| Procedure Code | Procedure Description | Pricing Indicator | Rate Type | Mod1 | Mod2 | Mod3 | Mod4 | Max Fee | Max Fee Eff. Date | Max Fee End Date | PA |
| 97799 | UNLISTED PHYSCL MED/REHAB PX | IPXOVR | DEF | NA | NA | NA | N | ||||
| 97799 | UNLISTED PHYSCL MED/REHAB PX | OPXOVR | DEF | NA | NA | NA | N | ||||
| 97799 | UNLISTED PHYSCL MED/REHAB PX | MAXFEE | NFT | 25.96 | 10/16/2003 | 12/31/2299 | N |