illinois workers' compensation fee schedule updated january 2015 … · 2017-06-27 ·...

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2=Payment adjustment does NOT apply Multiple Procedure (Modifier 51) Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global Days, Multiple Procedures, Bilateral Surgeries, Assistant Surgeons, Co-Surgeons, Team Surgery ######################################################################################### Global Days 000=0 day postoperative 010=10 day postoperative 090= 1-day preoperative and 90-day post operative XXX=The global concept does not apply to the code YYY=Global period determined on case-by-case basis ZZZ=Global period of service is ALWAYS included in the global period of another service 0=Payment adjustment for bilateral procedures does NOT apply 3 = Special rules for multiple endoscopic procedures apply if procedure is billed with another endoscopy in the same family (i.e., another endoscopy that has the same base procedure). The base procedure for each code with this indicator is identified in the Endobase field of this file. Apply the multiple endoscopy rules to a family before ranking the family with the other procedures performed on the same day (for example, if multiple endoscopies in the same family are reported on the same day as endoscopies in another family or on the same day as a non-endoscopic procedure). If an endoscopic procedure is reported with only its base procedure, do not pay separately for the base procedure. Payment for the base procedure is included in the payment for the other endoscopy. The bilateral adjustment is inappropriate for codes in this category (a) because of physiology or anatomy, or (b) because the code description specifically states that it is a unilateral procedure and there is an existing code for 1=150% payment adjustment for bilateral procedure APPLIES Base payment on the lower of the total actual charge for both sides or 150% of the fee schedule amount for a 0 = No payment adjustment rules for multiple procedures apply -pay the lower of actual charge or the fee schedule amount for each procedure. 2 = Standard payment adjustment (100%, 50%, 50%, 50%, 50% and by report) 9 = Concept does not apply Bilateral Surgery (Modifier 50) Base payment for both sides on the lower of the total actual charge by the physician for both sides or 100% of the fee schedule for a SINGLE code (these are single procedure codes that assume what is being performed is 1=Co-surgeons shall be paid when supporting documentation establishs the medical necessity of two surgeons Services in this category are generally radiology/diagnostic tests which are not subject to the special payment 9=Concept does not apply Assistant at Surgery 0=No payment for assistant unless supporting documentation is submitted to establish medical necessity. 1=No payment for assistant at surgery 2=Assistant at surgery is payable 9=Concept does not apply Co-surgeons (Modifier 62) Payment will be 150% of fee schedule which is then to be divided between 0=Co-surgeon payment rule not recommneded for these procedures 3=The usual payment for bilateral procedures does NOT apply 2=Co-surgeons always permitted and no documentation required if the two-specialty requirement is met. 9=Concept does not apply.

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Page 1: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

2=Payment adjustment does NOT apply

Multiple Procedure (Modifier 51)

Illinois Workers' Compensation Fee Schedule Updated January 20152014 Payment Guide to Global Days, Multiple Procedures, Bilateral Surgeries, Assistant Surgeons, Co-Surgeons, Team Surgery #########################################################################################

Global Days000=0 day postoperative010=10 day postoperative090= 1-day preoperative and 90-day post operativeXXX=The global concept does not apply to the codeYYY=Global period determined on case-by-case basisZZZ=Global period of service is ALWAYS included in the global period of another service

0=Payment adjustment for bilateral procedures does NOT apply

3 = Special rules for multiple endoscopic procedures apply if procedure is billed with another endoscopy in the same family (i.e., another endoscopy that has the same base procedure). The base procedure for each code with this indicator is identified in the Endobase field of this file. Apply the multiple endoscopy rules to a family before ranking the family with the other procedures performed on the same day (for example, if multiple endoscopies in the same family are reported on the same day as endoscopies in another family or on the same day as a non-endoscopic procedure). If an endoscopic procedure is reported with only its base procedure, do not pay separately for the base procedure. Payment for the base procedure is included in the payment for the other endoscopy.

The bilateral adjustment is inappropriate for codes in this category (a) because of physiology or anatomy, or (b) because the code description specifically states that it is a unilateral procedure and there is an existing code for 1=150% payment adjustment for bilateral procedure APPLIESBase payment on the lower of the total actual charge for both sides or 150% of the fee schedule amount for a

0 = No payment adjustment rules for multiple procedures apply -pay the lower of actual charge or the fee schedule amount for each procedure. 2 = Standard payment adjustment (100%, 50%, 50%, 50%, 50% and by report)

9 = Concept does not apply

Bilateral Surgery (Modifier 50)

Base payment for both sides on the lower of the total actual charge by the physician for both sides or 100% of the fee schedule for a SINGLE code (these are single procedure codes that assume what is being performed is

1=Co-surgeons shall be paid when supporting documentation establishs the medical necessity of two surgeons

Services in this category are generally radiology/diagnostic tests which are not subject to the special payment 9=Concept does not apply

Assistant at Surgery0=No payment for assistant unless supporting documentation is submitted to establish medical necessity.1=No payment for assistant at surgery2=Assistant at surgery is payable9=Concept does not apply

Co-surgeons (Modifier 62) Payment will be 150% of fee schedule which is then to be divided between 0=Co-surgeon payment rule not recommneded for these procedures

3=The usual payment for bilateral procedures does NOT apply

2=Co-surgeons always permitted and no documentation required if the two-specialty requirement is met.9=Concept does not apply.

Page 2: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

GLOBAL MULTIPLE BILATERAL ASST CO- TEAMCPT/HCPCS DAYS PROC SURG SURG SURG SURG10021 XXX 0 0 0 0 010022 XXX 0 0 0 0 010030 XXX 2 9 0 0 010040 10 2 0 1 0 010060 10 2 0 1 0 010061 10 2 0 1 0 010080 10 2 0 1 0 010081 10 2 0 1 0 010120 10 2 0 1 0 010121 10 2 0 1 0 010140 10 2 0 1 0 010160 10 2 0 1 0 010180 10 2 0 1 0 011000 0 2 0 1 0 011001 ZZZ 0 0 1 0 011004 0 2 0 1 0 011005 0 0 0 0 0 011006 0 2 0 1 0 011008 ZZZ 0 0 0 0 011010 10 2 2 1 0 011011 0 2 2 1 0 011012 0 2 2 1 0 011042 0 2 0 1 0 011043 0 2 0 1 0 011044 0 2 0 1 0 011045 ZZZ 0 0 0 0 011046 ZZZ 0 0 0 0 011047 ZZZ 0 0 0 0 011055 0 2 0 1 0 011056 0 2 0 1 0 011057 0 2 0 1 0 011100 0 2 0 1 0 011101 ZZZ 0 0 1 0 011200 10 2 0 1 0 011201 ZZZ 0 0 1 0 011300 0 2 9 0 0 011301 0 2 9 0 0 011302 0 2 9 0 0 011303 0 2 9 0 0 0

2=Team surgeons permitted; pay by report9=Concept does not apply

Team Surgery (Modifier 66)0=Team surgeon payment rules not recommneded for these procedures1=Team surgeons shall be paid when supporting documentation establishes the medical necessity of a team;

Page 3: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

11305 0 2 9 0 0 011306 0 2 9 0 0 011307 0 2 9 0 0 011308 0 2 9 0 0 011310 0 2 9 0 0 011311 0 2 9 0 0 011312 0 2 9 0 0 011313 0 2 9 0 0 011400 10 2 0 1 0 011401 10 2 0 1 0 011402 10 2 0 1 0 011403 10 2 0 1 0 011404 10 2 0 1 0 011406 10 2 0 1 0 011420 10 2 0 1 0 011421 10 2 0 1 0 011422 10 2 0 1 0 011423 10 2 0 1 0 011424 10 2 0 1 0 011426 10 2 0 1 0 011440 10 2 0 1 0 011441 10 2 0 1 0 011442 10 2 0 1 0 011443 10 2 0 1 0 011444 10 2 0 1 0 011446 10 2 0 1 0 011450 90 2 1 1 0 011451 90 2 1 0 0 011462 90 2 1 0 0 011463 90 2 1 0 0 011470 90 2 0 1 0 011471 90 2 0 0 0 011600 10 2 0 1 0 011601 10 2 0 1 0 011602 10 2 0 1 0 011603 10 2 0 1 0 011604 10 2 0 1 0 011606 10 2 0 1 0 011620 10 2 0 1 0 011621 10 2 0 1 0 011622 10 2 0 1 0 011623 10 2 0 1 0 011624 10 2 0 1 0 011626 10 2 0 1 0 011640 10 2 0 1 0 011641 10 2 0 1 0 011642 10 2 0 1 0 0

Page 4: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

11643 10 2 0 1 0 011644 10 2 0 1 0 011646 10 2 0 1 0 011719 0 2 0 1 0 011720 0 0 0 1 0 011721 0 0 0 1 0 011730 0 2 0 1 0 011732 ZZZ 0 0 1 0 011740 0 2 0 1 0 011750 10 2 0 1 0 011752 10 2 0 1 0 011755 0 2 0 0 0 011760 10 2 0 1 0 011762 10 2 0 1 0 011765 10 2 0 1 0 011770 10 2 0 1 0 011771 90 2 0 1 0 011772 90 2 0 1 0 011900 0 2 0 1 0 011901 0 2 0 1 0 011920 0 2 0 0 0 011921 0 2 0 0 0 011922 ZZZ 0 0 0 0 011950 0 2 0 0 0 011951 0 2 0 0 0 011952 0 2 0 0 0 011954 0 2 0 0 0 011960 90 2 0 1 0 011970 90 2 1 1 0 011971 90 2 1 0 0 011976 0 2 0 0 0 011980 0 2 0 1 0 011981 XXX 2 0 0 0 011982 XXX 2 0 0 0 011983 XXX 2 0 0 0 012001 0 2 0 1 0 012002 0 2 0 1 0 012004 0 2 0 1 0 012005 0 2 0 1 0 012006 0 2 0 1 0 012007 0 2 0 1 1 012011 0 2 0 1 0 012013 0 2 0 1 0 012014 0 2 0 1 0 012015 0 2 0 1 0 012016 0 2 0 1 0 012017 0 2 0 0 0 0

Page 5: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

12018 0 2 0 2 0 012020 10 2 0 1 0 012021 10 2 0 1 0 012031 10 2 0 1 0 012032 10 2 0 1 0 012034 10 2 0 1 0 012035 10 2 0 1 0 012036 10 2 0 1 0 012037 10 2 0 0 1 012041 10 2 0 1 0 012042 10 2 0 1 0 012044 10 2 0 1 0 012045 10 2 0 1 0 012046 10 2 0 0 0 012047 10 2 0 2 1 012051 10 2 0 1 0 012052 10 2 0 1 0 012053 10 2 0 1 0 012054 10 2 0 1 0 012055 10 2 0 1 0 012056 10 2 0 0 0 012057 10 2 0 2 1 013100 10 2 0 1 0 013101 10 2 0 1 0 013102 ZZZ 0 0 1 0 013120 10 2 0 1 0 013121 10 2 0 1 0 013122 ZZZ 0 0 1 0 013131 10 2 0 1 0 013132 10 2 0 1 0 013133 ZZZ 0 0 1 0 013151 10 2 0 1 0 013152 10 2 0 1 0 013153 ZZZ 0 0 1 0 013160 90 2 0 1 0 014000 90 2 0 1 0 014001 90 2 0 1 0 014020 90 2 0 1 0 014021 90 2 0 1 0 014040 90 2 0 1 0 014041 90 2 0 1 0 014060 90 2 0 1 0 014061 90 2 0 1 0 014301 90 2 0 2 0 014302 ZZZ 0 0 2 0 014350 90 2 0 0 0 015002 0 0 0 0 0 0

Page 6: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

15003 ZZZ 0 0 0 0 015004 0 0 0 0 0 015005 ZZZ 0 0 0 0 015040 0 0 0 1 0 015050 90 2 0 1 0 015100 90 2 0 1 0 015101 ZZZ 0 0 1 0 015110 90 2 0 1 0 015111 ZZZ 0 0 1 0 015115 90 2 0 1 0 015116 ZZZ 0 0 1 1 015120 90 2 0 1 0 015121 ZZZ 0 0 1 1 015130 90 2 0 1 0 015131 ZZZ 0 0 1 1 015135 90 2 0 1 0 015136 ZZZ 0 0 1 1 015150 90 2 0 1 0 015151 ZZZ 0 0 1 0 015152 ZZZ 0 0 1 0 015155 90 2 0 1 0 015156 ZZZ 0 0 1 1 015157 ZZZ 0 0 1 1 015200 90 2 0 1 0 015201 ZZZ 0 0 1 0 015220 90 2 0 1 0 015221 ZZZ 0 0 1 0 015240 90 2 0 1 0 015241 ZZZ 0 0 1 0 015260 90 2 0 1 0 015261 ZZZ 0 0 1 0 015271 0 2 0 1 0 015272 ZZZ 0 0 1 0 015273 0 2 0 1 0 015274 ZZZ 0 0 1 0 015275 0 2 0 1 0 015276 ZZZ 0 0 1 0 015277 0 2 0 1 1 015278 ZZZ 0 0 1 1 015570 90 2 0 1 0 015572 90 2 0 1 0 015574 90 2 0 1 0 015576 90 2 0 1 0 015600 90 2 0 0 0 015610 90 2 0 0 0 015620 90 2 0 1 0 015630 90 2 0 1 0 0

Page 7: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

15650 90 2 0 0 0 015731 90 2 0 0 0 015732 90 2 0 1 1 015734 90 2 0 2 1 015736 90 2 0 1 1 015738 90 2 0 2 1 015740 90 2 0 1 0 015750 90 2 0 2 0 015756 90 2 0 2 2 015757 90 2 0 2 2 015758 90 2 0 2 2 015760 90 2 0 1 0 015770 90 2 0 2 1 015775 0 2 0 0 0 015776 0 2 0 0 0 015777 ZZZ 0 1 1 0 015780 90 2 0 0 0 015781 90 2 0 1 0 015782 90 2 0 0 0 015783 90 2 0 0 0 015786 10 2 0 1 0 015787 ZZZ 0 0 1 0 015788 90 2 0 1 0 015789 90 2 0 1 0 015792 90 2 0 0 0 015793 90 2 0 0 0 015819 90 2 0 0 0 015820 90 2 1 0 0 015821 90 2 1 0 0 015822 90 2 1 1 0 015823 90 2 1 1 0 015824 0 2 1 0 0 015825 0 2 1 0 0 015826 0 2 1 0 0 015828 0 2 1 0 0 015829 0 2 1 0 0 015830 90 2 0 2 1 015832 90 2 1 2 1 015833 90 2 1 0 0 015834 90 2 1 0 0 015835 90 2 0 0 0 015836 90 2 1 0 0 015837 90 2 0 0 0 015838 90 2 0 0 0 015839 90 2 0 0 0 015840 90 2 0 1 0 015841 90 2 0 2 1 0

Page 8: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

15842 90 2 0 2 1 015845 90 2 0 2 0 015847 YYY 0 0 2 1 015850 XXX 9 9 9 9 915851 0 2 0 1 0 015852 0 2 0 1 0 015860 0 2 0 0 0 015876 0 2 0 0 0 015877 0 2 0 0 0 015878 0 2 1 0 0 015879 0 2 1 0 0 015920 90 2 0 0 0 015922 90 2 0 2 1 015931 90 2 0 1 0 015933 90 2 0 0 0 015934 90 2 0 1 0 015935 90 2 0 2 1 015936 90 2 0 1 1 015937 90 2 0 1 1 015940 90 2 0 1 0 015941 90 2 0 0 0 015944 90 2 0 0 0 015945 90 2 0 0 0 015946 90 2 0 1 1 015950 90 2 0 1 0 015951 90 2 0 0 1 015952 90 2 0 2 1 015953 90 2 0 1 1 015956 90 2 0 1 1 015958 90 2 0 1 1 015999 YYY 2 0 0 1 116000 0 2 0 1 0 016020 0 2 0 1 0 016025 0 2 0 1 0 016030 0 2 0 1 0 016035 0 2 0 1 0 016036 ZZZ 0 0 1 0 017000 10 2 0 1 0 017003 ZZZ 0 0 1 0 017004 10 0 0 1 0 017106 90 2 0 1 0 017107 90 2 0 1 0 017108 90 2 0 0 0 017110 10 2 0 1 0 017111 10 2 0 1 0 017250 0 2 0 1 0 017260 10 2 0 1 0 0

Page 9: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

17261 10 2 0 1 0 017262 10 2 0 1 0 017263 10 2 0 1 0 017264 10 2 0 1 0 017266 10 2 0 1 0 017270 10 2 0 1 0 017271 10 2 0 1 0 017272 10 2 0 1 0 017273 10 2 0 1 0 017274 10 2 0 1 0 017276 10 2 0 1 0 017280 10 2 0 1 0 017281 10 2 0 1 0 017282 10 2 0 1 0 017283 10 2 0 1 0 017284 10 2 0 1 0 017286 10 2 0 1 0 017311 0 2 0 1 0 017312 ZZZ 0 0 1 0 017313 0 2 0 1 0 017314 ZZZ 0 0 1 0 017315 ZZZ 0 0 1 0 017340 10 2 0 1 0 017360 10 2 0 1 0 017380 0 2 0 0 0 017999 YYY 2 0 0 1 119000 0 2 0 1 0 019001 ZZZ 0 0 1 0 019020 90 2 1 1 0 019030 0 2 1 1 0 019081 0 2 1 0 0 019082 ZZZ 0 0 0 0 019083 0 2 1 0 0 019084 ZZZ 0 0 0 0 019085 0 2 1 0 0 019086 ZZZ 0 0 0 0 019100 0 2 1 1 0 019101 10 2 1 1 0 019105 0 2 1 1 0 019110 90 2 1 1 0 019112 90 2 1 0 0 019120 90 2 1 1 0 019125 90 2 1 1 1 019126 ZZZ 0 0 1 1 019260 90 2 0 2 1 019271 90 2 0 2 1 019272 90 2 0 2 1 0

Page 10: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

19281 0 2 1 0 0 019282 ZZZ 0 0 0 0 019283 0 2 1 0 0 019284 ZZZ 0 0 0 0 019285 0 2 1 0 0 019286 ZZZ 0 0 0 0 019287 0 2 1 0 0 019288 ZZZ 0 0 0 0 019296 0 2 1 0 0 019297 ZZZ 0 0 0 0 019298 0 2 1 0 0 019300 90 2 1 1 0 019301 90 2 1 0 0 019302 90 2 1 2 1 019303 90 2 1 2 1 019304 90 2 1 2 1 019305 90 2 1 2 1 019306 90 2 1 2 1 019307 90 2 1 2 1 019316 90 2 1 2 1 019318 90 2 1 2 1 019324 90 2 1 0 0 019325 90 2 1 0 0 019328 90 2 1 1 0 019330 90 2 1 1 0 019340 90 2 1 1 1 019342 90 2 1 0 1 019350 90 2 1 1 0 019355 90 2 1 0 0 019357 90 2 1 2 1 019361 90 2 1 2 1 019364 90 2 1 2 1 019366 90 2 1 2 1 019367 90 2 1 2 1 019368 90 2 1 2 1 019369 90 2 1 2 1 019370 90 2 1 1 0 019371 90 2 1 1 0 019380 90 2 1 1 0 019396 0 2 1 0 0 019499 YYY 2 1 0 1 120005 10 2 0 1 0 020100 10 2 1 2 0 020101 10 2 0 1 0 020102 10 2 0 1 0 020103 10 2 0 0 0 020150 90 2 1 2 1 0

Page 11: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

20200 0 2 0 1 0 020205 0 2 0 1 0 020206 0 2 0 1 0 020220 0 2 0 1 0 020225 0 2 0 1 0 020240 10 2 0 1 0 020245 10 2 0 1 0 020250 10 2 0 1 0 020251 10 2 0 2 0 020500 10 2 0 1 0 020501 0 2 0 1 0 020520 10 2 0 1 0 020525 10 2 0 1 0 020526 0 2 1 1 0 020527 0 2 1 1 0 020550 0 2 1 1 0 020551 0 2 0 1 0 020552 0 2 0 1 0 020553 0 2 0 1 0 020555 0 2 0 0 0 020600 0 2 1 1 0 020604 0 2 1 1 0 020605 0 2 1 1 0 020606 0 2 1 1 0 020610 0 2 1 1 0 020611 0 2 1 1 0 020612 0 2 0 1 0 020615 10 2 0 1 0 020650 10 2 0 1 1 020660 0 2 0 1 0 020661 90 2 0 1 0 020662 90 2 0 0 0 020663 90 2 1 0 0 020664 90 2 0 1 0 020665 10 2 0 0 0 020670 10 2 0 1 0 020680 90 2 0 0 0 020690 90 2 0 1 0 020692 90 2 0 2 1 020693 90 2 0 1 0 020694 90 2 0 1 0 020696 90 2 0 2 1 020697 0 0 0 2 1 020802 90 2 1 2 1 020805 90 2 1 2 1 020808 90 2 1 2 1 020816 90 2 0 2 1 0

Page 12: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

20822 90 2 0 2 1 020824 90 2 1 2 1 020827 90 2 1 2 1 020838 90 2 1 2 1 020900 0 2 0 2 1 020902 0 2 0 2 1 020910 90 2 0 0 0 020912 90 2 0 0 0 020920 90 2 0 1 1 020922 90 2 0 2 1 020924 90 2 0 2 1 020926 90 2 0 1 0 020930 XXX 9 9 9 9 920931 ZZZ 0 0 1 1 020936 XXX 9 9 9 9 920937 ZZZ 0 0 2 1 020938 ZZZ 0 0 2 1 020950 0 2 0 0 0 020955 90 2 0 2 1 020956 90 2 0 2 1 020957 90 2 0 2 1 020962 90 2 0 2 1 020969 90 2 0 2 1 020970 90 2 0 2 1 020972 90 2 0 2 0 020973 90 2 1 2 1 020974 0 0 0 1 0 020975 0 0 0 2 1 020979 0 0 0 1 0 020982 0 2 1 1 0 020983 0 2 1 1 0 020985 ZZZ 0 0 0 0 020999 YYY 2 0 0 1 121010 90 2 1 0 0 021011 90 2 0 2 0 021012 90 2 0 2 0 021013 90 2 0 2 0 021014 90 2 0 2 0 021015 90 2 0 1 0 021016 90 2 0 2 0 021025 90 2 0 1 0 021026 90 2 0 1 0 021029 90 2 0 0 0 021030 90 2 1 1 0 021031 90 2 1 1 0 021032 90 2 0 1 0 021034 90 2 0 2 1 0

Page 13: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

21040 90 2 0 1 0 021044 90 2 0 2 1 021045 90 2 0 2 1 021046 90 2 0 0 1 021047 90 2 0 2 1 021048 90 2 0 0 1 021049 90 2 0 2 1 021050 90 2 1 0 0 021060 90 2 1 2 1 021070 90 2 1 0 0 021073 90 2 1 0 0 021076 10 2 0 0 0 021077 90 2 1 0 0 021079 90 2 0 1 0 021080 90 2 0 1 0 021081 90 2 0 0 0 021082 90 2 0 0 0 021083 90 2 0 0 0 021084 90 2 0 0 0 021085 10 2 0 0 0 021086 90 2 1 0 0 021087 90 2 0 0 0 021088 90 0 0 0 0 021089 YYY 0 0 1 1 121100 90 2 0 0 0 021110 90 2 0 1 0 021116 0 2 1 1 0 021120 90 2 0 1 1 021121 90 2 0 2 0 021122 90 2 0 2 0 021123 90 2 0 2 1 021125 90 2 0 2 0 021127 90 2 0 2 1 021137 90 2 0 2 0 021138 90 2 0 2 1 021139 90 2 0 2 1 021141 90 2 0 2 1 021142 90 2 0 2 1 021143 90 2 0 2 1 021145 90 2 0 2 0 021146 90 2 0 2 1 021147 90 2 0 2 0 021150 90 2 0 2 0 021151 90 2 0 2 0 021154 90 2 0 2 1 021155 90 2 0 2 0 021159 90 2 0 2 1 0

