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 J9207 04 1/1/2009 N Y N 76.58 90 6892.20 J9208 04 N N N 134.50 5 672.50 J9209 04 N N N 35.75 25 893.75 J9211 04 N Y N 417.26 10 4172.60 J9212 04 N Y N 14.16 90 1274.40 J9213 04 N Y N 42.02 1 42.02 J9214 04 N Y N 14.16 90 1274.40 J9215 04 N Y N 8.23 20 164.60 J9216 04 N Y N 379.81 2 759.62 J9217 04 N Y N 736.43 6 4418.58 J9218 04 N Y N 154.69 12 1856.28 J9219 04 N Y N 5,666.17 1 5666.17 J9225 04 N Y N 5,500.00 1 5,500.00 J9226 04 1/1/2008 N Y N 15,400.00 1 15,400.00 J9230 04 N Y N 12.59 3 37.77 J9245 04 N Y N 1948.76 1 1948.76 J9250 04 N Y N 0.21 20 4.20 J9260 04 N Y N 2.24 600 1344.00 J9261 04 1/1/2007 N Y N 117.01 30 3510.30 J9263 04 N Y N 10.30 400 4120.00 J9264 04 N Y N 9.91 500 4955.00 Wednesday, April 01, 2009 Page 448 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 J9265 04 N Y N 146.69 15 2200.35 J9266 04 N Y N 1,894.04 5 9470.20 J9268 04 N Y N 2,354.63 1 2354.63 J9270 04 N Y N 98.41 1 98.41 J9280 04 N Y N 92.36 8 738.88 J9290 04 N Y N 369.46 2 738.92 J9291 04 N Y N 895.77 1 895.77 J9293 04 N Y N 411.65 5 2058.25 J9300 04 N Y N 2,751.34 3 8254.02 J9303 04 1/1/2008 Y Y N J9305 04 N Y N 49.80 100 4980.00 J9310 04 N Y N 546.80 10 5468.00 J9320 04 N Y N 185.66 1 185.66 J9330 04 1/1/2009 N Y N 57.45 25 1436.25 J9340 04 N Y N 104.60 3 313.80 J9350 04 N Y N Y 972.24 3 2916.72 J9355 04 N Y N 66.34 100 6634.00 J9357 04 N Y N 552.65 1 552.65 J9360 04 N Y N 1.01 20 20.20 J9370 04 N Y N 15.97 4 63.88 J9375 04 N Y N 31.94 1 31.94 Wednesday, April 01, 2009 Page 449 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 />
J9207 <strong>04</strong> 1/1/20<strong>09</strong> N Y N 76.58 90 6892.20<br />
J9208 <strong>04</strong> N N N 134.50 5 672.50<br />
J92<strong>09</strong> <strong>04</strong> N N N 35.75 25 893.75<br />
J9211 <strong>04</strong> N Y N 417.26 10 4172.60<br />
J9212 <strong>04</strong> N Y N 14.16 90 1274.40<br />
J9213 <strong>04</strong> N Y N 42.02 1 42.02<br />
J9214 <strong>04</strong> N Y N 14.16 90 1274.40<br />
J9215 <strong>04</strong> N Y N 8.23 20 164.60<br />
J9216 <strong>04</strong> N Y N 379.81 2 759.62<br />
J9217 <strong>04</strong> N Y N 736.43 6 4418.58<br />
J9218 <strong>04</strong> N Y N 154.69 12 1856.28<br />
J9219 <strong>04</strong> N Y N 5,666.17 1 5666.17<br />
J9225 <strong>04</strong> N Y N 5,500.00 1 5,500.00<br />
J9226 <strong>04</strong> 1/1/2008 N Y N 15,400.00 1 15,400.00<br />
J9230 <strong>04</strong> N Y N 12.59 3 37.77<br />
J9245 <strong>04</strong> N Y N 1948.76 1 1948.76<br />
J9250 <strong>04</strong> N Y N 0.21 20 4.20<br />
J9260 <strong>04</strong> N Y N 2.24 600 1344.00<br />
J9261 <strong>04</strong> 1/1/2007 N Y N 117.<strong>01</strong> 30 3510.30<br />
J9263 <strong>04</strong> N Y N 10.30 400 4120.00<br />
J9264 <strong>04</strong> N Y N 9.91 500 4955.00<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 448 <strong>of</strong> 458
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