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 32160 04 N M Y 374.55 32200 04 N M Y 480.00 32201 04 N M 434.45 32215 04 N M Y 599.35 32220 04 N M Y 749.20 32225 04 N M Y 599.35 32310 04 N M Y 958.60 32320 04 N M Y 1,198.70 32400 04 N I 71.40 34.00 32402 04 N M Y 524.40 32405 04 N I 107.00 34.00 32420 04 N I 107.00 34.00 32421 04 1/1/2008 N I 87.98 32422 04 1/1/2008 N I 108.51 32440 04 N M Y Y 1,198.70 32442 04 N M Y Y 1,414.70 32445 04 N M Y Y 1,198.70 32480 04 N M Y Y 1,213.95 32482 04 N M Y Y 1,213.95 32484 04 N M Y Y 1,213.95 32486 04 N M Y Y 1,350.15 Wednesday, April 01, 2009 Page 120 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 32488 04 N M Y Y 1,213.95 32491 04 N M Y Y 1,213.95 32500 04 N M Y 718.70 32501 04 N M Y Y 324.05 32503 04 N M Y 1,050.34 32504 04 N M Y 1,203.13 32540 04 N M Y Y 958.60 32550 04 1/1/2008 N M 127.01 318.46 32551 04 1/1/2008 N M 224.70 32560 04 1/1/2008 N I 198.20 32601 04 N I Y 167.20 32602 04 N I Y 181.35 32603 04 N I Y 302.40 32604 04 N I Y 302.40 32605 04 N I Y 314.95 32606 04 N I Y 314.95 32650 04 N M Y 349.85 32651 04 N M Y 426.10 32652 04 N M Y 591.40 32653 04 N M Y 418.50 32654 04 N M Y 400.80 Wednesday, April 01, 2009 Page 121 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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