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 J1520 04 Y Y N J1530 04 Y Y N J1540 04 Y Y N J1550 04 Y Y N J1560 04 Y Y N J1561 04 1/1/2008 Y Y N J1562 04 1/1/2007 N Y N 14.95 140 2093.00 J1565 04 N Y N 19.00 4 76.00 J1566 04 Y Y N J1568 04 1/1/2008 Y Y N J1569 04 1/1/2008 Y Y N J1570 04 N Y N 61.95 2 123.90 J1571 04 1/1/2008 N Y N 79.74 9 717.66 J1572 04 1/1/2008 Y Y N J1573 04 1/1/2008 Y Y N J1580 04 N Y N 0.70 5 3.50 J1590 04 Y Y N J1595 04 Y Y N J1600 04 N N 10.80 1 10.80 J1626 04 N Y N 19.45 20 389.00 J1630 04 N N 2.37 40 94.80 Wednesday, April 01, 2009 Page 430 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 J1631 04 N Y N 23.86 6 143.16 J1640 04 N Y N 7.65 1 7.65 J1642 04 N Y N 0.03 5 0.15 J1644 04 N Y N 1.18 10 11.80 J1645 04 N Y N 19.89 4 79.56 J1650 04 N Y N 7.40 84 621.60 J1652 04 N Y N 43.36 20 867.20 J1655 04 N Y N 4.51 20 90.20 J1670 04 N N 107.66 1 107.66 J1675 04 N Y N 3.39 10 33.90 J1700 04 Y Y N J1710 04 N Y N 5.83 5 29.15 J1720 04 N Y N 2.26 10 22.60 J1730 04 Y N J1740 04 1/1/2007 N Y N 167.69 3 503.07 J1742 04 N Y N 302.88 1 302.88 J1743 04 1/1/2008 Y Y N J1756 04 N Y N 0.67 100 67.00 J1785 04 N Y N 4.61 400 1844.00 J1790 04 N Y N 4.23 1 4.23 J1800 04 N Y N 8.22 3 24.66 Wednesday, April 01, 2009 Page 431 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 />
J1520 <strong>04</strong> Y Y N<br />
J1530 <strong>04</strong> Y Y N<br />
J1540 <strong>04</strong> Y Y N<br />
J1550 <strong>04</strong> Y Y N<br />
J1560 <strong>04</strong> Y Y N<br />
J1561 <strong>04</strong> 1/1/2008 Y Y N<br />
J1562 <strong>04</strong> 1/1/2007 N Y N 14.95 140 2<strong>09</strong>3.00<br />
J1565 <strong>04</strong> N Y N 19.00 4 76.00<br />
J1566 <strong>04</strong> Y Y N<br />
J1568 <strong>04</strong> 1/1/2008 Y Y N<br />
J1569 <strong>04</strong> 1/1/2008 Y Y N<br />
J1570 <strong>04</strong> N Y N 61.95 2 123.90<br />
J1571 <strong>04</strong> 1/1/2008 N Y N 79.74 9 717.66<br />
J1572 <strong>04</strong> 1/1/2008 Y Y N<br />
J1573 <strong>04</strong> 1/1/2008 Y Y N<br />
J1580 <strong>04</strong> N Y N 0.70 5 3.50<br />
J1590 <strong>04</strong> Y Y N<br />
J1595 <strong>04</strong> Y Y N<br />
J1600 <strong>04</strong> N N 10.80 1 10.80<br />
J1626 <strong>04</strong> N Y N 19.45 20 389.00<br />
J1630 <strong>04</strong> N N 2.37 40 94.80<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 430 <strong>of</strong> 458
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