2014 WC FEE SCHEDULE

Table J: Out-of-State RCC

Provider #

Revenue Code

In-Patient RCC

Out-Patient RCC

Description

   

Decimal 6 (percentage of bill charges)

 
999994 124 725 0 PSYCH ROOM & BOARD
999994 128 516 0 REHAB ROOM & BOARD
999994 250 0.247078 0.231776 PHARMACY
999994 260 0.572536 0.538411 IV THERAPY
999994 270 0.162082 0.151892 MEDICAL/SURGICAL SUPPLIES
999994 300 0.443699 0.415832 LABORATORY
999994 310 0.443699 0.415832 PATHOLOGY
999994 320 0.385371 0.358543 RADIOLOGY-DIAGNOSTIC
999994 330 0.385371 0.358543 RADIOLOGY-THERAPEUTIC
999994 340 0.702075 0.654145 NUCLEAR MEDICINE
999994 350 0.409509 0.380299 CAT SCAN
999994 360 0.5219 0.489053 OPERATING ROOM SERVICES
999994 370 0.243852 0.227742 ANESTHESIA
999994 380 0.476568 0.447296 WHOLE BLOOD
999994 390 0.476568 0.447296 BLOOD STORAGE AND PROCESSING
999994 400 0.373349 0.347059 OTHER IMAGING SERVICES
999994 410 0.170092 0.159419 RESPIRATORY SERVICES
999994 420 0.707859 0.6752 PHYSICAL THERAPY
999994 430 0.707859 0.687844 OCCUPATION THERAPY
999994 440 0.442788 0.415734 SPEECH THERAPY
999994 450 0.707965 0.707965 EMERGENCY ROOM
999994 460 0.170092 0.159419 PULMONARY FUNCTION
999994 470 0.442788 0.415734 AUDIOLOGY
999994 480 0.373715 0.349715 CARDIOLOGY
999994 490 0.5219 0.489053 AMBULATORY SURGICAL CARE
999994 510 0.707965 0.707965 CLINIC
999994 520 0.707965 0.707965 FREE-STANDING CLINIC
999994 530 0.707965 0.707965 OSTEOPATHIC SERVICES
999994 540 0.707965 0.707965 AMBULANCE
999994 610 0.385371 0.358543 MAGNETIC RESONANCE IMAGING (MRI)
999994 620 0.385371 0.358543 MEDICAL/SURGICAL SUPPLIES (RAD)
999994 636 0.247078 0.231776 DRUGS REQUIRING SPECIFIC ID
999994 700 0.5219 0.489053 CAST ROOM
999994 710 0.707859 0.707859 RECOVERY ROOM
999994 730 0.373715 0.349715 EKG/ECG
999994 740 0.373715 0.349715 EEG
999994 750 0.5219 0.489053 GATRO-INTESTINAL SERVICES
999994 760 0.554176 0.554176 TREATMENT OR OBSERVATION ROOM
999994 790 0.242092 0.227815 LITHOTRIPSY
999994 800 0.707965 0.701785 INPATIENT RENAL DIALYSIS
999994 820 0.701785 0.701785 HEMODIALYSIS
999994 830 0.701785 0.701785 PERITONEAL DIALYSIS
999994 910 0.454186 0.424381 PSYCHIATRIC/PSYCHOLOGICAL SERVICES
999994 920 0.385371 0.358543 OTHER DIAGNOSTIC SERVICES
999994 940 0.373715 0.349715 OTHER THERAPEUTIC SERVICES
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