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 99145 04 N I 38.35 2 76.70 99148 04 N I 38.35 99149 04 N I 38.35 99150 04 N I 19.17 2 38.35 99170 04 N I 58.90 99172 04 Y I 99173 04 N N 7.45 1 7.45 99175 09 Y N 99183 04 N I 60.50 99185 04 Y I 99186 04 Y I 99190 04 Y I Y 99191 04 Y I Y 99192 04 Y I Y 99195 04 N I 33.25 99199 04 Y I Y Y 99201 P 04 2/1/2009 N N 27.95 1 27.95 1.60 1.60 99202 P 04 2/1/2009 N N 32.00 1 32.00 1.60 1.60 99203 P 04 2/1/2009 N N 41.60 1 41.60 1.95 1.95 99204 P 04 2/1/2009 N N 66.40 1 66.40 3.25 3.25 99205 P 04 2/1/2009 N N 70.85 1 70.85 3.25 3.25 Wednesday, April 01, 2009 Page 404 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 99211 P 04 2/1/2009 N N 12.30 1 12.30 .58 .58 99212 P 04 2/1/2009 N N 24.25 1 24.25 1.40 1.40 99213 P 04 2/1/2009 N N 28.35 1 28.35 18.21 18.21 99214 P 04 2/1/2009 N N 42.50 1 42.50 30.47 30.47 99215 P 04 2/1/2009 N N 48.00 1 48.00 1.95 1.95 99217 09 Y N 99218 04 N N 69.55 99219 04 N N 69.55 99220 04 N N 69.55 99221 04 N N 33.90 99222 04 N N 51.40 99223 04 N N 69.00 99231 04 N N 16.40 99232 04 N N 24.90 99233 04 N N 35.05 99234 04 N N 69.55 99235 04 N N 76.65 99236 04 N N 94.20 99238 04 N N 29.65 99239 04 N N 39.05 99241 04 2/1/2009 N N 32.15 7.04 Wednesday, April 01, 2009 Page 405 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 />
99145 <strong>04</strong> N I 38.35 2 76.70<br />
99148 <strong>04</strong> N I 38.35<br />
99149 <strong>04</strong> N I 38.35<br />
99150 <strong>04</strong> N I 19.17 2 38.35<br />
99170 <strong>04</strong> N I 58.90<br />
99172 <strong>04</strong> Y I<br />
99173 <strong>04</strong> N N 7.45 1 7.45<br />
99175 <strong>09</strong> Y N<br />
99183 <strong>04</strong> N I 60.50<br />
99185 <strong>04</strong> Y I<br />
99186 <strong>04</strong> Y I<br />
99190 <strong>04</strong> Y I Y<br />
99191 <strong>04</strong> Y I Y<br />
99192 <strong>04</strong> Y I Y<br />
99195 <strong>04</strong> N I 33.25<br />
99199 <strong>04</strong> Y I Y Y<br />
992<strong>01</strong> P <strong>04</strong> 2/1/20<strong>09</strong> N N 27.95 1 27.95 1.60 1.60<br />
99202 P <strong>04</strong> 2/1/20<strong>09</strong> N N 32.00 1 32.00 1.60 1.60<br />
99203 P <strong>04</strong> 2/1/20<strong>09</strong> N N 41.60 1 41.60 1.95 1.95<br />
992<strong>04</strong> P <strong>04</strong> 2/1/20<strong>09</strong> N N 66.40 1 66.40 3.25 3.25<br />
99205 P <strong>04</strong> 2/1/20<strong>09</strong> N N 70.85 1 70.85 3.25 3.25<br />
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