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 78456 B 04 N N 70.85 70.85 141.70 78457 04 N N 60.10 78458 04 N N 84.90 78459 B 04 N N 65.40 65.40 130.80 78460 B 04 N N 24.85 24.85 49.70 78461 B 04 N N 32.67 32.67 65.35 78464 B 04 N N 65.40 65.40 130.80 78465 B 04 N N 65.40 65.40 130.80 78466 B 04 N N 24.85 24.85 49.70 78468 B 04 N N 24.85 24.85 49.70 78469 B 04 N N 65.40 65.40 130.80 78472 B 04 N N 32.67 32.67 65.35 78473 B 04 N N 37.20 37.20 74.40 78478 B 04 N N 23.60 23.60 47.20 78480 B 04 N N 23.60 23.60 47.20 78481 B 04 N N 24.85 24.85 49.70 78483 B 04 N N 31.07 31.07 62.15 78491 B 04 N I 65.40 65.40 130.80 78492 B 04 N I 65.40 65.40 130.80 78494 B 04 N N 31.07 31.07 62.15 78496 B 04 N N 31.07 31.07 62.15 Wednesday, April 01, 2009 Page 304 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 78499 04 Y N 78580 B 04 N N 32.67 32.67 65.35 78584 B 04 N N 35.30 35.30 70.60 78585 B 04 N N 35.30 35.30 70.60 78586 B 04 N N 32.67 32.67 65.35 78587 B 04 N N 32.67 32.67 65.35 78588 B 04 N N 32.67 32.67 65.35 78591 B 04 N N 32.67 32.67 65.35 78593 B 04 N N 32.67 32.67 65.35 78594 B 04 N N 35.95 35.95 71.90 78596 B 04 N N 35.95 35.95 71.90 78599 A 04 Y N 78600 B 04 N N 49.05 49.05 98.10 78601 B 04 N N 65.40 65.40 130.80 78605 B 04 N N 49.05 49.05 98.10 78606 B 04 N N 65.40 65.40 130.80 78607 B 04 N N 65.40 65.40 130.80 78608 B 04 N N 65.40 65.40 130.80 78609 B 04 N N 65.40 65.40 130.80 78610 B 04 N N 65.40 65.40 130.80 78630 B 04 N N 49.05 49.05 98.10 Wednesday, April 01, 2009 Page 305 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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