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 43045 04 N M Y Y 839.35 43100 04 N M Y Y 749.20 43101 04 N M Y Y 749.20 43107 04 N M Y Y 1467.80 43108 04 N M Y Y 1782.30 43112 04 N M Y Y 1467.80 43113 04 N M Y Y 1782.30 43116 04 N M Y Y 2106.30 43117 04 N M Y Y 1467.80 43118 04 N M Y Y 1782.30 43121 04 N M Y Y 1467.80 43122 04 N M Y Y 1467.80 43123 04 N M Y Y 1782.30 43124 04 Y M Y Y 43130 04 N M Y Y 718.70 43135 04 N M Y Y 718.70 43200 04 N I 186.20 56.70 43201 04 N I 113.55 43202 04 N I 199.50 56.70 43204 04 N M Y Y 256.60 43205 04 N M 256.60 Wednesday, April 01, 2009 Page 166 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 43215 04 N I 244.50 56.70 43216 04 N I 244.50 43217 04 N I 244.50 56.70 43219 04 N I 244.50 56.70 43220 04 N I 142.70 56.70 43226 04 N M 224.60 56.70 43227 04 N I 235.20 56.70 43228 04 N M 235.20 56.70 43231 04 N I Y 158.20 43232 04 N I Y 183.70 43234 04 N I 159.35 56.70 43235 04 N I 239.15 56.70 43236 04 N I 239.15 43237 04 N I 117.67 43238 04 N I 145.34 43239 04 N I 249.70 56.70 43240 04 N I Y 201.55 43241 04 N I 249.70 56.70 43242 04 N I Y 201.55 43243 04 N M 256.60 43244 04 N M 256.60 Wednesday, April 01, 2009 Page 167 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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