mi workers' compensation fee schedule 2006 · wca hcsd mi workers' compensation fee...

43
WCA HCSD MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY 1 CODE MOD RVU MAP NA IND* RVU MAP NA IND* 70010 6.56 322.88 $ 6.56 322.88 $ NA 70010 TC 4.82 237.24 $ 4.82 237.24 $ NA 70010 26 1.74 85.64 $ 1.74 85.64 $ 70015 3.32 163.41 $ 3.32 163.41 $ NA 70015 TC 1.53 75.31 $ 1.53 75.31 $ NA 70015 26 1.79 88.10 $ 1.79 88.10 $ 70030 0.72 35.44 $ 0.72 35.44 $ NA 70030 TC 0.46 22.64 $ 0.46 22.64 $ NA 70030 26 0.26 12.80 $ 0.26 12.80 $ 70100 0.83 40.85 $ 0.83 40.85 $ NA 70100 TC 0.56 27.56 $ 0.56 27.56 $ NA 70100 26 0.27 13.29 $ 0.27 13.29 $ 70110 1.07 52.67 $ 1.07 52.67 $ NA 70110 TC 0.71 34.95 $ 0.71 34.95 $ NA 70110 26 0.36 17.72 $ 0.36 17.72 $ 70120 0.98 48.24 $ 0.98 48.24 $ NA 70120 TC 0.71 34.95 $ 0.71 34.95 $ NA 70120 26 0.27 13.29 $ 0.27 13.29 $ 70130 1.4 68.91 $ 1.4 68.91 $ NA 70130 TC 0.89 43.81 $ 0.89 43.81 $ NA 70130 26 0.5 24.61 $ 0.5 24.61 $ 70134 1.35 66.45 $ 1.35 66.45 $ NA 70134 TC 0.84 41.34 $ 0.84 41.34 $ NA 70134 26 0.5 24.61 $ 0.5 24.61 $ 70140 0.99 48.73 $ 0.99 48.73 $ NA 70140 TC 0.71 34.95 $ 0.71 34.95 $ NA 70140 26 0.28 13.78 $ 0.28 13.78 $ 70150 1.26 62.02 $ 1.26 62.02 $ NA 70150 TC 0.89 43.81 $ 0.89 43.81 $ NA 70150 26 0.37 18.21 $ 0.37 18.21 $ 70160 0.82 40.36 $ 0.82 40.36 $ NA 70160 TC 0.56 27.56 $ 0.56 27.56 $ NA 70160 26 0.26 12.80 $ 0.26 12.80 $ 70170 1.51 74.32 $ 1.51 74.32 $ NA 70170 TC 1.08 53.16 $ 1.08 53.16 $ NA 70170 26 0.43 21.16 $ 0.43 21.16 $ 70190 1.02 50.20 $ 1.02 50.20 $ NA 70190 TC 0.71 34.95 $ 0.71 34.95 $ NA 70190 26 0.31 15.26 $ 0.31 15.26 $ 70200 1.29 63.49 $ 1.29 63.49 $ NA 70200 TC 0.89 43.81 $ 0.89 43.81 $ NA 70200 26 0.4 19.69 $ 0.4 19.69 $ 70210 0.97 47.74 $ 0.97 47.74 $ NA 70210 TC 0.71 34.95 $ 0.71 34.95 $ NA 70210 26 0.26 12.80 $ 0.26 12.80 $ 70220 1.25 61.53 $ 1.25 61.53 $ NA 70220 TC 0.89 43.81 $ 0.89 43.81 $ NA 70220 26 0.36 17.72 $ 0.36 17.72 $ NON FACILITY FACILITY NA IND*--NOT APPLICABLE IN THIS SETTING Procedures with 0.0 RVU are BR Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors. Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Upload: others

Post on 02-Oct-2020

1 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY1

CODE MOD RVU MAP NA IND* RVU MAP NA IND*70010 6.56 322.88$ 6.56 322.88$ NA70010 TC 4.82 237.24$ 4.82 237.24$ NA70010 26 1.74 85.64$ 1.74 85.64$ 70015 3.32 163.41$ 3.32 163.41$ NA70015 TC 1.53 75.31$ 1.53 75.31$ NA70015 26 1.79 88.10$ 1.79 88.10$ 70030 0.72 35.44$ 0.72 35.44$ NA70030 TC 0.46 22.64$ 0.46 22.64$ NA70030 26 0.26 12.80$ 0.26 12.80$ 70100 0.83 40.85$ 0.83 40.85$ NA70100 TC 0.56 27.56$ 0.56 27.56$ NA70100 26 0.27 13.29$ 0.27 13.29$ 70110 1.07 52.67$ 1.07 52.67$ NA70110 TC 0.71 34.95$ 0.71 34.95$ NA70110 26 0.36 17.72$ 0.36 17.72$ 70120 0.98 48.24$ 0.98 48.24$ NA70120 TC 0.71 34.95$ 0.71 34.95$ NA70120 26 0.27 13.29$ 0.27 13.29$ 70130 1.4 68.91$ 1.4 68.91$ NA70130 TC 0.89 43.81$ 0.89 43.81$ NA70130 26 0.5 24.61$ 0.5 24.61$ 70134 1.35 66.45$ 1.35 66.45$ NA70134 TC 0.84 41.34$ 0.84 41.34$ NA70134 26 0.5 24.61$ 0.5 24.61$ 70140 0.99 48.73$ 0.99 48.73$ NA70140 TC 0.71 34.95$ 0.71 34.95$ NA70140 26 0.28 13.78$ 0.28 13.78$ 70150 1.26 62.02$ 1.26 62.02$ NA70150 TC 0.89 43.81$ 0.89 43.81$ NA70150 26 0.37 18.21$ 0.37 18.21$ 70160 0.82 40.36$ 0.82 40.36$ NA70160 TC 0.56 27.56$ 0.56 27.56$ NA70160 26 0.26 12.80$ 0.26 12.80$ 70170 1.51 74.32$ 1.51 74.32$ NA70170 TC 1.08 53.16$ 1.08 53.16$ NA70170 26 0.43 21.16$ 0.43 21.16$ 70190 1.02 50.20$ 1.02 50.20$ NA70190 TC 0.71 34.95$ 0.71 34.95$ NA70190 26 0.31 15.26$ 0.31 15.26$ 70200 1.29 63.49$ 1.29 63.49$ NA70200 TC 0.89 43.81$ 0.89 43.81$ NA70200 26 0.4 19.69$ 0.4 19.69$ 70210 0.97 47.74$ 0.97 47.74$ NA70210 TC 0.71 34.95$ 0.71 34.95$ NA70210 26 0.26 12.80$ 0.26 12.80$ 70220 1.25 61.53$ 1.25 61.53$ NA70220 TC 0.89 43.81$ 0.89 43.81$ NA70220 26 0.36 17.72$ 0.36 17.72$

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 2: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY2

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

70240 0.74 36.42$ 0.74 36.42$ NA70240 TC 0.46 22.64$ 0.46 22.64$ NA70240 26 0.28 13.78$ 0.28 13.78$ 70250 1.06 52.17$ 1.06 52.17$ NA70250 TC 0.71 34.95$ 0.71 34.95$ NA70250 26 0.35 17.23$ 0.35 17.23$ 70260 1.53 75.31$ 1.53 75.31$ NA70260 TC 1.02 50.20$ 1.02 50.20$ NA70260 26 0.5 24.61$ 0.5 24.61$ 70300 0.48 23.63$ 0.48 23.63$ NA70300 TC 0.3 14.77$ 0.3 14.77$ NA70300 26 0.17 8.37$ 0.17 8.37$ 70310 0.73 35.93$ 0.73 35.93$ NA70310 TC 0.46 22.64$ 0.46 22.64$ NA70310 26 0.27 13.29$ 0.27 13.29$ 70320 1.22 60.05$ 1.22 60.05$ NA70320 TC 0.89 43.81$ 0.89 43.81$ NA70320 26 0.33 16.24$ 0.33 16.24$ 70328 0.8 39.38$ 0.8 39.38$ NA70328 TC 0.53 26.09$ 0.53 26.09$ NA70328 26 0.27 13.29$ 0.27 13.29$ 70330 1.3 63.99$ 1.3 63.99$ NA70330 TC 0.95 46.76$ 0.95 46.76$ NA70330 26 0.35 17.23$ 0.35 17.23$ 70332 3.19 157.01$ 3.19 157.01$ NA70332 TC 2.37 116.65$ 2.37 116.65$ NA70332 26 0.82 40.36$ 0.82 40.36$ 70336 14.68 722.55$ 14.68 722.55$ NA70336 TC 12.52 616.23$ 12.52 616.23$ NA70336 26 2.16 106.32$ 2.16 106.32$ 70350 0.69 33.96$ 0.69 33.96$ NA70350 TC 0.42 20.67$ 0.42 20.67$ NA70350 26 0.27 13.29$ 0.27 13.29$ 70355 0.96 47.25$ 0.96 47.25$ NA70355 TC 0.66 32.49$ 0.66 32.49$ NA70355 26 0.3 14.77$ 0.3 14.77$ 70360 0.72 35.44$ 0.72 35.44$ NA70360 TC 0.46 22.64$ 0.46 22.64$ NA70360 26 0.26 12.80$ 0.26 12.80$ 70370 1.92 94.50$ 1.92 94.50$ NA70370 TC 1.47 72.35$ 1.47 72.35$ NA70370 26 0.45 22.15$ 0.45 22.15$ 70371 3.6 177.19$ 3.6 177.19$ NA70371 TC 2.37 116.65$ 2.37 116.65$ NA70371 26 1.23 60.54$ 1.23 60.54$ 70373 2.66 130.93$ 2.66 130.93$ NA70373 TC 2.03 99.92$ 2.03 99.92$ NA70373 26 0.64 31.50$ 0.64 31.50$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 3: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY3

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

70380 1.02 50.20$ 1.02 50.20$ NA70380 TC 0.76 37.41$ 0.76 37.41$ NA70380 26 0.26 12.80$ 0.26 12.80$ 70390 2.58 126.99$ 2.58 126.99$ NA70390 TC 2.03 99.92$ 2.03 99.92$ NA70390 26 0.55 27.07$ 0.55 27.07$ 70450 6.52 320.91$ 6.52 320.91$ NA70450 TC 5.28 259.88$ 5.28 259.88$ NA70450 26 1.24 61.03$ 1.24 61.03$ 70460 7.97 392.28$ 7.97 392.28$ NA70460 TC 6.33 311.56$ 6.33 311.56$ NA70460 26 1.64 80.72$ 1.64 80.72$ 70470 9.75 479.90$ 9.75 479.90$ NA70470 TC 7.9 388.84$ 7.9 388.84$ NA70470 26 1.86 91.55$ 1.86 91.55$ 70480 7.14 351.43$ 7.14 351.43$ NA70480 TC 5.28 259.88$ 5.28 259.88$ NA70480 26 1.87 92.04$ 1.87 92.04$ 70481 8.33 410.00$ 8.33 410.00$ NA70481 TC 6.33 311.56$ 6.33 311.56$ NA70481 26 2 98.44$ 2 98.44$ 70482 10 492.20$ 10 492.20$ NA70482 TC 7.9 388.84$ 7.9 388.84$ NA70482 26 2.1 103.36$ 2.1 103.36$ 70486 6.93 341.09$ 6.93 341.09$ NA70486 TC 5.28 259.88$ 5.28 259.88$ NA70486 26 1.65 81.21$ 1.65 81.21$ 70487 8.23 405.08$ 8.23 405.08$ NA70487 TC 6.33 311.56$ 6.33 311.56$ NA70487 26 1.9 93.52$ 1.9 93.52$ 70488 9.95 489.74$ 9.95 489.74$ NA70488 TC 7.9 388.84$ 7.9 388.84$ NA70488 26 2.05 100.90$ 2.05 100.90$ 70490 7.14 351.43$ 7.14 351.43$ NA70490 TC 5.28 259.88$ 5.28 259.88$ NA70490 26 1.87 92.04$ 1.87 92.04$ 70491 8.33 410.00$ 8.33 410.00$ NA70491 TC 6.33 311.56$ 6.33 311.56$ NA70491 26 2 98.44$ 2 98.44$ 70492 9.99 491.71$ 9.99 491.71$ NA70492 TC 7.9 388.84$ 7.9 388.84$ NA70492 26 2.09 102.87$ 2.09 102.87$ 70496 14.44 710.74$ 14.44 710.74$ NA70496 TC 11.9 585.72$ 11.9 585.72$ NA70496 26 2.54 125.02$ 2.54 125.02$ 70498 14.44 710.74$ 14.44 710.74$ NA70498 TC 11.9 585.72$ 11.9 585.72$ NA70498 26 2.54 125.02$ 2.54 125.02$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 4: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY4

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

70540 14.02 690.06$ 14.02 690.06$ NA70540 TC 12.07 594.09$ 12.07 594.09$ NA70540 26 1.96 96.47$ 1.96 96.47$ 70542 16.83 828.37$ 16.83 828.37$ NA70542 TC 14.49 713.20$ 14.49 713.20$ NA70542 26 2.35 115.67$ 2.35 115.67$ 70543 29.88 1,470.69$ 29.88 1,470.69$ NA70543 TC 26.75 1,316.64$ 26.75 1,316.64$ NA70543 26 3.14 154.55$ 3.14 154.55$ 70544 14.26 701.88$ 14.26 701.88$ NA70544 TC 12.52 616.23$ 12.52 616.23$ NA70544 26 1.74 85.64$ 1.74 85.64$ 70545 14.25 701.39$ 14.25 701.39$ NA70545 TC 12.52 616.23$ 12.52 616.23$ NA70545 26 1.73 85.15$ 1.73 85.15$ 70546 26.33 1,295.96$ 26.33 1,295.96$ NA70546 TC 23.72 1,167.50$ 23.72 1,167.50$ NA70546 26 2.61 128.46$ 2.61 128.46$ 70547 14.25 701.39$ 14.25 701.39$ NA70547 TC 12.52 616.23$ 12.52 616.23$ NA70547 26 1.73 85.15$ 1.73 85.15$ 70548 14.25 701.39$ 14.25 701.39$ NA70548 TC 12.52 616.23$ 12.52 616.23$ NA70548 26 1.73 85.15$ 1.73 85.15$ 70549 26.33 1,295.96$ 26.33 1,295.96$ NA70549 TC 23.72 1,167.50$ 23.72 1,167.50$ NA70549 26 2.61 128.46$ 2.61 128.46$ 70551 14.68 722.55$ 14.68 722.55$ NA70551 TC 12.52 616.23$ 12.52 616.23$ NA70551 26 2.16 106.32$ 2.16 106.32$ 70552 17.6 866.27$ 17.6 866.27$ NA70552 TC 15 738.30$ 15 738.30$ NA70552 26 2.59 127.48$ 2.59 127.48$ 70553 31.25 1,538.13$ 31.25 1,538.13$ NA70553 TC 27.81 1,368.81$ 27.81 1,368.81$ NA70553 26 3.44 169.32$ 3.44 169.32$ 70557 0 -$ 0 -$ 70557 TC 0 -$ 0 -$ 70557 26 4.28 210.66$ 4.28 210.66$ 70558 0 -$ 0 -$ 70558 TC 0 -$ 0 -$ 70558 26 4.74 233.30$ 4.74 233.30$ 70559 0 -$ 0 -$ 70559 TC 0 -$ 0 -$ 70559 26 4.79 235.76$ 4.79 235.76$ 71010 0.78 38.39$ 0.78 38.39$ NA71010 TC 0.51 25.10$ 0.51 25.10$ NA71010 26 0.27 13.29$ 0.27 13.29$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 5: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY5

