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 41135 04 N M Y Y 861.50 41140 04 N M Y Y 735.65 41145 04 N M Y Y 1048.85 41150 04 N M Y Y 1498.30 41153 04 N M Y Y 1498.30 41155 04 N M Y Y 1798.05 41250 04 N I 71.40 34.00 41251 04 N I 74.10 34.00 41252 04 N I 95.25 34.00 41500 04 N I 121.70 41510 04 N M 374.55 41512 04 1/1/2009 N I 71.40 41520 04 N I 92.70 41530 04 1/1/2009 N I 222.81 41599 04 Y M Y 41800 04 N I 39.70 17.00 41805 04 N I 42.30 17.00 41806 04 N I 90.10 41820 04 N I 99.05 41821 04 N I 71.60 41822 04 N I 90.10 Wednesday, April 01, 2009 Page 160 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 41823 04 N M 169.40 41825 04 N I 76.95 41826 04 N M 224.70 41827 04 N M 299.70 41828 04 N I 110.35 41830 04 N M 224.70 41850 04 N I 41.25 41870 04 N M Y Y 169.40 41872 04 N M 169.40 41874 04 N M 169.40 41899 04 Y M Y 42000 04 N I 43.05 17.00 42100 04 N I 50.20 34.00 42104 04 N I 79.30 34.00 42106 04 N M Y Y 480.00 42107 04 N M Y Y 506.40 42120 04 N M Y Y 647.90 42140 04 N M 184.50 42145 04 N M Y 359.30 42160 04 N I 64.10 17.00 42180 04 N M Y Y 149.80 Wednesday, April 01, 2009 Page 161 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 />
41135 <strong>04</strong> N M Y Y 861.50<br />
41140 <strong>04</strong> N M Y Y 735.65<br />
41145 <strong>04</strong> N M Y Y 1<strong>04</strong>8.85<br />
41150 <strong>04</strong> N M Y Y 1498.30<br />
41153 <strong>04</strong> N M Y Y 1498.30<br />
41155 <strong>04</strong> N M Y Y 1798.05<br />
41250 <strong>04</strong> N I 71.40 34.00<br />
41251 <strong>04</strong> N I 74.10 34.00<br />
41252 <strong>04</strong> N I 95.25 34.00<br />
41500 <strong>04</strong> N I 121.70<br />
41510 <strong>04</strong> N M 374.55<br />
41512 <strong>04</strong> 1/1/20<strong>09</strong> N I 71.40<br />
41520 <strong>04</strong> N I 92.70<br />
41530 <strong>04</strong> 1/1/20<strong>09</strong> N I 222.81<br />
41599 <strong>04</strong> Y M Y<br />
41800 <strong>04</strong> N I 39.70 17.00<br />
41805 <strong>04</strong> N I 42.30 17.00<br />
41806 <strong>04</strong> N I 90.10<br />
41820 <strong>04</strong> N I 99.05<br />
41821 <strong>04</strong> N I 71.60<br />
41822 <strong>04</strong> N I 90.10<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 160 <strong>of</strong> 458
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