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 24900 04 N M Y 313.50 24920 04 N M Y 595.20 24925 04 N M Y 262.20 24930 04 N M Y 595.20 24931 04 N M Y 674.20 24935 04 N M Y 599.35 24940 04 N M Y 621.10 24999 04 Y M Y 25000 04 N M Y 351.00 25001 04 N M Y 207.95 25020 04 N M Y 388.50 25023 04 N M Y 394.80 25024 04 N M Y 458.20 25025 04 N M Y 588.15 25028 04 N I 179.25 17.00 25031 04 N M 232.55 17.00 25035 04 N M 287.60 25040 04 N M Y 480.00 25065 04 N I 113.60 17.00 25066 04 N I 149.25 17.00 25075 04 N M Y 149.80 Wednesday, April 01, 2009 Page 62 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 25076 04 N M Y 262.20 25077 04 Y M Y Y 25085 04 N M Y 262.20 25100 04 N M Y 419.00 25101 04 N M Y 480.00 25105 04 N M Y 480.00 25107 04 N M Y 480.00 25109 04 1/1/2007 N M Y 240.00 25110 04 N M 217.80 25111 04 N M 214.00 34.00 25112 04 N M 214.00 34.00 25115 04 N M Y 599.35 25116 04 N M Y 599.35 25118 04 N M Y 480.00 25119 04 N M Y 659.00 25120 04 N M Y 599.35 25125 04 N M Y 674.20 25126 04 N M Y 674.20 25130 04 N M Y 299.70 25135 04 N M Y 449.50 25136 04 N M Y 449.50 Wednesday, April 01, 2009 Page 63 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 />
24900 <strong>04</strong> N M Y 313.50<br />
24920 <strong>04</strong> N M Y 595.20<br />
24925 <strong>04</strong> N M Y 262.20<br />
24930 <strong>04</strong> N M Y 595.20<br />
24931 <strong>04</strong> N M Y 674.20<br />
24935 <strong>04</strong> N M Y 599.35<br />
24940 <strong>04</strong> N M Y 621.10<br />
24999 <strong>04</strong> Y M Y<br />
25000 <strong>04</strong> N M Y 351.00<br />
250<strong>01</strong> <strong>04</strong> N M Y 207.95<br />
25020 <strong>04</strong> N M Y 388.50<br />
25023 <strong>04</strong> N M Y 394.80<br />
25024 <strong>04</strong> N M Y 458.20<br />
25025 <strong>04</strong> N M Y 588.15<br />
25028 <strong>04</strong> N I 179.25 17.00<br />
25031 <strong>04</strong> N M 232.55 17.00<br />
25035 <strong>04</strong> N M 287.60<br />
25<strong>04</strong>0 <strong>04</strong> N M Y 480.00<br />
25065 <strong>04</strong> N I 113.60 17.00<br />
25066 <strong>04</strong> N I 149.25 17.00<br />
25075 <strong>04</strong> N M Y 149.80<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 62 <strong>of</strong> 458
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