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 01215 04 Y I 01220 04 Y M 01230 04 Y M 01232 04 Y M 01234 04 Y M 0123T 04 Y M 0124T 04 Y M 01250 04 Y M 01260 04 Y M 01270 04 Y M 01272 04 Y M 01274 04 Y M 01320 04 Y M 01340 04 Y M 01360 04 Y M 01380 04 Y M 01382 04 Y M 01390 04 Y M 01392 04 Y M 01400 04 Y M 01402 04 Y M Wednesday, April 01, 2009 Page 10 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 01404 04 Y M 01420 04 Y I 01430 04 Y M 01432 04 Y M 0143T 04 Y N 01440 04 Y M 01442 04 Y M 01444 04 Y M 01462 04 Y M 01464 04 Y M 01470 04 Y M 01472 04 Y M 01474 04 Y M 0147T C 04 N N 21.37 88.48 109.85 01480 04 Y M 01482 04 Y M 01484 04 Y M 01486 04 Y M 01490 04 Y I 01500 04 Y M 01502 04 Y M Wednesday, April 01, 2009 Page 11 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 17: 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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