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 55821 04 N M Y 958.60 55831 04 N M Y 958.60 55840 04 N M Y Y 1198.70 55842 04 N M Y 1285.40 55845 04 N M Y Y 1438.70 55860 04 Y M Y 55862 04 Y M Y 55865 04 Y M Y Y 55866 04 Y M Y Y 55870 09 Y I 55873 04 N M Y 739.15 55875 04 1/1/2007 N M Y 359.30 55876 04 1/1/2007 N M Y 59.34 55899 04 Y M Y Y 55920 04 1/1/2008 N M Y 246.06 56405 04 N I 95.05 56420 04 N I 103.05 17.00 56440 04 N M 202.50 56441 04 N I 127.90 56442 04 1/1/2007 N I 68.65 56501 04 N I Y 52.70 17.00 Wednesday, April 01, 2009 Page 218 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 56515 04 N M Y 181.00 34.00 56605 04 N I 108.30 56606 04 N I 35.65 56620 04 N M Y 335.70 56625 04 N M Y 480.00 56630 04 N M Y 524.40 56631 04 N M Y 511.20 56632 04 N M Y 599.65 56633 04 N M Y 524.40 56634 04 N M Y 599.35 56637 04 N M Y 749.20 56640 04 N M Y 749.20 56700 04 N I 113.60 56740 04 N M 226.10 56800 04 N I 119.25 56805 04 N M 496.90 56810 04 N M Y 190.00 56820 04 N I 37.40 56821 04 N I 50.20 57000 04 N M 202.55 57010 04 N M 224.70 Wednesday, April 01, 2009 Page 219 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 />
55821 <strong>04</strong> N M Y 958.60<br />
55831 <strong>04</strong> N M Y 958.60<br />
55840 <strong>04</strong> N M Y Y 1198.70<br />
55842 <strong>04</strong> N M Y 1285.40<br />
55845 <strong>04</strong> N M Y Y 1438.70<br />
55860 <strong>04</strong> Y M Y<br />
55862 <strong>04</strong> Y M Y<br />
55865 <strong>04</strong> Y M Y Y<br />
55866 <strong>04</strong> Y M Y Y<br />
55870 <strong>09</strong> Y I<br />
55873 <strong>04</strong> N M Y 739.15<br />
55875 <strong>04</strong> 1/1/2007 N M Y 359.30<br />
55876 <strong>04</strong> 1/1/2007 N M Y 59.34<br />
55899 <strong>04</strong> Y M Y Y<br />
55920 <strong>04</strong> 1/1/2008 N M Y 246.06<br />
56405 <strong>04</strong> N I 95.05<br />
56420 <strong>04</strong> N I 103.05 17.00<br />
56440 <strong>04</strong> N M 202.50<br />
56441 <strong>04</strong> N I 127.90<br />
56442 <strong>04</strong> 1/1/2007 N I 68.65<br />
565<strong>01</strong> <strong>04</strong> N I Y 52.70 17.00<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 218 <strong>of</strong> 458
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