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

71015 0.87 42.82$ 0.87 42.82$ NA71015 TC 0.56 27.56$ 0.56 27.56$ NA71015 26 0.31 15.26$ 0.31 15.26$ 71020 1.03 50.70$ 1.03 50.70$ NA71020 TC 0.71 34.95$ 0.71 34.95$ NA71020 26 0.32 15.75$ 0.32 15.75$ 71021 1.23 60.54$ 1.23 60.54$ NA71021 TC 0.84 41.34$ 0.84 41.34$ NA71021 26 0.39 19.20$ 0.39 19.20$ 71022 1.28 63.00$ 1.28 63.00$ NA71022 TC 0.84 41.34$ 0.84 41.34$ NA71022 26 0.44 21.66$ 0.44 21.66$ 71023 1.46 71.86$ 1.46 71.86$ NA71023 TC 0.89 43.81$ 0.89 43.81$ NA71023 26 0.56 27.56$ 0.56 27.56$ 71030 1.33 65.46$ 1.33 65.46$ NA71030 TC 0.89 43.81$ 0.89 43.81$ NA71030 26 0.44 21.66$ 0.44 21.66$ 71034 2.29 112.71$ 2.29 112.71$ NA71034 TC 1.62 79.74$ 1.62 79.74$ NA71034 26 0.68 33.47$ 0.68 33.47$ 71035 0.83 40.85$ 0.83 40.85$ NA71035 TC 0.56 27.56$ 0.56 27.56$ NA71035 26 0.27 13.29$ 0.27 13.29$ 71040 2.49 122.56$ 2.49 122.56$ NA71040 TC 1.64 80.72$ 1.64 80.72$ NA71040 26 0.85 41.84$ 0.85 41.84$ 71060 3.58 176.21$ 3.58 176.21$ NA71060 TC 2.49 122.56$ 2.49 122.56$ NA71060 26 1.09 53.65$ 1.09 53.65$ 71090 2.73 134.37$ 2.73 134.37$ NA71090 TC 1.93 94.99$ 1.93 94.99$ NA71090 26 0.81 39.87$ 0.81 39.87$ 71100 0.98 48.24$ 0.98 48.24$ NA71100 TC 0.66 32.49$ 0.66 32.49$ NA71100 26 0.32 15.75$ 0.32 15.75$ 71101 1.15 56.60$ 1.15 56.60$ NA71101 TC 0.76 37.41$ 0.76 37.41$ NA71101 26 0.39 19.20$ 0.39 19.20$ 71110 1.28 63.00$ 1.28 63.00$ NA71110 TC 0.89 43.81$ 0.89 43.81$ NA71110 26 0.39 19.20$ 0.39 19.20$ 71111 1.47 72.35$ 1.47 72.35$ NA71111 TC 1.02 50.20$ 1.02 50.20$ NA71111 26 0.45 22.15$ 0.45 22.15$ 71120 1.04 51.19$ 1.04 51.19$ NA71120 TC 0.74 36.42$ 0.74 36.42$ NA71120 26 0.3 14.77$ 0.3 14.77$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 6: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY6

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

71130 1.12 55.13$ 1.12 55.13$ NA71130 TC 0.8 39.38$ 0.8 39.38$ NA71130 26 0.32 15.75$ 0.32 15.75$ 71250 8.28 407.54$ 8.28 407.54$ NA71250 TC 6.6 324.85$ 6.6 324.85$ NA71250 26 1.68 82.69$ 1.68 82.69$ 71260 9.71 477.93$ 9.71 477.93$ NA71260 TC 7.9 388.84$ 7.9 388.84$ NA71260 26 1.81 89.09$ 1.81 89.09$ 71270 11.88 584.73$ 11.88 584.73$ NA71270 TC 9.88 486.29$ 9.88 486.29$ NA71270 26 2 98.44$ 2 98.44$ 71275 16.04 789.49$ 16.04 789.49$ NA71275 TC 13.25 652.17$ 13.25 652.17$ NA71275 26 2.8 137.82$ 2.8 137.82$ 71550 14.31 704.34$ 14.31 704.34$ NA71550 TC 12.2 600.48$ 12.2 600.48$ NA71550 26 2.11 103.85$ 2.11 103.85$ 71551 17.12 842.65$ 17.12 842.65$ NA71551 TC 14.6 718.61$ 14.6 718.61$ NA71551 26 2.52 124.03$ 2.52 124.03$ 71552 29.67 1,460.36$ 29.67 1,460.36$ NA71552 TC 26.39 1,298.92$ 26.39 1,298.92$ NA71552 26 3.28 161.44$ 3.28 161.44$ 71555 15.15 745.68$ 15.15 745.68$ NA71555 TC 12.52 616.23$ 12.52 616.23$ NA71555 26 2.63 129.45$ 2.63 129.45$ 72010 1.81 89.09$ 1.81 89.09$ NA72010 TC 1.15 56.60$ 1.15 56.60$ NA72010 26 0.66 32.49$ 0.66 32.49$ 72020 0.69 33.96$ 0.69 33.96$ NA72020 TC 0.46 22.64$ 0.46 22.64$ NA72020 26 0.23 11.32$ 0.23 11.32$ 72040 1.01 49.71$ 1.01 49.71$ NA72040 TC 0.69 33.96$ 0.69 33.96$ NA72040 26 0.32 15.75$ 0.32 15.75$ 72050 1.46 71.86$ 1.46 71.86$ NA72050 TC 1.02 50.20$ 1.02 50.20$ NA72050 26 0.44 21.66$ 0.44 21.66$ 72052 1.8 88.60$ 1.8 88.60$ NA72052 TC 1.26 62.02$ 1.26 62.02$ NA72052 26 0.53 26.09$ 0.53 26.09$ 72069 0.86 42.33$ 0.86 42.33$ NA72069 TC 0.53 26.09$ 0.53 26.09$ NA72069 26 0.33 16.24$ 0.33 16.24$ 72070 1.06 52.17$ 1.06 52.17$ NA72070 TC 0.74 36.42$ 0.74 36.42$ NA72070 26 0.32 15.75$ 0.32 15.75$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 7: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY7

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

72072 1.16 57.10$ 1.16 57.10$ NA72072 TC 0.84 41.34$ 0.84 41.34$ NA72072 26 0.32 15.75$ 0.32 15.75$ 72074 1.36 66.94$ 1.36 66.94$ NA72074 TC 1.04 51.19$ 1.04 51.19$ NA72074 26 0.32 15.75$ 0.32 15.75$ 72080 1.08 53.16$ 1.08 53.16$ NA72080 TC 0.76 37.41$ 0.76 37.41$ NA72080 26 0.32 15.75$ 0.32 15.75$ 72090 1.16 57.10$ 1.16 57.10$ NA72090 TC 0.76 37.41$ 0.76 37.41$ NA72090 26 0.4 19.69$ 0.4 19.69$ 72100 1.08 53.16$ 1.08 53.16$ NA72100 TC 0.76 37.41$ 0.76 37.41$ NA72100 26 0.32 15.75$ 0.32 15.75$ 72110 1.48 72.85$ 1.48 72.85$ NA72110 TC 1.04 51.19$ 1.04 51.19$ NA72110 26 0.44 21.66$ 0.44 21.66$ 72114 1.86 91.55$ 1.86 91.55$ NA72114 TC 1.32 64.97$ 1.32 64.97$ NA72114 26 0.53 26.09$ 0.53 26.09$ 72120 1.34 65.95$ 1.34 65.95$ NA72120 TC 1.02 50.20$ 1.02 50.20$ NA72120 26 0.32 15.75$ 0.32 15.75$ 72125 8.28 407.54$ 8.28 407.54$ NA72125 TC 6.6 324.85$ 6.6 324.85$ NA72125 26 1.68 82.69$ 1.68 82.69$ 72126 9.66 475.47$ 9.66 475.47$ NA72126 TC 7.9 388.84$ 7.9 388.84$ NA72126 26 1.76 86.63$ 1.76 86.63$ 72127 11.73 577.35$ 11.73 577.35$ NA72127 TC 9.88 486.29$ 9.88 486.29$ NA72127 26 1.86 91.55$ 1.86 91.55$ 72128 8.28 407.54$ 8.28 407.54$ NA72128 TC 6.6 324.85$ 6.6 324.85$ NA72128 26 1.68 82.69$ 1.68 82.69$ 72129 9.68 476.45$ 9.68 476.45$ NA72129 TC 7.9 388.84$ 7.9 388.84$ NA72129 26 1.78 87.61$ 1.78 87.61$ 72130 11.73 577.35$ 11.73 577.35$ NA72130 TC 9.88 486.29$ 9.88 486.29$ NA72130 26 1.86 91.55$ 1.86 91.55$ 72131 8.28 407.54$ 8.28 407.54$ NA72131 TC 6.6 324.85$ 6.6 324.85$ NA72131 26 1.68 82.69$ 1.68 82.69$ 72132 9.66 475.47$ 9.66 475.47$ NA72132 TC 7.9 388.84$ 7.9 388.84$ NA72132 26 1.76 86.63$ 1.76 86.63$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 8: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY8

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

72133 11.73 577.35$ 11.73 577.35$ NA72133 TC 9.88 486.29$ 9.88 486.29$ NA72133 26 1.86 91.55$ 1.86 91.55$ 72141 14.84 730.42$ 14.84 730.42$ NA72141 TC 12.52 616.23$ 12.52 616.23$ NA72141 26 2.33 114.68$ 2.33 114.68$ 72142 17.81 876.61$ 17.81 876.61$ NA72142 TC 15 738.30$ 15 738.30$ NA72142 26 2.81 138.31$ 2.81 138.31$ 72146 16.2 797.36$ 16.2 797.36$ NA72146 TC 13.87 682.68$ 13.87 682.68$ NA72146 26 2.33 114.68$ 2.33 114.68$ 72147 17.8 876.12$ 17.8 876.12$ NA72147 TC 15 738.30$ 15 738.30$ NA72147 26 2.8 137.82$ 2.8 137.82$ 72148 16.03 789.00$ 16.03 789.00$ NA72148 TC 13.87 682.68$ 13.87 682.68$ NA72148 26 2.16 106.32$ 2.16 106.32$ 72149 17.61 866.76$ 17.61 866.76$ NA72149 TC 15 738.30$ 15 738.30$ NA72149 26 2.6 127.97$ 2.6 127.97$ 72156 31.56 1,553.38$ 31.56 1,553.38$ NA72156 TC 27.81 1,368.81$ 27.81 1,368.81$ NA72156 26 3.75 184.58$ 3.75 184.58$ 72157 31.53 1,551.91$ 31.53 1,551.91$ NA72157 TC 27.81 1,368.81$ 27.81 1,368.81$ NA72157 26 3.72 183.10$ 3.72 183.10$ 72158 31.25 1,538.13$ 31.25 1,538.13$ NA72158 TC 27.81 1,368.81$ 27.81 1,368.81$ NA72158 26 3.44 169.32$ 3.44 169.32$ 72159 16.42 808.19$ 16.42 808.19$ 72159 TC 13.66 672.35$ 13.66 672.35$ 72159 26 2.76 135.85$ 2.76 135.85$ 72170 0.82 40.36$ 0.82 40.36$ NA72170 TC 0.56 27.56$ 0.56 27.56$ NA72170 26 0.26 12.80$ 0.26 12.80$ 72190 1.07 52.67$ 1.07 52.67$ NA72190 TC 0.76 37.41$ 0.76 37.41$ NA72190 26 0.31 15.26$ 0.31 15.26$ 72191 15.53 764.39$ 15.53 764.39$ NA72191 TC 12.9 634.94$ 12.9 634.94$ NA72191 26 2.63 129.45$ 2.63 129.45$ 72192 8.19 403.11$ 8.19 403.11$ NA72192 TC 6.6 324.85$ 6.6 324.85$ NA72192 26 1.59 78.26$ 1.59 78.26$ 72193 9.32 458.73$ 9.32 458.73$ NA72193 TC 7.64 376.04$ 7.64 376.04$ NA72193 26 1.68 82.69$ 1.68 82.69$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 9: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY9

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

72194 11.21 551.76$ 11.21 551.76$ NA72194 TC 9.45 465.13$ 9.45 465.13$ NA72194 26 1.76 86.63$ 1.76 86.63$ 72195 14.34 705.81$ 14.34 705.81$ NA72195 TC 12.2 600.48$ 12.2 600.48$ NA72195 26 2.13 104.84$ 2.13 104.84$ 72196 17.12 842.65$ 17.12 842.65$ NA72196 TC 14.6 718.61$ 14.6 718.61$ NA72196 26 2.52 124.03$ 2.52 124.03$ 72197 30.21 1,486.94$ 30.21 1,486.94$ NA72197 TC 26.93 1,325.49$ 26.93 1,325.49$ NA72197 26 3.28 161.44$ 3.28 161.44$ 72198 15.13 744.70$ 15.13 744.70$ NA72198 TC 12.52 616.23$ 12.52 616.23$ NA72198 26 2.61 128.46$ 2.61 128.46$ 72200 0.82 40.36$ 0.82 40.36$ NA72200 TC 0.56 27.56$ 0.56 27.56$ NA72200 26 0.26 12.80$ 0.26 12.80$ 72202 0.99 48.73$ 0.99 48.73$ NA72202 TC 0.71 34.95$ 0.71 34.95$ NA72202 26 0.28 13.78$ 0.28 13.78$ 72220 0.92 45.28$ 0.92 45.28$ NA72220 TC 0.66 32.49$ 0.66 32.49$ NA72220 26 0.26 12.80$ 0.26 12.80$ 72240 6.62 325.84$ 6.62 325.84$ NA72240 TC 5.31 261.36$ 5.31 261.36$ NA72240 26 1.31 64.48$ 1.31 64.48$ 72255 6.11 300.73$ 6.11 300.73$ NA72255 TC 4.82 237.24$ 4.82 237.24$ NA72255 26 1.29 63.49$ 1.29 63.49$ 72265 5.75 283.02$ 5.75 283.02$ NA72265 TC 4.56 224.44$ 4.56 224.44$ NA72265 26 1.19 58.57$ 1.19 58.57$ 72270 8.75 430.68$ 8.75 430.68$ NA72270 TC 6.84 336.66$ 6.84 336.66$ NA72270 26 1.92 94.50$ 1.92 94.50$ 72275 3.66 180.15$ 3.66 180.15$ NA72275 TC 2.59 127.48$ 2.59 127.48$ NA72275 26 1.07 52.67$ 1.07 52.67$ 72285 11.05 543.88$ 11.05 543.88$ NA72285 TC 9.34 459.71$ 9.34 459.71$ NA72285 26 1.71 84.17$ 1.71 84.17$ 72295 10.01 492.69$ 10.01 492.69$ NA72295 TC 8.75 430.68$ 8.75 430.68$ NA72295 26 1.25 61.53$ 1.25 61.53$ 73000 0.8 39.38$ 0.8 39.38$ NA73000 TC 0.56 27.56$ 0.56 27.56$ NA73000 26 0.24 11.81$ 0.24 11.81$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 10: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY10

