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 43245 04 N I 249.70 56.70 43246 04 N I Y 249.70 56.70 43247 04 N M 249.70 56.70 43248 04 N I 295.95 43249 04 N I 113.40 43250 04 N I 249.70 43251 04 N I 249.70 56.70 43255 04 N I 249.70 56.70 43256 04 N M Y 159.35 43257 04 N I 170.53 43258 04 N M 249.70 43259 04 N I 240.30 43260 04 N I 264.25 56.70 43261 04 N I 264.25 43262 04 N M 390.10 56.70 43263 04 N I Y Y 264.25 56.70 43264 04 N M 390.10 56.70 43265 04 N M 390.10 43267 04 N I 264.25 56.70 43268 04 N M 358.60 56.70 43269 04 N M 358.60 Wednesday, April 01, 2009 Page 168 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 43271 04 N M 358.60 56.70 43272 04 N M 390.10 56.70 43273 04 1/1/2009 N M Y 117.03 43279 04 1/1/2009 N M Y 682.60 43280 04 N M Y Y 682.60 43289 04 Y M Y 43300 04 N M Y Y 786.60 43305 04 N M Y Y 1258.35 43310 04 N M Y Y 839.35 43312 04 N M Y Y 1258.35 43313 04 N M Y Y 1188.50 43314 04 N M Y Y 1564.90 43320 04 N M Y Y 958.60 43324 04 N M Y Y 682.60 43325 04 N M Y Y 749.20 43326 04 N M Y 749.20 43330 04 N M Y Y 1082.10 43331 04 N M Y Y 1082.10 43340 04 N M Y Y 1198.70 43341 04 N M Y Y 1082.10 43350 04 N M Y Y 839.35 Wednesday, April 01, 2009 Page 169 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 />
43271 <strong>04</strong> N M 358.60 56.70<br />
43272 <strong>04</strong> N M 390.10 56.70<br />
43273 <strong>04</strong> 1/1/20<strong>09</strong> N M Y 117.03<br />
43279 <strong>04</strong> 1/1/20<strong>09</strong> N M Y 682.60<br />
43280 <strong>04</strong> N M Y Y 682.60<br />
43289 <strong>04</strong> Y M Y<br />
43300 <strong>04</strong> N M Y Y 786.60<br />
43305 <strong>04</strong> N M Y Y 1258.35<br />
43310 <strong>04</strong> N M Y Y 839.35<br />
43312 <strong>04</strong> N M Y Y 1258.35<br />
43313 <strong>04</strong> N M Y Y 1188.50<br />
43314 <strong>04</strong> N M Y Y 1564.90<br />
43320 <strong>04</strong> N M Y Y 958.60<br />
43324 <strong>04</strong> N M Y Y 682.60<br />
43325 <strong>04</strong> N M Y Y 749.20<br />
43326 <strong>04</strong> N M Y 749.20<br />
43330 <strong>04</strong> N M Y Y 1082.10<br />
43331 <strong>04</strong> N M Y Y 1082.10<br />
43340 <strong>04</strong> N M Y Y 1198.70<br />
43341 <strong>04</strong> N M Y Y 1082.10<br />
43350 <strong>04</strong> N M Y Y 839.35<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 169 <strong>of</strong> 458
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