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Hospital

Milwaukee Rehabilitation Hospital At Greenfield

Milwaukee, WI · CCN 523029 · Rates published

400 distinct procedures filed
16 distinct payers
7,815 rate rows
2026-04-01 last MRF observed
Data quality

72 of 7,815 rate rows are consumer-grade (0.9%)

7,743 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 7,743
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://hospitalpricedisclosure.com/download.aspx?pi=ZmZLJmNeB3ZIJPZugtZLxg*-*
Found on page https://www.milwaukee-rehabhospital.com/cms-hpt.txt
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-01
Content fingerprint 3392cd6381ba6953… · 2,674,903 bytes · first seen 2026-08-01

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
D0106
HCPCS 		Stroke M <41.50 And A <84.50 (Tier 3) 5 $13,606.80 $100,800.00 $42,000.00 nat. median
$43,929
1.0× median
C0106
HCPCS 		Stroke M <41.50 And A <84.50 (Tier 2) 2 $26,000.00 $52,213.19 $39,106.60 nat. median
$48,486
0.8× median
C0505
HCPCS 		Non-traumatic Spinal Cord Injury M <39.50 (Tier 2) 1 $39,000.00 $39,000.00 $39,000.00 nat. median
$46,281
0.8× median
A0106
HCPCS 		Stroke M <41.50 And A <84.50 (No Comorbidities) 5 $200.00 $76,800.00 $35,750.00 nat. median
$41,668
0.9× median
D0604
HCPCS 		Neurological M <43.50 (Tier 3) 1 $34,125.00 $34,125.00 $34,125.00 nat. median
$30,918
1.1× median
C0205
HCPCS 		Traumatic Brain Injury M <35.50 (Tier 2) 1 $32,500.00 $32,500.00 $32,500.00 nat. median
$41,763
0.8× median
D1404
HCPCS 		Cardiac M <45.50 (Tier 3) 1 $32,271.29 $32,271.29 $32,271.29 nat. median
$30,825
1.0× median
C0305
HCPCS 		Non-traumatic Brain Injury M <42.50 And A <78.50 (Tier 2) 1 $28,322.00 $28,322.00 $28,322.00 nat. median
$36,207
0.8× median
C0203
HCPCS 		Traumatic Brain Injury M >=49.50 And M <61.50 (Tier 2) 1 $26,000.00 $26,000.00 $26,000.00 nat. median
$26,413
1.0× median
D2003
HCPCS 		Miscellaneous M >=46.50 And M <55.50 (Tier 3) 1 $25,886.77 $25,886.77 $25,886.77 nat. median
$25,005
1.0× median
A1803
HCPCS 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50 (n… 1 $25,253.68 $25,253.68 $25,253.68 nat. median
$24,092
1.0× median
A0403
HCPCS 		Traumatic Spinal Cord Injury M >=41.50 And M <47.50 (No Comorbidities) 1 $24,990.00 $24,990.00 $24,990.00 nat. median
$28,089
0.9× median
D0703
HCPCS 		Fracture Of Lower Extremity M >=41.50 And M <52.50 (Tier 3) 2 $13,000.00 $36,003.55 $24,501.78 nat. median
$125
outlier · 195.9×
D0203
HCPCS 		Traumatic Brain Injury M >=49.50 And M <61.50 (Tier 3) 1 $24,455.72 $24,455.72 $24,455.72 nat. median
$24,130
1.0× median
A1703
HCPCS 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 1 $23,513.26 $23,513.26 $23,513.26 nat. median
$24,903
0.9× median
B0604
HCPCS 		Neurological M <43.50 (Tier 1) 3 $19,948.12 $40,192.15 $23,457.68 nat. median
$47,224
outlier · 0.5×
D0505
HCPCS 		Non-traumatic Spinal Cord Injury M <39.50 (Tier 3) 1 $22,750.00 $22,750.00 $22,750.00 nat. median
$43,056
0.5× median
D0303
HCPCS 		Non-traumatic Brain Injury M >=42.50 And M <52.50 (Tier 3) 2 $19,500.00 $26,000.00 $22,750.00 nat. median
$26,012
0.9× median
D0602
HCPCS 		Neurological M >=52.50 And M <64.50 (Tier 3) 2 $19,992.00 $22,400.00 $21,196.00 nat. median
$20,962
1.0× median
A1002
HCPCS 		Amputation Lower Extremity M >=55.50 And M <64.50 (No Comorbidities) 1 $21,125.00 $21,125.00 $21,125.00 nat. median
$20,229
1.0× median
D0104
HCPCS 		Stroke M >=41.50 And M <50.50 (Tier 3) 2 $19,500.00 $22,750.00 $21,125.00 nat. median
$31,294
0.7× median
B1402
HCPCS 		Cardiac M >=55.50 And M <68.50 (Tier 1) 1 $19,875.00 $19,875.00 $19,875.00 nat. median
$27,442
0.7× median
B0603
HCPCS 		Neurological M >=43.50 And M <52.50 (Tier 1) 1 $19,875.00 $19,875.00 $19,875.00 nat. median
$37,339
0.5× median
D0103
HCPCS 		Stroke M >=50.50 And M <63.50 (Tier 3) 3 $15,638.45 $26,000.00 $19,500.00 nat. median
$24,500
0.8× median
D1701
HCPCS 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50 (Tier 3) 1 $18,000.00 $18,000.00 $18,000.00 nat. median
$17,098
1.1× median
A0804
HCPCS 		Replacement Of Lower-extremity Joint M >=42.50 And M <51.50 (No Comorbidities) 1 $17,526.96 $17,526.96 $17,526.96 nat. median
$22,915
0.8× median
D0504
HCPCS 		Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 (Tier 3) 1 $16,000.00 $16,000.00 $16,000.00 nat. median
$30,303
0.5× median
D0903
HCPCS 		Other Orthopedic M >=44.50 And M <51.50 (Tier 3) 1 $14,625.00 $14,625.00 $14,625.00 nat. median
$25,750
0.6× median
A0203
HCPCS 		Traumatic Brain Injury M >=49.50 And M <61.50 (No Comorbidities) 1 $14,625.00 $14,625.00 $14,625.00 nat. median
$22,671
0.6× median
A0305
