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 96910 04 N I 9.55 96912 04 N I 10.95 96913 04 N I 30.05 96920 04 Y I 96921 04 Y I 96922 04 Y I 96999 04 Y I 97001 09 Y I 97002 09 Y I 97003 09 Y I 97004 09 Y I 97005 04 Y N 97006 04 Y N 97010 04 N I 4.40 97012 04 N I 7.70 97014 04 N I 6.50 97016 04 N I 7.00 97018 04 N I 5.95 97022 04 N I 6.50 97024 04 N I 4.50 97026 04 N I 4.40 Wednesday, April 01, 2009 Page 400 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 97028 04 N I 4.70 97032 04 N I 7.40 97033 04 N I 7.70 97034 04 N I 6.40 97035 04 N I 5.50 97036 04 N I 8.95 97039 04 Y I 97110 04 N N 10.40 97112 04 N I 10.90 97113 04 N N 11.50 97116 04 N I 9.75 97124 04 N I 8.90 97139 04 Y I 97140 04 N I 11.80 97150 04 N I 8.40 97530 04 N I 22.15 97532 09 Y I 97533 04 N I 18.75 97535 04 N I 11.20 97537 04 N I 11.00 97542 04 N I 7.55 Wednesday, April 01, 2009 Page 401 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 />
97028 <strong>04</strong> N I 4.70<br />
97032 <strong>04</strong> N I 7.40<br />
97033 <strong>04</strong> N I 7.70<br />
97034 <strong>04</strong> N I 6.40<br />
97035 <strong>04</strong> N I 5.50<br />
97036 <strong>04</strong> N I 8.95<br />
97039 <strong>04</strong> Y I<br />
97110 <strong>04</strong> N N 10.40<br />
97112 <strong>04</strong> N I 10.90<br />
97113 <strong>04</strong> N N 11.50<br />
97116 <strong>04</strong> N I 9.75<br />
97124 <strong>04</strong> N I 8.90<br />
97139 <strong>04</strong> Y I<br />
97140 <strong>04</strong> N I 11.80<br />
97150 <strong>04</strong> N I 8.40<br />
97530 <strong>04</strong> N I 22.15<br />
97532 <strong>09</strong> Y I<br />
97533 <strong>04</strong> N I 18.75<br />
97535 <strong>04</strong> N I 11.20<br />
97537 <strong>04</strong> N I 11.00<br />
97542 <strong>04</strong> N I 7.55<br />
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