Page 14: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

21160 90 2 0 2 0 021172 90 2 0 2 1 021175 90 2 0 2 0 021179 90 2 0 2 0 021180 90 2 0 2 1 021181 90 2 0 0 0 021182 90 2 0 2 1 021183 90 2 0 2 1 021184 90 2 0 2 0 021188 90 2 0 2 0 021193 90 2 2 2 1 021194 90 2 2 2 0 021195 90 2 2 2 0 021196 90 2 2 2 1 021198 90 2 0 2 1 021199 90 2 0 2 1 021206 90 2 0 2 1 021208 90 2 0 0 0 021209 90 2 0 2 0 021210 90 2 0 1 0 021215 90 2 0 1 1 021230 90 2 0 0 0 021235 90 2 0 1 0 021240 90 2 1 2 1 021242 90 2 1 2 1 021243 90 2 1 2 1 021244 90 2 0 2 1 021245 90 2 0 2 0 021246 90 2 0 2 0 021247 90 2 1 2 1 021248 90 2 0 1 0 021249 90 2 0 0 0 021255 90 2 1 2 1 021256 90 2 1 2 1 021260 90 2 0 2 1 021261 90 2 0 2 1 021263 90 2 0 2 1 021267 90 2 1 2 1 021268 90 2 1 2 1 021270 90 2 1 2 1 021275 90 2 0 2 1 021280 90 2 1 0 0 021282 90 2 1 1 0 021295 90 2 1 0 0 021296 90 2 1 0 0 021299 YYY 2 0 0 1 121310 0 2 0 1 0 0

Page 15: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

21315 10 2 0 1 0 021320 10 2 0 1 0 021325 90 2 0 0 0 021330 90 2 0 0 0 021335 90 2 0 1 0 021336 90 2 0 0 0 021337 90 2 0 0 0 021338 90 2 0 0 0 021339 90 2 0 2 1 021340 90 2 0 0 0 021343 90 2 0 2 1 021344 90 2 0 2 2 021345 90 2 0 0 0 021346 90 2 0 1 1 021347 90 2 0 2 1 021348 90 2 0 2 2 021355 10 2 1 0 0 021356 10 2 1 0 0 021360 90 2 1 2 0 021365 90 2 1 2 1 021366 90 2 1 2 2 021385 90 2 1 2 1 021386 90 2 1 2 0 021387 90 2 1 2 0 021390 90 2 1 2 1 021395 90 2 1 2 1 021400 90 2 1 0 0 021401 90 2 1 2 0 021406 90 2 1 2 1 021407 90 2 1 2 1 021408 90 2 1 2 2 021421 90 2 0 0 0 021422 90 2 0 2 1 021423 90 2 0 2 2 021431 90 2 0 2 0 021432 90 2 0 2 0 021433 90 2 0 2 1 021435 90 2 0 2 0 021436 90 2 0 2 2 021440 90 2 0 0 0 021445 90 2 0 2 0 021450 90 2 0 0 0 021451 90 2 0 0 0 021452 90 2 0 0 0 021453 90 2 0 0 0 021454 90 2 0 0 1 021461 90 2 0 1 1 0

Page 16: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

21462 90 2 0 2 1 021465 90 2 1 2 1 021470 90 2 0 2 1 021480 0 2 1 1 0 021485 90 2 1 0 0 021490 90 2 1 2 1 021495 90 2 0 2 0 021497 90 2 0 0 0 021499 YYY 2 0 0 1 121501 90 2 0 1 0 021502 90 2 0 2 0 021510 90 2 0 0 0 021550 10 2 0 1 0 021552 90 2 0 2 0 021554 90 2 0 2 0 021555 90 2 0 1 0 021556 90 2 0 1 0 021557 90 2 0 2 1 021558 90 2 0 2 1 021600 90 2 0 2 1 021610 90 2 0 2 0 021615 90 2 1 2 1 021616 90 2 1 2 0 021620 90 2 0 2 1 021627 90 2 0 2 0 021630 90 2 0 2 1 021632 90 2 0 2 1 021685 90 2 0 2 1 021700 90 2 1 2 0 021705 90 2 1 2 0 021720 90 2 0 2 0 021725 90 2 0 2 1 021740 90 2 0 2 1 021742 90 2 0 2 1 021743 90 2 0 2 1 021750 90 2 0 2 1 021805 90 2 0 0 0 021811 0 2 1 2 0 021812 0 2 1 2 0 021813 0 2 1 2 0 021820 90 2 0 1 0 021825 90 2 0 2 1 021899 YYY 2 0 0 1 121920 10 2 0 1 0 021925 90 2 0 1 0 021930 90 2 0 1 0 021931 90 2 0 2 0 0

Page 17: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

21932 90 2 0 2 0 021933 90 2 0 2 0 021935 90 2 0 1 1 021936 90 2 0 2 1 022010 90 2 0 0 0 022015 90 2 0 1 0 022100 90 2 0 2 1 022101 90 2 0 2 1 022102 90 2 0 2 1 022103 ZZZ 0 0 2 1 022110 90 2 0 2 1 022112 90 2 0 2 1 022114 90 2 0 2 1 022116 ZZZ 0 0 2 1 022206 90 2 0 2 1 022207 90 2 0 2 1 022208 ZZZ 0 0 2 1 022210 90 2 0 2 1 022212 90 2 0 2 1 022214 90 2 0 2 1 022216 ZZZ 0 0 2 1 022220 90 2 0 2 1 022222 90 2 0 2 1 022224 90 2 0 2 1 022226 ZZZ 0 0 2 1 022305 90 2 0 1 0 022310 90 2 0 1 0 022315 90 2 0 1 0 022318 90 2 0 2 2 022319 90 2 0 2 2 022325 90 2 0 2 1 022326 90 2 0 2 1 022327 90 2 0 2 1 022328 ZZZ 0 0 2 1 022505 10 2 0 1 0 022510 10 2 0 1 0 022511 10 2 0 1 0 022512 ZZZ 0 0 1 0 022513 10 2 0 1 0 022514 10 2 0 1 0 022515 ZZZ 0 0 1 0 022526 10 9 9 9 9 922527 ZZZ 9 9 9 9 922532 90 2 0 2 2 022533 90 2 0 2 2 022534 ZZZ 0 0 2 2 022548 90 2 0 2 2 0

Page 18: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

22551 90 2 0 2 2 022552 ZZZ 0 0 2 2 022554 90 2 0 2 2 022556 90 2 0 2 2 022558 90 2 0 2 2 022585 ZZZ 0 0 2 2 022586 90 2 0 2 2 022590 90 2 0 2 2 022595 90 2 0 2 2 022600 90 2 0 2 2 022610 90 2 0 2 2 022612 90 2 0 2 2 022614 ZZZ 0 0 2 2 022630 90 2 0 2 2 022632 ZZZ 0 0 2 2 022633 90 2 0 2 2 022634 ZZZ 0 0 2 2 022800 90 2 0 2 1 022802 90 2 0 2 1 022804 90 2 0 2 1 022808 90 2 0 2 1 022810 90 2 0 2 1 022812 90 2 0 2 1 022818 90 2 0 2 2 222819 90 2 0 2 2 222830 90 2 0 2 1 022840 ZZZ 0 0 2 1 022841 XXX 9 9 9 9 922842 ZZZ 0 0 2 2 022843 ZZZ 0 0 2 2 022844 ZZZ 0 0 2 2 022845 ZZZ 0 0 2 2 022846 ZZZ 0 0 2 2 022847 ZZZ 0 0 2 2 022848 ZZZ 0 0 2 2 022849 90 2 0 2 1 022850 90 2 0 2 1 022851 ZZZ 0 0 2 2 022852 90 2 0 2 1 022855 90 2 0 2 1 022856 90 2 0 2 2 022857 90 2 0 2 2 022858 ZZZ 0 0 2 2 022861 90 2 0 2 2 022862 90 2 0 2 2 222864 90 2 0 2 2 022865 90 2 0 2 2 2

Page 19: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

22899 YYY 2 0 2 1 122900 90 2 0 2 1 022901 90 2 0 2 1 022902 90 2 0 2 1 022903 90 2 0 2 1 022904 90 2 0 2 1 122905 90 2 0 2 1 122999 YYY 2 0 0 1 123000 90 2 1 2 1 023020 90 2 1 2 0 023030 10 2 0 1 0 023031 10 2 1 1 0 023035 90 2 1 2 0 023040 90 2 1 2 1 023044 90 2 1 1 1 023065 10 2 1 1 0 023066 90 2 1 1 0 023071 90 2 1 2 0 023073 90 2 1 2 0 023075 90 2 1 1 0 023076 90 2 1 1 0 023077 90 2 1 2 1 023078 90 2 1 2 1 023100 90 2 1 2 1 023101 90 2 1 1 1 023105 90 2 1 2 1 023106 90 2 1 1 1 023107 90 2 1 2 1 023120 90 2 1 2 1 023125 90 2 1 2 1 023130 90 2 1 1 1 023140 90 2 1 1 0 023145 90 2 1 2 1 023146 90 2 1 0 0 023150 90 2 1 2 1 023155 90 2 1 2 1 023156 90 2 1 2 0 023170 90 2 1 1 0 023172 90 2 1 2 0 023174 90 2 1 2 1 023180 90 2 1 1 1 023182 90 2 1 2 0 023184 90 2 1 2 1 023190 90 2 1 2 1 023195 90 2 1 2 1 023200 90 2 1 2 1 023210 90 2 1 2 1 0

Page 20: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

23220 90 2 1 2 1 023330 10 2 1 0 0 023333 90 2 1 0 0 023334 90 2 1 1 1 023335 90 2 1 1 1 023350 0 2 1 1 0 023395 90 2 0 2 1 023397 90 2 0 2 1 023400 90 2 1 2 1 023405 90 2 0 2 1 023406 90 2 0 2 0 023410 90 2 1 2 1 023412 90 2 1 2 1 023415 90 2 1 1 1 023420 90 2 1 2 1 023430 90 2 1 2 1 023440 90 2 1 2 1 023450 90 2 1 2 1 023455 90 2 1 2 1 023460 90 2 1 2 1 023462 90 2 1 2 1 023465 90 2 1 2 1 023466 90 2 1 2 1 023470 90 2 1 2 1 023472 90 2 1 2 1 023473 90 2 1 2 1 023474 90 2 1 2 1 023480 90 2 1 1 1 023485 90 2 1 2 1 023490 90 2 1 2 0 023491 90 2 1 2 1 023500 90 2 1 1 0 023505 90 2 1 1 0 023515 90 2 1 2 1 023520 90 2 1 0 0 023525 90 2 1 0 0 023530 90 2 1 2 0 023532 90 2 1 2 0 023540 90 2 1 1 0 023545 90 2 1 0 0 023550 90 2 1 2 1 023552 90 2 1 2 1 023570 90 2 1 1 0 023575 90 2 1 0 0 023585 90 2 1 2 1 023600 90 2 1 1 0 023605 90 2 1 1 0 0

Page 21: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

23615 90 2 1 2 1 023616 90 2 1 2 2 023620 90 2 1 1 0 023625 90 2 1 1 0 023630 90 2 1 2 1 023650 90 2 1 1 0 023655 90 2 1 1 0 023660 90 2 1 2 1 023665 90 2 1 1 0 023670 90 2 1 2 1 023675 90 2 1 1 0 023680 90 2 1 2 1 023700 10 2 1 1 0 023800 90 2 1 2 1 023802 90 2 1 2 1 023900 90 2 0 2 0 023920 90 2 1 2 1 023921 90 2 1 1 0 023929 YYY 2 0 2 1 123930 10 2 1 1 0 023931 10 2 1 1 0 023935 90 2 1 0 0 024000 90 2 1 0 1 024006 90 2 1 2 2 024065 10 2 1 1 0 024066 90 2 1 1 0 024071 90 2 1 2 0 024073 90 2 1 2 0 024075 90 2 1 1 0 024076 90 2 1 1 0 024077 90 2 1 1 1 024079 90 2 1 2 1 024100 90 2 1 2 1 024101 90 2 1 2 0 024102 90 2 1 2 1 024105 90 2 1 1 0 024110 90 2 1 1 1 024115 90 2 1 2 1 024116 90 2 1 2 0 024120 90 2 1 0 0 024125 90 2 1 2 1 024126 90 2 1 2 0 024130 90 2 1 1 1 024134 90 2 1 2 0 024136 90 2 1 1 0 024138 90 2 1 2 0 024140 90 2 1 2 0 0

Page 22: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

24145 90 2 1 1 1 024147 90 2 1 1 1 024149 90 2 1 2 1 024150 90 2 1 2 1 024152 90 2 1 2 1 024155 90 2 1 2 1 024160 90 2 1 1 1 024164 90 2 1 1 1 024200 10 2 1 0 0 024201 90 2 1 1 0 024220 0 2 1 0 0 024300 90 2 1 1 0 024301 90 2 0 2 1 024305 90 2 0 0 0 024310 90 2 0 0 0 024320 90 2 0 2 1 024330 90 2 1 2 0 024331 90 2 1 2 0 024332 90 2 1 1 0 024340 90 2 1 2 1 024341 90 2 1 2 1 024342 90 2 1 2 1 024343 90 2 1 2 1 024344 90 2 1 2 1 024345 90 2 1 2 1 024346 90 2 1 2 1 024357 90 2 1 0 0 024358 90 2 1 0 0 024359 90 2 1 0 0 024360 90 2 1 2 1 024361 90 2 1 2 1 024362 90 2 1 2 0 024363 90 2 1 2 0 024365 90 2 1 2 1 024366 90 2 1 2 1 024370 90 2 1 2 0 024371 90 2 1 2 0 024400 90 2 1 2 1 024410 90 2 1 2 1 024420 90 2 1 2 1 024430 90 2 1 2 1 024435 90 2 1 2 1 024470 90 2 1 2 0 024495 90 2 1 0 0 024498 90 2 1 2 1 024500 90 2 1 1 0 024505 90 2 1 1 0 0

Page 23: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

24515 90 2 1 2 1 024516 90 2 1 2 2 024530 90 2 1 1 0 024535 90 2 1 1 0 024538 90 2 1 1 0 024545 90 2 1 2 1 024546 90 2 1 2 2 024560 90 2 1 1 0 024565 90 2 1 1 0 024566 90 2 1 1 0 024575 90 2 1 2 1 024576 90 2 1 1 0 024577 90 2 1 1 0 024579 90 2 1 2 1 024582 90 2 1 1 0 024586 90 2 1 2 1 024587 90 2 1 2 1 024600 90 2 1 1 0 024605 90 2 1 1 0 024615 90 2 1 2 1 024620 90 2 1 0 0 024635 90 2 1 2 1 024640 10 2 1 0 0 024650 90 2 1 1 0 024655 90 2 1 1 0 024665 90 2 1 2 1 024666 90 2 1 2 1 024670 90 2 1 1 0 024675 90 2 1 1 0 024685 90 2 1 2 1 024800 90 2 1 2 1 024802 90 2 1 2 0 024900 90 2 1 2 1 024920 90 2 1 2 1 024925 90 2 1 2 0 024930 90 2 1 2 0 024931 90 2 1 2 0 024935 90 2 1 0 0 024940 90 2 1 2 0 024999 YYY 2 1 0 1 125000 90 2 1 1 0 025001 90 2 1 1 0 025020 90 2 1 1 0 025023 90 2 1 0 0 025024 90 2 1 1 0 025025 90 2 1 0 0 025028 90 2 1 1 0 0

Page 24: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

25031 90 2 1 0 0 025035 90 2 1 0 0 025040 90 2 1 0 0 025065 10 2 1 1 0 025066 90 2 1 1 0 025071 90 2 1 2 0 025073 90 2 1 2 0 025075 90 2 1 1 0 025076 90 2 1 1 0 025077 90 2 1 1 0 025078 90 2 1 2 0 025085 90 2 1 2 0 025100 90 2 1 0 0 025101 90 2 1 0 0 025105 90 2 1 0 1 025107 90 2 1 2 1 025109 90 2 1 1 0 025110 90 2 1 1 0 025111 90 2 1 1 0 025112 90 2 1 1 0 025115 90 2 1 1 0 025116 90 2 1 0 1 025118 90 2 1 1 0 025119 90 2 1 2 1 025120 90 2 1 0 1 025125 90 2 1 0 0 025126 90 2 1 2 0 025130 90 2 1 0 0 025135 90 2 1 2 1 025136 90 2 1 2 1 025145 90 2 1 2 0 025150 90 2 1 1 1 025151 90 2 1 2 1 025170 90 2 1 2 1 025210 90 2 0 0 1 025215 90 2 1 2 1 025230 90 2 1 1 1 025240 90 2 1 0 1 025246 0 2 1 1 0 025248 90 2 1 1 0 025250 90 2 1 2 0 025251 90 2 1 2 0 025259 90 2 1 1 0 025260 90 2 0 1 0 025263 90 2 0 2 0 025265 90 2 0 2 0 025270 90 2 0 0 0 0

Page 25: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

25272 90 2 0 0 0 025274 90 2 0 0 1 025275 90 2 1 0 1 025280 90 2 0 0 1 025290 90 2 0 1 0 025295 90 2 0 1 0 025300 90 2 1 2 0 025301 90 2 1 2 0 025310 90 2 0 2 1 025312 90 2 0 2 1 025315 90 2 1 2 0 025316 90 2 1 2 0 025320 90 2 1 2 0 025332 90 2 1 2 0 025335 90 2 1 2 0 025337 90 2 1 1 0 025350 90 2 1 2 0 025355 90 2 1 2 0 025360 90 2 1 2 1 025365 90 2 1 2 0 025370 90 2 1 2 0 025375 90 2 1 2 1 025390 90 2 1 2 1 025391 90 2 1 2 1 025392 90 2 1 2 0 025393 90 2 1 2 0 025394 90 2 1 2 1 025400 90 2 1 2 1 025405 90 2 1 2 1 025415 90 2 1 2 1 025420 90 2 1 2 1 025425 90 2 1 2 1 025426 90 2 1 2 1 025430 90 2 1 1 0 025431 90 2 1 2 1 025440 90 2 1 2 1 025441 90 2 1 2 1 025442 90 2 1 2 1 025443 90 2 1 2 1 025444 90 2 1 2 0 025445 90 2 1 1 1 025446 90 2 1 2 1 025447 90 2 1 2 1 025449 90 2 1 2 1 025450 90 2 1 1 0 025455 90 2 1 1 0 025490 90 2 1 2 0 0

Page 26: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

25491 90 2 1 2 0 025492 90 2 1 2 0 025500 90 2 1 1 0 025505 90 2 1 1 0 025515 90 2 1 2 1 025520 90 2 1 1 0 025525 90 2 1 2 2 025526 90 2 1 2 2 025530 90 2 1 1 0 025535 90 2 1 1 0 025545 90 2 1 2 1 025560 90 2 1 1 0 025565 90 2 1 1 0 025574 90 2 1 2 2 025575 90 2 1 2 1 025600 90 2 1 1 0 025605 90 2 1 1 0 025606 90 2 1 1 0 025607 90 2 1 2 0 025608 90 2 1 2 0 025609 90 2 1 2 0 025622 90 2 1 1 0 025624 90 2 1 0 0 025628 90 2 1 2 0 025630 90 2 1 1 0 025635 90 2 1 0 0 025645 90 2 1 2 0 025650 90 2 1 1 0 025651 90 2 1 0 0 025652 90 2 1 1 1 025660 90 2 1 0 0 025670 90 2 1 2 1 025671 90 2 1 1 0 025675 90 2 1 0 0 025676 90 2 1 2 0 025680 90 2 1 0 0 025685 90 2 1 2 0 025690 90 2 1 0 0 025695 90 2 1 2 1 025800 90 2 1 2 1 025805 90 2 1 2 1 025810 90 2 1 2 1 025820 90 2 1 2 1 025825 90 2 1 2 1 025830 90 2 1 2 1 025900 90 2 1 0 0 025905 90 2 1 2 0 0

Page 27: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

25907 90 2 1 2 0 025909 90 2 1 2 0 025915 90 2 1 2 0 025920 90 2 1 0 0 025922 90 2 1 2 0 025924 90 2 1 2 0 025927 90 2 1 0 0 025929 90 2 1 2 0 025931 90 2 1 1 0 025999 YYY 2 1 0 1 126010 10 2 0 1 0 026011 10 2 0 1 0 026020 90 2 0 1 0 026025 90 2 1 0 0 026030 90 2 1 0 0 026034 90 2 0 1 0 026035 90 2 0 0 0 026037 90 2 1 0 0 026040 90 2 1 1 0 026045 90 2 1 1 0 026055 90 2 0 1 0 026060 90 2 0 0 0 026070 90 2 1 1 0 026075 90 2 1 1 0 026080 90 2 0 1 0 026100 90 2 1 0 0 026105 90 2 1 0 0 026110 90 2 0 1 0 026111 90 2 0 2 0 026113 90 2 0 2 0 026115 90 2 0 1 0 026116 90 2 0 1 0 026117 90 2 0 1 0 026118 90 2 0 2 0 026121 90 2 1 1 0 026123 90 2 1 1 0 026125 ZZZ 0 0 1 0 026130 90 2 1 1 0 026135 90 2 0 0 0 026140 90 2 0 1 0 026145 90 2 0 1 0 026160 90 2 0 1 0 026170 90 2 0 0 0 026180 90 2 0 0 0 026185 90 2 1 2 1 026200 90 2 0 0 0 026205 90 2 0 1 0 0

Page 28: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

26210 90 2 0 1 0 026215 90 2 0 1 0 026230 90 2 0 0 0 026235 90 2 0 0 0 026236 90 2 0 1 0 026250 90 2 0 0 0 026260 90 2 0 2 0 026262 90 2 0 2 0 026320 90 2 0 1 0 026340 90 2 1 1 0 026341 10 2 1 1 0 026350 90 2 0 1 0 026352 90 2 0 2 1 026356 90 2 0 1 0 026357 90 2 0 2 0 026358 90 2 0 2 0 026370 90 2 0 0 0 026372 90 2 0 2 0 026373 90 2 0 2 0 026390 90 2 0 2 1 026392 90 2 0 2 1 026410 90 2 0 1 0 026412 90 2 0 0 0 026415 90 2 0 0 0 026416 90 2 0 1 0 026418 90 2 0 1 0 026420 90 2 0 2 0 026426 90 2 0 1 0 026428 90 2 0 0 0 026432 90 2 0 1 0 026433 90 2 0 1 0 026434 90 2 0 2 0 026437 90 2 0 1 0 026440 90 2 0 1 0 026442 90 2 0 1 0 026445 90 2 0 1 0 026449 90 2 0 0 0 026450 90 2 0 0 0 026455 90 2 0 0 0 026460 90 2 0 1 0 026471 90 2 0 0 0 026474 90 2 0 2 0 026476 90 2 0 1 0 026477 90 2 0 1 1 026478 90 2 0 0 0 026479 90 2 0 2 0 026480 90 2 0 0 0 0

Page 29: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

26483 90 2 0 2 1 026485 90 2 0 2 1 026489 90 2 0 0 0 026490 90 2 0 0 0 026492 90 2 0 2 1 026494 90 2 0 2 1 026496 90 2 0 0 0 026497 90 2 0 2 0 026498 90 2 0 2 1 026499 90 2 0 2 1 026500 90 2 0 0 0 026502 90 2 0 2 0 026508 90 2 1 0 0 026510 90 2 0 0 0 026516 90 2 1 0 0 026517 90 2 1 2 0 026518 90 2 1 2 1 026520 90 2 0 1 0 026525 90 2 0 1 1 026530 90 2 0 2 0 026531 90 2 0 2 1 026535 90 2 0 1 0 026536 90 2 0 0 0 026540 90 2 0 0 1 026541 90 2 0 2 1 026542 90 2 0 0 0 026545 90 2 0 0 0 026546 90 2 1 2 0 026548 90 2 0 0 0 026550 90 2 1 2 0 026551 90 2 1 2 0 026553 90 2 1 2 1 026554 90 2 1 2 1 026555 90 2 0 2 0 026556 90 2 0 2 1 026560 90 2 0 2 0 026561 90 2 0 2 1 026562 90 2 0 2 0 026565 90 2 0 2 0 026567 90 2 0 0 0 026568 90 2 0 2 0 026580 90 2 1 2 0 026587 90 2 0 2 0 026590 90 2 0 2 0 026591 90 2 0 0 0 026593 90 2 0 1 0 026596 90 2 0 2 0 0

