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 63173 04 N M Y Y 1393.75 63180 04 N M Y Y 1198.70 63182 04 N M Y Y 1198.70 63185 04 N M Y Y 839.35 63190 04 N M Y Y 1079.30 63191 04 Y M Y Y 63194 04 N M Y Y 958.60 63195 04 N M Y Y 958.60 63196 04 N M Y Y 958.60 63197 04 N M Y Y 958.60 63198 04 N M Y Y 1291.70 63199 04 Y M Y Y 63200 04 N M Y Y 1198.70 63250 04 N M Y Y 1198.70 63251 04 N M Y Y 1198.70 63252 04 N M Y Y 1224.30 63265 04 N M Y Y 1198.70 63266 04 N M Y Y 1198.70 63267 04 N M Y Y 1198.70 63268 04 N M Y Y 1198.70 63270 04 N M Y Y 1198.70 Wednesday, April 01, 2009 Page 246 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 63271 04 N M Y Y 1198.70 63272 04 N M Y Y 1198.70 63273 04 N M Y Y 1198.70 63275 04 N M Y Y 1198.70 63276 04 N M Y Y 1198.70 63277 04 N M Y Y 1198.70 63278 04 N M Y Y 1198.70 63280 04 N M Y Y 1198.70 63281 04 N M Y Y 1198.70 63282 04 N M Y Y 1198.70 63283 04 N M Y Y 1198.70 63285 04 N M Y Y 1198.70 63286 04 N M Y Y 1198.70 63287 04 N M Y Y 1198.70 63290 04 N M Y Y 1198.70 63295 04 N M Y Y 190.18 63300 04 N M Y Y 1606.30 63301 04 N M Y Y 1615.70 63302 04 N M Y Y 1291.70 63303 04 N M Y Y 1291.70 63304 04 N M Y Y 1291.70 Wednesday, April 01, 2009 Page 247 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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