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 G0179 09 Y N G0180 09 Y N G0181 09 Y N G0182 09 Y N G0186 04 Y I G0202 B 04 N N 35.95 35.95 71.90 G0204 B 04 N N 35.95 35.95 71.90 G0206 B 04 N N 19.60 19.60 39.20 G0219 B 04 N N 35.25 35.25 70.50 G0237 04 Y I G0238 04 Y I G0239 04 Y I G0245 09 Y N G0246 09 Y N G0247 09 Y N G0248 09 Y N G0249 09 Y N G0250 09 Y N G0251 04 Y N Y Y G0252 04 N N 35.25 35.25 70.50 G0255 04 Y I Wednesday, April 01, 2009 Page 414 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 G0256 04 N I 256.30 G0257 04 N I 35.75 G0259 04 N I 172.50 G0260 04 N I 31.80 G0261 04 N I 256.30 G0265 09 Y N G0266 09 Y N G0268 04 N I 21.40 G0269 04 Y I G0270 09 Y N G0271 09 Y N G0275 04 N I 78.45 G0278 04 N I 78.45 G0281 04 Y I G0282 04 Y I G0283 04 Y I G0288 B 04 Y I G0289 04 Y M Y G0290 04 Y M Y G0291 04 Y N M Y G0293 09 Y M Wednesday, April 01, 2009 Page 415 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 />
G0256 <strong>04</strong> N I 256.30<br />
G0257 <strong>04</strong> N I 35.75<br />
G0259 <strong>04</strong> N I 172.50<br />
G0260 <strong>04</strong> N I 31.80<br />
G0261 <strong>04</strong> N I 256.30<br />
G0265 <strong>09</strong> Y N<br />
G0266 <strong>09</strong> Y N<br />
G0268 <strong>04</strong> N I 21.40<br />
G0269 <strong>04</strong> Y I<br />
G0270 <strong>09</strong> Y N<br />
G0271 <strong>09</strong> Y N<br />
G0275 <strong>04</strong> N I 78.45<br />
G0278 <strong>04</strong> N I 78.45<br />
G0281 <strong>04</strong> Y I<br />
G0282 <strong>04</strong> Y I<br />
G0283 <strong>04</strong> Y I<br />
G0288 B <strong>04</strong> Y I<br />
G0289 <strong>04</strong> Y M Y<br />
G0290 <strong>04</strong> Y M Y<br />
G0291 <strong>04</strong> Y N M Y<br />
G0293 <strong>09</strong> Y M<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 415 <strong>of</strong> 458
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