HCPCS 		Non-traumatic Brain Injury M <42.50 And A <78.50 (No Comorbidities) 2 $1,770.00 $26,656.00 $14,213.00 nat. median
$31,600
outlier · 0.4×
A0603
HCPCS 		Neurological M >=43.50 And M <52.50 (No Comorbidities) 1 $14,095.56 $14,095.56 $14,095.56 nat. median
$23,924
0.6× median
C0604
HCPCS 		Neurological M <43.50 (Tier 2) 2 $3,928.16 $22,750.00 $13,339.08 nat. median
$35,764
outlier · 0.4×
A0502
HCPCS 		Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50 (No Comorbidities) 1 $13,000.00 $13,000.00 $13,000.00 nat. median
$20,639
0.6× median
B0904
HCPCS 		Other Orthopedic M <44.5 (Tier 1) 1 $12,606.46 $12,606.46 $12,606.46 nat. median
$43,337
outlier · 0.3×
B0106
HCPCS 		Stroke M <41.50 And A <84.50 (Tier 1) 1 $12,574.79 $12,574.79 $12,574.79 nat. median
$54,601
outlier · 0.2×
D2002
HCPCS 		Miscellaneous M >=55.50 And M <66.50 (Tier 3) 1 $11,662.00 $11,662.00 $11,662.00 nat. median
$21,212
0.5× median
A0504
HCPCS 		Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 (No Comorbidities) 1 $11,662.00 $11,662.00 $11,662.00 nat. median
$27,926
outlier · 0.4×
D0402
HCPCS 		Traumatic Spinal Cord Injury M >=47.50 And M <56.50 (Tier 3) 1 $11,375.00 $11,375.00 $11,375.00 nat. median
$26,058
outlier · 0.4×
D0102
HCPCS 		Stroke M >=63.50 And M <72.50 (Tier 3) 2 $8,125.00 $13,328.00 $10,726.50 nat. median
$19,086
0.6× median
D0302
HCPCS 		Non-traumatic Brain Injury M >=52.50 And M <65.50 (Tier 3) 2 $6,500.00 $13,738.36 $10,119.18 nat. median
$21,998
outlier · 0.5×
D0603
HCPCS 		Neurological M >=43.50 And M <52.50 (Tier 3) 3 $1,770.00 $11,375.00 $8,330.00 nat. median
$24,699
outlier · 0.3×
D0502
HCPCS 		Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50 (Tier 3) 1 $8,125.00 $8,125.00 $8,125.00 nat. median
$20,792
outlier · 0.4×
D0301
HCPCS 		Non-traumatic Brain Injury M >=65.50 (Tier 3) 1 $8,125.00 $8,125.00 $8,125.00 nat. median
$17,006
outlier · 0.5×
A0102
HCPCS 		Stroke M >=63.50 And M <72.50 (No Comorbidities) 1 $8,125.00 $8,125.00 $8,125.00 nat. median
$18,105
outlier · 0.4×
A1802
HCPCS 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50 (n… 1 $8,000.00 $8,000.00 $8,000.00 nat. median
$19,678
outlier · 0.4×
A0202
HCPCS 		Traumatic Brain Injury M >=61.50 And M <73.50 (No Comorbidities) 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$18,236
outlier · 0.4×
D1004
HCPCS 		Amputation Lower Extremity M <47.50 (Tier 3) 1 $4,691.67 $4,691.67 $4,691.67 nat. median
$34,358
outlier · 0.1×
A0302
HCPCS 		Non-traumatic Brain Injury M >=52.50 And M <65.50 (No Comorbidities) 1 $1,770.00 $1,770.00 $1,770.00 nat. median
$20,593
outlier · 0.1×
A0802
HCPCS 		Replacement Of Lower-extremity Joint M >=57.50 And M <63.50 (No Comorbidities) 1 $713.76 $713.76 $713.76 nat. median
$18,259
outlier · 0.0×
A0602
HCPCS 		Neurological M >=52.50 And M <64.50 (No Comorbidities) 0 — — — nat. median
$20,119

Other procedures at this hospital

Browse this hospital's 400 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
D0106 HCPCS Stroke M <41.50 And A <84.50 (Tier 3) 5 5 — — $13,606.80 $100,800.00 $42,000.00 2026-04-01
C0106 HCPCS Stroke M <41.50 And A <84.50 (Tier 2) 2 2 — — $26,000.00 $52,213.19 $39,106.60 2026-04-01
C0505 HCPCS Non-traumatic Spinal Cord Injury M <39.50 (Tier 2) 1 1 — — $39,000.00 $39,000.00 $39,000.00 2026-04-01
A0106 HCPCS Stroke M <41.50 And A <84.50 (No Comorbidities) 5 5 — — $200.00 $76,800.00 $35,750.00 2026-04-01
D0604 HCPCS Neurological M <43.50 (Tier 3) 1 1 — — $34,125.00 $34,125.00 $34,125.00 2026-04-01
C0205 HCPCS Traumatic Brain Injury M <35.50 (Tier 2) 1 1 — — $32,500.00 $32,500.00 $32,500.00 2026-04-01
D1404 HCPCS Cardiac M <45.50 (Tier 3) 1 1 — — $32,271.29 $32,271.29 $32,271.29 2026-04-01
C0305 HCPCS Non-traumatic Brain Injury M <42.50 And A <78.50 (Tier 2) 1 1 — — $28,322.00 $28,322.00 $28,322.00 2026-04-01
C0203 HCPCS Traumatic Brain Injury M >=49.50 And M <61.50 (Tier 2) 1 1 — — $26,000.00 $26,000.00 $26,000.00 2026-04-01
D2003 HCPCS Miscellaneous M >=46.50 And M <55.50 (Tier 3) 1 1 — — $25,886.77 $25,886.77 $25,886.77 2026-04-01
A1803 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50 (n… 1 1 — — $25,253.68 $25,253.68 $25,253.68 2026-04-01
A0403 HCPCS Traumatic Spinal Cord Injury M >=41.50 And M <47.50 (No Comorbidities) 1 1 — — $24,990.00 $24,990.00 $24,990.00 2026-04-01
D0703 HCPCS Fracture Of Lower Extremity M >=41.50 And M <52.50 (Tier 3) 2 2 — — $13,000.00 $36,003.55 $24,501.78 2026-04-01
D0203 HCPCS Traumatic Brain Injury M >=49.50 And M <61.50 (Tier 3) 1 1 — — $24,455.72 $24,455.72 $24,455.72 2026-04-01
A1703 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 1 1 — — $23,513.26 $23,513.26 $23,513.26 2026-04-01
