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 J3265 04 N Y N 2.03 10 20.30 J3280 04 Y Y N J3285 04 N Y N 64.79 2 129.58 J3300 04 1/1/2009 N Y N 3.86 4 15.44 J3301 04 N N N 1.78 8 14.24 J3302 04 N Y N 0.54 32 17.28 J3303 04 N Y 1.76 4 7.04 J3305 04 N Y N 175.99 5 879.95 J3310 04 N Y N 1.75 J3315 04 N Y N 604.34 3 1813.02 J3320 04 N Y N 35.36 1 35.36 J3350 04 Y N J3360 04 N Y N 0.14 6 0.84 J3364 04 N Y N 56.42 2 112.84 J3365 04 N Y N Y Y 538.08 2 1076.16 J3370 04 N Y N 3.34 4 13.36 J3396 04 N Y N 11.20 150 1680.00 J3400 04 N Y N 3.80 J3410 04 N Y N 0.27 4 1.08 J3411 04 N Y N 0.84 2 1.68 J3415 04 N Y N 0.61 5 3.05 Wednesday, April 01, 2009 Page 438 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 J3420 04 N Y N 0.18 1 0.18 J3430 04 N Y N 0.19 25 4.87 J3465 04 N Y N 5.72 60 343.20 J3470 04 N N 24.92 1 24.92 J3471 04 N Y N 0.13 999 129.87 J3472 04 N Y N 0.13 1,000 130.00 J3473 04 1/1/2007 Y Y N J3475 04 N Y N 0.07 20 1.40 J3480 04 N Y N 0.13 20 2.60 J3485 04 N Y N 1.21 50 60.50 J3486 04 N Y N 23.84 4 95.36 J3487 04 N Y N 237.65 4 950.60 J3488 04 1/1/2008 Y Y N J3490 04 Y Y N J3520 04 N Y N 1.40 20 28.00 J3530 04 Y N J3590 04 Y Y N J7030 04 N Y N 1.30 2 2.60 J7040 04 N Y N 1.17 2 2.34 J7042 04 N Y N 1.52 2 3.04 J7050 04 N Y N 3.64 2 7.28 Wednesday, April 01, 2009 Page 439 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 />
J3420 <strong>04</strong> N Y N 0.18 1 0.18<br />
J3430 <strong>04</strong> N Y N 0.19 25 4.87<br />
J3465 <strong>04</strong> N Y N 5.72 60 343.20<br />
J3470 <strong>04</strong> N N 24.92 1 24.92<br />
J3471 <strong>04</strong> N Y N 0.13 999 129.87<br />
J3472 <strong>04</strong> N Y N 0.13 1,000 130.00<br />
J3473 <strong>04</strong> 1/1/2007 Y Y N<br />
J3475 <strong>04</strong> N Y N 0.07 20 1.40<br />
J3480 <strong>04</strong> N Y N 0.13 20 2.60<br />
J3485 <strong>04</strong> N Y N 1.21 50 60.50<br />
J3486 <strong>04</strong> N Y N 23.84 4 95.36<br />
J3487 <strong>04</strong> N Y N 237.65 4 950.60<br />
J3488 <strong>04</strong> 1/1/2008 Y Y N<br />
J3490 <strong>04</strong> Y Y N<br />
J3520 <strong>04</strong> N Y N 1.40 20 28.00<br />
J3530 <strong>04</strong> Y N<br />
J3590 <strong>04</strong> Y Y N<br />
J7030 <strong>04</strong> N Y N 1.30 2 2.60<br />
J7<strong>04</strong>0 <strong>04</strong> N Y N 1.17 2 2.34<br />
J7<strong>04</strong>2 <strong>04</strong> N Y N 1.52 2 3.<strong>04</strong><br />
J7050 <strong>04</strong> N Y N 3.64 2 7.28<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 439 <strong>of</strong> 458
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