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 21188 04 N M Y Y 1,306.65 21193 04 N M Y Y 1,198.70 21194 04 N M Y Y 1,414.70 21195 04 N M Y Y 1,198.70 21196 04 N M Y Y 1,198.70 21198 04 N M Y Y 958.60 21199 04 N M Y Y 700.70 21206 04 N M Y 1,198.70 21208 04 N M Y Y 1,198.70 21209 04 N M Y Y 1,198.70 21210 04 N M Y Y 636.80 21215 04 N M Y Y 1,048.85 21230 04 N M Y Y 957.25 21235 04 N M Y Y 449.50 21240 04 N M Y Y 599.35 21242 04 N M Y Y 599.35 21243 04 N M Y Y 1,198.70 21244 04 N M Y Y 1,198.70 21245 04 N M Y Y 1,198.70 21246 04 N M Y Y 1,198.70 21247 04 N M Y Y 1,306.65 Wednesday, April 01, 2009 Page 42 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 21248 04 N M Y Y 1,198.70 21249 04 N M Y Y 1,198.70 21255 04 N M Y Y 1,306.65 21256 04 N M Y Y 1,306.65 21260 04 N M Y Y 1,306.65 21261 04 N M Y Y 1,522.70 21263 04 N M Y Y 1,522.70 21267 04 N M Y Y 1,306.65 21268 04 N M Y Y 1,522.70 21270 04 N M Y Y 1,048.85 21275 04 N M Y Y 1,048.85 21280 04 N M Y Y 359.30 21282 04 N M Y Y 359.30 21295 04 N M Y Y 449.50 21296 04 N M Y Y 449.50 21299 04 Y M Y Y 21310 04 N I 138.75 21315 04 N M 176.20 21320 04 N M 280.25 21325 04 N M Y 337.10 21330 04 N M Y 424.45 Wednesday, April 01, 2009 Page 43 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 />
21188 <strong>04</strong> N M Y Y 1,306.65<br />
21193 <strong>04</strong> N M Y Y 1,198.70<br />
21194 <strong>04</strong> N M Y Y 1,414.70<br />
21195 <strong>04</strong> N M Y Y 1,198.70<br />
21196 <strong>04</strong> N M Y Y 1,198.70<br />
21198 <strong>04</strong> N M Y Y 958.60<br />
21199 <strong>04</strong> N M Y Y 700.70<br />
21206 <strong>04</strong> N M Y 1,198.70<br />
21208 <strong>04</strong> N M Y Y 1,198.70<br />
212<strong>09</strong> <strong>04</strong> N M Y Y 1,198.70<br />
21210 <strong>04</strong> N M Y Y 636.80<br />
21215 <strong>04</strong> N M Y Y 1,<strong>04</strong>8.85<br />
21230 <strong>04</strong> N M Y Y 957.25<br />
21235 <strong>04</strong> N M Y Y 449.50<br />
21240 <strong>04</strong> N M Y Y 599.35<br />
21242 <strong>04</strong> N M Y Y 599.35<br />
21243 <strong>04</strong> N M Y Y 1,198.70<br />
21244 <strong>04</strong> N M Y Y 1,198.70<br />
21245 <strong>04</strong> N M Y Y 1,198.70<br />
21246 <strong>04</strong> N M Y Y 1,198.70<br />
21247 <strong>04</strong> N M Y Y 1,306.65<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 42 <strong>of</strong> 458
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