Page 30: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

26600 90 2 0 1 0 026605 90 2 0 1 0 026607 90 2 0 0 0 026608 90 2 0 0 0 026615 90 2 0 1 0 026641 90 2 1 0 0 026645 90 2 1 0 0 026650 90 2 1 1 0 026665 90 2 1 1 1 026670 90 2 0 0 0 026675 90 2 0 0 0 026676 90 2 0 1 0 026685 90 2 0 1 1 026686 90 2 0 2 0 026700 90 2 0 1 0 026705 90 2 0 0 0 026706 90 2 0 1 0 026715 90 2 0 0 0 026720 90 2 0 1 0 026725 90 2 0 1 0 026727 90 2 0 1 0 026735 90 2 0 1 0 026740 90 2 0 1 0 026742 90 2 0 1 0 026746 90 2 0 1 0 026750 90 2 0 1 0 026755 90 2 0 1 0 026756 90 2 0 0 0 026765 90 2 0 1 0 026770 90 2 0 1 0 026775 90 2 0 1 0 026776 90 2 0 1 0 026785 90 2 0 1 0 026820 90 2 1 2 1 026841 90 2 1 0 1 026842 90 2 1 2 1 026843 90 2 0 2 1 026844 90 2 0 2 1 026850 90 2 0 0 0 026852 90 2 0 2 1 026860 90 2 0 1 0 026861 ZZZ 0 0 1 0 026862 90 2 0 2 1 026863 ZZZ 0 0 2 0 026910 90 2 0 1 0 026951 90 2 0 1 0 026952 90 2 0 1 0 0

Page 31: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

26989 YYY 2 0 1 1 126990 90 2 0 1 0 026991 90 2 0 0 0 026992 90 2 0 0 0 027000 90 2 1 1 1 027001 90 2 1 2 1 027003 90 2 1 2 1 027005 90 2 1 2 1 027006 90 2 1 2 1 027025 90 2 1 0 1 027027 90 2 1 0 0 027030 90 2 1 2 1 027033 90 2 1 2 1 027035 90 2 1 2 1 027036 90 2 1 2 1 027040 10 2 1 1 0 027041 90 2 1 1 0 027043 90 2 1 1 0 027045 90 2 1 2 1 027047 90 2 1 1 0 027048 90 2 1 2 1 027049 90 2 1 2 1 027050 90 2 1 0 1 027052 90 2 1 2 1 027054 90 2 1 2 1 027057 90 2 1 0 0 027059 90 2 1 2 1 027060 90 2 1 1 0 027062 90 2 1 1 1 027065 90 2 1 2 1 027066 90 2 1 2 1 027067 90 2 1 2 0 027070 90 2 1 2 1 027071 90 2 1 2 1 027075 90 2 0 2 1 027076 90 2 0 2 1 027077 90 2 0 2 1 027078 90 2 1 2 1 027080 90 2 0 2 1 027086 10 2 1 0 0 027087 90 2 1 2 1 027090 90 2 1 2 1 027091 90 2 1 2 1 027093 0 2 1 1 0 027095 0 2 1 1 0 027096 0 2 1 1 0 027097 90 2 1 2 0 0

Page 32: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

27098 90 2 1 2 0 027100 90 2 1 2 1 027105 90 2 1 2 0 027110 90 2 1 2 1 027111 90 2 1 2 1 027120 90 2 1 2 1 027122 90 2 1 2 1 027125 90 2 1 2 1 027130 90 2 1 2 1 027132 90 2 1 2 1 027134 90 2 1 2 1 027137 90 2 1 2 1 027138 90 2 1 2 1 027140 90 2 1 2 1 027146 90 2 1 2 1 027147 90 2 1 2 1 027151 90 2 1 2 1 027156 90 2 1 2 1 027158 90 2 2 2 0 027161 90 2 1 2 1 027165 90 2 1 2 1 027170 90 2 1 2 1 027175 90 2 1 0 0 027176 90 2 1 2 1 027177 90 2 1 2 1 027178 90 2 1 2 1 027179 90 2 1 2 0 027181 90 2 1 2 0 027185 90 2 1 1 1 027187 90 2 1 2 1 027193 90 2 0 1 0 027194 90 2 0 0 2 027200 90 2 0 1 0 027202 90 2 0 2 0 027215 90 9 9 9 9 927216 90 9 9 9 9 927217 90 9 9 9 9 927218 90 9 9 9 9 927220 90 2 1 1 0 027222 90 2 1 1 0 027226 90 2 1 2 2 027227 90 2 1 2 2 027228 90 2 1 2 2 027230 90 2 1 1 0 027232 90 2 1 1 0 027235 90 2 1 1 1 027236 90 2 1 2 1 0

Page 33: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

27238 90 2 1 1 0 027240 90 2 1 1 0 027244 90 2 1 2 1 027245 90 2 1 2 2 027246 90 2 1 1 0 027248 90 2 1 2 1 027250 0 2 1 1 0 027252 90 2 1 1 0 027253 90 2 1 2 1 027254 90 2 1 2 1 027256 10 2 1 0 0 027257 10 2 1 0 0 027258 90 2 1 2 1 027259 90 2 1 2 0 027265 90 2 1 1 0 027266 90 2 1 1 0 027267 90 2 1 2 1 027268 90 2 1 2 1 027269 90 2 1 2 1 027275 10 2 0 1 0 027279 90 2 1 2 1 027280 90 2 1 2 1 027282 90 2 0 2 1 027284 90 2 1 2 1 027286 90 2 1 2 1 027290 90 2 0 2 1 027295 90 2 1 2 1 027299 YYY 2 1 2 1 127301 90 2 1 1 0 027303 90 2 1 2 1 027305 90 2 1 2 1 027306 90 2 1 2 0 027307 90 2 1 0 1 027310 90 2 1 2 1 027323 10 2 1 1 0 027324 90 2 1 1 0 027325 90 2 1 2 0 027326 90 2 1 2 1 027327 90 2 1 1 0 027328 90 2 1 1 0 027329 90 2 1 2 1 027330 90 2 1 1 1 027331 90 2 1 2 1 027332 90 2 1 2 1 027333 90 2 1 2 1 027334 90 2 1 2 1 027335 90 2 1 2 1 0

Page 34: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

27337 90 2 1 2 0 027339 90 2 1 2 0 027340 90 2 1 1 0 027345 90 2 1 2 1 027347 90 2 1 2 1 027350 90 2 1 2 1 027355 90 2 1 2 1 027356 90 2 1 2 1 027357 90 2 1 2 1 027358 ZZZ 0 0 2 0 027360 90 2 1 2 1 027364 90 2 1 2 1 027365 90 2 1 2 1 027370 0 2 1 1 0 027372 90 2 1 0 0 027380 90 2 1 2 1 027381 90 2 1 2 1 027385 90 2 1 2 1 027386 90 2 1 2 1 027390 90 2 1 2 0 027391 90 2 0 0 1 027392 90 2 2 2 1 027393 90 2 1 2 1 027394 90 2 0 2 0 027395 90 2 2 2 1 027396 90 2 1 2 1 027397 90 2 1 2 0 027400 90 2 1 2 1 027403 90 2 1 2 1 027405 90 2 1 2 1 027407 90 2 1 2 1 027409 90 2 1 2 1 027412 90 2 1 2 1 027415 90 2 1 2 1 027416 90 2 1 0 0 027418 90 2 1 2 1 027420 90 2 1 2 1 027422 90 2 1 2 1 027424 90 2 1 2 1 027425 90 2 1 1 1 027427 90 2 1 2 1 027428 90 2 1 2 1 027429 90 2 1 2 1 027430 90 2 1 2 1 027435 90 2 1 2 1 027437 90 2 1 1 1 027438 90 2 1 2 1 0

Page 35: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

27440 90 2 1 2 1 027441 90 2 1 2 1 027442 90 2 1 2 1 027443 90 2 1 2 1 027445 90 2 1 2 1 027446 90 2 1 2 1 027447 90 2 1 2 1 027448 90 2 1 2 1 027450 90 2 1 2 1 027454 90 2 1 2 1 027455 90 2 1 2 1 027457 90 2 1 2 1 027465 90 2 1 2 1 027466 90 2 1 2 1 027468 90 2 1 2 1 027470 90 2 1 2 1 027472 90 2 1 2 1 027475 90 2 1 1 1 027477 90 2 1 1 1 027479 90 2 1 2 0 027485 90 2 1 1 0 027486 90 2 1 2 1 027487 90 2 1 2 1 027488 90 2 1 2 1 027495 90 2 1 2 1 027496 90 2 1 1 0 027497 90 2 1 0 2 027498 90 2 1 2 2 027499 90 2 1 2 2 027500 90 2 1 1 0 027501 90 2 1 0 0 027502 90 2 1 1 0 027503 90 2 1 0 0 027506 90 2 1 2 1 027507 90 2 1 2 2 027508 90 2 1 1 0 027509 90 2 1 0 0 027510 90 2 1 1 0 027511 90 2 1 2 2 027513 90 2 1 2 2 027514 90 2 1 2 1 027516 90 2 1 1 0 027517 90 2 1 0 0 027519 90 2 1 2 1 027520 90 2 1 1 0 027524 90 2 1 2 1 027530 90 2 1 1 0 0

Page 36: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

27532 90 2 1 1 0 027535 90 2 1 2 2 027536 90 2 1 2 1 027538 90 2 1 0 0 027540 90 2 1 2 1 027550 90 2 1 0 0 027552 90 2 1 0 0 027556 90 2 1 2 1 027557 90 2 1 2 1 027558 90 2 1 2 2 027560 90 2 1 1 0 027562 90 2 1 0 0 027566 90 2 1 2 1 027570 10 2 1 1 0 027580 90 2 1 2 1 027590 90 2 1 2 1 027591 90 2 1 2 1 027592 90 2 1 2 1 027594 90 2 1 1 0 027596 90 2 1 1 1 027598 90 2 1 2 1 027599 YYY 2 1 2 1 127600 90 2 1 1 1 027601 90 2 1 1 0 027602 90 2 1 2 1 027603 90 2 1 1 0 027604 90 2 1 0 0 027605 10 2 1 0 0 027606 10 2 1 1 1 027607 90 2 1 1 0 027610 90 2 1 1 0 027612 90 2 1 2 1 027613 10 2 1 1 0 027614 90 2 1 1 0 027615 90 2 1 0 1 027616 90 2 1 0 1 027618 90 2 1 1 0 027619 90 2 1 1 0 027620 90 2 1 2 1 027625 90 2 1 2 1 027626 90 2 1 2 0 027630 90 2 1 1 0 027632 90 2 1 2 0 027634 90 2 1 2 0 027635 90 2 1 1 1 027637 90 2 1 2 1 027638 90 2 1 2 1 0

Page 37: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

27640 90 2 1 1 1 027641 90 2 1 1 1 027645 90 2 1 2 1 027646 90 2 1 2 1 027647 90 2 1 2 0 027648 0 2 1 0 0 027650 90 2 1 2 1 027652 90 2 1 1 1 027654 90 2 1 2 1 027656 90 2 1 2 0 027658 90 2 0 2 1 027659 90 2 0 2 1 027664 90 2 0 0 0 027665 90 2 0 2 1 027675 90 2 1 2 1 027676 90 2 1 2 0 027680 90 2 0 1 1 027681 90 2 1 1 1 027685 90 2 1 2 1 027686 90 2 1 1 1 027687 90 2 1 2 1 027690 90 2 1 2 1 027691 90 2 1 2 1 027692 ZZZ 0 0 2 1 027695 90 2 1 1 1 027696 90 2 1 1 1 027698 90 2 1 2 1 027700 90 2 1 2 1 027702 90 2 1 2 1 027703 90 2 1 2 0 027704 90 2 1 1 1 027705 90 2 1 2 1 027707 90 2 1 1 1 027709 90 2 1 2 1 027712 90 2 1 2 1 027715 90 2 1 2 1 027720 90 2 1 2 1 027722 90 2 1 2 1 027724 90 2 1 2 1 027725 90 2 1 2 1 027726 90 2 1 1 1 027727 90 2 1 2 1 027730 90 2 1 1 1 027732 90 2 1 1 0 027734 90 2 1 1 0 027740 90 2 1 2 0 027742 90 2 1 2 1 0

Page 38: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

27745 90 2 1 2 1 027750 90 2 1 1 0 027752 90 2 1 1 0 027756 90 2 1 2 1 027758 90 2 1 2 1 027759 90 2 1 2 2 027760 90 2 1 1 0 027762 90 2 1 1 0 027766 90 2 1 1 1 027767 90 2 1 1 0 027768 90 2 1 1 0 027769 90 2 1 1 0 027780 90 2 1 1 0 027781 90 2 1 1 0 027784 90 2 1 1 1 027786 90 2 1 1 0 027788 90 2 1 1 0 027792 90 2 1 1 1 027808 90 2 1 1 0 027810 90 2 1 1 0 027814 90 2 1 2 1 027816 90 2 1 1 0 027818 90 2 1 1 0 027822 90 2 1 2 1 027823 90 2 1 2 1 027824 90 2 1 1 0 027825 90 2 1 0 0 027826 90 2 1 2 2 027827 90 2 1 2 2 027828 90 2 1 2 2 027829 90 2 1 2 2 027830 90 2 1 0 0 027831 90 2 1 0 0 027832 90 2 1 2 1 027840 90 2 1 1 0 027842 90 2 1 1 0 027846 90 2 1 2 1 027848 90 2 1 2 1 027860 10 2 1 0 0 027870 90 2 1 2 1 027871 90 2 1 2 1 027880 90 2 1 2 1 027881 90 2 1 2 1 027882 90 2 1 0 1 027884 90 2 1 1 0 027886 90 2 1 1 1 027888 90 2 1 2 1 0

Page 39: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

27889 90 2 1 1 1 027892 90 2 1 0 0 027893 90 2 1 0 0 027894 90 2 1 2 0 027899 YYY 2 1 0 1 128001 10 2 0 1 0 028002 10 2 0 1 0 028003 90 2 0 1 0 028005 90 2 0 1 0 028008 90 2 1 1 0 028010 90 2 0 1 0 028011 90 2 0 1 0 028020 90 2 0 1 1 028022 90 2 0 1 0 028024 90 2 0 1 0 028035 90 2 1 1 1 028039 90 2 1 2 0 028041 90 2 1 0 0 028043 90 2 1 1 0 028045 90 2 1 0 0 028046 90 2 1 1 1 028047 90 2 1 2 1 028050 90 2 1 1 1 028052 90 2 1 1 1 028054 90 2 1 0 0 028055 90 2 1 0 0 028060 90 2 1 1 0 028062 90 2 1 1 1 028070 90 2 0 1 0 028072 90 2 0 1 0 028080 90 2 0 0 0 028086 90 2 1 2 1 028088 90 2 1 0 0 028090 90 2 1 1 0 028092 90 2 0 1 0 028100 90 2 1 2 1 028102 90 2 1 2 0 028103 90 2 1 2 0 028104 90 2 0 2 1 028106 90 2 0 2 1 028107 90 2 0 2 0 028108 90 2 0 1 0 028110 90 2 1 1 1 028111 90 2 1 1 1 028112 90 2 1 1 1 028113 90 2 1 0 0 028114 90 2 1 2 1 0

Page 40: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

28116 90 2 1 1 0 028118 90 2 1 2 1 028119 90 2 1 1 1 028120 90 2 1 1 1 028122 90 2 1 2 1 028124 90 2 1 1 0 028126 90 2 0 1 0 028130 90 2 1 2 1 028140 90 2 0 1 1 028150 90 2 0 1 0 028153 90 2 0 1 0 028160 90 2 0 1 0 028171 90 2 0 2 0 028173 90 2 0 1 1 028175 90 2 0 1 1 028190 10 2 1 1 0 028192 90 2 1 1 0 028193 90 2 1 1 0 028200 90 2 0 1 1 028202 90 2 0 2 1 028208 90 2 0 1 1 028210 90 2 0 2 0 028220 90 2 1 1 0 028222 90 2 1 1 0 028225 90 2 1 1 1 028226 90 2 1 1 0 028230 90 2 1 1 0 028232 90 2 0 1 0 028234 90 2 0 1 0 028238 90 2 1 2 1 028240 90 2 1 1 0 028250 90 2 1 2 1 028260 90 2 1 2 1 028261 90 2 1 0 0 028262 90 2 1 2 1 028264 90 2 1 2 0 028270 90 2 1 1 0 028272 90 2 1 1 0 028280 90 2 1 0 0 028285 90 2 1 1 1 028286 90 2 1 1 0 028288 90 2 0 1 0 028289 90 2 1 2 1 028290 90 2 1 1 0 028292 90 2 1 2 1 028293 90 2 1 2 1 028294 90 2 1 2 1 0

Page 41: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

28296 90 2 1 2 1 028297 90 2 1 2 1 028298 90 2 1 2 1 028299 90 2 1 2 1 028300 90 2 1 2 1 028302 90 2 1 2 1 028304 90 2 1 2 1 028305 90 2 1 2 1 028306 90 2 1 2 1 028307 90 2 1 0 0 028308 90 2 1 2 1 028309 90 2 1 0 0 028310 90 2 1 1 1 028312 90 2 0 1 1 028313 90 2 0 1 0 028315 90 2 1 1 1 028320 90 2 1 2 1 028322 90 2 0 2 1 028340 90 2 0 1 0 028341 90 2 0 1 0 028344 90 2 1 1 1 028345 90 2 0 0 0 028360 90 2 1 2 0 028400 90 2 1 1 0 028405 90 2 1 0 0 028406 90 2 1 0 0 028415 90 2 1 2 1 028420 90 2 1 2 1 028430 90 2 1 1 0 028435 90 2 1 0 0 028436 90 2 1 1 0 028445 90 2 1 2 1 028446 90 2 1 2 1 028450 90 2 0 1 0 028455 90 2 0 0 0 028456 90 2 0 1 0 028465 90 2 0 1 0 028470 90 2 0 1 0 028475 90 2 0 1 0 028476 90 2 0 0 0 028485 90 2 0 1 1 028490 90 2 1 1 0 028495 90 2 1 1 0 028496 90 2 1 1 0 028505 90 2 1 1 0 028510 90 2 0 1 0 028515 90 2 0 1 0 0

Page 42: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

28525 90 2 0 0 0 028530 90 2 1 0 0 028531 90 2 1 1 2 028540 90 2 1 0 0 028545 90 2 1 0 0 028546 90 2 1 0 0 028555 90 2 1 2 1 028570 90 2 1 0 0 028575 90 2 1 0 0 028576 90 2 1 0 0 028585 90 2 1 2 1 028600 90 2 0 0 0 028605 90 2 0 0 0 028606 90 2 0 1 0 028615 90 2 0 2 1 028630 10 2 0 0 0 028635 10 2 0 0 0 028636 10 2 0 1 2 028645 90 2 0 1 1 028660 10 2 0 1 0 028665 10 2 0 0 0 028666 10 2 0 1 2 028675 90 2 0 1 0 028705 90 2 1 2 1 028715 90 2 1 2 1 028725 90 2 1 2 1 028730 90 2 1 2 1 028735 90 2 1 2 1 028737 90 2 1 2 1 028740 90 2 0 2 1 028750 90 2 1 0 0 028755 90 2 1 1 1 028760 90 2 1 2 1 028800 90 2 1 2 1 028805 90 2 1 0 0 028810 90 2 0 0 0 028820 90 2 0 1 0 028825 90 2 0 1 0 028890 90 2 1 1 1 028899 YYY 2 0 0 1 129000 0 2 0 0 0 029010 0 2 0 0 0 029015 0 2 0 0 0 029035 0 2 0 0 0 029040 0 2 0 0 0 029044 0 2 0 0 0 029046 0 2 0 0 0 0

Page 43: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

29049 0 2 0 0 0 029055 0 2 0 0 0 029058 0 2 0 0 0 029065 0 2 1 1 0 029075 0 2 1 1 0 029085 0 2 1 1 0 029086 0 2 1 1 0 029105 0 2 1 1 0 029125 0 2 1 1 0 029126 0 2 1 1 0 029130 0 2 1 1 0 029131 0 2 1 1 0 029200 0 2 0 1 0 029240 0 2 1 1 0 029260 0 2 1 1 0 029280 0 2 1 1 0 029305 0 2 0 0 0 029325 0 2 0 0 0 029345 0 2 1 1 0 029355 0 2 1 1 0 029358 0 2 1 1 0 029365 0 2 1 1 0 029405 0 2 1 1 0 029425 0 2 1 1 0 029435 0 2 1 1 0 029440 0 2 1 1 0 029445 0 2 1 1 0 029450 0 2 1 1 0 029505 0 2 1 1 0 029515 0 2 1 1 0 029520 0 2 1 0 0 029530 0 2 1 1 0 029540 0 2 1 1 0 029550 0 2 1 1 0 029580 0 2 1 1 0 029581 0 2 1 0 0 029582 0 2 1 0 0 029583 0 2 1 0 0 029584 0 2 1 0 0 029700 0 2 0 1 0 029705 0 2 1 1 0 029710 0 2 1 0 0 029720 0 2 0 1 0 029730 0 2 0 1 0 029740 0 2 0 1 0 029750 0 2 1 0 0 029799 YYY 2 0 0 1 1

Page 44: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

29800 90 2 1 0 0 029804 90 2 1 2 1 029805 90 2 1 1 1 029806 90 3 1 1 1 029807 90 3 1 1 1 029819 90 3 1 1 1 029820 90 3 1 2 1 029821 90 3 1 2 1 029822 90 3 1 2 0 029823 90 3 1 2 1 029824 90 3 1 2 1 029825 90 3 1 2 1 029826 ZZZ 0 1 2 1 029827 90 3 1 2 1 029828 90 3 1 2 1 029830 90 2 1 1 0 029834 90 3 1 2 1 029835 90 3 1 2 1 029836 90 3 1 2 1 029837 90 3 1 2 1 029838 90 3 1 0 0 029840 90 2 1 0 0 029843 90 3 1 2 1 029844 90 3 1 2 0 029845 90 3 1 2 1 029846 90 3 1 0 0 029847 90 3 1 2 0 029848 90 2 1 1 0 029850 90 2 1 0 2 029851 90 2 1 2 2 029855 90 2 1 2 2 029856 90 2 1 2 2 029860 90 2 1 2 1 029861 90 3 1 2 1 029862 90 3 1 2 1 029863 90 3 1 2 1 029866 90 2 1 0 0 029867 90 2 1 0 0 029868 90 2 1 0 0 029870 90 2 1 1 1 029871 90 3 1 1 0 029873 90 3 1 1 1 029874 90 3 1 0 0 029875 90 3 1 0 0 029876 90 3 1 1 0 029877 90 3 1 0 0 029879 90 3 1 0 0 0

