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 32655 04 N M Y 838.95 32656 04 N M Y 523.85 32657 04 N M Y 523.85 32658 04 N M Y 415.90 32659 04 N M Y 415.55 32660 04 N M Y 648.10 32661 04 N M Y 523.85 32662 04 N M Y 598.40 32663 04 N M Y 1,213.85 32664 04 N M Y 749.20 32665 04 N M Y 1,082.10 32800 04 Y M Y Y 32810 04 N M 398.40 32815 04 N M Y 813.26 32820 04 Y M Y 32850 04 N M Y 1,134.10 32851 04 N M Y Y 2,106.30 32852 04 N M Y Y 2,397.40 32853 04 N M Y Y 3,402.50 32854 04 N M Y Y 3,834.55 32900 04 N M Y 564.90 Wednesday, April 01, 2009 Page 122 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 32905 04 N M Y 749.20 32906 04 N M Y 772.90 32940 04 N M Y Y 571.55 32960 04 N I 299.70 32997 04 N M 246.40 32998 04 1/1/2007 N M 214.24 32999 04 Y M Y 33010 04 N I 61.25 33011 04 N I 57.55 33015 04 N I 204.05 33020 04 N M Y Y 733.85 33025 04 N M Y Y 839.35 33030 04 N M Y Y 839.35 33031 04 N M Y Y 2,397.40 33050 04 N M Y Y 1,048.85 33120 04 N M Y Y 2,397.40 33130 04 N M Y Y 749.20 33140 04 Y M Y 33141 04 Y M Y 33202 04 1/1/2007 N M Y 861.50 33203 04 1/1/2007 N M Y 349.85 Wednesday, April 01, 2009 Page 123 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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