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 47712 04 N M Y Y 1198.70 47715 04 N M Y Y 862.30 47720 04 N M Y Y 685.40 47721 04 N M Y Y 1044.70 47740 04 N M Y Y 685.40 47741 04 N M Y Y 1044.70 47760 04 N M Y Y 685.40 47765 04 N M Y Y 1438.70 47780 04 N M Y Y 770.00 47785 04 N M Y Y 1438.70 47800 04 N M Y Y 770.00 47801 04 N M Y 621.95 47802 04 N M Y 948.90 47900 04 N M Y Y 621.95 47999 04 Y M 48000 04 N M Y 718.70 48001 04 N M Y Y 801.90 48020 04 N M Y 839.35 48100 04 N M Y 480.00 48102 04 N I Y 154.90 48105 04 1/1/2007 N M Y 810.10 Wednesday, April 01, 2009 Page 190 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 48120 04 N M Y 599.35 48140 04 N M Y Y 839.35 48145 04 N M Y Y 1438.70 48146 04 N M Y 1438.70 48148 04 N M Y 859.00 48150 04 N M Y Y 1438.70 48152 04 N M Y Y 1438.70 48153 04 N M Y Y 1438.70 48154 04 N M Y Y 1438.70 48155 04 N M Y Y 1438.70 48160 04 N M Y Y 2397.40 48400 04 N I 47.30 48500 04 N M Y 839.35 48510 04 N M Y 839.35 48511 04 N M Y Y 839.35 48520 04 N M Y Y 839.35 48540 04 N M Y Y 839.35 48545 04 N M Y Y 599.35 48547 04 N M Y Y 718.70 48548 04 1/1/2007 N M Y 958.60 48550 04 N M Y Y 599.35 Wednesday, April 01, 2009 Page 191 of 458
- Page 147 and 148: Hcpcs Note ProgCov Eff Date HP NDC
- Page 149 and 150: Hcpcs Note ProgCov Eff Date HP NDC
- Page 151 and 152: Hcpcs Note ProgCov Eff Date HP NDC
- Page 153 and 154: Hcpcs Note ProgCov Eff Date HP NDC
- Page 155 and 156: Hcpcs Note ProgCov Eff Date HP NDC
- Page 157 and 158: Hcpcs Note ProgCov Eff Date HP NDC
- Page 159 and 160: Hcpcs Note ProgCov Eff Date HP NDC
- Page 161 and 162: Hcpcs Note ProgCov Eff Date HP NDC
- Page 163 and 164: Hcpcs Note ProgCov Eff Date HP NDC
- Page 165 and 166: Hcpcs Note ProgCov Eff Date HP NDC
- Page 167 and 168: Hcpcs Note ProgCov Eff Date HP NDC
- Page 169 and 170: Hcpcs Note ProgCov Eff Date HP NDC
- Page 171 and 172: Hcpcs Note ProgCov Eff Date HP NDC
- Page 173 and 174: Hcpcs Note ProgCov Eff Date HP NDC
- Page 175 and 176: Hcpcs Note ProgCov Eff Date HP NDC
- Page 177 and 178: Hcpcs Note ProgCov Eff Date HP NDC
- Page 179 and 180: Hcpcs Note ProgCov Eff Date HP NDC
- Page 181 and 182: Hcpcs Note ProgCov Eff Date HP NDC
- Page 183 and 184: Hcpcs Note ProgCov Eff Date HP NDC
- Page 185 and 186: Hcpcs Note ProgCov Eff Date HP NDC
- Page 187 and 188: Hcpcs Note ProgCov Eff Date HP NDC
- Page 189 and 190: Hcpcs Note ProgCov Eff Date HP NDC
- Page 191 and 192: Hcpcs Note ProgCov Eff Date HP NDC
- Page 193 and 194: Hcpcs Note ProgCov Eff Date HP NDC
- Page 195 and 196: Hcpcs Note ProgCov Eff Date HP NDC
- Page 197: Hcpcs Note ProgCov Eff Date HP NDC
- Page 201 and 202: Hcpcs Note ProgCov Eff Date HP NDC
- Page 203 and 204: Hcpcs Note ProgCov Eff Date HP NDC
- Page 205 and 206: Hcpcs Note ProgCov Eff Date HP NDC
- Page 207 and 208: Hcpcs Note ProgCov Eff Date HP NDC
- Page 209 and 210: Hcpcs Note ProgCov Eff Date HP NDC
- Page 211 and 212: Hcpcs Note ProgCov Eff Date HP NDC
- Page 213 and 214: Hcpcs Note ProgCov Eff Date HP NDC
- Page 215 and 216: Hcpcs Note ProgCov Eff Date HP NDC
- Page 217 and 218: Hcpcs Note ProgCov Eff Date HP NDC
- Page 219 and 220: Hcpcs Note ProgCov Eff Date HP NDC
- Page 221 and 222: Hcpcs Note ProgCov Eff Date HP NDC
- Page 223 and 224: Hcpcs Note ProgCov Eff Date HP NDC
- Page 225 and 226: Hcpcs Note ProgCov Eff Date HP NDC
- Page 227 and 228: Hcpcs Note ProgCov Eff Date HP NDC
- Page 229 and 230: Hcpcs Note ProgCov Eff Date HP NDC
- Page 231 and 232: Hcpcs Note ProgCov Eff Date HP NDC
- Page 233 and 234: Hcpcs Note ProgCov Eff Date HP NDC
- Page 235 and 236: Hcpcs Note ProgCov Eff Date HP NDC
- Page 237 and 238: Hcpcs Note ProgCov Eff Date HP NDC
- Page 239 and 240: Hcpcs Note ProgCov Eff Date HP NDC
- Page 241 and 242: Hcpcs Note ProgCov Eff Date HP NDC
- Page 243 and 244: Hcpcs Note ProgCov Eff Date HP NDC
- Page 245 and 246: Hcpcs Note ProgCov Eff Date HP NDC
- Page 247 and 248: Hcpcs Note ProgCov Eff Date HP NDC
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 />
47712 <strong>04</strong> N M Y Y 1198.70<br />
47715 <strong>04</strong> N M Y Y 862.30<br />
47720 <strong>04</strong> N M Y Y 685.40<br />
47721 <strong>04</strong> N M Y Y 1<strong>04</strong>4.70<br />
47740 <strong>04</strong> N M Y Y 685.40<br />
47741 <strong>04</strong> N M Y Y 1<strong>04</strong>4.70<br />
47760 <strong>04</strong> N M Y Y 685.40<br />
47765 <strong>04</strong> N M Y Y 1438.70<br />
47780 <strong>04</strong> N M Y Y 770.00<br />
47785 <strong>04</strong> N M Y Y 1438.70<br />
47800 <strong>04</strong> N M Y Y 770.00<br />
478<strong>01</strong> <strong>04</strong> N M Y 621.95<br />
47802 <strong>04</strong> N M Y 948.90<br />
47900 <strong>04</strong> N M Y Y 621.95<br />
47999 <strong>04</strong> Y M<br />
48000 <strong>04</strong> N M Y 718.70<br />
480<strong>01</strong> <strong>04</strong> N M Y Y 8<strong>01</strong>.90<br />
48020 <strong>04</strong> N M Y 839.35<br />
48100 <strong>04</strong> N M Y 480.00<br />
48102 <strong>04</strong> N I Y 154.90<br />
48105 <strong>04</strong> 1/1/2007 N M Y 810.10<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 190 <strong>of</strong> 458