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 59409 Q 04 4/1/2009 N B 924.45 59410 Q 04 4/1/2009 N B 924.45 59412 04 N B 72.95 59414 04 N B 67.50 59430 04 N B 50.15 59510 09 Y N 59514 Q 04 4/1/2009 N B Y 1070.45 59515 Q 04 4/1/2009 N B Y 1070.45 59525 04 N M Y 299.30 59610 09 Y N 59612 Q 04 4/1/2009 N B 924.45 59614 Q 04 4/1/2009 N B 924.45 59618 09 Y B 59620 Q 04 4/1/2009 N B Y 1070.45 59622 Q 04 4/1/2009 N B Y 1070.45 59812 04 N M 298.70 59820 04 N M 199.95 59821 04 N M Y 298.70 59830 04 N M Y 223.70 59840 04 N M Y 199.95 59841 04 N B 199.95 Wednesday, April 01, 2009 Page 230 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 59850 04 N M Y 199.95 59851 04 N M Y 199.95 59855 04 N M Y 199.95 59856 04 N M Y 199.95 59857 04 N M Y 199.95 59866 09 Y M 59870 04 N M Y 389.25 59871 04 N I Y 66.95 59897 04 Y M Y 59898 09 Y B 59899 04 Y B Y 60000 04 N I 113.60 17.00 60100 04 N I 50.20 17.00 60200 04 N M Y 360.70 60210 04 N M Y Y 550.90 60212 04 N M Y Y 718.70 60220 04 N M Y Y 703.30 60225 04 N M Y Y 703.30 60240 04 N M Y Y 718.70 60252 04 N M Y Y 1198.70 60254 04 N M Y Y 1198.70 Wednesday, April 01, 2009 Page 231 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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