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 28825 04 N I Y 145.60 28890 04 N M 121.80 28899 04 Y M Y 29000 04 N I 156.80 29010 04 N I 141.50 29015 04 N I 188.70 29020 04 N I 205.30 29025 04 N I 227.50 29035 04 N I 152.60 29040 04 N I 181.65 29044 04 N I 173.40 29046 04 N I 187.30 29049 04 N I 66.10 34.00 29055 04 N I 115.80 34.00 29058 04 N I 79.30 34.00 29065 04 N I 59.45 34.00 29075 04 N I 59.45 34.00 29085 04 N I 49.30 17.00 29086 04 N I 30.70 29105 04 N I 42.10 17.00 29125 04 N I 32.15 17.00 Wednesday, April 01, 2009 Page 104 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 29126 04 N I 39.30 17.00 29130 04 N I 23.00 17.00 29131 04 N I 23.50 17.00 29200 04 N I 24.25 29220 04 N I 23.00 29240 04 N I 37.40 29260 04 N I 19.95 29280 04 N I 19.30 29305 04 N I 166.40 29325 04 N I 194.20 29345 04 N I 79.30 34.00 29355 04 N I 92.40 34.00 29358 04 N I 174.40 34.00 29365 04 N I 79.30 34.00 29405 04 N I 70.00 34.00 29425 04 N I 75.30 34.00 29435 04 N I 79.30 34.00 29440 04 N I 29.80 29445 04 N I 91.65 29450 04 N I 43.50 17.00 29505 04 N I 43.50 17.00 Wednesday, April 01, 2009 Page 105 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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