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 45383 04 N M 285.40 56.70 45384 04 N M 285.40 45385 04 N M 285.40 56.70 45386 04 N I 108.86 45387 04 N M 215.35 45391 04 N M Y 204.00 45392 04 N I Y 214.00 45395 04 N I Y 1015.28 45397 04 N I Y 1103.45 45400 04 N I Y 592.90 45402 04 N I Y 805.75 45499 04 Y I Y 45500 04 N M Y 419.00 45505 04 N M Y 419.00 45520 04 N I 74.90 45540 04 N M Y 599.35 45541 04 N M Y 599.35 45550 04 N M Y Y 749.20 45560 04 N M Y 227.70 45562 04 N M Y Y 496.12 45563 04 N M Y Y 756.60 Wednesday, April 01, 2009 Page 182 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 45800 04 N M Y Y 599.35 45805 04 N M Y Y 674.20 45820 04 N M Y Y 599.35 45825 04 N M Y Y 674.20 45900 04 N I 44.40 45905 04 N I 58.05 45910 04 N I 73.40 45915 04 N I 77.60 45990 04 N I Y 58.42 45999 04 Y M Y 46020 04 N I 140.75 46030 04 N I 71.40 34.00 46040 04 N M 149.80 46045 04 N M 149.80 46050 04 N I 71.40 34.00 46060 04 N M 471.70 46070 04 N I 81.20 46080 04 N I 119.25 46083 04 N I 64.10 17.00 46200 04 N M 262.20 46210 04 N I 93.50 17.00 Wednesday, April 01, 2009 Page 183 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 />
45383 <strong>04</strong> N M 285.40 56.70<br />
45384 <strong>04</strong> N M 285.40<br />
45385 <strong>04</strong> N M 285.40 56.70<br />
45386 <strong>04</strong> N I 108.86<br />
45387 <strong>04</strong> N M 215.35<br />
45391 <strong>04</strong> N M Y 2<strong>04</strong>.00<br />
45392 <strong>04</strong> N I Y 214.00<br />
45395 <strong>04</strong> N I Y 1<strong>01</strong>5.28<br />
45397 <strong>04</strong> N I Y 1103.45<br />
45400 <strong>04</strong> N I Y 592.90<br />
45402 <strong>04</strong> N I Y 805.75<br />
45499 <strong>04</strong> Y I Y<br />
45500 <strong>04</strong> N M Y 419.00<br />
45505 <strong>04</strong> N M Y 419.00<br />
45520 <strong>04</strong> N I 74.90<br />
45540 <strong>04</strong> N M Y 599.35<br />
45541 <strong>04</strong> N M Y 599.35<br />
45550 <strong>04</strong> N M Y Y 749.20<br />
45560 <strong>04</strong> N M Y 227.70<br />
45562 <strong>04</strong> N M Y Y 496.12<br />
45563 <strong>04</strong> N M Y Y 756.60<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 182 <strong>of</strong> 458
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