District of Columbia workers’ comp
Code 99204 — maximum allowable reimbursement
DC + MD/VA SUBURBS
Maximum allowable (non-facility)
$223.33
Single statewide rate
Show your work — how this rate is computed
By statute (DC Code §32-1507(a-1)(5)), District of Columbia sets the workers’-comp maximum at 113% of the Medicare fee for this code in the DC + MD/VA SUBURBS Medicare locality.
- RVUs: CMS National Physician Fee Schedule Relative Value File; GPCIs: CMS Geographic Practice Cost Indices (the DC + MD/VA SUBURBS Medicare locality).
- The 113%-of-Medicare rule: District of Columbiaworkers’ comp statute (DC Code §32-1507(a-1)(5)) — source ↗
- The Medicare fee itself is verified to the penny against the CMS Physician Fee Schedule Look-Up Tool; a code Medicare does not price is shown as an honest gap.
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