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 J9380 04 N Y N 79.86 1 79.86 J9390 04 N Y N 119.14 8 953.12 J9395 04 N Y N 196.11 10 1961.10 J9600 04 N Y N 3,005.31 2 6010.62 J9999 04 Y N M0064 02 N N 10.00 M0075 04 Y N M0076 04 Y N P3000 04 N N 3.55 P3001 04 N N 11.45 P7001 A 04 N N 6.40 6.40 12.80 P9041 09 Y N P9043 09 Y N P9045 09 Y N P9046 09 Y N P9047 09 Y N P9048 09 Y N P9050 04 Y N P9604 04 N N 2.90 P9612 09 Y N P9615 09 Y N Wednesday, April 01, 2009 Page 450 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 Q0044 02 N N 7.60 Q0081 04 Y I Q0083 04 N I 19.00 Q0084 04 N I 19.00 Q0085 04 N I 19.00 Q0111 B 04 N N 2.40 2.40 4.80 Q0112 B 04 N N 2.40 2.40 4.80 Q0113 B 04 N N 2.40 2.40 4.80 Q0114 B 04 N N 2.40 2.40 4.80 Q0163 04 N Y N 0.09 2 0.18 Q0164 04 N Y N 0.44 10 4.40 Q0165 04 N Y N 0.64 5 3.20 Q0166 04 N Y N 46.88 2 93.76 Q0168 04 N Y N 10.47 2 20.94 Q0169 04 N Y N 0.28 4 1.12 Q0170 04 N Y N 0.57 2 1.14 Q0171 04 N Y N 0.27 5 1.35 Q0172 04 N Y N 0.41 16 6.56 Q0173 04 N Y N 0.28 4 1.12 Q0174 04 N Y N 0.60 6 3.60 Q0175 04 N Y N 0.79 6 4.74 Wednesday, April 01, 2009 Page 451 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 />
J9380 <strong>04</strong> N Y N 79.86 1 79.86<br />
J9390 <strong>04</strong> N Y N 119.14 8 953.12<br />
J9395 <strong>04</strong> N Y N 196.11 10 1961.10<br />
J9600 <strong>04</strong> N Y N 3,005.31 2 6<strong>01</strong>0.62<br />
J9999 <strong>04</strong> Y N<br />
M0064 02 N N 10.00<br />
M0075 <strong>04</strong> Y N<br />
M0076 <strong>04</strong> Y N<br />
P3000 <strong>04</strong> N N 3.55<br />
P30<strong>01</strong> <strong>04</strong> N N 11.45<br />
P70<strong>01</strong> A <strong>04</strong> N N 6.40 6.40 12.80<br />
P9<strong>04</strong>1 <strong>09</strong> Y N<br />
P9<strong>04</strong>3 <strong>09</strong> Y N<br />
P9<strong>04</strong>5 <strong>09</strong> Y N<br />
P9<strong>04</strong>6 <strong>09</strong> Y N<br />
P9<strong>04</strong>7 <strong>09</strong> Y N<br />
P9<strong>04</strong>8 <strong>09</strong> Y N<br />
P9050 <strong>04</strong> Y N<br />
P96<strong>04</strong> <strong>04</strong> N N 2.90<br />
P9612 <strong>09</strong> Y N<br />
P9615 <strong>09</strong> Y N<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 450 <strong>of</strong> 458
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