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 49605 04 N M Y 573.10 49606 04 Y M Y 49610 04 N M Y 599.35 49611 04 N M Y 449.50 49650 04 N M Y 387.05 49651 04 N M Y 409.20 49652 04 1/1/2009 N M Y 387.05 49653 04 1/1/2009 N M Y 387.05 49654 04 1/1/2009 N M Y 387.05 49655 04 1/1/2009 N M Y 387.05 49656 04 1/1/2009 N M Y 387.05 49657 04 1/1/2009 N M Y 387.05 49659 04 Y M Y 49900 04 N M Y 307.05 49904 04 N M Y Y 617.40 49905 04 N M Y Y 442.90 49906 04 N M Y Y 1306.65 49999 04 Y M Y 50010 04 N M Y 480.00 50020 04 N M Y 398.35 50021 04 N M 299.70 Wednesday, April 01, 2009 Page 196 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 50040 04 N M Y 775.60 50045 04 N M Y 718.70 50060 04 N M Y 718.70 50065 04 N M Y 599.35 50070 04 N M Y 749.20 50075 04 N M Y 749.20 50080 04 N M 434.20 50081 04 N M 600.55 50100 04 N M Y 767.20 50120 04 N M Y 839.35 50125 04 N M Y 839.35 50130 04 N M Y 837.90 50135 04 Y M Y Y 50200 04 N I 112.40 50205 04 N M Y 480.00 50220 04 N M Y Y 933.80 50225 04 N M Y Y 933.80 50230 04 N M Y Y 1057.20 50234 04 N M Y Y 933.80 50236 04 Y M Y Y 50240 04 N M Y 749.20 Wednesday, April 01, 2009 Page 197 of 458
- 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 and 198: Hcpcs Note ProgCov Eff Date HP NDC
- Page 199 and 200: Hcpcs Note ProgCov Eff Date HP NDC
- Page 201 and 202: Hcpcs Note ProgCov Eff Date HP NDC
- Page 203: 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
- Page 249 and 250: Hcpcs Note ProgCov Eff Date HP NDC
- Page 251 and 252: Hcpcs Note ProgCov Eff Date HP NDC
- Page 253 and 254: 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 />
49605 <strong>04</strong> N M Y 573.10<br />
49606 <strong>04</strong> Y M Y<br />
49610 <strong>04</strong> N M Y 599.35<br />
49611 <strong>04</strong> N M Y 449.50<br />
49650 <strong>04</strong> N M Y 387.05<br />
49651 <strong>04</strong> N M Y 4<strong>09</strong>.20<br />
49652 <strong>04</strong> 1/1/20<strong>09</strong> N M Y 387.05<br />
49653 <strong>04</strong> 1/1/20<strong>09</strong> N M Y 387.05<br />
49654 <strong>04</strong> 1/1/20<strong>09</strong> N M Y 387.05<br />
49655 <strong>04</strong> 1/1/20<strong>09</strong> N M Y 387.05<br />
49656 <strong>04</strong> 1/1/20<strong>09</strong> N M Y 387.05<br />
49657 <strong>04</strong> 1/1/20<strong>09</strong> N M Y 387.05<br />
49659 <strong>04</strong> Y M Y<br />
49900 <strong>04</strong> N M Y 307.05<br />
499<strong>04</strong> <strong>04</strong> N M Y Y 617.40<br />
49905 <strong>04</strong> N M Y Y 442.90<br />
49906 <strong>04</strong> N M Y Y 1306.65<br />
49999 <strong>04</strong> Y M Y<br />
50<strong>01</strong>0 <strong>04</strong> N M Y 480.00<br />
50020 <strong>04</strong> N M Y 398.35<br />
50021 <strong>04</strong> N M 299.70<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 196 <strong>of</strong> 458
Change language