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 43351 04 N M Y Y 839.35 43352 04 N M Y Y 839.35 43360 04 N M Y Y 1467.80 43361 04 N M Y Y 1782.30 43400 04 N M Y Y 480.00 43401 04 N M Y 822.80 43405 04 Y M Y Y 43410 04 N M Y Y 480.00 43415 04 N M Y Y 839.35 43420 04 N M Y Y 480.00 43425 04 N M Y Y 839.35 43450 04 N I 74.90 43453 04 N I 74.90 43456 04 N I 112.40 43458 04 N I 142.70 43460 04 N I 93.05 43496 04 N M Y Y 1778.60 43499 04 Y M Y 43500 04 N M Y Y 599.35 43501 04 N M Y Y 599.35 43502 04 N M Y Y 658.90 Wednesday, April 01, 2009 Page 170 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 43510 04 N M Y Y 599.35 43520 04 N M Y Y 599.35 43600 04 N I 108.20 43605 04 N M Y Y 599.35 43610 04 N M Y Y 718.70 43611 04 N M Y Y 564.99 43620 04 N M Y Y 1011.40 43621 04 N M Y Y 1011.40 43622 04 N M Y Y 1173.40 43631 04 N M Y Y 915.65 43632 04 N M Y Y 915.65 43633 04 N M Y Y 915.65 43634 04 N M Y Y 1077.70 43635 04 N M Y Y 1026.65 43640 04 N M Y Y 812.90 43641 04 N M Y 812.90 43644 K 04 N M Y 942.28 43645 K 04 N M Y 1017.05 43647 04 1/1/2007 N M Y 399.59 43648 04 1/1/2007 N M 399.50 43651 04 N M Y 524.40 Wednesday, April 01, 2009 Page 171 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 />
43351 <strong>04</strong> N M Y Y 839.35<br />
43352 <strong>04</strong> N M Y Y 839.35<br />
43360 <strong>04</strong> N M Y Y 1467.80<br />
43361 <strong>04</strong> N M Y Y 1782.30<br />
43400 <strong>04</strong> N M Y Y 480.00<br />
434<strong>01</strong> <strong>04</strong> N M Y 822.80<br />
43405 <strong>04</strong> Y M Y Y<br />
43410 <strong>04</strong> N M Y Y 480.00<br />
43415 <strong>04</strong> N M Y Y 839.35<br />
43420 <strong>04</strong> N M Y Y 480.00<br />
43425 <strong>04</strong> N M Y Y 839.35<br />
43450 <strong>04</strong> N I 74.90<br />
43453 <strong>04</strong> N I 74.90<br />
43456 <strong>04</strong> N I 112.40<br />
43458 <strong>04</strong> N I 142.70<br />
43460 <strong>04</strong> N I 93.05<br />
43496 <strong>04</strong> N M Y Y 1778.60<br />
43499 <strong>04</strong> Y M Y<br />
43500 <strong>04</strong> N M Y Y 599.35<br />
435<strong>01</strong> <strong>04</strong> N M Y Y 599.35<br />
43502 <strong>04</strong> N M Y Y 658.90<br />
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