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 38770 04 N M Y 918.40 38780 04 N M Y 998.80 38790 04 N I 220.85 38792 04 N I 105.40 38794 04 Y M 38999 04 Y M Y 39000 04 N M Y Y 718.70 39010 04 N M Y Y 718.70 39200 04 N M Y 749.20 39220 04 N M Y 749.20 39400 04 N I 314.95 39499 04 Y M Y 39501 04 N M Y Y 648.60 39502 04 N M Y Y 826.50 39503 04 N M Y Y 960.55 39520 04 N M Y Y 682.60 39530 04 N M Y Y 682.60 39531 04 N M Y Y 735.45 39540 04 N M Y Y 682.60 39541 04 N M Y Y 682.60 39545 04 N M Y Y 682.60 Wednesday, April 01, 2009 Page 156 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 39560 04 N M Y Y 708.60 39561 04 N M Y 803.05 39599 04 Y M Y 40490 04 N I 46.25 17.00 40500 04 N M 165.10 40510 04 N I 170.45 40520 04 N M Y Y 524.40 40525 04 N M Y Y 629.90 40527 04 N M Y Y 718.70 40530 04 N M Y Y 524.35 40650 04 N M Y Y 629.90 40652 04 N M Y Y 629.90 40654 04 N M Y Y 629.90 40700 04 N M Y Y 718.70 40701 04 N M Y Y 958.60 40702 04 N M Y 958.60 40720 04 N M Y Y 718.70 40761 04 N M Y Y 802.00 40799 04 Y M Y 40800 04 N I 39.90 17.00 40801 04 N I 76.15 Wednesday, April 01, 2009 Page 157 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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