Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois

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Hcpcs Note ProgCov Eff Date HP NDC Ind SurgInd M1 (26) M2 (TC) Assist Surg Co-Surg Unitprice MaxQty StateMax Surg Child Adult 28003 04 N M Y 246.85 28005 04 N M Y 270.50 28008 04 N I 147.95 28010 04 N I Y 123.35 28011 04 Y M Y 28020 04 N M Y 224.70 28022 04 N M Y 153.65 28024 04 N I Y 146.15 28035 04 N M Y 524.40 28043 04 N M Y 149.80 28045 04 N M Y 224.70 28046 04 Y M Y Y 28050 04 N M Y 299.70 28052 04 N M Y 299.70 28054 04 N M Y 224.70 28055 04 1/1/2007 N M Y 302.40 28060 04 N M Y 224.70 28062 04 Y M Y 28070 04 N M Y 224.70 28072 04 N M Y 161.90 28080 04 N M Y 180.30 Wednesday, April 01, 2009 Page 96 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 28086 04 N M Y 184.50 28088 04 N M Y 184.50 28090 04 N M Y 175.75 34.00 28092 04 N M Y 211.35 34.00 28100 04 N M Y 224.70 28102 04 N M Y 718.70 28103 04 N M Y 718.70 28104 04 N M Y 259.40 28106 04 N M Y 449.50 28107 04 N M Y 449.50 28108 04 N M Y 259.40 28110 04 N M Y 359.30 28111 04 N M Y 359.30 28112 04 N M Y 314.95 28113 04 N M Y 314.95 28114 04 N M Y 943.40 28116 04 N M Y 346.75 28118 04 N M Y 346.75 28119 04 N M Y 264.90 28120 04 N M Y 259.40 28122 04 N M Y 253.90 Wednesday, April 01, 2009 Page 97 of 458
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Healthcare and Family Services Prac
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Q State maximum amount now includes
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MODIFIERS RECOGNIZED IN PROCESSING
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HO Masters degree level; added 0601
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Health Care and Family Services Rev
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Hcpcs Note ProgCov Eff Date HP NDC
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Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois

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