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 J7511 04 N N N 429.89 1 429.89 J7513 04 N Y N 512.28 4 2049.12 J7515 04 N Y N 1.67 20 33.40 J7516 04 N Y N 24.77 3 74.31 J7517 04 N Y N 3.21 8 25.68 J7518 04 Y Y N J7520 04 N Y N 8.31 6 49.86 J7525 04 N Y N 164.48 1 164.48 J7599 04 Y Y N J7604 04 1/1/2008 N Y N 5.53 1 5.53 J7605 04 1/1/2008 N Y N 5.73 1 5.73 J7606 04 1/1/2009 N Y N 6.13 1 6.13 J7607 04 1/1/2007 Y Y N J7608 04 N Y N 3.28 4 13.12 J7609 04 1/1/2007 Y Y N J7610 04 1/1/2007 Y Y N J7611 04 4/1/2008 N Y 0.03 5 0.15 J7612 04 4/1/2008 N Y 1.15 5 5.75 J7613 04 4/1/2008 N Y 0.06 5 0.30 J7614 04 4/1/2008 N Y 2.11 5 10.55 J7615 04 1/1/2007 Y Y N Wednesday, April 01, 2009 Page 442 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 J7620 04 Y Y N J7625 04 N Y N 1.10 J7626 04 N Y N 4.91 4 19.64 J7627 04 N Y N 0.09 4 0.36 J7628 04 Y Y N J7629 04 Y Y N J7630 04 N Y N 1.10 J7631 04 N Y N 0.33 2 0.66 J7632 04 1/1/2008 N Y N 0.33 2 0.66 J7633 04 N Y N 5.16 2 10.32 J7634 04 1/1/2007 Y Y N J7635 04 N Y N 0.40 2 0.80 J7636 04 Y Y N J7637 04 N Y N 11.21 1 11.21 J7638 04 Y Y N J7639 04 N Y N 22.56 2 45.12 J7640 04 N Y N 1.85 5 9.25 J7642 04 Y Y N J7644 04 N Y N 0.40 5 2.00 J7645 04 1/1/2007 Y Y N J7647 04 1/1/2007 Y Y N Wednesday, April 01, 2009 Page 443 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 />
J7511 <strong>04</strong> N N N 429.89 1 429.89<br />
J7513 <strong>04</strong> N Y N 512.28 4 2<strong>04</strong>9.12<br />
J7515 <strong>04</strong> N Y N 1.67 20 33.40<br />
J7516 <strong>04</strong> N Y N 24.77 3 74.31<br />
J7517 <strong>04</strong> N Y N 3.21 8 25.68<br />
J7518 <strong>04</strong> Y Y N<br />
J7520 <strong>04</strong> N Y N 8.31 6 49.86<br />
J7525 <strong>04</strong> N Y N 164.48 1 164.48<br />
J7599 <strong>04</strong> Y Y N<br />
J76<strong>04</strong> <strong>04</strong> 1/1/2008 N Y N 5.53 1 5.53<br />
J7605 <strong>04</strong> 1/1/2008 N Y N 5.73 1 5.73<br />
J7606 <strong>04</strong> 1/1/20<strong>09</strong> N Y N 6.13 1 6.13<br />
J7607 <strong>04</strong> 1/1/2007 Y Y N<br />
J7608 <strong>04</strong> N Y N 3.28 4 13.12<br />
J76<strong>09</strong> <strong>04</strong> 1/1/2007 Y Y N<br />
J7610 <strong>04</strong> 1/1/2007 Y Y N<br />
J7611 <strong>04</strong> 4/1/2008 N Y 0.03 5 0.15<br />
J7612 <strong>04</strong> 4/1/2008 N Y 1.15 5 5.75<br />
J7613 <strong>04</strong> 4/1/2008 N Y 0.06 5 0.30<br />
J7614 <strong>04</strong> 4/1/2008 N Y 2.11 5 10.55<br />
J7615 <strong>04</strong> 1/1/2007 Y Y N<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 442 <strong>of</strong> 458
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