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 84481 B 04 10/1/2008 N N 5.06 5.06 10.12 84482 B 04 10/1/2008 N N 3.41 3.41 6.82 84484 A 04 10/1/2008 N N 3.71 3.71 7.42 84485 A 04 10/1/2008 N N 2.70 2.70 5.40 84488 B 04 10/1/2008 N N 2.70 2.70 5.40 84490 B 04 10/1/2008 N N 2.70 2.70 5.40 84510 B 04 10/1/2008 N N 5.10 5.10 10.20 84512 A 04 10/1/2008 N N 3.71 3.71 7.42 84520 A 04 10/1/2008 N N 1.93 1.93 3.86 84525 A 04 10/1/2008 N N .86 .86 1.72 84540 A 04 10/1/2008 N N 1.76 1.76 3.52 84545 A 04 10/1/2008 N N 2.01 2.01 4.02 84550 A 04 10/1/2008 N N 2.21 2.21 4.42 84560 A 04 10/1/2008 N N 1.31 1.31 2.62 84577 A 04 10/1/2008 N N 2.70 2.70 5.40 84578 A 04 10/1/2008 N N .86 .86 1.72 84580 A 04 10/1/2008 N N 2.01 2.01 4.02 84583 A 04 10/1/2008 N N 1.31 1.31 2.62 84585 B 04 10/1/2008 N N 7.58 7.58 15.16 84586 B 04 10/1/2008 N N 3.49 3.49 6.98 84588 B 04 10/1/2008 N N 2.33 2.33 4.66 Wednesday, April 01, 2009 Page 332 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 84590 B 04 10/1/2008 N N 2.33 2.33 4.66 84591 B 04 10/1/2008 N N 4.54 4.54 9.08 84597 B 04 10/1/2008 N N 2.51 2.51 5.02 84600 A 04 10/1/2008 N N 1.76 1.76 3.52 84620 A 04 10/1/2008 N N 3.75 3.75 7.50 84630 B 04 10/1/2008 N N 5.04 5.04 10.08 84681 B 04 10/1/2008 N N 6.41 6.41 12.82 84702 B 04 10/1/2008 N N 4.43 4.43 8.86 84703 B 04 10/1/2008 N N 3.58 3.58 7.16 84704 04 10/1/2008 N N 4.73 4.73 9.46 84999 A 04 10/1/2008 Y N 85002 A 04 10/1/2008 N N .86 .86 1.72 85004 A 04 10/1/2008 N N 1.70 1.70 3.40 85007 A 04 N N 1.75 1.75 3.50 85008 A 04 10/1/2008 N N 1.69 1.69 3.38 85009 A 04 N N 1.75 1.75 3.50 85013 A 04 10/1/2008 N N 1.16 1.16 2.32 85014 A 04 10/1/2008 N N 1.16 1.16 2.32 85018 A 04 10/1/2008 N N 1.16 1.16 2.32 85025 A 04 10/1/2008 N N 2.87 2.87 5.74 85027 A 04 10/1/2008 N N 2.87 2.87 5.74 Wednesday, April 01, 2009 Page 333 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 />
84481 B <strong>04</strong> 10/1/2008 N N 5.06 5.06 10.12<br />
84482 B <strong>04</strong> 10/1/2008 N N 3.41 3.41 6.82<br />
84484 A <strong>04</strong> 10/1/2008 N N 3.71 3.71 7.42<br />
84485 A <strong>04</strong> 10/1/2008 N N 2.70 2.70 5.40<br />
84488 B <strong>04</strong> 10/1/2008 N N 2.70 2.70 5.40<br />
84490 B <strong>04</strong> 10/1/2008 N N 2.70 2.70 5.40<br />
84510 B <strong>04</strong> 10/1/2008 N N 5.10 5.10 10.20<br />
84512 A <strong>04</strong> 10/1/2008 N N 3.71 3.71 7.42<br />
84520 A <strong>04</strong> 10/1/2008 N N 1.93 1.93 3.86<br />
84525 A <strong>04</strong> 10/1/2008 N N .86 .86 1.72<br />
84540 A <strong>04</strong> 10/1/2008 N N 1.76 1.76 3.52<br />
84545 A <strong>04</strong> 10/1/2008 N N 2.<strong>01</strong> 2.<strong>01</strong> 4.02<br />
84550 A <strong>04</strong> 10/1/2008 N N 2.21 2.21 4.42<br />
84560 A <strong>04</strong> 10/1/2008 N N 1.31 1.31 2.62<br />
84577 A <strong>04</strong> 10/1/2008 N N 2.70 2.70 5.40<br />
84578 A <strong>04</strong> 10/1/2008 N N .86 .86 1.72<br />
84580 A <strong>04</strong> 10/1/2008 N N 2.<strong>01</strong> 2.<strong>01</strong> 4.02<br />
84583 A <strong>04</strong> 10/1/2008 N N 1.31 1.31 2.62<br />
84585 B <strong>04</strong> 10/1/2008 N N 7.58 7.58 15.16<br />
84586 B <strong>04</strong> 10/1/2008 N N 3.49 3.49 6.98<br />
84588 B <strong>04</strong> 10/1/2008 N N 2.33 2.33 4.66<br />
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