Procedure Code

Description

Facility Dec 2015 Fee

Facility Jan 2016 Fee

Facility Fee %  Change

Non-Facility Dec 2015 Fee

Non-Facility Jan 2016 Fee

Non-Facility Fee % Change

72110

X-ray exam l-2 spine 4/>vws

$77.18

$73.19

-5.17%

$77.18

$73.19

-5.17%

73030

X-ray exam of shoulder

$45.52

$43.24

-5.01%

$45.52

$43.24

-5.01%

77003

Fluoroguide for spine inject

$135.51

$129.79

-4.22%

$135.51

$129.79

-4.22%

73221

Mri joint upr extrem w/o dye

$375.11

$355.96

-5.11%

$375.11

$355.96

-5.11%

72148

Mri lumbar spine w/o dye

$352.16

$334.26

-5.08%

$352.16

$334.26

-5.08%

72040

X-ray exam neck spine 2-3 vw

$52.27

$49.63

-5.05%

$52.27

$49.63

-5.05%

72100

X-ray exam l-s spine 2/3 vws

$55.19

$52.39

-5.07%

$55.19

$52.39

-5.07%

73110

X-ray exam of wrist

$56.08

$53.23

-5.08%

$56.08

$53.23

-5.08%

73100

X-ray exam of wrist

$46.22

$43.91

-5.00%

$46.22

$43.91

-5.00%

72141

Mri neck spine w/o dye

$353.91

$335.91

-5.09%

$353.91

$335.91

-5.09%

73721

Mri jnt of lwr extre w/o dye

$374.52

$356.51

-4.81%

$374.52

$356.51

-4.81%

73564

X-ray exam knee 4 or more

$63.14

$59.56

-5.67%

$63.14

$59.56

-5.67%

73130

X-ray exam of hand

$48.12

$46.06

-4.28%

$48.12

$46.06

-4.28%

73562

X-ray exam of knee 3

$54.27

$53.72

-1.01%

$54.27

$53.72

-1.01%

73020

X-ray exam of shoulder

$36.37

$34.04

-6.41%

$36.37

$34.04

-6.41%

73560

X-ray exam of knee 1 or 2

$46.16

$46.66

1.08%

$46.16

$46.66

1.08%

71020

Chest x-ray 2vw frontal&latl

$43.74

$41.36

-5.44%

$43.74

$41.36

-5.44%

72050

X-ray exam neck spine 4/5vws

$70.40

$67.12

-4.66%

$70.40

$67.12

-4.66%

73610

X-ray exam of ankle

$49.66

$47.16

-5.03%

$49.66

$47.16

-5.03%

73080

X-ray exam of elbow

$49.66

$46.61

-6.14%

$49.66

$46.61

-6.14%

California Specific Code

Description

Dec 2015 Fee

Jan 2016 Fee

Fee% Change

WC001

Doctor's First Report of Occupational Illness or Injury (Form 5021)

$0.00

$0.00

0.00%

WC002

Treating Physician's Progress Report

$12.01

$12.14

1.08%

WC003

Primary Treating Physician’s Permanent and Stationary Report (Form PR-3)

$38.99

$39.42

1.10%

WC004

Primary Treating Physician’s Permanent and Stationary Report (Form PR-4)

$38.99

$39.42

1.10%

WC005

Psychiatric Report requested by the WCAB or the Administrative Director, other than medical-legal report.

$38.99

$39.42

1.10%

WC007

Consultation Reports Requested by the Workers’ Compensation Appeals Board or the Administrative Director

$38.99

$39.42

1.10%

WC008

Chart Notes

$10.34

$10.45

1.06%