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 15330 04 N M Y 141.50 15331 04 N M Y 32.90 15335 04 N M Y 158.29 15336 04 N M Y 47.01 15340 04 N M Y 143.60 15341 04 N M Y 16.19 15360 04 N M Y 153.62 15361 04 N M Y 37.29 15365 04 N M Y 162.56 15366 04 N M Y 46.85 15400 04 N M Y 165.30 15401 04 Y M Y Y 15420 04 N M Y 183.07 15421 04 N M Y 49.73 15430 04 N M Y 267.39 15431 04 Y M Y 15570 04 N M Y 298.24 15572 04 N M Y 292.34 15574 04 N M Y 466.61 15576 04 N M Y 296.30 15600 04 N M Y 259.81 Wednesday, April 01, 2009 Page 26 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 15610 04 N M Y 97.47 15620 04 N M Y 158.26 15630 04 N M Y 310.61 15650 04 N M Y 168.27 15731 04 1/1/2007 N M Y 168.27 15732 04 N M Y Y 536.60 15734 04 N M Y Y 569.25 15736 04 N M Y 512.70 15738 04 N M Y 520.25 15740 04 N M Y 321.69 15750 04 N M Y 339.54 15756 04 N M Y Y 1,306.65 15757 04 N M Y Y 1,306.65 15758 04 N M Y Y 1,306.65 15760 04 N M Y 300.05 15770 04 N M Y 307.90 15775 09 Y M 15776 09 Y M 15780 09 Y M 15781 09 Y M 15782 09 Y M Wednesday, April 01, 2009 Page 27 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 33: 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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