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 00756 04 Y M 0075T 04 N I 83.00 0076T 04 N I 83.00 00770 04 Y M 0077T 04 N M Y Y 449.50 0078T 04 N M Y Y 1,148.60 00790 04 Y M 00792 04 Y M 00794 04 Y M 00796 04 Y M 00797 04 Y M 0079T 04 Y M Y Y 00800 04 Y M 00802 04 Y M 0080T 04 Y N 00810 04 Y M 0081T 04 Y M 00820 04 Y M 00830 04 Y M 00832 04 Y M 00834 04 Y M Wednesday, April 01, 2009 Page 6 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 00836 04 Y M 00840 04 Y M 00842 04 Y I 00844 04 Y M 00846 04 Y M 00848 04 Y M 0084T 04 N I 118.20 00851 04 Y M 00860 04 Y M 00862 04 Y M 00864 04 Y M 00865 04 Y M 00866 04 Y M 00868 04 Y M 00870 04 Y M 00872 04 Y M 00873 04 Y M 00880 04 Y M 00882 04 Y M 00902 04 Y M 00904 04 Y M Wednesday, April 01, 2009 Page 7 of 458
Page 1 and 2: Healthcare and Family Services Prac
Page 3 and 4: Q State maximum amount now includes
Page 5 and 6: MODIFIERS RECOGNIZED IN PROCESSING
Page 7 and 8: HO Masters degree level; added 0601
Page 9 and 10: Health Care and Family Services Rev
Page 11 and 12: Hcpcs Note ProgCov Eff Date HP NDC
Page 13: 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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