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 J0740 04 N Y N 885.21 2 1770.42 J0743 04 N Y N 18.88 6 113.28 J0744 04 N Y N 15.55 5 77.75 J0745 04 N Y N 0.55 12 6.60 J0760 04 N Y N 7.72 2 15.44 J0770 04 N Y N 29.73 4 118.92 J0780 04 N Y N 7.90 10 79.00 J0795 04 N Y N 5.15 10 51.50 J0800 04 N N 129.26 2 258.52 J0835 04 N Y N 88.55 1 88.55 J0878 04 N Y N 0.35 500 175.00 J0881 04 N Y N 5.54 500 2770.00 J0882 04 N Y N 5.54 500 2770.00 J0885 04 N Y N 15.16 80 1212.80 J0886 04 N Y N 15.16 80 1212.80 J0894 04 1/1/2007 Y Y N J0895 04 N Y N Y Y 15.36 6 92.16 J0900 04 Y N J0945 04 N Y N 0.77 10 7.70 J0950 04 N Y N 8.10 J0970 04 N Y N 34.14 1 34.14 Wednesday, April 01, 2009 Page 426 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 J1000 04 N Y N 6.35 1 6.35 J1015 04 N Y N 18.63 J1020 04 N Y N 2.20 8 17.60 J1030 04 N Y N 4.93 4 19.72 J1040 04 N Y N 9.87 4 39.48 J1051 04 N Y N 20.56 9 185.04 J1055 04 N Y N 61.69 1 61.69 J1060 04 Y Y N J1070 04 N Y N 6.18 3 18.54 J1080 04 N Y N 11.80 2 23.60 J1094 04 N Y N 0.86 32 27.52 J1100 04 N Y N 0.10 40 4.00 J1110 04 N N 50.87 3 152.61 J1120 04 N N 22.42 2 44.84 J1160 04 N Y N 2.53 3 7.59 J1162 04 N Y N 755.86 80 60468.80 J1165 04 N Y N 0.40 20 8.00 J1170 04 N Y N 1.78 2 3.56 J1180 04 Y N J1190 04 N Y N 255.72 4 1022.88 J1200 04 N Y N 0.79 2 1.58 Wednesday, April 01, 2009 Page 427 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 />
J1000 <strong>04</strong> N Y N 6.35 1 6.35<br />
J1<strong>01</strong>5 <strong>04</strong> N Y N 18.63<br />
J1020 <strong>04</strong> N Y N 2.20 8 17.60<br />
J1030 <strong>04</strong> N Y N 4.93 4 19.72<br />
J1<strong>04</strong>0 <strong>04</strong> N Y N 9.87 4 39.48<br />
J1051 <strong>04</strong> N Y N 20.56 9 185.<strong>04</strong><br />
J1055 <strong>04</strong> N Y N 61.69 1 61.69<br />
J1060 <strong>04</strong> Y Y N<br />
J1070 <strong>04</strong> N Y N 6.18 3 18.54<br />
J1080 <strong>04</strong> N Y N 11.80 2 23.60<br />
J1<strong>09</strong>4 <strong>04</strong> N Y N 0.86 32 27.52<br />
J1100 <strong>04</strong> N Y N 0.10 40 4.00<br />
J1110 <strong>04</strong> N N 50.87 3 152.61<br />
J1120 <strong>04</strong> N N 22.42 2 44.84<br />
J1160 <strong>04</strong> N Y N 2.53 3 7.59<br />
J1162 <strong>04</strong> N Y N 755.86 80 6<strong>04</strong>68.80<br />
J1165 <strong>04</strong> N Y N 0.40 20 8.00<br />
J1170 <strong>04</strong> N Y N 1.78 2 3.56<br />
J1180 <strong>04</strong> Y N<br />
J1190 <strong>04</strong> N Y N 255.72 4 1022.88<br />
J1200 <strong>04</strong> N Y N 0.79 2 1.58<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 427 <strong>of</strong> 458
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