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 63305 04 N M Y Y 1291.70 63306 04 N M Y Y 1291.70 63307 04 N M Y Y 1291.70 63308 04 Y M Y 63600 04 N M Y Y 898.95 63610 04 N M Y Y 599.35 63615 04 N M Y Y 898.95 63620 04 1/1/2009 N M Y 629.27 63621 04 1/1/2009 N M Y 201.37 63650 04 N M Y Y 524.40 63655 04 N M Y Y 733.85 63660 04 N M Y Y 374.55 63685 04 N M Y Y 599.35 63688 04 N M Y Y 374.55 63700 04 N M Y Y 599.35 63702 04 N M Y 599.35 63704 04 N M Y Y 630.10 63706 04 N M Y Y 689.00 63707 04 N M Y Y 1198.70 63709 04 N M Y Y 1198.70 63710 04 N M Y Y 1102.95 Wednesday, April 01, 2009 Page 248 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 63740 04 N M Y Y 839.35 63741 04 N M Y Y 324.05 63744 04 N M Y Y 374.55 63746 04 N M Y Y 194.05 64400 04 N I 74.90 64402 04 N I 74.90 64405 04 N I 74.90 64408 04 N I 52.40 64410 04 N I 49.40 64412 04 N I 46.65 64413 04 N I 52.70 64415 04 N I 52.70 64416 04 N I 74.90 64417 04 N I 48.40 64418 04 N I 47.15 64420 04 N I 43.25 64421 04 N I 56.40 64425 04 N I 52.65 64430 04 N I 51.10 64435 04 N I 50.55 64445 04 N I 53.20 Wednesday, April 01, 2009 Page 249 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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