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 21080 04 Y I 21081 04 Y I 21082 04 Y I 21083 04 Y I 21084 04 Y I 21085 04 Y I 21086 04 Y I 21087 04 Y I 21088 04 Y I 21089 04 Y I 21100 04 N M 192.85 21110 04 N M Y 176.70 21116 04 N I 73.20 21120 04 N M Y Y 1,198.70 21121 04 N M Y Y 1,198.70 21122 04 N M Y Y 1,414.70 21123 04 N M Y Y 1,522.70 21125 04 N M Y Y 1,198.70 21127 04 N M Y Y 1,306.65 21137 04 N M Y Y 958.60 21138 04 N M Y Y 1,198.70 Wednesday, April 01, 2009 Page 40 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 21139 04 N M Y Y 1,522.70 21141 04 N M Y Y 1,198.70 21142 04 N M Y Y 1,306.65 21143 04 N M Y Y 1,414.70 21145 04 N M Y Y 1,306.65 21146 04 N M Y Y 1,522.70 21147 04 N M Y Y 1,522.70 21150 04 N M Y Y 1,306.65 21151 04 N M Y Y 1,522.70 21154 04 N M Y Y 1,306.65 21155 04 N M Y Y 1,522.70 21159 04 N M Y Y 1,522.70 21160 04 N M Y Y 1,522.70 21172 04 N M Y Y 1,522.70 21175 04 N M Y Y 1,522.70 21179 04 N M Y Y 1,414.70 21180 04 N M Y Y 1,522.70 21181 04 N M Y Y 958.60 21182 04 N M Y Y 1,522.70 21183 04 N M Y Y 1,522.70 21184 04 N M Y Y 1,630.70 Wednesday, April 01, 2009 Page 41 of 458
- Page 1 and 2: Healthcare and Family Services Prac
- Page 3 and 4: Q State maximum amount now includes
- Page 5 and 6: MODIFIERS RECOGNIZED IN PROCESSING
- Page 7 and 8: HO Masters degree level; added 0601
- Page 9 and 10: Health Care and Family Services Rev
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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 />
21080 <strong>04</strong> Y I<br />
21081 <strong>04</strong> Y I<br />
21082 <strong>04</strong> Y I<br />
21083 <strong>04</strong> Y I<br />
21084 <strong>04</strong> Y I<br />
21085 <strong>04</strong> Y I<br />
21086 <strong>04</strong> Y I<br />
21087 <strong>04</strong> Y I<br />
21088 <strong>04</strong> Y I<br />
21089 <strong>04</strong> Y I<br />
21100 <strong>04</strong> N M 192.85<br />
21110 <strong>04</strong> N M Y 176.70<br />
21116 <strong>04</strong> N I 73.20<br />
21120 <strong>04</strong> N M Y Y 1,198.70<br />
21121 <strong>04</strong> N M Y Y 1,198.70<br />
21122 <strong>04</strong> N M Y Y 1,414.70<br />
21123 <strong>04</strong> N M Y Y 1,522.70<br />
21125 <strong>04</strong> N M Y Y 1,198.70<br />
21127 <strong>04</strong> N M Y Y 1,306.65<br />
21137 <strong>04</strong> N M Y Y 958.60<br />
21138 <strong>04</strong> N M Y Y 1,198.70<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong><br />
Page 40 <strong>of</strong> 458
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