2014 Workers' Compensation Fee Schedule

Table G: Physical Therapy Per Visit Based Provider
&
OP End Stage Renal Dialysis Table

NPI or
Provider
#
Prov.
#
Provider
Name
Rev
Code
420-
429
Rev
Code
430-
439
Rev
Code
440-
449
Rev
Code
550-
559
Rev
Code
560-
569
Rev
Code
820-
859
Rev
Code
910-
919
Routine
Care
Contin-
uous
Care
Respite
Care
General
Inpt
Implied Decimal 2 (in dollars)
1063498541
391656
HOSPICE
OF THE
SACRED
HEART
0
0
0
0
0
0
0
19006
110938
19731
84653
1962583922
392300
GEISINGER
MEDICAL
CENTER-
ESRD
0
0
0
0
0
24579
0
0
0
0
0
1780831198
392632
FRESENIUS
MEDICAL
CARE
PENN
HILLS
0
0
0
0
0
25832
0
0
0
0
0
1083677587
392691
DCA OF
MECHANICS-
BURG
0
0
0
0
0
25626
0
0
0
0
0
1306808472
392723
DUNMORE
DIALYSIS
0
0
0
0
0
24579
0
0
0
0
0
1265739411
392786
USRC
ALTOONA
DIALYSIS
CENTER
0
0
0
0
0
25179
0
0
0
0
0
1023384013
392791
WEST-
TOWN
DIALYSIS
0
0
0
0
0
27215
0
0
0
0
0
1811257108
392803
SUBURB-
AN
CAMPUS
DIALYSIS
0
0
0
0
0
25832
0
0
0
0
0
1538391248
393518
GEISINGER
MEDICAL
CENTER-
ESRD
0
0
0
0
0
24579
0
0
0
0
0
394527
394527
TRINDLE
REHAB
MEDICINE
CENTER
19177
0
0
0
0
0
0
0
0
0
0
396522
396522
WILKES-
BARRE
SPEECH
AND
LANGUAGE
0
0
7731
0
0
0
0
0
0
0
0
396538
396538
JENKIN-
TOWN
REHAB
19618
14398
18938
0
0
0
0
0
0
0
0
396558
396558
SOUTH-
WEST
REHAB
ASSOC-
IATES
12340
13550
10434
0
0
0
0
0
0
0
0
396578
396578
MONTG-
OMERY
COUNTY
REHAB
18870
0
0
0
0
0
0
0
0
0
0
396581
396581
PROFESS-
IONAL
REHAB
ASSOC-
IATES,
INC.
10198
0
23581
0
0
0
0
0
0
0
0
396582
396582
DR. DAVID
POTOKER
0
0
13035
0
0
0
0
0
0
0
0
396603
396603
THERA-
PEUTIC
REHAB
(TRAC)
10175
0
29844
0
0
0
0
0
0
0
0
396611
396611
BRYN
MAWR
ORTHO-
PEDICS
13316
0
0
0
0
0
0
0
0
0
0
396616
396616
MAHONING
PT /
TWOLICK
VALLEY PT
10469
0
0
0
0
0
0
0
0
0
0
396625
396625
MANOA
SPORTS
AND
SPINAL
INSTITUTE
14681
0
0
0
0
0
0
0
0
0
0
1407838055
396850
HEALTH
POCONO,
INC
(RIVER-
SIDE
CENTER)
18224
12486
66951
0
0
12486
0
0
0
0
0
1275526725
396854
ADULT
SERVICES
UNLIMITED
30310
28624
37758
0
0
28624
0
0
0
0
0
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