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 82009 A 04 10/1/2008 N N .86 .86 1.72 82010 A 04 10/1/2008 N N .86 .86 1.72 82013 A 04 10/1/2008 N N 2.70 2.70 5.40 82016 A 04 10/1/2008 N N 2.55 2.55 5.10 82017 A 04 10/1/2008 N N 5.82 5.82 11.64 82024 A 04 10/1/2008 N N 6.71 6.71 13.42 82030 B 04 10/1/2008 N N 4.43 4.43 8.86 82040 A 04 10/1/2008 N N 2.25 2.25 4.50 82042 A 04 10/1/2008 N N 2.25 2.25 4.50 82043 A 04 10/1/2008 N N 1.97 1.97 3.94 82044 A 04 10/1/2008 N N 1.97 1.97 3.94 82045 A 04 10/1/2008 Y N 82055 A 04 10/1/2008 N N 4.31 4.31 8.62 82075 A 04 10/1/2008 N N 2.51 2.51 5.02 82085 B 04 10/1/2008 N N 3.15 3.15 6.30 82088 A 04 10/1/2008 N N 19.95 19.95 39.90 82101 A 04 10/1/2008 N N 8.85 8.85 17.70 82103 B 04 10/1/2008 N N 4.43 4.43 8.86 82104 B 04 10/1/2008 N N 3.58 3.58 7.16 82105 B 04 10/1/2008 N N 8.21 8.21 16.42 82106 B 04 10/1/2008 N N 3.11 3.11 6.22 Wednesday, April 01, 2009 Page 312 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 82107 B 04 10/1/2008 N N 14.72 14.72 29.44 82108 A 04 10/1/2008 N N 2.51 2.51 5.02 82120 A 04 10/1/2008 N N 1.84 1.84 3.68 82127 A 04 10/1/2008 N N 2.55 2.55 5.10 82128 A 04 10/1/2008 N N 2.55 2.55 5.10 82131 A 04 10/1/2008 N N 5.81 5.81 11.62 82135 B 04 10/1/2008 N N 4.43 4.43 8.86 82136 A 04 10/1/2008 N N 5.81 5.81 11.62 82139 A 04 10/1/2008 N N 5.81 5.81 11.62 82140 A 04 10/1/2008 N N 3.58 3.58 7.16 82143 A 04 10/1/2008 N N 3.36 3.36 6.72 82145 A 04 10/1/2008 N N 5.25 5.25 10.50 82150 A 04 10/1/2008 N N 3.19 3.19 6.38 82154 B 04 10/1/2008 N N 8.40 8.40 16.80 82157 B 04 10/1/2008 N N 8.40 8.40 16.80 82160 A 04 10/1/2008 N N 2.70 2.70 5.40 82163 B 04 10/1/2008 N N 3.75 3.75 7.50 82164 B 04 10/1/2008 N N 3.58 3.58 7.16 82172 A 04 10/1/2008 N N 6.00 6.00 12.00 82175 A 04 10/1/2008 N N 4.43 4.43 8.86 82180 B 04 10/1/2008 N N 2.51 2.51 5.02 Wednesday, April 01, 2009 Page 313 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 />
820<strong>09</strong> A <strong>04</strong> 10/1/2008 N N .86 .86 1.72<br />
82<strong>01</strong>0 A <strong>04</strong> 10/1/2008 N N .86 .86 1.72<br />
82<strong>01</strong>3 A <strong>04</strong> 10/1/2008 N N 2.70 2.70 5.40<br />
82<strong>01</strong>6 A <strong>04</strong> 10/1/2008 N N 2.55 2.55 5.10<br />
82<strong>01</strong>7 A <strong>04</strong> 10/1/2008 N N 5.82 5.82 11.64<br />
82024 A <strong>04</strong> 10/1/2008 N N 6.71 6.71 13.42<br />
82030 B <strong>04</strong> 10/1/2008 N N 4.43 4.43 8.86<br />
82<strong>04</strong>0 A <strong>04</strong> 10/1/2008 N N 2.25 2.25 4.50<br />
82<strong>04</strong>2 A <strong>04</strong> 10/1/2008 N N 2.25 2.25 4.50<br />
82<strong>04</strong>3 A <strong>04</strong> 10/1/2008 N N 1.97 1.97 3.94<br />
82<strong>04</strong>4 A <strong>04</strong> 10/1/2008 N N 1.97 1.97 3.94<br />
82<strong>04</strong>5 A <strong>04</strong> 10/1/2008 Y N<br />
82055 A <strong>04</strong> 10/1/2008 N N 4.31 4.31 8.62<br />
82075 A <strong>04</strong> 10/1/2008 N N 2.51 2.51 5.02<br />
82085 B <strong>04</strong> 10/1/2008 N N 3.15 3.15 6.30<br />
82088 A <strong>04</strong> 10/1/2008 N N 19.95 19.95 39.90<br />
821<strong>01</strong> A <strong>04</strong> 10/1/2008 N N 8.85 8.85 17.70<br />
82103 B <strong>04</strong> 10/1/2008 N N 4.43 4.43 8.86<br />
821<strong>04</strong> B <strong>04</strong> 10/1/2008 N N 3.58 3.58 7.16<br />
82105 B <strong>04</strong> 10/1/2008 N N 8.21 8.21 16.42<br />
82106 B <strong>04</strong> 10/1/2008 N N 3.11 3.11 6.22<br />
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