TWCC MEDICAL FEE GUIDELINES

(Effective January 1, 2004)

If your county is not listed specifically,

then you are in Locality 99 – Other Texas Regions

Brazoria County

09	98925	OMT	$36.68
09	98926		$50.74
09	98927		$66.35
09	98928		$77.93
09	98929		$89.65

09	99201	E & M	$45.05
09	99202		$80.83
09	99203		$120.28
09	99204		$169.65
09	99205		$215.39
09	99211		$26.35
09	99212		$46.88
09	99213		$65.69
09	99214		$102.34
09	99215		$148.70

Dallas County

11	98925	OMT	$38.08
11	98926		$52.45
11	98927		$68.23
11	98928		$80.24
11	98929		$92.22

11	99201	E & M	$47.00
11	99202		$83.54
11	99203		$123.98
11	99204		$174.91
11	99205		$221.84
11	99211		$27.86
11	99212		$48.99
11	99213		$68.24
11	99214		$106.36
11	99215		$153.76

Galveston County

15	98925	OMT	$36.54
15	98926		$50.56
15	98927		$66.13
15	98928		$77.66
15	98929		$89.36

15	99201	E & M	$44.85
15	99202		$80.49
15	99203		$119.80
15	99204		$169.01
15	99205		$214.63
15	99211		$26.19
15	99212		$46.65
15	99213		$65.39
15	99214		$101.90
15	99215		$148.14

Harris County

18	98925	OMT	$37.55
18	98926		$51.91
18	98927		$67.84
18	98928		$79.69
18	98929		$91.68

18	99201	E & M	$46.15
18	99202		$82.71
18	99203		$123.04
18	99204		$173.55
18	99205		$220.30
18	99211		$27.04
18	99212		$48.03
18	99213		$67.25
18	99214		$104.79
18	99215		$152.15

Jefferson County

20	98925	OMT	$35.33
20	98926		$49.01
20	98927		$64.25
20	98928		$75.45
20	98929		$86.86

20	99201	E & M	$43.00
20	99202		$77.58
20	99203		$115.63
20	99204		$163.45
20	99205		$207.99
20	99211		$24.75
20	99212		$44.66
20	99213		$62.81
20	99214		$98.03
20	99215		$143.19

Tarrant County

28	98925	OMT	$36.58
28	98926		$50.50
28	98927		$65.81
28	98928		$77.40
28	98929		$89.00

28	99201	E & M	$44.83
28	99202		$80.03
28	99203		$118.93
28	99204		$168.06
28	99205		$213.54
28	99211		$26.25
28	99212		$46.65
28	99213		$65.18
28	99214		$101.74
28	99215		$147.68

Travis County

31	98925	OMT	$36.78
31	98926		$50.73
31	98927		$66.04
31	98928		$77.69
31	98929		$89.30

31	99201	E & M	$45.10
31	99202		$80.38
31	99203		$119.38
31	99204		$168.70
31	99205		$214.31
31	99211		$26.49
31	99212		$46.96
31	99213		$65.53
31	99214		$102.30
31	99215		$148.34

Other Texas Regions

99	98925	OMT	$35.05
99	98926		$48.56
99	98927		$63.50
99	98928		$74.68
99	98929		$85.91

99	99201	E & M	$42.51
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