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 31635 04 N M 239.15 56.70 31636 04 N M Y 251.10 31637 04 N M Y 251.10 31638 04 N M Y 251.10 31640 04 N M 251.10 31641 04 N M 251.10 31643 04 N I 235.95 31645 04 N I 219.35 56.70 31646 04 N I 219.35 56.70 31656 04 N I 270.50 31715 04 N I 74.90 31717 04 N I 230.25 31720 04 N I 224.70 31725 04 N I 224.70 31730 04 N I Y 88.90 31750 04 N M Y Y 713.50 31755 04 N M Y 527.50 31760 04 N M Y Y 1,123.70 31766 04 N M Y Y 1,198.70 31770 04 N M Y Y 1,048.85 31775 04 N M Y Y 1,123.70 Wednesday, April 01, 2009 Page 118 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 31780 04 N M Y Y 749.20 31781 04 N M Y Y 1,123.70 31785 04 N M Y Y 1,198.70 31786 04 N M Y Y 1,198.70 31800 04 N M Y Y 524.40 31805 04 N M Y Y 749.20 31820 04 N M 214.00 34.00 31825 04 N M Y 374.55 31830 04 N M Y 166.75 31899 04 Y M Y 32035 04 N M Y 524.40 32036 04 N M Y 331.15 32095 04 N M Y 419.00 32100 04 N M Y 811.50 32110 04 N M Y 811.50 32120 04 N M Y 599.35 32124 04 N M Y 599.35 32140 04 N M Y 599.35 32141 04 N M Y 599.35 32150 04 N M Y 599.35 32151 04 N M Y 599.35 Wednesday, April 01, 2009 Page 119 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 />
31780 <strong>04</strong> N M Y Y 749.20<br />
31781 <strong>04</strong> N M Y Y 1,123.70<br />
31785 <strong>04</strong> N M Y Y 1,198.70<br />
31786 <strong>04</strong> N M Y Y 1,198.70<br />
31800 <strong>04</strong> N M Y Y 524.40<br />
31805 <strong>04</strong> N M Y Y 749.20<br />
31820 <strong>04</strong> N M 214.00 34.00<br />
31825 <strong>04</strong> N M Y 374.55<br />
31830 <strong>04</strong> N M Y 166.75<br />
31899 <strong>04</strong> Y M Y<br />
32035 <strong>04</strong> N M Y 524.40<br />
32036 <strong>04</strong> N M Y 331.15<br />
32<strong>09</strong>5 <strong>04</strong> N M Y 419.00<br />
32100 <strong>04</strong> N M Y 811.50<br />
32110 <strong>04</strong> N M Y 811.50<br />
32120 <strong>04</strong> N M Y 599.35<br />
32124 <strong>04</strong> N M Y 599.35<br />
32140 <strong>04</strong> N M Y 599.35<br />
32141 <strong>04</strong> N M Y 599.35<br />
32150 <strong>04</strong> N M Y 599.35<br />
32151 <strong>04</strong> N M Y 599.35<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 119 <strong>of</strong> 458
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