-Q

CPT CODE:

J$41.61J0215-6

CPT CODE:

J$41.61J0215-Q

CPT CODE:

J$161.05J0220-6

CPT CODE:

J$161.05J0220-Q

CPT CODE:

J$190.65J0256-6

CPT CODE:

J$190.65J0256-Q

CPT CODE:

J$34.89J0275-6

CPT CODE:

J$4.45J0278-6

CPT CODE:

J$4.45J0278-Q

CPT CODE:

J$20.54J0280-6

CPT CODE:

J$20.54J0280-Q

CPT CODE:

J$28.04J0282-6

CPT CODE:

J$28.04J0282-Q

CPT CODE:

J$54.83J0285-6

CPT CODE:

J$54.83J0285-Q

CPT CODE:

J$34.59J0287-6

CPT CODE:

J$34.59J0287-Q

CPT CODE:

J$24.05J0288-6

CPT CODE:

J$24.05J0288-Q

CPT CODE:

J$56.69J0289-6

CPT CODE:

J$56.69J0289-Q

CPT CODE:

J$20.54J0290-6

CPT CODE:

J$20.54J0290-Q

CPT CODE:

J$20.54J0300-6

CPT CODE:

J$20.54J0300-Q

CPT CODE:

J$20.54J0330-6

CPT CODE:

J$20.54J0330-Q

CPT CODE:

J$3.04J0348-6

CPT CODE:

J$3.04J0348-Q

CPT CODE:

J$20.54J0360-6

CPT CODE:

J$20.54J0360-Q

CPT CODE:

J$4.92J0364-6

CPT CODE:

J$4.92J0364-Q

CPT CODE:

J$4.09J0365-6

CPT CODE:

J$4.09J0365-Q

CPT CODE:

J$20.54J0380-6

CPT CODE:

J$20.54J0380-Q

CPT CODE:

J$42.60J0390-6

CPT CODE:

J$42.60J0390-Q

CPT CODE:

J$352.15J0395-6

CPT CODE:

J$352.15J0395-Q

CPT CODE:

J$0.45J0400-6

CPT CODE:

J$0.45J0400-Q

CPT CODE:

J$4.54J0401-6

CPT CODE:

J$38.33J0456-6

CPT CODE:

J$38.33J0456-Q

CPT CODE:

J$0.02J0461-6

CPT CODE:

J$0.02J0461-Q

CPT CODE:

J$65.32J0470-6

CPT CODE:

J$65.32J0470-Q

CPT CODE:

J$403.77J0475-6

CPT CODE:

J$403.77J0475-Q

CPT CODE:

J$142.85J0476-6

CPT CODE:

J$142.85J0476-Q

CPT CODE:

J$2,561.91J0480-6

CPT CODE:

J$2,561.91J0480-Q

CPT CODE:

J$4.61J0485-6

CPT CODE:

J$20.54J0500-6

CPT CODE:

J$20.54J0500-Q

CPT CODE:

J$20.54J0515-6

CPT CODE:

J$20.54J0515-Q

CPT CODE:

J$174.20J0517-6

CPT CODE:

J$20.54J0520-6

CPT CODE:

J$20.54J0520-Q

CPT CODE:

J$5.05J0558-6

CPT CODE:

J$5.05J0558-Q

CPT CODE:

J$7.00J0561-6

CPT CODE:

J$7.00J0561-Q

CPT CODE:

J$45.27J0565-6

CPT CODE:

J$98.98J0567-6

CPT CODE:

J$20.31J0570-6

CPT CODE:

J$2.70J0583-6

CPT CODE:

J$2.70J0583-Q

CPT CODE:

J$373.91J0584-6

CPT CODE:

J$6.94J0585-6

CPT CODE:

J$6.94J0585-Q

CPT CODE:

J$9.09J0586-6

CPT CODE:

J$9.09J0586-Q

CPT CODE:

J$14.26J0587-6

CPT CODE:

J$14.26J0587-Q

CPT CODE:

J$1.50J0592-6

CPT CODE:

J$1.50J0592-Q

CPT CODE:

J$13.44J0594-Q

CPT CODE:

J$11.94J0595-6

CPT CODE:

J$11.94J0595-Q

CPT CODE:

J$38.41J0596-6

CPT CODE:

J$46.07J0597-6

CPT CODE:

J$46.07J0597-Q

CPT CODE:

J$54.77J0598-6

CPT CODE:

J$54.77J0598-Q

CPT CODE:

J$10.34J0599-6

CPT CODE:

J$74.07J0600-6

CPT CODE:

J$74.07J0600-Q

CPT CODE:

J$3.67J0606-6

CPT CODE:

J$63.46J0610-6

CPT CODE:

J$63.46J0610-Q

CPT CODE:

J$20.54J0620-6

CPT CODE:

J$20.54J0620-Q

CPT CODE:

J$93.34J0630-6

CPT CODE:

J$93.34J0630-Q

CPT CODE:

J$21.87J0636-6

CPT CODE:

J$21.87J0636-Q

CPT CODE:

J$49.82J0637-6

CPT CODE:

