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 64623 04 N I 48.20 64626 04 N I 113.40 64627 04 N I 66.50 64630 04 N I 88.50 64632 04 1/1/2009 N I 90.50 64640 04 N I 90.50 64650 04 N I 22.42 64653 04 N I 28.36 64680 04 N M 224.70 64681 04 N I 116.11 64702 04 N M Y Y 524.40 64704 04 N M Y Y 524.40 64708 04 N M Y Y 524.40 64712 04 N M Y Y 524.40 64713 04 N M Y Y 647.90 64714 04 N M Y Y 647.90 64716 04 Y M Y Y 64718 04 N M Y Y 524.40 64719 04 N M Y Y 524.40 64721 04 N M Y Y 524.40 64722 04 N M Y Y 524.40 Wednesday, April 01, 2009 Page 252 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 64726 04 N M Y Y 524.40 64727 04 N M Y Y 524.40 64732 04 N I Y Y 148.20 64734 04 N M Y Y 158.30 64736 04 N M 224.70 64738 04 N M Y Y 374.55 64740 04 N M Y Y 224.70 64742 04 N M Y Y 224.70 64744 04 N M Y Y 607.60 64746 04 N I Y Y 181.05 64752 04 N M Y Y 524.40 64755 04 N M Y Y 524.40 64760 04 N M Y Y 524.40 64761 04 N M Y Y 299.70 64763 04 N M Y Y 224.70 64766 04 N M Y Y 374.55 64771 04 N M Y 374.55 64772 04 N M Y Y 374.55 64774 04 N I Y 144.55 34.00 64776 04 N M Y Y 180.30 64778 04 Y M Y Y Wednesday, April 01, 2009 Page 253 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 />
64726 <strong>04</strong> N M Y Y 524.40<br />
64727 <strong>04</strong> N M Y Y 524.40<br />
64732 <strong>04</strong> N I Y Y 148.20<br />
64734 <strong>04</strong> N M Y Y 158.30<br />
64736 <strong>04</strong> N M 224.70<br />
64738 <strong>04</strong> N M Y Y 374.55<br />
64740 <strong>04</strong> N M Y Y 224.70<br />
64742 <strong>04</strong> N M Y Y 224.70<br />
64744 <strong>04</strong> N M Y Y 607.60<br />
64746 <strong>04</strong> N I Y Y 181.05<br />
64752 <strong>04</strong> N M Y Y 524.40<br />
64755 <strong>04</strong> N M Y Y 524.40<br />
64760 <strong>04</strong> N M Y Y 524.40<br />
64761 <strong>04</strong> N M Y Y 299.70<br />
64763 <strong>04</strong> N M Y Y 224.70<br />
64766 <strong>04</strong> N M Y Y 374.55<br />
64771 <strong>04</strong> N M Y 374.55<br />
64772 <strong>04</strong> N M Y Y 374.55<br />
64774 <strong>04</strong> N I Y 144.55 34.00<br />
64776 <strong>04</strong> N M Y Y 180.30<br />
64778 <strong>04</strong> Y M Y Y<br />
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