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 50250 04 N M Y 373.74 50280 04 N M Y 718.70 50290 04 N M Y 718.70 50300 04 Y M Y 50320 04 N M Y Y 933.80 50323 09 Y M 50328 09 Y M 50340 04 N M Y 933.80 50360 04 N M Y Y 1366.60 50365 04 N M Y Y 1833.45 50370 04 N M Y Y 933.80 50380 04 Y M Y Y 50382 04 N I 163.58 50384 04 N I 148.92 50385 04 1/1/2008 N M Y 137.81 572.99 50386 04 1/1/2008 N M Y 104.23 356.14 50387 04 N I 59.20 50389 04 N I 32.75 50390 04 N I 119.25 50391 04 N I 117.95 50392 04 N I 119.25 Wednesday, April 01, 2009 Page 198 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 50393 04 N I Y Y 119.25 50394 04 N I 117.35 50395 04 N I 119.25 50396 04 N I 50.20 34.00 50398 04 N I 36.70 34.00 50400 04 N M Y Y 958.60 50405 04 N M Y Y 958.60 50500 04 N M Y 718.70 50520 04 N M Y 480.00 50525 04 N M Y 674.20 50526 04 N M Y 674.20 50540 04 N M Y Y 1198.70 50541 04 N M Y 718.70 50542 04 N M Y Y 718.70 50543 04 N M Y Y 749.20 50544 04 N M Y 958.60 50545 04 N M Y Y 906.40 50546 04 N M 933.80 50547 04 N M Y Y 933.80 50548 04 N M Y 933.80 50549 04 Y M Y Wednesday, April 01, 2009 Page 199 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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