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 66986 04 N M 546.00 66990 09 Y N 66999 04 Y M Y 67005 04 N M Y 749.20 67010 04 N M Y 749.20 67015 04 N M Y 861.50 67025 04 N M Y 818.45 67027 04 N M Y 524.35 67028 04 N M Y 287.10 67030 04 N M Y 818.45 67031 04 N M 818.45 67036 04 N M Y 1086.30 67039 04 N M Y 1086.30 67040 04 N M Y Y 1086.30 67041 04 1/1/2008 N M Y Y 613.65 67042 04 1/1/2008 N M Y Y 703.00 67043 04 1/1/2008 N M Y Y 737.55 67101 04 N M 434.30 67105 04 N M 457.20 67107 04 N M Y 980.85 67108 04 N M Y 1086.30 Wednesday, April 01, 2009 Page 262 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 67110 04 N M Y 434.30 67112 04 Y M 67113 04 1/1/2008 N M Y Y 809.66 67115 04 N M Y 735.60 67120 04 N M 958.60 67121 04 Y M Y 67141 04 N M 443.95 67145 04 N M Y 443.95 67208 04 N M Y 443.95 67210 04 N M Y 443.95 67218 04 N M 486.10 67220 04 N M Y 443.95 67221 04 N M Y 225.30 67225 04 N I 42.55 67227 04 N M Y 443.95 67228 04 N M 466.15 67229 04 1/1/2008 N M 532.19 67250 04 N M 749.20 67255 04 N M 898.95 67299 04 Y M Y 67311 04 N M Y 511.90 Wednesday, April 01, 2009 Page 263 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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