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 50551 04 N I 151.00 56.70 50553 04 N I 245.35 56.70 50555 04 N I 250.35 56.70 50557 04 N I 294.80 56.70 50561 04 N I 301.85 56.70 50562 04 N M 301.95 50570 04 N I 204.70 50572 04 N I 268.20 50574 04 N I 281.05 50575 04 N I 365.15 50576 04 N I 294.80 50580 04 N I 269.70 50590 04 N M Y Y 749.20 50592 04 N I 214.22 50593 04 1/1/2008 N M Y 267.81 2228.0 50600 04 N M Y 718.70 50605 04 N M Y 738.10 50610 04 N M Y 738.10 50620 04 N M Y 738.10 50630 04 N M Y 738.10 50650 04 N M Y 599.35 Wednesday, April 01, 2009 Page 200 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 50660 04 N M Y Y 599.35 50684 04 N I 120.00 17.00 50686 04 N I 64.10 34.00 50688 04 N I 37.40 34.00 50690 04 N I 129.70 17.00 50700 04 N M Y 958.60 50715 04 N M Y 749.20 50722 04 N M Y 749.20 50725 04 N M Y 958.60 50727 04 N M Y Y 455.80 50728 04 N M Y Y 567.10 50740 04 N M Y 958.60 50750 04 N M Y 958.60 50760 04 N M Y 958.60 50770 04 N M Y 958.60 50780 04 N M Y 958.60 50782 04 N M Y Y 945.15 50783 04 N M Y Y 945.15 50785 04 N M Y 958.60 50800 04 N M Y 718.70 50810 04 N M Y 718.70 Wednesday, April 01, 2009 Page 201 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 />
50551 <strong>04</strong> N I 151.00 56.70<br />
50553 <strong>04</strong> N I 245.35 56.70<br />
50555 <strong>04</strong> N I 250.35 56.70<br />
50557 <strong>04</strong> N I 294.80 56.70<br />
50561 <strong>04</strong> N I 3<strong>01</strong>.85 56.70<br />
50562 <strong>04</strong> N M 3<strong>01</strong>.95<br />
50570 <strong>04</strong> N I 2<strong>04</strong>.70<br />
50572 <strong>04</strong> N I 268.20<br />
50574 <strong>04</strong> N I 281.05<br />
50575 <strong>04</strong> N I 365.15<br />
50576 <strong>04</strong> N I 294.80<br />
50580 <strong>04</strong> N I 269.70<br />
50590 <strong>04</strong> N M Y Y 749.20<br />
50592 <strong>04</strong> N I 214.22<br />
50593 <strong>04</strong> 1/1/2008 N M Y 267.81 2228.0<br />
50600 <strong>04</strong> N M Y 718.70<br />
50605 <strong>04</strong> N M Y 738.10<br />
50610 <strong>04</strong> N M Y 738.10<br />
50620 <strong>04</strong> N M Y 738.10<br />
50630 <strong>04</strong> N M Y 738.10<br />
50650 <strong>04</strong> N M Y 599.35<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 200 <strong>of</strong> 458
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