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 89132 A 04 Y N 89135 B 04 N N 14.60 14.60 29.20 89136 B 04 Y N 89140 B 04 N N 23.60 23.60 47.20 89141 A 04 N N 14.00 14.00 28.00 89160 B 04 N N 0.67 0.67 1.35 89190 B 04 N N 1.67 1.67 3.35 89225 B 04 N N 1.40 1.40 2.80 89235 B 04 N N 2.30 2.30 4.61 89240 A 04 Y N 89250 09 Y N 89310 B 04 N N 3.35 3.35 6.70 89321 09 Y N 89322 04 1/1/2008 N N 11.36 90375 04 Y Y N 90376 04 Y Y N 90378 04 Y Y N 90379 04 Y Y N 90384 04 N Y N 107.70 90385 04 N Y N 37.70 90386 04 Y Y N Wednesday, April 01, 2009 Page 364 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 90393 04 Y Y N 90399 04 Y Y N 90471 09 Y N 90472 09 Y N 90473 09 Y N 90474 09 Y N 90476 F 04 Y N 90477 F 04 Y N 90581 F 04 Y N 90585 F 04 Y N 90586 F 04 Y N 90632 G 04 N N 6.40 56.15 90633 E 04 N N 6.40 90634 E 04 N N 6.40 90636 G 04 N N 6.40 111.18 90645 E 04 N N 6.40 90646 E 04 N N 6.40 90647 E 04 N N 6.40 90648 E 04 N N 6.40 90649 M 04 Y N 6.40 149.33 90655 E 04 N N 6.40 Wednesday, April 01, 2009 Page 365 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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