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 25609 04 1/1/2007 N M 443.95 25622 04 N I 147.10 25624 04 N I 181.10 25628 04 N M Y 335.70 25630 04 N M 201.10 25635 04 N I 174.60 25645 04 N M Y 335.70 25650 04 N I Y Y 126.90 25651 04 N M Y 271.25 25652 04 N M Y 374.00 25660 04 N I 139.00 25670 04 N M Y 266.70 25671 04 N M Y 205.30 25675 04 N I 168.25 25676 04 N M Y 270.40 25680 04 N M 240.00 25685 04 N M Y 449.50 25690 04 N I 188.65 25695 04 N M Y 276.50 25800 04 N M Y 718.70 25805 04 N M Y 786.60 Wednesday, April 01, 2009 Page 68 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 25810 04 N M Y 839.35 25820 04 N M Y 664.25 25825 04 N M Y 718.70 25830 04 N M Y 786.60 25900 04 N M Y 359.30 25905 04 N M Y 359.30 25907 04 N M Y 290.30 25909 04 N M Y 359.30 25915 04 N M Y 1198.70 25920 04 N M Y 359.30 25922 04 N M Y 244.50 25924 04 N M Y 359.30 25927 04 N M Y 302.60 25929 04 N M Y 236.30 25931 04 N M Y 285.80 25999 04 Y M 26010 04 N I 76.25 26011 04 N I 97.40 26020 04 N M 191.80 26025 04 N M 201.60 26030 04 N M 237.15 Wednesday, April 01, 2009 Page 69 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 />
25810 <strong>04</strong> N M Y 839.35<br />
25820 <strong>04</strong> N M Y 664.25<br />
25825 <strong>04</strong> N M Y 718.70<br />
25830 <strong>04</strong> N M Y 786.60<br />
25900 <strong>04</strong> N M Y 359.30<br />
25905 <strong>04</strong> N M Y 359.30<br />
25907 <strong>04</strong> N M Y 290.30<br />
259<strong>09</strong> <strong>04</strong> N M Y 359.30<br />
25915 <strong>04</strong> N M Y 1198.70<br />
25920 <strong>04</strong> N M Y 359.30<br />
25922 <strong>04</strong> N M Y 244.50<br />
25924 <strong>04</strong> N M Y 359.30<br />
25927 <strong>04</strong> N M Y 302.60<br />
25929 <strong>04</strong> N M Y 236.30<br />
25931 <strong>04</strong> N M Y 285.80<br />
25999 <strong>04</strong> Y M<br />
26<strong>01</strong>0 <strong>04</strong> N I 76.25<br />
26<strong>01</strong>1 <strong>04</strong> N I 97.40<br />
26020 <strong>04</strong> N M 191.80<br />
26025 <strong>04</strong> N M 2<strong>01</strong>.60<br />
26030 <strong>04</strong> N M 237.15<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 69 <strong>of</strong> 458
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