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

73010 0.82 40.36$ 0.82 40.36$ NA73010 TC 0.56 27.56$ 0.56 27.56$ NA73010 26 0.26 12.80$ 0.26 12.80$ 73020 0.74 36.42$ 0.74 36.42$ NA73020 TC 0.51 25.10$ 0.51 25.10$ NA73020 26 0.23 11.32$ 0.23 11.32$ 73030 0.93 45.77$ 0.93 45.77$ NA73030 TC 0.66 32.49$ 0.66 32.49$ NA73030 26 0.27 13.29$ 0.27 13.29$ 73040 3.15 155.04$ 3.15 155.04$ NA73040 TC 2.37 116.65$ 2.37 116.65$ NA73040 26 0.78 38.39$ 0.78 38.39$ 73050 1.06 52.17$ 1.06 52.17$ NA73050 TC 0.76 37.41$ 0.76 37.41$ NA73050 26 0.3 14.77$ 0.3 14.77$ 73060 0.92 45.28$ 0.92 45.28$ NA73060 TC 0.66 32.49$ 0.66 32.49$ NA73060 26 0.26 12.80$ 0.26 12.80$ 73070 0.79 38.88$ 0.79 38.88$ NA73070 TC 0.56 27.56$ 0.56 27.56$ NA73070 26 0.23 11.32$ 0.23 11.32$ 73080 0.92 45.28$ 0.92 45.28$ NA73080 TC 0.66 32.49$ 0.66 32.49$ NA73080 26 0.26 12.80$ 0.26 12.80$ 73085 3.18 156.52$ 3.18 156.52$ NA73085 TC 2.37 116.65$ 2.37 116.65$ NA73085 26 0.81 39.87$ 0.81 39.87$ 73090 0.8 39.38$ 0.8 39.38$ NA73090 TC 0.56 27.56$ 0.56 27.56$ NA73090 26 0.24 11.81$ 0.24 11.81$ 73092 0.77 37.90$ 0.77 37.90$ NA73092 TC 0.53 26.09$ 0.53 26.09$ NA73092 26 0.24 11.81$ 0.24 11.81$ 73100 0.77 37.90$ 0.77 37.90$ NA73100 TC 0.53 26.09$ 0.53 26.09$ NA73100 26 0.24 11.81$ 0.24 11.81$ 73110 0.83 40.85$ 0.83 40.85$ NA73110 TC 0.57 28.06$ 0.57 28.06$ NA73110 26 0.26 12.80$ 0.26 12.80$ 73115 2.6 127.97$ 2.6 127.97$ NA73115 TC 1.8 88.60$ 1.8 88.60$ NA73115 26 0.8 39.38$ 0.8 39.38$ 73120 0.77 37.90$ 0.77 37.90$ NA73120 TC 0.53 26.09$ 0.53 26.09$ NA73120 26 0.24 11.81$ 0.24 11.81$ 73130 0.83 40.85$ 0.83 40.85$ NA73130 TC 0.57 28.06$ 0.57 28.06$ NA73130 26 0.26 12.80$ 0.26 12.80$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 11: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY11

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

73140 0.66 32.49$ 0.66 32.49$ NA73140 TC 0.46 22.64$ 0.46 22.64$ NA73140 26 0.2 9.84$ 0.2 9.84$ 73200 7.11 349.95$ 7.11 349.95$ NA73200 TC 5.52 271.69$ 5.52 271.69$ NA73200 26 1.59 78.26$ 1.59 78.26$ 73201 8.28 407.54$ 8.28 407.54$ NA73201 TC 6.6 324.85$ 6.6 324.85$ NA73201 26 1.68 82.69$ 1.68 82.69$ 73202 10.08 496.14$ 10.08 496.14$ NA73202 TC 8.29 408.03$ 8.29 408.03$ NA73202 26 1.78 87.61$ 1.78 87.61$ 73206 14.45 711.23$ 14.45 711.23$ NA73206 TC 11.83 582.27$ 11.83 582.27$ NA73206 26 2.62 128.96$ 2.62 128.96$ 73218 14.02 690.06$ 14.02 690.06$ NA73218 TC 12.07 594.09$ 12.07 594.09$ NA73218 26 1.96 96.47$ 1.96 96.47$ 73219 16.84 828.86$ 16.84 828.86$ NA73219 TC 14.49 713.20$ 14.49 713.20$ NA73219 26 2.36 116.16$ 2.36 116.16$ 73220 29.88 1,470.69$ 29.88 1,470.69$ NA73220 TC 26.75 1,316.64$ 26.75 1,316.64$ NA73220 26 3.14 154.55$ 3.14 154.55$ 73221 14.02 690.06$ 14.02 690.06$ NA73221 TC 12.07 594.09$ 12.07 594.09$ NA73221 26 1.96 96.47$ 1.96 96.47$ 73222 16.83 828.37$ 16.83 828.37$ NA73222 TC 14.49 713.20$ 14.49 713.20$ NA73222 26 2.35 115.67$ 2.35 115.67$ 73223 29.88 1,470.69$ 29.88 1,470.69$ NA73223 TC 26.75 1,316.64$ 26.75 1,316.64$ NA73223 26 3.14 154.55$ 3.14 154.55$ 73225 14.99 737.81$ 14.99 737.81$ 73225 TC 12.33 606.88$ 12.33 606.88$ 73225 26 2.67 131.42$ 2.67 131.42$ 73500 0.77 37.90$ 0.77 37.90$ NA73500 TC 0.51 25.10$ 0.51 25.10$ NA73500 26 0.26 12.80$ 0.26 12.80$ 73510 0.97 47.74$ 0.97 47.74$ NA73510 TC 0.66 32.49$ 0.66 32.49$ NA73510 26 0.31 15.26$ 0.31 15.26$ 73520 1.14 56.11$ 1.14 56.11$ NA73520 TC 0.76 37.41$ 0.76 37.41$ NA73520 26 0.38 18.70$ 0.38 18.70$ 73525 3.17 156.03$ 3.17 156.03$ NA73525 TC 2.37 116.65$ 2.37 116.65$ NA73525 26 0.8 39.38$ 0.8 39.38$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 12: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY12

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

73530 0.98 48.24$ 0.98 48.24$ NA73530 TC 0.56 27.56$ 0.56 27.56$ NA73530 26 0.42 20.67$ 0.42 20.67$ 73540 0.96 47.25$ 0.96 47.25$ NA73540 TC 0.66 32.49$ 0.66 32.49$ NA73540 26 0.3 14.77$ 0.3 14.77$ 73542 3.22 158.49$ 3.22 158.49$ NA73542 TC 2.37 116.65$ 2.37 116.65$ NA73542 26 0.85 41.84$ 0.85 41.84$ 73550 0.92 45.28$ 0.92 45.28$ NA73550 TC 0.66 32.49$ 0.66 32.49$ NA73550 26 0.26 12.80$ 0.26 12.80$ 73560 0.82 40.36$ 0.82 40.36$ NA73560 TC 0.56 27.56$ 0.56 27.56$ NA73560 26 0.26 12.80$ 0.26 12.80$ 73562 0.93 45.77$ 0.93 45.77$ NA73562 TC 0.66 32.49$ 0.66 32.49$ NA73562 26 0.27 13.29$ 0.27 13.29$ 73564 1.03 50.70$ 1.03 50.70$ NA73564 TC 0.71 34.95$ 0.71 34.95$ NA73564 26 0.32 15.75$ 0.32 15.75$ 73565 0.79 38.88$ 0.79 38.88$ NA73565 TC 0.53 26.09$ 0.53 26.09$ NA73565 26 0.26 12.80$ 0.26 12.80$ 73580 3.72 183.10$ 3.72 183.10$ NA73580 TC 2.93 144.21$ 2.93 144.21$ NA73580 26 0.79 38.88$ 0.79 38.88$ 73590 0.82 40.36$ 0.82 40.36$ NA73590 TC 0.56 27.56$ 0.56 27.56$ NA73590 26 0.26 12.80$ 0.26 12.80$ 73592 0.77 37.90$ 0.77 37.90$ NA73592 TC 0.53 26.09$ 0.53 26.09$ NA73592 26 0.24 11.81$ 0.24 11.81$ 73600 0.77 37.90$ 0.77 37.90$ NA73600 TC 0.53 26.09$ 0.53 26.09$ NA73600 26 0.24 11.81$ 0.24 11.81$ 73610 0.83 40.85$ 0.83 40.85$ NA73610 TC 0.57 28.06$ 0.57 28.06$ NA73610 26 0.26 12.80$ 0.26 12.80$ 73615 3.17 156.03$ 3.17 156.03$ NA73615 TC 2.37 116.65$ 2.37 116.65$ NA73615 26 0.8 39.38$ 0.8 39.38$ 73620 0.77 37.90$ 0.77 37.90$ NA73620 TC 0.53 26.09$ 0.53 26.09$ NA73620 26 0.24 11.81$ 0.24 11.81$ 73630 0.83 40.85$ 0.83 40.85$ NA73630 TC 0.57 28.06$ 0.57 28.06$ NA73630 26 0.26 12.80$ 0.26 12.80$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 13: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY13

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

73650 0.75 36.92$ 0.75 36.92$ NA73650 TC 0.51 25.10$ 0.51 25.10$ NA73650 26 0.24 11.81$ 0.24 11.81$ 73660 0.66 32.49$ 0.66 32.49$ NA73660 TC 0.46 22.64$ 0.46 22.64$ NA73660 26 0.2 9.84$ 0.2 9.84$ 73700 7.11 349.95$ 7.11 349.95$ NA73700 TC 5.52 271.69$ 5.52 271.69$ NA73700 26 1.59 78.26$ 1.59 78.26$ 73701 8.28 407.54$ 8.28 407.54$ NA73701 TC 6.6 324.85$ 6.6 324.85$ NA73701 26 1.68 82.69$ 1.68 82.69$ 73702 10.05 494.66$ 10.05 494.66$ NA73702 TC 8.29 408.03$ 8.29 408.03$ NA73702 26 1.76 86.63$ 1.76 86.63$ 73706 14.6 718.61$ 14.6 718.61$ NA73706 TC 11.83 582.27$ 11.83 582.27$ NA73706 26 2.77 136.34$ 2.77 136.34$ 73718 14.02 690.06$ 14.02 690.06$ NA73718 TC 12.07 594.09$ 12.07 594.09$ NA73718 26 1.96 96.47$ 1.96 96.47$ 73719 16.83 828.37$ 16.83 828.37$ NA73719 TC 14.49 713.20$ 14.49 713.20$ NA73719 26 2.35 115.67$ 2.35 115.67$ 73720 29.87 1,470.20$ 29.87 1,470.20$ NA73720 TC 26.75 1,316.64$ 26.75 1,316.64$ NA73720 26 3.13 154.06$ 3.13 154.06$ 73721 14.02 690.06$ 14.02 690.06$ NA73721 TC 12.07 594.09$ 12.07 594.09$ NA73721 26 1.96 96.47$ 1.96 96.47$ 73722 16.83 828.37$ 16.83 828.37$ NA73722 TC 14.49 713.20$ 14.49 713.20$ NA73722 26 2.35 115.67$ 2.35 115.67$ 73723 29.88 1,470.69$ 29.88 1,470.69$ NA73723 TC 26.75 1,316.64$ 26.75 1,316.64$ NA73723 26 3.14 154.55$ 3.14 154.55$ 73725 15.16 746.18$ 15.16 746.18$ NA73725 TC 12.52 616.23$ 12.52 616.23$ NA73725 26 2.64 129.94$ 2.64 129.94$ 74000 0.83 40.85$ 0.83 40.85$ NA74000 TC 0.56 27.56$ 0.56 27.56$ NA74000 26 0.27 13.29$ 0.27 13.29$ 74010 1 49.22$ 1 49.22$ NA74010 TC 0.66 32.49$ 0.66 32.49$ NA74010 26 0.34 16.73$ 0.34 16.73$ 74020 1.1 54.14$ 1.1 54.14$ NA74020 TC 0.71 34.95$ 0.71 34.95$ NA74020 26 0.39 19.20$ 0.39 19.20$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 14: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY14

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

74022 1.29 63.49$ 1.29 63.49$ NA74022 TC 0.84 41.34$ 0.84 41.34$ NA74022 26 0.45 22.15$ 0.45 22.15$ 74150 8.05 396.22$ 8.05 396.22$ NA74150 TC 6.33 311.56$ 6.33 311.56$ NA74150 26 1.72 84.66$ 1.72 84.66$ 74160 9.5 467.59$ 9.5 467.59$ NA74160 TC 7.64 376.04$ 7.64 376.04$ NA74160 26 1.86 91.55$ 1.86 91.55$ 74170 11.48 565.05$ 11.48 565.05$ NA74170 TC 9.45 465.13$ 9.45 465.13$ NA74170 26 2.03 99.92$ 2.03 99.92$ 74175 15.64 769.80$ 15.64 769.80$ NA74175 TC 12.9 634.94$ 12.9 634.94$ NA74175 26 2.75 135.36$ 2.75 135.36$ 74181 14.31 704.34$ 14.31 704.34$ NA74181 TC 12.2 600.48$ 12.2 600.48$ NA74181 26 2.11 103.85$ 2.11 103.85$ 74182 17.12 842.65$ 17.12 842.65$ NA74182 TC 14.6 718.61$ 14.6 718.61$ NA74182 26 2.52 124.03$ 2.52 124.03$ 74183 30.21 1,486.94$ 30.21 1,486.94$ NA74183 TC 26.93 1,325.49$ 26.93 1,325.49$ NA74183 26 3.28 161.44$ 3.28 161.44$ 74185 15.13 744.70$ 15.13 744.70$ NA74185 TC 12.52 616.23$ 12.52 616.23$ NA74185 26 2.61 128.46$ 2.61 128.46$ 74190 2.16 106.32$ 2.16 106.32$ NA74190 TC 1.47 72.35$ 1.47 72.35$ NA74190 26 0.7 34.45$ 0.7 34.45$ 74210 1.86 91.55$ 1.86 91.55$ NA74210 TC 1.32 64.97$ 1.32 64.97$ NA74210 26 0.53 26.09$ 0.53 26.09$ 74220 1.99 97.95$ 1.99 97.95$ NA74220 TC 1.32 64.97$ 1.32 64.97$ NA74220 26 0.67 32.98$ 0.67 32.98$ 74230 2.22 109.27$ 2.22 109.27$ NA74230 TC 1.47 72.35$ 1.47 72.35$ NA74230 26 0.76 37.41$ 0.76 37.41$ 74235 4.68 230.35$ 4.68 230.35$ NA74235 TC 2.93 144.21$ 2.93 144.21$ NA74235 26 1.74 85.64$ 1.74 85.64$ 74240 2.64 129.94$ 2.64 129.94$ NA74240 TC 1.64 80.72$ 1.64 80.72$ NA74240 26 1 49.22$ 1 49.22$ 74241 2.67 131.42$ 2.67 131.42$ NA74241 TC 1.67 82.20$ 1.67 82.20$ NA74241 26 1 49.22$ 1 49.22$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 15: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY15

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

74245 3.99 196.39$ 3.99 196.39$ NA74245 TC 2.67 131.42$ 2.67 131.42$ NA74245 26 1.32 64.97$ 1.32 64.97$ 74246 2.87 141.26$ 2.87 141.26$ NA74246 TC 1.86 91.55$ 1.86 91.55$ NA74246 26 1 49.22$ 1 49.22$ 74247 2.93 144.21$ 2.93 144.21$ NA74247 TC 1.93 94.99$ 1.93 94.99$ NA74247 26 1 49.22$ 1 49.22$ 74249 4.2 206.72$ 4.2 206.72$ NA74249 TC 2.88 141.75$ 2.88 141.75$ NA74249 26 1.32 64.97$ 1.32 64.97$ 74250 2.14 105.33$ 2.14 105.33$ NA74250 TC 1.47 72.35$ 1.47 72.35$ NA74250 26 0.68 33.47$ 0.68 33.47$ 74251 2.47 121.57$ 2.47 121.57$ NA74251 TC 1.47 72.35$ 1.47 72.35$ NA74251 26 1 49.22$ 1 49.22$ 74260 2.39 117.64$ 2.39 117.64$ NA74260 TC 1.67 82.20$ 1.67 82.20$ NA74260 26 0.72 35.44$ 0.72 35.44$ 74270 2.95 145.20$ 2.95 145.20$ NA74270 TC 1.95 95.98$ 1.95 95.98$ NA74270 26 1 49.22$ 1 49.22$ 74280 3.94 193.93$ 3.94 193.93$ NA74280 TC 2.52 124.03$ 2.52 124.03$ NA74280 26 1.42 69.89$ 1.42 69.89$ 74283 5.8 285.48$ 5.8 285.48$ NA74283 TC 2.87 141.26$ 2.87 141.26$ NA74283 26 2.93 144.21$ 2.93 144.21$ 74290 1.29 63.49$ 1.29 63.49$ NA74290 TC 0.84 41.34$ 0.84 41.34$ NA74290 26 0.45 22.15$ 0.45 22.15$ 74291 0.76 37.41$ 0.76 37.41$ NA74291 TC 0.46 22.64$ 0.46 22.64$ NA74291 26 0.3 14.77$ 0.3 14.77$ 74300 0 -$ 0 -$ 74300 TC 0 -$ 0 -$ 74300 26 0.53 26.09$ 0.53 26.09$ 74301 0 -$ 0 -$ 74301 TC 0 -$ 0 -$ 74301 26 0.31 15.26$ 0.31 15.26$ 74305 1.51 74.32$ 1.51 74.32$ NA74305 TC 0.89 43.81$ 0.89 43.81$ NA74305 26 0.62 30.52$ 0.62 30.52$ 74320 4.31 212.14$ 4.31 212.14$ NA74320 TC 3.53 173.75$ 3.53 173.75$ NA74320 26 0.78 38.39$ 0.78 38.39$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 16: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY16

