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 82634 A 04 10/1/2008 N N 7.76 7.76 15.52 82638 A 04 10/1/2008 N N 3.58 3.58 7.16 82646 A 04 10/1/2008 N N 1.76 1.76 3.52 82649 A 04 10/1/2008 N N 4.43 4.43 8.86 82651 B 04 10/1/2008 N N 10.09 10.09 20.18 82652 04 10/1/2008 N N 8.03 8.03 16.06 82654 B 04 10/1/2008 N N 1.69 1.69 3.38 82656 A 04 10/1/2008 N N 3.63 3.63 7.26 82657 A 04 10/1/2008 N N 6.09 6.09 12.18 82658 A 04 10/1/2008 N N 6.09 6.09 12.18 82664 B 04 10/1/2008 N N 13.53 13.53 27.06 82666 B 04 10/1/2008 N N 4.43 4.43 8.86 82668 B 04 10/1/2008 N N 5.21 5.21 10.42 82670 A 04 10/1/2008 N N 5.06 5.06 10.12 82671 B 04 10/1/2008 N N 8.85 8.85 17.70 82672 B 04 10/1/2008 N N 8.85 8.85 17.70 82677 B 04 10/1/2008 N N 5.06 5.06 10.12 82679 B 04 10/1/2008 N N 5.06 5.06 10.12 82690 A 04 10/1/2008 N N 4.22 4.22 8.44 82693 A 04 10/1/2008 N N 7.31 7.31 14.62 82696 B 04 10/1/2008 N N 5.04 5.04 10.08 Wednesday, April 01, 2009 Page 318 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 82705 A 04 10/1/2008 N N 1.28 1.28 2.56 82710 A 04 10/1/2008 N N 1.54 1.54 3.08 82715 A 04 10/1/2008 N N 1.61 1.61 3.22 82725 A 04 10/1/2008 N N 1.31 1.31 2.62 82726 B 04 10/1/2008 N N 6.09 6.09 12.18 82728 A 04 10/1/2008 N N 3.58 3.58 7.16 82731 B 04 10/1/2008 N N 18.39 18.39 36.78 82735 A 04 10/1/2008 N N 3.58 3.58 7.16 82742 A 04 10/1/2008 N N 3.58 3.58 7.16 82746 B 04 10/1/2008 N N 5.73 5.73 11.46 82747 B 04 10/1/2008 N N 6.64 6.64 13.28 82757 A 04 10/1/2008 N N 3.98 3.98 7.96 82759 A 04 10/1/2008 N N 2.33 2.33 4.66 82760 A 04 10/1/2008 N N 2.33 2.33 4.66 82775 A 04 10/1/2008 N N 6.71 6.71 13.42 82776 A 04 10/1/2008 N N 2.51 2.51 5.02 82784 A 04 10/1/2008 N N 4.54 4.54 9.08 82785 A 04 10/1/2008 N N 3.58 3.58 7.16 82787 A 04 10/1/2008 N N 3.94 3.94 7.88 82800 A 04 10/1/2008 N N 2.33 2.33 4.66 82803 A 04 10/1/2008 N N 5.44 5.44 10.88 Wednesday, April 01, 2009 Page 319 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 />
82634 A <strong>04</strong> 10/1/2008 N N 7.76 7.76 15.52<br />
82638 A <strong>04</strong> 10/1/2008 N N 3.58 3.58 7.16<br />
82646 A <strong>04</strong> 10/1/2008 N N 1.76 1.76 3.52<br />
82649 A <strong>04</strong> 10/1/2008 N N 4.43 4.43 8.86<br />
82651 B <strong>04</strong> 10/1/2008 N N 10.<strong>09</strong> 10.<strong>09</strong> 20.18<br />
82652 <strong>04</strong> 10/1/2008 N N 8.03 8.03 16.06<br />
82654 B <strong>04</strong> 10/1/2008 N N 1.69 1.69 3.38<br />
82656 A <strong>04</strong> 10/1/2008 N N 3.63 3.63 7.26<br />
82657 A <strong>04</strong> 10/1/2008 N N 6.<strong>09</strong> 6.<strong>09</strong> 12.18<br />
82658 A <strong>04</strong> 10/1/2008 N N 6.<strong>09</strong> 6.<strong>09</strong> 12.18<br />
82664 B <strong>04</strong> 10/1/2008 N N 13.53 13.53 27.06<br />
82666 B <strong>04</strong> 10/1/2008 N N 4.43 4.43 8.86<br />
82668 B <strong>04</strong> 10/1/2008 N N 5.21 5.21 10.42<br />
82670 A <strong>04</strong> 10/1/2008 N N 5.06 5.06 10.12<br />
82671 B <strong>04</strong> 10/1/2008 N N 8.85 8.85 17.70<br />
82672 B <strong>04</strong> 10/1/2008 N N 8.85 8.85 17.70<br />
82677 B <strong>04</strong> 10/1/2008 N N 5.06 5.06 10.12<br />
82679 B <strong>04</strong> 10/1/2008 N N 5.06 5.06 10.12<br />
82690 A <strong>04</strong> 10/1/2008 N N 4.22 4.22 8.44<br />
82693 A <strong>04</strong> 10/1/2008 N N 7.31 7.31 14.62<br />
82696 B <strong>04</strong> 10/1/2008 N N 5.<strong>04</strong> 5.<strong>04</strong> 10.08<br />
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