2016 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)
1528039039 390127 0 0 0 0 633294 813066 90828 0
1184620486 390130 0 0 0 0 3156950 667274 46550 0
1104897529 390132 35113 15735 6485 0 1536568 813066 133295 0
1164400131 390133 96119 30636 0 2145 517000 758538 69099 0
1255585303 390137 23063 14230 635 0 455845 668490 65558 0
1821091059 390138 0 0 0 0 791148 665842 48071 0
1508971441 390139 70978 34408 0 4335 408291 813066 78999 0
1902805245 390142 369904 212140 1506 4035 365688 813066 192383 0
1689691214 390145 0 0 360 1235 427067 743011 79949 0
1659360220 390146 0 0 0 0 896975 665842 65875 0
1912905548 390147 0 0 0 0 549750 743011 80000 0
1225417421 390150 0 0 0 0 591382 665842 64653 0
1972982882 390150 0 0 0 0 591382 665842 64653 0
1902804552 390151 0 0 0 0 640294 665842 44720 0
1215042114 390153 0 0 0 0 894406 813066 107467 0
1285639278 390154 0 0 0 0 1663757 665842 54333 0
1730173550 390156 159051 111309 1547 0 352862 813066 91340 0
1861486698 390156 159051 111309 1547 0 352862 813066 91340 0
1073598439 390157 0 0 0 35511 621777 743011 76038 0
1962401497 390160 0 0 0 0 846365 743011 76038 0
1740252964 390162 75610 51350 0 0 625314 758538 66346 0
1457408973 390163 0 0 374 0 909003 676557 58994 0
1568577724 390163 0 0 374 0 909003 676557 58994 0
1144384082 390164 429609 170349 862 7967 363586 743011 29590 226612
1821007881 390164 429609 170349 862 7967 363586 743011 29590 226612
1447317896 390168 0 0 732 0 515034 743011 14725 81625
1013098078 390169 0 0 266 0 556982 668490 48581 0
1356334510 390173 0 0 0 0 537053 711421 20197 65924
1134297393 390174 52652 34199 731 45941 383273 813066 12511 162983
1215916002 390174 463742 229874 1399 15681 377172 813066 19513 226401
1225048838 390178 28914 1845 826 0 674040 683662 64394 0
1952465890 390178 28914 1845 826 0 674040 683662 64394 0
1356333579 390179 0 0 260 41582 430116 813066 48145 70742
1134212772 390180 112319 70954 923 9057 384000 813066 87405 0
1437182847 390183 0 0 0 0 569778 665842 67319 0
1144215039 390184 0 0 0 0 815338 743011 47367 0
1548322720 390185 18769 18809 0 15960 461393 668490 58675 0
1528061314 390189 0 0 0 0 1217656 720884 66795 0
1518256726 390192 0 0 0 0 635752 668490 56256 0
1356354567 390194 0 0 0 0 565986 746526 76912 0
1245335629 390195 146350 43945 0 21370 404312 813066 66742 0
1952399933 390197 65092 34620 353 4497 455759 758538 77563 0
1548263973 390198 157011 55037 1444 0 386206 685464 38448 0
1265449870 390199 0 0 840 0 649447 665842 59047 0
1568459436 390201 0 0 0 0 473822 926895 67319 0
1225091697 390203 0 0 0 2762 460513 813066 125698 0
1124023015 390204 0 0 0 6730 410795 813066 107755 0
1184672214 390211 0 0 359 42894 516785 683662 69645 0
1144255159 390217 0 0 803 0 613350 743011 58718 0
1821015462 390219 51991 28021 360 3160 445265 743011 60162 0
1336110287 390220 0 0 0 0 469486 813066 35032 89821
1407856099 390222 0 0 0 0 402183 813066 59352 0
1245207521 390223 232106 71719 1750 19353 450145 813066 145582 0
1083615587 390225 0 0 0 0 676859 705871 68030 0
1548423684 390225 0 0 0 0 676859 705871 68030 0
1063489342 390226 0 79589 0 4412 431688 813066 6423 225153
1073587119 390228 0 0 0 0 490321 743011 78709 0
1811992084 390231 129440 54408 0 21332 366297 813066 96590 0
1730158981 390233 0 0 0 0 731036 687787 61250 0
1164421335 390236 0 0 0 0 645768 665842 68828 0
1336314384 390236 0 0 0 0 645768 665842 68828 0
1881983039 390237 15748 15537 0 1102 537339 668490 67590 0
1568435477 390256 543218 185283 516 1423 868053 720884 61572 0
1780686931 390258 0 0 0 0 941264 813066 49740 102944
1598743585 390263 13629 2497 0 0 624901 746526 59687 0
1578560504 390265 0 0 0 0 506455 743011 76038 0
1023000296 390266 0 0 0 0 889640 683662 69125 0
1679592380 390267 51991 29760 0 0 527563 743011 76038 0
1104991801 390268 0 0 0 4552 868457 735370 70883 0
1730173154 390268 0 0 0 4552 868457 735370 70883 0
1780750620 390268 0 0 0 4552 868457 735370 70883 0
1093001653 390270 0 0 0 0 415541 668490 21441 94947
1174822068 390270 0 0 0 0 415541 668490 21441 94947
1205197894 390270 0 0 0 0 415541 668490 21441 94947
1235424672 390270 0 0 0 0 415541 668490 21441 94947
1265728810 390270 0 0 0 0 415541 668490 21441 94947
1275620585 390270 0 0 0 0 415541 668490 21441 94947
1447538640 390270 0 0 0 0 415541 668490 21441 94947
1649305129 390270 0 0 0 0 415541 668490 21441 94947
1649568403 390270 0 0 0 0 415541 668490 21441 94947
1669768214 390270 0 0 0 0 415541 668490 21441 94947
1760777106 390270 0 0 0 0 415541 668490 21441 94947
1770953994 390270 0 0 0 0 415541 668490 21441 94947
1861791865 390270 0 0 0 0 415541 668490 21441 94947
1881980803 390270 0 0 0 0 415541 668490 21441 94947
1528026671 390272 0 0 500 0 0 813066 30489 0
1467510560 390278 0 0 9140 0 0 813066 114859 0
1023033792 390290 402638 145927 1513 4863 330477 813066 132373 0
1043240351 390302 0 0 0 0 412000 813066 82807 0
1821020421 390304 0 0 294 52838 496395 813066 137754 0
1659392595 390307 0 0 0 0 403000 683662 69125 0
1780919043 390307 0 0 0 0 403000 683662 69125 0
1427097864 390314 0 0 0 0 300000 746526 75303 0
1124193511 390316 0 0 0 0 300000 695983 70353 0
1043456957 390321 0 0 0 0 284000 758538 75326 0
1336378132 390322 0 0 0 0 284000 813066 82807 0
1528398534 390323 0 0 0 0 278000 743011 76036 0
1265664544 390324 0 0 0 0 271000 813066 82807 0
1578881652 390325 0 0 0 0 271000 687787 69533 0
1962758375 390325 0 0 0 0 271000 687787 69533 0
1497050470 390326 0 0 0 0 271000 758538 75326 0
1760787576 390327 0 0 0 0 407000 687787 69533 0
1225323983 390328 0 0 0 0 268000 743011 76038 0
1104192590 390329 0 0 0 0 268000 813066 82807 0
999993 999993 75972 37367 433 8021 431343 720884 72803 0
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