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 85362 A 04 10/1/2008 N N 1.31 1.31 2.62 85366 A 04 10/1/2008 N N 2.74 2.74 5.48 85370 A 04 10/1/2008 N N 2.74 2.74 5.48 85378 B 04 10/1/2008 N N 3.49 3.49 6.98 85379 B 04 10/1/2008 N N 3.75 3.75 7.50 85380 B 04 10/1/2008 N N 2.67 2.67 5.34 85384 A 04 10/1/2008 N N 2.63 2.63 5.26 85385 A 04 10/1/2008 N N 2.63 2.63 5.26 85390 A 04 N N 1.62 1.62 3.25 85396 A 04 N N 5.84 5.84 11.69 85397 B 04 1/1/2009 N N 6.21 6.21 12.42 85400 A 04 10/1/2008 N N 2.33 2.33 4.66 85410 A 04 10/1/2008 N N 2.33 2.33 4.66 85415 A 04 10/1/2008 N N 4.31 4.31 8.62 85420 A 04 10/1/2008 N N 2.33 2.33 4.66 85421 A 04 10/1/2008 N N 3.23 3.23 6.46 85441 A 04 10/1/2008 N N 2.04 2.04 4.08 85445 A 04 10/1/2008 N N .86 .86 1.72 85460 A 04 10/1/2008 N N 1.61 1.61 3.22 85461 A 04 10/1/2008 N N 1.58 1.58 3.16 85475 A 04 10/1/2008 N N 4.35 4.35 8.70 Wednesday, April 01, 2009 Page 336 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 85520 B 04 10/1/2008 N N 3.15 3.15 6.30 85525 B 04 10/1/2008 N N 5.38 5.38 10.76 85530 B 04 10/1/2008 N N 3.15 3.15 6.30 85536 A 04 10/1/2008 N N 2.53 2.53 5.06 85540 A 04 10/1/2008 N N 1.76 1.76 3.52 85547 A 04 10/1/2008 N N 1.14 1.14 2.28 85549 A 04 10/1/2008 N N 3.58 3.58 7.16 85555 A 04 10/1/2008 N N 2.33 2.33 4.66 85557 A 04 10/1/2008 N N 2.33 2.33 4.66 85576 A 04 10/1/2008 N N 2.55 2.55 5.10 85597 A 04 10/1/2008 N N 2.74 2.74 5.48 85610 A 04 10/1/2008 N N 1.91 1.91 3.82 85611 A 04 10/1/2008 N N 1.93 1.93 3.86 85612 B 04 10/1/2008 N N 2.78 2.78 5.56 85613 B 04 10/1/2008 N N 3.51 3.51 7.02 85635 B 04 10/1/2008 N N 1.31 1.31 2.62 85651 A 04 N N 2.30 2.30 4.60 85652 A 04 10/1/2008 N N 1.31 1.31 2.62 85660 A 04 10/1/2008 N N 2.33 2.33 4.66 85670 A 04 10/1/2008 N N 2.33 2.33 4.66 85675 A 04 10/1/2008 N N 3.19 3.19 6.38 Wednesday, April 01, 2009 Page 337 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 />
85520 B <strong>04</strong> 10/1/2008 N N 3.15 3.15 6.30<br />
85525 B <strong>04</strong> 10/1/2008 N N 5.38 5.38 10.76<br />
85530 B <strong>04</strong> 10/1/2008 N N 3.15 3.15 6.30<br />
85536 A <strong>04</strong> 10/1/2008 N N 2.53 2.53 5.06<br />
85540 A <strong>04</strong> 10/1/2008 N N 1.76 1.76 3.52<br />
85547 A <strong>04</strong> 10/1/2008 N N 1.14 1.14 2.28<br />
85549 A <strong>04</strong> 10/1/2008 N N 3.58 3.58 7.16<br />
85555 A <strong>04</strong> 10/1/2008 N N 2.33 2.33 4.66<br />
85557 A <strong>04</strong> 10/1/2008 N N 2.33 2.33 4.66<br />
85576 A <strong>04</strong> 10/1/2008 N N 2.55 2.55 5.10<br />
85597 A <strong>04</strong> 10/1/2008 N N 2.74 2.74 5.48<br />
85610 A <strong>04</strong> 10/1/2008 N N 1.91 1.91 3.82<br />
85611 A <strong>04</strong> 10/1/2008 N N 1.93 1.93 3.86<br />
85612 B <strong>04</strong> 10/1/2008 N N 2.78 2.78 5.56<br />
85613 B <strong>04</strong> 10/1/2008 N N 3.51 3.51 7.02<br />
85635 B <strong>04</strong> 10/1/2008 N N 1.31 1.31 2.62<br />
85651 A <strong>04</strong> N N 2.30 2.30 4.60<br />
85652 A <strong>04</strong> 10/1/2008 N N 1.31 1.31 2.62<br />
85660 A <strong>04</strong> 10/1/2008 N N 2.33 2.33 4.66<br />
85670 A <strong>04</strong> 10/1/2008 N N 2.33 2.33 4.66<br />
85675 A <strong>04</strong> 10/1/2008 N N 3.19 3.19 6.38<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 337 <strong>of</strong> 458
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