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 88188 04 N N 50.00 88189 04 N N 65.85 88199 A 04 Y N 88230 B 04 N N 45.40 45.40 90..80 88233 B 04 N N 58.77 58.77 117.55 88235 B 04 N N 66.80 66.80 133.60 88237 B 04 N N 53.47 53.47 106.95 88239 B 04 N N 66.80 66.80 133.60 88240 A 09 Y N 88241 A 09 Y N 88245 B 04 N N 43.82 43.82 87.65 88248 B 04 N N 44.12 44.12 88.25 88249 B 04 N N 43.77 43.77 87.55 88261 B 04 N N 58.90 58.90 117.80 88262 B 04 N N 81.37 81.37 162.75 88263 B 04 N N 94.37 94.37 188.75 88264 B 04 N N 81.37 81.37 162.75 88267 B 04 N N 44.30 44.30 88.60 88269 B 04 N N 38.17 38.17 76.35 88271 B 04 N N 9.45 9.45 18.90 88272 B 04 N N 16.52 16.52 33.05 Wednesday, April 01, 2009 Page 360 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 88273 B 04 N N 20.95 20.95 41.90 88274 B 04 N N 22.70 22.70 45.40 88275 B 04 N N 26.20 26.20 52.40 88280 B 04 N N 16.35 16.35 32.70 88283 B 04 N N 12.27 12.27 24.55 88285 B 04 N N 12.40 12.40 24.80 88289 B 04 N N 8.55 8.55 17.10 88291 B 04 N N 2.62 2.62 5.25 88299 A 04 Y N 88300 A 04 N N 6.52 6.52 13.05 88302 A 04 N N 10.47 10.47 20.95 88304 A 04 N N 18.67 18.67 37.35 88305 A 04 N N 20.55 20.55 41.10 88307 A 04 N N 21.80 21.80 43.60 88309 A 04 N N 23.70 23.70 47.40 88311 B 04 N N 5.75 5.75 11.50 88312 A 04 N N 5.90 5.90 11.80 88313 A 04 N N 3.35 3.35 6.70 88314 B 04 N N 3.10 3.10 6.20 88318 B 04 N N 20.90 20.90 41.80 88319 B 04 N N 11.20 11.20 22.40 Wednesday, April 01, 2009 Page 361 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 />
88188 <strong>04</strong> N N 50.00<br />
88189 <strong>04</strong> N N 65.85<br />
88199 A <strong>04</strong> Y N<br />
88230 B <strong>04</strong> N N 45.40 45.40 90..80<br />
88233 B <strong>04</strong> N N 58.77 58.77 117.55<br />
88235 B <strong>04</strong> N N 66.80 66.80 133.60<br />
88237 B <strong>04</strong> N N 53.47 53.47 106.95<br />
88239 B <strong>04</strong> N N 66.80 66.80 133.60<br />
88240 A <strong>09</strong> Y N<br />
88241 A <strong>09</strong> Y N<br />
88245 B <strong>04</strong> N N 43.82 43.82 87.65<br />
88248 B <strong>04</strong> N N 44.12 44.12 88.25<br />
88249 B <strong>04</strong> N N 43.77 43.77 87.55<br />
88261 B <strong>04</strong> N N 58.90 58.90 117.80<br />
88262 B <strong>04</strong> N N 81.37 81.37 162.75<br />
88263 B <strong>04</strong> N N 94.37 94.37 188.75<br />
88264 B <strong>04</strong> N N 81.37 81.37 162.75<br />
88267 B <strong>04</strong> N N 44.30 44.30 88.60<br />
88269 B <strong>04</strong> N N 38.17 38.17 76.35<br />
88271 B <strong>04</strong> N N 9.45 9.45 18.90<br />
88272 B <strong>04</strong> N N 16.52 16.52 33.05<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 360 <strong>of</strong> 458
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