B0604 HCPCS Neurological M <43.50 (Tier 1) 3 3 — — $19,948.12 $40,192.15 $23,457.68 2026-04-01
D0505 HCPCS Non-traumatic Spinal Cord Injury M <39.50 (Tier 3) 1 1 — — $22,750.00 $22,750.00 $22,750.00 2026-04-01
D0303 HCPCS Non-traumatic Brain Injury M >=42.50 And M <52.50 (Tier 3) 2 2 — — $19,500.00 $26,000.00 $22,750.00 2026-04-01
D0602 HCPCS Neurological M >=52.50 And M <64.50 (Tier 3) 2 2 — — $19,992.00 $22,400.00 $21,196.00 2026-04-01
A1002 HCPCS Amputation Lower Extremity M >=55.50 And M <64.50 (No Comorbidities) 1 1 — — $21,125.00 $21,125.00 $21,125.00 2026-04-01
D0104 HCPCS Stroke M >=41.50 And M <50.50 (Tier 3) 2 2 — — $19,500.00 $22,750.00 $21,125.00 2026-04-01
B1402 HCPCS Cardiac M >=55.50 And M <68.50 (Tier 1) 1 1 — — $19,875.00 $19,875.00 $19,875.00 2026-04-01
B0603 HCPCS Neurological M >=43.50 And M <52.50 (Tier 1) 1 1 — — $19,875.00 $19,875.00 $19,875.00 2026-04-01
D0103 HCPCS Stroke M >=50.50 And M <63.50 (Tier 3) 3 3 — — $15,638.45 $26,000.00 $19,500.00 2026-04-01
D1701 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50 (Tier 3) 1 1 — — $18,000.00 $18,000.00 $18,000.00 2026-04-01
A0804 HCPCS Replacement Of Lower-extremity Joint M >=42.50 And M <51.50 (No Comorbidities) 1 1 — — $17,526.96 $17,526.96 $17,526.96 2026-04-01
D0504 HCPCS Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 (Tier 3) 1 1 — — $16,000.00 $16,000.00 $16,000.00 2026-04-01
D0903 HCPCS Other Orthopedic M >=44.50 And M <51.50 (Tier 3) 1 1 — — $14,625.00 $14,625.00 $14,625.00 2026-04-01
A0203 HCPCS Traumatic Brain Injury M >=49.50 And M <61.50 (No Comorbidities) 1 1 — — $14,625.00 $14,625.00 $14,625.00 2026-04-01
A0305 HCPCS Non-traumatic Brain Injury M <42.50 And A <78.50 (No Comorbidities) 2 2 — — $1,770.00 $26,656.00 $14,213.00 2026-04-01
A0603 HCPCS Neurological M >=43.50 And M <52.50 (No Comorbidities) 1 1 — — $14,095.56 $14,095.56 $14,095.56 2026-04-01
C0604 HCPCS Neurological M <43.50 (Tier 2) 2 2 — — $3,928.16 $22,750.00 $13,339.08 2026-04-01
A0502 HCPCS Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50 (No Comorbidities) 1 1 — — $13,000.00 $13,000.00 $13,000.00 2026-04-01
B0904 HCPCS Other Orthopedic M <44.5 (Tier 1) 1 1 — — $12,606.46 $12,606.46 $12,606.46 2026-04-01
B0106 HCPCS Stroke M <41.50 And A <84.50 (Tier 1) 1 1 — — $12,574.79 $12,574.79 $12,574.79 2026-04-01
D2002 HCPCS Miscellaneous M >=55.50 And M <66.50 (Tier 3) 1 1 — — $11,662.00 $11,662.00 $11,662.00 2026-04-01
A0504 HCPCS Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 (No Comorbidities) 1 1 — — $11,662.00 $11,662.00 $11,662.00 2026-04-01
D0402 HCPCS Traumatic Spinal Cord Injury M >=47.50 And M <56.50 (Tier 3) 1 1 — — $11,375.00 $11,375.00 $11,375.00 2026-04-01
D0102 HCPCS Stroke M >=63.50 And M <72.50 (Tier 3) 2 2 — — $8,125.00 $13,328.00 $10,726.50 2026-04-01
D0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50 (Tier 3) 2 2 — — $6,500.00 $13,738.36 $10,119.18 2026-04-01
D0603 HCPCS Neurological M >=43.50 And M <52.50 (Tier 3) 3 3 — — $1,770.00 $11,375.00 $8,330.00 2026-04-01
D0301 HCPCS Non-traumatic Brain Injury M >=65.50 (Tier 3) 1 1 — — $8,125.00 $8,125.00 $8,125.00 2026-04-01
D0502 HCPCS Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50 (Tier 3) 1 1 — — $8,125.00 $8,125.00 $8,125.00 2026-04-01
A0102 HCPCS Stroke M >=63.50 And M <72.50 (No Comorbidities) 1 1 — — $8,125.00 $8,125.00 $8,125.00 2026-04-01
A1802 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50 (n… 1 1 — — $8,000.00 $8,000.00 $8,000.00 2026-04-01
A0202 HCPCS Traumatic Brain Injury M >=61.50 And M <73.50 (No Comorbidities) 1 1 — — $6,500.00 $6,500.00 $6,500.00 2026-04-01
D1004 HCPCS Amputation Lower Extremity M <47.50 (Tier 3) 1 1 — — $4,691.67 $4,691.67 $4,691.67 2026-04-01
A0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50 (No Comorbidities) 1 1 — — $1,770.00 $1,770.00 $1,770.00 2026-04-01
A0802 HCPCS Replacement Of Lower-extremity Joint M >=57.50 And M <63.50 (No Comorbidities) 1 1 — — $713.76 $713.76 $713.76 2026-04-01
A1402 HCPCS Cardiac M >=55.50 And M <68.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A1403 HCPCS Cardiac M >=45.50 And M <55.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A1404 HCPCS Cardiac M <45.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A1501 HCPCS Pulmonary M >=68.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A1502 HCPCS Pulmonary M >=56.50 And M <68.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A1503 HCPCS Pulmonary M >=45.50 And M <56.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A1504 HCPCS Pulmonary M <45.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A1601 HCPCS Pain Syndrome M >=65.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A1602 HCPCS Pain Syndrome M >=58.50 And M <65.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A1603 HCPCS Pain Syndrome M >=43.50 And M <58.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A1604 HCPCS Pain Syndrome M <43.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A1701 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50 (No Comorbid… 0 0 — — — — — 2026-04-01
