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 22533 04 N M Y 816.43 22534 04 N M Y 208.02 22548 04 N M Y 1,642.15 22554 04 N M Y Y 1,642.65 22556 04 N M Y Y 1,642.65 22558 04 N M Y Y 1,642.65 22585 04 Y M Y Y 22590 04 N M Y Y 1,198.70 22595 04 N M Y Y 1,198.70 22600 04 N M Y Y 1,198.70 22610 04 N M Y Y 1,198.70 22612 04 N M Y Y 1,198.70 22614 04 Y M Y Y 22630 04 N M Y Y 1,198.70 22632 04 Y M Y Y 22800 04 N M Y Y 1,086.30 22802 04 N M Y Y 1,086.30 22804 04 N M Y Y 1,782.30 22808 04 N M Y Y 1,086.30 22810 04 N M Y Y 1,086.30 22812 04 N M Y Y 1,086.30 Wednesday, April 01, 2009 Page 50 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 22818 04 N M Y Y 1,610.65 22819 04 N M Y Y 1,610.65 22830 04 N M Y Y 443.39 22840 04 N M Y Y 1,872.90 22841 04 N M Y Y 1,872.90 22842 04 N M Y Y 1,872.90 22843 04 N M Y Y 1,872.90 22844 04 N M Y Y 1,872.90 22845 04 N M Y Y 1,872.90 22846 04 N M Y Y 1,872.90 22847 04 N M Y Y 1,872.90 22848 04 N M Y Y 351.00 22849 04 N M Y Y 1,134.10 22850 04 N M Y 449.50 22851 04 N M Y Y 750.70 22852 04 N M Y Y 449.50 22855 04 N M Y 449.50 22856 04 1/1/2009 N M Y Y 925.00 22857 04 1/1/2007 N M Y 938.71 22861 04 1/1/2009 N M Y Y 1121.33 22862 04 1/1/2007 N M Y 1104.45 Wednesday, April 01, 2009 Page 51 of 458
- 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 />
22818 <strong>04</strong> N M Y Y 1,610.65<br />
22819 <strong>04</strong> N M Y Y 1,610.65<br />
22830 <strong>04</strong> N M Y Y 443.39<br />
22840 <strong>04</strong> N M Y Y 1,872.90<br />
22841 <strong>04</strong> N M Y Y 1,872.90<br />
22842 <strong>04</strong> N M Y Y 1,872.90<br />
22843 <strong>04</strong> N M Y Y 1,872.90<br />
22844 <strong>04</strong> N M Y Y 1,872.90<br />
22845 <strong>04</strong> N M Y Y 1,872.90<br />
22846 <strong>04</strong> N M Y Y 1,872.90<br />
22847 <strong>04</strong> N M Y Y 1,872.90<br />
22848 <strong>04</strong> N M Y Y 351.00<br />
22849 <strong>04</strong> N M Y Y 1,134.10<br />
22850 <strong>04</strong> N M Y 449.50<br />
22851 <strong>04</strong> N M Y Y 750.70<br />
22852 <strong>04</strong> N M Y Y 449.50<br />
22855 <strong>04</strong> N M Y 449.50<br />
22856 <strong>04</strong> 1/1/20<strong>09</strong> N M Y Y 925.00<br />
22857 <strong>04</strong> 1/1/2007 N M Y 938.71<br />
22861 <strong>04</strong> 1/1/20<strong>09</strong> N M Y Y 1121.33<br />
22862 <strong>04</strong> 1/1/2007 N M Y 11<strong>04</strong>.45<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 51 <strong>of</strong> 458
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