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 47362 04 N M Y 523.85 47370 04 N M Y Y 761.10 47371 04 N M Y Y 761.10 47379 04 Y M Y Y 47380 04 N M Y Y 892.80 47381 04 N M Y 892.80 47382 04 N M 474.20 47399 04 Y M Y 47400 04 N M Y 718.70 47420 04 N M Y 647.90 47425 04 N M Y 682.60 47460 04 N M Y 463.80 47480 04 N M Y 647.90 47490 04 N M 599.35 47500 04 N I 50.75 47505 04 N I 127.50 47510 04 N M 230.75 47511 04 N M 284.60 47525 04 N I Y 129.90 47530 04 N M 199.80 47550 04 N M 94.30 Wednesday, April 01, 2009 Page 188 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 47552 04 N I 135.70 47553 04 N I 155.75 47554 04 N I 220.30 47555 04 N I 169.10 47556 04 N I 187.90 47560 04 N M Y 299.70 47561 04 N M Y 317.60 47562 04 N M Y 647.90 47563 04 N M Y 699.20 47564 04 N M Y 801.90 47570 04 N M Y 685.40 47579 04 Y M Y 47600 04 N M Y 647.90 47605 04 N M Y 699.20 47610 04 N M Y 801.90 47612 04 N M Y 801.90 47620 04 N M Y 801.90 47630 04 N M Y 299.70 47700 04 N M Y 449.50 47701 04 N M Y Y 685.40 47711 04 N M Y Y 801.90 Wednesday, April 01, 2009 Page 189 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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