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 86486 04 1/1/2008 Y N 86490 B 04 N N 2.57 2.57 5.15 86510 B 04 N N 2.57 2.57 5.15 86580 04 N N 4.00 86590 B 04 N N 5.90 5.90 11.80 86592 B 04 N N 2.00 2.00 4.00 86593 B 04 N N 2.00 2.00 4.00 86602 B 04 N N 5.10 5.10 10.20 86603 A 04 N N 7.40 7.40 14.80 86606 B 04 N N 5.10 5.10 10.20 86609 B 04 N N 5.12 5.12 10.25 86611 B 04 N N 5.30 5.30 10.60 86612 B 04 N N 5.10 5.10 10.20 86615 B 04 N N 5.95 5.95 11.90 86617 B 04 N N 10.10 10.10 20.20 86618 B 04 N N 11.10 11.10 22.20 86619 B 04 N N 5.10 5.10 10.20 86622 B 04 N N 5.10 5.10 10.20 86625 B 04 N N 4.85 4.85 9.70 86628 B 04 N N 5.10 5.10 10.20 86631 B 04 N N 7.70 7.70 15.40 Wednesday, April 01, 2009 Page 342 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 86632 B 04 N N 8.27 8.27 16.55 86635 B 04 N N 5.10 5.10 10.20 86638 B 04 N N 5.10 5.10 10.20 86641 B 04 N N 5.10 5.10 10.20 86644 B 04 N N 6.67 6.67 13.35 86645 B 04 N N 9.12 9.12 18.25 86648 B 04 N N 9.60 9.60 19.20 86651 B 04 N N 8.00 8.00 16.00 86652 B 04 N N 8.00 8.00 16.00 86653 B 04 N N 7.80 7.80 15.60 86654 B 04 N N 8.00 8.00 16.00 86658 B 04 N N 8.50 8.50 17.00 86663 B 04 N N 8.57 8.57 17.15 86664 B 04 N N 8.80 8.80 17.60 86665 B 04 N N 9.60 9.60 19.20 86666 B 04 N N 5.30 5.30 10.60 86668 B 04 N N 5.10 5.10 10.20 86671 B 04 N N 8.01 8.01 16.02 86674 B 04 N N 5.10 5.10 10.20 86677 B 04 N N 7.50 7.50 15.00 86682 B 04 Y N Wednesday, April 01, 2009 Page 343 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 />
86486 <strong>04</strong> 1/1/2008 Y N<br />
86490 B <strong>04</strong> N N 2.57 2.57 5.15<br />
86510 B <strong>04</strong> N N 2.57 2.57 5.15<br />
86580 <strong>04</strong> N N 4.00<br />
86590 B <strong>04</strong> N N 5.90 5.90 11.80<br />
86592 B <strong>04</strong> N N 2.00 2.00 4.00<br />
86593 B <strong>04</strong> N N 2.00 2.00 4.00<br />
86602 B <strong>04</strong> N N 5.10 5.10 10.20<br />
86603 A <strong>04</strong> N N 7.40 7.40 14.80<br />
86606 B <strong>04</strong> N N 5.10 5.10 10.20<br />
866<strong>09</strong> B <strong>04</strong> N N 5.12 5.12 10.25<br />
86611 B <strong>04</strong> N N 5.30 5.30 10.60<br />
86612 B <strong>04</strong> N N 5.10 5.10 10.20<br />
86615 B <strong>04</strong> N N 5.95 5.95 11.90<br />
86617 B <strong>04</strong> N N 10.10 10.10 20.20<br />
86618 B <strong>04</strong> N N 11.10 11.10 22.20<br />
86619 B <strong>04</strong> N N 5.10 5.10 10.20<br />
86622 B <strong>04</strong> N N 5.10 5.10 10.20<br />
86625 B <strong>04</strong> N N 4.85 4.85 9.70<br />
86628 B <strong>04</strong> N N 5.10 5.10 10.20<br />
86631 B <strong>04</strong> N N 7.70 7.70 15.40<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 342 <strong>of</strong> 458
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