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 11420 04 N I 38.30 17.00 11421 04 N I 50.85 17.00 11422 04 N I 64.80 17.00 11423 04 N I 77.90 17.00 11424 04 N I 92.40 17.00 11426 04 N I 127.48 17.00 11440 04 N I 54.15 17.00 11441 04 N I 75.30 17.00 11442 04 N I 96.40 17.00 11443 04 N I 111.00 17.00 11444 04 N I 117.55 17.00 11446 04 N I 146.37 17.00 11450 04 N M Y 215.40 34.00 11451 04 N M Y 244.10 34.00 11462 04 N M Y 215.40 34.00 11463 04 N M Y 232.20 11470 04 N M Y 291.30 11471 04 N M Y 297.00 11600 04 N I 54.15 17.00 11601 04 N I 75.30 17.00 11602 04 N I 96.40 17.00 Wednesday, April 01, 2009 Page 18 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 11603 04 N I 117.55 17.00 11604 04 N I 138.75 17.00 11606 04 N M 185.52 17.00 11620 04 N I 54.15 17.00 11621 04 N I 75.30 17.00 11622 04 N I 96.40 17.00 11623 04 N I 117.55 17.00 11624 04 N I 138.75 17.00 11626 04 N M 185.52 17.00 11640 04 N I 107.00 17.00 11641 04 N I 149.25 17.00 11642 04 N M 192.95 17.00 11643 04 N M 235.20 17.00 11644 04 N M 278.80 17.00 11646 04 N M 294.77 17.00 11719 04 N I 15.90 11720 04 N I 15.90 11721 04 N I 18.10 11730 04 N I 34.30 17.00 11732 04 N I 14.45 11740 04 N I 36.00 Wednesday, April 01, 2009 Page 19 of 458
Page 1 and 2: Healthcare and Family Services Prac
Page 3 and 4: Q State maximum amount now includes
Page 5 and 6: MODIFIERS RECOGNIZED IN PROCESSING
Page 7 and 8: HO Masters degree level; added 0601
Page 9 and 10: Health Care and Family Services Rev
Page 11 and 12: Hcpcs Note ProgCov Eff Date HP NDC
Page 25: 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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