J$49.82J0637-Q

CPT CODE:

J$113.96J0638-6

CPT CODE:

J$113.96J0638-Q

CPT CODE:

J$44.79J0640-Q

CPT CODE:

J$1.70J0641-6

CPT CODE:

J$1.70J0641-Q

CPT CODE:

J$20.54J0670-6

CPT CODE:

J$20.54J0670-Q

CPT CODE:

J$20.54J0690-6

CPT CODE:

J$20.54J0690-Q

CPT CODE:

J$12.34J0692-6

CPT CODE:

J$12.34J0692-Q

CPT CODE:

J$20.54J0694-6

CPT CODE:

J$2,554.24J0695-6

CPT CODE:

J$20.54J0696-6

CPT CODE:

J$20.54J0696-Q

CPT CODE:

J$20.54J0697-6

CPT CODE:

J$20.54J0697-Q

CPT CODE:

J$20.54J0698-6

CPT CODE:

J$20.54J0698-Q

CPT CODE:

J$7.51J0702-6

CPT CODE:

J$7.51J0702-Q

CPT CODE:

J$4.96J0706-6

CPT CODE:

J$4.96J0706-Q

CPT CODE:

J$20.54J0710-6

CPT CODE:

J$20.54J0710-Q

CPT CODE:

J$350.83J0714-6

CPT CODE:

J$6.30J0717-6

CPT CODE:

J$5.03J0718-6

CPT CODE:

J$5.03J0718-Q

CPT CODE:

J$20.54J0720-6

CPT CODE:

J$20.54J0720-Q

CPT CODE:

J$20.54J0725-6

CPT CODE:

J$20.54J0725-Q

CPT CODE:

J$96.29J0735-6

CPT CODE:

J$96.29J0735-Q

CPT CODE:

J$1,314.31J0740-3

CPT CODE:

J$1,351.46J0740-6

CPT CODE:

J$1,351.46J0740-Q

CPT CODE:

J$20.54J0743-6

CPT CODE:

J$20.54J0743-Q

CPT CODE:

J$24.08J0744-6

CPT CODE:

J$24.08J0744-Q

CPT CODE:

J$20.54J0745-6

CPT CODE:

J$20.54J0745-Q

CPT CODE:

J$69.07J0770-6

Page 65

Page 66: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

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

J$69.07J0770-Q

CPT CODE:

J$49.29J0775-6

CPT CODE:

J$49.29J0775-Q

CPT CODE:

J$20.54J0780-6

CPT CODE:

J$20.54J0780-Q

CPT CODE:

J$7.12J0795-6

CPT CODE:

J$7.12J0795-Q

CPT CODE:

J$48.55J0800-6

CPT CODE:

J$48.55J0800-Q

CPT CODE:

J$148.07J0834-6

CPT CODE:

J$148.07J0834-Q

CPT CODE:

J$1,341.66J0841-6

CPT CODE:

J$1,834.13J0875-6

CPT CODE:

J$0.49J0878-6

CPT CODE:

J$0.49J0878-Q

CPT CODE:

J$6.35J0881-6

CPT CODE:

J$6.35J0881-Q

CPT CODE:

J$6.35J0882-6

CPT CODE:

J$6.35J0882-Q

CPT CODE:

J$5.14J0883-6

CPT CODE:

J$5.14J0884-6

CPT CODE:

J$17.23J0885-6

CPT CODE:

J$17.23J0885-Q

CPT CODE:

J$13.53J0890-6

CPT CODE:

J$34.40J0894-Q

CPT CODE:

J$20.54J0895-6

CPT CODE:

J$20.54J0945-6

CPT CODE:

J$20.54J0945-Q

CPT CODE:

J$20.54J1000-6

CPT CODE:

J$20.54J1000-Q

CPT CODE:

J$20.54J1020-6

CPT CODE:

J$20.54J1020-Q

CPT CODE:

J$20.54J1030-6

CPT CODE:

J$20.54J1030-Q

CPT CODE:

J$20.54J1040-6

CPT CODE:

J$20.54J1040-Q

CPT CODE:

J$0.41J1050-6

CPT CODE:

J$0.03J1071-6

CPT CODE:

J$1.50J1094-6

CPT CODE:

J$1.50J1094-Q

CPT CODE:

J$1.15J1095-6

CPT CODE:

J$20.54J1100-6

CPT CODE:

J$20.54J1100-Q

CPT CODE:

J$20.54J1110-6

CPT CODE:

J$20.54J1110-Q

CPT CODE:

J$77.78J1120-6

CPT CODE:

J$77.78J1120-Q

CPT CODE:

J$0.25J1130-6

CPT CODE:

J$20.54J1160-6

CPT CODE:

J$20.54J1160-Q

CPT CODE:

J$826.52J1162-6

CPT CODE:

J$826.52J1162-Q

CPT CODE:

J$20.54J1165-6

CPT CODE:

J$20.54J1165-Q

CPT CODE:

J$20.54J1170-6

CPT CODE:

J$20.54J1170-Q

CPT CODE:

J$20.54J1180-6

CPT CODE:

J$20.54J1180-Q

CPT CODE:

J$20.54J1200-6

CPT CODE:

J$20.54J1200-Q

CPT CODE:

J$20.54J1205-6

CPT CODE:

J$20.54J1205-Q

CPT CODE:

J$87.72J1212-6

CPT CODE:

J$87.72J1212-Q

CPT CODE:

J$20.54J1230-6

CPT CODE:

J$20.54J1230-Q

CPT CODE:

J$20.54J1240-6

CPT CODE:

J$20.54J1240-Q

CPT CODE:

J$61.11J1245-6

CPT CODE:

J$3.31J1260-6

CPT CODE:

J$3.31J1260-Q

CPT CODE:

J$1.06J1267-6

CPT CODE:

J$1.06J1267-Q

CPT CODE:

J$17.06J1270-6

CPT CODE:

J$17.06J1270-Q

CPT CODE:

J$353.68J1290-6

CPT CODE:

J$353.68J1290-Q

CPT CODE:

J$242.15J1300-6

CPT CODE:

J$242.15J1300-Q

CPT CODE:

J$20.30J1301-6

CPT CODE:

J$20.54J1320-6

CPT CODE:

J$20.54J1320-Q

CPT CODE:

J$262.94J1322-6

CPT CODE:

J$30.40J1325-6

CPT CODE:

J$30.40J1325-Q

CPT CODE:

J$19.61J1327-6

CPT CODE:

J$19.61J1327-Q

CPT CODE:

J$18.58J1330-Q

CPT CODE:

J$36.88J1335-6

CPT CODE:

J$36.88J1335-Q

CPT CODE:

J$20.54J1380-6

CPT CODE:

J$20.54J1380-Q

CPT CODE:

J$75.94J1410-6

CPT CODE:

J$75.94J1410-Q

CPT CODE:

J$190.62J1428-6

CPT CODE:

J$115.36J1430-6

CPT CODE:

J$115.36J1430-Q

CPT CODE:

J$20.54J1435-6

CPT CODE:

J$20.54J1435-Q

CPT CODE:

J$130.64J1436-6

CPT CODE:

J$130.64J1436-Q

CPT CODE:

J$228.85J1438-6

CPT CODE:

J$228.85J1438-Q

CPT CODE:

J$1.23J1439-6

CPT CODE:

J$1.22J1442-6

CPT CODE:

J$7.57J1443-6

CPT CODE:

J$1.77J1447-6

CPT CODE:

J$138.47J1450-6

CPT CODE:

J$138.47J1450-Q

CPT CODE:

J$19.07J1451-6

CPT CODE:

J$19.07J1451-Q

CPT CODE:

J$1,559.72J1452-6

CPT CODE:

J$1,559.72J1452-Q

CPT CODE:

J$2.46J1453-6

CPT CODE:

J$2.46J1453-Q

CPT CODE:

J$560.86J1454-6

CPT CODE:

J$20.54J1455-6

CPT CODE:

J$20.54J1455-Q

CPT CODE:

J$2.07J1457-6

CPT CODE:

J$2.07J1457-Q

CPT CODE:

J$488.95J1458-6

CPT CODE:

J$488.95J1458-Q

CPT CODE:

J$58.70J1459-6

CPT CODE:

J$58.70J1459-Q

CPT CODE:

J$20.54J1460-6

CPT CODE:

J$20.54J1460-Q

CPT CODE:

J$20.02J1555-6

CPT CODE:

J$75.01J1556-6

CPT CODE:

J$20.54J1560-6

CPT CODE:

J$20.54J1560-Q

CPT CODE:

J$59.87J1561-6

CPT CODE:

J$59.87J1561-Q

CPT CODE:

J$47.73J1566-6

CPT CODE:

J$47.73J1566-Q

CPT CODE:

J$72.80J1570-6

CPT CODE:

J$72.80J1570-Q

CPT CODE:

J$54.22J1575-6

CPT CODE:

J$20.54J1580-6

CPT CODE:

J$20.54J1580-Q

CPT CODE:

J$20.54J1600-6

CPT CODE:

J$20.54J1600-Q

CPT CODE:

J$28.76J1602-6

CPT CODE:

J$30.40J1626-6

CPT CODE:

J$30.40J1626-Q

CPT CODE:

J$5.90J1627-6

CPT CODE:

J$20.54J1630-6

CPT CODE:

J$20.54J1630-Q

CPT CODE:

J$67.17J1631-6

CPT CODE:

J$67.17J1631-Q

CPT CODE:

J$11.26J1640-6

CPT CODE:

J$11.26J1640-Q

CPT CODE:

J$13.08J1652-6

Page 66

Page 67: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

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

J$13.08J1652-Q

CPT CODE:

J$6.49J1655-6

CPT CODE:

J$6.49J1655-Q

CPT CODE:

J$124.01J1670-6

CPT CODE:

J$124.01J1670-Q

CPT CODE:

J$20.54J1700-6

CPT CODE:

J$20.54J1700-Q

CPT CODE:

J$20.54J1710-6

CPT CODE:

J$20.54J1710-Q

CPT CODE:

J$20.54J1720-6

CPT CODE:

J$20.54J1720-Q

CPT CODE:

J$32.73J1726-6

CPT CODE:

J$15.33J1729-6

CPT CODE:

J$192.93J1740-6

CPT CODE:

J$192.93J1740-Q

CPT CODE:

J$1.64J1741-6

CPT CODE:

J$292.27J1742-6

CPT CODE:

J$292.27J1742-Q

CPT CODE:

J$98.86J1745-6

CPT CODE:

J$98.86J1745-Q

CPT CODE:

J$62.41J1746-6

CPT CODE:

J$1.03J1756-6

CPT CODE:

J$1.03J1756-Q

CPT CODE:

J$49.91J1786-6

CPT CODE:

J$49.91J1786-Q

CPT CODE:

J$20.54J1790-6

CPT CODE:

J$20.54J1790-Q

CPT CODE:

J$20.54J1800-6

CPT CODE:

J$20.54J1800-Q

CPT CODE:

J$20.54J1810-6

CPT CODE:

J$20.54J1810-Q

CPT CODE:

J$0.18J1815-6

CPT CODE:

J$0.18J1815-Q

CPT CODE:

J$1.82J1817-6

CPT CODE:

J$1.82J1817-Q

CPT CODE:

J$1,032.85J1826-6

CPT CODE:

J$1,032.85J1826-Q

CPT CODE:

J$293.58J1833-6

CPT CODE:

J$1,426.05J1835-6

CPT CODE:

J$1,426.05J1835-Q

CPT CODE:

J$20.54J1840-6

CPT CODE:

J$20.54J1840-Q

CPT CODE:

J$20.54J1850-6

CPT CODE:

J$20.54J1850-Q

CPT CODE:

J$20.54J1885-6

CPT CODE:

J$20.54J1885-Q

CPT CODE:

J$20.54J1890-6

CPT CODE:

J$20.54J1890-Q

CPT CODE:

J$33.65J1930-6

CPT CODE:

J$33.65J1930-Q

CPT CODE:

J$36.88J1931-6

CPT CODE:

J$36.88J1931-Q

CPT CODE:

J$20.54J1940-6

CPT CODE:

J$20.54J1940-Q

CPT CODE:

J$248.65J1945-6

CPT CODE:

J$248.65J1945-Q

CPT CODE:

J$0.80J1953-6

CPT CODE:

J$0.80J1953-Q

CPT CODE:

J$36.55J1956-6

CPT CODE:

J$36.55J1956-Q

CPT CODE:

J$20.54J1960-6

CPT CODE:

J$20.54J1960-Q

CPT CODE:

J$20.54J1980-6

CPT CODE:

J$20.54J1980-Q

CPT CODE:

J$20.54J1990-6

CPT CODE:

J$20.54J1990-Q

CPT CODE:

J$20.54J2010-6

CPT CODE:

J$20.54J2010-Q

CPT CODE:

J$58.78J2020-6

CPT CODE:

J$58.78J2020-Q

CPT CODE:

J$20.54J2060-6

CPT CODE:

J$20.54J2060-Q

CPT CODE:

J$16.50J2062-6

CPT CODE:

J$20.54J2150-6

CPT CODE:

J$20.54J2150-Q

CPT CODE:

J$20.54J2175-6

CPT CODE:

J$20.54J2175-Q

CPT CODE:

J$20.54J2180-6

CPT CODE:

J$20.54J2180-Q

CPT CODE:

J$30.76J2182-6

CPT CODE:

J$8.10J2185-6

CPT CODE:

J$8.10J2185-Q

CPT CODE:

J$18.15J2186-6

CPT CODE:

J$20.54J2210-6

CPT CODE:

J$20.54J2210-Q

CPT CODE:

J$0.48J2212-6

CPT CODE:

J$2.68J2248-6

CPT CODE:

J$2.68J2248-Q

CPT CODE:

J$20.54J2270-6

CPT CODE:

J$20.54J2270-Q

CPT CODE:

J$9.81J2274-6

CPT CODE:

J$9.62J2278-6

CPT CODE:

J$9.62J2278-Q

CPT CODE:

J$16.14J2280-6

CPT CODE:

J$16.14J2280-Q

CPT CODE:

J$20.54J2320-6

CPT CODE:

J$20.54J2320-Q

CPT CODE:

J$48.66J2325-6

CPT CODE:

J$48.66J2325-Q

CPT CODE:

J$1,241.00J2326-6

CPT CODE:

J$60.88J2350-6

CPT CODE:

J$129.01J2353-6

CPT CODE:

J$129.01J2353-Q

CPT CODE:

J$7.07J2354-6

CPT CODE:

J$7.07J2354-Q

CPT CODE:

J$438.52J2355-6

CPT CODE:

J$438.52J2355-Q

CPT CODE:

J$22.52J2357-6

CPT CODE:

J$22.52J2357-Q

CPT CODE:

J$4.02J2358-6

CPT CODE:

J$4.02J2358-Q

CPT CODE:

J$20.54J2360-6

CPT CODE:

J$20.54J2360-Q

CPT CODE:

J$20.54J2370-6

CPT CODE:

J$20.54J2370-Q

CPT CODE:

J$46.30J2400-6

CPT CODE:

J$46.30J2400-Q

CPT CODE:

J$11.20J2405-6

CPT CODE:

J$11.20J2405-Q

CPT CODE:

J$3,569.79J2407-6

CPT CODE:

J$20.54J2410-6

CPT CODE:

J$20.54J2410-Q

CPT CODE:

J$18.94J2425-6

CPT CODE:

J$18.94J2425-Q

CPT CODE:

J$9.61J2426-6

CPT CODE:

J$9.61J2426-Q

CPT CODE:

J$20.54J2460-6

CPT CODE:

J$20.54J2460-Q

CPT CODE:

J$48.74J2469-6

CPT CODE:

J$48.74J2469-Q

CPT CODE:

J$7.95J2501-6

CPT CODE:

J$7.95J2501-Q

CPT CODE:

J$13,256.45J2502-6

CPT CODE:

J$1,480.31J2503-6

CPT CODE:

J$1,480.31J2503-Q

CPT CODE:

J$270.00J2504-6

CPT CODE:

J$270.00J2504-Q

CPT CODE:

J$4,353.07J2505-6

CPT CODE:

J$4,353.07J2505-Q

CPT CODE:

J$20.54J2510-6

CPT CODE:

J$20.54J2510-Q

CPT CODE:

J$21.90J2513-6

CPT CODE:

J$21.90J2513-Q

CPT CODE:

J$20.54J2515-6

CPT CODE:

J$20.54J2515-Q

CPT CODE:

J$20.54J2540-6

CPT CODE:

J$20.54J2540-Q

CPT CODE:

J$8.88J2543-6

CPT CODE:

J$8.88J2543-Q

CPT CODE:

J$1,169.41J2547-6

CPT CODE:

J$20.54J2550-6

CPT CODE:

J$20.54J2550-Q

Page 67

Page 68: 2020 Alabama Workers' Compensation Prevailing …cpt code:12056-2 $760.83 cpt code:12057-2 $1,027.65 cpt code:13100-2 $296.43 cpt code:13101-2 $345.84 cpt code:13102-2 $80.87 cpt code:13120-2

2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

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

J$20.54J2560-6

CPT CODE:

J$20.54J2560-Q

CPT CODE:

J$358.81J2562-6

CPT CODE:

J$358.81J2562-Q

CPT CODE:

J$20.54J2590-6

CPT CODE:

J$20.54J2590-Q

CPT CODE:

J$20.54J2650-6

CPT CODE:

J$20.54J2650-Q

CPT CODE:

J$50.00J2680-6

CPT CODE:

J$50.00J2680-Q

CPT CODE:

J$20.54J2690-6

CPT CODE:

J$20.54J2690-Q

CPT CODE:

J$20.54J2700-6

CPT CODE:

J$20.54J2700-Q

CPT CODE:

J$20.54J2710-6

CPT CODE:

J$20.54J2710-Q

CPT CODE:

J$20.54J2720-6

CPT CODE:

J$20.54J2720-Q

CPT CODE:

J$65.32J2730-6

CPT CODE:

J$65.32J2730-Q

CPT CODE:

J$63.46J2760-6

CPT CODE:

J$63.46J2760-Q

CPT CODE:

J$20.54J2765-6

CPT CODE:

J$20.54J2765-Q

CPT CODE:

J$167.56J2770-6

CPT CODE:

J$167.56J2770-Q

CPT CODE:

J$2.50J2780-6

CPT CODE:

J$2.50J2780-Q

CPT CODE:

J$549.67J2783-6

CPT CODE:

J$549.67J2783-Q

CPT CODE:

J$73.59J2785-6

CPT CODE:

J$73.59J2785-Q

CPT CODE:

J$9.60J2786-6

CPT CODE:

J$3,134.22J2787-6

CPT CODE:

J$56.85J2788-6

CPT CODE:

J$56.85J2788-Q

CPT CODE:

J$130.64J2790-6

CPT CODE:

J$38.21J2792-6

CPT CODE:

J$38.21J2792-Q

CPT CODE:

J$7.82J2794-6

CPT CODE:

J$7.82J2794-C

CPT CODE:

J$7.82J2794-Q

CPT CODE:

J$7.82J2794-X

CPT CODE:

J$1.57J2795-6

CPT CODE:

J$1.57J2795-Q

CPT CODE:

J$58.01J2796-6

CPT CODE:

J$58.01J2796-Q

CPT CODE:

J$0.98J2797-6

CPT CODE:

J$20.54J2800-6

CPT CODE:

J$20.54J2800-Q

CPT CODE:

J$218.38J2820-Q

CPT CODE:

J$574.32J2840-6

CPT CODE:

J$102.55J2860-6

CPT CODE:

J$20.54J2910-6

CPT CODE:

J$20.54J2910-Q

CPT CODE:

J$12.93J2916-6

CPT CODE:

J$12.93J2916-Q

CPT CODE:

J$20.54J2920-6

CPT CODE:

J$20.54J2920-Q

CPT CODE:

J$20.54J2930-6

CPT CODE:

J$20.54J2930-Q

CPT CODE:

J$68.04J2940-6

CPT CODE:

J$68.04J2940-Q

CPT CODE:

J$68.04J2941-6

CPT CODE:

J$68.04J2941-Q

CPT CODE:

J$20.54J2950-6

CPT CODE:

J$20.54J2950-Q

CPT CODE:

J$2,144.63J2993-6

CPT CODE:

J$42.87J2997-6

CPT CODE:

J$42.87J2997-Q

CPT CODE:

J$20.54J3000-6

CPT CODE:

J$20.54J3000-Q

CPT CODE:

J$20.54J3010-6

CPT CODE:

J$20.54J3010-Q

CPT CODE:

J$37.28J3060-6

CPT CODE:

J$20.54J3070-6

CPT CODE:

J$20.54J3070-Q

CPT CODE:

J$1.45J3090-6

CPT CODE:

J$3.14J3095-6

CPT CODE:

J$3.14J3095-Q

CPT CODE:

J$77.72J3101-6

CPT CODE:

J$77.72J3101-Q

CPT CODE:

J$20.54J3105-6

CPT CODE:

J$20.54J3105-Q

CPT CODE:

J$0.06J3121-6

CPT CODE:

J$1.38J3145-6

CPT CODE:

J$20.54J3230-6

CPT CODE:

J$20.54J3230-Q

CPT CODE:

J$363.97J3240-6

CPT CODE:

J$363.97J3240-Q

CPT CODE:

J$1.52J3243-6

CPT CODE:

J$1.52J3243-Q

CPT CODE:

J$145.78J3245-6

CPT CODE:

J$14.21J3246-6

CPT CODE:

J$14.21J3246-Q

CPT CODE:

J$20.54J3250-6

CPT CODE:

J$20.54J3250-Q

CPT CODE:

J$20.54J3260-6

CPT CODE:

J$20.54J3260-Q

CPT CODE:

J$4.28J3262-6

CPT CODE:

J$4.28J3262-Q

CPT CODE:

J$20.54J3280-6

CPT CODE:

J$20.54J3280-Q

CPT CODE:

J$89.54J3285-6

CPT CODE:

J$5.01J3300-6

CPT CODE:

J$5.01J3300-Q

CPT CODE:

J$20.54J3301-6

CPT CODE:

J$20.54J3301-Q

CPT CODE:

J$20.54J3302-6

CPT CODE:

J$20.54J3302-Q

CPT CODE:

J$20.54J3303-6

CPT CODE:

J$20.54J3303-Q

CPT CODE:

J$19.59J3304-6

CPT CODE:

J$20.54J3310-6

CPT CODE:

J$20.54J3310-Q

CPT CODE:

J$624.38J3315-6

CPT CODE:

J$624.38J3315-Q

CPT CODE:

J$3,005.91J3316-6

CPT CODE:

J$44.45J3320-6

CPT CODE:

J$44.45J3320-Q

CPT CODE:

J$139.99J3350-6

CPT CODE:

J$139.99J3350-Q

CPT CODE:

J$145.07J3357-6

CPT CODE:

J$145.07J3357-Q

CPT CODE:

J$13.83J3358-6

CPT CODE:

J$20.54J3360-6

CPT CODE:

J$20.54J3360-Q

CPT CODE:

J$109.28J3364-6

CPT CODE:

J$109.28J3364-Q

CPT CODE:

J$52.25J3370-6

CPT CODE:

J$52.25J3370-Q

CPT CODE:

J$19.77J3380-6

CPT CODE:

J$424.86J3385-6

CPT CODE:

J$424.86J3385-Q

CPT CODE:

J$14.52J3396-6

CPT CODE:

J$14.52J3396-Q

CPT CODE:

J$46.52J3397-6

CPT CODE:

J$20.54J3400-6

CPT CODE:

J$20.54J3400-Q

CPT CODE:

J$20.54J3410-6

CPT CODE:

J$20.54J3410-Q

CPT CODE:

J$1.47J3411-6

CPT CODE:

J$1.47J3411-Q

CPT CODE:

J$1.47J3415-6

CPT CODE:

J$1.47J3415-Q

CPT CODE:

J$20.54J3420-6

CPT CODE:

J$20.54J3420-Q

CPT CODE:

J$20.54J3430-6

CPT CODE:

J$20.54J3430-Q

CPT CODE:

J$7.75J3465-6

CPT CODE:

J$7.75J3465-Q

CPT CODE:

J$20.54J3470-6

Page 68

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

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

J$20.54J3470-Q

CPT CODE:

J$0.19J3471-6

CPT CODE:

J$0.19J3471-Q

CPT CODE:

J$223.85J3472-6

CPT CODE:

J$223.85J3472-Q

CPT CODE:

J$0.64J3473-6

CPT CODE:

J$0.64J3473-Q

CPT CODE:

J$1.57J3485-6

CPT CODE:

J$1.57J3485-Q

CPT CODE:

J$32.30J3486-6

CPT CODE:

J$32.30J3486-Q

CPT CODE:

J$262.31J3489-6

CPT CODE:

J$2.41J7121-6

CPT CODE:

J$54.55J7170-6

CPT CODE:

J$1.21J7177-6

CPT CODE:

J$1.14J7178-6

CPT CODE:

J$6.35J7188-6

CPT CODE:

J$2.13J7189-6

CPT CODE:

J$2.13J7189-Q

CPT CODE:

J$4.40J7203-6

CPT CODE:

J$2.23J7205-6

CPT CODE:

J$964.69J7296-6

CPT CODE:

J$765.57J7297-6

CPT CODE:

J$997.70J7298-6

CPT CODE:

J$813.17J7301-6

CPT CODE:

J$163.93J7308-6

CPT CODE:

J$163.93J7308-Q

CPT CODE:

J$103.89J7309-6

CPT CODE:

J$103.89J7309-Q

CPT CODE:

J$238.49J7312-6

CPT CODE:

J$238.49J7312-Q

CPT CODE:

J$570.13J7313-6

CPT CODE:

J$449.42J7315-6

CPT CODE:

J$1,234.79J7316-6

CPT CODE:

J$17.87J7318-6

CPT CODE:

J$8.04J7320-6

CPT CODE:

J$159.43J7321-6

CPT CODE:

J$19.15J7322-6

CPT CODE:

J$168.34J7323-6

CPT CODE:

J$287.38J7324-6

CPT CODE:

J$20.60J7325-6

CPT CODE:

J$1,130.45J7327-6

CPT CODE:

J$7.47J7329-6

CPT CODE:

J$3.28J7336-6

CPT CODE:

J$15.17J7345-6

CPT CODE:

J$527.94J7511-6

CPT CODE:

J$527.94J7511-Q

CPT CODE:

J$765.77J7513-6

CPT CODE:

J$378.72J7513-Q

CPT CODE:

J$53.38J7516-6

CPT CODE:

J$53.38J7516-Q

CPT CODE:

J$102.66J9000-Q

CPT CODE:

J$806.37J9010-Q

CPT CODE:

J$410.63J9019-6

CPT CODE:

J$104.54J9020-Q

CPT CODE:

J$85.57J9022-6

CPT CODE:

J$84.52J9023-6

CPT CODE:

J$5.67J9025-Q

CPT CODE:

J$162.73J9027-Q

CPT CODE:

J$37.10J9032-6

CPT CODE:

J$24.74J9033-Q

CPT CODE:

J$28.32J9034-Q

CPT CODE:

J$93.57J9035-Q

CPT CODE:

J$111.79J9039-6

CPT CODE:

J$546.89J9040-Q

CPT CODE:

J$44.58J9041-Q

CPT CODE:

J$121.58J9042-6

CPT CODE:

J$50.37J9044-6

CPT CODE:

J$181.49J9045-Q

CPT CODE:

J$34.55J9047-6

CPT CODE:

J$158.66J9050-Q

CPT CODE:

J$78.39J9055-Q

CPT CODE:

J$83.83J9057-6

CPT CODE:

J$75.94J9060-Q

CPT CODE:

J$11.20J9070-Q

CPT CODE:

J$592.42J9098-Q

CPT CODE:

J$14.93J9100-Q

CPT CODE:

J$24.26J9120-Q

CPT CODE:

J$28.00J9130-Q

CPT CODE:

J$54.79J9145-Q

CPT CODE:

J$151.21J9150-Q

CPT CODE:

J$114.63J9151-Q

CPT CODE:

J$199.52J9153-6

CPT CODE:

J$4.90J9155-Q

CPT CODE:

J$1,559.52J9160-Q

CPT CODE:

J$26.13J9165-Q

CPT CODE:

J$24.60J9171-Q

CPT CODE:

J$77.09J9173-6

CPT CODE:

J$5.18J9175-6

CPT CODE:

J$5.18J9175-Q

CPT CODE:

J$7.21J9176-Q

CPT CODE:

J$42.00J9178-Q

CPT CODE:

J$29.84J9181-Q

CPT CODE:

J$349.05J9185-Q

CPT CODE:

J$5.62J9190-Q

CPT CODE:

J$81.70J9199-6

CPT CODE:

J$242.64J9200-Q

CPT CODE:

J$148.67J9201-Q

CPT CODE:

J$837.16J9202-Q

CPT CODE:

J$204.80J9203-6

CPT CODE:

J$45.86J9205-Q

CPT CODE:

J$190.91J9206-Q

CPT CODE:

J$82.46J9207-Q

CPT CODE:

J$244.46J9208-Q

CPT CODE:

J$64.82J9209-Q

CPT CODE:

J$464.76J9211-Q

CPT CODE:

J$8.32J9212-Q

CPT CODE:

J$59.71J9213-Q

CPT CODE:

J$20.54J9214-Q

CPT CODE:

