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 15783 09 Y M 15786 09 Y I 15787 09 Y M 15819 04 N M Y 274.36 15820 04 N M 651.10 15821 04 N M 651.10 15822 04 N M 651.10 15823 04 N M 651.10 15830 04 1/1/2007 Y M Y 15832 04 N M 340.15 15833 04 N M 306.75 15834 04 N M 308.30 15835 04 N M 319.10 15836 04 N M 265.30 15837 04 N M 255.00 15838 04 N M Y 219.35 15839 04 N M Y 237.80 15840 04 N M Y 891.10 15841 04 N M Y 663.96 15842 04 N M Y 1,063.03 15845 04 N M Y 355.83 Wednesday, April 01, 2009 Page 28 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 15847 04 1/1/2007 Y M Y 15850 04 N I 31.40 15851 04 N I 48.60 15852 04 N I Y 31.95 15860 04 N I Y 55.50 15876 04 Y M 15877 04 Y M 15878 04 Y M 15879 04 Y M 15920 04 N M Y 374.55 15922 04 N M Y 449.50 15931 04 N M Y Y 449.50 15933 04 N M Y 674.20 15934 04 N M Y Y 749.20 15935 04 N M Y Y 749.20 15936 04 N M Y 749.20 15937 04 N M Y Y 749.20 15940 04 N M Y 449.50 15941 04 N M Y 524.40 15944 04 N M Y 524.40 15945 04 N M Y 600.00 Wednesday, April 01, 2009 Page 29 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 35: 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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