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 J2770 04 N N N 110.30 4 441.20 J2778 04 1/1/2008 N Y N 485.97 5 2429.85 J2780 04 N Y N 1.50 2 3.00 J2783 04 N Y N 133.87 3 401.61 J2785 04 1/1/2009 N Y N 63.03 4 252.12 J2788 04 N Y N 33.03 6 198.18 J2790 04 N Y N 99.92 1 99.92 J2791 04 1/1/2008 Y Y N J2792 04 N Y N 23.58 340 8017.20 J2794 04 Y Y N J2795 04 N N N 0.36 2 0.72 J2800 04 N N 15.49 3 46.47 J2810 04 Y Y N J2820 04 N Y N 37.21 15 558.15 J2910 04 N Y N 16.70 1 16.70 J2916 04 N Y N 8.56 10 85.60 J2920 04 N Y N 1.73 3 5.19 J2930 04 N Y N 2.88 4 11.52 J2940 04 N Y N 52.69 2 105.38 J2941 04 N Y N 35.68 20 713.60 J2993 04 N N N 1,503.32 2 3006.64 Wednesday, April 01, 2009 Page 436 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 J2994 04 Y Y N J2995 04 Y Y N J2996 04 N Y N 280.60 J2997 04 N Y N 40.41 4 161.64 J3000 04 N Y N 9.06 2 18.12 J3010 04 N Y N 0.29 20 5.80 J3030 04 N Y N 65.71 1 65.71 J3070 04 N N 2.49 12 29.88 J3101 04 1/1/2009 N Y N 59.91 50 2995.57 J3105 04 N Y N 19.09 3 57.27 J3110 04 N Y N 12.25 2 24.50 J3120 04 N N 8.46 4 33.84 J3130 04 N N 16.93 2 33.86 J3140 04 N Y N 0.41 4 1.64 J3150 04 N N 0.83 4 3.32 J3230 04 N Y N 12.86 8 102.88 J3240 04 N Y N 822.41 1 822.41 J3243 04 1/1/2007 N N 1.33 100 133.00 J3246 04 N Y N 105.80 1 105.80 J3250 04 N Y N 5.46 4 21.84 J3260 04 N Y N 7.73 5 38.65 Wednesday, April 01, 2009 Page 437 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 />
J2770 <strong>04</strong> N N N 110.30 4 441.20<br />
J2778 <strong>04</strong> 1/1/2008 N Y N 485.97 5 2429.85<br />
J2780 <strong>04</strong> N Y N 1.50 2 3.00<br />
J2783 <strong>04</strong> N Y N 133.87 3 4<strong>01</strong>.61<br />
J2785 <strong>04</strong> 1/1/20<strong>09</strong> N Y N 63.03 4 252.12<br />
J2788 <strong>04</strong> N Y N 33.03 6 198.18<br />
J2790 <strong>04</strong> N Y N 99.92 1 99.92<br />
J2791 <strong>04</strong> 1/1/2008 Y Y N<br />
J2792 <strong>04</strong> N Y N 23.58 340 8<strong>01</strong>7.20<br />
J2794 <strong>04</strong> Y Y N<br />
J2795 <strong>04</strong> N N N 0.36 2 0.72<br />
J2800 <strong>04</strong> N N 15.49 3 46.47<br />
J2810 <strong>04</strong> Y Y N<br />
J2820 <strong>04</strong> N Y N 37.21 15 558.15<br />
J2910 <strong>04</strong> N Y N 16.70 1 16.70<br />
J2916 <strong>04</strong> N Y N 8.56 10 85.60<br />
J2920 <strong>04</strong> N Y N 1.73 3 5.19<br />
J2930 <strong>04</strong> N Y N 2.88 4 11.52<br />
J2940 <strong>04</strong> N Y N 52.69 2 105.38<br />
J2941 <strong>04</strong> N Y N 35.68 20 713.60<br />
J2993 <strong>04</strong> N N N 1,503.32 2 3006.64<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 436 <strong>of</strong> 458
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