Page 45: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

29880 90 3 1 0 1 029881 90 3 1 0 0 029882 90 3 1 1 0 029883 90 3 1 0 0 029884 90 3 1 2 1 029885 90 3 1 2 1 029886 90 3 1 1 0 029887 90 3 1 2 1 029888 90 2 1 2 1 029889 90 2 1 2 1 029891 90 2 1 2 0 029892 90 2 1 2 0 029893 90 2 1 1 1 029894 90 2 1 2 1 029895 90 2 1 2 1 029897 90 2 1 2 0 029898 90 2 1 2 1 029899 90 2 1 2 1 029900 90 2 1 0 0 029901 90 2 1 0 0 029902 90 2 1 0 0 029904 90 2 1 2 0 029905 90 2 1 2 0 029906 90 2 1 2 0 029907 90 2 1 2 0 029914 90 3 1 2 1 029915 90 3 1 2 1 029916 90 3 1 2 1 029999 YYY 2 1 0 1 130000 10 2 0 0 0 030020 10 2 0 1 0 030100 0 2 0 1 0 030110 10 2 1 1 0 030115 90 2 1 1 0 030117 90 2 0 1 0 030118 90 2 0 1 1 030120 90 2 0 1 0 030124 90 2 0 1 0 030125 90 2 0 2 0 030130 90 2 1 1 0 030140 90 2 1 1 0 030150 90 2 0 1 1 030160 90 2 0 2 1 030200 0 2 0 1 0 030210 10 2 0 1 0 030220 10 2 0 1 0 030300 10 2 0 1 0 0

Page 46: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

30310 10 2 0 0 0 030320 90 2 0 0 0 030400 90 2 0 0 0 030410 90 2 0 2 0 030420 90 2 0 1 0 030430 90 2 0 2 0 030435 90 2 0 2 0 030450 90 2 0 2 0 030460 90 2 0 2 2 030462 90 2 0 2 2 030465 90 2 0 0 0 030520 90 2 0 1 0 030540 90 2 0 2 0 030545 90 2 0 2 0 030560 10 2 0 1 0 030580 90 2 0 1 0 030600 90 2 0 0 0 030620 90 2 0 1 0 030630 90 2 0 0 0 030801 10 2 2 1 0 030802 10 2 2 1 0 030901 0 2 1 1 0 030903 0 2 1 1 0 030905 0 2 2 1 0 030906 0 2 2 1 0 030915 90 2 0 1 0 030920 90 2 0 1 0 030930 10 2 1 1 0 030999 YYY 2 0 0 1 131000 10 2 1 1 0 031002 10 2 1 0 0 031020 90 2 1 1 0 031030 90 2 1 1 0 031032 90 2 1 1 0 031040 90 2 1 1 1 031050 90 2 1 1 0 031051 90 2 1 1 0 031070 90 2 1 1 0 031075 90 2 1 2 1 031080 90 2 1 2 0 031081 90 2 1 2 1 031084 90 2 1 2 1 031085 90 2 1 2 1 031086 90 2 1 2 0 031087 90 2 1 2 1 031090 90 2 1 1 0 031200 90 2 1 1 0 0

Page 47: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

31201 90 2 1 1 0 031205 90 2 1 2 1 031225 90 2 1 2 1 031230 90 2 1 2 1 031231 0 2 2 1 0 031233 0 2 1 0 0 031235 0 2 1 0 0 031237 0 2 1 1 0 031238 0 2 1 0 0 031239 10 2 1 0 0 031240 0 2 1 0 0 031254 0 2 1 1 0 031255 0 2 1 1 0 031256 0 2 1 1 0 031267 0 2 1 1 0 031276 0 2 1 1 0 031287 0 2 1 0 0 031288 0 2 1 0 0 031290 10 2 1 0 0 031291 10 2 1 0 0 031292 10 2 1 0 0 031293 10 2 1 0 0 031294 10 2 1 0 0 031295 0 2 1 2 0 031296 0 2 1 2 0 031297 0 2 1 0 0 031299 YYY 2 0 0 1 131300 90 2 0 2 1 031320 90 2 0 0 0 031360 90 2 0 2 1 031365 90 2 0 2 1 031367 90 2 0 2 1 031368 90 2 0 2 1 031370 90 2 0 2 1 031375 90 2 0 2 1 031380 90 2 0 2 1 031382 90 2 0 2 1 031390 90 2 0 2 1 031395 90 2 0 2 1 031400 90 2 0 2 0 031420 90 2 0 2 1 031500 0 0 0 1 0 031502 0 2 0 1 0 031505 0 2 0 1 0 031510 0 3 0 0 0 031511 0 3 0 1 0 031512 0 3 0 0 0 0

Page 48: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

31513 0 3 0 0 0 031515 0 2 0 1 0 031520 0 2 0 0 0 031525 0 2 0 1 0 031526 0 2 0 1 0 031527 0 3 0 0 0 031528 0 3 0 0 0 031529 0 3 0 0 0 031530 0 3 0 1 0 031531 0 3 0 0 0 031535 0 3 0 1 0 031536 0 3 0 1 0 031540 0 3 0 1 0 031541 0 3 0 1 0 031545 0 3 1 1 0 031546 0 3 1 1 0 031560 0 3 0 0 0 031561 0 3 0 0 0 031570 0 3 0 1 0 031571 0 3 0 1 0 031575 0 2 0 1 0 031576 0 3 0 1 0 031577 0 3 0 0 0 031578 0 3 0 0 0 031579 0 3 0 1 0 031580 90 2 0 2 1 031582 90 2 0 1 1 031584 90 2 0 2 1 031587 90 2 0 2 1 031588 90 2 0 2 0 031590 90 2 0 2 1 031595 90 2 1 2 1 031599 YYY 2 0 0 1 131600 0 2 0 1 0 031601 0 2 0 2 1 031603 0 2 0 1 0 031605 0 2 0 1 0 031610 90 2 0 1 0 031611 90 2 0 2 1 031612 0 2 0 0 0 031613 90 2 0 1 0 031614 90 2 0 1 0 031615 0 2 0 1 0 031620 ZZZ 0 0 1 0 031622 0 2 0 1 0 031623 0 3 0 1 0 031624 0 3 0 1 0 0

Page 49: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

31625 0 3 0 1 0 031626 0 2 0 0 0 031627 ZZZ 0 0 0 0 031628 0 3 0 1 0 031629 0 3 0 1 0 031630 0 3 0 1 0 031631 0 3 0 1 0 031632 ZZZ 0 0 1 0 031633 ZZZ 0 0 1 0 031634 0 3 0 2 0 031635 0 3 0 1 0 031636 0 3 0 1 0 031637 ZZZ 0 0 1 0 031638 0 3 0 1 0 031640 0 3 0 1 0 031641 0 3 0 1 0 031643 0 2 0 1 0 031645 0 3 0 1 0 031646 0 2 0 1 0 031647 0 3 0 1 0 031648 0 3 0 1 0 031649 ZZZ 0 0 1 0 031651 ZZZ 0 0 1 0 031660 0 3 0 1 0 031661 0 3 0 1 0 031717 0 2 0 1 0 031720 0 2 0 1 0 031725 0 2 0 1 0 031730 0 2 0 1 0 031750 90 2 0 2 1 031755 90 2 0 2 1 031760 90 2 0 2 1 031766 90 2 0 2 1 031770 90 2 0 2 1 031775 90 2 0 2 0 031780 90 2 0 2 1 031781 90 2 0 2 1 031785 90 2 0 2 1 031786 90 2 0 2 1 031800 90 2 0 0 0 031805 90 2 0 2 1 031820 90 2 0 0 0 031825 90 2 0 0 0 031830 90 2 0 0 0 031899 YYY 2 0 0 1 132035 90 2 1 2 1 032036 90 2 1 2 1 0

Page 50: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

32096 90 2 0 2 1 032097 90 2 0 2 1 032098 90 2 0 2 1 032100 90 2 0 2 1 032110 90 2 0 2 1 032120 90 2 0 2 1 032124 90 2 0 2 1 032140 90 2 0 2 1 032141 90 2 0 2 1 032150 90 2 0 2 1 032151 90 2 0 2 1 032160 90 2 0 2 1 032200 90 2 0 2 1 032215 90 2 1 2 1 032220 90 2 1 2 1 032225 90 2 1 2 1 032310 90 2 0 2 1 032320 90 2 0 2 1 032400 0 2 0 1 0 032405 0 2 0 1 0 032440 90 2 0 2 1 032442 90 2 0 2 1 032445 90 2 0 2 1 032480 90 2 0 2 1 032482 90 2 0 2 1 032484 90 2 0 2 1 032486 90 2 0 2 1 032488 90 2 0 2 1 032491 90 2 1 2 1 032501 ZZZ 0 0 2 1 032503 90 2 0 2 1 032504 90 2 0 2 1 032505 90 2 0 2 1 032506 ZZZ 0 0 2 1 032507 ZZZ 0 0 2 1 032540 90 2 0 2 1 032550 0 0 0 1 0 032551 0 2 1 1 0 032552 10 2 0 0 0 032553 0 2 0 2 0 032554 0 2 1 1 0 032555 0 2 1 1 0 032556 0 2 1 1 0 032557 0 2 1 1 0 032560 0 2 0 1 0 032561 0 2 0 2 0 032562 0 2 0 2 0 0

Page 51: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

32601 0 2 0 0 0 032604 0 2 0 0 0 032606 0 2 0 0 0 032607 0 2 0 0 0 032608 0 2 0 0 0 032609 0 2 0 0 0 032650 90 2 1 2 1 032651 90 2 1 2 1 032652 90 2 1 2 1 032653 90 2 0 2 1 032654 90 2 1 2 1 032655 90 2 1 2 1 032656 90 2 1 2 1 032658 90 2 0 2 1 032659 90 2 0 2 1 032661 90 2 0 2 1 032662 90 2 0 2 1 032663 90 2 0 2 1 032664 90 2 1 2 1 032665 90 2 0 2 1 032666 90 2 0 2 1 032667 ZZZ 0 0 2 1 032668 ZZZ 0 0 2 1 032669 90 2 0 2 1 032670 90 2 0 2 1 032671 90 2 0 2 1 032672 90 2 0 2 1 032673 90 2 0 2 1 032674 ZZZ 0 0 2 1 032701 XXX 0 0 0 1 032800 90 2 0 2 1 032810 90 2 0 2 0 032815 90 2 0 2 1 032820 90 2 0 2 1 032850 XXX 9 9 9 9 932851 90 2 0 2 1 232852 90 2 0 2 1 232853 90 2 2 2 1 232854 90 2 2 2 1 232855 XXX 2 0 2 1 032856 XXX 2 0 2 1 032900 90 2 0 2 1 032905 90 2 0 2 1 032906 90 2 0 2 1 032940 90 2 0 2 1 032960 0 2 0 1 0 032997 0 2 1 1 0 0

Page 52: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

32998 0 2 1 2 0 032999 YYY 2 0 1 1 133010 0 2 0 1 0 033011 0 2 0 0 0 033015 90 2 0 1 0 033020 90 2 0 2 1 033025 90 2 0 2 1 033030 90 2 0 2 1 033031 90 2 0 2 1 033050 90 2 0 2 1 033120 90 2 0 2 1 033130 90 2 0 2 1 033140 90 2 0 2 0 033141 ZZZ 0 0 2 1 033202 90 2 0 1 0 033203 90 2 0 1 0 033206 90 2 0 1 2 033207 90 2 0 1 2 033208 90 2 0 1 2 033210 0 2 0 1 0 033211 0 2 0 1 0 033212 90 2 0 1 0 033213 90 2 0 1 0 033214 90 2 0 0 2 033215 90 2 0 1 0 033216 90 2 0 1 0 033217 90 2 0 1 0 033218 90 2 0 1 0 033220 90 2 0 1 0 033221 90 2 0 1 0 033222 90 2 0 1 0 033223 90 2 0 0 0 033224 0 2 0 1 0 033225 ZZZ 0 0 1 0 033226 0 2 0 1 0 033227 90 2 0 1 0 033228 90 2 0 1 0 033229 90 2 0 1 0 033230 90 2 0 1 0 033231 90 2 0 1 0 033233 90 2 0 1 0 033234 90 2 0 1 0 033235 90 2 0 1 0 033236 90 2 0 0 2 033237 90 2 0 0 2 033238 90 2 0 0 2 033240 90 2 0 1 0 0

Page 53: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

33241 90 2 0 1 0 033243 90 2 0 2 1 033244 90 2 0 1 1 033249 90 2 0 1 1 033250 90 2 0 2 1 033251 90 2 0 2 1 033254 90 2 0 2 1 033255 90 2 0 2 1 033256 90 2 0 2 1 033257 ZZZ 0 0 2 0 033258 ZZZ 0 0 2 0 033259 ZZZ 0 0 2 0 033261 90 2 0 2 1 033262 90 2 0 1 0 033263 90 2 0 1 0 033264 90 2 0 1 0 033265 90 2 0 2 1 033266 90 2 0 2 1 033270 90 2 0 1 0 033271 90 2 0 1 0 033272 90 2 0 1 0 033273 90 2 0 1 0 033282 90 2 0 1 0 033284 90 2 0 1 0 033300 90 2 0 2 1 033305 90 2 0 2 1 033310 90 2 0 2 1 033315 90 2 0 2 1 033320 90 2 0 2 1 033321 90 2 0 2 1 033322 90 2 0 2 1 033335 90 2 0 2 1 033361 0 2 0 0 2 133362 0 2 0 0 2 133363 0 2 0 0 2 133364 0 2 0 0 2 133365 0 2 0 0 2 133366 0 2 0 0 2 133367 ZZZ 0 0 0 0 133368 ZZZ 0 0 0 0 133369 ZZZ 0 0 0 0 133400 90 2 0 2 1 033401 90 2 0 2 1 033403 90 2 0 2 1 033404 90 2 0 2 1 033405 90 2 0 2 1 033406 90 2 0 2 1 0

Page 54: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

33410 90 2 0 2 1 033411 90 2 0 2 0 033412 90 2 0 2 1 033413 90 2 0 2 1 033414 90 2 0 2 1 033415 90 2 0 2 1 033416 90 2 0 2 1 033417 90 2 0 2 1 033418 90 2 0 0 0 033419 ZZZ 0 0 0 0 033420 90 2 0 1 1 033422 90 2 0 2 1 033425 90 2 0 2 1 033426 90 2 0 2 1 033427 90 2 0 2 1 033430 90 2 0 2 1 033460 90 2 0 2 1 033463 90 2 0 2 1 033464 90 2 0 2 1 033465 90 2 0 2 1 033468 90 2 0 2 1 033470 90 2 0 2 0 033471 90 2 0 2 1 033475 90 2 0 2 1 033476 90 2 0 2 1 033478 90 2 0 2 1 033496 90 2 0 2 1 033500 90 2 0 2 1 033501 90 2 0 2 2 033502 90 2 0 2 1 033503 90 2 0 0 1 033504 90 2 0 2 1 033505 90 2 0 2 1 033506 90 2 0 2 1 033507 90 2 0 2 1 033508 ZZZ 0 0 2 1 033510 90 2 0 2 0 033511 90 2 0 2 0 033512 90 2 0 2 0 033513 90 2 0 2 0 033514 90 2 0 2 0 033516 90 2 0 2 0 033517 ZZZ 0 0 2 0 033518 ZZZ 0 0 2 0 033519 ZZZ 0 0 2 0 033521 ZZZ 0 0 2 0 033522 ZZZ 0 0 2 0 0

Page 55: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

33523 ZZZ 0 0 2 0 033530 ZZZ 0 0 2 0 033533 90 2 0 2 0 033534 90 2 0 2 0 033535 90 2 0 2 0 033536 90 2 0 2 0 033542 90 2 0 2 1 033545 90 2 0 2 1 033548 90 2 0 2 1 033572 ZZZ 0 0 2 0 033600 90 2 0 2 1 033602 90 2 0 2 1 033606 90 2 0 2 1 033608 90 2 0 2 1 033610 90 2 0 2 1 033611 90 2 0 2 1 033612 90 2 0 2 1 033615 90 2 0 2 1 033617 90 2 0 2 1 033619 90 2 0 2 1 033620 90 2 0 2 1 033621 90 2 0 2 1 033622 90 2 0 2 1 033641 90 2 0 2 1 033645 90 2 0 2 1 033647 90 2 0 2 1 033660 90 2 0 2 1 033665 90 2 0 2 1 033670 90 2 0 2 1 033675 90 2 0 2 1 033676 90 2 0 2 1 033677 90 2 0 2 1 033681 90 2 0 2 1 033684 90 2 0 2 1 033688 90 2 0 2 1 033690 90 2 0 2 1 033692 90 2 0 2 1 033694 90 2 0 2 1 033697 90 2 0 2 1 033702 90 2 0 2 1 033710 90 2 0 2 0 033720 90 2 0 2 1 033722 90 2 0 2 1 033724 90 2 0 2 1 033726 90 2 0 2 1 033730 90 2 0 2 1 033732 90 2 0 2 1 0

Page 56: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

33735 90 2 0 2 0 033736 90 2 0 2 1 033737 90 2 0 2 1 033750 90 2 0 2 1 033755 90 2 0 2 1 033762 90 2 0 2 1 033764 90 2 0 2 1 033766 90 2 0 2 1 033767 90 2 0 2 1 033768 ZZZ 0 0 2 2 033770 90 2 0 2 1 033771 90 2 0 2 1 033774 90 2 0 2 1 033775 90 2 0 2 0 033776 90 2 0 2 1 033777 90 2 0 2 0 033778 90 2 0 2 1 033779 90 2 0 2 1 033780 90 2 0 2 1 033781 90 2 0 2 0 033782 90 2 0 2 1 033783 90 2 0 2 1 033786 90 2 0 2 1 033788 90 2 0 2 1 033800 90 2 0 2 2 033802 90 2 0 2 1 033803 90 2 0 2 1 033813 90 2 0 2 1 033814 90 2 0 2 1 033820 90 2 0 2 0 033822 90 2 0 2 1 033824 90 2 0 2 1 033840 90 2 0 2 1 033845 90 2 0 2 1 033851 90 2 0 2 1 033852 90 2 0 2 0 033853 90 2 0 2 1 033860 90 2 0 2 1 033863 90 2 0 2 1 033864 90 2 0 2 1 033870 90 2 0 2 1 033875 90 2 0 2 1 033877 90 2 0 2 1 033880 90 2 2 2 2 033881 90 2 2 2 2 033883 90 2 0 2 2 033884 ZZZ 0 0 2 2 0

Page 57: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

33886 90 2 0 2 2 033889 0 2 1 2 2 033891 0 2 1 2 2 033910 90 2 0 2 1 033915 90 2 0 2 1 033916 90 2 0 2 1 033917 90 2 0 2 1 033920 90 2 0 2 1 033922 90 2 0 2 1 033924 ZZZ 0 0 2 1 033925 90 2 0 2 1 033926 90 2 0 2 1 033930 XXX 9 9 9 9 933933 XXX 2 0 2 1 033935 90 2 0 2 1 233940 XXX 9 9 9 9 933944 XXX 2 0 2 1 033945 90 2 0 2 1 233946 XXX 0 0 1 0 033947 XXX 0 0 1 0 033948 XXX 0 0 1 0 033949 XXX 0 0 1 0 033951 0 2 0 0 0 033952 0 2 0 0 0 033953 0 2 0 0 0 033954 0 2 0 0 0 033955 0 2 0 0 1 133956 0 2 0 0 1 133957 0 2 0 0 0 033958 0 2 0 0 0 033959 0 2 0 0 0 033962 0 2 0 0 0 033963 0 2 0 0 1 133964 0 2 0 0 1 133965 0 2 0 0 0 033966 0 2 0 0 0 033967 0 2 0 0 0 033968 0 0 0 1 0 033969 0 2 0 0 0 033970 0 2 0 2 1 033971 90 2 0 1 0 033973 0 2 0 2 1 033974 90 2 0 1 0 033975 XXX 2 0 2 0 033976 XXX 2 2 2 0 033977 XXX 2 0 2 0 033978 XXX 2 2 2 0 0

Page 58: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

33979 XXX 2 0 2 0 033980 XXX 2 0 2 0 033981 XXX 2 0 2 0 033982 XXX 2 0 2 0 033983 XXX 2 0 2 0 033984 0 2 0 0 0 033985 0 2 0 0 1 133986 0 2 0 0 1 133987 ZZZ 0 0 0 1 133988 0 2 0 0 1 133989 0 2 0 0 1 133990 XXX 2 0 2 0 033991 XXX 2 0 2 0 033992 XXX 2 0 2 0 033993 XXX 2 0 2 0 033999 YYY 2 0 2 1 134001 90 2 1 2 1 034051 90 2 1 2 1 034101 90 2 1 2 1 034111 90 2 1 2 1 034151 90 2 1 2 1 034201 90 2 1 2 1 034203 90 2 1 2 1 034401 90 2 1 2 1 034421 90 2 1 2 1 034451 90 2 1 2 1 034471 90 2 1 1 1 034490 90 2 1 1 0 034501 90 2 1 2 1 034502 90 2 0 2 0 034510 90 2 1 2 1 034520 90 2 1 2 1 034530 90 2 1 2 1 034800 90 2 0 2 2 034802 90 2 0 2 2 034803 90 2 2 2 2 034804 90 2 0 2 2 034805 90 2 0 2 2 034806 ZZZ 0 0 2 2 034808 ZZZ 0 0 2 2 034812 0 2 1 2 2 034813 ZZZ 0 0 2 2 034820 0 2 1 2 2 034825 90 2 0 2 2 034826 ZZZ 0 0 2 2 034830 90 2 0 2 2 034831 90 2 0 2 2 0

Page 59: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

34832 90 2 0 2 2 034833 0 2 1 2 2 034834 0 2 1 2 2 034839 YYY 0 0 0 0 034841 YYY 0 0 0 0 034842 YYY 0 0 0 0 034843 YYY 0 0 0 0 034844 YYY 0 0 0 0 034845 YYY 0 0 0 0 034846 YYY 0 0 0 0 034847 YYY 0 0 0 0 034848 YYY 0 0 0 0 034900 90 2 1 2 2 035001 90 2 1 2 1 035002 90 2 1 2 1 035005 90 2 1 2 1 035011 90 2 1 2 1 035013 90 2 1 2 1 035021 90 2 1 2 1 035022 90 2 1 2 1 035045 90 2 1 2 1 035081 90 2 0 2 1 035082 90 2 0 2 1 035091 90 2 1 2 1 035092 90 2 1 2 1 035102 90 2 1 2 1 035103 90 2 1 2 1 035111 90 2 1 2 1 035112 90 2 1 2 1 035121 90 2 1 2 0 035122 90 2 1 2 1 035131 90 2 1 2 1 035132 90 2 1 2 1 035141 90 2 1 2 1 035142 90 2 1 2 1 035151 90 2 1 2 1 035152 90 2 1 2 1 035180 90 2 0 2 1 035182 90 2 0 2 1 035184 90 2 0 2 1 035188 90 2 0 2 1 035189 90 2 0 2 1 035190 90 2 0 2 1 035201 90 2 1 2 1 035206 90 2 1 2 1 035207 90 2 1 1 1 035211 90 2 1 2 1 0

Page 60: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

35216 90 2 1 2 1 035221 90 2 1 2 1 035226 90 2 1 2 1 035231 90 2 1 2 1 035236 90 2 1 2 1 035241 90 2 1 2 1 035246 90 2 1 2 1 035251 90 2 1 2 1 035256 90 2 1 2 1 035261 90 2 1 2 1 035266 90 2 1 2 1 035271 90 2 1 2 1 035276 90 2 1 2 1 035281 90 2 1 2 1 035286 90 2 1 2 1 035301 90 2 1 2 1 035302 90 2 1 2 1 035303 90 2 1 2 1 035304 90 2 1 2 1 035305 90 2 1 2 1 035306 ZZZ 0 0 2 1 035311 90 2 1 2 1 035321 90 2 1 2 1 035331 90 2 1 2 1 035341 90 2 1 2 1 035351 90 2 1 2 1 035355 90 2 1 2 1 035361 90 2 1 2 1 035363 90 2 1 2 1 035371 90 2 1 2 1 035372 90 2 1 2 1 035390 ZZZ 0 0 2 1 035400 ZZZ 0 0 0 1 035450 0 2 1 2 1 035452 0 2 1 2 1 035458 0 2 1 2 1 035460 0 2 1 1 1 035471 0 2 1 1 0 035472 0 2 1 0 1 035475 0 2 1 1 0 035476 0 2 1 1 0 035500 ZZZ 0 0 2 1 035501 90 2 1 2 1 035506 90 2 1 2 1 035508 90 2 1 2 1 035509 90 2 1 2 1 035510 90 2 1 2 1 0

