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 44025 04 N M Y Y 599.35 44050 04 N M Y Y 599.35 44055 04 N M Y 599.35 44100 04 N I 108.20 44110 04 N M Y Y 599.35 44111 04 N M Y Y 599.35 44120 04 N M Y Y 806.10 44121 04 N M Y Y 403.05 44125 04 N M Y Y 733.85 44126 04 N M Y Y 1039.70 44127 04 N M Y Y 1195.80 44128 04 N M Y Y 175.20 44130 04 N M Y Y 718.70 44132 04 N M Y Y 1039.70 44133 04 N M Y Y 1039.70 44135 04 N M Y Y 1180.95 44136 04 N M Y Y 1180.95 44137 04 N M Y 806.10 44139 04 N M Y Y 108.00 44140 04 N M Y Y 951.80 44141 04 N M Y Y 951.80 Wednesday, April 01, 2009 Page 174 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 44143 04 N M Y Y 951.80 44144 04 N M Y Y 951.80 44145 04 N M Y Y 958.60 44146 04 N M Y Y 951.80 44147 04 N M Y Y 1198.70 44150 04 N M Y Y 1079.30 44151 04 N M Y Y 1079.10 44155 04 N M Y Y 1198.70 44156 04 N M Y Y 1198.70 44157 04 1/1/2007 N M Y 1198.70 44158 04 1/1/2007 N M Y 1198.70 44160 04 N M Y Y 1198.70 44180 04 N I Y 479.20 44186 04 N I Y 335.80 44187 04 N I Y 553.18 44188 04 N I Y 607.88 44202 04 N M Y 806.10 44203 04 N M Y Y 191.80 44204 04 N M Y Y 973.80 44205 04 N M Y Y 861.80 44206 04 N M Y Y 951.80 Wednesday, April 01, 2009 Page 175 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 />
44143 <strong>04</strong> N M Y Y 951.80<br />
44144 <strong>04</strong> N M Y Y 951.80<br />
44145 <strong>04</strong> N M Y Y 958.60<br />
44146 <strong>04</strong> N M Y Y 951.80<br />
44147 <strong>04</strong> N M Y Y 1198.70<br />
44150 <strong>04</strong> N M Y Y 1079.30<br />
44151 <strong>04</strong> N M Y Y 1079.10<br />
44155 <strong>04</strong> N M Y Y 1198.70<br />
44156 <strong>04</strong> N M Y Y 1198.70<br />
44157 <strong>04</strong> 1/1/2007 N M Y 1198.70<br />
44158 <strong>04</strong> 1/1/2007 N M Y 1198.70<br />
44160 <strong>04</strong> N M Y Y 1198.70<br />
44180 <strong>04</strong> N I Y 479.20<br />
44186 <strong>04</strong> N I Y 335.80<br />
44187 <strong>04</strong> N I Y 553.18<br />
44188 <strong>04</strong> N I Y 607.88<br />
44202 <strong>04</strong> N M Y 806.10<br />
44203 <strong>04</strong> N M Y Y 191.80<br />
442<strong>04</strong> <strong>04</strong> N M Y Y 973.80<br />
44205 <strong>04</strong> N M Y Y 861.80<br />
44206 <strong>04</strong> N M Y Y 951.80<br />
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