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 10140 04 N I 41.50 10160 04 N I 35.95 10180 04 N I Y 130.55 11000 04 N I 77.70 11001 04 N I 20.85 11004 04 N M Y Y 154.43 11005 04 N M Y Y 154.43 11006 04 N M Y Y 154.43 11008 04 N M Y Y 154.43 11010 04 N I 127.60 11011 04 N I 157.90 11012 04 N I 218.40 11040 04 N I 34.10 11041 04 N I Y 51.90 11042 04 N I Y Y 70.55 11043 04 N M Y 170.55 11044 04 N M Y 219.35 11055 04 N I 22.15 11056 04 Y I 11057 04 Y I 11100 04 N I 50.20 17.00 Wednesday, April 01, 2009 Page 16 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 11101 04 N I 22.15 11200 04 N I 35.65 17.00 11201 04 N I 15.20 11300 04 N I 21.10 11301 04 N I 29.20 11302 04 N I 37.50 11303 04 N I 45.70 11305 04 N I 22.25 11306 04 N I 31.25 11307 04 N I 37.50 11308 04 N I 45.70 11310 04 N I 32.40 11311 04 N I 40.55 11312 04 N I 48.80 11313 04 N I 57.10 11400 04 N I 39.05 17.00 11401 04 N I 50.20 17.00 11402 04 N I 64.80 17.00 11403 04 N I 77.90 17.00 11404 04 N I 92.40 17.00 11406 04 N I 108.00 17.00 Wednesday, April 01, 2009 Page 17 of 458
- Page 1 and 2: Healthcare and Family Services Prac
- Page 3 and 4: Q State maximum amount now includes
- Page 5 and 6: MODIFIERS RECOGNIZED IN PROCESSING
- Page 7 and 8: HO Masters degree level; added 0601
- Page 9 and 10: Health Care and Family Services Rev
- Page 11 and 12: Hcpcs Note ProgCov Eff Date HP NDC
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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 />
111<strong>01</strong> <strong>04</strong> N I 22.15<br />
11200 <strong>04</strong> N I 35.65 17.00<br />
112<strong>01</strong> <strong>04</strong> N I 15.20<br />
11300 <strong>04</strong> N I 21.10<br />
113<strong>01</strong> <strong>04</strong> N I 29.20<br />
11302 <strong>04</strong> N I 37.50<br />
11303 <strong>04</strong> N I 45.70<br />
11305 <strong>04</strong> N I 22.25<br />
11306 <strong>04</strong> N I 31.25<br />
11307 <strong>04</strong> N I 37.50<br />
11308 <strong>04</strong> N I 45.70<br />
11310 <strong>04</strong> N I 32.40<br />
11311 <strong>04</strong> N I 40.55<br />
11312 <strong>04</strong> N I 48.80<br />
11313 <strong>04</strong> N I 57.10<br />
11400 <strong>04</strong> N I 39.05 17.00<br />
114<strong>01</strong> <strong>04</strong> N I 50.20 17.00<br />
11402 <strong>04</strong> N I 64.80 17.00<br />
11403 <strong>04</strong> N I 77.90 17.00<br />
114<strong>04</strong> <strong>04</strong> N I 92.40 17.00<br />
11406 <strong>04</strong> N I 108.00 17.00<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 17 <strong>of</strong> 458
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