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 90656 G 04 N N 6.40 11.19 90657 E 04 N N 6.40 90658 G 04 N N 6.40 11.19 90660 G 04 N N 6.40 22.37 90665 09 Y Y N 90669 E 04 N N 6.40 90675 F 04 Y N 90676 F 04 Y N 90680 E 04 N N 6.40 90681 E 04 8/1/2008 N N 6.40 90690 09 Y N 90691 09 Y N 90692 09 Y N 90693 09 Y N 90696 E 04 8/1/2008 N N 6.40 90698 E 04 8/1/2008 N N 6.40 90700 E 04 N N 6.40 90701 E 04 N N 6.40 90702 F 04 N N 2.70 90703 F 04 N N 1.85 1.85 90704 F 04 Y N Wednesday, April 01, 2009 Page 366 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 90705 F 04 Y N 90706 F 04 Y N 90707 G 04 N N 6.40 39.70 90708 F 04 Y N 90710 E 04 N N 6.40 90712 F 04 N N 14.00 90713 E 04 N N 6.40 90714 G 04 N N 6.40 18.92 90715 G 04 N N 6.40 38.28 90716 G 04 N N 6.40 46.60 90717 09 Y N 90718 G 04 N N 6.40 2.70 90719 F 04 N N 3.40 90721 F 04 N N 35.25 90723 E 04 N N 6.40 90725 09 Y N 90727 09 Y N 90732 G 04 N N 6.40 14.60 90733 F 04 N N 85.00 90734 G 04 N N 6.40 116.78 90735 F 04 N N 243.80 243.80 Wednesday, April 01, 2009 Page 367 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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