Page 61: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

35511 90 2 1 2 1 035512 90 2 1 2 1 035515 90 2 1 2 1 035516 90 2 1 2 1 035518 90 2 1 2 1 035521 90 2 1 2 1 035522 90 2 1 2 1 035523 90 2 1 2 1 035525 90 2 1 2 1 035526 90 2 1 2 1 035531 90 2 1 2 1 035533 90 2 1 2 1 035535 90 2 1 2 1 035536 90 2 1 2 1 035537 90 2 0 2 1 035538 90 2 0 2 1 035539 90 2 1 2 1 035540 90 2 1 1 1 035556 90 2 1 2 1 035558 90 2 1 2 1 035560 90 2 1 2 1 035563 90 2 1 2 1 035565 90 2 1 2 1 035566 90 2 1 2 1 035570 90 2 1 2 1 035571 90 2 1 2 1 035572 ZZZ 0 0 2 0 035583 90 2 1 2 1 035585 90 2 1 2 1 035587 90 2 1 2 1 035600 ZZZ 0 0 2 1 035601 90 2 1 2 1 035606 90 2 1 2 1 035612 90 2 1 2 1 035616 90 2 1 2 1 035621 90 2 1 2 1 035623 90 2 1 2 1 035626 90 2 1 2 1 035631 90 2 1 2 1 035632 90 2 1 2 1 035633 90 2 1 2 1 035634 90 2 1 2 1 035636 90 2 1 2 1 035637 90 2 0 2 1 035638 90 2 0 2 1 035642 90 2 1 2 1 035645 90 2 1 2 1 0

Page 62: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

35646 90 2 0 2 1 035647 90 2 1 2 1 035650 90 2 1 2 1 035654 90 2 0 2 1 035656 90 2 1 2 1 035661 90 2 1 2 1 035663 90 2 1 2 1 035665 90 2 1 2 1 035666 90 2 1 2 1 035671 90 2 1 2 1 035681 ZZZ 0 0 2 1 035682 ZZZ 0 0 0 1 035683 ZZZ 0 0 0 1 035685 ZZZ 0 0 2 1 035686 ZZZ 0 0 2 1 035691 90 2 1 2 1 035693 90 2 1 2 1 035694 90 2 1 2 1 035695 90 2 1 2 1 035697 ZZZ 0 0 2 2 035700 ZZZ 0 0 2 1 035701 90 2 1 2 1 035721 90 2 1 2 1 035741 90 2 1 2 1 035761 90 2 1 2 1 035800 90 2 0 2 1 035820 90 2 0 2 1 035840 90 2 0 2 1 035860 90 2 0 2 1 035870 90 2 0 2 1 035875 90 2 0 1 1 035876 90 2 0 2 1 035879 90 2 1 2 1 035881 90 2 1 2 1 035883 90 2 1 2 1 035884 90 2 1 2 1 035901 90 2 0 2 1 035903 90 2 0 2 1 035905 90 2 0 2 1 035907 90 2 0 2 1 036000 XXX 9 9 9 9 936002 0 2 1 1 0 036005 0 2 1 0 0 036010 XXX 2 1 1 0 036011 XXX 2 1 1 0 036012 XXX 2 1 1 0 036013 XXX 2 0 1 0 0

Page 63: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

36014 XXX 2 1 1 0 036015 XXX 2 1 1 0 036100 XXX 2 1 1 0 036120 XXX 2 0 1 0 036140 XXX 2 0 1 0 036147 XXX 2 0 2 0 036148 ZZZ 0 0 2 0 036160 XXX 2 0 1 0 036200 0 2 1 1 0 036215 XXX 2 0 1 0 036216 XXX 2 0 1 0 036217 XXX 2 0 1 0 036218 ZZZ 0 0 1 0 036221 0 2 2 1 0 036222 0 2 1 1 0 036223 0 2 1 1 0 036224 0 2 1 1 0 036225 0 2 1 1 0 036226 0 2 1 1 0 036227 ZZZ 0 1 1 0 036228 ZZZ 0 1 1 0 036245 XXX 2 1 1 0 036246 0 2 1 1 0 036247 0 2 1 1 0 036248 ZZZ 0 0 1 0 036251 0 2 0 1 0 036252 0 2 2 1 0 036253 0 2 0 1 0 036254 0 2 2 1 0 036260 90 2 0 1 0 036261 90 2 0 2 0 036262 90 2 0 1 0 036299 YYY 2 0 0 1 136400 XXX 2 0 1 0 036405 XXX 2 0 1 0 036406 XXX 2 0 1 0 036410 XXX 2 0 1 0 036415 XXX 9 9 9 9 936416 XXX 9 9 9 9 936420 XXX 2 0 0 0 036425 XXX 2 0 1 0 036430 XXX 0 0 1 0 036440 XXX 2 0 0 0 036450 XXX 2 0 0 0 036455 XXX 2 0 1 0 036460 XXX 2 0 2 0 036468 0 2 0 0 0 0

Page 64: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

36470 10 2 1 1 0 036471 10 2 1 1 0 036475 0 2 1 1 0 036476 ZZZ 0 1 1 0 036478 0 2 1 1 0 036479 ZZZ 0 1 1 0 036481 0 2 0 1 0 036500 0 2 0 1 0 036510 0 2 0 0 0 036511 0 2 0 1 0 036512 0 2 0 1 0 036513 0 2 0 1 0 036514 0 2 0 1 0 036515 0 2 0 1 0 036516 0 2 0 1 0 036522 0 2 0 1 0 036555 0 0 0 1 0 036556 0 0 0 1 0 036557 10 2 1 0 0 036558 10 2 1 0 0 036560 10 2 1 0 0 036561 10 2 1 0 0 036563 10 2 0 0 0 036565 10 2 1 0 0 036566 10 2 1 0 0 036568 0 0 0 1 0 036569 0 0 0 1 0 036570 10 2 1 0 0 036571 10 2 1 0 0 036575 0 2 0 0 0 036576 10 2 0 0 0 036578 10 2 0 0 0 036580 0 0 0 1 0 036581 10 2 0 0 0 036582 10 2 0 0 0 036583 10 2 0 0 0 036584 0 0 0 1 0 036585 10 2 0 0 0 036589 10 2 0 0 0 036590 10 2 0 0 0 036591 XXX 0 0 0 0 036592 XXX 0 0 0 0 036593 XXX 0 0 0 0 036595 0 2 0 1 0 036596 0 2 0 1 0 036597 0 2 0 1 0 036598 0 2 1 0 0 0

Page 65: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

36600 XXX 2 0 1 0 036620 0 0 0 1 0 036625 0 0 0 1 0 036640 0 2 0 1 0 036660 0 2 0 0 0 036680 0 2 0 0 0 036800 0 2 0 1 0 036810 0 2 0 1 0 036815 0 2 0 1 0 036818 90 2 0 2 1 036819 90 2 0 2 1 036820 90 2 1 2 1 036821 90 2 0 2 1 036823 90 2 0 1 0 036825 90 2 0 2 1 036830 90 2 0 2 1 036831 90 2 0 2 1 036832 90 2 0 2 1 036833 90 2 0 2 1 036835 90 2 0 1 0 036838 90 2 1 2 1 036860 0 2 0 1 0 036861 0 2 0 1 0 036870 90 2 1 1 2 037140 90 2 0 1 1 037145 90 2 0 2 0 037160 90 2 0 2 1 037180 90 2 0 2 1 037181 90 2 0 2 1 037182 0 2 0 0 0 037183 0 2 0 0 0 037184 0 2 1 1 2 037185 ZZZ 0 2 1 2 037186 ZZZ 0 2 1 2 037187 0 2 1 1 2 037188 0 2 1 1 2 037191 0 2 0 1 0 037192 0 2 0 1 0 037193 0 2 0 1 0 037195 XXX 0 0 0 0 037197 0 2 0 1 0 037200 0 2 0 1 0 037202 0 2 0 1 0 037211 0 2 1 1 0 037212 0 2 1 1 0 037213 0 2 0 1 0 037214 0 2 0 1 0 0

Page 66: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

37215 90 2 1 0 0 037216 90 9 9 9 9 937217 90 2 1 0 0 037218 90 2 1 0 0 037220 0 2 1 1 0 037221 0 2 1 0 0 037222 ZZZ 0 1 0 0 037223 ZZZ 0 1 0 0 037224 0 2 1 0 0 037225 0 2 1 0 0 037226 0 2 1 0 0 037227 0 2 1 0 0 037228 0 2 1 0 0 037229 0 2 1 0 0 037230 0 2 1 0 0 037231 0 2 1 0 0 037232 ZZZ 0 1 0 0 037233 ZZZ 0 1 0 0 037234 ZZZ 0 1 0 0 037235 ZZZ 0 1 0 0 037236 0 2 1 0 0 037237 ZZZ 0 1 0 0 037238 0 2 1 0 0 037239 ZZZ 0 1 0 0 037241 0 2 0 1 0 037242 0 2 0 1 0 037243 0 2 0 1 0 037244 0 2 0 1 0 037250 ZZZ 0 0 0 1 037251 ZZZ 0 0 0 1 037500 90 2 1 1 1 037501 YYY 2 1 1 1 137565 90 2 1 0 1 037600 90 2 0 2 1 037605 90 2 0 2 1 037606 90 2 0 2 0 037607 90 2 0 1 1 037609 10 2 1 1 0 037615 90 2 0 2 1 037616 90 2 0 2 1 037617 90 2 0 2 1 037618 90 2 0 2 1 037619 90 2 0 2 0 037650 90 2 1 1 1 037660 90 2 1 2 1 037700 90 2 1 1 0 037718 90 2 1 1 1 0

Page 67: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

37722 90 2 1 1 1 037735 90 2 1 1 1 037760 90 2 1 1 1 037761 90 2 1 2 1 037765 90 2 1 1 1 037766 90 2 1 1 1 037780 90 2 1 1 1 037785 90 2 1 1 0 037788 90 2 0 2 1 037790 90 2 0 0 0 037799 YYY 2 0 0 1 138100 90 2 0 2 1 038101 90 2 0 2 1 038102 ZZZ 0 0 2 1 038115 90 2 0 2 1 038120 90 2 0 2 1 038129 YYY 2 0 2 1 138200 0 2 0 0 0 038204 XXX 9 9 9 9 938205 0 2 0 0 0 038206 0 2 0 0 0 038207 XXX 9 9 9 9 938208 XXX 9 9 9 9 938209 XXX 9 9 9 9 938210 XXX 9 9 9 9 938211 XXX 9 9 9 9 938212 XXX 9 9 9 9 938213 XXX 9 9 9 9 938214 XXX 9 9 9 9 938215 XXX 9 9 9 9 938220 XXX 2 1 0 0 038221 XXX 2 1 0 0 038230 0 2 0 0 0 038232 0 2 0 0 0 038240 XXX 2 0 0 0 038241 XXX 2 0 0 0 038242 0 2 0 0 0 038243 0 2 0 0 0 038300 10 2 0 1 0 038305 90 2 0 1 0 038308 90 2 0 2 1 038380 90 2 0 2 1 038381 90 2 0 2 1 038382 90 2 0 2 1 038500 10 2 1 1 0 038505 0 2 1 1 0 038510 10 2 1 1 0 0

Page 68: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

38520 90 2 1 1 0 038525 90 2 1 1 0 038530 90 2 1 2 1 038542 90 2 1 2 1 038550 90 2 0 0 0 038555 90 2 0 2 1 038562 90 2 2 2 1 038564 90 2 0 2 1 038570 10 3 0 2 2 038571 10 2 2 2 2 038572 10 2 2 2 2 038589 YYY 2 1 2 1 138700 90 2 1 2 1 038720 90 2 1 2 1 038724 90 2 1 2 1 038740 90 2 1 2 1 038745 90 2 1 2 1 038746 ZZZ 0 0 2 1 038747 ZZZ 0 0 2 1 038760 90 2 1 2 1 038765 90 2 1 2 1 038770 90 2 1 2 1 038780 90 2 0 2 1 038790 0 2 1 1 0 038792 0 2 1 1 0 038794 90 2 0 0 0 038900 ZZZ 0 1 2 1 038999 YYY 2 0 0 1 139000 90 2 0 2 1 039010 90 2 0 2 1 039200 90 2 0 2 1 039220 90 2 0 2 1 039400 10 2 0 1 0 039499 YYY 2 0 2 1 139501 90 2 0 2 1 039503 90 2 0 2 1 039540 90 2 0 2 1 039541 90 2 0 2 1 039545 90 2 0 2 1 039560 90 2 0 2 1 039561 90 2 0 2 1 039599 YYY 2 0 2 1 140490 0 2 0 1 0 040500 90 2 0 1 0 040510 90 2 0 1 0 040520 90 2 0 1 0 040525 90 2 0 1 0 0

Page 69: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

40527 90 2 0 0 0 040530 90 2 0 1 0 040650 90 2 0 0 0 040652 90 2 0 0 0 040654 90 2 0 1 0 040700 90 2 0 0 0 040701 90 2 2 2 0 040702 90 2 2 2 0 040720 90 2 1 0 0 040761 90 2 0 1 0 040799 YYY 2 0 2 1 140800 10 2 0 1 0 040801 10 2 0 1 0 040804 10 2 0 0 0 040805 10 2 0 0 0 040806 0 2 0 0 0 040808 10 2 0 1 0 040810 10 2 0 1 0 040812 10 2 0 1 0 040814 90 2 0 1 0 040816 90 2 0 1 0 040818 90 2 0 0 0 040819 90 2 0 0 0 040820 10 2 0 1 0 040830 10 2 0 0 0 040831 10 2 0 0 0 040840 90 2 0 2 0 040842 90 2 0 0 0 040843 90 2 2 2 0 040844 90 2 0 2 0 040845 90 2 0 0 0 040899 YYY 2 0 0 1 141000 10 2 0 1 0 041005 10 2 0 0 0 041006 90 2 0 0 0 041007 90 2 0 0 0 041008 90 2 0 0 0 041009 90 2 0 0 0 041010 10 2 0 0 0 041015 90 2 0 0 0 041016 90 2 0 0 0 041017 90 2 0 0 0 041018 90 2 0 0 0 041019 0 2 0 0 1 141100 10 2 0 1 0 041105 10 2 0 1 0 041108 10 2 0 1 0 0

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41110 10 2 0 1 0 041112 90 2 0 1 0 041113 90 2 0 1 0 041114 90 2 0 0 0 041115 10 2 0 0 0 041116 90 2 0 1 0 041120 90 2 0 2 1 041130 90 2 0 2 1 041135 90 2 0 2 1 041140 90 2 0 2 1 041145 90 2 0 2 1 041150 90 2 0 2 1 041153 90 2 0 2 1 041155 90 2 0 2 1 041250 10 2 0 0 0 041251 10 2 0 0 0 041252 10 2 0 0 0 041500 90 2 0 0 0 041510 90 2 0 0 0 041512 90 2 0 0 0 041520 90 2 0 0 0 041530 10 2 0 0 0 041599 YYY 2 0 0 1 141800 10 2 0 1 0 041805 10 2 0 0 0 041806 10 2 0 0 0 041820 0 2 0 0 0 041821 0 2 0 0 0 041822 10 2 0 0 0 041823 90 2 0 0 0 041825 10 2 0 1 0 041826 10 2 0 1 0 041827 90 2 0 1 0 041828 10 2 0 0 0 041830 10 2 0 0 0 041850 0 2 0 0 0 041870 0 2 0 0 0 041872 90 2 0 0 0 041874 90 2 0 0 0 041899 YYY 2 0 0 1 142000 10 2 0 0 0 042100 10 2 0 1 0 042104 10 2 0 1 0 042106 10 2 0 1 0 042107 90 2 0 1 0 042120 90 2 0 2 1 042140 90 2 0 1 0 0

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42145 90 2 0 1 0 042160 10 2 0 0 0 042180 10 2 0 0 0 042182 10 2 0 0 0 042200 90 2 0 2 0 042205 90 2 0 2 0 042210 90 2 0 2 0 042215 90 2 0 2 0 042220 90 2 0 2 0 042225 90 2 0 2 0 042226 90 2 0 2 0 042227 90 2 0 2 0 042235 90 2 0 2 0 042260 90 2 0 2 0 042280 10 2 0 0 0 042281 10 2 0 0 0 042299 YYY 2 0 2 1 142300 10 2 0 1 0 042305 90 2 0 0 0 042310 10 2 0 0 0 042320 10 2 0 0 0 042330 10 2 0 1 0 042335 90 2 0 1 0 042340 90 2 1 0 0 042400 0 2 0 1 0 042405 10 2 0 1 0 042408 90 2 0 0 0 042409 90 2 0 2 0 042410 90 2 1 2 1 042415 90 2 1 2 1 042420 90 2 1 2 1 042425 90 2 1 2 1 042426 90 2 1 2 1 042440 90 2 1 2 1 042450 90 2 0 0 0 042500 90 2 0 0 0 042505 90 2 0 1 0 042507 90 2 2 2 0 042509 90 2 2 0 0 042510 90 2 2 2 1 042550 0 2 0 1 0 042600 90 2 0 0 0 042650 0 2 0 1 0 042660 0 2 0 0 0 042665 90 2 0 0 0 042699 YYY 2 0 2 1 142700 10 2 0 1 0 0

Page 72: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

42720 10 2 0 0 0 042725 90 2 0 2 1 042800 10 2 0 1 0 042804 10 2 0 1 0 042806 10 2 0 1 0 042808 10 2 0 1 0 042809 10 2 0 1 0 042810 90 2 1 2 0 042815 90 2 1 2 1 042820 90 2 0 0 0 042821 90 2 0 0 0 042825 90 2 0 0 0 042826 90 2 0 1 0 042830 90 2 0 0 0 042831 90 2 0 0 0 042835 90 2 0 0 0 042836 90 2 0 0 0 042842 90 2 0 0 0 042844 90 2 0 2 1 042845 90 2 0 2 1 042860 90 2 0 0 0 042870 90 2 0 0 0 042890 90 2 0 2 1 042892 90 2 0 2 1 042894 90 2 0 2 1 042900 10 2 0 0 0 042950 90 2 0 2 1 042953 90 2 0 2 0 042955 90 2 0 2 0 042960 10 2 0 0 0 042961 90 2 0 2 0 042962 90 2 0 1 0 042970 90 2 0 1 0 042971 90 2 0 2 0 042972 90 2 0 2 0 042999 YYY 2 0 0 1 143020 90 2 0 2 1 043030 90 2 0 2 1 043045 90 2 0 2 1 043100 90 2 0 2 1 043101 90 2 0 2 1 043107 90 2 0 2 1 043108 90 2 0 2 1 043112 90 2 0 2 2 043113 90 2 0 2 2 043116 90 2 0 2 1 043117 90 2 0 2 2 0

Page 73: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

43118 90 2 0 2 2 043121 90 2 0 2 2 043122 90 2 0 2 1 043123 90 2 0 2 1 043124 90 2 0 2 1 043130 90 2 0 2 1 043135 90 2 0 2 1 043180 90 2 0 1 0 043191 0 2 0 1 0 043192 0 3 0 1 0 043193 0 3 0 1 0 043194 0 3 0 1 0 043195 0 3 0 1 0 043196 0 3 0 1 0 043197 0 2 0 1 0 043198 0 3 0 1 0 043200 0 2 0 1 0 043201 0 3 0 1 0 043202 0 3 0 1 0 043204 0 3 0 1 0 043205 0 3 0 1 0 043206 0 3 0 1 0 043211 0 3 0 1 0 043212 0 3 0 1 0 043213 0 3 0 1 0 043214 0 3 0 1 0 043215 0 3 0 1 0 043216 0 3 0 1 0 043217 0 3 0 1 0 043220 0 3 0 1 0 043226 0 3 0 1 0 043227 0 3 0 1 0 043229 0 3 0 1 0 043231 0 3 0 1 2 043232 0 3 0 1 2 043233 0 3 0 1 0 043235 0 2 0 1 0 043236 0 3 0 1 0 043237 0 3 0 1 0 043238 0 3 0 1 0 043239 0 3 0 1 0 043240 0 3 0 1 0 043241 0 3 0 1 0 043242 0 3 0 1 0 043243 0 3 0 1 0 043244 0 3 0 1 0 043245 0 3 0 1 0 0

Page 74: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

43246 0 3 0 0 2 043247 0 3 0 1 0 043248 0 3 0 1 0 043249 0 3 0 1 0 043250 0 3 0 1 0 043251 0 3 0 1 0 043252 0 3 0 1 0 043253 0 3 0 1 0 043254 0 3 0 1 0 043255 0 3 0 1 0 043257 0 3 0 1 0 043259 0 3 0 1 0 043260 0 2 0 1 0 043261 0 3 0 1 0 043262 0 3 0 1 0 043263 0 3 0 1 0 043264 0 3 0 1 0 043265 0 3 0 1 0 043266 0 3 0 1 0 043270 0 3 0 1 0 043273 ZZZ 0 0 0 0 043274 0 3 0 1 0 043275 0 3 0 1 0 043276 0 3 0 1 0 043277 0 3 0 1 0 043278 0 3 0 1 0 043279 90 2 0 2 1 043280 90 2 0 2 1 043281 90 2 0 2 1 043282 90 2 0 2 1 043283 ZZZ 0 0 2 1 043289 YYY 2 1 2 1 143300 90 2 0 2 1 043305 90 2 0 2 1 043310 90 2 0 2 1 043312 90 2 0 2 1 043313 90 2 0 2 1 043314 90 2 0 2 1 043320 90 2 0 2 1 043325 90 2 0 2 1 043327 90 2 0 2 1 043328 90 2 0 2 1 043330 90 2 0 2 1 043331 90 2 0 2 1 043332 90 2 0 2 1 043333 90 2 0 2 1 043334 90 2 0 2 1 0

Page 75: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

43335 90 2 0 2 1 043336 90 2 0 2 1 043337 90 2 0 2 1 043338 ZZZ 0 0 2 1 043340 90 2 0 2 1 043341 90 2 0 2 1 043351 90 2 0 2 1 043352 90 2 0 2 1 043360 90 2 0 2 1 043361 90 2 0 2 1 043400 90 2 0 2 1 043401 90 2 0 2 1 043405 90 2 0 2 1 043410 90 2 0 2 1 043415 90 2 0 2 1 043420 90 2 0 0 1 043425 90 2 0 2 1 043450 0 2 0 1 0 043453 0 2 0 1 0 043460 0 2 0 1 0 043496 90 2 0 2 1 043499 YYY 2 0 1 1 143500 90 2 0 2 1 043501 90 2 0 2 1 043502 90 2 0 2 1 043510 90 2 0 2 1 043520 90 2 0 2 1 043605 90 2 0 2 1 043610 90 2 0 2 1 043611 90 2 0 2 1 043620 90 2 0 2 1 043621 90 2 0 2 1 043622 90 2 0 2 1 043631 90 2 0 2 1 043632 90 2 0 2 1 043633 90 2 0 2 1 043634 90 2 0 2 1 043635 ZZZ 0 0 2 1 043640 90 2 0 2 1 043641 90 2 0 2 1 043644 90 2 0 2 1 043645 90 2 0 2 1 043647 YYY 2 0 2 1 043648 YYY 2 0 2 1 043651 90 2 0 2 1 043652 90 2 0 2 1 043653 90 2 0 2 1 0

