2015 Workers' Compensation Fee Schedule

Table A: Prospective Payment System

NPI or Provider # Provider # Indirect Medical Education Add-On Direct Medical Education Add-On Disproportionate Share Add-On Paramedical Education Add-On Aggregate RCC DRG Rate Capital Rate Hold Harmless Rate
Implied Decimal 6 (in percentages) Implied Decimal 4 (in percentages) Implied Decimal 6 (in percentages) Implied Decimal 2 (in dollars)
1366444507 390001 36081 15591 646 36277 485198 649650 16673 125921
1194734798 390002 135468 52932 414 0 551833 722071 68255 0
1942364898 390002 135468 52932 414 0 551833 722071 68255 0
1821198755 390003 0 0 297 0 579483 649650 63461 0
1881690212 390004 0 0 0 1397 498517 700568 55833 0
1235215427 390006 263657 107593 444 15014 508391 649650 56339 0
1033491741 390006 263657 107593 444 15014 508391 649650 56339 0
1982988408 390006 263657 107593 444 15014 508391 649650 56339 0
1417231937 390006 263657 107593 444 15014 508391 649650 56339 0
1275832164 390006 263657 107593 444 15014 508391 649650 56339 0
1457650343 390006 263657 107593 444 15014 508391 649650 56339 0
1427344969 390006 263657 107593 444 15014 508391 649650 56339 0
1154617694 390006 263657 107593 444 15014 508391 649650 56339 0
1467748475 390006 263657 107593 444 15014 508391 649650 56339 0
1063708501 390006 263657 107593 444 15014 508391 649650 56339 0
1770879215 390006 263657 107593 444 15014 508391 649650 56339 0
1275850620 390006 263657 107593 444 15014 508391 649650 56339 0
1528197720 390006 263657 107593 444 15014 508391 649650 56339 0
1063540011 390006 263657 107593 444 15014 508391 649650 56339 0
1851508162 390006 263657 107593 444 15014 508391 649650 56339 0
1669768289 390006 263657 107593 444 15014 508391 649650 56339 0
1710087069 390008 0 0 0 0 642456 722071 56338 0
1861435042 390009 35262 16381 283 16884 388855 666146 70796 0
1386896306 390012 0 0 0 0 681384 790152 70340 0
1124076039 390013 0 0 0 0 770580 647077 43879 0
1477538312 390016 0 0 383 46405 645555 722071 73895 0
1750488995 390019 0 0 0 0 585491 725487 54371 0
1356313464 390026 102863 44440 0 0 700974 790152 56168 0
1962579029 390027 369197 164426 3735 1000 346350 790152 37491 169761
1881695146 390028 212670 105091 638 19969 407418 722071 78369 0
1568526135 390028 212670 105091 638 19969 407418 722071 78369 0
1235138405 390030 0 0 0 36715 651378 647077 65422 0
1427050376 390031 0 0 0 0 506323 647077 16429 70204
1689679581 390032 0 0 0 6702 511963 722071 73895 0
1669405072 390035 0 0 0 0 361107 790152 80473 0
1063422053 390036 39427 27555 0 969 537674 722071 33998 61467
1588770416 390037 0 0 0 43300 635158 722071 75946 0
1912900168 390039 0 0 825 2588 541040 658900 70316 0
1871594127 390041 0 0 841 23769 496716 722071 73895 0
1609984889 390042 43209 30912 256 42196 0 722071 73895 0
1740298017 390043 0 0 0 0 551130 647077 41307 0
1669530069 390044 84971 23313 0 21042 1186896 676368 58772 0
1609801976 390045 44467 21869 287 5640 402000 638701 13100 103946
1326060492 390046 144496 64117 259 5922 604415 668403 52608 0
1861545683 390048 8240 34578 0 0 1965165 647077 63958 0
1013933175 390049 68656 32236 0 133798 607630 737160 73203 0
1548293954 390049 68656 32236 0 133798 607630 737160 73203 0
1285667493 390050 248542 77734 534 3112 387091 722071 37175 92596
1427022078 390052 0 0 0 4853 513732 647077 49253 0
1700878840 390056 0 0 0 0 597279 647077 9370 147793
1568459287 390057 0 0 0 0 450593 790152 86883 0
1730133844 390058 0 0 0 3047 554630 700568 58413 0
1467491027 390061 0 0 286 18710 628825 685978 72869 0
1497708473 390062 0 0 0 0 1116623 678678 67159 0
1487647590 390063 52946 32583 539 6973 397020 666146 67346 0
1265466957 390065 0 0 0 0 736431 788428 80312 0
1407928500 390066 39353 17255 0 0 492272 700568 54520 0
1407813603 390067 130828 52674 433 2232 445000 700568 62368 0
1770539637 390068 58594 33076 854 0 193955 685978 70115 0
1528319621 390070 9153 2964 0 0 431480 790152 46272 0
1144291840 390071 0 0 0 0 1179577 647077 64401 0
1316919699 390072 0 0 710 0 519617 649650 60121 0
1649278730 390073 37941 30974 410 25331 446000 678678 68599 0
1083685622 390076 0 0 411 33214 487369 790152 31749 120701
1083614382 390079 112108 37346 0 20184 634945 647077 21804 131499
1912902206 390080 7099 5644 0 0 387978 790152 23694 137043
1073606737 390081 29962 0 0 0 351953 790152 57026 0
1467424820 390084 0 0 0 0 554025 647077 45180 0
1144249657 390086 0 0 400 0 677485 647077 63964 0
1194744805 390090 174532 60762 649 37073 356554 722071 73895 0
1619069440 390091 0 0 0 3356 597181 647077 68710 0
1265422901 390093 30411 20351 0 0 620784 647077 4873 94842
1699734665 390096 26367 33298 859 3219 528137 676368 23121 64041
1750371522 390097 0 0 0 570 357027 790152 71295 0
1104875103 390100 56910 18259 0 19607 724335 685978 50425 0
1043585524 390101 92128 52381 390 0 497259 668403 47824 0
1790795359 390102 110841 116437 0 14691 462514 722071 78835 0
1750445607 390102 110841 116437 0 14691 462514 722071 78835 0
1861478307 390104 0 0 0 0 0 712893 65422 0
1225047699 390107 0 0 0 0 560569 722071 58437 0
1639218936 390107 0 0 0 0 560569 722071 58437 0
1801897038 390110 126380 68584 690 37359 416925 648468 22099 88499
1851370910 390111 539305 313211 1585 7937 321731 790152 20899 270454
1275620536 390112 0 0 0 0 607604 648468 6774 78054
1942276423 390113 0 0 1000 0 802026 661552 58714 0
1952311508 390114 147995 110633 1702 0 479453 722071 30634 124161
1659435501 390114 147995 110633 1702 0 479453 722071 30634 124161
1801963343 390115 60642 41217 671 31461 288789 790152 44234 77363
1114095791 390115 60642 41217 671 31461 288789 790152 44234 77363
1205904885 390115 60642 41217 671 31461 288789 790152 44234 77363
1215952106 390115 60642 41217 671 31461 288789 790152 44234 77363
1225022064 390116 219851 95443 268 894 449520 790152 84560 124995
1295724193 390117 0 0 0 0 726684 647077 52592 0
1578569885 390118 0 0 0 0 414013 647077 56114 0
1922376136 390119 24716 27385 0 0 428010 649650 5733 116676
1891899332 390122 0 0 0 0 605943 647077 52175 0
1891768099 390123 0 0 0 0 475055 790152 70177 0
1124026182 390125 0 0 0 0 562680 647077 65422 0
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