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 67312 04 N M Y 511.90 67314 04 N M Y 511.90 67316 04 N M Y 511.90 67318 04 N M Y 550.90 67320 04 N M Y 647.20 67331 04 N M Y 374.55 67332 04 N M Y 511.90 67334 04 N M Y 511.90 67335 09 Y N 67340 04 N M Y 405.10 67343 04 N M Y 399.60 67345 04 N M Y 100.00 67346 04 1/1/2007 N I 107.00 67399 04 Y M Y 67400 04 N M Y 681.10 67405 04 N M Y 524.40 67412 04 N M Y 839.35 67413 04 N M Y 839.35 67414 04 N M Y 797.40 67415 04 N I 56.80 17.00 67420 04 N M Y 1079.30 Wednesday, April 01, 2009 Page 264 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 67430 04 N M 1079.30 67440 04 N M 681.10 67445 04 N M Y 1025.40 67450 04 N M Y 681.10 67500 04 N I 78.20 67505 04 N M 74.90 67515 04 N I 74.90 67550 04 N M 415.85 67560 04 N M 340.90 67570 04 N M Y 797.40 67599 04 Y M Y 67700 04 N I 73.50 67710 04 N M 224.70 67715 04 N I 59.60 67800 04 N I 77.20 17.00 67801 04 N I 91.85 17.00 67805 04 N M 99.05 17.00 67808 04 N I 112.80 67810 04 N I 68.10 17.00 67820 04 N I 30.50 67825 04 N I 88.50 Wednesday, April 01, 2009 Page 265 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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