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 43652 04 N M Y 524.40 43653 04 N M Y 399.50 43659 04 Y M Y 43752 04 N I Y 35.05 43760 04 N I 35.65 17.00 43761 04 N I 48.50 43770 K 04 N I Y 565.47 43771 K 04 N I Y 652.01 43772 K 04 N I Y 497.20 43773 K 04 N I Y 652.27 43774 K 04 N I Y 497.78 43800 04 N M Y Y 699.20 43810 04 N M Y Y 718.70 43820 04 N M Y Y 718.70 43825 04 N M Y YY 898.95 43830 04 N M Y Y 399.50 43831 04 N M Y Y 399.50 43832 04 N M Y Y 399.50 43840 04 N M Y Y 678.40 43842 K 04 N M Y 718.70 43843 K 04 N M Y 718.70 Wednesday, April 01, 2009 Page 172 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 43845 K 04 N M Y 982.18 43846 K 04 N M Y Y 770.00 43847 K 04 N M Y Y 986.00 43848 K 04 N M Y Y 770.00 43850 04 N M Y Y 718.70 43855 04 N M Y Y 793.60 43860 04 N M Y Y 718.70 43865 04 N M Y Y 793.60 43870 04 N M Y Y 240.00 43880 04 N M Y Y 958.60 43881 04 1/1/2007 N M Y 599.35 43882 04 1/1/2007 N M Y 599.35 43886 04 N I Y 152.73 43887 04 N I Y 151.56 43888 04 N I Y 215.38 43999 04 Y M Y 44005 04 N M Y Y 643.65 44010 04 N M Y Y 599.35 44015 04 N M Y 399.50 44020 04 N M Y Y 599.35 44021 04 N M Y Y 599.35 Wednesday, April 01, 2009 Page 173 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 />
43652 <strong>04</strong> N M Y 524.40<br />
43653 <strong>04</strong> N M Y 399.50<br />
43659 <strong>04</strong> Y M Y<br />
43752 <strong>04</strong> N I Y 35.05<br />
43760 <strong>04</strong> N I 35.65 17.00<br />
43761 <strong>04</strong> N I 48.50<br />
43770 K <strong>04</strong> N I Y 565.47<br />
43771 K <strong>04</strong> N I Y 652.<strong>01</strong><br />
43772 K <strong>04</strong> N I Y 497.20<br />
43773 K <strong>04</strong> N I Y 652.27<br />
43774 K <strong>04</strong> N I Y 497.78<br />
43800 <strong>04</strong> N M Y Y 699.20<br />
43810 <strong>04</strong> N M Y Y 718.70<br />
43820 <strong>04</strong> N M Y Y 718.70<br />
43825 <strong>04</strong> N M Y YY 898.95<br />
43830 <strong>04</strong> N M Y Y 399.50<br />
43831 <strong>04</strong> N M Y Y 399.50<br />
43832 <strong>04</strong> N M Y Y 399.50<br />
43840 <strong>04</strong> N M Y Y 678.40<br />
43842 K <strong>04</strong> N M Y 718.70<br />
43843 K <strong>04</strong> N M Y 718.70<br />
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