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 36140 04 N I 188.70 36145 04 N I 188.70 36160 04 N I 202.50 36200 04 N I 224.70 36215 04 N I 198.90 36216 04 N I 264.80 36217 04 N I 281.00 36218 04 N I 281.00 36245 04 N I 213.50 36246 04 N I 264.80 36247 04 N I 281.00 36248 04 N I 281.00 36260 04 Y M 36261 04 Y M 36262 04 Y M 36299 04 Y I Y 36400 04 N I 16.65 36405 04 N I 16.65 36406 04 N I 16.65 36410 04 N I 16.65 36415 J 04 N I 4.10 Wednesday, April 01, 2009 Page 146 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 36416 J 04 5/1/2007 N I 4.10 36420 04 N I 37.40 36425 04 N I 37.40 36430 04 N I 16.65 36440 04 N I 28.80 36450 04 N I 308.00 36455 04 N I 338.50 36460 04 N I 176.90 36470 04 Y I 17.00 36471 04 Y I 17.00 36475 04 N M 213.52 36476 04 N M 104.57 36478 04 N M 213.52 36479 04 N M 104.57 36481 04 N I 264.80 36500 04 N I 71.05 36510 04 N I 25.20 36511 04 Y I 36512 04 Y I 36513 04 Y I 36514 04 Y I Wednesday, April 01, 2009 Page 147 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 />
36416 J <strong>04</strong> 5/1/2007 N I 4.10<br />
36420 <strong>04</strong> N I 37.40<br />
36425 <strong>04</strong> N I 37.40<br />
36430 <strong>04</strong> N I 16.65<br />
36440 <strong>04</strong> N I 28.80<br />
36450 <strong>04</strong> N I 308.00<br />
36455 <strong>04</strong> N I 338.50<br />
36460 <strong>04</strong> N I 176.90<br />
36470 <strong>04</strong> Y I 17.00<br />
36471 <strong>04</strong> Y I 17.00<br />
36475 <strong>04</strong> N M 213.52<br />
36476 <strong>04</strong> N M 1<strong>04</strong>.57<br />
36478 <strong>04</strong> N M 213.52<br />
36479 <strong>04</strong> N M 1<strong>04</strong>.57<br />
36481 <strong>04</strong> N I 264.80<br />
36500 <strong>04</strong> N I 71.05<br />
36510 <strong>04</strong> N I 25.20<br />
36511 <strong>04</strong> Y I<br />
36512 <strong>04</strong> Y I<br />
36513 <strong>04</strong> Y I<br />
36514 <strong>04</strong> Y I<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 147 <strong>of</strong> 458
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