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 Q0176 04 N Y N 0.96 3 2.88 Q0177 04 N Y N 0.09 16 1.44 Q0178 04 N Y N 0.11 8 0.88 Q0179 04 N Y N 28.80 4 115.20 Q0180 04 N Y N 75.99 1 75.99 Q0181 04 Y Y N Q0515 04 Y Y N Q2004 04 Y Y N Q2009 04 N Y N 7.30 40 292.00 Q2017 04 N Y N 320.97 6 1925.82 Q3014 09 Y N Q3025 04 Y Y N Q3026 04 N Y N 55.40 Q3031 04 Y N Q4001 09 Y N Q4002 09 Y N Q4003 09 Y N Q4004 09 Y N Q4005 09 Y N Q4011 09 Y N Q4013 09 Y N Wednesday, April 01, 2009 Page 452 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 Q4014 09 Y N Q4015 09 Y N Q4016 09 Y N Q4018 09 Y N Q4019 09 Y N Q4020 09 Y N Q4024 09 Y N Q4025 09 Y N Q4026 09 Y N Q4027 09 Y N Q4028 09 Y N Q4029 09 Y N Q4031 09 Y N Q4033 09 Y N Q4035 09 Y N Q4036 09 Y N Q4037 09 Y N Q4041 09 Y N Q4044 09 Y N Q4045 09 Y N Q4046 09 Y N Wednesday, April 01, 2009 Page 453 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 />
Q4<strong>01</strong>4 <strong>09</strong> Y N<br />
Q4<strong>01</strong>5 <strong>09</strong> Y N<br />
Q4<strong>01</strong>6 <strong>09</strong> Y N<br />
Q4<strong>01</strong>8 <strong>09</strong> Y N<br />
Q4<strong>01</strong>9 <strong>09</strong> Y N<br />
Q4020 <strong>09</strong> Y N<br />
Q4024 <strong>09</strong> Y N<br />
Q4025 <strong>09</strong> Y N<br />
Q4026 <strong>09</strong> Y N<br />
Q4027 <strong>09</strong> Y N<br />
Q4028 <strong>09</strong> Y N<br />
Q4029 <strong>09</strong> Y N<br />
Q4031 <strong>09</strong> Y N<br />
Q4033 <strong>09</strong> Y N<br />
Q4035 <strong>09</strong> Y N<br />
Q4036 <strong>09</strong> Y N<br />
Q4037 <strong>09</strong> Y N<br />
Q4<strong>04</strong>1 <strong>09</strong> Y N<br />
Q4<strong>04</strong>4 <strong>09</strong> Y N<br />
Q4<strong>04</strong>5 <strong>09</strong> Y N<br />
Q4<strong>04</strong>6 <strong>09</strong> Y N<br />
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