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 85032 A 04 N N 1.50 1.50 3.00 85041 A 04 10/1/2008 N N .86 .86 1.72 85044 04 N N 1.75 1.75 3.50 85045 A 04 10/1/2008 N N 1.31 1.31 2.62 85046 A 04 10/1/2008 N N 2.74 2.74 5.48 85048 A 04 10/1/2008 N N .86 .86 1.72 85049 A 04 10/1/2008 N N 1.17 1.17 2.34 85055 A 04 10/1/2008 N N 4.25 4.25 8.50 85060 04 N N 4.50 85097 04 N N 22.40 85130 B 04 10/1/2008 N N 5.82 5.82 11.64 85170 A 04 10/1/2008 N N 2.23 2.23 4.46 85175 A 04 10/1/2008 N N 2.23 2.23 4.46 85210 B 04 10/1/2008 N N 4.43 4.43 8.86 85220 B 04 10/1/2008 N N 4.43 4.43 8.86 85230 B 04 10/1/2008 N N 4.43 4.43 8.86 85240 B 04 10/1/2008 N N 4.43 4.43 8.86 85244 B 04 10/1/2008 N N 3.58 3.58 7.16 85245 B 04 10/1/2008 N N 3.60 3.60 7.20 85246 B 04 10/1/2008 N N 3.60 3.60 7.20 85247 B 04 10/1/2008 N N 6.94 6.94 13.88 Wednesday, April 01, 2009 Page 334 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 85250 B 04 10/1/2008 N N 4.43 4.43 8.86 85260 B 04 10/1/2008 N N 4.43 4.43 8.86 85270 B 04 10/1/2008 N N 4.43 4.43 8.86 85280 B 04 10/1/2008 N N 4.43 4.43 8.86 85290 B 04 10/1/2008 N N 4.43 4.43 8.86 85291 B 04 10/1/2008 N N 4.35 4.35 8.70 85292 B 04 10/1/2008 N N 5.63 5.63 11.26 85293 B 04 10/1/2008 N N 5.63 5.63 11.26 85300 B 04 10/1/2008 N N 4.43 4.43 8.86 85301 B 04 10/1/2008 N N 5.29 5.29 10.58 85302 B 04 10/1/2008 N N 5.89 5.89 11.78 85303 B 04 10/1/2008 N N 5.85 5.85 11.70 85305 B 04 10/1/2008 N N 5.66 5.66 11.32 85306 B 04 10/1/2008 N N 5.85 5.85 11.70 85307 B 04 10/1/2008 N N 6.00 6.00 12.00 85335 A 04 10/1/2008 N N 5.29 5.29 10.58 85337 A 04 10/1/2008 N N 5.10 5.10 10.20 85345 A 04 10/1/2008 N N 1.50 1.50 3.00 85347 A 04 10/1/2008 N N 1.31 1.31 2.62 85348 A 04 10/1/2008 N N 1.84 1.84 3.68 85360 A 04 10/1/2008 N N 2.96 2.96 5.92 Wednesday, April 01, 2009 Page 335 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 />
85250 B <strong>04</strong> 10/1/2008 N N 4.43 4.43 8.86<br />
85260 B <strong>04</strong> 10/1/2008 N N 4.43 4.43 8.86<br />
85270 B <strong>04</strong> 10/1/2008 N N 4.43 4.43 8.86<br />
85280 B <strong>04</strong> 10/1/2008 N N 4.43 4.43 8.86<br />
85290 B <strong>04</strong> 10/1/2008 N N 4.43 4.43 8.86<br />
85291 B <strong>04</strong> 10/1/2008 N N 4.35 4.35 8.70<br />
85292 B <strong>04</strong> 10/1/2008 N N 5.63 5.63 11.26<br />
85293 B <strong>04</strong> 10/1/2008 N N 5.63 5.63 11.26<br />
85300 B <strong>04</strong> 10/1/2008 N N 4.43 4.43 8.86<br />
853<strong>01</strong> B <strong>04</strong> 10/1/2008 N N 5.29 5.29 10.58<br />
85302 B <strong>04</strong> 10/1/2008 N N 5.89 5.89 11.78<br />
85303 B <strong>04</strong> 10/1/2008 N N 5.85 5.85 11.70<br />
85305 B <strong>04</strong> 10/1/2008 N N 5.66 5.66 11.32<br />
85306 B <strong>04</strong> 10/1/2008 N N 5.85 5.85 11.70<br />
85307 B <strong>04</strong> 10/1/2008 N N 6.00 6.00 12.00<br />
85335 A <strong>04</strong> 10/1/2008 N N 5.29 5.29 10.58<br />
85337 A <strong>04</strong> 10/1/2008 N N 5.10 5.10 10.20<br />
85345 A <strong>04</strong> 10/1/2008 N N 1.50 1.50 3.00<br />
85347 A <strong>04</strong> 10/1/2008 N N 1.31 1.31 2.62<br />
85348 A <strong>04</strong> 10/1/2008 N N 1.84 1.84 3.68<br />
85360 A <strong>04</strong> 10/1/2008 N N 2.96 2.96 5.92<br />
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