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 17286 04 Y I 17311 04 1/1/2007 N M 216.00 17312 04 1/1/2007 Y M 17313 04 1/1/2007 Y M 17314 04 1/1/2007 Y M 17315 04 1/1/2007 Y M 17340 04 N I 26.20 17360 04 N I 38.65 17380 04 Y I 17999 04 Y M Y Y 19000 04 N I 37.40 19001 04 N I 17.80 19020 04 N I 135.90 19030 04 N I 102.50 19100 04 N I 59.60 19101 04 N M 192.85 34.00 19102 04 N M 164.85 34.00 19103 04 N M 324.90 34.00 19105 04 1/1/2007 Y M 19110 04 N M 240.00 34.00 19112 04 N M 240.00 Wednesday, April 01, 2009 Page 32 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 19120 04 N M 240.00 34.00 19125 04 N M 240.00 19126 04 N M 74.45 19260 04 N M Y 430.64 19271 04 N M Y 534.45 19272 04 N M Y 598.34 19290 04 N I 59.40 19291 04 N I 27.00 19295 04 N I 63.10 19296 04 N I 109.01 19297 04 N I 109.01 19298 04 N I 109.01 19300 04 1/1/2007 N M Y 374.55 19301 04 1/1/2007 N M Y 310.80 19302 04 1/1/2007 N M Y 601.45 19303 04 1/1/2007 N M Y 461.95 19304 04 1/1/2007 N M Y 574.35 19305 04 1/1/2007 N M Y 787.95 19306 04 1/1/2007 N M Y 948.90 19307 04 1/1/2007 N M Y 738.10 19316 04 N M Y 567.10 Wednesday, April 01, 2009 Page 33 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 />
19120 <strong>04</strong> N M 240.00 34.00<br />
19125 <strong>04</strong> N M 240.00<br />
19126 <strong>04</strong> N M 74.45<br />
19260 <strong>04</strong> N M Y 430.64<br />
19271 <strong>04</strong> N M Y 534.45<br />
19272 <strong>04</strong> N M Y 598.34<br />
19290 <strong>04</strong> N I 59.40<br />
19291 <strong>04</strong> N I 27.00<br />
19295 <strong>04</strong> N I 63.10<br />
19296 <strong>04</strong> N I 1<strong>09</strong>.<strong>01</strong><br />
19297 <strong>04</strong> N I 1<strong>09</strong>.<strong>01</strong><br />
19298 <strong>04</strong> N I 1<strong>09</strong>.<strong>01</strong><br />
19300 <strong>04</strong> 1/1/2007 N M Y 374.55<br />
193<strong>01</strong> <strong>04</strong> 1/1/2007 N M Y 310.80<br />
19302 <strong>04</strong> 1/1/2007 N M Y 6<strong>01</strong>.45<br />
19303 <strong>04</strong> 1/1/2007 N M Y 461.95<br />
193<strong>04</strong> <strong>04</strong> 1/1/2007 N M Y 574.35<br />
19305 <strong>04</strong> 1/1/2007 N M Y 787.95<br />
19306 <strong>04</strong> 1/1/2007 N M Y 948.90<br />
19307 <strong>04</strong> 1/1/2007 N M Y 738.10<br />
19316 <strong>04</strong> N M Y 567.10<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 33 <strong>of</strong> 458
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