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

74327 3.02 148.64$ 3.02 148.64$ NA74327 TC 2.01 98.93$ 2.01 98.93$ NA74327 26 1.01 49.71$ 1.01 49.71$ 74328 4.54 223.46$ 4.54 223.46$ NA74328 TC 3.53 173.75$ 3.53 173.75$ NA74328 26 1.01 49.71$ 1.01 49.71$ 74329 4.54 223.46$ 4.54 223.46$ NA74329 TC 3.53 173.75$ 3.53 173.75$ NA74329 26 1.01 49.71$ 1.01 49.71$ 74330 4.83 237.73$ 4.83 237.73$ NA74330 TC 3.53 173.75$ 3.53 173.75$ NA74330 26 1.3 63.99$ 1.3 63.99$ 74340 3.71 182.61$ 3.71 182.61$ NA74340 TC 2.93 144.21$ 2.93 144.21$ NA74340 26 0.78 38.39$ 0.78 38.39$ 74350 4.63 227.89$ 4.63 227.89$ NA74350 TC 3.53 173.75$ 3.53 173.75$ NA74350 26 1.1 54.14$ 1.1 54.14$ 74355 4.03 198.36$ 4.03 198.36$ NA74355 TC 2.93 144.21$ 2.93 144.21$ NA74355 26 1.1 54.14$ 1.1 54.14$ 74360 4.34 213.61$ 4.34 213.61$ NA74360 TC 3.53 173.75$ 3.53 173.75$ NA74360 26 0.81 39.87$ 0.81 39.87$ 74363 8.12 399.67$ 8.12 399.67$ NA74363 TC 6.84 336.66$ 6.84 336.66$ NA74363 26 1.28 63.00$ 1.28 63.00$ 74400 2.63 129.45$ 2.63 129.45$ NA74400 TC 1.93 94.99$ 1.93 94.99$ NA74400 26 0.71 34.95$ 0.71 34.95$ 74410 2.9 142.74$ 2.9 142.74$ NA74410 TC 2.2 108.28$ 2.2 108.28$ NA74410 26 0.71 34.95$ 0.71 34.95$ 74415 3.09 152.09$ 3.09 152.09$ NA74415 TC 2.39 117.64$ 2.39 117.64$ NA74415 26 0.71 34.95$ 0.71 34.95$ 74420 3.47 170.79$ 3.47 170.79$ NA74420 TC 2.93 144.21$ 2.93 144.21$ NA74420 26 0.53 26.09$ 0.53 26.09$ 74425 2 98.44$ 2 98.44$ NA74425 TC 1.47 72.35$ 1.47 72.35$ NA74425 26 0.53 26.09$ 0.53 26.09$ 74430 1.66 81.71$ 1.66 81.71$ NA74430 TC 1.18 58.08$ 1.18 58.08$ NA74430 26 0.47 23.13$ 0.47 23.13$ 74440 1.82 89.58$ 1.82 89.58$ NA74440 TC 1.26 62.02$ 1.26 62.02$ NA74440 26 0.55 27.07$ 0.55 27.07$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 17: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY17

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

74445 2.96 145.69$ 2.96 145.69$ NA74445 TC 1.26 62.02$ 1.26 62.02$ NA74445 26 1.69 83.18$ 1.69 83.18$ 74450 2.13 104.84$ 2.13 104.84$ NA74450 TC 1.64 80.72$ 1.64 80.72$ NA74450 26 0.49 24.12$ 0.49 24.12$ 74455 2.3 113.21$ 2.3 113.21$ NA74455 TC 1.8 88.60$ 1.8 88.60$ NA74455 26 0.49 24.12$ 0.49 24.12$ 74470 2.18 107.30$ 2.18 107.30$ NA74470 TC 1.41 69.40$ 1.41 69.40$ NA74470 26 0.78 38.39$ 0.78 38.39$ 74475 5.34 262.83$ 5.34 262.83$ NA74475 TC 4.56 224.44$ 4.56 224.44$ NA74475 26 0.78 38.39$ 0.78 38.39$ 74480 5.34 262.83$ 5.34 262.83$ NA74480 TC 4.56 224.44$ 4.56 224.44$ NA74480 26 0.78 38.39$ 0.78 38.39$ 74485 4.32 212.63$ 4.32 212.63$ NA74485 TC 3.53 173.75$ 3.53 173.75$ NA74485 26 0.79 38.88$ 0.79 38.88$ 74710 1.69 83.18$ 1.69 83.18$ NA74710 TC 1.18 58.08$ 1.18 58.08$ NA74710 26 0.5 24.61$ 0.5 24.61$ 74740 2.03 99.92$ 2.03 99.92$ NA74740 TC 1.47 72.35$ 1.47 72.35$ NA74740 26 0.56 27.56$ 0.56 27.56$ 74742 4.42 217.55$ 4.42 217.55$ NA74742 TC 3.53 173.75$ 3.53 173.75$ NA74742 26 0.89 43.81$ 0.89 43.81$ 74775 2.55 125.51$ 2.55 125.51$ NA74775 TC 1.64 80.72$ 1.64 80.72$ NA74775 26 0.91 44.79$ 0.91 44.79$ 75552 14.84 730.42$ 14.84 730.42$ NA75552 TC 12.52 616.23$ 12.52 616.23$ NA75552 26 2.33 114.68$ 2.33 114.68$ 75553 15.37 756.51$ 15.37 756.51$ NA75553 TC 12.52 616.23$ 12.52 616.23$ NA75553 26 2.86 140.77$ 2.86 140.77$ 75554 15.19 747.65$ 15.19 747.65$ NA75554 TC 12.52 616.23$ 12.52 616.23$ NA75554 26 2.67 131.42$ 2.67 131.42$ 75555 15.1 743.22$ 15.1 743.22$ NA75555 TC 12.52 616.23$ 12.52 616.23$ NA75555 26 2.58 126.99$ 2.58 126.99$ 75556 0 -$ 0 -$ 75600 14.79 727.96$ 14.79 727.96$ NA75600 TC 14.05 691.54$ 14.05 691.54$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 18: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY18

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

75600 26 0.74 36.42$ 0.74 36.42$ 75605 15.73 774.23$ 15.73 774.23$ NA75605 TC 14.05 691.54$ 14.05 691.54$ NA75605 26 1.68 82.69$ 1.68 82.69$ 75625 15.73 774.23$ 15.73 774.23$ NA75625 TC 14.05 691.54$ 14.05 691.54$ NA75625 26 1.68 82.69$ 1.68 82.69$ 75630 17.36 854.46$ 17.36 854.46$ NA75630 TC 14.67 722.06$ 14.67 722.06$ NA75630 26 2.69 132.40$ 2.69 132.40$ 75635 20.27 997.69$ 20.27 997.69$ NA75635 TC 16.77 825.42$ 16.77 825.42$ NA75635 26 3.49 171.78$ 3.49 171.78$ 75650 16.25 799.83$ 16.25 799.83$ NA75650 TC 14.05 691.54$ 14.05 691.54$ NA75650 26 2.2 108.28$ 2.2 108.28$ 75658 16.02 788.50$ 16.02 788.50$ NA75658 TC 14.05 691.54$ 14.05 691.54$ NA75658 26 1.97 96.96$ 1.97 96.96$ 75660 16.01 788.01$ 16.01 788.01$ NA75660 TC 14.05 691.54$ 14.05 691.54$ NA75660 26 1.96 96.47$ 1.96 96.47$ 75662 16.52 813.11$ 16.52 813.11$ NA75662 TC 14.05 691.54$ 14.05 691.54$ NA75662 26 2.47 121.57$ 2.47 121.57$ 75665 16.04 789.49$ 16.04 789.49$ NA75665 TC 14.05 691.54$ 14.05 691.54$ NA75665 26 1.98 97.46$ 1.98 97.46$ 75671 16.5 812.13$ 16.5 812.13$ NA75671 TC 14.05 691.54$ 14.05 691.54$ NA75671 26 2.45 120.59$ 2.45 120.59$ 75676 16.04 789.49$ 16.04 789.49$ NA75676 TC 14.05 691.54$ 14.05 691.54$ NA75676 26 1.98 97.46$ 1.98 97.46$ 75680 16.5 812.13$ 16.5 812.13$ NA75680 TC 14.05 691.54$ 14.05 691.54$ NA75680 26 2.45 120.59$ 2.45 120.59$ 75685 15.98 786.54$ 15.98 786.54$ NA75685 TC 14.05 691.54$ 14.05 691.54$ NA75685 26 1.93 94.99$ 1.93 94.99$ 75705 17.31 852.00$ 17.31 852.00$ NA75705 TC 14.05 691.54$ 14.05 691.54$ NA75705 26 3.25 159.97$ 3.25 159.97$ 75710 15.77 776.20$ 15.77 776.20$ NA75710 TC 14.05 691.54$ 14.05 691.54$ NA75710 26 1.71 84.17$ 1.71 84.17$ 75716 15.98 786.54$ 15.98 786.54$ NA75716 TC 14.05 691.54$ 14.05 691.54$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 19: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY19

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

75716 26 1.93 94.99$ 1.93 94.99$ 75722 15.75 775.22$ 15.75 775.22$ NA75722 TC 14.05 691.54$ 14.05 691.54$ NA75722 26 1.7 83.67$ 1.7 83.67$ 75724 16.27 800.81$ 16.27 800.81$ NA75724 TC 14.05 691.54$ 14.05 691.54$ NA75724 26 2.22 109.27$ 2.22 109.27$ 75726 15.7 772.75$ 15.7 772.75$ NA75726 TC 14.05 691.54$ 14.05 691.54$ NA75726 26 1.65 81.21$ 1.65 81.21$ 75731 15.72 773.74$ 15.72 773.74$ NA75731 TC 14.05 691.54$ 14.05 691.54$ NA75731 26 1.67 82.20$ 1.67 82.20$ 75733 15.97 786.04$ 15.97 786.04$ NA75733 TC 14.05 691.54$ 14.05 691.54$ NA75733 26 1.92 94.50$ 1.92 94.50$ 75736 15.73 774.23$ 15.73 774.23$ NA75736 TC 14.05 691.54$ 14.05 691.54$ NA75736 26 1.68 82.69$ 1.68 82.69$ 75741 15.96 785.55$ 15.96 785.55$ NA75741 TC 14.05 691.54$ 14.05 691.54$ NA75741 26 1.91 94.01$ 1.91 94.01$ 75743 16.45 809.67$ 16.45 809.67$ NA75743 TC 14.05 691.54$ 14.05 691.54$ NA75743 26 2.4 118.13$ 2.4 118.13$ 75746 15.71 773.25$ 15.71 773.25$ NA75746 TC 14.05 691.54$ 14.05 691.54$ NA75746 26 1.66 81.71$ 1.66 81.71$ 75756 15.76 775.71$ 15.76 775.71$ NA75756 TC 14.05 691.54$ 14.05 691.54$ NA75756 26 1.71 84.17$ 1.71 84.17$ 75774 14.59 718.12$ 14.59 718.12$ NA75774 TC 14.05 691.54$ 14.05 691.54$ NA75774 26 0.53 26.09$ 0.53 26.09$ 75790 4.24 208.69$ 4.24 208.69$ NA75790 TC 1.53 75.31$ 1.53 75.31$ NA75790 26 2.71 133.39$ 2.71 133.39$ 75801 7.32 360.29$ 7.32 360.29$ NA75801 TC 6.06 298.27$ 6.06 298.27$ NA75801 26 1.26 62.02$ 1.26 62.02$ 75803 7.75 381.46$ 7.75 381.46$ NA75803 TC 6.06 298.27$ 6.06 298.27$ NA75803 26 1.69 83.18$ 1.69 83.18$ 75805 8.05 396.22$ 8.05 396.22$ NA75805 TC 6.84 336.66$ 6.84 336.66$ NA75805 26 1.21 59.56$ 1.21 59.56$ 75807 8.53 419.85$ 8.53 419.85$ NA75807 TC 6.84 336.66$ 6.84 336.66$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 20: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY20

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

75807 26 1.69 83.18$ 1.69 83.18$ 75809 1.57 77.28$ 1.57 77.28$ NA75809 TC 0.89 43.81$ 0.89 43.81$ NA75809 26 0.68 33.47$ 0.68 33.47$ 75810 15.7 772.75$ 15.7 772.75$ NA75810 TC 14.05 691.54$ 14.05 691.54$ NA75810 26 1.65 81.21$ 1.65 81.21$ 75820 2.12 104.35$ 2.12 104.35$ NA75820 TC 1.08 53.16$ 1.08 53.16$ NA75820 26 1.04 51.19$ 1.04 51.19$ 75822 3.21 158.00$ 3.21 158.00$ NA75822 TC 1.66 81.71$ 1.66 81.71$ NA75822 26 1.55 76.29$ 1.55 76.29$ 75825 15.75 775.22$ 15.75 775.22$ NA75825 TC 14.05 691.54$ 14.05 691.54$ NA75825 26 1.69 83.18$ 1.69 83.18$ 75827 15.72 773.74$ 15.72 773.74$ NA75827 TC 14.05 691.54$ 14.05 691.54$ NA75827 26 1.67 82.20$ 1.67 82.20$ 75831 15.75 775.22$ 15.75 775.22$ NA75831 TC 14.05 691.54$ 14.05 691.54$ NA75831 26 1.69 83.18$ 1.69 83.18$ 75833 16.27 800.81$ 16.27 800.81$ NA75833 TC 14.05 691.54$ 14.05 691.54$ NA75833 26 2.22 109.27$ 2.22 109.27$ 75840 15.76 775.71$ 15.76 775.71$ NA75840 TC 14.05 691.54$ 14.05 691.54$ NA75840 26 1.7 83.67$ 1.7 83.67$ 75842 16.22 798.35$ 16.22 798.35$ NA75842 TC 14.05 691.54$ 14.05 691.54$ NA75842 26 2.16 106.32$ 2.16 106.32$ 75860 15.72 773.74$ 15.72 773.74$ NA75860 TC 14.05 691.54$ 14.05 691.54$ NA75860 26 1.67 82.20$ 1.67 82.20$ 75870 15.72 773.74$ 15.72 773.74$ NA75870 TC 14.05 691.54$ 14.05 691.54$ NA75870 26 1.67 82.20$ 1.67 82.20$ 75872 15.88 781.61$ 15.88 781.61$ NA75872 TC 14.05 691.54$ 14.05 691.54$ NA75872 26 1.83 90.07$ 1.83 90.07$ 75880 2.1 103.36$ 2.1 103.36$ NA75880 TC 1.08 53.16$ 1.08 53.16$ NA75880 26 1.01 49.71$ 1.01 49.71$ 75885 16.15 794.90$ 16.15 794.90$ NA75885 TC 14.05 691.54$ 14.05 691.54$ NA75885 26 2.1 103.36$ 2.1 103.36$ 75887 16.13 793.92$ 16.13 793.92$ NA75887 TC 14.05 691.54$ 14.05 691.54$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 21: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY21

