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 50815 04 N M Y 718.70 50820 04 N M Y 718.70 50825 04 N M Y Y 1438.70 50830 04 Y M Y Y 50840 04 N M Y 718.70 50845 04 Y M Y 50860 04 N M Y 958.60 50900 04 N M Y Y 958.60 50920 04 N M Y 480.00 50930 04 N M Y 629.90 50940 04 N M Y 934.70 50945 04 N M Y 738.10 50947 04 N M Y Y 973.55 50948 04 N M Y 890.50 50949 04 Y M Y Y 50951 04 N I 152.60 56.70 50953 04 N I 251.25 56.70 50955 04 N I 235.50 56.70 50957 04 N I 236.20 56.70 50961 04 N M 297.95 56.70 50970 04 N I 187.70 Wednesday, April 01, 2009 Page 202 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 50972 04 N I 152.10 50974 04 N I 243.40 50976 04 N I 236.20 50980 04 N M 262.20 51020 04 N M Y 524.40 51030 04 N M Y 524.40 51040 04 N M Y 449.50 51045 04 N M Y 449.50 51050 04 N M Y 599.35 51060 04 N M Y 738.10 51065 04 N M Y 738.10 51080 04 N M Y 599.35 51100 04 1/1/2008 N I 22.55 13.02 51101 04 1/1/2008 N I 30.11 41.49 51102 04 1/1/2008 N I 141.08 47.69 51500 04 N M Y 599.35 51520 04 N M Y 480.00 51525 04 N M Y 718.70 51530 04 N M Y 599.35 51535 04 N M Y 599.35 51550 04 N M Y 599.35 Wednesday, April 01, 2009 Page 203 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 />
50815 <strong>04</strong> N M Y 718.70<br />
50820 <strong>04</strong> N M Y 718.70<br />
50825 <strong>04</strong> N M Y Y 1438.70<br />
50830 <strong>04</strong> Y M Y Y<br />
50840 <strong>04</strong> N M Y 718.70<br />
50845 <strong>04</strong> Y M Y<br />
50860 <strong>04</strong> N M Y 958.60<br />
5<strong>09</strong>00 <strong>04</strong> N M Y Y 958.60<br />
5<strong>09</strong>20 <strong>04</strong> N M Y 480.00<br />
5<strong>09</strong>30 <strong>04</strong> N M Y 629.90<br />
5<strong>09</strong>40 <strong>04</strong> N M Y 934.70<br />
5<strong>09</strong>45 <strong>04</strong> N M Y 738.10<br />
5<strong>09</strong>47 <strong>04</strong> N M Y Y 973.55<br />
5<strong>09</strong>48 <strong>04</strong> N M Y 890.50<br />
5<strong>09</strong>49 <strong>04</strong> Y M Y Y<br />
5<strong>09</strong>51 <strong>04</strong> N I 152.60 56.70<br />
5<strong>09</strong>53 <strong>04</strong> N I 251.25 56.70<br />
5<strong>09</strong>55 <strong>04</strong> N I 235.50 56.70<br />
5<strong>09</strong>57 <strong>04</strong> N I 236.20 56.70<br />
5<strong>09</strong>61 <strong>04</strong> N M 297.95 56.70<br />
5<strong>09</strong>70 <strong>04</strong> N I 187.70<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 202 <strong>of</strong> 458
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