Page 76: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

43659 YYY 2 1 2 1 143752 0 0 0 1 0 043753 0 0 0 2 0 043754 0 0 0 2 0 043755 0 0 0 2 0 043756 0 0 0 2 0 043757 0 0 0 2 0 043760 0 2 0 1 0 043761 0 2 0 1 0 043770 90 2 0 2 1 043771 90 2 0 2 1 043772 90 2 0 2 1 043773 90 2 0 2 1 043774 90 2 0 2 1 043775 YYY 2 0 2 1 143800 90 2 0 2 1 043810 90 2 0 2 1 043820 90 2 0 2 1 043825 90 2 0 2 1 043830 90 2 0 2 1 043831 90 2 0 2 1 043832 90 2 0 2 1 043840 90 2 0 2 1 043842 90 9 9 9 9 943843 90 2 0 2 2 043845 90 2 0 2 1 043846 90 2 0 2 1 043847 90 2 0 2 1 043848 90 2 0 2 1 043850 90 2 0 2 1 043855 90 2 0 2 1 043860 90 2 0 2 1 043865 90 2 0 2 1 043870 90 2 0 2 1 043880 90 2 0 2 1 043881 YYY 2 0 2 1 043882 YYY 2 0 2 1 043886 90 2 0 2 1 043887 90 2 0 2 1 043888 90 2 0 2 1 043999 YYY 2 0 0 1 144005 90 2 0 2 1 044010 90 2 0 2 1 044015 ZZZ 0 0 2 1 044020 90 2 0 2 1 044021 90 2 0 2 1 044025 90 2 0 2 1 0

Page 77: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

44050 90 2 0 2 1 044055 90 2 0 2 1 044100 0 2 0 1 0 044110 90 2 0 2 1 044111 90 2 0 2 1 044120 90 2 0 2 1 044121 ZZZ 0 0 2 1 044125 90 2 0 2 1 044126 90 2 0 2 1 044127 90 2 0 2 1 044128 ZZZ 0 0 2 1 044130 90 2 0 2 1 044132 XXX 0 0 0 0 044133 XXX 0 0 0 0 044135 XXX 0 0 0 0 044136 XXX 0 0 0 0 044137 XXX 2 0 2 1 044139 ZZZ 0 0 2 1 044140 90 2 0 2 1 044141 90 2 0 2 1 044143 90 2 0 2 1 044144 90 2 0 2 1 044145 90 2 0 2 1 044146 90 2 0 2 1 044147 90 2 0 2 1 044150 90 2 0 2 1 044151 90 2 0 2 1 044155 90 2 0 2 1 044156 90 2 0 2 1 044157 90 2 0 2 1 044158 90 2 0 2 1 044160 90 2 0 2 1 044180 90 2 0 2 1 044186 90 2 0 2 1 044187 90 2 0 2 1 044188 90 2 0 2 1 044202 90 2 0 2 1 044203 ZZZ 0 0 2 1 044204 90 2 0 2 1 044205 90 2 0 2 1 044206 90 2 0 2 1 044207 90 2 0 2 1 044208 90 2 0 2 1 044210 90 2 0 2 1 044211 90 2 0 2 1 044212 90 2 0 2 1 044213 ZZZ 0 0 2 1 0

Page 78: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

44227 90 2 0 2 1 044238 YYY 2 1 2 1 144300 90 2 0 2 1 044310 90 2 0 2 1 044312 90 2 0 0 0 044314 90 2 0 2 1 044316 90 2 0 2 1 044320 90 2 0 2 1 044322 90 2 0 2 1 044340 90 2 0 1 1 044345 90 2 0 2 1 044346 90 2 0 2 1 044360 0 2 0 1 0 044361 0 3 0 1 0 044363 0 3 0 0 0 044364 0 3 0 0 0 044365 0 3 0 0 0 044366 0 3 0 1 0 044369 0 3 0 0 0 044370 0 3 0 0 0 044372 0 3 0 1 0 044373 0 3 0 1 0 044376 0 2 0 0 0 044377 0 3 0 0 0 044378 0 3 0 0 0 044379 0 3 0 0 0 044380 0 2 0 1 0 044381 0 3 0 1 0 044382 0 3 0 1 0 044384 0 3 0 1 0 044385 0 2 0 1 0 044386 0 2 0 1 0 044388 0 2 0 1 0 044389 0 3 0 1 0 044390 0 3 0 1 0 044391 0 3 0 1 0 044392 0 3 0 1 0 044394 0 3 0 1 0 044401 0 3 0 1 0 044402 0 3 0 1 0 044403 0 3 0 1 0 044404 0 3 0 1 0 044405 0 3 0 1 0 044406 0 3 0 1 0 044407 0 3 0 1 0 044408 0 3 0 1 0 044500 0 0 0 0 0 0

Page 79: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

44602 90 2 0 2 1 044603 90 2 0 2 1 044604 90 2 0 2 1 044605 90 2 0 2 1 044615 90 2 0 2 1 044620 90 2 0 2 1 044625 90 2 0 2 1 044626 90 2 0 2 1 044640 90 2 0 2 1 044650 90 2 0 2 1 044660 90 2 0 2 1 044661 90 2 0 2 1 044680 90 2 0 2 1 044700 90 2 0 2 1 044701 ZZZ 0 0 2 1 044705 XXX 9 9 9 9 944715 XXX 2 0 2 1 044720 XXX 2 0 2 1 044721 XXX 2 0 2 1 044799 XXX 2 0 1 1 144800 90 2 0 2 1 044820 90 2 0 2 1 044850 90 2 0 2 1 044899 YYY 2 0 2 1 144900 90 2 0 2 1 044950 90 2 0 2 1 044955 ZZZ 0 0 2 1 044960 90 2 0 2 1 044970 90 2 0 2 2 044979 YYY 2 1 2 1 145000 90 2 0 1 0 045005 10 2 0 1 0 045020 90 2 0 1 0 045100 90 2 0 1 0 045108 90 2 0 1 1 045110 90 2 0 2 1 045111 90 2 0 2 1 045112 90 2 0 2 1 045113 90 2 0 2 1 045114 90 2 0 2 1 045116 90 2 0 2 1 045119 90 2 0 2 1 045120 90 2 0 2 1 045121 90 2 0 2 1 045123 90 2 0 2 1 045126 90 2 0 2 1 045130 90 2 0 2 1 0

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45135 90 2 0 2 1 045136 90 2 0 2 1 045150 90 2 0 0 0 045160 90 2 0 2 1 045171 90 2 0 2 1 045172 90 2 0 2 1 045190 90 2 0 1 1 045300 0 2 0 1 0 045303 0 3 0 1 0 045305 0 3 0 1 0 045307 0 3 0 0 0 045308 0 3 0 1 0 045309 0 3 0 1 0 045315 0 3 0 1 0 045317 0 3 0 1 0 045320 0 3 0 1 0 045321 0 3 0 1 0 045327 0 3 0 1 0 045330 0 2 0 1 0 045331 0 3 0 1 0 045332 0 3 0 1 0 045333 0 3 0 1 0 045334 0 3 0 1 0 045335 0 3 0 1 0 045337 0 3 0 1 0 045338 0 3 0 1 0 045340 0 3 0 1 0 045341 0 3 0 1 0 045342 0 3 0 1 0 045346 0 3 0 1 0 045347 0 3 0 1 0 045349 0 3 0 1 0 045350 0 3 0 1 0 045378 0 2 0 1 0 045378 0 2 0 1 0 045379 0 3 0 1 0 045380 0 3 0 1 0 045381 0 3 0 1 0 045382 0 3 0 1 0 045384 0 3 0 1 0 045385 0 3 0 1 0 045386 0 3 0 1 0 045388 0 3 0 1 0 045389 0 3 0 1 0 045390 0 3 0 1 0 045391 0 3 0 1 0 045392 0 3 0 1 0 0

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45393 0 3 0 1 0 045395 90 2 0 2 1 045397 90 2 0 2 1 045398 0 3 0 1 0 045399 XXX 2 0 1 1 145400 90 2 0 2 1 045402 90 2 0 2 1 045499 YYY 2 0 2 1 145500 90 2 0 0 0 045505 90 2 0 1 0 045520 0 2 0 1 0 045540 90 2 0 2 1 045541 90 2 0 2 1 045550 90 2 0 2 1 045560 90 2 0 2 1 045562 90 2 0 2 1 045563 90 2 0 2 1 045800 90 2 0 2 1 045805 90 2 0 2 1 045820 90 2 0 2 1 045825 90 2 0 2 1 045900 10 2 0 0 0 045905 10 2 0 1 0 045910 10 2 0 1 0 045915 10 2 0 1 0 045990 0 2 0 0 1 145999 YYY 2 0 0 1 146020 10 2 0 1 0 046030 10 2 0 0 0 046040 90 2 0 1 0 046045 90 2 0 1 0 046050 10 2 0 1 0 046060 90 2 0 1 0 046070 90 2 0 0 0 046080 10 2 0 1 0 046083 10 2 0 1 0 046200 90 2 0 1 0 046220 10 2 0 1 0 046221 10 2 0 1 0 046230 10 2 0 1 0 046250 90 2 0 1 0 046255 90 2 0 1 0 046257 90 2 0 1 0 046258 90 2 0 0 0 046260 90 2 0 1 0 046261 90 2 0 1 0 046262 90 2 0 1 0 0

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46270 90 2 0 1 0 046275 90 2 0 1 0 046280 90 2 0 1 0 046285 90 2 0 1 0 046288 90 2 0 1 0 046320 10 2 0 1 0 046500 10 2 0 1 0 046505 10 2 1 1 0 046600 0 2 0 1 0 046601 0 3 0 1 0 046604 0 3 0 1 0 046606 0 3 0 1 0 046607 0 3 0 1 0 046608 0 3 0 1 0 046610 0 3 0 1 0 046611 0 3 0 1 0 046612 0 3 0 1 0 046614 0 3 0 1 0 046615 0 3 0 1 0 046700 90 2 0 1 0 046705 90 2 0 2 1 046706 10 2 0 1 0 046707 90 2 0 0 0 046710 90 2 0 2 1 046712 90 2 0 2 1 046715 90 2 0 2 0 046716 90 2 0 2 1 046730 90 2 0 2 1 046735 90 2 0 2 1 046740 90 2 0 2 1 046742 90 2 0 2 1 046744 90 2 0 2 1 046746 90 2 0 2 1 046748 90 2 0 2 1 046750 90 2 0 2 1 046751 90 2 0 2 1 046753 90 2 0 1 0 046754 10 2 0 0 0 046760 90 2 0 2 1 046761 90 2 0 2 1 046762 90 2 0 2 1 046900 10 2 0 1 0 046910 10 2 0 1 0 046916 10 2 0 1 0 046917 10 2 0 1 0 046922 10 2 0 1 0 046924 10 2 0 1 0 0

Page 83: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

46930 90 2 0 0 0 046940 10 2 0 1 0 046942 10 2 0 0 0 046945 90 2 0 1 0 046946 90 2 0 1 0 046947 90 2 0 1 0 046999 YYY 2 0 0 1 147000 0 2 0 1 0 047001 ZZZ 0 0 1 1 047010 90 2 0 2 1 047015 90 2 0 2 1 047100 90 2 0 2 1 047120 90 2 0 2 1 047122 90 2 0 2 1 047125 90 2 0 2 1 047130 90 2 0 2 1 047133 XXX 9 9 9 9 947135 90 2 0 2 1 247136 90 2 0 2 1 247140 90 2 0 2 1 247141 90 2 0 2 1 247142 90 2 0 2 1 047143 XXX 2 0 2 1 047144 90 2 0 2 1 047145 XXX 2 0 2 1 047146 XXX 2 0 2 1 047147 XXX 2 0 2 1 047300 90 2 0 2 1 047350 90 2 0 2 1 047360 90 2 0 2 1 047361 90 2 0 2 1 047362 90 2 0 2 1 047370 90 2 0 2 1 047371 90 2 0 2 1 047379 YYY 2 0 2 1 147380 90 2 0 2 1 047381 90 2 0 2 1 047382 10 2 0 1 0 047383 10 2 0 1 0 047399 YYY 2 0 1 1 147400 90 2 0 2 1 047420 90 2 0 2 1 047425 90 2 0 2 1 047460 90 2 0 2 1 047480 90 2 0 2 1 047490 10 2 0 1 0 047500 0 2 0 1 0 0

Page 84: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

47505 0 2 0 0 0 047510 90 2 0 1 0 047511 90 2 1 1 0 047525 0 2 1 1 0 047530 90 2 0 1 0 047550 ZZZ 0 0 2 1 047552 0 2 0 1 1 047553 0 3 0 1 0 047554 0 3 0 1 1 047555 0 3 0 1 0 047556 0 3 0 1 0 047560 0 2 0 0 0 047561 0 2 0 0 0 047562 90 2 0 2 1 047563 90 2 0 2 1 047564 90 2 0 2 1 047570 90 2 0 2 1 047579 YYY 2 1 2 1 147600 90 2 0 2 1 047605 90 2 0 2 1 047610 90 2 0 2 1 047612 90 2 0 2 1 047620 90 2 0 2 1 047630 90 2 0 1 1 047700 90 2 0 2 1 047701 90 2 0 0 0 047711 90 2 0 2 1 047712 90 2 0 2 1 047715 90 2 0 2 1 047720 90 2 0 2 1 047721 90 2 0 2 1 047740 90 2 0 2 1 047741 90 2 0 2 1 047760 90 2 0 2 1 047765 90 2 0 2 1 047780 90 2 0 2 1 047785 90 2 0 2 1 047800 90 2 0 2 1 047801 90 2 0 2 1 047802 90 2 0 2 1 047900 90 2 0 2 1 047999 YYY 2 0 1 1 148000 90 2 0 2 1 048001 90 2 0 2 1 048020 90 2 0 2 1 048100 90 2 0 2 1 048102 10 2 0 1 0 0

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48105 90 2 0 2 1 048120 90 2 0 2 1 048140 90 2 0 2 1 048145 90 2 0 2 1 048146 90 2 0 2 1 048148 90 2 0 2 1 048150 90 2 0 2 1 048152 90 2 0 2 1 048153 90 2 0 2 1 048154 90 2 0 2 1 048155 90 2 0 2 1 048160 XXX 9 9 9 9 948400 ZZZ 0 0 0 0 048500 90 2 0 2 1 048510 90 2 0 2 1 048520 90 2 0 2 1 048540 90 2 0 2 1 048545 90 2 0 2 1 048547 90 2 0 2 1 048548 90 2 0 2 1 048550 XXX 9 9 9 9 948551 XXX 2 0 2 1 048552 XXX 2 0 2 1 048554 90 2 0 2 2 248556 90 2 0 2 2 248999 YYY 2 0 2 1 149000 90 2 0 2 1 049002 90 2 0 2 1 049010 90 2 0 2 1 049020 90 2 0 2 0 049040 90 2 0 2 1 049060 90 2 0 1 1 049062 90 2 0 2 1 049082 0 2 0 1 0 049083 0 2 0 1 0 049084 0 2 0 1 0 049180 0 2 0 1 0 049203 90 2 0 2 1 049204 90 2 0 2 1 049205 90 2 0 2 1 049215 90 2 0 2 1 049220 90 2 0 2 1 049250 90 2 0 1 1 049255 90 2 0 2 1 049320 10 2 0 2 0 049321 10 3 0 2 2 049322 10 3 0 2 2 0

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49323 90 3 0 2 2 049324 10 3 0 2 2 049325 10 3 0 2 2 049326 ZZZ 0 0 2 1 049327 ZZZ 0 0 2 1 049329 YYY 2 1 2 1 149400 0 2 0 1 0 049402 90 2 0 1 1 049405 0 2 0 1 0 049406 0 2 0 1 0 049407 0 2 0 1 0 049411 0 2 0 0 0 049412 ZZZ 0 0 0 1 049418 0 2 0 0 0 049419 90 2 0 1 0 049421 0 2 0 1 0 049422 10 2 0 1 0 049423 0 2 0 0 0 049424 0 2 0 0 0 049425 90 2 0 2 1 049426 90 2 0 1 0 049427 0 2 0 0 0 049428 10 2 0 1 0 049429 10 2 0 1 0 049435 ZZZ 0 0 2 1 049436 10 2 0 2 1 049440 10 2 0 0 0 049441 10 2 0 0 0 049442 10 2 0 0 0 049446 0 2 0 0 0 049450 0 2 0 0 0 049451 0 2 0 0 0 049452 0 2 0 0 0 049460 0 2 0 0 0 049465 0 2 0 0 0 049491 90 2 1 2 1 049492 90 2 1 2 1 049495 90 2 1 2 1 049496 90 2 1 2 1 049500 90 2 1 2 1 049501 90 2 1 2 1 049505 90 2 1 2 1 049507 90 2 1 2 1 049520 90 2 1 2 1 049521 90 2 1 2 1 049525 90 2 1 2 1 049540 90 2 1 2 1 0

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49550 90 2 1 2 1 049553 90 2 1 2 1 049555 90 2 1 2 1 049557 90 2 1 2 1 049560 90 2 1 2 1 049561 90 2 1 2 1 049565 90 2 1 2 1 049566 90 2 1 2 1 049568 ZZZ 0 0 2 1 049570 90 2 1 2 1 049572 90 2 1 2 1 049580 90 2 0 2 1 049582 90 2 0 2 1 049585 90 2 0 2 1 049587 90 2 0 2 1 049590 90 2 1 2 1 049600 90 2 0 2 1 049605 90 2 0 2 1 049606 90 2 0 2 1 049610 90 2 0 2 1 049611 90 2 0 2 1 049650 90 2 1 2 1 049651 90 2 1 2 1 049652 90 2 1 2 1 049653 90 2 1 2 1 049654 90 2 1 2 1 049655 90 2 1 2 1 049656 90 2 1 2 1 049657 90 2 1 2 1 049659 YYY 2 1 2 1 149900 90 2 0 2 1 049904 90 2 0 1 1 149905 ZZZ 0 0 2 2 049906 90 2 0 1 1 049999 YYY 2 0 1 1 150010 90 2 1 2 1 050020 90 2 0 1 1 050040 90 2 1 1 1 050045 90 2 1 2 1 050060 90 2 1 2 1 050065 90 2 1 2 0 050070 90 2 1 2 1 050075 90 2 1 2 1 050080 90 2 1 1 0 050081 90 2 1 2 1 050100 90 2 1 2 1 050120 90 2 1 2 1 0

Page 88: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

50125 90 2 1 2 1 050130 90 2 1 2 1 050135 90 2 1 2 1 050200 0 2 1 1 0 050205 90 2 1 2 1 050220 90 2 1 2 1 050225 90 2 1 2 1 050230 90 2 1 2 2 050234 90 2 1 2 1 050236 90 2 1 2 1 050240 90 2 1 2 1 050250 90 2 0 2 1 050280 90 2 1 2 1 050290 90 2 0 2 1 050300 XXX 9 9 9 9 950320 90 2 1 2 1 050323 XXX 2 0 2 1 050325 XXX 2 0 2 1 050327 XXX 2 0 2 1 050328 XXX 2 0 2 1 050329 XXX 2 0 2 1 050340 90 2 1 2 1 050360 90 2 0 2 2 250365 90 2 1 2 2 250370 90 2 0 2 1 050380 90 2 0 2 1 050382 0 2 1 1 0 050384 0 2 1 1 0 050385 0 2 1 0 0 050386 0 2 1 0 0 050387 0 2 1 0 0 050389 0 2 1 1 0 050390 0 2 1 1 0 050391 0 2 1 1 0 050392 0 2 1 1 0 050393 0 2 1 1 0 050394 0 2 1 1 0 050395 0 2 1 1 0 050396 0 2 1 0 0 050398 0 2 1 1 0 050400 90 2 1 2 1 050405 90 2 1 2 1 050500 90 2 0 2 1 050520 90 2 0 2 1 050525 90 2 0 2 1 050526 90 2 0 2 0 050540 90 2 2 2 1 0

Page 89: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

50541 90 2 1 2 1 050542 90 2 1 2 1 050543 90 2 1 2 1 050544 90 2 1 2 1 050545 90 2 1 2 1 050546 90 2 1 2 1 050547 90 2 1 2 1 050548 90 2 1 2 1 050549 YYY 2 1 2 1 150551 0 2 1 0 0 050553 0 2 1 1 0 050555 0 3 1 0 0 050557 0 3 1 0 0 050561 0 3 1 0 0 050562 90 2 0 2 1 050570 0 2 1 0 0 050572 0 3 1 0 0 050574 0 3 1 0 0 050575 0 3 1 1 0 050576 0 3 1 0 0 050580 0 3 1 0 0 050590 90 2 1 1 0 050592 10 2 1 1 0 050593 10 2 1 2 0 050600 90 2 1 2 1 050605 90 2 1 2 1 050610 90 2 1 2 1 050620 90 2 1 2 1 050630 90 2 1 2 1 050650 90 2 1 2 1 050660 90 2 0 2 1 050684 0 2 1 1 0 050686 0 2 0 0 0 050688 10 2 0 1 0 050690 0 2 0 1 0 050700 90 2 1 2 1 050715 90 2 1 2 1 050722 90 2 0 2 1 050725 90 2 0 2 1 050727 90 2 0 2 2 050728 90 2 0 2 2 050740 90 2 1 2 1 050750 90 2 1 2 0 050760 90 2 1 2 1 050770 90 2 0 2 1 050780 90 2 1 2 1 050782 90 2 1 2 2 0

Page 90: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

50783 90 2 1 2 2 050785 90 2 1 2 1 050800 90 2 1 2 1 050810 90 2 0 2 1 050815 90 2 1 2 1 050820 90 2 1 2 1 050825 90 2 0 2 1 050830 90 2 0 2 1 050840 90 2 1 2 1 050845 90 2 0 2 1 050860 90 2 1 2 1 050900 90 2 1 2 1 050920 90 2 0 2 1 050930 90 2 0 2 1 050940 90 2 1 2 1 050945 90 2 1 2 1 050947 90 2 1 2 1 050948 90 2 1 2 1 050949 YYY 2 1 2 1 150951 0 2 1 0 0 050953 0 3 1 0 0 050955 0 3 1 0 0 050957 0 3 1 0 0 050961 0 3 1 0 0 050970 0 2 1 0 0 050972 0 2 1 0 0 050974 0 3 1 0 0 050976 0 3 1 0 0 050980 0 2 1 0 0 051020 90 2 0 2 1 051030 90 2 0 0 0 051040 90 2 0 2 1 051045 90 2 0 2 0 051050 90 2 0 2 1 051060 90 2 0 2 1 051065 90 2 0 0 0 051080 90 2 0 2 1 051100 0 2 0 1 0 051101 0 2 0 1 0 051102 0 2 0 1 0 051500 90 2 0 2 1 051520 90 2 0 2 1 051525 90 2 0 2 1 051530 90 2 0 2 1 051535 90 2 1 2 1 051550 90 2 0 2 1 051555 90 2 0 2 1 0

Page 91: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

51565 90 2 0 2 1 051570 90 2 0 2 1 051575 90 2 2 2 1 051580 90 2 0 2 1 051585 90 2 2 2 1 051590 90 2 0 2 1 051595 90 2 2 2 1 051596 90 2 0 2 1 051597 90 2 0 2 1 051600 0 2 0 1 0 051605 0 2 0 1 0 051610 0 2 0 1 0 051700 0 2 0 1 0 051701 0 2 0 1 0 051702 0 2 0 1 0 051703 0 2 0 1 0 051705 0 2 0 1 0 051710 0 2 0 1 0 051715 0 2 0 0 0 051720 0 2 0 1 0 051725 0 2 0 0 0 051725 0 2 0 0 0 051725 0 2 0 0 0 051726 0 2 0 1 0 051726 0 2 0 1 0 051726 0 2 0 1 0 051727 0 2 0 0 0 051727 0 2 0 0 0 051727 0 2 0 0 0 051728 0 2 0 0 0 051728 0 2 0 0 0 051728 0 2 0 0 0 051729 0 2 0 0 0 051729 0 2 0 0 0 051729 0 2 0 0 0 051736 XXX 2 0 0 0 051736 XXX 2 0 0 0 051736 XXX 2 0 0 0 051741 XXX 2 0 1 0 051741 XXX 2 0 1 0 051741 XXX 2 0 1 0 051784 0 2 0 1 0 051784 0 2 0 1 0 051784 0 2 0 1 0 051785 0 2 0 0 0 051785 0 2 0 0 0 051785 0 2 0 0 0 0