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

75887 26 2.08 102.38$ 2.08 102.38$ 75889 15.7 772.75$ 15.7 772.75$ NA75889 TC 14.05 691.54$ 14.05 691.54$ NA75889 26 1.65 81.21$ 1.65 81.21$ 75891 15.7 772.75$ 15.7 772.75$ NA75891 TC 14.05 691.54$ 14.05 691.54$ NA75891 26 1.65 81.21$ 1.65 81.21$ 75893 14.85 730.92$ 14.85 730.92$ NA75893 TC 14.05 691.54$ 14.05 691.54$ NA75893 26 0.8 39.38$ 0.8 39.38$ 75894 28.92 1,423.44$ 28.92 1,423.44$ NA75894 TC 26.97 1,327.46$ 26.97 1,327.46$ NA75894 26 1.95 95.98$ 1.95 95.98$ 75896 25.4 1,250.19$ 25.4 1,250.19$ NA75896 TC 23.45 1,154.21$ 23.45 1,154.21$ NA75896 26 1.95 95.98$ 1.95 95.98$ 75898 3.6 177.19$ 3.6 177.19$ NA75898 TC 1.18 58.08$ 1.18 58.08$ NA75898 26 2.42 119.11$ 2.42 119.11$ 75900 24.18 1,190.14$ 24.18 1,190.14$ NA75900 TC 23.45 1,154.21$ 23.45 1,154.21$ NA75900 26 0.73 35.93$ 0.73 35.93$ 75901 3.89 191.47$ 3.89 191.47$ NA75901 TC 3.18 156.52$ 3.18 156.52$ NA75901 26 0.71 34.95$ 0.71 34.95$ 75902 3.75 184.58$ 3.75 184.58$ NA75902 TC 3.18 156.52$ 3.18 156.52$ NA75902 26 0.57 28.06$ 0.57 28.06$ 75940 14.88 732.39$ 14.88 732.39$ NA75940 TC 14.05 691.54$ 14.05 691.54$ NA75940 26 0.82 40.36$ 0.82 40.36$ 75945 5.74 282.52$ 5.74 282.52$ NA75945 TC 5.1 251.02$ 5.1 251.02$ NA75945 26 0.64 31.50$ 0.64 31.50$ 75946 3.24 159.47$ 3.24 159.47$ NA75946 TC 2.58 126.99$ 2.58 126.99$ NA75946 26 0.66 32.49$ 0.66 32.49$ 75952 0 -$ 0 -$ 75952 TC 0 -$ 0 -$ 75952 26 7.08 348.48$ 7.08 348.48$ 75953 0 -$ 0 -$ 75953 TC 0 -$ 0 -$ 75953 26 2.14 105.33$ 2.14 105.33$ 75954 0 -$ 0 -$ 75954 TC 0 -$ 0 -$ 75954 26 3.42 168.33$ 3.42 168.33$ 75960 17.85 878.58$ 17.85 878.58$ NA75960 TC 16.62 818.04$ 16.62 818.04$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 22: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY22

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

75960 26 1.23 60.54$ 1.23 60.54$ 75961 17.96 883.99$ 17.96 883.99$ NA75961 TC 11.73 577.35$ 11.73 577.35$ NA75961 26 6.23 306.64$ 6.23 306.64$ 75962 18.42 906.63$ 18.42 906.63$ NA75962 TC 17.59 865.78$ 17.59 865.78$ NA75962 26 0.82 40.36$ 0.82 40.36$ 75964 9.91 487.77$ 9.91 487.77$ NA75964 TC 9.35 460.21$ 9.35 460.21$ NA75964 26 0.56 27.56$ 0.56 27.56$ 75966 19.55 962.25$ 19.55 962.25$ NA75966 TC 17.59 865.78$ 17.59 865.78$ NA75966 26 1.96 96.47$ 1.96 96.47$ 75968 9.89 486.79$ 9.89 486.79$ NA75968 TC 9.35 460.21$ 9.35 460.21$ NA75968 26 0.54 26.58$ 0.54 26.58$ 75970 14.1 694.00$ 14.1 694.00$ NA75970 TC 12.88 633.95$ 12.88 633.95$ NA75970 26 1.22 60.05$ 1.22 60.05$ 75978 18.4 905.65$ 18.4 905.65$ NA75978 TC 17.59 865.78$ 17.59 865.78$ NA75978 26 0.8 39.38$ 0.8 39.38$ 75980 8.14 400.65$ 8.14 400.65$ NA75980 TC 6.06 298.27$ 6.06 298.27$ NA75980 26 2.08 102.38$ 2.08 102.38$ 75982 8.92 439.04$ 8.92 439.04$ NA75982 TC 6.84 336.66$ 6.84 336.66$ NA75982 26 2.08 102.38$ 2.08 102.38$ 75984 3.23 158.98$ 3.23 158.98$ NA75984 TC 2.2 108.28$ 2.2 108.28$ NA75984 26 1.03 50.70$ 1.03 50.70$ 75989 5.25 258.41$ 5.25 258.41$ NA75989 TC 3.53 173.75$ 3.53 173.75$ NA75989 26 1.72 84.66$ 1.72 84.66$ 75992 18.41 906.14$ 18.41 906.14$ NA75992 TC 17.59 865.78$ 17.59 865.78$ NA75992 26 0.81 39.87$ 0.81 39.87$ 75993 9.89 486.79$ 9.89 486.79$ NA75993 TC 9.35 460.21$ 9.35 460.21$ NA75993 26 0.54 26.58$ 0.54 26.58$ 75994 19.55 962.25$ 19.55 962.25$ NA75994 TC 17.59 865.78$ 17.59 865.78$ NA75994 26 1.96 96.47$ 1.96 96.47$ 75995 19.52 960.77$ 19.52 960.77$ NA75995 TC 17.59 865.78$ 17.59 865.78$ NA75995 26 1.92 94.50$ 1.92 94.50$ 75996 9.88 486.29$ 9.88 486.29$ NA75996 TC 9.35 460.21$ 9.35 460.21$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 23: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY23

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

75996 26 0.53 26.09$ 0.53 26.09$ 75998 2.08 102.38$ 2.08 102.38$ NA75998 TC 1.53 75.31$ 1.53 75.31$ NA75998 26 0.54 26.58$ 0.54 26.58$ 76000 1.71 84.17$ 1.71 84.17$ NA76000 TC 1.47 72.35$ 1.47 72.35$ NA76000 26 0.25 12.31$ 0.25 12.31$ 76001 3.95 194.42$ 3.95 194.42$ NA76001 TC 2.93 144.21$ 2.93 144.21$ NA76001 26 1.02 50.20$ 1.02 50.20$ 76003 2.26 111.24$ 2.26 111.24$ NA76003 TC 1.47 72.35$ 1.47 72.35$ NA76003 26 0.79 38.88$ 0.79 38.88$ 76005 2.32 114.19$ 2.32 114.19$ NA76005 TC 1.47 72.35$ 1.47 72.35$ NA76005 26 0.85 41.84$ 0.85 41.84$ 76006 0.73 35.93$ 0.73 35.93$ 76010 0.83 40.85$ 0.83 40.85$ NA76010 TC 0.56 27.56$ 0.56 27.56$ NA76010 26 0.27 13.29$ 0.27 13.29$ 76012 0 -$ 0 -$ 76012 TC 0 -$ 0 -$ 76012 26 2.04 100.41$ 2.04 100.41$ 76013 0 -$ 0 -$ 76013 TC 0 -$ 0 -$ 76013 26 2.07 101.89$ 2.07 101.89$ 76020 0.84 41.34$ 0.84 41.34$ NA76020 TC 0.56 27.56$ 0.56 27.56$ NA76020 26 0.28 13.78$ 0.28 13.78$ 76040 1.28 63.00$ 1.28 63.00$ NA76040 TC 0.89 43.81$ 0.89 43.81$ NA76040 26 0.39 19.20$ 0.39 19.20$ 76061 1.79 88.10$ 1.79 88.10$ NA76061 TC 1.13 55.62$ 1.13 55.62$ NA76061 26 0.66 32.49$ 0.66 32.49$ 76062 2.4 118.13$ 2.4 118.13$ NA76062 TC 1.62 79.74$ 1.62 79.74$ NA76062 26 0.78 38.39$ 0.78 38.39$ 76065 1.86 91.55$ 1.86 91.55$ NA76065 TC 0.84 41.34$ 0.84 41.34$ NA76065 26 1.01 49.71$ 1.01 49.71$ 76066 1.71 84.17$ 1.71 84.17$ NA76066 TC 1.24 61.03$ 1.24 61.03$ NA76066 26 0.46 22.64$ 0.46 22.64$ 76070 3.67 180.64$ 3.67 180.64$ NA76070 TC 3.31 162.92$ 3.31 162.92$ NA76070 26 0.36 17.72$ 0.36 17.72$ 76071 3.38 166.36$ 3.38 166.36$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 24: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY24

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

76071 TC 3.06 150.61$ 3.06 150.61$ NA76071 26 0.32 15.75$ 0.32 15.75$ 76075 3.9 191.96$ 3.9 191.96$ NA76075 TC 3.47 170.79$ 3.47 170.79$ NA76075 26 0.43 21.16$ 0.43 21.16$ 76076 1.19 58.57$ 1.19 58.57$ NA76076 TC 0.86 42.33$ 0.86 42.33$ NA76076 26 0.33 16.24$ 0.33 16.24$ 76077 1.12 55.13$ 1.12 55.13$ NA76077 TC 0.86 42.33$ 0.86 42.33$ NA76077 26 0.26 12.80$ 0.26 12.80$ 76078 1.16 57.10$ 1.16 57.10$ NA76078 TC 0.86 42.33$ 0.86 42.33$ NA76078 26 0.3 14.77$ 0.3 14.77$ 76080 1.96 96.47$ 1.96 96.47$ NA76080 TC 1.18 58.08$ 1.18 58.08$ NA76080 26 0.78 38.39$ 0.78 38.39$ 76082 0.55 27.07$ 0.55 27.07$ NA76082 TC 0.44 21.66$ 0.44 21.66$ NA76082 26 0.1 4.92$ 0.1 4.92$ 76083 0.55 27.07$ 0.55 27.07$ NA76083 TC 0.44 21.66$ 0.44 21.66$ NA76083 26 0.1 4.92$ 0.1 4.92$ 76086 3.47 170.79$ 3.47 170.79$ NA76086 TC 2.93 144.21$ 2.93 144.21$ NA76086 26 0.53 26.09$ 0.53 26.09$ 76088 4.74 233.30$ 4.74 233.30$ NA76088 TC 4.08 200.82$ 4.08 200.82$ NA76088 26 0.66 32.49$ 0.66 32.49$ 76090 2.2 108.28$ 2.2 108.28$ NA76090 TC 1.18 58.08$ 1.18 58.08$ NA76090 26 1.01 49.71$ 1.01 49.71$ 76091 2.73 134.37$ 2.73 134.37$ NA76091 TC 1.47 72.35$ 1.47 72.35$ NA76091 26 1.26 62.02$ 1.26 62.02$ 76092 2.4 118.13$ 2.4 118.13$ NA76092 TC 1.39 68.42$ 1.39 68.42$ NA76092 26 1.01 49.71$ 1.01 49.71$ 76093 22.03 1,084.32$ 22.03 1,084.32$ NA76093 TC 19.68 968.65$ 19.68 968.65$ NA76093 26 2.36 116.16$ 2.36 116.16$ 76094 29.04 1,429.35$ 29.04 1,429.35$ NA76094 TC 26.68 1,313.19$ 26.68 1,313.19$ NA76094 26 2.36 116.16$ 2.36 116.16$ 76095 10.34 508.93$ 10.34 508.93$ NA76095 TC 7.99 393.27$ 7.99 393.27$ NA76095 26 2.35 115.67$ 2.35 115.67$ 76096 2.29 112.71$ 2.29 112.71$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 25: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY25

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

76096 TC 1.47 72.35$ 1.47 72.35$ NA76096 26 0.82 40.36$ 0.82 40.36$ 76098 0.7 34.45$ 0.7 34.45$ NA76098 TC 0.46 22.64$ 0.46 22.64$ NA76098 26 0.24 11.81$ 0.24 11.81$ 76100 2.26 111.24$ 2.26 111.24$ NA76100 TC 1.41 69.40$ 1.41 69.40$ NA76100 26 0.85 41.84$ 0.85 41.84$ 76101 2.45 120.59$ 2.45 120.59$ NA76101 TC 1.6 78.75$ 1.6 78.75$ NA76101 26 0.85 41.84$ 0.85 41.84$ 76102 2.83 139.29$ 2.83 139.29$ NA76102 TC 1.98 97.46$ 1.98 97.46$ NA76102 26 0.85 41.84$ 0.85 41.84$ 76120 1.75 86.14$ 1.75 86.14$ NA76120 TC 1.18 58.08$ 1.18 58.08$ NA76120 26 0.56 27.56$ 0.56 27.56$ 76125 1.28 63.00$ 1.28 63.00$ NA76125 TC 0.89 43.81$ 0.89 43.81$ NA76125 26 0.39 19.20$ 0.39 19.20$ 76140 0 -$ 0 -$ 76150 0.46 22.64$ 0.46 22.64$ NA76350 0 -$ 0 -$ 76355 10.97 539.94$ 10.97 539.94$ NA76355 TC 9.2 452.82$ 9.2 452.82$ NA76355 26 1.77 87.12$ 1.77 87.12$ 76360 10.88 535.51$ 10.88 535.51$ NA76360 TC 9.2 452.82$ 9.2 452.82$ NA76360 26 1.68 82.69$ 1.68 82.69$ 76362 17.35 853.97$ 17.35 853.97$ NA76362 TC 11.54 568.00$ 11.54 568.00$ NA76362 26 5.81 285.97$ 5.81 285.97$ 76370 4.55 223.95$ 4.55 223.95$ NA76370 TC 3.31 162.92$ 3.31 162.92$ NA76370 26 1.24 61.03$ 1.24 61.03$ 76375 4.18 205.74$ 4.18 205.74$ NA76375 TC 3.94 193.93$ 3.94 193.93$ NA76375 26 0.24 11.81$ 0.24 11.81$ 76380 5.32 261.85$ 5.32 261.85$ NA76380 TC 3.9 191.96$ 3.9 191.96$ NA76380 26 1.41 69.40$ 1.41 69.40$ 76390 14.39 708.28$ 14.39 708.28$ 76390 TC 12.33 606.88$ 12.33 606.88$ 76390 26 2.06 101.39$ 2.06 101.39$ 76393 14.67 722.06$ 14.67 722.06$ NA76393 TC 12.43 611.80$ 12.43 611.80$ NA76393 26 2.24 110.25$ 2.24 110.25$ 76394 20.97 1,032.14$ 20.97 1,032.14$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 26: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY26

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

76394 TC 14.7 723.53$ 14.7 723.53$ NA76394 26 6.26 308.12$ 6.26 308.12$ 76400 14.83 729.93$ 14.83 729.93$ NA76400 TC 12.52 616.23$ 12.52 616.23$ NA76400 26 2.32 114.19$ 2.32 114.19$ 76496 0 -$ 0 -$ 76496 TC 0 -$ 0 -$ 76496 26 0 -$ 0 -$ 76497 0 -$ 0 -$ 76497 TC 0 -$ 0 -$ 76497 26 0 -$ 0 -$ 76498 0 -$ 0 -$ 76498 TC 0 -$ 0 -$ 76498 26 0 -$ 0 -$ 76499 0 -$ 0 -$ 76499 TC 0 -$ 0 -$ 76499 26 0 -$ 0 -$ 76506 2.6 127.97$ 2.6 127.97$ NA76506 TC 1.6 78.75$ 1.6 78.75$ NA76506 26 1 49.22$ 1 49.22$ 76510 4.67 229.86$ 4.67 229.86$ NA76510 TC 2.34 115.17$ 2.34 115.17$ NA76510 26 2.33 114.68$ 2.33 114.68$ 76511 3.62 178.18$ 3.62 178.18$ NA76511 TC 2.19 107.79$ 2.19 107.79$ NA76511 26 1.43 70.38$ 1.43 70.38$ 76512 3.46 170.30$ 3.46 170.30$ NA76512 TC 2.03 99.92$ 2.03 99.92$ NA76512 26 1.43 70.38$ 1.43 70.38$ 76513 2.75 135.36$ 2.75 135.36$ NA76513 TC 1.74 85.64$ 1.74 85.64$ NA76513 26 1.01 49.71$ 1.01 49.71$ 76514 0.35 17.23$ 0.35 17.23$ NA76514 TC 0.07 3.45$ 0.07 3.45$ NA76514 26 0.28 13.78$ 0.28 13.78$ 76516 2.19 107.79$ 2.19 107.79$ NA76516 TC 1.38 67.92$ 1.38 67.92$ NA76516 26 0.82 40.36$ 0.82 40.36$ 76519 2.28 112.22$ 2.28 112.22$ NA76519 TC 1.47 72.35$ 1.47 72.35$ NA76519 26 0.82 40.36$ 0.82 40.36$ 76529 2.18 107.30$ 2.18 107.30$ NA76529 TC 1.31 64.48$ 1.31 64.48$ NA76529 26 0.87 42.82$ 0.87 42.82$ 76536 2.42 119.11$ 2.42 119.11$ NA76536 TC 1.6 78.75$ 1.6 78.75$ NA76536 26 0.82 40.36$ 0.82 40.36$ 76604 2.25 110.75$ 2.25 110.75$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 27: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY27

