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 33206 04 N M Y 861.50 33207 04 N M Y Y 861.50 33208 04 N M Y 861.50 33210 04 N I Y 240.00 33211 04 N I Y 240.00 33212 04 N I Y 240.00 33213 04 N I Y 240.00 33214 04 N M Y 299.70 33215 04 N M 299.70 33216 04 N M Y 299.70 33217 04 N M Y 299.70 33218 04 N M 299.70 33220 04 N M 245.65 33222 04 N M Y 299.70 33223 04 N M Y 299.70 33224 04 N M Y Y 299.70 33225 04 N M Y Y 299.70 33226 04 N M Y Y 299.70 33233 04 N M Y 167.40 33234 04 N M Y 351.00 33235 04 N M Y 351.00 Wednesday, April 01, 2009 Page 124 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 33236 04 N M Y Y 419.00 33237 04 N M Y Y 433.95 33238 04 N M Y Y 452.80 33240 04 Y I Y 33241 04 Y I Y 33243 04 Y M Y Y 33244 04 Y I Y 33249 04 N M Y 642.60 33250 04 N M Y Y 1,798.10 33251 04 N M Y Y 2,397.40 33254 04 1/1/2007 N M Y 2,397.40 33255 04 1/1/2007 N M Y 2,397.40 33256 04 1/1/2007 N M Y 2,397.40 33257 04 1/1/2008 N M Y 327.74 33258 04 1/1/2008 N M Y 371.27 33259 04 1/1/2008 N M 489.48 33261 04 N M Y Y 2,397.40 33265 04 1/1/2007 N M Y 2,397.40 33266 04 1/1/2007 N M Y 2,397.40 33282 04 N M 584.80 33284 04 N M 444.05 Wednesday, April 01, 2009 Page 125 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 />
33206 <strong>04</strong> N M Y 861.50<br />
33207 <strong>04</strong> N M Y Y 861.50<br />
33208 <strong>04</strong> N M Y 861.50<br />
33210 <strong>04</strong> N I Y 240.00<br />
33211 <strong>04</strong> N I Y 240.00<br />
33212 <strong>04</strong> N I Y 240.00<br />
33213 <strong>04</strong> N I Y 240.00<br />
33214 <strong>04</strong> N M Y 299.70<br />
33215 <strong>04</strong> N M 299.70<br />
33216 <strong>04</strong> N M Y 299.70<br />
33217 <strong>04</strong> N M Y 299.70<br />
33218 <strong>04</strong> N M 299.70<br />
33220 <strong>04</strong> N M 245.65<br />
33222 <strong>04</strong> N M Y 299.70<br />
33223 <strong>04</strong> N M Y 299.70<br />
33224 <strong>04</strong> N M Y Y 299.70<br />
33225 <strong>04</strong> N M Y Y 299.70<br />
33226 <strong>04</strong> N M Y Y 299.70<br />
33233 <strong>04</strong> N M Y 167.40<br />
33234 <strong>04</strong> N M Y 351.00<br />
33235 <strong>04</strong> N M Y 351.00<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 124 <strong>of</strong> 458
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