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 76815 B 04 N N 35.95 35.95 71.90 76816 B 04 N N 35.95 35.95 71.90 76817 B 04 N N 35.95 35.95 71.90 76818 B 04 N N 31.97 31.97 63.95 76819 B 04 N N 15.55 15.55 31.10 76820 B 04 N N 35.95 35.95 71.90 76821 B 04 N N 35.95 35.95 71.90 76825 B 04 N N 35.95 35.95 71.90 76826 B 04 N N 35.95 35.95 71.90 76827 B 04 N N 35.95 35.95 71.90 76828 B 04 N N 35.95 35.95 71.90 76830 B 04 N N 35.95 35.95 71.90 76831 B 04 N N 35.95 35.90 71.90 76856 B 04 N N 35.95 35.95 71.90 76857 B 04 N N 35.95 35.95 71.90 76870 B 04 N N 24.85 24.85 49.70 76872 B 04 N N 35.95 35.95 71.90 76873 B 04 N N 71.35 71.35 142.70 76880 B 04 N N 24.85 24.85 49.70 76885 B 04 N N 35.95 35.95 71.90 76886 B 04 N N 35.95 35.95 71.90 Wednesday, April 01, 2009 Page 294 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 76930 04 N I 56.20 76932 04 N I 65.35 76936 04 N I 56.20 76937 C 04 N I 9.21 9.60 1 18.81 76940 C 04 N I 55.84 35.48 1 91.32 76941 04 N I 56.20 76942 04 N I 60.10 76945 04 N I 49.70 76946 04 N I 51.00 76950 B 04 N N 31.35 31.35 62.70 76965 B 04 N N 24.85 24.85 49.70 76970 A 04 Y N 76975 04 N I 51.00 76977 B 04 N N 17.25 17.25 34.50 76998 04 1/1/2007 N N 33.37 76999 04 Y N 77001 C 04 1/1/2007 N N 8.75 29.29 1 38.04 77002 C 04 1/1/2007 N N 13.27 24.63 1 37.90 77003 C 04 1/1/2007 N N 20.40 31.90 1 52.30 77011 C 04 1/1/2007 N N 7.31 48.89 1 56.20 77012 C 04 1/1/2007 N N 10.12 46.08 1 56.20 Wednesday, April 01, 2009 Page 295 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 />
76930 <strong>04</strong> N I 56.20<br />
76932 <strong>04</strong> N I 65.35<br />
76936 <strong>04</strong> N I 56.20<br />
76937 C <strong>04</strong> N I 9.21 9.60 1 18.81<br />
76940 C <strong>04</strong> N I 55.84 35.48 1 91.32<br />
76941 <strong>04</strong> N I 56.20<br />
76942 <strong>04</strong> N I 60.10<br />
76945 <strong>04</strong> N I 49.70<br />
76946 <strong>04</strong> N I 51.00<br />
76950 B <strong>04</strong> N N 31.35 31.35 62.70<br />
76965 B <strong>04</strong> N N 24.85 24.85 49.70<br />
76970 A <strong>04</strong> Y N<br />
76975 <strong>04</strong> N I 51.00<br />
76977 B <strong>04</strong> N N 17.25 17.25 34.50<br />
76998 <strong>04</strong> 1/1/2007 N N 33.37<br />
76999 <strong>04</strong> Y N<br />
770<strong>01</strong> C <strong>04</strong> 1/1/2007 N N 8.75 29.29 1 38.<strong>04</strong><br />
77002 C <strong>04</strong> 1/1/2007 N N 13.27 24.63 1 37.90<br />
77003 C <strong>04</strong> 1/1/2007 N N 20.40 31.90 1 52.30<br />
77<strong>01</strong>1 C <strong>04</strong> 1/1/2007 N N 7.31 48.89 1 56.20<br />
77<strong>01</strong>2 C <strong>04</strong> 1/1/2007 N N 10.12 46.08 1 56.20<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 295 <strong>of</strong> 458
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