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 88321 04 N N 6.20 88323 04 N N 17.90 88325 04 N N 19.90 88329 04 N N 48.55 88331 04 N N 48.55 88332 04 N N 19.90 88333 04 N N 50.86 88334 04 N N 26.40 88342 A 04 N N 6.72 6.72 Y 13.45 88346 A 04 N N 8.42 8.42 16.85 88347 A 04 N N 8.42 8.42 16.85 88348 B 04 N N 23.60 23.60 47.20 88349 B 04 N N 35.35 35.35 70.70 88355 B 04 N N 54.30 54.30 108.60 88356 B 04 N N 54.30 54.30 108.60 88358 B 04 N N 54.30 54.30 108.60 88360 A 04 N N 30.91 30.91 61.83 88361 C 04 N N 24.79 35.80 72.70 88362 A 04 Y N 88365 04 N N 40.81 88367 A 04 N N 57.57 57.57 115.15 Wednesday, April 01, 2009 Page 362 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 88368 04 N N 105.20 88371 B 04 N N 14.22 14.22 28.45 88372 B 04 N N 14.85 14.85 29.70 88380 B 04 Y N 88381 C 04 1/1/2008 N N 31.82 83.72 115.54 88384 04 Y N 88385 04 N N 46.41 88386 04 N N 58.39 88399 A 04 Y N 88720 B 04 1/1/2009 N N 2.20 2.20 4.40 88740 B 04 1/1/2009 N N 2.20 2.20 4.40 88741 B 04 1/1/2009 N N 2.20 2.20 4.40 89049 B 04 N N 18.52 18.52 37.05 89050 B 04 N N 1.75 1.75 3.50 89051 B 04 N N 3.10 3.10 6.20 89055 A 04 N N 1.49 1.49 2.98 89060 B 04 N N 4.67 4.67 9.35 89100 B 04 N N 3.10 3.10 6.20 89105 B 04 N N 29.75 29.75 59.50 89125 B 04 N N 1.67 1.67 3.35 89130 A 04 N I 14.60 14.60 29.20 Wednesday, April 01, 2009 Page 363 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 />
88368 <strong>04</strong> N N 105.20<br />
88371 B <strong>04</strong> N N 14.22 14.22 28.45<br />
88372 B <strong>04</strong> N N 14.85 14.85 29.70<br />
88380 B <strong>04</strong> Y N<br />
88381 C <strong>04</strong> 1/1/2008 N N 31.82 83.72 115.54<br />
88384 <strong>04</strong> Y N<br />
88385 <strong>04</strong> N N 46.41<br />
88386 <strong>04</strong> N N 58.39<br />
88399 A <strong>04</strong> Y N<br />
88720 B <strong>04</strong> 1/1/20<strong>09</strong> N N 2.20 2.20 4.40<br />
88740 B <strong>04</strong> 1/1/20<strong>09</strong> N N 2.20 2.20 4.40<br />
88741 B <strong>04</strong> 1/1/20<strong>09</strong> N N 2.20 2.20 4.40<br />
89<strong>04</strong>9 B <strong>04</strong> N N 18.52 18.52 37.05<br />
89050 B <strong>04</strong> N N 1.75 1.75 3.50<br />
89051 B <strong>04</strong> N N 3.10 3.10 6.20<br />
89055 A <strong>04</strong> N N 1.49 1.49 2.98<br />
89060 B <strong>04</strong> N N 4.67 4.67 9.35<br />
89100 B <strong>04</strong> N N 3.10 3.10 6.20<br />
89105 B <strong>04</strong> N N 29.75 29.75 59.50<br />
89125 B <strong>04</strong> N N 1.67 1.67 3.35<br />
89130 A <strong>04</strong> N I 14.60 14.60 29.20<br />
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