Page 92: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

51792 0 2 0 0 0 051792 0 2 0 0 0 051792 0 2 0 0 0 051797 ZZZ 0 0 0 0 051797 ZZZ 0 0 0 0 051797 ZZZ 0 0 0 0 051798 XXX 0 0 0 0 051800 90 2 0 2 1 051820 90 2 2 2 1 051840 90 2 0 2 1 051841 90 2 0 2 1 051845 90 2 0 2 1 051860 90 2 0 2 1 051865 90 2 0 2 1 051880 90 2 0 2 1 051900 90 2 0 2 1 051920 90 2 0 2 1 051925 90 2 0 2 1 051940 90 2 0 2 1 051960 90 2 0 2 1 051980 90 2 0 2 1 051990 90 2 0 2 1 051992 90 2 0 2 1 051999 YYY 0 0 0 1 152000 0 2 0 1 0 052001 0 3 0 1 0 052005 0 3 0 1 0 052007 0 3 1 1 0 052010 0 3 0 1 0 052204 0 3 0 1 0 052214 0 3 0 1 0 052224 0 3 0 1 0 052234 0 3 0 1 0 052235 0 3 0 1 0 052240 0 3 0 1 0 052250 0 3 0 1 0 052260 0 3 0 1 0 052265 0 3 0 1 0 052270 0 3 0 1 0 052275 0 3 0 1 0 052276 0 3 0 1 0 052277 0 3 0 0 0 052281 0 3 0 1 0 052282 0 3 0 1 0 052283 0 3 0 1 0 052285 0 3 0 1 0 052287 0 3 0 1 0 0

Page 93: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

52290 0 3 2 1 0 052300 0 3 2 0 0 052301 0 3 2 0 0 052305 0 3 0 1 0 052310 0 3 0 1 0 052315 0 3 0 1 0 052317 0 3 0 1 0 052318 0 3 0 1 0 052320 0 3 1 1 0 052325 0 3 1 1 0 052327 0 3 1 1 0 052330 0 3 1 1 0 052332 0 3 1 1 0 052334 0 3 1 1 0 052341 0 3 1 1 0 052342 0 3 1 1 0 052343 0 3 1 1 0 052344 0 3 1 1 0 052345 0 3 1 0 0 052346 0 3 1 0 0 052351 0 2 0 1 0 052352 0 3 1 1 0 052353 0 3 1 1 0 052354 0 3 1 1 0 052355 0 3 1 1 0 052356 0 3 1 1 0 052400 90 3 0 1 0 052402 0 3 0 1 0 052441 0 3 0 1 0 052442 ZZZ 0 0 1 0 052450 90 2 0 1 0 052500 90 2 0 1 0 052601 90 2 0 1 0 052630 90 2 0 1 0 052640 90 2 0 1 0 052647 90 2 0 1 0 052648 90 2 0 1 0 052649 90 2 0 0 0 052700 90 2 0 0 0 053000 10 2 0 1 0 053010 90 2 0 1 0 053020 0 2 0 1 0 053025 0 2 0 0 0 053040 90 2 0 0 0 053060 10 2 0 1 0 053080 90 2 0 1 0 053085 90 2 0 2 1 0

Page 94: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

53200 0 2 0 1 0 053210 90 2 0 2 1 053215 90 2 0 2 1 053220 90 2 0 0 0 053230 90 2 0 2 1 053235 90 2 0 2 1 053240 90 2 0 1 0 053250 90 2 0 1 0 053260 10 2 0 1 0 053265 10 2 0 1 0 053270 10 2 0 1 0 053275 10 2 0 1 0 053400 90 2 0 2 1 053405 90 2 0 2 1 053410 90 2 0 2 1 053415 90 2 0 2 1 053420 90 2 0 1 1 053425 90 2 0 2 1 053430 90 2 0 2 1 053431 90 2 0 2 1 053440 90 2 0 2 1 053442 90 2 0 2 0 053444 90 2 0 2 1 053445 90 2 0 2 1 053446 90 2 0 2 1 053447 90 2 0 2 1 053448 90 2 0 2 1 053449 90 2 0 2 1 053450 90 2 0 1 0 053460 90 2 0 0 0 053500 90 2 0 2 1 053502 90 2 0 1 0 053505 90 2 0 2 0 053510 90 2 0 2 1 053515 90 2 0 2 1 053520 90 2 0 1 0 053600 0 2 0 1 0 053601 0 2 0 1 0 053605 0 2 0 1 0 053620 0 2 0 1 0 053621 0 2 0 1 0 053660 0 2 0 1 0 053661 0 2 0 1 0 053665 0 2 0 1 0 053850 90 2 0 1 0 053852 90 2 0 1 0 053855 0 2 0 0 0 0

Page 95: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

53860 90 2 0 0 0 053899 YYY 2 0 0 1 154000 10 2 0 0 0 054001 10 2 0 1 0 054015 10 2 0 0 0 054050 10 2 0 1 0 054055 10 2 0 1 0 054056 10 2 0 1 0 054057 10 2 0 1 0 054060 10 2 0 1 0 054065 10 2 0 1 0 054100 0 2 0 1 0 054105 10 2 0 1 0 054110 90 2 0 2 0 054111 90 2 0 2 1 054112 90 2 0 2 1 054115 90 2 0 2 0 054120 90 2 0 2 1 054125 90 2 0 2 1 054130 90 2 2 2 1 054135 90 2 2 2 0 054150 0 2 0 0 0 054160 10 2 0 1 0 054161 10 2 0 1 0 054162 10 2 0 1 0 054163 10 2 0 1 0 054164 10 2 0 1 0 054200 10 2 0 1 0 054205 90 2 0 2 0 054220 0 2 0 1 0 054230 0 2 0 1 0 054231 0 2 0 1 0 054235 0 2 0 1 0 054240 0 0 0 0 0 054240 0 0 0 0 0 054240 0 0 0 0 0 054250 0 0 0 0 0 054250 0 0 0 0 0 054250 0 0 0 0 0 054300 90 2 0 2 1 054304 90 2 0 2 0 054308 90 2 0 2 1 054312 90 2 0 2 1 054316 90 2 0 2 1 054318 90 2 0 2 1 054322 90 2 0 2 0 054324 90 2 0 2 1 0

Page 96: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

54326 90 2 0 2 1 054328 90 2 0 2 1 054332 90 2 0 2 1 054336 90 2 0 2 1 054340 90 2 0 2 1 054344 90 2 0 2 1 054348 90 2 0 2 1 054352 90 2 0 2 1 054360 90 2 0 2 1 054380 90 2 0 2 1 054385 90 2 0 2 1 054390 90 2 0 2 1 054400 90 2 0 1 1 054401 90 2 0 1 1 054405 90 2 0 2 1 054406 90 2 0 2 1 054408 90 2 0 2 1 054410 90 2 0 2 1 054411 90 2 0 2 1 054415 90 2 0 2 1 054416 90 2 0 2 1 054417 90 2 0 2 1 054420 90 2 0 2 0 054430 90 2 2 2 0 054435 90 2 0 1 0 054440 90 2 0 2 1 054450 0 2 0 1 0 054500 0 2 1 0 0 054505 10 2 1 0 0 054512 90 2 1 1 1 054520 90 2 1 1 0 054522 90 2 1 2 1 054530 90 2 1 2 1 054535 90 2 1 2 0 054550 90 2 1 2 0 054560 90 2 1 2 1 054600 90 2 1 1 0 054620 10 2 1 1 0 054640 90 2 1 0 0 054650 90 2 1 2 0 054660 90 2 1 0 0 054670 90 2 1 0 0 054680 90 2 1 2 1 054690 90 2 1 2 1 054692 90 2 1 1 0 054699 YYY 2 1 2 1 154700 10 2 1 1 0 0

Page 97: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

54800 0 2 1 0 0 054830 90 2 1 0 0 054840 90 2 1 1 0 054860 90 2 0 1 0 054861 90 2 0 0 0 054865 90 2 0 0 0 054900 90 2 0 0 0 054901 90 2 2 0 0 055000 0 2 1 1 0 055040 90 2 0 1 0 055041 90 2 2 1 0 055060 90 2 1 0 0 055100 10 2 0 1 0 055110 90 2 0 1 0 055120 90 2 0 0 0 055150 90 2 0 2 1 055175 90 2 0 0 0 055180 90 2 0 0 0 055200 90 2 2 0 0 055250 90 2 2 1 0 055300 0 2 2 0 0 055400 90 2 1 2 1 055450 10 2 2 0 0 055500 90 2 1 0 0 055520 90 2 1 2 1 055530 90 2 1 1 1 055535 90 2 1 2 1 055540 90 2 1 1 1 055550 90 2 1 2 1 055559 YYY 2 1 2 1 155600 90 2 1 0 0 055605 90 2 1 0 0 055650 90 2 1 2 1 055680 90 2 1 0 0 055700 0 2 0 1 0 055705 10 2 0 1 1 055706 10 2 0 2 1 055720 90 2 0 2 1 055725 90 2 0 2 1 055801 90 2 0 2 1 055810 90 2 0 2 1 055812 90 2 0 2 1 055815 90 2 2 2 1 055821 90 2 0 2 1 055831 90 2 0 2 1 055840 90 2 0 2 1 055842 90 2 0 2 1 0

Page 98: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

55845 90 2 2 2 1 055860 90 2 0 1 1 055862 90 2 0 2 1 055865 90 2 2 2 1 055866 90 2 0 2 1 055870 0 2 0 1 1 055873 90 2 0 1 0 055875 90 2 0 0 0 055876 0 2 0 1 1 155899 YYY 2 0 0 1 155920 0 2 0 0 0 055970 YYY 9 9 9 9 955980 YYY 9 9 9 9 956405 10 2 0 1 2 056420 10 2 0 1 0 056440 10 2 0 1 0 056441 10 2 0 0 0 056442 0 2 0 0 0 056501 10 2 0 1 0 056515 10 2 0 1 0 056605 0 2 0 1 2 056606 ZZZ 0 0 1 2 056620 90 2 0 2 1 056625 90 2 0 2 1 056630 90 2 0 2 1 056631 90 2 0 2 2 056632 90 2 2 2 2 056633 90 2 0 2 2 056634 90 2 0 2 2 056637 90 2 0 2 2 056640 90 2 1 2 1 056700 10 2 0 2 1 056740 10 2 1 1 0 056800 10 2 0 2 1 056805 90 2 0 2 1 056810 10 2 0 2 2 056820 0 2 0 1 0 056821 0 2 0 1 0 057000 10 2 0 0 0 057010 90 2 0 0 0 057020 0 2 0 0 0 057022 10 2 0 0 0 057023 10 2 0 0 0 057061 10 2 0 1 0 057065 10 2 0 1 0 057100 0 2 0 1 0 057105 10 2 0 1 0 0

Page 99: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

57106 90 2 0 2 1 057107 90 2 0 2 1 057109 90 2 2 2 1 057110 90 2 0 2 1 057111 90 2 2 2 1 057112 90 2 2 2 1 057120 90 2 0 2 1 057130 10 2 0 2 1 057135 10 2 0 1 0 057150 0 2 0 1 0 057155 0 2 0 1 2 057156 0 2 0 0 0 057160 0 2 0 1 0 057170 0 2 0 0 0 057180 10 2 0 1 0 057200 90 2 0 2 1 057210 90 2 0 2 1 057220 90 2 0 2 1 057230 90 2 0 2 1 057240 90 2 0 2 1 057250 90 2 0 2 1 057260 90 2 0 2 1 057265 90 2 0 2 1 057267 ZZZ 0 0 2 1 057268 90 2 0 2 1 057270 90 2 0 2 1 057280 90 2 0 2 1 057282 90 2 0 2 1 057283 90 2 0 2 1 057284 90 2 0 2 2 057285 90 2 0 2 2 057287 90 2 0 2 1 057288 90 2 0 2 1 057289 90 2 0 2 1 057291 90 2 0 2 0 057292 90 2 0 2 1 057295 90 2 0 2 1 057296 90 2 0 2 1 057300 90 2 0 2 1 057305 90 2 0 2 1 057307 90 2 0 2 1 057308 90 2 0 2 1 057310 90 2 0 2 1 057311 90 2 0 2 1 057320 90 2 0 2 1 057330 90 2 0 2 1 057335 90 2 0 2 1 0

Page 100: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

57400 0 2 0 0 0 057410 0 2 0 1 0 057415 10 2 0 0 0 057420 0 2 0 1 0 057421 0 2 0 1 0 057423 90 2 0 2 2 057425 90 2 0 2 1 057426 90 2 0 2 1 057452 0 2 0 1 0 057454 0 3 0 1 0 057455 0 3 0 1 0 057456 0 3 0 1 0 057460 0 3 0 1 0 057461 0 3 0 1 0 057500 0 2 0 1 0 057505 10 2 0 1 0 057510 10 2 0 1 0 057511 10 2 0 1 0 057513 10 2 0 1 0 057520 90 2 0 1 0 057522 90 2 0 1 0 057530 90 2 0 2 1 057531 90 2 2 2 1 057540 90 2 0 2 1 057545 90 2 0 2 1 057550 90 2 0 2 1 057555 90 2 0 2 1 057556 90 2 0 2 1 057558 10 2 0 1 0 057700 90 2 0 0 0 057720 90 2 0 2 0 057800 0 2 0 1 0 058100 0 2 0 1 0 058110 ZZZ 0 0 0 0 058120 10 2 0 1 0 058140 90 2 0 2 1 058145 90 2 0 2 1 058146 90 2 0 2 1 058150 90 2 0 2 1 058152 90 2 0 2 1 058180 90 2 0 2 1 058200 90 2 0 2 1 058210 90 2 2 2 1 058240 90 2 0 2 1 058260 90 2 0 2 1 058262 90 2 0 2 2 058263 90 2 0 2 2 0

Page 101: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

58267 90 2 0 2 1 058270 90 2 0 2 1 058275 90 2 0 2 1 058280 90 2 0 2 1 058285 90 2 0 2 1 058290 90 2 0 2 1 058291 90 2 0 2 2 058292 90 2 0 2 2 058293 90 2 0 2 1 058294 90 2 0 2 1 058300 XXX 9 9 9 9 958301 0 2 0 0 0 058321 0 2 0 0 0 058322 0 2 0 0 0 058323 0 2 0 0 0 058340 0 2 0 1 0 058345 10 2 1 2 2 058346 90 2 0 1 0 058350 10 2 1 1 0 058353 10 2 0 1 2 058356 10 2 0 2 2 058400 90 2 0 2 1 058410 90 2 0 2 1 058520 90 2 0 2 1 058540 90 2 0 2 0 058541 90 3 0 2 2 058542 90 2 0 2 2 058543 90 2 0 2 2 058544 90 2 0 2 2 058545 90 2 0 2 2 058546 90 2 0 2 2 058548 90 2 2 2 2 058550 90 3 0 2 2 058552 90 2 0 2 2 058553 90 2 0 2 2 058554 90 2 0 2 2 058555 0 2 0 0 2 058558 0 3 0 1 2 058559 0 3 0 1 2 058560 0 3 0 2 2 058561 0 3 0 0 2 058562 0 3 0 1 2 058563 0 3 0 0 2 058565 90 3 2 1 2 058570 90 2 0 2 2 058571 90 2 0 2 2 058572 90 2 0 2 2 0

Page 102: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

58573 90 2 0 2 2 058578 YYY 2 1 2 1 158579 YYY 2 1 2 1 158600 90 2 2 2 1 058605 90 2 2 2 0 058611 ZZZ 0 0 2 0 058615 10 2 0 2 0 058660 90 3 0 2 2 058661 10 3 1 2 2 058662 90 3 0 2 2 058670 90 3 0 1 2 058671 90 3 0 1 2 058672 90 3 1 2 0 058673 90 3 1 2 0 058679 YYY 2 1 2 1 158700 90 2 2 2 1 058720 90 2 2 2 1 058740 90 2 0 2 1 058750 90 2 1 2 1 058752 90 2 1 2 0 058760 90 2 1 2 1 058770 90 2 1 2 0 058800 90 2 2 1 0 058805 90 2 2 2 1 058820 90 2 1 2 0 058822 90 2 1 2 1 058825 90 2 0 2 1 058900 90 2 2 2 1 058920 90 2 2 2 1 058925 90 2 2 2 1 058940 90 2 2 2 1 058943 90 2 0 2 1 058950 90 2 2 2 1 058951 90 2 2 2 1 058952 90 2 2 2 1 058953 90 2 2 2 1 058954 90 2 2 2 1 058956 90 2 2 2 1 058957 90 2 2 2 1 058958 90 2 2 2 1 058960 90 2 0 2 1 058970 0 2 0 0 0 058974 0 2 0 2 1 058976 0 2 0 2 1 058999 YYY 2 0 1 1 159000 0 2 0 1 0 059001 0 2 0 1 0 0

Page 103: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

59012 0 2 0 0 0 059015 0 2 0 0 0 059020 0 0 0 0 0 059020 0 0 0 0 0 059020 0 0 0 0 0 059025 0 0 0 0 0 059025 0 0 0 0 0 059025 0 0 0 0 0 059030 0 2 0 0 0 059050 XXX 0 0 0 0 059051 XXX 0 0 0 0 059070 0 2 0 2 0 059072 0 2 0 1 0 059074 0 2 0 2 0 059076 0 2 0 2 0 059100 90 2 0 2 1 059120 90 2 0 2 1 059121 90 2 0 2 1 059130 90 2 0 0 0 059135 90 2 0 0 0 059136 90 2 0 2 0 059140 90 2 0 2 0 059150 90 2 0 2 0 059151 90 2 0 2 0 059160 10 2 0 0 0 059200 0 2 0 1 0 059300 0 2 0 0 0 059320 0 2 0 0 0 059325 0 2 0 0 0 059350 0 2 0 2 0 059400 MMM 2 0 1 0 059409 MMM 2 0 0 0 059410 MMM 2 0 1 0 059412 MMM 0 0 0 0 059414 MMM 2 0 0 0 059425 MMM 0 0 0 0 059426 MMM 0 0 0 0 059430 MMM 2 0 1 0 059510 MMM 2 0 1 0 059514 MMM 2 0 2 1 059515 MMM 2 0 1 0 059525 ZZZ 0 0 2 1 059610 MMM 2 0 0 0 059612 MMM 2 0 0 0 059614 MMM 2 0 0 0 059618 MMM 2 0 0 0 059620 MMM 2 0 2 0 0

Page 104: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

59622 MMM 2 0 0 0 059812 90 2 0 1 0 059820 90 2 0 1 0 059821 90 2 0 0 0 059830 90 2 0 0 0 059840 10 2 0 0 0 059841 10 2 0 0 0 059850 90 2 0 0 0 059851 90 2 0 0 0 059852 90 2 0 0 0 059855 90 2 0 0 0 059856 90 2 0 0 0 059857 90 2 0 0 0 059866 0 2 0 2 1 059870 90 2 0 2 0 059871 0 2 0 0 0 059897 YYY 2 0 1 0 059898 YYY 2 1 2 1 159899 YYY 2 0 2 1 160000 10 2 0 0 0 060100 0 2 0 1 0 060200 90 2 0 2 1 060210 90 2 0 2 1 060212 90 2 0 2 1 060220 90 2 0 2 1 060225 90 2 0 2 1 060240 90 2 0 2 1 060252 90 2 0 2 1 060254 90 2 0 2 1 060260 90 2 1 2 1 060270 90 2 0 2 1 060271 90 2 0 2 1 060280 90 2 0 2 1 060281 90 2 0 2 1 060300 0 2 0 1 0 060500 90 2 0 2 1 060502 90 2 0 2 1 060505 90 2 0 2 1 060512 ZZZ 0 0 2 1 060520 90 2 0 2 1 060521 90 2 0 2 1 060522 90 2 0 2 1 060540 90 2 1 2 1 060545 90 2 1 2 1 060600 90 2 0 2 1 060605 90 2 0 2 1 060650 90 2 1 2 1 0

Page 105: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

60659 YYY 2 1 2 0 060699 YYY 2 0 2 1 161000 0 2 2 1 0 061001 0 2 2 1 0 061020 0 2 0 1 0 061026 0 2 0 1 0 061050 0 2 0 0 0 061055 0 0 0 1 0 061070 0 2 0 1 0 061105 90 2 0 0 0 061107 0 0 0 1 0 061108 90 2 0 1 0 061120 90 2 0 0 0 061140 90 2 0 2 0 061150 90 2 0 1 1 061151 90 2 0 1 0 061154 90 2 1 2 1 061156 90 2 0 2 1 061210 0 2 0 1 0 061215 90 2 0 1 1 061250 90 2 1 2 1 061253 90 2 2 2 0 061304 90 2 0 2 1 061305 90 2 0 2 1 061312 90 2 0 2 1 061313 90 2 0 2 1 061314 90 2 0 2 1 061315 90 2 0 2 1 061316 ZZZ 0 0 1 0 061320 90 2 0 2 1 061321 90 2 0 2 1 061322 90 2 0 2 1 061323 90 2 0 1 1 061330 90 2 1 2 1 061332 90 2 1 2 1 061333 90 2 1 2 1 061340 90 2 1 2 1 061343 90 2 0 2 1 061345 90 2 0 2 1 061450 90 2 0 2 1 061458 90 2 0 2 1 061460 90 2 0 2 2 061480 90 2 0 2 1 061500 90 2 0 2 1 061501 90 2 0 2 1 061510 90 2 0 2 1 061512 90 2 0 2 1 0

Page 106: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

61514 90 2 0 2 1 061516 90 2 0 2 1 061517 ZZZ 0 0 1 0 061518 90 2 0 2 1 061519 90 2 0 2 1 061520 90 2 0 2 2 061521 90 2 0 2 1 061522 90 2 0 2 1 061524 90 2 0 2 1 061526 90 2 0 1 2 061530 90 2 0 1 2 061531 90 2 0 2 2 061533 90 2 0 2 1 061534 90 2 0 2 1 061535 90 2 0 2 1 061536 90 2 0 2 1 061537 90 2 0 2 1 061538 90 2 0 2 1 061539 90 2 0 2 1 061540 90 2 0 2 1 061541 90 2 0 2 1 061543 90 2 0 2 1 061544 90 2 0 2 0 061545 90 2 0 2 1 061546 90 2 0 2 1 061548 90 2 0 2 2 061550 90 2 0 2 1 061552 90 2 0 2 1 061556 90 2 0 2 0 061557 90 2 0 2 0 061558 90 2 0 2 0 061559 90 2 0 2 1 061563 90 2 0 2 1 061564 90 2 1 2 1 061566 90 2 0 2 1 061567 90 2 0 2 1 061570 90 2 0 2 1 061571 90 2 0 2 1 061575 90 2 0 2 1 061576 90 2 0 2 1 061580 90 2 1 1 1 261581 90 2 1 1 2 261582 90 2 0 2 1 261583 90 2 0 2 1 261584 90 2 1 2 1 261585 90 2 1 2 1 261586 90 2 0 2 1 2

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61590 90 2 1 2 1 261591 90 2 1 2 1 261592 90 2 1 2 1 261595 90 2 1 1 1 261596 90 2 1 2 1 261597 90 2 1 2 1 261598 90 2 0 2 1 261600 90 2 0 2 1 261601 90 2 0 2 1 261605 90 2 0 2 1 261606 90 2 0 2 1 261607 90 2 0 2 1 261608 90 2 0 2 1 261611 ZZZ 0 0 2 1 261612 ZZZ 0 0 2 1 261613 90 2 1 2 1 261615 90 2 0 2 1 261616 90 2 0 2 1 261618 90 2 0 2 1 261619 90 2 0 2 1 261623 0 2 0 1 0 061624 0 2 0 1 0 061626 0 2 0 1 0 061630 XXX 2 0 2 1 061635 XXX 2 0 2 1 061640 0 9 9 9 9 961641 ZZZ 9 9 9 9 961642 ZZZ 9 9 9 9 961680 90 2 0 2 1 061682 90 2 0 2 1 061684 90 2 0 2 1 061686 90 2 0 2 1 061690 90 2 0 2 1 061692 90 2 0 2 1 061697 90 2 0 2 1 061698 90 2 0 2 1 061700 90 2 0 2 1 061702 90 2 0 2 1 061703 90 2 0 2 1 061705 90 2 0 2 1 061708 90 2 0 2 0 061710 90 2 0 0 0 061711 90 2 0 2 1 061720 90 2 0 1 0 061735 90 2 0 1 1 061750 90 2 0 1 1 061751 90 2 0 1 1 0

