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 />
37760 <strong>04</strong> N M Y 299.70<br />
37765 <strong>04</strong> N M 245.90<br />
37766 <strong>04</strong> N M 298.81<br />
37780 <strong>04</strong> N M 149.80<br />
37785 <strong>04</strong> N I 131.25<br />
37788 <strong>04</strong> Y M<br />
37790 <strong>04</strong> Y M Y<br />
37799 <strong>04</strong> Y M Y<br />
38100 <strong>04</strong> N M Y Y 770.00<br />
381<strong>01</strong> <strong>04</strong> N M Y 770.00<br />
38102 <strong>04</strong> Y M Y Y<br />
38115 <strong>04</strong> N M Y 770.00<br />
38120 <strong>04</strong> N M Y 770.00<br />
38129 <strong>04</strong> Y M Y<br />
38200 <strong>04</strong> N I 66.50<br />
382<strong>04</strong> <strong>09</strong> Y I<br />
38205 <strong>04</strong> Y I<br />
38206 <strong>04</strong> Y I<br />
38207 <strong>09</strong> Y I<br />
38208 <strong>09</strong> Y I<br />
382<strong>09</strong> <strong>09</strong> Y I<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 153 <strong>of</strong> 458
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