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

76604 TC 1.47 72.35$ 1.47 72.35$ NA76604 26 0.79 38.88$ 0.79 38.88$ 76645 1.96 96.47$ 1.96 96.47$ NA76645 TC 1.18 58.08$ 1.18 58.08$ NA76645 26 0.78 38.39$ 0.78 38.39$ 76700 3.41 167.84$ 3.41 167.84$ NA76700 TC 2.22 109.27$ 2.22 109.27$ NA76700 26 1.19 58.57$ 1.19 58.57$ 76705 2.46 121.08$ 2.46 121.08$ NA76705 TC 1.6 78.75$ 1.6 78.75$ NA76705 26 0.86 42.33$ 0.86 42.33$ 76770 3.28 161.44$ 3.28 161.44$ NA76770 TC 2.22 109.27$ 2.22 109.27$ NA76770 26 1.07 52.67$ 1.07 52.67$ 76775 2.45 120.59$ 2.45 120.59$ NA76775 TC 1.6 78.75$ 1.6 78.75$ NA76775 26 0.85 41.84$ 0.85 41.84$ 76778 3.28 161.44$ 3.28 161.44$ NA76778 TC 2.22 109.27$ 2.22 109.27$ NA76778 26 1.07 52.67$ 1.07 52.67$ 76800 3.21 158.00$ 3.21 158.00$ NA76800 TC 1.6 78.75$ 1.6 78.75$ NA76800 26 1.61 79.24$ 1.61 79.24$ 76801 3.81 187.53$ 3.81 187.53$ NA76801 TC 2.37 116.65$ 2.37 116.65$ NA76801 26 1.44 70.88$ 1.44 70.88$ 76802 2.55 125.51$ 2.55 125.51$ NA76802 TC 1.32 64.97$ 1.32 64.97$ NA76802 26 1.23 60.54$ 1.23 60.54$ 76805 3.81 187.53$ 3.81 187.53$ NA76805 TC 2.37 116.65$ 2.37 116.65$ NA76805 26 1.44 70.88$ 1.44 70.88$ 76810 2.98 146.68$ 2.98 146.68$ NA76810 TC 1.54 75.80$ 1.54 75.80$ NA76810 26 1.43 70.38$ 1.43 70.38$ 76811 7.35 361.77$ 7.35 361.77$ NA76811 TC 4.5 221.49$ 4.5 221.49$ NA76811 26 2.86 140.77$ 2.86 140.77$ 76812 4.64 228.38$ 4.64 228.38$ NA76812 TC 1.97 96.96$ 1.97 96.96$ NA76812 26 2.66 130.93$ 2.66 130.93$ 76815 2.56 126.00$ 2.56 126.00$ NA76815 TC 1.6 78.75$ 1.6 78.75$ NA76815 26 0.96 47.25$ 0.96 47.25$ 76816 2.52 124.03$ 2.52 124.03$ NA76816 TC 1.24 61.03$ 1.24 61.03$ NA76816 26 1.28 63.00$ 1.28 63.00$ 76817 2.75 135.36$ 2.75 135.36$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 28: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY28

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

76817 TC 1.65 81.21$ 1.65 81.21$ NA76817 26 1.1 54.14$ 1.1 54.14$ 76818 3.41 167.84$ 3.41 167.84$ NA76818 TC 1.83 90.07$ 1.83 90.07$ NA76818 26 1.58 77.77$ 1.58 77.77$ 76819 2.97 146.18$ 2.97 146.18$ NA76819 TC 1.83 90.07$ 1.83 90.07$ NA76819 26 1.14 56.11$ 1.14 56.11$ 76820 2.65 130.43$ 2.65 130.43$ NA76820 TC 1.88 92.53$ 1.88 92.53$ NA76820 26 0.77 37.90$ 0.77 37.90$ 76821 2.93 144.21$ 2.93 144.21$ NA76821 TC 1.88 92.53$ 1.88 92.53$ NA76821 26 1.05 51.68$ 1.05 51.68$ 76825 4.68 230.35$ 4.68 230.35$ NA76825 TC 2.22 109.27$ 2.22 109.27$ NA76825 26 2.47 121.57$ 2.47 121.57$ 76826 2.03 99.92$ 2.03 99.92$ NA76826 TC 0.82 40.36$ 0.82 40.36$ NA76826 26 1.21 59.56$ 1.21 59.56$ 76827 2.86 140.77$ 2.86 140.77$ NA76827 TC 1.99 97.95$ 1.99 97.95$ NA76827 26 0.87 42.82$ 0.87 42.82$ 76828 2.15 105.82$ 2.15 105.82$ NA76828 TC 1.29 63.49$ 1.29 63.49$ NA76828 26 0.86 42.33$ 0.86 42.33$ 76830 2.75 135.36$ 2.75 135.36$ NA76830 TC 1.74 85.64$ 1.74 85.64$ NA76830 26 1 49.22$ 1 49.22$ 76831 2.8 137.82$ 2.8 137.82$ NA76831 TC 1.74 85.64$ 1.74 85.64$ NA76831 26 1.05 51.68$ 1.05 51.68$ 76856 2.75 135.36$ 2.75 135.36$ NA76856 TC 1.74 85.64$ 1.74 85.64$ NA76856 26 1 49.22$ 1 49.22$ 76857 2.4 118.13$ 2.4 118.13$ NA76857 TC 1.84 90.56$ 1.84 90.56$ NA76857 26 0.55 27.07$ 0.55 27.07$ 76870 2.68 131.91$ 2.68 131.91$ NA76870 TC 1.74 85.64$ 1.74 85.64$ NA76870 26 0.93 45.77$ 0.93 45.77$ 76872 3.26 160.46$ 3.26 160.46$ NA76872 TC 2.24 110.25$ 2.24 110.25$ NA76872 26 1.02 50.20$ 1.02 50.20$ 76873 4.75 233.80$ 4.75 233.80$ NA76873 TC 2.46 121.08$ 2.46 121.08$ NA76873 26 2.29 112.71$ 2.29 112.71$ 76880 2.46 121.08$ 2.46 121.08$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 29: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY29

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

76880 TC 1.6 78.75$ 1.6 78.75$ NA76880 26 0.86 42.33$ 0.86 42.33$ 76885 2.81 138.31$ 2.81 138.31$ NA76885 TC 1.74 85.64$ 1.74 85.64$ NA76885 26 1.07 52.67$ 1.07 52.67$ 76886 2.5 123.05$ 2.5 123.05$ NA76886 TC 1.6 78.75$ 1.6 78.75$ NA76886 26 0.9 44.30$ 0.9 44.30$ 76930 2.72 133.88$ 2.72 133.88$ NA76930 TC 1.74 85.64$ 1.74 85.64$ NA76930 26 0.98 48.24$ 0.98 48.24$ 76932 2.72 133.88$ 2.72 133.88$ NA76932 TC 1.74 85.64$ 1.74 85.64$ NA76932 26 0.98 48.24$ 0.98 48.24$ 76936 10.04 494.17$ 10.04 494.17$ NA76936 TC 7.05 347.00$ 7.05 347.00$ NA76936 26 2.99 147.17$ 2.99 147.17$ 76937 1.08 53.16$ 1.08 53.16$ NA76937 TC 0.6 29.53$ 0.6 29.53$ NA76937 26 0.47 23.13$ 0.47 23.13$ 76940 5.52 271.69$ 5.52 271.69$ NA76940 TC 2.17 106.81$ 2.17 106.81$ NA76940 26 3.35 164.89$ 3.35 164.89$ 76941 3.71 182.61$ 3.71 182.61$ NA76941 TC 1.71 84.17$ 1.71 84.17$ NA76941 26 2 98.44$ 2 98.44$ 76942 4.01 197.37$ 4.01 197.37$ NA76942 TC 3.03 149.14$ 3.03 149.14$ NA76942 26 0.97 47.74$ 0.97 47.74$ 76945 2.7 132.89$ 2.7 132.89$ NA76945 TC 1.71 84.17$ 1.71 84.17$ NA76945 26 1 49.22$ 1 49.22$ 76946 2.32 114.19$ 2.32 114.19$ NA76946 TC 1.74 85.64$ 1.74 85.64$ NA76946 26 0.57 28.06$ 0.57 28.06$ 76948 2.31 113.70$ 2.31 113.70$ NA76948 TC 1.74 85.64$ 1.74 85.64$ NA76948 26 0.56 27.56$ 0.56 27.56$ 76950 2.32 114.19$ 2.32 114.19$ NA76950 TC 1.47 72.35$ 1.47 72.35$ NA76950 26 0.85 41.84$ 0.85 41.84$ 76965 8.2 403.60$ 8.2 403.60$ NA76965 TC 6.22 306.15$ 6.22 306.15$ NA76965 26 1.98 97.46$ 1.98 97.46$ 76970 1.77 87.12$ 1.77 87.12$ NA76970 TC 1.18 58.08$ 1.18 58.08$ NA76970 26 0.58 28.55$ 0.58 28.55$ 76975 2.94 144.71$ 2.94 144.71$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 30: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY30

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

76975 TC 1.74 85.64$ 1.74 85.64$ NA76975 26 1.2 59.06$ 1.2 59.06$ 76977 1.03 50.70$ 1.03 50.70$ NA76977 TC 0.93 45.77$ 0.93 45.77$ NA76977 26 0.09 4.43$ 0.09 4.43$ 76986 4.83 237.73$ 4.83 237.73$ NA76986 TC 2.93 144.21$ 2.93 144.21$ NA76986 26 1.9 93.52$ 1.9 93.52$ 76999 0 -$ 0 -$ 76999 TC 0 -$ 0 -$ 76999 26 0 -$ 0 -$ 77261 2.09 102.87$ 2.09 102.87$ 77262 3.16 155.54$ 3.16 155.54$ 77263 4.68 230.35$ 4.68 230.35$ 77280 4.9 241.18$ 4.9 241.18$ NA77280 TC 3.87 190.48$ 3.87 190.48$ NA77280 26 1.03 50.70$ 1.03 50.70$ 77285 7.77 382.44$ 7.77 382.44$ NA77285 TC 6.24 307.13$ 6.24 307.13$ NA77285 26 1.53 75.31$ 1.53 75.31$ 77290 9.57 471.04$ 9.57 471.04$ NA77290 TC 7.29 358.81$ 7.29 358.81$ NA77290 26 2.28 112.22$ 2.28 112.22$ 77295 37.91 1,865.93$ 37.91 1,865.93$ NA77295 TC 31.24 1,537.63$ 31.24 1,537.63$ NA77295 26 6.67 328.30$ 6.67 328.30$ 77299 0 -$ 0 -$ 77299 TC 0 -$ 0 -$ 77299 26 0 -$ 0 -$ 77300 2.4 118.13$ 2.4 118.13$ NA77300 TC 1.5 73.83$ 1.5 73.83$ NA77300 26 0.9 44.30$ 0.9 44.30$ 77301 42.88 2,110.55$ 42.88 2,110.55$ NA77301 TC 31.24 1,537.63$ 31.24 1,537.63$ NA77301 26 11.64 572.92$ 11.64 572.92$ 77305 3.14 154.55$ 3.14 154.55$ NA77305 TC 2.11 103.85$ 2.11 103.85$ NA77305 26 1.04 51.19$ 1.04 51.19$ 77310 4.15 204.26$ 4.15 204.26$ NA77310 TC 2.62 128.96$ 2.62 128.96$ NA77310 26 1.53 75.31$ 1.53 75.31$ 77315 5.25 258.41$ 5.25 258.41$ NA77315 TC 2.97 146.18$ 2.97 146.18$ NA77315 26 2.28 112.22$ 2.28 112.22$ 77321 5.89 289.91$ 5.89 289.91$ NA77321 TC 4.51 221.98$ 4.51 221.98$ NA77321 26 1.39 68.42$ 1.39 68.42$ 77326 4.02 197.86$ 4.02 197.86$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 31: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY31

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

77326 TC 2.65 130.43$ 2.65 130.43$ NA77326 26 1.36 66.94$ 1.36 66.94$ 77327 5.89 289.91$ 5.89 289.91$ NA77327 TC 3.87 190.48$ 3.87 190.48$ NA77327 26 2.02 99.42$ 2.02 99.42$ 77328 8.58 422.31$ 8.58 422.31$ NA77328 TC 5.52 271.69$ 5.52 271.69$ NA77328 26 3.06 150.61$ 3.06 150.61$ 77331 1.81 89.09$ 1.81 89.09$ NA77331 TC 0.54 26.58$ 0.54 26.58$ NA77331 26 1.26 62.02$ 1.26 62.02$ 77332 2.29 112.71$ 2.29 112.71$ NA77332 TC 1.5 73.83$ 1.5 73.83$ NA77332 26 0.79 38.88$ 0.79 38.88$ 77333 3.36 165.38$ 3.36 165.38$ NA77333 TC 2.14 105.33$ 2.14 105.33$ NA77333 26 1.22 60.05$ 1.22 60.05$ 77334 5.43 267.26$ 5.43 267.26$ NA77334 TC 3.63 178.67$ 3.63 178.67$ NA77334 26 1.8 88.60$ 1.8 88.60$ 77336 3.34 164.39$ 3.34 164.39$ NA77370 3.89 191.47$ 3.89 191.47$ NA77399 0 -$ 0 -$ 77399 TC 0 -$ 0 -$ 77399 26 0 -$ 0 -$ 77401 2.02 99.42$ 2.02 99.42$ NA77402 2.02 99.42$ 2.02 99.42$ NA77403 2.02 99.42$ 2.02 99.42$ NA77404 2.02 99.42$ 2.02 99.42$ NA77406 2.02 99.42$ 2.02 99.42$ NA77407 2.36 116.16$ 2.36 116.16$ NA77408 2.36 116.16$ 2.36 116.16$ NA77409 2.36 116.16$ 2.36 116.16$ NA77411 2.36 116.16$ 2.36 116.16$ NA77412 2.62 128.96$ 2.62 128.96$ NA77413 2.62 128.96$ 2.62 128.96$ NA77414 2.62 128.96$ 2.62 128.96$ NA77416 2.62 128.96$ 2.62 128.96$ NA77417 0.68 33.47$ 0.68 33.47$ NA77418 18.29 900.23$ 18.29 900.23$ NA77427 4.83 237.73$ 4.83 237.73$ 77431 2.74 134.86$ 2.74 134.86$ 77432 11.93 587.19$ 11.93 587.19$ 77470 15.53 764.39$ 15.53 764.39$ NA77470 TC 12.47 613.77$ 12.47 613.77$ NA77470 26 3.06 150.61$ 3.06 150.61$ 77499 0 -$ 0 -$ 77499 TC 0 -$ 0 -$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 32: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY32

