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 44207 04 N M Y Y 958.60 44208 04 N M Y Y 951.80 44210 04 N M Y Y 1255.88 44211 04 N M Y Y 1079.30 44212 04 N M Y Y 1198.70 44213 04 N I Y 110.46 44227 04 N I Y 864.06 44238 04 Y M Y Y 44300 04 N M Y Y 599.35 44310 04 N M Y Y 629.90 44312 04 N M Y Y 374.55 44314 04 N M Y Y 599.35 44316 04 N M Y Y 535.45 44320 04 N M Y Y 535.45 44322 04 N M Y Y 535.45 44340 04 N M Y Y 299.70 44345 04 N M Y Y 480.00 44346 04 N M Y Y 951.80 44360 04 N I 264.25 56.70 44361 04 N I 285.40 56.70 44363 04 N M Y 285.40 56.70 Wednesday, April 01, 2009 Page 176 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 44364 04 N M 356.70 56.70 44365 04 N M 356.70 44366 04 N M 285.40 56.70 44369 04 N M 285.40 56.70 44370 04 N M 158.30 44372 04 N M 285.40 44373 04 N M 356.70 44376 04 N I 318.30 44377 04 N I 318.30 44378 04 N M 318.30 44379 04 N M 258.55 44380 04 N I 182.30 56.70 44382 04 N I 218.00 56.70 44383 04 N I 88.30 44385 04 N I 182.30 56.70 44386 04 N I 182.30 56.70 44388 04 N I 192.85 56.70 44389 04 N I 192.85 56.70 44390 04 N I 192.85 56.70 44391 04 N I 283.40 56.70 44392 04 N M 230.80 56.70 Wednesday, April 01, 2009 Page 177 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 />
44207 <strong>04</strong> N M Y Y 958.60<br />
44208 <strong>04</strong> N M Y Y 951.80<br />
44210 <strong>04</strong> N M Y Y 1255.88<br />
44211 <strong>04</strong> N M Y Y 1079.30<br />
44212 <strong>04</strong> N M Y Y 1198.70<br />
44213 <strong>04</strong> N I Y 110.46<br />
44227 <strong>04</strong> N I Y 864.06<br />
44238 <strong>04</strong> Y M Y Y<br />
44300 <strong>04</strong> N M Y Y 599.35<br />
44310 <strong>04</strong> N M Y Y 629.90<br />
44312 <strong>04</strong> N M Y Y 374.55<br />
44314 <strong>04</strong> N M Y Y 599.35<br />
44316 <strong>04</strong> N M Y Y 535.45<br />
44320 <strong>04</strong> N M Y Y 535.45<br />
44322 <strong>04</strong> N M Y Y 535.45<br />
44340 <strong>04</strong> N M Y Y 299.70<br />
44345 <strong>04</strong> N M Y Y 480.00<br />
44346 <strong>04</strong> N M Y Y 951.80<br />
44360 <strong>04</strong> N I 264.25 56.70<br />
44361 <strong>04</strong> N I 285.40 56.70<br />
44363 <strong>04</strong> N M Y 285.40 56.70<br />
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