A1702 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 0 0 — — — — — 2026-04-01
A1704 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 0 0 — — — — — 2026-04-01
A1705 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 (No Comorbidi… 0 0 — — — — — 2026-04-01
A1801 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=67.50 (No Comorbiditi… 0 0 — — — — — 2026-04-01
A1804 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50 (n… 0 0 — — — — — 2026-04-01
A1805 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 (n… 0 0 — — — — — 2026-04-01
A1806 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 (No Comorbiditie… 0 0 — — — — — 2026-04-01
A1901 HCPCS Guillain-barré M >=66.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A1902 HCPCS Guillain-barré M >=51.50 And M <66.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A1903 HCPCS Guillain-barré M >=38.50 And M <51.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A1904 HCPCS Guillain-barré M <38.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A2001 HCPCS Miscellaneous M >=66.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A2002 HCPCS Miscellaneous M >=55.50 And M <66.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A2003 HCPCS Miscellaneous M >=46.50 And M <55.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A2004 HCPCS Miscellaneous M <46.50 And A >=77.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A2005 HCPCS Miscellaneous M <46.50 And A <77.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A2101 HCPCS Burns M >=52.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A2102 HCPCS Burns M <52.50 (No Comorbidities) 0 0 — — — — — 2026-04-01
A5001 HCPCS Short-stay Cases, Length Of Stay Is 3 Days Or Fewer (No Comorbidities) 0 0 — — — — — 2026-04-01
A5101 HCPCS Expired, Orthopedic, Length Of Stay Is 13 Days Or Fewer (No Comorbidities) 0 0 — — — — — 2026-04-01
A5102 HCPCS Expired, Orthopedic, Length Of Stay Is 14 Days Or More (No Comorbidities) 0 0 — — — — — 2026-04-01
A5103 HCPCS Expired, Not Orthopedic, Length Of Stay Is 15 Days Or Fewer (No Comorbidities) 0 0 — — — — — 2026-04-01
A5104 HCPCS Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More (No Comorbidities) 0 0 — — — — — 2026-04-01
B0101 HCPCS Stroke M >=72.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0102 HCPCS Stroke M >=63.50 And M <72.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0103 HCPCS Stroke M >=50.50 And M <63.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0104 HCPCS Stroke M >=41.50 And M <50.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0105 HCPCS Stroke M <41.50 And A >=84.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0201 HCPCS Traumatic Brain Injury M >=73.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0202 HCPCS Traumatic Brain Injury M >=61.50 And M <73.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0203 HCPCS Traumatic Brain Injury M >=49.50 And M <61.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0204 HCPCS Traumatic Brain Injury M >=35.50 And M <49.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0205 HCPCS Traumatic Brain Injury M <35.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0301 HCPCS Non-traumatic Brain Injury M >=65.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0303 HCPCS Non-traumatic Brain Injury M >=42.50 And M <52.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0304 HCPCS Non-traumatic Brain Injury M <42.50 And A >=78.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0305 HCPCS Non-traumatic Brain Injury M <42.50 And A <78.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0401 HCPCS Traumatic Spinal Cord Injury M >=56.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0402 HCPCS Traumatic Spinal Cord Injury M >=47.50 And M <56.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0403 HCPCS Traumatic Spinal Cord Injury M >=41.50 And M <47.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0404 HCPCS Traumatic Spinal Cord Injury M <31.50 And A <61.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0405 HCPCS Traumatic Spinal Cord Injury M >=31.50 And M <41.