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 72142 B 04 N N 148.30 148.30 296.60 72146 B 04 N N 148.30 148.30 296.60 72147 B 04 N N 148.30 148.30 296.60 72148 B 04 N N 148.30 148.30 296.60 72149 B 04 N N 148.30 148.30 296.60 72156 B 04 N N 148.30 148.30 296.60 72157 B 04 N N 148.30 148.30 296.60 72158 B 04 N N 148.30 148.30 296.60 72159 B 04 N N 148.30 148.30 296.60 72170 A 04 N N 7.85 7.85 15.70 72190 A 04 N N 17.63 17.62 35.25 72191 B 04 N N 128.30 128.30 256.60 72192 B 04 N N 31.35 31.35 62.70 72193 B 04 N N 37.95 37.95 75.90 72194 B 04 N N 54.93 54.92 109.85 72195 B 04 N N 148.30 148.30 296.60 72196 B 04 N N 148.30 148.30 296.60 72197 B 04 N N 226.15 226.15 452.30 72198 B 04 N N 148.30 148.30 296.60 72200 A 04 N N 10.75 10.75 21.50 72202 A 04 N N 11.40 11.40 22.80 Wednesday, April 01, 2009 Page 280 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 72220 A 04 N N 10.75 10.75 21.50 72240 04 N I 65.35 72255 04 N I 52.30 72265 04 N N 52.30 72270 04 N N 99.35 72275 04 N I 57.45 72285 04 N I 52.30 72291 04 1/1/2007 N I 78.05 72292 04 1/1/2007 N I 62.50 72295 04 N I 45.80 73000 A 04 N N 7.50 7.50 15.00 73010 A 04 N N 10.75 10.75 21.50 73020 A 04 N N 10.75 10.75 21.50 73030 A 04 N N 11.10 11.10 22.20 73040 C 04 N I 6.03 17.47 23.50 73050 A 04 N N 10.07 10.08 20.15 73060 A 04 N N 7.85 7.85 15.70 73070 A 04 N N 9.80 9.80 19.60 73080 A 04 N N 10.75 10.75 21.50 73085 04 N I 22.20 73090 A 04 N N 9.15 9.15 18.30 Wednesday, April 01, 2009 Page 281 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 />
72220 A <strong>04</strong> N N 10.75 10.75 21.50<br />
72240 <strong>04</strong> N I 65.35<br />
72255 <strong>04</strong> N I 52.30<br />
72265 <strong>04</strong> N N 52.30<br />
72270 <strong>04</strong> N N 99.35<br />
72275 <strong>04</strong> N I 57.45<br />
72285 <strong>04</strong> N I 52.30<br />
72291 <strong>04</strong> 1/1/2007 N I 78.05<br />
72292 <strong>04</strong> 1/1/2007 N I 62.50<br />
72295 <strong>04</strong> N I 45.80<br />
73000 A <strong>04</strong> N N 7.50 7.50 15.00<br />
73<strong>01</strong>0 A <strong>04</strong> N N 10.75 10.75 21.50<br />
73020 A <strong>04</strong> N N 10.75 10.75 21.50<br />
73030 A <strong>04</strong> N N 11.10 11.10 22.20<br />
73<strong>04</strong>0 C <strong>04</strong> N I 6.03 17.47 23.50<br />
73050 A <strong>04</strong> N N 10.07 10.08 20.15<br />
73060 A <strong>04</strong> N N 7.85 7.85 15.70<br />
73070 A <strong>04</strong> N N 9.80 9.80 19.60<br />
73080 A <strong>04</strong> N N 10.75 10.75 21.50<br />
73085 <strong>04</strong> N I 22.20<br />
73<strong>09</strong>0 A <strong>04</strong> N N 9.15 9.15 18.30<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 281 <strong>of</strong> 458
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