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 99348 04 N N 31.30 99349 04 N N 47.50 99350 04 N N 68.85 99354 04 Y I 99355 04 Y I 99356 04 Y I 99357 04 Y I 99358 09 Y I 99359 09 Y I 99360 09 Y I 99374 09 Y N 99377 09 Y N 99379 09 Y N 99380 09 Y N 99381 P 04 N N 32.15 59.75 99382 P 04 N N 32.15 66.50 99383 P 04 N N 32.15 64.45 99384 P 04 N N 32.15 72.81 99385 P 04 2/1/2009 N N 32.15 C 66.40 (A) 72.81 38.56 99386 P 04 2/1/2009 N N 66.40 38.56 99387 P 04 2/1/2009 N N 66.40 38.56 Wednesday, April 01, 2009 Page 408 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 99391 P 04 N N 32.15 C 32.15 37.37 99392 P 04 N N 32.15 C 32.15 45.72 99393 P 04 N N 32.15 C 32.15 44.69 99394 P 04 N N 32.15 C 32.15 52.47 99395 P 04 N N 32.15 C 42.50 A 53.50 43.15 99396 P 04 N N 42.50 43.15 99397 P 04 N N 42.50 43.15 99420 04 N N 14.60 1 14.60 99450 09 Y N 99455 09 Y N 99456 09 Y N 99460 04 1/1/2009 N 38.75 99461 04 1/1/2009 N 16.40 99462 04 1/1/2009 N 16.40 99463 04 1/1/2009 N 42.55 99464 04 1/1/2009 N 83.70 99465 04 1/1/2009 N 94.50 99466 04 1/1/2009 Y I 99467 04 1/1/2009 Y 99468 04 2/1/2009 N 586.70 99469 04 2/1/2009 N 251.69 Wednesday, April 01, 2009 Page 409 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 />
99391 P <strong>04</strong> N N 32.15 C 32.15 37.37<br />
99392 P <strong>04</strong> N N 32.15 C 32.15 45.72<br />
99393 P <strong>04</strong> N N 32.15 C 32.15 44.69<br />
99394 P <strong>04</strong> N N 32.15 C 32.15 52.47<br />
99395 P <strong>04</strong> N N 32.15 C 42.50 A 53.50 43.15<br />
99396 P <strong>04</strong> N N 42.50 43.15<br />
99397 P <strong>04</strong> N N 42.50 43.15<br />
99420 <strong>04</strong> N N 14.60 1 14.60<br />
99450 <strong>09</strong> Y N<br />
99455 <strong>09</strong> Y N<br />
99456 <strong>09</strong> Y N<br />
99460 <strong>04</strong> 1/1/20<strong>09</strong> N 38.75<br />
99461 <strong>04</strong> 1/1/20<strong>09</strong> N 16.40<br />
99462 <strong>04</strong> 1/1/20<strong>09</strong> N 16.40<br />
99463 <strong>04</strong> 1/1/20<strong>09</strong> N 42.55<br />
99464 <strong>04</strong> 1/1/20<strong>09</strong> N 83.70<br />
99465 <strong>04</strong> 1/1/20<strong>09</strong> N 94.50<br />
99466 <strong>04</strong> 1/1/20<strong>09</strong> Y I<br />
99467 <strong>04</strong> 1/1/20<strong>09</strong> Y<br />
99468 <strong>04</strong> 2/1/20<strong>09</strong> N 586.70<br />
99469 <strong>04</strong> 2/1/20<strong>09</strong> N 251.69<br />
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