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0406 HCPCS Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0407 HCPCS Traumatic Spinal Cord Injury M <24.50 And A >=61.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0501 HCPCS Non-traumatic Spinal Cord Injury M >=60.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0502 HCPCS Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0503 HCPCS Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0504 HCPCS Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0505 HCPCS Non-traumatic Spinal Cord Injury M <39.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0601 HCPCS Neurological M >=64.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0602 HCPCS Neurological M >=52.50 And M <64.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0701 HCPCS Fracture Of Lower Extremity M >=61.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0702 HCPCS Fracture Of Lower Extremity M >=52.50 And M <61.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0703 HCPCS Fracture Of Lower Extremity M >=41.50 And M <52.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0704 HCPCS Fracture Of Lower Extremity M <41.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0801 HCPCS Replacement Of Lower-extremity Joint M >=63.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0802 HCPCS Replacement Of Lower-extremity Joint M >=57.50 And M <63.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0803 HCPCS Replacement Of Lower-extremity Joint M >=51.50 And M <57.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0804 HCPCS Replacement Of Lower-extremity Joint M >=42.50 And M <51.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0805 HCPCS Replacement Of Lower-extremity Joint M <42.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0901 HCPCS Other Orthopedic M >=63.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0902 HCPCS Other Orthopedic M >=51.50 And M <63.50 (Tier 1) 0 0 — — — — — 2026-04-01
B0903 HCPCS Other Orthopedic M >=44.50 And M <51.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1001 HCPCS Amputation Lower Extremity M >=64.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1002 HCPCS Amputation Lower Extremity M >=55.50 And M <64.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1003 HCPCS Amputation Lower Extremity M >=47.50 And M <55.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1004 HCPCS Amputation Lower Extremity M <47.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1101 HCPCS Amputation Non-lower Extremity M >=58.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1102 HCPCS Amputation Non-lower Extremity M >=52.50 And M <58.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1103 HCPCS Amputation Non-lower Extremity M <52.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1201 HCPCS Osteoarthritis M >=61.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1202 HCPCS Osteoarthritis M >=49.50 And M <61.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1203 HCPCS Osteoarthritis M <49.50 And A >=74.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1204 HCPCS Osteoarthritis M <49.50 And A <74.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1301 HCPCS Rheumatoid Other Arthritis M >=62.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1302 HCPCS Rheumatoid Other Arthritis M >=51.50 And M <62.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1303 HCPCS Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1304 HCPCS Rheumatoid Other Arthritis M <44.50 And A >=64.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1305 HCPCS Rheumatoid Other Arthritis M <51.50 And A <64.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1401 HCPCS Cardiac M >=68.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1403 HCPCS Cardiac M >=45.50 And M <55.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1404 HCPCS Cardiac M <45.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1501 HCPCS Pulmonary M >=68.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1502 HCPCS Pulmonary M >=56.50 And M <68.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1503 HCPCS Pulmonary M >=45.50 And M <56.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1504 HCPCS Pulmonary M <45.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1601 HCPCS Pain Syndrome M >=65.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1602 HCPCS Pain Syndrome M >=58.50 And M <65.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1603 HCPCS Pain Syndrome M >=43.50 And M <58.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1604 HCPCS Pain Syndrome M <43.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1701 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1702 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 0 0 — — — — — 2026-04-01
