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 54830 04 N M 299.70 54840 04 N M 299.70 54860 04 N M 359.30 54861 04 N M 480.00 54865 04 1/1/2007 N M 179.47 54900 04 N M Y 480.00 54901 04 N M Y 599.35 55000 04 N I 42.35 17.00 55040 04 N M Y 299.70 55041 04 N M 449.50 55060 04 N M Y 259.40 55100 04 N I 110.90 17.00 55110 04 Y M 55120 04 N I 129.30 17.00 55150 04 N I 206.10 55175 04 Y M 55180 04 Y M Y 55200 04 N I 147.95 56.70 55250 04 N I 147.95 56.70 55300 04 N I 112.40 55400 04 Y M Y Wednesday, April 01, 2009 Page 216 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 55450 04 N M 150.40 56.70 55500 04 N M 359.30 55520 04 N M 240.00 55530 04 N M 359.30 55535 04 N M Y 359.30 55540 04 N M Y 480.00 55550 04 N M Y 359.30 55559 04 Y M Y 55600 04 N I 178.30 55605 04 N M 223.60 55650 04 N M Y 958.60 55680 04 N I Y 299.70 55700 04 N I 113.60 17.00 55705 04 N M 187.30 55706 04 1/1/2009 N I 291.03 55720 04 N M 359.30 55725 04 N M 359.30 55801 04 N M Y 839.35 55810 04 N M Y 1198.70 55812 04 N M Y 1678.65 55815 04 N M Y 1809.25 Wednesday, April 01, 2009 Page 217 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 />
55450 <strong>04</strong> N M 150.40 56.70<br />
55500 <strong>04</strong> N M 359.30<br />
55520 <strong>04</strong> N M 240.00<br />
55530 <strong>04</strong> N M 359.30<br />
55535 <strong>04</strong> N M Y 359.30<br />
55540 <strong>04</strong> N M Y 480.00<br />
55550 <strong>04</strong> N M Y 359.30<br />
55559 <strong>04</strong> Y M Y<br />
55600 <strong>04</strong> N I 178.30<br />
55605 <strong>04</strong> N M 223.60<br />
55650 <strong>04</strong> N M Y 958.60<br />
55680 <strong>04</strong> N I Y 299.70<br />
55700 <strong>04</strong> N I 113.60 17.00<br />
55705 <strong>04</strong> N M 187.30<br />
55706 <strong>04</strong> 1/1/20<strong>09</strong> N I 291.03<br />
55720 <strong>04</strong> N M 359.30<br />
55725 <strong>04</strong> N M 359.30<br />
558<strong>01</strong> <strong>04</strong> N M Y 839.35<br />
55810 <strong>04</strong> N M Y 1198.70<br />
55812 <strong>04</strong> N M Y 1678.65<br />
55815 <strong>04</strong> N M Y 18<strong>09</strong>.25<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 217 <strong>of</strong> 458
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