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 46750 04 N M Y 419.00 46751 04 N M Y 419.00 46753 04 N I Y 187.90 46754 04 N I 134.60 46760 04 N M Y 524.40 46761 04 N M Y 524.40 46762 04 N M Y 739.90 46900 04 N I 62.70 17.00 46910 04 N I 108.30 17.00 46916 04 N I 108.30 34.00 46917 04 N I 108.30 34.00 46922 04 N I 108.30 17.00 46924 04 N M 181.00 17.00 46930 04 1/1/2009 N M 127.20 46937 04 N I 96.95 34.00 46938 04 N I 148.20 34.00 46940 04 N I 68.50 17.00 46942 04 N I 61.15 17.00 46945 04 N I 72.45 17.00 46946 04 N I 112.40 46947 04 N M 342.65 Wednesday, April 01, 2009 Page 186 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 46999 04 Y M Y 47000 04 N I 106.80 47001 04 N I 65.90 47010 04 N M Y 599.35 47011 04 N M Y Y 599.35 47015 04 N M Y Y 480.00 47100 04 N M Y 480.00 47120 04 N M Y 682.60 47122 04 N M Y Y 1048.85 47125 04 N M Y Y 1048.85 47130 04 N M Y Y 1048.85 47133 04 N M Y Y 1048.85 47135 04 N M Y Y 3299.30 47136 04 N M Y Y 3299.30 47140 04 N M Y Y 1660.18 47141 04 N M Y Y 2001.23 47142 04 N M Y Y 2201.17 47300 04 N M Y 718.70 47350 04 N M Y 659.00 47360 04 N M Y 697.90 47361 04 N M Y 810.10 Wednesday, April 01, 2009 Page 187 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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