B1703 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 0 0 — — — — — 2026-04-01
B1704 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 0 0 — — — — — 2026-04-01
B1705 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1801 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=67.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1802 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50 (t… 0 0 — — — — — 2026-04-01
B1803 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50 (t… 0 0 — — — — — 2026-04-01
B1804 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50 (t… 0 0 — — — — — 2026-04-01
B1805 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 (t… 0 0 — — — — — 2026-04-01
B1806 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1901 HCPCS Guillain-barré M >=66.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1902 HCPCS Guillain-barré M >=51.50 And M <66.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1903 HCPCS Guillain-barré M >=38.50 And M <51.50 (Tier 1) 0 0 — — — — — 2026-04-01
B1904 HCPCS Guillain-barré M <38.50 (Tier 1) 0 0 — — — — — 2026-04-01
B2001 HCPCS Miscellaneous M >=66.50 (Tier 1) 0 0 — — — — — 2026-04-01
B2002 HCPCS Miscellaneous M >=55.50 And M <66.50 (Tier 1) 0 0 — — — — — 2026-04-01
B2003 HCPCS Miscellaneous M >=46.50 And M <55.50 (Tier 1) 0 0 — — — — — 2026-04-01
B2004 HCPCS Miscellaneous M <46.50 And A >=77.50 (Tier 1) 0 0 — — — — — 2026-04-01
B2005 HCPCS Miscellaneous M <46.50 And A <77.50 (Tier 1) 0 0 — — — — — 2026-04-01
B2101 HCPCS Burns M >=52.50 (Tier 1) 0 0 — — — — — 2026-04-01
B2102 HCPCS Burns M <52.50 (Tier 1) 0 0 — — — — — 2026-04-01
B5001 HCPCS Short-stay Cases, Length Of Stay Is 3 Days Or Fewer (Tier 1) 0 0 — — — — — 2026-04-01
B5101 HCPCS Expired, Orthopedic, Length Of Stay Is 13 Days Or Fewer (Tier 1) 0 0 — — — — — 2026-04-01
B5102 HCPCS Expired, Orthopedic, Length Of Stay Is 14 Days Or More (Tier 1) 0 0 — — — — — 2026-04-01
B5103 HCPCS Expired, Not Orthopedic, Length Of Stay Is 15 Days Or Fewer (Tier 1) 0 0 — — — — — 2026-04-01
B5104 HCPCS Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More (Tier 1) 0 0 — — — — — 2026-04-01
C0101 HCPCS Stroke M >=72.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0102 HCPCS Stroke M >=63.50 And M <72.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0103 HCPCS Stroke M >=50.50 And M <63.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0104 HCPCS Stroke M >=41.50 And M <50.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0105 HCPCS Stroke M <41.50 And A >=84.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0201 HCPCS Traumatic Brain Injury M >=73.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0202 HCPCS Traumatic Brain Injury M >=61.50 And M <73.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0204 HCPCS Traumatic Brain Injury M >=35.50 And M <49.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0301 HCPCS Non-traumatic Brain Injury M >=65.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0303 HCPCS Non-traumatic Brain Injury M >=42.50 And M <52.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0304 HCPCS Non-traumatic Brain Injury M <42.50 And A >=78.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0401 HCPCS Traumatic Spinal Cord Injury M >=56.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0402 HCPCS Traumatic Spinal Cord Injury M >=47.50 And M <56.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0403 HCPCS Traumatic Spinal Cord Injury M >=41.50 And M <47.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0404 HCPCS Traumatic Spinal Cord Injury M <31.50 And A <61.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0405 HCPCS Traumatic Spinal Cord Injury M >=31.50 And M <41.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0406 HCPCS Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0407 HCPCS Traumatic Spinal Cord Injury M <24.50 And A >=61.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0501 HCPCS Non-traumatic Spinal Cord Injury M >=60.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0502 HCPCS Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0503 HCPCS Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0504 HCPCS Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0601 HCPCS Neurological M >=64.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0602 HCPCS Neurological M >=52.50 And M <64.