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 83633 A 04 10/1/2008 N N 2.70 2.70 5.40 83634 A 04 10/1/2008 N N 2.96 2.96 5.92 83655 B 04 10/1/2008 N N 5.93 5.93 11.96 83661 B 04 10/1/2008 N N 6.71 6.71 13.42 83662 B 04 10/1/2008 N N 6.21 6.21 12.42 83663 B 04 10/1/2008 N N 3.68 3.68 7.36 83664 B 04 10/1/2008 N N 1.86 1.86 3.72 83670 B 04 10/1/2008 N N 3.15 3.15 6.30 83690 A 04 10/1/2008 N N 3.36 3.36 6.72 83695 B 04 10/1/2008 N N 4.07 4.07 8.14 83698 04 10/1/2008 N N 8.92 8.92 17.84 83700 04 10/1/2008 N N 3.54 3.54 7.08 83701 04 10/1/2008 N N 7.80 7.80 15.60 83704 04 10/1/2008 N N 9.92 9.92 19.84 83718 B 04 10/1/2008 N N 4.01 4.01 8.02 83719 B 04 10/1/2008 N N 5.70 5.70 11.40 83721 B 04 10/1/2008 N N 4.67 4.67 9.34 83727 A 04 10/1/2008 N N 4.43 4.43 8.86 83735 A 04 10/1/2008 N N 3.28 3.28 6.56 83775 A 04 10/1/2008 N N 2.78 2.78 5.56 83785 A 04 10/1/2008 N N .64 .64 1.28 Wednesday, April 01, 2009 Page 324 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 83788 A 04 10/1/2008 N N 3.58 3.58 7.16 83789 A 04 10/1/2008 N N 3.58 3.58 7.16 83805 A 04 10/1/2008 N N 3.53 3.53 7.06 83825 A 04 10/1/2008 N N 3.96 3.96 7.92 83835 B 04 10/1/2008 N N 6.71 6.71 13.42 83840 A 04 10/1/2008 N N 4.43 4.43 8.86 83857 A 04 10/1/2008 N N 1.31 1.31 2.62 83858 A 04 10/1/2008 N N 3.96 3.96 7.92 83864 B 04 10/1/2008 N N 5.25 5.25 10.50 83866 B 04 10/1/2008 N N 4.46 4.46 8.92 83872 A 04 10/1/2008 N N 1.31 1.31 2.62 83873 B 04 10/1/2008 N N 4.82 4.82 9.64 83874 B 04 10/1/2008 N N 6.32 6.32 12.64 83876 B 04 1/1/2009 N N 5.68 5.68 11.36 83880 B 04 10/1/2008 N N 7.43 7.43 14.86 83883 A 04 10/1/2008 N N 5.22 5.22 10.44 83885 A 04 10/1/2008 N N 3.96 3.96 7.92 83887 A 04 10/1/2008 N N 3.34 3.34 6.68 83890 B 04 N N 2.62 2.62 5.25 83891 B 04 N N 2.62 2.62 5.25 83892 B 04 N N 2.52 2.52 5.05 Wednesday, April 01, 2009 Page 325 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 />
83633 A <strong>04</strong> 10/1/2008 N N 2.70 2.70 5.40<br />
83634 A <strong>04</strong> 10/1/2008 N N 2.96 2.96 5.92<br />
83655 B <strong>04</strong> 10/1/2008 N N 5.93 5.93 11.96<br />
83661 B <strong>04</strong> 10/1/2008 N N 6.71 6.71 13.42<br />
83662 B <strong>04</strong> 10/1/2008 N N 6.21 6.21 12.42<br />
83663 B <strong>04</strong> 10/1/2008 N N 3.68 3.68 7.36<br />
83664 B <strong>04</strong> 10/1/2008 N N 1.86 1.86 3.72<br />
83670 B <strong>04</strong> 10/1/2008 N N 3.15 3.15 6.30<br />
83690 A <strong>04</strong> 10/1/2008 N N 3.36 3.36 6.72<br />
83695 B <strong>04</strong> 10/1/2008 N N 4.07 4.07 8.14<br />
83698 <strong>04</strong> 10/1/2008 N N 8.92 8.92 17.84<br />
83700 <strong>04</strong> 10/1/2008 N N 3.54 3.54 7.08<br />
837<strong>01</strong> <strong>04</strong> 10/1/2008 N N 7.80 7.80 15.60<br />
837<strong>04</strong> <strong>04</strong> 10/1/2008 N N 9.92 9.92 19.84<br />
83718 B <strong>04</strong> 10/1/2008 N N 4.<strong>01</strong> 4.<strong>01</strong> 8.02<br />
83719 B <strong>04</strong> 10/1/2008 N N 5.70 5.70 11.40<br />
83721 B <strong>04</strong> 10/1/2008 N N 4.67 4.67 9.34<br />
83727 A <strong>04</strong> 10/1/2008 N N 4.43 4.43 8.86<br />
83735 A <strong>04</strong> 10/1/2008 N N 3.28 3.28 6.56<br />
83775 A <strong>04</strong> 10/1/2008 N N 2.78 2.78 5.56<br />
83785 A <strong>04</strong> 10/1/2008 N N .64 .64 1.28<br />
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