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 69910 04 N M Y 1198.70 69915 04 N M Y Y 1198.70 69930 04 N M Y 1296.20 69949 04 Y M Y 69950 04 N M Y Y 1079.30 69955 04 N M Y Y 1079.30 69960 04 N M Y Y 1198.70 69970 04 N M Y Y 1188.20 69979 04 Y M Y 69990 09 Y N 70010 04 N I 28.70 70015 04 N I 39.20 70030 A 04 N N 10.75 10.75 21.50 70100 A 04 N N 11.40 11.40 22.80 70110 A 04 N N 15.65 15.65 31.30 70120 A 04 N N 11.40 11.40 22.80 70130 A 04 N N 15.65 15.65 31.30 70134 A 04 N N 20.25 20.25 40.50 70140 A 04 N N 14.35 14.35 28.70 70150 A 04 N N 17.62 15.62 35.25 70160 A 04 N N 10.47 10.47 20.95 Wednesday, April 01, 2009 Page 274 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 70170 04 N I 18.30 70190 A 04 N N 11.40 11.40 22.80 70200 A 04 N N 17.62 17.62 35.25 70210 A 04 N N 11.10 11.10 22.20 70220 A 04 N N 14.35 14.35 28.70 70240 A 04 N N 11.40 11.40 22.80 70250 A 04 N N 10.75 10.75 21.50 70260 A 04 N N 17.62 17.62 35.25 70300 A 04 N N 5.90 5.90 11.80 70310 A 04 N N 7.17 7.17 14.35 70320 A 04 N N 14.35 14.35 28.70 70328 A 04 N N 14.35 14.35 28.70 70330 A 04 N N 14.35 14.35 28.70 70332 04 N I 23.30 70336 B 04 N N 148.30 148.30 296.60 70350 A 04 N N 7.17 7.17 14.35 70355 A 04 N N 14.35 14.35 28.70 70360 A 04 N N 7.17 7.17 14.35 70370 A 04 N N 13.07 13.07 26.15 70371 A 04 N N 12.70 12.70 25.40 70373 04 N I 20.20 Wednesday, April 01, 2009 Page 275 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 />
7<strong>01</strong>70 <strong>04</strong> N I 18.30<br />
7<strong>01</strong>90 A <strong>04</strong> N N 11.40 11.40 22.80<br />
70200 A <strong>04</strong> N N 17.62 17.62 35.25<br />
70210 A <strong>04</strong> N N 11.10 11.10 22.20<br />
70220 A <strong>04</strong> N N 14.35 14.35 28.70<br />
70240 A <strong>04</strong> N N 11.40 11.40 22.80<br />
70250 A <strong>04</strong> N N 10.75 10.75 21.50<br />
70260 A <strong>04</strong> N N 17.62 17.62 35.25<br />
70300 A <strong>04</strong> N N 5.90 5.90 11.80<br />
70310 A <strong>04</strong> N N 7.17 7.17 14.35<br />
70320 A <strong>04</strong> N N 14.35 14.35 28.70<br />
70328 A <strong>04</strong> N N 14.35 14.35 28.70<br />
70330 A <strong>04</strong> N N 14.35 14.35 28.70<br />
70332 <strong>04</strong> N I 23.30<br />
70336 B <strong>04</strong> N N 148.30 148.30 296.60<br />
70350 A <strong>04</strong> N N 7.17 7.17 14.35<br />
70355 A <strong>04</strong> N N 14.35 14.35 28.70<br />
70360 A <strong>04</strong> N N 7.17 7.17 14.35<br />
70370 A <strong>04</strong> N N 13.07 13.07 26.15<br />
70371 A <strong>04</strong> N N 12.70 12.70 25.40<br />
70373 <strong>04</strong> N I 20.20<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 275 <strong>of</strong> 458
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