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0603 HCPCS Neurological M >=43.50 And M <52.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0701 HCPCS Fracture Of Lower Extremity M >=61.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0702 HCPCS Fracture Of Lower Extremity M >=52.50 And M <61.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0703 HCPCS Fracture Of Lower Extremity M >=41.50 And M <52.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0704 HCPCS Fracture Of Lower Extremity M <41.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0801 HCPCS Replacement Of Lower-extremity Joint M >=63.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0802 HCPCS Replacement Of Lower-extremity Joint M >=57.50 And M <63.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0803 HCPCS Replacement Of Lower-extremity Joint M >=51.50 And M <57.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0804 HCPCS Replacement Of Lower-extremity Joint M >=42.50 And M <51.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0805 HCPCS Replacement Of Lower-extremity Joint M <42.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0901 HCPCS Other Orthopedic M >=63.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0902 HCPCS Other Orthopedic M >=51.50 And M <63.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0903 HCPCS Other Orthopedic M >=44.50 And M <51.50 (Tier 2) 0 0 — — — — — 2026-04-01
C0904 HCPCS Other Orthopedic M <44.5 (Tier 2) 0 0 — — — — — 2026-04-01
C1001 HCPCS Amputation Lower Extremity M >=64.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1002 HCPCS Amputation Lower Extremity M >=55.50 And M <64.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1003 HCPCS Amputation Lower Extremity M >=47.50 And M <55.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1004 HCPCS Amputation Lower Extremity M <47.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1101 HCPCS Amputation Non-lower Extremity M >=58.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1102 HCPCS Amputation Non-lower Extremity M >=52.50 And M <58.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1103 HCPCS Amputation Non-lower Extremity M <52.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1201 HCPCS Osteoarthritis M >=61.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1202 HCPCS Osteoarthritis M >=49.50 And M <61.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1203 HCPCS Osteoarthritis M <49.50 And A >=74.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1204 HCPCS Osteoarthritis M <49.50 And A <74.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1301 HCPCS Rheumatoid Other Arthritis M >=62.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1302 HCPCS Rheumatoid Other Arthritis M >=51.50 And M <62.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1303 HCPCS Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1304 HCPCS Rheumatoid Other Arthritis M <44.50 And A >=64.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1305 HCPCS Rheumatoid Other Arthritis M <51.50 And A <64.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1401 HCPCS Cardiac M >=68.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1402 HCPCS Cardiac M >=55.50 And M <68.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1403 HCPCS Cardiac M >=45.50 And M <55.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1404 HCPCS Cardiac M <45.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1501 HCPCS Pulmonary M >=68.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1502 HCPCS Pulmonary M >=56.50 And M <68.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1503 HCPCS Pulmonary M >=45.50 And M <56.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1504 HCPCS Pulmonary M <45.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1601 HCPCS Pain Syndrome M >=65.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1602 HCPCS Pain Syndrome M >=58.50 And M <65.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1603 HCPCS Pain Syndrome M >=43.50 And M <58.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1604 HCPCS Pain Syndrome M <43.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1701 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1702 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 0 0 — — — — — 2026-04-01
C1703 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 0 0 — — — — — 2026-04-01
C1704 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 0 0 — — — — — 2026-04-01
C1705 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1801 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=67.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1802 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50 (t… 0 0 — — — — — 2026-04-01
