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 37250 04 N I 89.10 37251 04 N I 57.65 37500 04 N I 299.70 37501 04 Y I 37565 04 N M Y 374.55 37600 04 N M Y 374.55 37605 04 N M Y 449.50 37606 04 N M Y 449.50 37607 04 N M Y Y 262.20 37609 04 N I 112.40 37615 04 N M Y 374.55 37616 04 N M Y 524.40 37617 04 N M Y 524.40 37618 04 N M Y 262.20 37620 04 N M Y 449.50 37650 04 N M Y 374.55 37660 04 N M Y 449.50 37700 04 N M Y 203.95 37718 04 N I Y 227.39 37722 04 N I Y 275.02 37735 04 N M Y 419.00 Wednesday, April 01, 2009 Page 152 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 37760 04 N M Y 299.70 37765 04 N M 245.90 37766 04 N M 298.81 37780 04 N M 149.80 37785 04 N I 131.25 37788 04 Y M 37790 04 Y M Y 37799 04 Y M Y 38100 04 N M Y Y 770.00 38101 04 N M Y 770.00 38102 04 Y M Y Y 38115 04 N M Y 770.00 38120 04 N M Y 770.00 38129 04 Y M Y 38200 04 N I 66.50 38204 09 Y I 38205 04 Y I 38206 04 Y I 38207 09 Y I 38208 09 Y I 38209 09 Y I Wednesday, April 01, 2009 Page 153 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 />
37250 <strong>04</strong> N I 89.10<br />
37251 <strong>04</strong> N I 57.65<br />
37500 <strong>04</strong> N I 299.70<br />
375<strong>01</strong> <strong>04</strong> Y I<br />
37565 <strong>04</strong> N M Y 374.55<br />
37600 <strong>04</strong> N M Y 374.55<br />
37605 <strong>04</strong> N M Y 449.50<br />
37606 <strong>04</strong> N M Y 449.50<br />
37607 <strong>04</strong> N M Y Y 262.20<br />
376<strong>09</strong> <strong>04</strong> N I 112.40<br />
37615 <strong>04</strong> N M Y 374.55<br />
37616 <strong>04</strong> N M Y 524.40<br />
37617 <strong>04</strong> N M Y 524.40<br />
37618 <strong>04</strong> N M Y 262.20<br />
37620 <strong>04</strong> N M Y 449.50<br />
37650 <strong>04</strong> N M Y 374.55<br />
37660 <strong>04</strong> N M Y 449.50<br />
37700 <strong>04</strong> N M Y 203.95<br />
37718 <strong>04</strong> N I Y 227.39<br />
37722 <strong>04</strong> N I Y 275.02<br />
37735 <strong>04</strong> N M Y 419.00<br />
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