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 63003 04 N M Y Y 1102.95 63005 04 N M Y Y 1102.95 63011 04 N M Y Y 881.00 63012 04 N M Y 1404.20 63015 04 N M Y Y 1161.20 63016 04 N M Y Y 1161.20 63017 04 N M Y Y 1161.20 63020 04 Y M Y Y 63030 04 N M Y Y 1129.30 63035 04 Y M Y Y 63040 04 N M Y Y 1129.30 63042 04 N M Y Y 1129.30 63043 04 Y M Y 63044 04 Y M Y 63045 04 N M Y Y 1129.30 63046 04 N M Y Y 1129.30 63047 04 N M Y Y 1129.30 63048 04 Y M Y Y 63050 04 N M Y Y 843.88 63051 04 N M Y Y 947.11 63055 04 N M Y Y 1291.70 Wednesday, April 01, 2009 Page 244 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 63056 04 N M Y Y 1291.70 63057 04 Y M Y Y 63064 04 N M Y Y 1198.70 63066 04 Y M Y Y 63075 04 N M Y Y 1198.70 63076 04 N M Y Y 1198.70 63077 04 N M Y Y 1198.70 63078 04 N M Y Y 1198.70 63081 04 N M Y Y 1291.70 63082 04 Y M Y Y 63085 04 N M Y Y 1291.70 63086 04 Y M Y Y 63087 04 N M Y Y 1291.70 63088 04 Y M Y Y 63090 04 N M Y Y 1291.70 63091 04 Y M Y Y 63101 04 N M Y Y 1153.57 63102 04 N M Y Y 1153.57 63103 04 Y M Y Y 63170 04 N M Y Y 1291.70 63172 04 N M Y Y 1198.70 Wednesday, April 01, 2009 Page 245 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 />
63056 <strong>04</strong> N M Y Y 1291.70<br />
63057 <strong>04</strong> Y M Y Y<br />
63064 <strong>04</strong> N M Y Y 1198.70<br />
63066 <strong>04</strong> Y M Y Y<br />
63075 <strong>04</strong> N M Y Y 1198.70<br />
63076 <strong>04</strong> N M Y Y 1198.70<br />
63077 <strong>04</strong> N M Y Y 1198.70<br />
63078 <strong>04</strong> N M Y Y 1198.70<br />
63081 <strong>04</strong> N M Y Y 1291.70<br />
63082 <strong>04</strong> Y M Y Y<br />
63085 <strong>04</strong> N M Y Y 1291.70<br />
63086 <strong>04</strong> Y M Y Y<br />
63087 <strong>04</strong> N M Y Y 1291.70<br />
63088 <strong>04</strong> Y M Y Y<br />
63<strong>09</strong>0 <strong>04</strong> N M Y Y 1291.70<br />
63<strong>09</strong>1 <strong>04</strong> Y M Y Y<br />
631<strong>01</strong> <strong>04</strong> N M Y Y 1153.57<br />
63102 <strong>04</strong> N M Y Y 1153.57<br />
63103 <strong>04</strong> Y M Y Y<br />
63170 <strong>04</strong> N M Y Y 1291.70<br />
63172 <strong>04</strong> N M Y Y 1198.70<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 245 <strong>of</strong> 458
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