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 49428 04 Y M Y Y 49429 04 Y M Y Y 49435 04 1/1/2007 N M 60.90 49436 04 1/1/2007 N M 88.75 49440 04 1/1/2008 N I Y 133.76 465.96 49441 04 1/1/2008 N I Y 144.19 563.56 49442 04 1/1/2008 N I Y 119.66 457.55 49446 04 1/1/2008 N I Y 94.47 493.61 49450 04 1/1/2008 Y I Y 49451 04 1/1/2008 Y I Y 49452 04 1/1/2008 Y I Y 49460 04 1/1/2008 N I Y 27.00 406.44 49465 04 1/1/2008 N I Y 17.80 73.55 49491 04 N M Y Y 433.70 49492 04 N M Y Y 535.00 49495 04 N M Y 362.00 49496 04 N M Y 362.00 49500 04 N M Y 362.00 49501 04 N M Y 387.05 49505 04 N M Y 387.05 49507 04 N M Y 387.05 Wednesday, April 01, 2009 Page 194 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 49520 04 N M Y 409.20 49521 04 N M Y 387.05 49525 04 N M Y 464.80 49540 04 N M Y 337.10 49550 04 N M Y 409.20 49553 04 N M Y 409.20 49555 04 N M Y 460.60 49557 04 N M Y 460.60 49560 04 N M Y 503.60 49561 04 N M Y 503.60 49565 04 N M Y 546.65 49566 04 N M Y 572.50 49568 04 N M Y 460.60 49570 04 N M Y 345.50 49572 04 N M Y 345.50 49580 04 N M Y Y 342.65 49582 04 N M Y 374.55 49585 04 N M Y 374.55 49587 04 N M Y 374.55 49590 04 N M Y 374.55 49600 04 N M Y 275.80 Wednesday, April 01, 2009 Page 195 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 />
49428 <strong>04</strong> Y M Y Y<br />
49429 <strong>04</strong> Y M Y Y<br />
49435 <strong>04</strong> 1/1/2007 N M 60.90<br />
49436 <strong>04</strong> 1/1/2007 N M 88.75<br />
49440 <strong>04</strong> 1/1/2008 N I Y 133.76 465.96<br />
49441 <strong>04</strong> 1/1/2008 N I Y 144.19 563.56<br />
49442 <strong>04</strong> 1/1/2008 N I Y 119.66 457.55<br />
49446 <strong>04</strong> 1/1/2008 N I Y 94.47 493.61<br />
49450 <strong>04</strong> 1/1/2008 Y I Y<br />
49451 <strong>04</strong> 1/1/2008 Y I Y<br />
49452 <strong>04</strong> 1/1/2008 Y I Y<br />
49460 <strong>04</strong> 1/1/2008 N I Y 27.00 406.44<br />
49465 <strong>04</strong> 1/1/2008 N I Y 17.80 73.55<br />
49491 <strong>04</strong> N M Y Y 433.70<br />
49492 <strong>04</strong> N M Y Y 535.00<br />
49495 <strong>04</strong> N M Y 362.00<br />
49496 <strong>04</strong> N M Y 362.00<br />
49500 <strong>04</strong> N M Y 362.00<br />
495<strong>01</strong> <strong>04</strong> N M Y 387.05<br />
49505 <strong>04</strong> N M Y 387.05<br />
49507 <strong>04</strong> N M Y 387.05<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 194 <strong>of</strong> 458
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