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 51925 04 N M Y 958.60 51940 04 N M Y 839.35 51960 04 N M Y 1105.80 51980 04 N M Y 449.50 51990 04 N M Y 631.25 51992 04 N M Y 631.25 51999 04 Y M 52000 04 N I 85.90 56.70 52001 04 N I 90.40 52005 04 N I 118.90 56.70 52007 04 N M 154.60 56.70 52010 04 N I 118.90 56.70 52204 04 N I 163.90 56.70 52214 04 N M 178.30 56.70 52224 04 N M 295.95 56.70 52234 04 N M 374.55 52235 04 N M 374.55 52240 04 N M 524.40 52250 04 N I 141.30 56.70 52260 04 N I 149.80 52265 04 N I 142.70 56.70 Wednesday, April 01, 2009 Page 206 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 52270 04 N M 180.30 52275 04 N M 194.20 52276 04 N M 209.40 52277 04 N M 180.30 52281 04 N I 134.80 56.70 52282 04 N I 204.10 56.70 52283 04 N I 149.80 52285 04 N I 135.70 52290 04 N M 184.50 52300 04 N M 240.00 52301 04 N M 240.00 52305 04 N M 297.00 52310 04 N I 180.30 56.70 52315 04 N M 239.00 56.70 52317 04 N M Y Y 342.15 56.70 52318 04 N M Y Y 339.25 56.70 52320 04 N M 249.70 56.70 52325 04 N M 379.40 52327 04 N I 295.95 52330 04 N M 260.80 56.70 52332 04 N I 138.90 Wednesday, April 01, 2009 Page 207 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 />
51925 <strong>04</strong> N M Y 958.60<br />
51940 <strong>04</strong> N M Y 839.35<br />
51960 <strong>04</strong> N M Y 1105.80<br />
51980 <strong>04</strong> N M Y 449.50<br />
51990 <strong>04</strong> N M Y 631.25<br />
51992 <strong>04</strong> N M Y 631.25<br />
51999 <strong>04</strong> Y M<br />
52000 <strong>04</strong> N I 85.90 56.70<br />
520<strong>01</strong> <strong>04</strong> N I 90.40<br />
52005 <strong>04</strong> N I 118.90 56.70<br />
52007 <strong>04</strong> N M 154.60 56.70<br />
52<strong>01</strong>0 <strong>04</strong> N I 118.90 56.70<br />
522<strong>04</strong> <strong>04</strong> N I 163.90 56.70<br />
52214 <strong>04</strong> N M 178.30 56.70<br />
52224 <strong>04</strong> N M 295.95 56.70<br />
52234 <strong>04</strong> N M 374.55<br />
52235 <strong>04</strong> N M 374.55<br />
52240 <strong>04</strong> N M 524.40<br />
52250 <strong>04</strong> N I 141.30 56.70<br />
52260 <strong>04</strong> N I 149.80<br />
52265 <strong>04</strong> N I 142.70 56.70<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 206 <strong>of</strong> 458
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