Page 108: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

61760 90 2 0 1 2 061770 90 2 0 1 1 061781 ZZZ 0 0 0 0 061782 ZZZ 0 0 0 0 061783 ZZZ 0 0 0 0 061790 90 2 1 1 0 061791 90 2 1 0 0 061796 90 0 0 2 0 061797 ZZZ 0 0 2 0 061798 90 0 0 2 0 061799 ZZZ 0 0 2 0 061800 ZZZ 0 0 2 0 061850 90 2 0 2 0 061860 90 2 0 2 0 061863 90 2 1 2 1 061864 ZZZ 0 0 2 1 061867 90 2 1 2 1 061868 ZZZ 0 0 2 1 061880 90 2 1 2 1 061885 90 2 1 0 0 061886 90 2 0 0 0 061888 10 2 1 1 0 062000 90 2 0 1 0 062005 90 2 0 2 1 062010 90 2 0 2 1 062100 90 2 0 2 1 062115 90 2 0 2 1 062117 90 2 0 2 1 062120 90 2 0 2 1 062121 90 2 0 2 1 062140 90 2 0 2 1 062141 90 2 0 2 1 062142 90 2 0 2 0 062143 90 2 0 2 1 062145 90 2 0 2 1 062146 90 2 0 2 1 062147 90 2 0 2 1 062148 ZZZ 0 0 1 0 062160 ZZZ 0 0 1 0 062161 90 2 0 2 1 062162 90 2 0 2 1 062163 90 2 0 2 1 062164 90 2 0 2 1 062165 90 2 0 0 1 062180 90 2 0 2 0 062190 90 2 0 1 1 062192 90 2 0 2 1 0

Page 109: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

62194 10 2 0 0 0 062200 90 2 0 2 1 062201 90 2 0 1 0 062220 90 2 0 2 1 062223 90 2 0 2 1 062225 90 2 0 1 0 062230 90 2 0 2 1 062252 XXX 0 0 0 0 062252 XXX 0 0 0 0 062252 XXX 0 0 0 0 062256 90 2 0 2 0 062258 90 2 0 2 1 062263 10 2 0 1 0 062264 10 2 0 1 0 062267 0 2 0 0 0 062268 0 2 0 1 0 062269 0 2 0 0 0 062270 0 2 0 1 0 062272 0 2 0 1 0 062273 0 2 0 1 0 062280 10 2 0 1 0 062281 10 2 0 1 0 062282 10 2 0 1 0 062284 0 2 0 1 0 062287 90 2 0 1 0 062290 0 2 0 1 0 062291 0 2 0 1 0 062292 90 2 0 0 0 062294 90 2 0 1 0 062302 0 2 0 1 0 062303 0 2 0 1 0 062304 0 2 0 1 0 062305 0 2 0 1 0 062310 0 2 0 1 0 062311 0 2 0 1 0 062318 0 2 0 1 0 062319 0 2 0 1 0 062350 10 2 0 1 1 062351 90 2 0 2 2 062355 10 2 0 0 0 062360 10 2 0 0 1 062361 10 2 0 0 1 062362 10 2 0 0 1 062365 10 2 0 0 0 062367 XXX 0 0 1 0 062368 XXX 0 0 1 0 062369 XXX 0 0 1 0 0

Page 110: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

62370 XXX 0 0 1 0 063001 90 2 0 2 2 063003 90 2 0 2 2 063005 90 2 0 2 2 063011 90 2 0 2 2 063012 90 2 0 2 2 063015 90 2 0 2 2 063016 90 2 0 2 2 063017 90 2 0 2 2 063020 90 2 1 2 2 063030 90 2 1 2 2 063035 ZZZ 0 1 2 2 063040 90 2 1 2 2 063042 90 2 1 2 2 063043 ZZZ 0 1 2 2 063044 ZZZ 0 1 2 2 063045 90 2 2 2 2 063046 90 2 2 2 2 063047 90 2 2 2 2 063048 ZZZ 0 0 2 2 063050 90 2 0 2 2 063051 90 2 0 2 2 063055 90 2 0 2 1 063056 90 2 0 2 1 063057 ZZZ 0 0 2 1 063064 90 2 0 2 1 063066 ZZZ 0 0 2 1 063075 90 2 0 2 2 063076 ZZZ 0 0 2 2 063077 90 2 0 2 2 063078 ZZZ 0 0 2 2 063081 90 2 0 2 1 263082 ZZZ 0 0 2 1 263085 90 2 0 2 2 263086 ZZZ 0 0 2 2 263087 90 2 0 2 2 263088 ZZZ 0 0 2 2 263090 90 2 0 2 2 263091 ZZZ 0 0 2 2 263101 90 2 0 2 1 063102 90 2 0 2 1 063103 ZZZ 0 0 2 1 063170 90 2 0 2 1 063172 90 2 0 2 1 063173 90 2 0 2 1 063180 90 2 0 2 1 063182 90 2 0 2 1 0

Page 111: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

63185 90 2 0 2 1 063190 90 2 0 2 1 063191 90 2 1 2 1 063194 90 2 0 2 1 063195 90 2 0 2 1 063196 90 2 0 2 1 063197 90 2 0 2 1 063198 90 2 0 2 1 063199 90 2 0 2 1 063200 90 2 0 2 0 063250 90 2 0 2 1 063251 90 2 0 2 1 063252 90 2 0 2 1 063265 90 2 0 2 1 063266 90 2 0 2 1 063267 90 2 0 2 1 063268 90 2 0 2 1 063270 90 2 0 2 1 063271 90 2 0 2 1 063272 90 2 0 2 1 063273 90 2 0 2 0 063275 90 2 0 2 1 063276 90 2 0 2 1 063277 90 2 0 2 1 063278 90 2 0 2 1 063280 90 2 0 2 1 063281 90 2 0 2 1 063282 90 2 0 2 1 063283 90 2 0 2 1 063285 90 2 0 2 1 063286 90 2 0 2 1 063287 90 2 0 2 1 063290 90 2 0 2 1 063295 ZZZ 0 2 2 2 063300 90 2 0 2 1 063301 90 2 0 2 1 063302 90 2 0 2 1 063303 90 2 0 2 1 063304 90 2 0 2 1 063305 90 2 0 2 1 063306 90 2 0 2 1 063307 90 2 0 2 1 063308 ZZZ 0 0 2 1 063600 90 2 0 0 0 063610 0 2 0 0 0 063615 90 2 0 1 1 063620 90 0 0 2 0 0

Page 112: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

63621 ZZZ 0 0 2 0 063650 10 2 0 1 0 063655 90 2 0 2 1 063661 10 2 0 2 1 063662 90 2 0 2 1 063663 10 2 0 2 1 063664 90 2 0 2 1 063685 10 2 0 2 1 063688 10 2 0 1 0 063700 90 2 0 2 1 063702 90 2 0 2 1 063704 90 2 0 2 1 063706 90 2 0 2 1 063707 90 2 0 2 1 063709 90 2 0 2 1 063710 90 2 0 2 1 063740 90 2 0 2 1 063741 90 2 0 2 1 063744 90 2 0 2 1 063746 90 2 0 0 0 064400 0 2 1 1 0 064402 0 2 1 1 0 064405 0 2 1 1 0 064408 0 2 1 0 0 064410 0 2 1 0 0 064412 0 2 1 1 0 064413 0 2 1 1 0 064415 0 2 1 1 0 064416 0 2 1 1 0 064417 0 2 1 1 0 064418 0 2 1 1 0 064420 0 2 0 1 0 064421 0 2 1 1 0 064425 0 2 1 1 0 064430 0 2 1 1 0 064435 0 2 1 1 0 064445 0 2 1 1 0 064446 0 2 1 1 0 064447 0 2 1 1 0 064448 0 2 1 1 0 064449 0 2 1 1 0 064450 0 2 1 1 0 064455 0 2 1 0 0 064479 0 2 1 1 0 064480 ZZZ 0 1 1 0 064483 0 2 1 1 0 064484 ZZZ 0 1 1 0 0

Page 113: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

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Page 114: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

64642 0 2 0 1 0 064643 ZZZ 0 0 1 0 064644 0 2 0 1 0 064645 ZZZ 0 0 1 0 064646 0 2 0 1 0 064647 0 2 0 1 0 064650 0 2 0 0 0 064653 0 2 0 0 0 064680 10 2 0 1 0 064681 10 2 0 1 0 064702 90 2 0 1 0 064704 90 2 0 2 1 064708 90 2 0 2 1 064712 90 2 1 2 1 064713 90 2 1 2 1 064714 90 2 1 2 1 064716 90 2 0 2 1 064718 90 2 1 0 0 064719 90 2 1 1 0 064721 90 2 1 1 0 064722 90 2 0 2 1 064726 90 2 0 1 0 064727 ZZZ 0 0 1 0 064732 90 2 1 2 0 064734 90 2 1 0 0 064736 90 2 1 2 0 064738 90 2 1 2 0 064740 90 2 1 2 0 064742 90 2 1 2 0 064744 90 2 1 0 0 064746 90 2 1 2 1 064755 90 2 0 2 1 064760 90 2 0 2 1 064763 90 2 1 2 1 064766 90 2 1 2 0 064771 90 2 0 2 0 064772 90 2 0 2 1 064774 90 2 0 1 0 064776 90 2 0 0 0 064778 ZZZ 0 0 1 0 064782 90 2 0 1 1 064783 ZZZ 0 0 1 0 064784 90 2 0 0 0 064786 90 2 1 2 0 064787 ZZZ 0 0 0 0 064788 90 2 0 1 0 064790 90 2 0 0 1 0

Page 115: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

64792 90 2 0 2 1 064795 0 2 0 1 0 064802 90 2 1 2 1 064804 90 2 1 2 1 064809 90 2 1 2 1 064818 90 2 1 2 1 064820 90 2 0 1 0 064821 90 2 1 1 0 064822 90 2 1 1 0 064823 90 2 1 1 0 064831 90 2 1 1 0 064832 ZZZ 0 0 0 0 064834 90 2 1 0 0 064835 90 2 1 2 0 064836 90 2 1 2 0 064837 ZZZ 0 0 2 0 064840 90 2 1 2 0 064856 90 2 0 1 1 064857 90 2 0 2 1 064858 90 2 1 2 1 064859 ZZZ 0 0 2 1 064861 90 2 1 2 1 064862 90 2 1 2 0 064864 90 2 0 2 1 064865 90 2 0 2 1 064866 90 2 0 2 1 064868 90 2 0 2 1 064872 ZZZ 0 0 2 1 064874 ZZZ 0 0 2 1 064876 ZZZ 0 0 2 1 064885 90 2 0 2 1 064886 90 2 0 2 1 064890 90 2 0 2 0 064891 90 2 0 2 0 064892 90 2 0 2 1 064893 90 2 0 2 0 064895 90 2 0 2 1 064896 90 2 0 2 1 064897 90 2 0 2 0 064898 90 2 0 2 1 064901 ZZZ 0 0 2 1 064902 ZZZ 0 0 2 0 064905 90 2 0 2 1 064907 90 2 0 2 1 064910 90 2 0 2 1 064911 90 2 0 2 1 064999 YYY 2 0 0 1 1

Page 116: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

65091 90 2 1 0 1 065093 90 2 1 1 1 065101 90 2 1 1 0 065103 90 2 1 1 1 065105 90 2 1 2 1 065110 90 2 1 2 1 065112 90 2 1 2 1 065114 90 2 1 2 1 065125 90 2 1 1 1 065130 90 2 1 1 1 065135 90 2 1 1 0 065140 90 2 1 1 0 065150 90 2 1 0 0 065155 90 2 1 1 0 065175 90 2 1 1 1 065205 0 2 1 1 0 065210 0 2 1 1 0 065220 0 2 1 1 0 065222 0 2 1 1 0 065235 90 2 1 0 0 065260 90 2 1 2 0 065265 90 2 1 2 1 065270 10 2 1 0 0 065272 90 2 1 1 0 065273 90 2 1 1 1 065275 90 2 1 0 0 065280 90 2 1 0 0 065285 90 2 1 1 0 065286 90 2 1 1 0 065290 90 2 1 1 1 065400 90 2 1 1 0 065410 0 2 1 0 0 065420 90 2 1 1 0 065426 90 2 1 1 0 065430 0 2 1 1 0 065435 0 2 1 1 0 065436 90 2 1 1 0 065450 90 2 1 1 0 065600 90 2 1 1 0 065710 90 2 1 2 1 065730 90 2 1 2 1 065750 90 2 1 2 1 065755 90 2 1 2 1 065756 90 2 1 2 1 065757 ZZZ 0 0 0 0 065760 XXX 9 9 9 9 965765 XXX 9 9 9 9 9

Page 117: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

65767 XXX 9 9 9 9 965770 90 2 1 2 0 065771 XXX 9 9 9 9 965772 90 2 1 1 0 065775 90 2 1 1 0 065778 10 2 1 0 0 065779 10 2 1 0 0 065780 90 2 1 1 1 065781 90 2 1 2 1 065782 90 2 1 1 1 065800 0 2 1 1 0 065810 90 2 1 1 0 065815 90 2 1 1 0 065820 90 2 1 0 0 065850 90 2 1 1 1 065855 10 2 1 1 0 065860 90 2 1 0 0 065865 90 2 1 1 1 065870 90 2 1 1 1 065875 90 2 1 1 1 065880 90 2 1 1 0 065900 90 2 1 2 0 065920 90 2 1 1 1 065930 90 2 1 1 1 066020 10 2 1 1 0 066030 10 2 1 1 0 066130 90 2 1 0 0 066150 90 2 1 1 1 066155 90 2 1 1 0 066160 90 2 1 1 1 066170 90 2 1 2 1 066172 90 2 1 2 1 066174 90 2 1 2 1 066175 90 2 1 2 1 066179 90 2 1 2 0 066180 90 2 1 2 0 066183 90 2 1 2 0 066184 90 2 1 2 0 066185 90 2 1 2 0 066220 90 2 1 2 1 066225 90 2 1 1 1 066250 90 2 1 1 0 066500 90 2 1 1 1 066505 90 2 1 1 0 066600 90 2 1 1 0 066605 90 2 1 1 0 066625 90 2 1 1 0 0

Page 118: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

66630 90 2 1 1 0 066635 90 2 1 1 0 066680 90 2 1 1 1 066682 90 2 1 1 0 066700 90 2 1 0 0 066710 90 2 1 1 0 066711 90 3 1 1 0 066720 90 2 1 1 0 066740 90 2 1 1 0 066761 10 2 1 1 0 066762 90 2 1 1 0 066770 90 2 1 1 0 066820 90 2 1 1 0 066821 90 2 1 1 0 066825 90 2 1 0 0 066830 90 2 1 1 0 066840 90 2 1 1 0 066850 90 2 1 1 0 066852 90 2 1 0 1 066920 90 2 1 0 1 066930 90 2 1 0 0 066940 90 2 1 0 1 066982 90 2 1 1 0 066983 90 2 1 1 0 066984 90 2 1 1 0 066985 90 2 1 1 1 066986 90 2 1 1 1 066990 ZZZ 0 0 1 0 066999 YYY 2 1 0 1 167005 90 2 1 1 1 067010 90 2 1 1 1 067015 90 2 1 1 1 067025 90 2 1 1 1 067027 90 2 1 2 1 067028 0 2 1 1 0 067030 90 2 1 1 1 067031 90 2 1 1 0 067036 90 2 1 2 1 067039 90 2 1 2 1 067040 90 2 1 2 1 067041 90 2 1 2 1 067042 90 2 1 2 1 067043 90 2 1 2 1 067101 90 2 1 1 0 067105 90 2 1 1 0 067107 90 2 1 2 1 067108 90 2 1 2 1 0

Page 119: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

67110 90 2 1 1 0 067112 90 2 1 2 1 067113 90 2 1 2 1 067115 90 2 1 1 0 067120 90 2 1 1 1 067121 90 2 1 2 1 067141 90 2 1 1 0 067145 90 2 1 1 0 067208 90 2 1 1 0 067210 90 2 1 1 0 067218 90 2 1 1 0 067220 90 2 1 1 0 067221 0 2 0 1 0 067225 ZZZ 0 0 1 0 067227 90 2 1 1 0 067228 90 2 1 1 0 067229 90 2 1 1 0 067250 90 2 1 1 1 067255 90 2 1 2 1 067299 YYY 2 1 0 1 167311 90 2 1 1 0 067312 90 2 1 1 1 067314 90 2 1 1 0 067316 90 2 1 0 0 067318 90 2 1 1 1 067320 ZZZ 0 0 1 0 067331 ZZZ 0 1 1 1 067332 ZZZ 0 1 1 1 067334 ZZZ 0 1 1 1 067335 ZZZ 0 1 1 1 067340 ZZZ 0 0 2 0 067343 90 2 1 1 1 067345 10 2 1 1 0 067346 0 2 1 0 0 067399 YYY 2 1 2 1 167400 90 2 1 1 1 067405 90 2 1 1 0 067412 90 2 1 1 1 067413 90 2 1 2 0 067414 90 2 1 2 1 067415 0 2 1 0 0 067420 90 2 1 2 1 067430 90 2 1 2 0 067440 90 2 1 2 1 067445 90 2 1 2 1 067450 90 2 1 2 1 067500 0 2 1 1 0 0

Page 120: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

67505 0 2 1 1 0 067515 0 2 1 1 0 067550 90 2 1 1 1 067560 90 2 1 0 0 067570 90 2 1 2 1 067599 YYY 2 1 2 1 167700 10 2 1 1 0 067710 10 2 1 1 0 067715 10 2 1 1 0 067800 10 2 0 1 0 067801 10 2 0 1 0 067805 10 2 0 1 0 067808 90 2 0 1 0 067810 0 2 1 1 0 067820 0 2 1 1 0 067825 10 2 1 1 0 067830 10 2 1 1 0 067835 90 2 1 0 0 067840 10 2 1 1 0 067850 10 2 1 1 0 067875 0 2 1 1 0 067880 90 2 1 1 0 067882 90 2 1 1 0 067900 90 2 1 1 0 067901 90 2 1 1 0 067902 90 2 1 1 1 067903 90 2 1 1 1 067904 90 2 1 1 1 067906 90 2 1 1 0 067908 90 2 1 1 0 067909 90 2 1 1 0 067911 90 2 1 1 0 067912 90 2 1 1 0 067914 90 2 1 1 0 067915 90 2 1 1 0 067916 90 2 1 1 0 067917 90 2 1 1 0 067921 90 2 1 1 0 067922 90 2 1 1 0 067923 90 2 1 1 0 067924 90 2 1 1 0 067930 10 2 1 1 0 067935 90 2 1 1 0 067938 10 2 1 1 0 067950 90 2 1 1 1 067961 90 2 1 0 0 067966 90 2 1 1 0 0

Page 121: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

67971 90 2 1 1 1 067973 90 2 1 2 1 067974 90 2 1 2 1 067975 90 2 1 1 0 067999 YYY 2 1 0 1 168020 10 2 1 1 0 068040 0 2 1 1 0 068100 0 2 1 1 0 068110 10 2 1 1 0 068115 10 2 1 1 0 068130 90 2 1 1 0 068135 10 2 1 1 0 068200 0 2 1 1 0 068320 90 2 1 1 1 068325 90 2 1 1 1 068326 90 2 1 1 0 068328 90 2 1 0 0 068330 90 2 1 0 0 068335 90 2 1 1 1 068340 90 2 1 0 0 068360 90 2 1 1 0 068362 90 2 1 1 1 068371 10 2 1 1 0 068399 YYY 2 1 0 1 168400 10 2 1 1 0 068420 10 2 1 1 0 068440 10 2 1 1 0 068500 90 2 1 1 0 068505 90 2 1 1 0 068510 0 2 1 0 0 068520 90 2 1 0 0 068525 0 2 1 1 1 068530 10 2 1 1 0 068540 90 2 1 1 1 068550 90 2 1 1 0 068700 90 2 1 1 0 068705 10 2 1 1 0 068720 90 2 1 2 1 068745 90 2 1 2 1 068750 90 2 1 2 1 068760 10 2 1 1 0 068761 10 2 1 0 0 068770 90 2 1 0 0 068801 10 2 1 1 0 068810 10 2 1 1 0 068811 10 2 1 1 0 068815 10 2 1 1 0 0

Page 122: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

68816 10 2 1 1 0 068840 10 2 1 1 0 068850 0 2 1 1 0 068899 YYY 2 1 0 1 169000 10 2 1 1 0 069005 10 2 1 1 0 069020 10 2 1 1 0 069090 XXX 9 9 9 9 969100 0 2 0 1 0 069105 0 2 1 1 0 069110 90 2 1 1 0 069120 90 2 0 1 0 069140 90 2 1 0 0 069145 90 2 1 1 0 069150 90 2 0 1 1 069155 90 2 0 2 1 069200 0 2 1 1 0 069205 10 2 1 1 0 069210 0 2 2 1 0 069220 0 2 1 1 0 069222 10 2 1 1 0 069300 YYY 2 1 0 0 069310 90 2 1 1 0 069320 90 2 1 2 0 069399 YYY 2 0 0 1 169420 10 2 1 1 0 069421 10 2 1 1 0 069424 0 2 1 1 0 069433 10 2 1 1 0 069436 10 2 1 1 0 069440 90 2 1 1 0 069450 90 2 1 0 0 069501 90 2 1 1 0 069502 90 2 1 0 0 069505 90 2 1 0 0 069511 90 2 1 0 0 069530 90 2 1 2 0 069535 90 2 1 1 1 069540 10 2 1 1 0 069550 90 2 1 2 0 069552 90 2 1 2 0 069554 90 2 1 2 1 069601 90 2 1 0 0 069602 90 2 1 0 0 069603 90 2 1 0 0 069604 90 2 1 1 0 069605 90 2 1 2 0 0

Page 123: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

69610 10 2 1 1 0 069620 90 2 1 1 0 069631 90 2 1 1 0 069632 90 2 1 1 0 069633 90 2 1 1 0 069635 90 2 1 1 0 069636 90 2 1 0 0 069637 90 2 1 0 0 069641 90 2 1 1 0 069642 90 2 1 1 0 069643 90 2 1 1 0 069644 90 2 1 1 0 069645 90 2 1 1 0 069646 90 2 1 0 0 069650 90 2 1 1 0 069660 90 2 1 1 0 069661 90 2 1 0 0 069662 90 2 1 1 0 069666 90 2 1 0 0 069667 90 2 1 0 0 069670 90 2 1 2 0 069676 90 2 1 1 0 069700 90 2 1 1 0 069710 XXX 9 9 9 9 969711 90 2 1 2 0 069714 90 2 1 1 0 069715 90 2 1 1 0 069717 90 2 1 1 0 069718 90 2 1 1 0 069720 90 2 1 0 1 069725 90 2 1 2 0 069740 90 2 1 2 0 069745 90 2 1 2 0 069799 YYY 2 1 0 1 169801 0 2 1 0 0 069805 90 2 1 2 0 069806 90 2 1 1 0 069820 90 2 1 2 0 069840 90 2 1 2 0 069905 90 2 1 1 0 069910 90 2 1 0 0 069915 90 2 1 2 1 069930 90 2 1 0 0 069949 YYY 2 1 0 1 169950 90 2 1 2 1 069955 90 2 1 2 1 069960 90 2 1 2 1 0

Page 124: Illinois Workers' Compensation Fee Schedule Updated January 2015 … · 2017-06-27 · Illinois Workers' Compensation Fee Schedule Updated January 2015 2014 Payment Guide to Global

69970 90 2 1 2 1 069979 YYY 2 1 0 1 169990 ZZZ 0 0 2 0 0