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 47712 04 N M Y Y 1198.70 47715 04 N M Y Y 862.30 47720 04 N M Y Y 685.40 47721 04 N M Y Y 1044.70 47740 04 N M Y Y 685.40 47741 04 N M Y Y 1044.70 47760 04 N M Y Y 685.40 47765 04 N M Y Y 1438.70 47780 04 N M Y Y 770.00 47785 04 N M Y Y 1438.70 47800 04 N M Y Y 770.00 47801 04 N M Y 621.95 47802 04 N M Y 948.90 47900 04 N M Y Y 621.95 47999 04 Y M 48000 04 N M Y 718.70 48001 04 N M Y Y 801.90 48020 04 N M Y 839.35 48100 04 N M Y 480.00 48102 04 N I Y 154.90 48105 04 1/1/2007 N M Y 810.10 Wednesday, April 01, 2009 Page 190 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 48120 04 N M Y 599.35 48140 04 N M Y Y 839.35 48145 04 N M Y Y 1438.70 48146 04 N M Y 1438.70 48148 04 N M Y 859.00 48150 04 N M Y Y 1438.70 48152 04 N M Y Y 1438.70 48153 04 N M Y Y 1438.70 48154 04 N M Y Y 1438.70 48155 04 N M Y Y 1438.70 48160 04 N M Y Y 2397.40 48400 04 N I 47.30 48500 04 N M Y 839.35 48510 04 N M Y 839.35 48511 04 N M Y Y 839.35 48520 04 N M Y Y 839.35 48540 04 N M Y Y 839.35 48545 04 N M Y Y 599.35 48547 04 N M Y Y 718.70 48548 04 1/1/2007 N M Y 958.60 48550 04 N M Y Y 599.35 Wednesday, April 01, 2009 Page 191 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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