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

77499 26 0 -$ 0 -$ 77520 0 -$ 0 -$ 77522 0 -$ 0 -$ 77523 0 -$ 0 -$ 77525 0 -$ 0 -$ 77600 5.68 279.57$ 5.68 279.57$ NA77600 TC 3.41 167.84$ 3.41 167.84$ NA77600 26 2.28 112.22$ 2.28 112.22$ 77605 7.71 379.49$ 7.71 379.49$ NA77605 TC 4.55 223.95$ 4.55 223.95$ NA77605 26 3.16 155.54$ 3.16 155.54$ 77610 5.69 280.06$ 5.69 280.06$ NA77610 TC 3.41 167.84$ 3.41 167.84$ NA77610 26 2.29 112.71$ 2.29 112.71$ 77615 7.6 374.07$ 7.6 374.07$ NA77615 TC 4.55 223.95$ 4.55 223.95$ NA77615 26 3.05 150.12$ 3.05 150.12$ 77620 5.98 294.34$ 5.98 294.34$ NA77620 TC 3.41 167.84$ 3.41 167.84$ NA77620 26 2.57 126.50$ 2.57 126.50$ 77750 8.65 425.75$ 8.65 425.75$ NA77750 TC 1.49 73.34$ 1.49 73.34$ NA77750 26 7.16 352.42$ 7.16 352.42$ 77761 8.22 404.59$ 8.22 404.59$ NA77761 TC 2.81 138.31$ 2.81 138.31$ NA77761 26 5.41 266.28$ 5.41 266.28$ 77762 12.39 609.84$ 12.39 609.84$ NA77762 TC 4.03 198.36$ 4.03 198.36$ NA77762 26 8.35 410.99$ 8.35 410.99$ 77763 17.52 862.33$ 17.52 862.33$ NA77763 TC 5 246.10$ 5 246.10$ NA77763 26 12.52 616.23$ 12.52 616.23$ 77776 9.15 450.36$ 9.15 450.36$ NA77776 TC 2.47 121.57$ 2.47 121.57$ NA77776 26 6.68 328.79$ 6.68 328.79$ 77777 15.66 770.79$ 15.66 770.79$ NA77777 TC 4.72 232.32$ 4.72 232.32$ NA77777 26 10.94 538.47$ 10.94 538.47$ 77778 22.02 1,083.82$ 22.02 1,083.82$ NA77778 TC 5.73 282.03$ 5.73 282.03$ NA77778 26 16.29 801.79$ 16.29 801.79$ 77781 25.08 1,234.44$ 25.08 1,234.44$ NA77781 TC 22.67 1,115.82$ 22.67 1,115.82$ NA77781 26 2.41 118.62$ 2.41 118.62$ 77782 26.31 1,294.98$ 26.31 1,294.98$ NA77782 TC 22.67 1,115.82$ 22.67 1,115.82$ NA77782 26 3.64 179.16$ 3.64 179.16$ 77783 28.09 1,382.59$ 28.09 1,382.59$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 33: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY33

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

77783 TC 22.67 1,115.82$ 22.67 1,115.82$ NA77783 26 5.43 267.26$ 5.43 267.26$ 77784 30.84 1,517.94$ 30.84 1,517.94$ NA77784 TC 22.67 1,115.82$ 22.67 1,115.82$ NA77784 26 8.18 402.62$ 8.18 402.62$ 77789 2.12 104.35$ 2.12 104.35$ NA77789 TC 0.49 24.12$ 0.49 24.12$ NA77789 26 1.63 80.23$ 1.63 80.23$ 77790 2.07 101.89$ 2.07 101.89$ NA77790 TC 0.54 26.58$ 0.54 26.58$ NA77790 26 1.53 75.31$ 1.53 75.31$ 77799 0 -$ 0 -$ 77799 TC 0 -$ 0 -$ 77799 26 0 -$ 0 -$ 78000 1.38 67.92$ 1.38 67.92$ NA78000 TC 1.1 54.14$ 1.1 54.14$ NA78000 26 0.28 13.78$ 0.28 13.78$ 78001 1.85 91.06$ 1.85 91.06$ NA78001 TC 1.47 72.35$ 1.47 72.35$ NA78001 26 0.38 18.70$ 0.38 18.70$ 78003 1.57 77.28$ 1.57 77.28$ NA78003 TC 1.1 54.14$ 1.1 54.14$ NA78003 26 0.47 23.13$ 0.47 23.13$ 78006 3.38 166.36$ 3.38 166.36$ NA78006 TC 2.67 131.42$ 2.67 131.42$ NA78006 26 0.71 34.95$ 0.71 34.95$ 78007 3.61 177.68$ 3.61 177.68$ NA78007 TC 2.88 141.75$ 2.88 141.75$ NA78007 26 0.73 35.93$ 0.73 35.93$ 78010 2.64 129.94$ 2.64 129.94$ NA78010 TC 2.07 101.89$ 2.07 101.89$ NA78010 26 0.57 28.06$ 0.57 28.06$ 78011 3.36 165.38$ 3.36 165.38$ NA78011 TC 2.7 132.89$ 2.7 132.89$ NA78011 26 0.66 32.49$ 0.66 32.49$ 78015 3.87 190.48$ 3.87 190.48$ NA78015 TC 2.88 141.75$ 2.88 141.75$ NA78015 26 0.98 48.24$ 0.98 48.24$ 78016 5.09 250.53$ 5.09 250.53$ NA78016 TC 3.88 190.97$ 3.88 190.97$ NA78016 26 1.21 59.56$ 1.21 59.56$ 78018 7.34 361.27$ 7.34 361.27$ NA78018 TC 6.07 298.77$ 6.07 298.77$ NA78018 26 1.27 62.51$ 1.27 62.51$ 78020 2.49 122.56$ 2.49 122.56$ NA78020 TC 1.62 79.74$ 1.62 79.74$ NA78020 26 0.87 42.82$ 0.87 42.82$ 78070 5.72 281.54$ 5.72 281.54$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 34: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY34

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

78070 TC 4.51 221.98$ 4.51 221.98$ NA78070 26 1.21 59.56$ 1.21 59.56$ 78075 7.15 351.92$ 7.15 351.92$ NA78075 TC 6.07 298.77$ 6.07 298.77$ NA78075 26 1.09 53.65$ 1.09 53.65$ 78099 0 -$ 0 -$ 78099 TC 0 -$ 0 -$ 78099 26 0 -$ 0 -$ 78102 3.11 153.07$ 3.11 153.07$ NA78102 TC 2.31 113.70$ 2.31 113.70$ NA78102 26 0.8 39.38$ 0.8 39.38$ 78103 4.65 228.87$ 4.65 228.87$ NA78103 TC 3.55 174.73$ 3.55 174.73$ NA78103 26 1.1 54.14$ 1.1 54.14$ 78104 5.72 281.54$ 5.72 281.54$ NA78104 TC 4.56 224.44$ 4.56 224.44$ NA78104 26 1.16 57.10$ 1.16 57.10$ 78110 1.37 67.43$ 1.37 67.43$ NA78110 TC 1.08 53.16$ 1.08 53.16$ NA78110 26 0.29 14.27$ 0.29 14.27$ 78111 3.21 158.00$ 3.21 158.00$ NA78111 TC 2.88 141.75$ 2.88 141.75$ NA78111 26 0.33 16.24$ 0.33 16.24$ 78120 2.31 113.70$ 2.31 113.70$ NA78120 TC 1.98 97.46$ 1.98 97.46$ NA78120 26 0.34 16.73$ 0.34 16.73$ 78121 3.68 181.13$ 3.68 181.13$ NA78121 TC 3.22 158.49$ 3.22 158.49$ NA78121 26 0.46 22.64$ 0.46 22.64$ 78122 5.8 285.48$ 5.8 285.48$ NA78122 TC 5.14 252.99$ 5.14 252.99$ NA78122 26 0.67 32.98$ 0.67 32.98$ 78130 4.06 199.83$ 4.06 199.83$ NA78130 TC 3.16 155.54$ 3.16 155.54$ NA78130 26 0.9 44.30$ 0.9 44.30$ 78135 6.37 313.53$ 6.37 313.53$ NA78135 TC 5.43 267.26$ 5.43 267.26$ NA78135 26 0.94 46.27$ 0.94 46.27$ 78140 5.29 260.37$ 5.29 260.37$ NA78140 TC 4.4 216.57$ 4.4 216.57$ NA78140 26 0.89 43.81$ 0.89 43.81$ 78160 4.63 227.89$ 4.63 227.89$ NA78160 TC 4.08 200.82$ 4.08 200.82$ NA78160 26 0.55 27.07$ 0.55 27.07$ 78162 4.28 210.66$ 4.28 210.66$ NA78162 TC 3.58 176.21$ 3.58 176.21$ NA78162 26 0.7 34.45$ 0.7 34.45$ 78170 6.54 321.90$ 6.54 321.90$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 35: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY35

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

78170 TC 5.94 292.37$ 5.94 292.37$ NA78170 26 0.6 29.53$ 0.6 29.53$ 78172 0 -$ 0 -$ 78172 TC 0 -$ 0 -$ 78172 26 0.76 37.41$ 0.76 37.41$ 78185 3.25 159.97$ 3.25 159.97$ NA78185 TC 2.65 130.43$ 2.65 130.43$ NA78185 26 0.59 29.04$ 0.59 29.04$ 78190 8.07 397.21$ 8.07 397.21$ NA78190 TC 6.38 314.02$ 6.38 314.02$ NA78190 26 1.69 83.18$ 1.69 83.18$ 78191 9.06 445.93$ 9.06 445.93$ NA78191 TC 8.17 402.13$ 8.17 402.13$ NA78191 26 0.89 43.81$ 0.89 43.81$ 78195 6.34 312.05$ 6.34 312.05$ NA78195 TC 4.56 224.44$ 4.56 224.44$ NA78195 26 1.77 87.12$ 1.77 87.12$ 78199 0 -$ 0 -$ 78199 TC 0 -$ 0 -$ 78199 26 0 -$ 0 -$ 78201 3.3 162.43$ 3.3 162.43$ NA78201 TC 2.65 130.43$ 2.65 130.43$ NA78201 26 0.65 31.99$ 0.65 31.99$ 78202 3.93 193.43$ 3.93 193.43$ NA78202 TC 3.19 157.01$ 3.19 157.01$ NA78202 26 0.74 36.42$ 0.74 36.42$ 78205 7.64 376.04$ 7.64 376.04$ NA78205 TC 6.6 324.85$ 6.6 324.85$ NA78205 26 1.03 50.70$ 1.03 50.70$ 78206 7.55 371.61$ 7.55 371.61$ NA78206 TC 6.15 302.70$ 6.15 302.70$ NA78206 26 1.4 68.91$ 1.4 68.91$ 78215 3.96 194.91$ 3.96 194.91$ NA78215 TC 3.25 159.97$ 3.25 159.97$ NA78215 26 0.71 34.95$ 0.71 34.95$ 78216 4.7 231.33$ 4.7 231.33$ NA78216 TC 3.88 190.97$ 3.88 190.97$ NA78216 26 0.82 40.36$ 0.82 40.36$ 78220 4.85 238.72$ 4.85 238.72$ NA78220 TC 4.14 203.77$ 4.14 203.77$ NA78220 26 0.71 34.95$ 0.71 34.95$ 78223 5.31 261.36$ 5.31 261.36$ NA78223 TC 4.08 200.82$ 4.08 200.82$ NA78223 26 1.23 60.54$ 1.23 60.54$ 78230 3.13 154.06$ 3.13 154.06$ NA78230 TC 2.47 121.57$ 2.47 121.57$ NA78230 26 0.66 32.49$ 0.66 32.49$ 78231 4.31 212.14$ 4.31 212.14$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 36: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY36

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

78231 TC 3.55 174.73$ 3.55 174.73$ NA78231 26 0.76 37.41$ 0.76 37.41$ 78232 4.63 227.89$ 4.63 227.89$ NA78232 TC 3.94 193.93$ 3.94 193.93$ NA78232 26 0.69 33.96$ 0.69 33.96$ 78258 4.27 210.17$ 4.27 210.17$ NA78258 TC 3.19 157.01$ 3.19 157.01$ NA78258 26 1.08 53.16$ 1.08 53.16$ 78261 5.61 276.12$ 5.61 276.12$ NA78261 TC 4.59 225.92$ 4.59 225.92$ NA78261 26 1.01 49.71$ 1.01 49.71$ 78262 5.74 282.52$ 5.74 282.52$ NA78262 TC 4.74 233.30$ 4.74 233.30$ NA78262 26 0.99 48.73$ 0.99 48.73$ 78264 5.75 283.02$ 5.75 283.02$ NA78264 TC 4.62 227.40$ 4.62 227.40$ NA78264 26 1.13 55.62$ 1.13 55.62$ 78267 0 -$ 0 -$ 78268 0 -$ 0 -$ 78270 2.07 101.89$ 2.07 101.89$ NA78270 TC 1.77 87.12$ 1.77 87.12$ NA78270 26 0.3 14.77$ 0.3 14.77$ 78271 2.16 106.32$ 2.16 106.32$ NA78271 TC 1.86 91.55$ 1.86 91.55$ NA78271 26 0.3 14.77$ 0.3 14.77$ 78272 3 147.66$ 3 147.66$ NA78272 TC 2.61 128.46$ 2.61 128.46$ NA78272 26 0.39 19.20$ 0.39 19.20$ 78278 6.86 337.65$ 6.86 337.65$ NA78278 TC 5.43 267.26$ 5.43 267.26$ NA78278 26 1.43 70.38$ 1.43 70.38$ 78282 0 -$ 0 -$ 78282 TC 0 -$ 0 -$ 78282 26 0.56 27.56$ 0.56 27.56$ 78290 4.4 216.57$ 4.4 216.57$ NA78290 TC 3.41 167.84$ 3.41 167.84$ NA78290 26 0.99 48.73$ 0.99 48.73$ 78291 4.71 231.83$ 4.71 231.83$ NA78291 TC 3.42 168.33$ 3.42 168.33$ NA78291 26 1.29 63.49$ 1.29 63.49$ 78299 0 -$ 0 -$ 78299 TC 0 -$ 0 -$ 78299 26 0 -$ 0 -$ 78300 3.71 182.61$ 3.71 182.61$ NA78300 TC 2.79 137.32$ 2.79 137.32$ NA78300 26 0.91 44.79$ 0.91 44.79$ 78305 5.3 260.87$ 5.3 260.87$ NA78305 TC 4.08 200.82$ 4.08 200.82$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 37: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY37

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

78305 26 1.22 60.05$ 1.22 60.05$ 78306 6.02 296.30$ 6.02 296.30$ NA78306 TC 4.76 234.29$ 4.76 234.29$ NA78306 26 1.26 62.02$ 1.26 62.02$ 78315 6.81 335.19$ 6.81 335.19$ NA78315 TC 5.34 262.83$ 5.34 262.83$ NA78315 26 1.47 72.35$ 1.47 72.35$ 78320 8.12 399.67$ 8.12 399.67$ NA78320 TC 6.6 324.85$ 6.6 324.85$ NA78320 26 1.51 74.32$ 1.51 74.32$ 78350 1.18 58.08$ 1.18 58.08$ NA78350 TC 0.86 42.33$ 0.86 42.33$ NA78350 26 0.32 15.75$ 0.32 15.75$ 78351 2.05 100.90$ 0.45 22.15$ 78399 0 -$ 0 -$ 78399 TC 0 -$ 0 -$ 78399 26 0 -$ 0 -$ 78414 0 -$ 0 -$ 78414 TC 0 -$ 0 -$ 78414 26 0.67 32.98$ 0.67 32.98$ 78428 3.7 182.11$ 3.7 182.11$ NA78428 TC 2.54 125.02$ 2.54 125.02$ NA78428 26 1.16 57.10$ 1.16 57.10$ 78445 2.82 138.80$ 2.82 138.80$ NA78445 TC 2.11 103.85$ 2.11 103.85$ NA78445 26 0.72 35.44$ 0.72 35.44$ 78455 5.51 271.20$ 5.51 271.20$ NA78455 TC 4.45 219.03$ 4.45 219.03$ NA78455 26 1.06 52.17$ 1.06 52.17$ 78456 6.08 299.26$ 6.08 299.26$ NA78456 TC 4.63 227.89$ 4.63 227.89$ NA78456 26 1.45 71.37$ 1.45 71.37$ 78457 4.11 202.29$ 4.11 202.29$ NA78457 TC 2.97 146.18$ 2.97 146.18$ NA78457 26 1.14 56.11$ 1.14 56.11$ 78458 5.82 286.46$ 5.82 286.46$ NA78458 TC 4.49 221.00$ 4.49 221.00$ NA78458 26 1.33 65.46$ 1.33 65.46$ 78459 0 -$ 0 -$ 78459 TC 0 -$ 0 -$ 78459 26 2.22 109.27$ 2.22 109.27$ 78460 3.91 192.45$ 3.91 192.45$ NA78460 TC 2.65 130.43$ 2.65 130.43$ NA78460 26 1.26 62.02$ 1.26 62.02$ 78461 7.08 348.48$ 7.08 348.48$ NA78461 TC 5.28 259.88$ 5.28 259.88$ NA78461 26 1.8 88.60$ 1.8 88.60$ 78464 9.48 466.61$ 9.48 466.61$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 38: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY38

