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 J1810 04 Y Y N J1815 04 N Y N 0.23 20 4.60 J1817 04 N Y N 2.17 2 4.34 J1825 04 N Y N 601.23 1 601.23 J1835 04 N Y N 44.31 8 354.48 J1840 04 N N 2.93 3 8.79 J1850 04 N N 0.43 14 6.02 J1885 04 N Y N 1.05 8 8.40 J1930 04 1/1/2009 N Y N 31.24 90 2811.60 J1931 04 Y Y N J1940 04 N Y N 0.45 10 4.50 J1945 04 N Y N 179.93 1 179.93 J1950 04 N Y N 591.46 2 1182.92 J1953 04 1/1/2009 N Y N 0.81 50 40.50 J1955 04 N Y N 11.67 4 46.68 J1956 04 N Y N 22.65 2 45.30 J1960 04 N Y N 3.94 2 7.88 J1980 04 N N 10.99 8 87.92 J1990 04 N Y N 26.22 3 78.66 J2001 04 N Y N 0.06 20 1.20 J2010 04 N Y N 3.52 4 14.08 Wednesday, April 01, 2009 Page 432 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 J2020 04 N Y N 42.60 6 255.60 J2060 04 N Y N 1.18 4 4.72 J2150 04 N Y N 1.01 8 8.08 J2175 04 N Y N 0.87 6 5.22 J2180 04 Y Y N J2185 04 N Y N 6.15 10 61.50 J2210 04 N N 6.71 1 6.71 J2248 04 1/1/2007 N Y N 2.32 150 348.00 J2250 04 N Y N 0.62 10 6.20 J2260 04 N Y N 35.45 1 35.45 J2270 04 N Y N 0.78 10 7.80 J2271 04 N Y N 1.81 3 5.43 J2275 04 N Y N 2.49 10 24.90 J2278 04 N Y N 7.58 50 379.00 J2280 04 N Y N 10.90 4 43.60 J2300 04 N Y N 0.66 16 10.56 J2310 04 N N N 5.57 2 11.14 J2315 04 1/1/2007 N Y N 2.27 380 862.60 J2320 04 N N 4.02 4 16.08 J2321 04 N N 8.04 2 16.08 J2322 04 N N 16.94 1 16.94 Wednesday, April 01, 2009 Page 433 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 />
J1810 <strong>04</strong> Y Y N<br />
J1815 <strong>04</strong> N Y N 0.23 20 4.60<br />
J1817 <strong>04</strong> N Y N 2.17 2 4.34<br />
J1825 <strong>04</strong> N Y N 6<strong>01</strong>.23 1 6<strong>01</strong>.23<br />
J1835 <strong>04</strong> N Y N 44.31 8 354.48<br />
J1840 <strong>04</strong> N N 2.93 3 8.79<br />
J1850 <strong>04</strong> N N 0.43 14 6.02<br />
J1885 <strong>04</strong> N Y N 1.05 8 8.40<br />
J1930 <strong>04</strong> 1/1/20<strong>09</strong> N Y N 31.24 90 2811.60<br />
J1931 <strong>04</strong> Y Y N<br />
J1940 <strong>04</strong> N Y N 0.45 10 4.50<br />
J1945 <strong>04</strong> N Y N 179.93 1 179.93<br />
J1950 <strong>04</strong> N Y N 591.46 2 1182.92<br />
J1953 <strong>04</strong> 1/1/20<strong>09</strong> N Y N 0.81 50 40.50<br />
J1955 <strong>04</strong> N Y N 11.67 4 46.68<br />
J1956 <strong>04</strong> N Y N 22.65 2 45.30<br />
J1960 <strong>04</strong> N Y N 3.94 2 7.88<br />
J1980 <strong>04</strong> N N 10.99 8 87.92<br />
J1990 <strong>04</strong> N Y N 26.22 3 78.66<br />
J20<strong>01</strong> <strong>04</strong> N Y N 0.06 20 1.20<br />
J2<strong>01</strong>0 <strong>04</strong> N Y N 3.52 4 14.08<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 432 <strong>of</strong> 458
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