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 51555 04 N M Y 599.35 51565 04 N M Y Y 958.60 51570 04 N M Y Y 749.20 51575 04 N M Y Y 1198.70 51580 04 N M Y Y 1438.70 51585 04 N M Y Y 1438.70 51590 04 N M Y Y 1438.70 51595 04 N M Y Y 1498.30 51596 04 N M Y Y 1438.70 51597 04 N M Y Y 1498.30 51600 04 N I 121.35 17.00 51605 04 N I 121.35 17.00 51610 04 N I 130.80 17.00 51700 04 N I 44.60 51701 04 N I 24.02 51702 04 N I 24.02 51703 04 N I 26.18 51705 04 N I 38.85 17.00 51710 04 N I 66.85 17.00 51715 04 N I 295.95 51720 04 N I 66.85 17.00 Wednesday, April 01, 2009 Page 204 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 51725 04 N I 44.40 51726 04 N I 50.05 51736 04 N I 17.30 51741 04 N I 52.70 51772 04 N I 45.00 51784 04 N I 52.70 51785 04 N I 52.70 51792 04 N I 74.90 51795 04 N I 51.50 51797 04 N I 45.00 51798 A 04 N I 8.78 8.78 17.56 51800 04 N M Y 599.35 51820 04 N M Y 839.35 51840 04 N M Y 631.25 51841 04 N M Y 631.25 51845 04 N M Y 631.25 51860 04 N M Y Y 599.35 51865 04 N M Y Y 599.35 51880 04 N M 216.65 51900 04 N M Y 958.60 51920 04 N M Y 958.60 Wednesday, April 01, 2009 Page 205 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 />
51725 <strong>04</strong> N I 44.40<br />
51726 <strong>04</strong> N I 50.05<br />
51736 <strong>04</strong> N I 17.30<br />
51741 <strong>04</strong> N I 52.70<br />
51772 <strong>04</strong> N I 45.00<br />
51784 <strong>04</strong> N I 52.70<br />
51785 <strong>04</strong> N I 52.70<br />
51792 <strong>04</strong> N I 74.90<br />
51795 <strong>04</strong> N I 51.50<br />
51797 <strong>04</strong> N I 45.00<br />
51798 A <strong>04</strong> N I 8.78 8.78 17.56<br />
51800 <strong>04</strong> N M Y 599.35<br />
51820 <strong>04</strong> N M Y 839.35<br />
51840 <strong>04</strong> N M Y 631.25<br />
51841 <strong>04</strong> N M Y 631.25<br />
51845 <strong>04</strong> N M Y 631.25<br />
51860 <strong>04</strong> N M Y Y 599.35<br />
51865 <strong>04</strong> N M Y Y 599.35<br />
51880 <strong>04</strong> N M 216.65<br />
51900 <strong>04</strong> N M Y 958.60<br />
51920 <strong>04</strong> N M Y 958.60<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 205 <strong>of</strong> 458
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