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 61313 04 N M Y Y 861.50 61314 04 N M Y Y 861.50 61315 04 N M Y Y 1198.70 61316 04 Y M Y Y 61320 04 N M Y Y 1123.70 61321 04 N M Y Y 1123.70 61322 04 N M Y Y 1123.70 61323 04 N M Y Y 1123.70 61330 04 N M Y Y 973.90 61332 04 N M Y Y 973.90 61333 04 N M Y Y 1198.70 61334 04 N M Y Y 1198.70 61340 04 N M Y Y 839.35 61343 04 N M Y Y 1738.80 61345 04 N M Y Y 1198.70 61440 04 N M Y Y 839.35 61450 04 N M Y Y 839.35 61458 04 N M Y Y 893.25 61460 04 N M Y Y 891.30 61470 04 N M Y Y 958.60 61480 04 N M Y Y 958.60 Wednesday, April 01, 2009 Page 234 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 61490 04 N M Y Y 1198.70 61500 04 N M Y Y 1198.70 61501 04 N M Y Y 1198.70 61510 04 N M Y Y 1198.70 61512 04 N M Y Y 1198.70 61514 04 N M Y Y 1198.70 61516 04 N M Y Y 1198.70 61517 04 N I Y 49.85 61518 04 N M Y Y 1198.70 61519 04 N M Y Y 1271.10 61520 04 N M Y Y 1604.85 61521 04 N M Y Y 1351.20 61522 04 N M Y Y 1198.70 61524 04 N M Y Y 1198.70 61526 04 N M Y Y 1499.10 61530 04 N M Y Y 1327.00 61531 04 N M Y 1138.70 61533 04 N M Y Y 1138.70 61534 04 N M Y Y 1198.70 61535 04 Y M Y Y 61536 04 N M Y Y 1198.70 Wednesday, April 01, 2009 Page 235 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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