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 15946 04 N M Y 674.20 15950 04 N M Y 449.50 15951 04 N M Y 524.40 15952 04 N M Y 524.40 15953 04 N M Y 599.35 15956 04 N M Y 727.40 15958 04 N M Y 727.40 15962 04 Y M Y Y 15963 04 Y M Y Y 15999 04 Y M Y Y 16000 04 N I Y 45.80 16020 04 N I 24.90 17.00 16025 04 N I 49.50 34.00 16030 04 N I 61.65 34.00 16035 04 N M 92.79 34.00 16036 04 N M 36.74 17000 04 N I 52.70 17003 04 N I 8.85 13 115.05 17004 04 N I Y 86.59 17106 04 N I 125.35 17107 04 N M 238.80 Wednesday, April 01, 2009 Page 30 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 17108 04 N M 372.30 17110 04 N I 74.90 17111 04 N I 43.05 17250 04 N I 18.90 17260 04 N I 40.60 17261 04 N I 60.70 17262 04 N I 80.85 17263 04 N I 100.90 17264 04 N I 117.55 17266 04 N M 162.00 17270 04 N I 45.25 17271 04 N I 64.50 17272 04 N I 85.60 17273 04 N I 106.75 17274 04 N I 117.20 17276 04 N M 162.00 17280 04 N I 96.20 17281 04 N I 127.70 17282 04 N M 171.30 17283 04 N M 213.60 17284 04 N M 257.10 Wednesday, April 01, 2009 Page 31 of 458
- Page 1 and 2: Healthcare and Family Services Prac
- Page 3 and 4: Q State maximum amount now includes
- Page 5 and 6: MODIFIERS RECOGNIZED IN PROCESSING
- Page 7 and 8: HO Masters degree level; added 0601
- Page 9 and 10: Health Care and Family Services Rev
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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 />
15946 <strong>04</strong> N M Y 674.20<br />
15950 <strong>04</strong> N M Y 449.50<br />
15951 <strong>04</strong> N M Y 524.40<br />
15952 <strong>04</strong> N M Y 524.40<br />
15953 <strong>04</strong> N M Y 599.35<br />
15956 <strong>04</strong> N M Y 727.40<br />
15958 <strong>04</strong> N M Y 727.40<br />
15962 <strong>04</strong> Y M Y Y<br />
15963 <strong>04</strong> Y M Y Y<br />
15999 <strong>04</strong> Y M Y Y<br />
16000 <strong>04</strong> N I Y 45.80<br />
16020 <strong>04</strong> N I 24.90 17.00<br />
16025 <strong>04</strong> N I 49.50 34.00<br />
16030 <strong>04</strong> N I 61.65 34.00<br />
16035 <strong>04</strong> N M 92.79 34.00<br />
16036 <strong>04</strong> N M 36.74<br />
17000 <strong>04</strong> N I 52.70<br />
17003 <strong>04</strong> N I 8.85 13 115.05<br />
170<strong>04</strong> <strong>04</strong> N I Y 86.59<br />
17106 <strong>04</strong> N I 125.35<br />
17107 <strong>04</strong> N M 238.80<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 30 <strong>of</strong> 458
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