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 52334 04 N M 308.35 52341 04 N M 224.45 52342 04 N M 242.90 52343 04 N M 269.10 52344 04 N M 287.60 52345 04 N M 306.60 52346 04 N M 344.90 52351 04 N I 178.30 52352 04 N M 293.75 52353 04 N M 262.20 52354 04 N M 249.70 52355 04 N M 337.00 52400 04 N M 398.85 52402 04 N M 537.15 52450 04 N M 249.00 52500 04 N M 480.00 52601 04 N M 775.60 52630 04 N M 599.35 52640 04 N M 486.90 52647 04 N M 599.35 52648 04 N M 599.35 Wednesday, April 01, 2009 Page 208 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 52649 04 1/1/2008 N M Y 562.42 52700 04 N M 314.95 52920 04 Y Y 53000 04 N M Y 240.00 53010 04 N M 314.95 53020 04 N I 67.80 17.00 53025 04 N I 58.60 17.00 53040 04 N I 197.80 17.00 53060 04 N I 95.30 17.00 53080 04 Y M 17.00 53085 04 Y M 53200 04 N I 92.70 17.00 53210 04 N M 449.50 53215 04 N M 524.40 53220 04 N M 449.50 53230 04 N M Y 599.35 53235 04 N M Y 599.35 53240 04 N M 449.50 53250 04 Y M 34.00 53260 04 N I 113.60 34.00 53265 04 N I 115.00 34.00 Wednesday, April 01, 2009 Page 209 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 />
52334 <strong>04</strong> N M 308.35<br />
52341 <strong>04</strong> N M 224.45<br />
52342 <strong>04</strong> N M 242.90<br />
52343 <strong>04</strong> N M 269.10<br />
52344 <strong>04</strong> N M 287.60<br />
52345 <strong>04</strong> N M 306.60<br />
52346 <strong>04</strong> N M 344.90<br />
52351 <strong>04</strong> N I 178.30<br />
52352 <strong>04</strong> N M 293.75<br />
52353 <strong>04</strong> N M 262.20<br />
52354 <strong>04</strong> N M 249.70<br />
52355 <strong>04</strong> N M 337.00<br />
52400 <strong>04</strong> N M 398.85<br />
52402 <strong>04</strong> N M 537.15<br />
52450 <strong>04</strong> N M 249.00<br />
52500 <strong>04</strong> N M 480.00<br />
526<strong>01</strong> <strong>04</strong> N M 775.60<br />
52630 <strong>04</strong> N M 599.35<br />
52640 <strong>04</strong> N M 486.90<br />
52647 <strong>04</strong> N M 599.35<br />
52648 <strong>04</strong> N M 599.35<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 208 <strong>of</strong> 458
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