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 32160 04 N M Y 374.55 32200 04 N M Y 480.00 32201 04 N M 434.45 32215 04 N M Y 599.35 32220 04 N M Y 749.20 32225 04 N M Y 599.35 32310 04 N M Y 958.60 32320 04 N M Y 1,198.70 32400 04 N I 71.40 34.00 32402 04 N M Y 524.40 32405 04 N I 107.00 34.00 32420 04 N I 107.00 34.00 32421 04 1/1/2008 N I 87.98 32422 04 1/1/2008 N I 108.51 32440 04 N M Y Y 1,198.70 32442 04 N M Y Y 1,414.70 32445 04 N M Y Y 1,198.70 32480 04 N M Y Y 1,213.95 32482 04 N M Y Y 1,213.95 32484 04 N M Y Y 1,213.95 32486 04 N M Y Y 1,350.15 Wednesday, April 01, 2009 Page 120 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 32488 04 N M Y Y 1,213.95 32491 04 N M Y Y 1,213.95 32500 04 N M Y 718.70 32501 04 N M Y Y 324.05 32503 04 N M Y 1,050.34 32504 04 N M Y 1,203.13 32540 04 N M Y Y 958.60 32550 04 1/1/2008 N M 127.01 318.46 32551 04 1/1/2008 N M 224.70 32560 04 1/1/2008 N I 198.20 32601 04 N I Y 167.20 32602 04 N I Y 181.35 32603 04 N I Y 302.40 32604 04 N I Y 302.40 32605 04 N I Y 314.95 32606 04 N I Y 314.95 32650 04 N M Y 349.85 32651 04 N M Y 426.10 32652 04 N M Y 591.40 32653 04 N M Y 418.50 32654 04 N M Y 400.80 Wednesday, April 01, 2009 Page 121 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 />
32488 <strong>04</strong> N M Y Y 1,213.95<br />
32491 <strong>04</strong> N M Y Y 1,213.95<br />
32500 <strong>04</strong> N M Y 718.70<br />
325<strong>01</strong> <strong>04</strong> N M Y Y 324.05<br />
32503 <strong>04</strong> N M Y 1,050.34<br />
325<strong>04</strong> <strong>04</strong> N M Y 1,203.13<br />
32540 <strong>04</strong> N M Y Y 958.60<br />
32550 <strong>04</strong> 1/1/2008 N M 127.<strong>01</strong> 318.46<br />
32551 <strong>04</strong> 1/1/2008 N M 224.70<br />
32560 <strong>04</strong> 1/1/2008 N I 198.20<br />
326<strong>01</strong> <strong>04</strong> N I Y 167.20<br />
32602 <strong>04</strong> N I Y 181.35<br />
32603 <strong>04</strong> N I Y 302.40<br />
326<strong>04</strong> <strong>04</strong> N I Y 302.40<br />
32605 <strong>04</strong> N I Y 314.95<br />
32606 <strong>04</strong> N I Y 314.95<br />
32650 <strong>04</strong> N M Y 349.85<br />
32651 <strong>04</strong> N M Y 426.10<br />
32652 <strong>04</strong> N M Y 591.40<br />
32653 <strong>04</strong> N M Y 418.50<br />
32654 <strong>04</strong> N M Y 400.80<br />
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