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

78464 TC 7.9 388.84$ 7.9 388.84$ NA78464 26 1.59 78.26$ 1.59 78.26$ 78465 15.33 754.54$ 15.33 754.54$ NA78465 TC 13.18 648.72$ 13.18 648.72$ NA78465 26 2.15 105.82$ 2.15 105.82$ 78466 3.95 194.42$ 3.95 194.42$ NA78466 TC 2.93 144.21$ 2.93 144.21$ NA78466 26 1.01 49.71$ 1.01 49.71$ 78468 5.24 257.91$ 5.24 257.91$ NA78468 TC 4.08 200.82$ 4.08 200.82$ NA78468 26 1.16 57.10$ 1.16 57.10$ 78469 7.17 352.91$ 7.17 352.91$ NA78469 TC 5.85 287.94$ 5.85 287.94$ NA78469 26 1.32 64.97$ 1.32 64.97$ 78472 7.61 374.56$ 7.61 374.56$ NA78472 TC 6.18 304.18$ 6.18 304.18$ NA78472 26 1.43 70.38$ 1.43 70.38$ 78473 11.35 558.65$ 11.35 558.65$ NA78473 TC 9.2 452.82$ 9.2 452.82$ NA78473 26 2.15 105.82$ 2.15 105.82$ 78478 2.69 132.40$ 2.69 132.40$ NA78478 TC 1.78 87.61$ 1.78 87.61$ NA78478 26 0.91 44.79$ 0.91 44.79$ 78480 2.68 131.91$ 2.68 131.91$ NA78480 TC 1.78 87.61$ 1.78 87.61$ NA78480 26 0.9 44.30$ 0.9 44.30$ 78481 7.3 359.31$ 7.3 359.31$ NA78481 TC 5.85 287.94$ 5.85 287.94$ NA78481 26 1.45 71.37$ 1.45 71.37$ 78483 10.94 538.47$ 10.94 538.47$ NA78483 TC 8.79 432.64$ 8.79 432.64$ NA78483 26 2.16 106.32$ 2.16 106.32$ 78491 0 -$ 0 -$ 78491 TC 0 -$ 0 -$ 78491 26 2.26 111.24$ 2.26 111.24$ 78492 0 -$ 0 -$ 78492 TC 0 -$ 0 -$ 78492 26 2.81 138.31$ 2.81 138.31$ 78494 9.49 467.10$ 9.49 467.10$ NA78494 TC 7.74 380.96$ 7.74 380.96$ NA78494 26 1.75 86.14$ 1.75 86.14$ 78496 8.48 417.39$ 8.48 417.39$ NA78496 TC 7.74 380.96$ 7.74 380.96$ NA78496 26 0.74 36.42$ 0.74 36.42$ 78499 0 -$ 0 -$ 78499 TC 0 -$ 0 -$ 78499 26 0 -$ 0 -$ 78580 4.91 241.67$ 4.91 241.67$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 39: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY39

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

78580 TC 3.83 188.51$ 3.83 188.51$ NA78580 26 1.08 53.16$ 1.08 53.16$ 78584 5.01 246.59$ 5.01 246.59$ NA78584 TC 3.58 176.21$ 3.58 176.21$ NA78584 26 1.43 70.38$ 1.43 70.38$ 78585 7.9 388.84$ 7.9 388.84$ NA78585 TC 6.31 310.58$ 6.31 310.58$ NA78585 26 1.59 78.26$ 1.59 78.26$ 78586 3.49 171.78$ 3.49 171.78$ NA78586 TC 2.9 142.74$ 2.9 142.74$ NA78586 26 0.58 28.55$ 0.58 28.55$ 78587 3.83 188.51$ 3.83 188.51$ NA78587 TC 3.11 153.07$ 3.11 153.07$ NA78587 26 0.72 35.44$ 0.72 35.44$ 78588 5.19 255.45$ 5.19 255.45$ NA78588 TC 3.6 177.19$ 3.6 177.19$ NA78588 26 1.59 78.26$ 1.59 78.26$ 78591 3.75 184.58$ 3.75 184.58$ NA78591 TC 3.16 155.54$ 3.16 155.54$ NA78591 26 0.58 28.55$ 0.58 28.55$ 78593 4.56 224.44$ 4.56 224.44$ NA78593 TC 3.85 189.50$ 3.85 189.50$ NA78593 26 0.71 34.95$ 0.71 34.95$ 78594 6.31 310.58$ 6.31 310.58$ NA78594 TC 5.54 272.68$ 5.54 272.68$ NA78594 26 0.77 37.90$ 0.77 37.90$ 78596 9.73 478.91$ 9.73 478.91$ NA78596 TC 7.9 388.84$ 7.9 388.84$ NA78596 26 1.83 90.07$ 1.83 90.07$ 78599 0 -$ 0 -$ 78599 TC 0 -$ 0 -$ 78599 26 0 -$ 0 -$ 78600 3.84 189.00$ 3.84 189.00$ NA78600 TC 3.19 157.01$ 3.19 157.01$ NA78600 26 0.65 31.99$ 0.65 31.99$ 78601 4.54 223.46$ 4.54 223.46$ NA78601 TC 3.8 187.04$ 3.8 187.04$ NA78601 26 0.74 36.42$ 0.74 36.42$ 78605 4.57 224.94$ 4.57 224.94$ NA78605 TC 3.8 187.04$ 3.8 187.04$ NA78605 26 0.77 37.90$ 0.77 37.90$ 78606 5.27 259.39$ 5.27 259.39$ NA78606 TC 4.34 213.61$ 4.34 213.61$ NA78606 26 0.93 45.77$ 0.93 45.77$ 78607 9.13 449.38$ 9.13 449.38$ NA78607 TC 7.33 360.78$ 7.33 360.78$ NA78607 26 1.8 88.60$ 1.8 88.60$ 78608 0 -$ 0 -$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 40: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY40

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

78608 TC 0 -$ 0 -$ 78608 26 2.18 107.30$ 2.18 107.30$ 78609 0 -$ 0 -$ 78609 TC 0 -$ 0 -$ 78609 26 2.18 107.30$ 2.18 107.30$ 78610 2.24 110.25$ 2.24 110.25$ NA78610 TC 1.8 88.60$ 1.8 88.60$ NA78610 26 0.44 21.66$ 0.44 21.66$ 78615 4.94 243.15$ 4.94 243.15$ NA78615 TC 4.32 212.63$ 4.32 212.63$ NA78615 26 0.63 31.01$ 0.63 31.01$ 78630 6.64 326.82$ 6.64 326.82$ NA78630 TC 5.64 277.60$ 5.64 277.60$ NA78630 26 0.99 48.73$ 0.99 48.73$ 78635 3.75 184.58$ 3.75 184.58$ NA78635 TC 2.85 140.28$ 2.85 140.28$ NA78635 26 0.9 44.30$ 0.9 44.30$ 78645 4.65 228.87$ 4.65 228.87$ NA78645 TC 3.83 188.51$ 3.83 188.51$ NA78645 26 0.82 40.36$ 0.82 40.36$ 78647 7.92 389.82$ 7.92 389.82$ NA78647 TC 6.6 324.85$ 6.6 324.85$ NA78647 26 1.32 64.97$ 1.32 64.97$ 78650 6.08 299.26$ 6.08 299.26$ NA78650 TC 5.18 254.96$ 5.18 254.96$ NA78650 26 0.9 44.30$ 0.9 44.30$ 78660 3.16 155.54$ 3.16 155.54$ NA78660 TC 2.39 117.64$ 2.39 117.64$ NA78660 26 0.77 37.90$ 0.77 37.90$ 78699 0 -$ 0 -$ 78699 TC 0 -$ 0 -$ 78699 26 0 -$ 0 -$ 78700 4.06 199.83$ 4.06 199.83$ NA78700 TC 3.41 167.84$ 3.41 167.84$ NA78700 26 0.66 32.49$ 0.66 32.49$ 78701 4.67 229.86$ 4.67 229.86$ NA78701 TC 3.96 194.91$ 3.96 194.91$ NA78701 26 0.71 34.95$ 0.71 34.95$ 78704 5.49 270.22$ 5.49 270.22$ NA78704 TC 4.42 217.55$ 4.42 217.55$ NA78704 26 1.08 53.16$ 1.08 53.16$ 78707 6.38 314.02$ 6.38 314.02$ NA78707 TC 4.98 245.12$ 4.98 245.12$ NA78707 26 1.39 68.42$ 1.39 68.42$ 78708 6.75 332.24$ 6.75 332.24$ NA78708 TC 4.98 245.12$ 4.98 245.12$ NA78708 26 1.76 86.63$ 1.76 86.63$ 78709 7.03 346.02$ 7.03 346.02$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 41: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY41

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

78709 TC 4.98 245.12$ 4.98 245.12$ NA78709 26 2.05 100.90$ 2.05 100.90$ 78710 7.57 372.60$ 7.57 372.60$ NA78710 TC 6.6 324.85$ 6.6 324.85$ NA78710 26 0.96 47.25$ 0.96 47.25$ 78715 2.24 110.25$ 2.24 110.25$ NA78715 TC 1.8 88.60$ 1.8 88.60$ NA78715 26 0.44 21.66$ 0.44 21.66$ 78725 2.59 127.48$ 2.59 127.48$ NA78725 TC 2.03 99.92$ 2.03 99.92$ NA78725 26 0.56 27.56$ 0.56 27.56$ 78730 2.17 106.81$ 2.17 106.81$ NA78730 TC 1.64 80.72$ 1.64 80.72$ NA78730 26 0.53 26.09$ 0.53 26.09$ 78740 3.23 158.98$ 3.23 158.98$ NA78740 TC 2.39 117.64$ 2.39 117.64$ NA78740 26 0.84 41.34$ 0.84 41.34$ 78760 3.96 194.91$ 3.96 194.91$ NA78760 TC 2.99 147.17$ 2.99 147.17$ NA78760 26 0.96 47.25$ 0.96 47.25$ 78761 4.61 226.90$ 4.61 226.90$ NA78761 TC 3.58 176.21$ 3.58 176.21$ NA78761 26 1.03 50.70$ 1.03 50.70$ 78799 0 -$ 0 -$ 78799 TC 0 -$ 0 -$ 78799 26 0 -$ 0 -$ 78800 4.79 235.76$ 4.79 235.76$ NA78800 TC 3.8 187.04$ 3.8 187.04$ NA78800 26 0.99 48.73$ 0.99 48.73$ 78801 5.9 290.40$ 5.9 290.40$ NA78801 TC 4.71 231.83$ 4.71 231.83$ NA78801 26 1.19 58.57$ 1.19 58.57$ 78802 7.46 367.18$ 7.46 367.18$ NA78802 TC 6.2 305.16$ 6.2 305.16$ NA78802 26 1.26 62.02$ 1.26 62.02$ 78803 8.94 440.03$ 8.94 440.03$ NA78803 TC 7.33 360.78$ 7.33 360.78$ NA78803 26 1.61 79.24$ 1.61 79.24$ 78804 13.28 653.64$ 13.28 653.64$ NA78804 TC 11.73 577.35$ 11.73 577.35$ NA78804 26 1.56 76.78$ 1.56 76.78$ 78805 4.87 239.70$ 4.87 239.70$ NA78805 TC 3.8 187.04$ 3.8 187.04$ NA78805 26 1.06 52.17$ 1.06 52.17$ 78806 8.47 416.89$ 8.47 416.89$ NA78806 TC 7.21 354.88$ 7.21 354.88$ NA78806 26 1.26 62.02$ 1.26 62.02$ 78807 8.93 439.53$ 8.93 439.53$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 42: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY42

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

78807 TC 7.33 360.78$ 7.33 360.78$ NA78807 26 1.6 78.75$ 1.6 78.75$ 78811 0 -$ 0 -$ 78811 TC 0 -$ 0 -$ 78811 26 2.35 115.67$ 2.35 115.67$ 78812 0 -$ 0 -$ 78812 TC 0 -$ 0 -$ 78812 26 2.88 141.75$ 2.88 141.75$ 78813 0 -$ 0 -$ 78813 TC 0 -$ 0 -$ 78813 26 2.99 147.17$ 2.99 147.17$ 78814 0 -$ 0 -$ 78814 TC 0 -$ 0 -$ 78814 26 3.26 160.46$ 3.26 160.46$ 78815 0 -$ 0 -$ 78815 TC 0 -$ 0 -$ 78815 26 3.59 176.70$ 3.59 176.70$ 78816 0 -$ 0 -$ 78816 TC 0 -$ 0 -$ 78816 26 3.67 180.64$ 3.67 180.64$ 78890 1.54 75.80$ 1.54 75.80$ NA78890 TC 1.44 70.88$ 1.44 70.88$ NA78890 26 0.09 4.43$ 0.09 4.43$ 78891 3.08 151.60$ 3.08 151.60$ NA78891 TC 2.91 143.23$ 2.91 143.23$ NA78891 26 0.16 7.88$ 0.16 7.88$ 78999 0 -$ 0 -$ 78999 TC 0 -$ 0 -$ 78999 26 0 -$ 0 -$ 79005 5.56 273.66$ 5.56 273.66$ NA79005 TC 2.93 144.21$ 2.93 144.21$ NA79005 26 2.62 128.96$ 2.62 128.96$ 79101 5.79 284.98$ 5.79 284.98$ NA79101 TC 2.93 144.21$ 2.93 144.21$ NA79101 26 2.86 140.77$ 2.86 140.77$ 79200 5.86 288.43$ 5.86 288.43$ NA79200 TC 2.93 144.21$ 2.93 144.21$ NA79200 26 2.93 144.21$ 2.93 144.21$ 79300 0 -$ 0 -$ 79300 TC 0 -$ 0 -$ 79300 26 2.49 122.56$ 2.49 122.56$ 79403 8 393.76$ 8 393.76$ NA79403 TC 4.58 225.43$ 4.58 225.43$ NA79403 26 3.42 168.33$ 3.42 168.33$ 79440 5.87 288.92$ 5.87 288.92$ NA79440 TC 2.93 144.21$ 2.93 144.21$ NA79440 26 2.94 144.71$ 2.94 144.71$ 79445 6.53 321.41$ 6.53 321.41$ NA

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.

Page 43: MI WORKERS' COMPENSATION FEE SCHEDULE 2006 · wca hcsd mi workers' compensation fee schedule 2006 radiology 1 code mod rvu map na ind* rvu map na ind* 70010 6.56 322.88$ 6.56 322.88$

WCAHCSD

MI WORKERS' COMPENSATION FEE SCHEDULE 2006 RADIOLOGY43

CODE MOD RVU MAP NA IND* RVU MAP NA IND*

NON FACILITY FACILITYNA IND*--NOT APPLICABLE IN THIS SETTING

Procedures with 0.0 RVU are BR

79445 TC 2.98 146.68$ 2.98 146.68$ NA79445 26 3.55 174.73$ 3.55 174.73$ 79999 0 -$ 0 -$ 79999 TC 0 -$ 0 -$ 79999 26 0 -$ 0 -$

Codes from "2005 Current Procedural Terminology CPT ®". All rights reserved. Refer to CPT® for descriptors.

Fees determined by WCA. Conversion factor is $49.22 applied to 2005 RVU data. See Chapter I in the manual.