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 90736 F 04 N N 190.02 90738 F 04 7/1/2008 Y 90740 F 04 Y N 90743 F 04 Y N 90744 E 04 N N 6.40 90746 G 04 N N 6.40 74.38 90747 F 04 Y N 90748 E 04 N N 6.40 90749 F 04 Y N 90801 02 2/1/2009 N N 67.50 52.11 90802 02 2/1/2009 N N 27.55 92.06 90804 02 N N 27.55 90805 02 N N 30.90 90806 02 N N 47.50 90807 02 N N 47.50 90808 02 N N 64.80 90809 02 N N 67.50 90810 02 N N 31.70 90811 02 N N 34.85 90812 02 N N 47.50 90813 02 N N 47.50 Wednesday, April 01, 2009 Page 368 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 90814 02 N N 63.45 90815 02 N N 66.30 90816 02 N N 31.65 90817 02 N N 31.65 90818 02 N N 47.50 90819 02 N N 47.50 90821 02 N N 65.90 90822 02 N N 68.30 90823 02 N N 33.30 90824 02 N N 35.95 90826 02 N N 47.50 90827 02 N N 48.65 90828 02 N N 65.05 90829 02 N N 66.90 90845 D 04 N N 90846 09 Y N 90847 02 N N 61.20 90849 02 N N 61.20 90853 02 N N 33.70 90857 09 Y N 90862 04 N N 22.45 Wednesday, April 01, 2009 Page 369 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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