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Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois

Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois

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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 />

87880 H <strong>04</strong> N N 7.85 7.85 15.70<br />

87899 A <strong>04</strong> Y N<br />

87900 <strong>04</strong> N N 162.20<br />

879<strong>01</strong> <strong>04</strong> N N 168.05<br />

87902 B <strong>04</strong> N N 84.02 84.02 168.05<br />

87903 <strong>04</strong> N N 682.72<br />

879<strong>04</strong> <strong>04</strong> N N 32.44 9 291.96<br />

87905 B <strong>04</strong> 1/1/20<strong>09</strong> N N 5.27 5.27 10.54<br />

87999 A <strong>04</strong> Y N<br />

881<strong>04</strong> B <strong>04</strong> N N 5.90 5.90 11.80<br />

88106 B <strong>04</strong> N N 5.90 5.90 11.80<br />

88107 B <strong>04</strong> N N 5.90 5.90 11.80<br />

88108 B <strong>04</strong> N N 4.45 4.45 8.90<br />

88112 C <strong>04</strong> N N 29.33 23.68 63.61<br />

88125 B <strong>04</strong> N N 1.67 1.67 3.35<br />

88130 B <strong>04</strong> N N 7.00 7.00 14.00<br />

88140 B <strong>04</strong> N N 4.77 4.77 9.55<br />

88141 <strong>04</strong> N N 3.50<br />

88142 <strong>04</strong> N N 3.35<br />

88143 <strong>04</strong> N N 3.50<br />

88147 <strong>04</strong> N N 3.50<br />

Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 358 <strong>of</strong> 458

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