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 95958 04 N I 142.05 95961 04 N I 180.30 95962 04 Y I 95965 A 04 N I 138.25 138.25 276.50 95966 A 04 N I 93.83 93.82 187.65 95967 A 04 N I 82.35 82.35 164.70 95970 04 N I 41.90 95971 04 N I 41.90 95972 04 N I 41.90 95973 04 N I 41.90 95974 04 N I 68.50 95975 04 N I 41.90 95978 04 N I 110.51 95979 04 N I 53.28 95980 04 1/1/2008 N I Y 22.92 95981 04 1/1/2008 N I Y 8.89 6.41 95982 04 1/1/2008 N I Y 18.00 5.81 95990 04 N I 29.41 95991 04 N I 29.41 95992 04 1/1/2009 N N 22.15 95999 04 Y I Y Wednesday, April 01, 2009 Page 396 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 96000 04 N I 82.00 96001 04 N N 97.80 96002 04 N I 19.20 96003 04 N I 17.90 96004 04 N I 67.50 96020 04 N I 85.31 96040 04 8/1/2008 N N 40.20 96105 04 N I 52.70 96110 04 N N 16.07 2 32.15 96111 04 N N 16.07 2 32.15 96116 09 Y I 96118 09 Y N 96119 09 Y N 96120 09 Y N 96125 09 1/1/2008 N N 46.07 7.81 96150 04 Y N 96151 04 Y N 96152 04 Y N 96153 04 Y N 96154 04 Y N 96155 04 Y N Wednesday, April 01, 2009 Page 397 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 />
95958 <strong>04</strong> N I 142.05<br />
95961 <strong>04</strong> N I 180.30<br />
95962 <strong>04</strong> Y I<br />
95965 A <strong>04</strong> N I 138.25 138.25 276.50<br />
95966 A <strong>04</strong> N I 93.83 93.82 187.65<br />
95967 A <strong>04</strong> N I 82.35 82.35 164.70<br />
95970 <strong>04</strong> N I 41.90<br />
95971 <strong>04</strong> N I 41.90<br />
95972 <strong>04</strong> N I 41.90<br />
95973 <strong>04</strong> N I 41.90<br />
95974 <strong>04</strong> N I 68.50<br />
95975 <strong>04</strong> N I 41.90<br />
95978 <strong>04</strong> N I 110.51<br />
95979 <strong>04</strong> N I 53.28<br />
95980 <strong>04</strong> 1/1/2008 N I Y 22.92<br />
95981 <strong>04</strong> 1/1/2008 N I Y 8.89 6.41<br />
95982 <strong>04</strong> 1/1/2008 N I Y 18.00 5.81<br />
95990 <strong>04</strong> N I 29.41<br />
95991 <strong>04</strong> N I 29.41<br />
95992 <strong>04</strong> 1/1/20<strong>09</strong> N N 22.15<br />
95999 <strong>04</strong> Y I Y<br />
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