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 65290 04 N M 449.50 65400 04 N M 323.30 65410 04 N I 51.40 17.00 65420 04 N M Y 273.30 65426 04 N M 348.15 65430 04 N I 78.50 17.00 65435 04 N I 48.55 65436 04 N I 125.25 65450 04 N I Y 135.40 65600 04 N M 240.00 65710 04 N M 839.25 65730 04 N M Y 1317.95 65750 04 N M 1317.95 65755 04 N M Y 1317.95 65756 04 1/1/2009 N M 839.35 65760 04 N M 1560.80 65765 04 N M 1560.80 65767 04 N M Y 1560.80 65770 04 Y M 65772 04 N M Y 1252.00 65775 04 N M Y 648.10 Wednesday, April 01, 2009 Page 258 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 65780 04 N M Y Y 403.90 65781 04 N M Y Y 617.78 65782 04 N M Y Y 532.61 65800 04 N M 240.00 65805 04 N M 299.70 65810 04 N M 299.70 65815 04 N M 480.00 65820 04 N M 599.35 65850 04 N M Y 599.35 65855 04 N M 599.35 65860 04 N M Y 299.70 65865 04 N M 299.70 65870 04 N M 297.00 65875 04 N M 324.05 65880 04 N M 299.70 65900 04 N M 378.05 65920 04 Y M 65930 04 N M 480.00 66020 04 N M 180.30 66030 04 N M 180.30 66130 04 N M 273.30 Wednesday, April 01, 2009 Page 259 of 458
- Page 215 and 216: Hcpcs Note ProgCov Eff Date HP NDC
- Page 217 and 218: Hcpcs Note ProgCov Eff Date HP NDC
- Page 219 and 220: Hcpcs Note ProgCov Eff Date HP NDC
- Page 221 and 222: Hcpcs Note ProgCov Eff Date HP NDC
- Page 223 and 224: Hcpcs Note ProgCov Eff Date HP NDC
- Page 225 and 226: Hcpcs Note ProgCov Eff Date HP NDC
- Page 227 and 228: Hcpcs Note ProgCov Eff Date HP NDC
- Page 229 and 230: Hcpcs Note ProgCov Eff Date HP NDC
- Page 231 and 232: Hcpcs Note ProgCov Eff Date HP NDC
- Page 233 and 234: Hcpcs Note ProgCov Eff Date HP NDC
- Page 235 and 236: Hcpcs Note ProgCov Eff Date HP NDC
- Page 237 and 238: Hcpcs Note ProgCov Eff Date HP NDC
- Page 239 and 240: Hcpcs Note ProgCov Eff Date HP NDC
- Page 241 and 242: Hcpcs Note ProgCov Eff Date HP NDC
- Page 243 and 244: Hcpcs Note ProgCov Eff Date HP NDC
- Page 245 and 246: Hcpcs Note ProgCov Eff Date HP NDC
- Page 247 and 248: Hcpcs Note ProgCov Eff Date HP NDC
- Page 249 and 250: Hcpcs Note ProgCov Eff Date HP NDC
- Page 251 and 252: Hcpcs Note ProgCov Eff Date HP NDC
- Page 253 and 254: Hcpcs Note ProgCov Eff Date HP NDC
- Page 255 and 256: Hcpcs Note ProgCov Eff Date HP NDC
- Page 257 and 258: Hcpcs Note ProgCov Eff Date HP NDC
- Page 259 and 260: Hcpcs Note ProgCov Eff Date HP NDC
- Page 261 and 262: Hcpcs Note ProgCov Eff Date HP NDC
- Page 263 and 264: Hcpcs Note ProgCov Eff Date HP NDC
- Page 265: Hcpcs Note ProgCov Eff Date HP NDC
- Page 269 and 270: Hcpcs Note ProgCov Eff Date HP NDC
- Page 271 and 272: Hcpcs Note ProgCov Eff Date HP NDC
- Page 273 and 274: Hcpcs Note ProgCov Eff Date HP NDC
- Page 275 and 276: Hcpcs Note ProgCov Eff Date HP NDC
- Page 277 and 278: Hcpcs Note ProgCov Eff Date HP NDC
- Page 279 and 280: Hcpcs Note ProgCov Eff Date HP NDC
- Page 281 and 282: Hcpcs Note ProgCov Eff Date HP NDC
- Page 283 and 284: Hcpcs Note ProgCov Eff Date HP NDC
- Page 285 and 286: Hcpcs Note ProgCov Eff Date HP NDC
- Page 287 and 288: Hcpcs Note ProgCov Eff Date HP NDC
- Page 289 and 290: Hcpcs Note ProgCov Eff Date HP NDC
- Page 291 and 292: Hcpcs Note ProgCov Eff Date HP NDC
- Page 293 and 294: Hcpcs Note ProgCov Eff Date HP NDC
- Page 295 and 296: Hcpcs Note ProgCov Eff Date HP NDC
- Page 297 and 298: Hcpcs Note ProgCov Eff Date HP NDC
- Page 299 and 300: Hcpcs Note ProgCov Eff Date HP NDC
- Page 301 and 302: Hcpcs Note ProgCov Eff Date HP NDC
- Page 303 and 304: Hcpcs Note ProgCov Eff Date HP NDC
- Page 305 and 306: Hcpcs Note ProgCov Eff Date HP NDC
- Page 307 and 308: Hcpcs Note ProgCov Eff Date HP NDC
- Page 309 and 310: Hcpcs Note ProgCov Eff Date HP NDC
- Page 311 and 312: Hcpcs Note ProgCov Eff Date HP NDC
- Page 313 and 314: Hcpcs Note ProgCov Eff Date HP NDC
- Page 315 and 316: Hcpcs Note ProgCov Eff Date HP NDC
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 />
65780 <strong>04</strong> N M Y Y 403.90<br />
65781 <strong>04</strong> N M Y Y 617.78<br />
65782 <strong>04</strong> N M Y Y 532.61<br />
65800 <strong>04</strong> N M 240.00<br />
65805 <strong>04</strong> N M 299.70<br />
65810 <strong>04</strong> N M 299.70<br />
65815 <strong>04</strong> N M 480.00<br />
65820 <strong>04</strong> N M 599.35<br />
65850 <strong>04</strong> N M Y 599.35<br />
65855 <strong>04</strong> N M 599.35<br />
65860 <strong>04</strong> N M Y 299.70<br />
65865 <strong>04</strong> N M 299.70<br />
65870 <strong>04</strong> N M 297.00<br />
65875 <strong>04</strong> N M 324.05<br />
65880 <strong>04</strong> N M 299.70<br />
65900 <strong>04</strong> N M 378.05<br />
65920 <strong>04</strong> Y M<br />
65930 <strong>04</strong> N M 480.00<br />
66020 <strong>04</strong> N M 180.30<br />
66030 <strong>04</strong> N M 180.30<br />
66130 <strong>04</strong> N M 273.30<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 259 <strong>of</strong> 458
Change language