Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois
Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois
Hcpcs Note ProgCov Eff Date HP NDC Ind SurgInd M1 (26) M2 (TC) Assist Surg Co-Surg Unitprice MaxQty StateMax Surg Child Adult 28825 04 N I Y 145.60 28890 04 N M 121.80 28899 04 Y M Y 29000 04 N I 156.80 29010 04 N I 141.50 29015 04 N I 188.70 29020 04 N I 205.30 29025 04 N I 227.50 29035 04 N I 152.60 29040 04 N I 181.65 29044 04 N I 173.40 29046 04 N I 187.30 29049 04 N I 66.10 34.00 29055 04 N I 115.80 34.00 29058 04 N I 79.30 34.00 29065 04 N I 59.45 34.00 29075 04 N I 59.45 34.00 29085 04 N I 49.30 17.00 29086 04 N I 30.70 29105 04 N I 42.10 17.00 29125 04 N I 32.15 17.00 Wednesday, April 01, 2009 Page 104 of 458
Hcpcs Note ProgCov Eff Date HP NDC Ind SurgInd M1 (26) M2 (TC) Assist Surg Co-Surg Unitprice MaxQty StateMax Surg Child Adult 29126 04 N I 39.30 17.00 29130 04 N I 23.00 17.00 29131 04 N I 23.50 17.00 29200 04 N I 24.25 29220 04 N I 23.00 29240 04 N I 37.40 29260 04 N I 19.95 29280 04 N I 19.30 29305 04 N I 166.40 29325 04 N I 194.20 29345 04 N I 79.30 34.00 29355 04 N I 92.40 34.00 29358 04 N I 174.40 34.00 29365 04 N I 79.30 34.00 29405 04 N I 70.00 34.00 29425 04 N I 75.30 34.00 29435 04 N I 79.30 34.00 29440 04 N I 29.80 29445 04 N I 91.65 29450 04 N I 43.50 17.00 29505 04 N I 43.50 17.00 Wednesday, April 01, 2009 Page 105 of 458
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Hcpcs Note ProgCov Eff Date HP NDC Ind SurgInd M1 (26) M2 (TC) Assist Surg Co-Surg Unitprice MaxQty <strong>State</strong>Max Surg Child Adult<br />
29126 <strong>04</strong> N I 39.30 17.00<br />
29130 <strong>04</strong> N I 23.00 17.00<br />
29131 <strong>04</strong> N I 23.50 17.00<br />
29200 <strong>04</strong> N I 24.25<br />
29220 <strong>04</strong> N I 23.00<br />
29240 <strong>04</strong> N I 37.40<br />
29260 <strong>04</strong> N I 19.95<br />
29280 <strong>04</strong> N I 19.30<br />
29305 <strong>04</strong> N I 166.40<br />
29325 <strong>04</strong> N I 194.20<br />
29345 <strong>04</strong> N I 79.30 34.00<br />
29355 <strong>04</strong> N I 92.40 34.00<br />
29358 <strong>04</strong> N I 174.40 34.00<br />
29365 <strong>04</strong> N I 79.30 34.00<br />
29405 <strong>04</strong> N I 70.00 34.00<br />
29425 <strong>04</strong> N I 75.30 34.00<br />
29435 <strong>04</strong> N I 79.30 34.00<br />
29440 <strong>04</strong> N I 29.80<br />
29445 <strong>04</strong> N I 91.65<br />
29450 <strong>04</strong> N I 43.50 17.00<br />
29505 <strong>04</strong> N I 43.50 17.00<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 105 <strong>of</strong> 458
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