J$16.67J9215-Q

CPT CODE:

J$287.43J9216-Q

CPT CODE:

J$953.77J9217-Q

CPT CODE:

J$46.30J9218-Q

CPT CODE:

J$6,942.79J9225-Q

CPT CODE:

J$2,284.98J9229-6

CPT CODE:

J$22.38J9230-Q

CPT CODE:

J$18.67J9250-Q

CPT CODE:

J$31.72J9260-Q

CPT CODE:

J$2.99J9262-6

CPT CODE:

J$13.94J9263-Q

CPT CODE:

J$12.44J9264-Q

CPT CODE:

J$0.18J9267-6

CPT CODE:

J$2,956.42J9268-Q

CPT CODE:

J$154.93J9270-Q

CPT CODE:

J$53.12J9271-6

CPT CODE:

J$255.71J9280-Q

CPT CODE:

J$56.23J9285-6

CPT CODE:

J$1,265.44J9293-Q

CPT CODE:

J$6.09J9295-6

CPT CODE:

J$29.52J9299-6

CPT CODE:

J$62.99J9301-6

CPT CODE:

J$60.06J9302-Q

CPT CODE:

J$66.34J9305-Q

CPT CODE:

J$12.14J9306-6

CPT CODE:

J$213.29J9307-Q

CPT CODE:

J$62.78J9308-6

CPT CODE:

J$115.18J9309-6

CPT CODE:

J$51.66J9311-6

CPT CODE:

J$103.32J9312-6

CPT CODE:

J$288.17J9315-Q

CPT CODE:

J$140.75J9320-Q

CPT CODE:

J$53.69J9325-Q

CPT CODE:

J$6.12J9328-Q

CPT CODE:

J$61.87J9330-Q

CPT CODE:

J$172.25J9340-Q

CPT CODE:

J$35.51J9351-Q

CPT CODE:

J$328.74J9352-6

CPT CODE:

J$34.68J9354-6

CPT CODE:

J$79.00J9355-Q

CPT CODE:

J$684.54J9357-Q

CPT CODE:

J$31.72J9360-Q

CPT CODE:

J$67.17J9370-Q

Page 69

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2020 Alabama Workers' Compensation Prevailing Rate/Maximum Fee Schedule for Physicians effective March 1, 2020

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

J$2,438.32J9371-6

CPT CODE:

J$132.38J9395-Q

CPT CODE:

J$18.50J9400-6

CPT CODE:

J$4,348.35J9600-Q

CPT CODE: $89.48P9045-6

CPT CODE: $89.48P9045-Q

CPT CODE: $40.31P9046-6

CPT CODE: $40.31P9046-Q

CPT CODE: $120.72P9047-6

CPT CODE: $120.72P9047-Q

CPT CODE: $134.98P9048-6

CPT CODE: $134.98P9048-Q

CPT CODE: $13.29P9612-6

CPT CODE: $9.88P9615-6

CPT CODE: $1.08Q0138-6

CPT CODE: $1.08Q0138-Q

CPT CODE: $1.08Q0139-6

CPT CODE: $1.08Q0139-Q

CPT CODE: $59.03Q3031-6

CPT CODE: $1.71Q4081-6

CPT CODE: $1.71Q4081-Q

CPT CODE: $1.13Q5101-6

CPT CODE: $0.53Q9965-5

CPT CODE: $0.53Q9965-G

CPT CODE: $0.62Q9966-5

CPT CODE: $0.62Q9966-G

CPT CODE: $0.63Q9967-5

CPT CODE: $0.63Q9967-G

CPT CODE: $985.92Q9984-6

CPT CODE: $15.67Q9985-6

CPT CODE: $33.45Q9986-6

CPT CODE: $14.14Q9989-6

CPT CODE: $11.10S0156-6

CPT CODE: $11.10S0156-Q

CPT CODE: $32.66S0164-6

CPT CODE: $32.66S0164-Q

CPT CODE: $7.64S0166-6

CPT CODE: $7.64S0166-Q

CPT CODE: $34.44S0265-6

CPT CODE: $45.22S0311-6

CPT CODE: $67.66S0390-6

CPT CODE: $4,758.01S2068-2

CPT CODE: $3,120.13S2079-2

CPT CODE: $68.77S2083-2

CPT CODE: $2,434.77S2095-2

CPT CODE: $1,504.27S2117-2

CPT CODE: $4,651.61S2118-2

CPT CODE: $295.13S2225-2

CPT CODE: $2,157.37S2325-2

CPT CODE: $59.03S3000-6

CPT CODE: $59.03S3000-A

CPT CODE: $59.03S3000-M

CPT CODE: $59.03S3000-N

CPT CODE: $5,696.45S3865-8

CPT CODE: $926.25S3866-8

CPT CODE: $0.20S5550-6

CPT CODE: $0.20S5550-Q

CPT CODE: $0.47S5551-6

CPT CODE: $0.47S5551Q

CPT CODE: $736.18S9025-6

CPT CODE: $2,269.01S9034-2

CPT CODE: $687.42S9055-6

Page 70