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 J9027 04 Y Y N J9031 04 N Y N 190.89 1 190.89 J9033 04 1/1/2009 N Y N 22.42 300 6726.00 J9035 04 N Y N 68.53 100 6853.00 J9040 04 N Y N 248.46 3 745.38 J9041 04 N Y N 36.12 35 1264.20 J9045 04 N Y N 28.98 20 579.60 J9050 04 N Y N 169.76 8 1358.08 J9055 04 N Y N 59.81 100 5981.00 J9060 04 N Y N 40.78 30 1223.40 J9062 04 N Y N 203.90 4 815.60 J9065 04 N Y N 47.78 10 477.80 J9070 04 N Y N 2.87 20 57.40 J9080 04 N Y N 5.74 10 57.46 J9090 04 N Y N 13.49 4 53.96 J9091 04 N Y N 28.78 2 57.56 J9092 04 N Y N 44.59 1 44.59 J9093 04 N Y N 2.87 20 57.40 J9094 04 N Y N 9.99 4 39.96 J9095 04 N Y N 13.49 4 53.96 J9096 04 N Y N 28.78 2 57.56 Wednesday, April 01, 2009 Page 446 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 J9097 04 N Y N 44.59 2 89.18 J9098 04 N Y N 454.56 5 2272.80 J9100 04 N Y N 3.18 60 190.80 J9110 04 N Y N 9.01 4 36.04 J9120 04 N Y N 14.54 3 43.62 J9130 04 N Y N 11.76 10 117.60 J9140 04 N Y N 19.65 5 98.25 J9150 04 N Y N 32.68 6 196.08 J9151 04 N Y N 67.74 8 541.92 J9160 04 N Y N 1,694.66 6 10167.96 J9165 04 Y Y N J9170 04 N Y N 386.82 13 5028.66 J9175 04 Y Y N J9178 04 N Y N 29.87 100 2987.00 J9181 04 N Y N 13.38 45 602.10 J9185 04 N Y N 292.33 1 292.33 J9190 04 N Y N 3.18 12 38.16 J9200 04 N Y N 127.44 1 127.44 J9201 04 N Y N 142.20 10 1422.00 J9202 04 N Y N 468.51 3 1405.53 J9206 04 N Y N 152.95 44 6729.80 Wednesday, April 01, 2009 Page 447 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 />
J9<strong>09</strong>7 <strong>04</strong> N Y N 44.59 2 89.18<br />
J9<strong>09</strong>8 <strong>04</strong> N Y N 454.56 5 2272.80<br />
J9100 <strong>04</strong> N Y N 3.18 60 190.80<br />
J9110 <strong>04</strong> N Y N 9.<strong>01</strong> 4 36.<strong>04</strong><br />
J9120 <strong>04</strong> N Y N 14.54 3 43.62<br />
J9130 <strong>04</strong> N Y N 11.76 10 117.60<br />
J9140 <strong>04</strong> N Y N 19.65 5 98.25<br />
J9150 <strong>04</strong> N Y N 32.68 6 196.08<br />
J9151 <strong>04</strong> N Y N 67.74 8 541.92<br />
J9160 <strong>04</strong> N Y N 1,694.66 6 1<strong>01</strong>67.96<br />
J9165 <strong>04</strong> Y Y N<br />
J9170 <strong>04</strong> N Y N 386.82 13 5028.66<br />
J9175 <strong>04</strong> Y Y N<br />
J9178 <strong>04</strong> N Y N 29.87 100 2987.00<br />
J9181 <strong>04</strong> N Y N 13.38 45 602.10<br />
J9185 <strong>04</strong> N Y N 292.33 1 292.33<br />
J9190 <strong>04</strong> N Y N 3.18 12 38.16<br />
J9200 <strong>04</strong> N Y N 127.44 1 127.44<br />
J92<strong>01</strong> <strong>04</strong> N Y N 142.20 10 1422.00<br />
J9202 <strong>04</strong> N Y N 468.51 3 1405.53<br />
J9206 <strong>04</strong> N Y N 152.95 44 6729.80<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 447 <strong>of</strong> 458
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