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 62192 04 N M Y Y 761.60 62194 04 N M Y Y 599.35 62200 04 N M Y Y 839.35 62201 04 N M Y Y 1048.85 62220 04 N M Y Y 839.35 62223 04 N M Y Y 761.60 62225 04 N M Y Y 374.55 62230 04 N M Y Y 374.55 62252 04 N I Y 54.20 62256 04 N M Y Y 225.80 62258 04 N M Y Y 599.35 62263 04 N M 193.60 62264 04 N M 193.60 62267 04 1/1/2009 N M 481.80 62268 04 N M 449.50 62269 04 N M 449.50 62270 04 N I 53.70 62272 04 N I 59.10 62273 04 N I 74.90 62280 04 N I 158.20 62281 04 N I 81.10 Wednesday, April 01, 2009 Page 242 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 62282 04 N I 158.20 62284 04 N I 158.20 62287 04 N M Y 481.80 62290 04 N I 158.20 62291 04 N I 158.20 62292 04 N M Y 852.05 62294 04 N M 852.05 62310 04 N I 85.90 62311 04 N I 86.00 62318 04 Y M 62319 04 Y M 62350 04 N M Y Y 545.10 62351 04 N M Y Y 839.35 62355 04 N M Y Y 180.30 62360 04 N M Y Y 545.10 62361 04 N M Y Y 545.10 62362 04 N M Y Y 545.10 62365 04 N M Y Y 162.00 62367 04 N I 27.55 62368 04 N I 40.45 63001 04 N M Y Y 1102.95 Wednesday, April 01, 2009 Page 243 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 />
62282 <strong>04</strong> N I 158.20<br />
62284 <strong>04</strong> N I 158.20<br />
62287 <strong>04</strong> N M Y 481.80<br />
62290 <strong>04</strong> N I 158.20<br />
62291 <strong>04</strong> N I 158.20<br />
62292 <strong>04</strong> N M Y 852.05<br />
62294 <strong>04</strong> N M 852.05<br />
62310 <strong>04</strong> N I 85.90<br />
62311 <strong>04</strong> N I 86.00<br />
62318 <strong>04</strong> Y M<br />
62319 <strong>04</strong> Y M<br />
62350 <strong>04</strong> N M Y Y 545.10<br />
62351 <strong>04</strong> N M Y Y 839.35<br />
62355 <strong>04</strong> N M Y Y 180.30<br />
62360 <strong>04</strong> N M Y Y 545.10<br />
62361 <strong>04</strong> N M Y Y 545.10<br />
62362 <strong>04</strong> N M Y Y 545.10<br />
62365 <strong>04</strong> N M Y Y 162.00<br />
62367 <strong>04</strong> N I 27.55<br />
62368 <strong>04</strong> N I 40.45<br />
630<strong>01</strong> <strong>04</strong> N M Y Y 1102.95<br />
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