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 48554 04 N M Y Y 2397.40 48556 04 N M Y 599.35 48999 04 Y M Y 49000 04 N M Y 480.00 49002 04 N M Y 480.00 49010 04 N M Y 480.00 49020 04 N M Y 480.00 49021 04 N M 314.60 49040 04 N M Y 480.00 49041 04 N M Y Y 480.00 49060 04 N M Y 480.00 49061 04 N M Y Y 480.00 49062 04 N M Y 480.00 49080 04 N I 71.40 34.00 49081 04 N I 71.40 34.00 49180 04 N I 106.80 49203 04 1/1/2008 N M Y 480.00 49204 04 1/1/2008 N M Y 704.75 49205 04 1/1/2008 N M Y 947.27 49215 04 N M Y Y 766.90 49220 04 N M Y 998.80 Wednesday, April 01, 2009 Page 192 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 49250 04 N M Y 374.55 49255 04 N M Y 599.35 49320 04 N M Y 302.40 49321 04 N M Y 302.40 49322 04 Y M Y 49323 04 N M Y 480.00 49324 04 1/1/2007 N M Y 480.00 49325 04 1/1/2007 N M Y 480.00 49326 04 1/1/2007 N M Y 480.00 49329 04 Y M Y 49400 04 N I 47.00 49402 04 1/1/2007 N M Y 406.05 49419 04 N M Y 180.46 49420 04 N I 74.90 49421 04 N M 299.70 49422 04 N M 240.00 49423 04 N M 262.20 49424 04 N I 20.95 49425 04 N M Y Y 718.70 49426 04 Y M Y 49427 04 N I 37.40 Wednesday, April 01, 2009 Page 193 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 />
49250 <strong>04</strong> N M Y 374.55<br />
49255 <strong>04</strong> N M Y 599.35<br />
49320 <strong>04</strong> N M Y 302.40<br />
49321 <strong>04</strong> N M Y 302.40<br />
49322 <strong>04</strong> Y M Y<br />
49323 <strong>04</strong> N M Y 480.00<br />
49324 <strong>04</strong> 1/1/2007 N M Y 480.00<br />
49325 <strong>04</strong> 1/1/2007 N M Y 480.00<br />
49326 <strong>04</strong> 1/1/2007 N M Y 480.00<br />
49329 <strong>04</strong> Y M Y<br />
49400 <strong>04</strong> N I 47.00<br />
49402 <strong>04</strong> 1/1/2007 N M Y 406.05<br />
49419 <strong>04</strong> N M Y 180.46<br />
49420 <strong>04</strong> N I 74.90<br />
49421 <strong>04</strong> N M 299.70<br />
49422 <strong>04</strong> N M 240.00<br />
49423 <strong>04</strong> N M 262.20<br />
49424 <strong>04</strong> N I 20.95<br />
49425 <strong>04</strong> N M Y Y 718.70<br />
49426 <strong>04</strong> Y M Y<br />
49427 <strong>04</strong> N I 37.40<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 193 <strong>of</strong> 458
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