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 84080 A 04 10/1/2008 N N 4.43 4.43 8.86 84081 A 04 10/1/2008 N N 1.26 1.26 2.52 84085 A 04 10/1/2008 N N 1.76 1.76 3.52 84087 A 04 10/1/2008 N N 2.78 2.78 5.56 84100 A 04 10/1/2008 N N 2.33 2.33 4.66 84105 A 04 10/1/2008 N N 1.13 1.13 2.26 84106 A 04 10/1/2008 N N 2.10 2.10 4.20 84110 A 04 10/1/2008 N N 2.33 2.33 4.66 84119 B 04 10/1/2008 N N 4.22 4.22 8.44 84120 B 04 10/1/2008 N N 6.71 6.71 13.42 84126 B 04 10/1/2008 N N 10.95 10.95 21.90 84127 B 04 10/1/2008 N N 5.48 5.48 10.96 84132 A 04 10/1/2008 N N 2.25 2.25 4.50 84133 A 04 10/1/2008 N N 2.10 2.10 4.20 84134 A 04 10/1/2008 N N 2.79 2.79 5.58 84135 B 04 10/1/2008 N N 3.96 3.96 7.92 84138 B 04 10/1/2008 N N 4.43 4.43 8.86 84140 04 10/1/2008 N N 4.43 4.43 8.86 84143 04 10/1/2008 N N 4.61 4.61 9.22 84144 A 04 10/1/2008 N N 4.61 4.61 9.22 84146 A 04 10/1/2008 N N 6.71 6.71 13.42 Wednesday, April 01, 2009 Page 328 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 84150 A 04 10/1/2008 N N 1.76 1.76 3.52 84152 B 04 10/1/2008 N N 7.20 7.20 14.40 84153 B 04 10/1/2008 N N 6.60 6.60 13.20 84154 B 04 10/1/2008 N N 6.60 6.60 13.20 84155 A 04 10/1/2008 N N 1.80 1.80 3.60 84156 B 04 10/1/2008 N N 1.15 1.15 2.30 84157 B 04 10/1/2008 N N 1.15 1.15 2.30 84160 A 04 10/1/2008 N N 1.31 1.31 2.62 84163 04 10/1/2008 N N 4.79 4.79 9.58 84165 B 04 10/1/2008 N N 5.25 5.25 10.50 84166 04 10/1/2008 N N 5.61 5.61 11.22 84181 B 04 10/1/2008 N N 8.33 8.33 16.66 84182 B 04 10/1/2008 N N 8.80 8.80 17.60 84202 A 04 10/1/2008 N N 1.76 1.76 3.52 84203 A 04 10/1/2008 N N 1.31 1.31 2.62 84206 B 04 10/1/2008 N N 3.58 3.58 7.16 84207 B 04 10/1/2008 N N 6.00 6.00 12.00 84210 A 04 10/1/2008 N N 3.58 3.58 7.16 84220 A 04 10/1/2008 N N 2.33 2.33 4.66 84228 A 04 10/1/2008 N N 5.25 5.25 10.50 84233 B 04 10/1/2008 N N 16.50 16.50 33.00 Wednesday, April 01, 2009 Page 329 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 />
84080 A <strong>04</strong> 10/1/2008 N N 4.43 4.43 8.86<br />
84081 A <strong>04</strong> 10/1/2008 N N 1.26 1.26 2.52<br />
84085 A <strong>04</strong> 10/1/2008 N N 1.76 1.76 3.52<br />
84087 A <strong>04</strong> 10/1/2008 N N 2.78 2.78 5.56<br />
84100 A <strong>04</strong> 10/1/2008 N N 2.33 2.33 4.66<br />
84105 A <strong>04</strong> 10/1/2008 N N 1.13 1.13 2.26<br />
84106 A <strong>04</strong> 10/1/2008 N N 2.10 2.10 4.20<br />
84110 A <strong>04</strong> 10/1/2008 N N 2.33 2.33 4.66<br />
84119 B <strong>04</strong> 10/1/2008 N N 4.22 4.22 8.44<br />
84120 B <strong>04</strong> 10/1/2008 N N 6.71 6.71 13.42<br />
84126 B <strong>04</strong> 10/1/2008 N N 10.95 10.95 21.90<br />
84127 B <strong>04</strong> 10/1/2008 N N 5.48 5.48 10.96<br />
84132 A <strong>04</strong> 10/1/2008 N N 2.25 2.25 4.50<br />
84133 A <strong>04</strong> 10/1/2008 N N 2.10 2.10 4.20<br />
84134 A <strong>04</strong> 10/1/2008 N N 2.79 2.79 5.58<br />
84135 B <strong>04</strong> 10/1/2008 N N 3.96 3.96 7.92<br />
84138 B <strong>04</strong> 10/1/2008 N N 4.43 4.43 8.86<br />
84140 <strong>04</strong> 10/1/2008 N N 4.43 4.43 8.86<br />
84143 <strong>04</strong> 10/1/2008 N N 4.61 4.61 9.22<br />
84144 A <strong>04</strong> 10/1/2008 N N 4.61 4.61 9.22<br />
84146 A <strong>04</strong> 10/1/2008 N N 6.71 6.71 13.42<br />
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