C1803 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50 (t… 0 0 — — — — — 2026-04-01
C1804 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50 (t… 0 0 — — — — — 2026-04-01
C1805 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 (t… 0 0 — — — — — 2026-04-01
C1806 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1901 HCPCS Guillain-barré M >=66.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1902 HCPCS Guillain-barré M >=51.50 And M <66.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1903 HCPCS Guillain-barré M >=38.50 And M <51.50 (Tier 2) 0 0 — — — — — 2026-04-01
C1904 HCPCS Guillain-barré M <38.50 (Tier 2) 0 0 — — — — — 2026-04-01
C2001 HCPCS Miscellaneous M >=66.50 (Tier 2) 0 0 — — — — — 2026-04-01
C2002 HCPCS Miscellaneous M >=55.50 And M <66.50 (Tier 2) 0 0 — — — — — 2026-04-01
C2003 HCPCS Miscellaneous M >=46.50 And M <55.50 (Tier 2) 0 0 — — — — — 2026-04-01
C2004 HCPCS Miscellaneous M <46.50 And A >=77.50 (Tier 2) 0 0 — — — — — 2026-04-01
C2005 HCPCS Miscellaneous M <46.50 And A <77.50 (Tier 2) 0 0 — — — — — 2026-04-01
C2101 HCPCS Burns M >=52.50 (Tier 2) 0 0 — — — — — 2026-04-01
C2102 HCPCS Burns M <52.50 (Tier 2) 0 0 — — — — — 2026-04-01
C5001 HCPCS Short-stay Cases, Length Of Stay Is 3 Days Or Fewer (Tier 2) 0 0 — — — — — 2026-04-01
C5101 HCPCS Expired, Orthopedic, Length Of Stay Is 13 Days Or Fewer (Tier 2) 0 0 — — — — — 2026-04-01
C5102 HCPCS Expired, Orthopedic, Length Of Stay Is 14 Days Or More (Tier 2) 0 0 — — — — — 2026-04-01
C5103 HCPCS Expired, Not Orthopedic, Length Of Stay Is 15 Days Or Fewer (Tier 2) 0 0 — — — — — 2026-04-01
C5104 HCPCS Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More (Tier 2) 0 0 — — — — — 2026-04-01
D0101 HCPCS Stroke M >=72.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0105 HCPCS Stroke M <41.50 And A >=84.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0201 HCPCS Traumatic Brain Injury M >=73.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0202 HCPCS Traumatic Brain Injury M >=61.50 And M <73.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0204 HCPCS Traumatic Brain Injury M >=35.50 And M <49.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0205 HCPCS Traumatic Brain Injury M <35.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0304 HCPCS Non-traumatic Brain Injury M <42.50 And A >=78.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0305 HCPCS Non-traumatic Brain Injury M <42.50 And A <78.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0401 HCPCS Traumatic Spinal Cord Injury M >=56.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0403 HCPCS Traumatic Spinal Cord Injury M >=41.50 And M <47.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0404 HCPCS Traumatic Spinal Cord Injury M <31.50 And A <61.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0405 HCPCS Traumatic Spinal Cord Injury M >=31.50 And M <41.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0406 HCPCS Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0407 HCPCS Traumatic Spinal Cord Injury M <24.50 And A >=61.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0501 HCPCS Non-traumatic Spinal Cord Injury M >=60.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0503 HCPCS Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0601 HCPCS Neurological M >=64.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0701 HCPCS Fracture Of Lower Extremity M >=61.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0702 HCPCS Fracture Of Lower Extremity M >=52.50 And M <61.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0704 HCPCS Fracture Of Lower Extremity M <41.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0801 HCPCS Replacement Of Lower-extremity Joint M >=63.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0802 HCPCS Replacement Of Lower-extremity Joint M >=57.50 And M <63.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0803 HCPCS Replacement Of Lower-extremity Joint M >=51.50 And M <57.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0804 HCPCS Replacement Of Lower-extremity Joint M >=42.50 And M <51.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0805 HCPCS Replacement Of Lower-extremity Joint M <42.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0901 HCPCS Other Orthopedic M >=63.50 (Tier 3) 0 0 — — — — — 2026-04-01
D0902 HCPCS Other Orthopedic M >=51.50 And M <63.50 (Tier 3) 0 0 — — — — — 2026-04-01
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