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 50551 04 N I 151.00 56.70 50553 04 N I 245.35 56.70 50555 04 N I 250.35 56.70 50557 04 N I 294.80 56.70 50561 04 N I 301.85 56.70 50562 04 N M 301.95 50570 04 N I 204.70 50572 04 N I 268.20 50574 04 N I 281.05 50575 04 N I 365.15 50576 04 N I 294.80 50580 04 N I 269.70 50590 04 N M Y Y 749.20 50592 04 N I 214.22 50593 04 1/1/2008 N M Y 267.81 2228.0 50600 04 N M Y 718.70 50605 04 N M Y 738.10 50610 04 N M Y 738.10 50620 04 N M Y 738.10 50630 04 N M Y 738.10 50650 04 N M Y 599.35 Wednesday, April 01, 2009 Page 200 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 50660 04 N M Y Y 599.35 50684 04 N I 120.00 17.00 50686 04 N I 64.10 34.00 50688 04 N I 37.40 34.00 50690 04 N I 129.70 17.00 50700 04 N M Y 958.60 50715 04 N M Y 749.20 50722 04 N M Y 749.20 50725 04 N M Y 958.60 50727 04 N M Y Y 455.80 50728 04 N M Y Y 567.10 50740 04 N M Y 958.60 50750 04 N M Y 958.60 50760 04 N M Y 958.60 50770 04 N M Y 958.60 50780 04 N M Y 958.60 50782 04 N M Y Y 945.15 50783 04 N M Y Y 945.15 50785 04 N M Y 958.60 50800 04 N M Y 718.70 50810 04 N M Y 718.70 Wednesday, April 01, 2009 Page 201 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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