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 J2323 04 1/1/2008 N Y N 8.01 300 2403.08 J2325 04 N Y N 31.68 5 158.40 J2353 04 Y Y N J2354 04 N Y N 3.39 20 67.80 J2355 04 N Y N 305.04 1 305.04 J2357 04 Y Y N J2360 04 N N 20.43 1 20.43 J2370 04 N N 2.65 1 2.65 J2400 04 N Y N 16.66 2 33.32 J2405 04 N Y N 6.38 40 255.20 J2410 04 N Y N 3.23 10 32.30 J2425 04 N Y N 13.70 100 1370.00 J2430 04 N Y N 237.76 3 713.28 J2440 04 N N 2.96 3 8.88 J2460 04 N Y N 0.71 10 7.10 J2469 04 N Y N 35.64 10 356.40 J2501 04 N Y N 5.82 20 116.40 J2503 04 N Y N 1239.83 1 1239.83 J2504 04 N Y N 195.38 1 195.38 J2505 04 N Y N 3243.53 1 3243.53 J2510 04 N Y N 10.86 1 10.86 Wednesday, April 01, 2009 Page 434 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 J2513 04 N N 76.09 1 76.09 J2515 04 N N 5.24 4 20.96 J2540 04 N Y N 2.92 1 2.92 J2543 04 N Y N 12.38 12 148.56 J2545 04 N Y N 40.10 1 40.10 J2550 04 N Y N 0.48 1 0.48 J2560 04 N N 1.85 5 9.25 J2590 04 N N 3.57 3 10.71 J2597 04 N Y N 3.61 4 14.44 J2650 04 Y N J2670 04 Y N J2675 04 N Y N 3.28 3 9.84 J2680 04 N Y N 21.30 4 85.20 J2690 04 N Y N 2.96 1 2.96 J2700 04 N Y N 1.26 20 25.20 J2710 04 N Y N 1.56 8 12.48 J2720 04 N Y N 0.79 5 3.95 J2724 04 1/1/2008 Y Y N J2730 04 N Y N 108.03 3 324.09 J2760 04 N N 67.28 2 134.56 J2765 04 N Y N 0.40 14 5.60 Wednesday, April 01, 2009 Page 435 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 />
J2513 <strong>04</strong> N N 76.<strong>09</strong> 1 76.<strong>09</strong><br />
J2515 <strong>04</strong> N N 5.24 4 20.96<br />
J2540 <strong>04</strong> N Y N 2.92 1 2.92<br />
J2543 <strong>04</strong> N Y N 12.38 12 148.56<br />
J2545 <strong>04</strong> N Y N 40.10 1 40.10<br />
J2550 <strong>04</strong> N Y N 0.48 1 0.48<br />
J2560 <strong>04</strong> N N 1.85 5 9.25<br />
J2590 <strong>04</strong> N N 3.57 3 10.71<br />
J2597 <strong>04</strong> N Y N 3.61 4 14.44<br />
J2650 <strong>04</strong> Y N<br />
J2670 <strong>04</strong> Y N<br />
J2675 <strong>04</strong> N Y N 3.28 3 9.84<br />
J2680 <strong>04</strong> N Y N 21.30 4 85.20<br />
J2690 <strong>04</strong> N Y N 2.96 1 2.96<br />
J2700 <strong>04</strong> N Y N 1.26 20 25.20<br />
J2710 <strong>04</strong> N Y N 1.56 8 12.48<br />
J2720 <strong>04</strong> N Y N 0.79 5 3.95<br />
J2724 <strong>04</strong> 1/1/2008 Y Y N<br />
J2730 <strong>04</strong> N Y N 108.03 3 324.<strong>09</strong><br />
J2760 <strong>04</strong> N N 67.28 2 134.56<br />
J2765 <strong>04</strong> N Y N 0.40 14 5.60<br />
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