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 77013 04 N N 233.70 77014 C 04 1/1/2007 N N 14.05 42.15 1 56.20 77021 C 04 1/1/2007 N N 53.61 281.44 1 335.05 77022 C 04 1/1/2007 N N 53.61 281.44 1 335.05 77031 C 04 1/1/2007 N N 26.08 9.17 1 35.25 77032 C 04 1/1/2007 N N 13.75 21.50 1 35.25 77051 C 04 1/1/2007 N N 1.89 8.07 1 9.96 77052 C 04 1/1/2007 N N 1.89 8.07 1 9.96 77053 C 04 1/1/2007 N N 9.18 41.82 1 51.00 77054 C 04 1/1/2007 N N 11.44 60.06 1 71.50 77055 C 04 1/1/2007 N N 17.64 21.56 1 39.20 77056 C 04 1/1/2007 N N 31.64 40.26 1 71.90 77057 C 04 1/1/2007 N N 30.20 41.70 1 71.90 77058 C 04 1/1/2007 N N 29.66 266.94 1 296.60 77059 C 04 1/1/2007 N N 23.73 272.87 1 296.60 77071 04 1/1/2007 N N 15.53 77072 C 04 1/1/2007 N N 8.81 12.69 1 21.50 77073 C 04 1/1/2007 N N 9.18 19.52 1 28.70 77074 C 04 1/1/2007 N N 20.72 36.83 1 57.55 77075 C 04 1/1/2007 N N 30.41 67.69 1 98.10 77076 C 04 1/1/2007 N N 16.92 18.33 1 35.25 Wednesday, April 01, 2009 Page 296 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 77077 C 04 1/1/2007 N N 12.57 29.33 1 41.90 77078 C 04 1/1/2007 N N 3.20 32.40 1 35.60 77079 C 04 1/1/2007 N N 3.92 31.68 1 35.60 77080 C 04 1/1/2007 N N 9.81 88.29 1 98.10 77081 C 04 1/1/2007 N N 28.45 69.65 1 98.10 77082 C 04 1/1/2007 N N 24.53 73.57 1 98.10 77083 C 04 1/1/2007 N N 30.10 73.70 1 103.80 77084 C 04 1/1/2007 N N 48.83 238.43 1 287.26 77261 09 Y N 77262 09 Y N 77263 09 Y I 77280 09 Y N 77285 09 Y N 77290 09 Y N 77295 09 Y N 77299 09 Y N 77300 09 Y N 77301 09 Y N 77305 09 Y N 77310 09 Y N 77315 09 Y N Wednesday, April 01, 2009 Page 297 of 458
- 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 and 266: Hcpcs Note ProgCov Eff Date HP NDC
- Page 267 and 268: 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: 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
- Page 317 and 318: Hcpcs Note ProgCov Eff Date HP NDC
- Page 319 and 320: Hcpcs Note ProgCov Eff Date HP NDC
- Page 321 and 322: Hcpcs Note ProgCov Eff Date HP NDC
- Page 323 and 324: Hcpcs Note ProgCov Eff Date HP NDC
- Page 325 and 326: Hcpcs Note ProgCov Eff Date HP NDC
- Page 327 and 328: Hcpcs Note ProgCov Eff Date HP NDC
- Page 329 and 330: Hcpcs Note ProgCov Eff Date HP NDC
- Page 331 and 332: Hcpcs Note ProgCov Eff Date HP NDC
- Page 333 and 334: Hcpcs Note ProgCov Eff Date HP NDC
- Page 335 and 336: Hcpcs Note ProgCov Eff Date HP NDC
- Page 337 and 338: Hcpcs Note ProgCov Eff Date HP NDC
- Page 339 and 340: Hcpcs Note ProgCov Eff Date HP NDC
- Page 341 and 342: Hcpcs Note ProgCov Eff Date HP NDC
- Page 343 and 344: Hcpcs Note ProgCov Eff Date HP NDC
- Page 345 and 346: Hcpcs Note ProgCov Eff Date HP NDC
- Page 347 and 348: Hcpcs Note ProgCov Eff Date HP NDC
- Page 349 and 350: Hcpcs Note ProgCov Eff Date HP NDC
- Page 351 and 352: Hcpcs Note ProgCov Eff Date HP NDC
- Page 353 and 354: 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 />
77077 C <strong>04</strong> 1/1/2007 N N 12.57 29.33 1 41.90<br />
77078 C <strong>04</strong> 1/1/2007 N N 3.20 32.40 1 35.60<br />
77079 C <strong>04</strong> 1/1/2007 N N 3.92 31.68 1 35.60<br />
77080 C <strong>04</strong> 1/1/2007 N N 9.81 88.29 1 98.10<br />
77081 C <strong>04</strong> 1/1/2007 N N 28.45 69.65 1 98.10<br />
77082 C <strong>04</strong> 1/1/2007 N N 24.53 73.57 1 98.10<br />
77083 C <strong>04</strong> 1/1/2007 N N 30.10 73.70 1 103.80<br />
77084 C <strong>04</strong> 1/1/2007 N N 48.83 238.43 1 287.26<br />
77261 <strong>09</strong> Y N<br />
77262 <strong>09</strong> Y N<br />
77263 <strong>09</strong> Y I<br />
77280 <strong>09</strong> Y N<br />
77285 <strong>09</strong> Y N<br />
77290 <strong>09</strong> Y N<br />
77295 <strong>09</strong> Y N<br />
77299 <strong>09</strong> Y N<br />
77300 <strong>09</strong> Y N<br />
773<strong>01</strong> <strong>09</strong> Y N<br />
77305 <strong>09</strong> Y N<br />
77310 <strong>09</strong> Y N<br />
77315 <strong>09</strong> Y N<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 297 <strong>of</strong> 458
Change language