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 H1000 04 N N 14.60 J0120 04 N Y N 5.49 1 5.49 J0128 04 N Y N 80.66 10 806.60 J0129 04 1/1/2007 N Y N 22.98 75 1723.50 J0132 04 N Y N 0.32 2 0.64 J0133 04 N Y N 0.14 10 1.40 J0135 04 N Y N 862.86 8 6902.88 J0150 04 N Y 39.55 5 197.75 J0152 04 N Y N 87.14 3 261.42 J0170 04 N Y N 0.14 24 3.36 J0180 04 N Y N 149.52 105 15699.60 J0190 04 Y Y N J0200 04 Y Y N J0205 04 N Y N 44.74 8 357.92 J0207 04 N Y N 540.07 2 1080.14 J0210 04 N N 0.83 16 13.28 J0215 N 04 Y Y N J0220 04 1/1/2008 Y Y J0256 04 N Y N 2.94 600 1764.00 J0278 04 N Y N 1.37 3 4.11 J0280 04 N N 0.67 6 4.02 Wednesday, April 01, 2009 Page 422 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 J0282 04 N Y N 0.77 5 3.85 J0285 04 N Y N 17.36 6 104.16 J0287 04 N Y N 23.92 50 1196.00 J0288 04 N Y N 15.94 40 637.60 J0289 04 N Y N 39.12 50 1956.00 J0290 04 N Y N 3.39 4 13.56 J0295 04 N Y N 9.39 8 75.12 J0300 04 Y N J0348 04 1/1/2007 Y Y N J0350 04 Y Y N J0360 04 N Y N 15.92 12 191.04 J0364 04 1/1/2007 N Y N 4.95 6 29.70 J0365 04 N Y N 2.82 1 2.82 J0370 04 N Y N 1.85 J0380 04 N N 13.31 10 133.10 J0390 04 N Y N 3.50 J0395 04 N Y N 191.39 1 191.39 J0400 04 1/1/2008 N Y 2.61 120 313.20 J0456 04 N Y N 30.58 1 30.58 J0460 04 N N 0.61 10 6.10 J0470 04 N N 28.55 5 142.75 Wednesday, April 01, 2009 Page 423 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 />
J0282 <strong>04</strong> N Y N 0.77 5 3.85<br />
J0285 <strong>04</strong> N Y N 17.36 6 1<strong>04</strong>.16<br />
J0287 <strong>04</strong> N Y N 23.92 50 1196.00<br />
J0288 <strong>04</strong> N Y N 15.94 40 637.60<br />
J0289 <strong>04</strong> N Y N 39.12 50 1956.00<br />
J0290 <strong>04</strong> N Y N 3.39 4 13.56<br />
J0295 <strong>04</strong> N Y N 9.39 8 75.12<br />
J0300 <strong>04</strong> Y N<br />
J0348 <strong>04</strong> 1/1/2007 Y Y N<br />
J0350 <strong>04</strong> Y Y N<br />
J0360 <strong>04</strong> N Y N 15.92 12 191.<strong>04</strong><br />
J0364 <strong>04</strong> 1/1/2007 N Y N 4.95 6 29.70<br />
J0365 <strong>04</strong> N Y N 2.82 1 2.82<br />
J0370 <strong>04</strong> N Y N 1.85<br />
J0380 <strong>04</strong> N N 13.31 10 133.10<br />
J0390 <strong>04</strong> N Y N 3.50<br />
J0395 <strong>04</strong> N Y N 191.39 1 191.39<br />
J<strong>04</strong>00 <strong>04</strong> 1/1/2008 N Y 2.61 120 313.20<br />
J<strong>04</strong>56 <strong>04</strong> N Y N 30.58 1 30.58<br />
J<strong>04</strong>60 <strong>04</strong> N N 0.61 10 6.10<br />
J<strong>04</strong>70 <strong>04</strong> N N 28.55 5 142.75<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 423 <strong>of</strong> 458
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