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 92585 04 N I 53.75 92586 04 N I 47.80 92587 04 N I 52.70 92588 04 N I 61.00 92590 04 N I 37.40 92591 04 N I 37.40 92592 04 N I 15.20 92593 04 N I 15.20 92594 04 N I 15.20 92595 04 N I 15.20 92596 04 N I 15.20 92597 04 N I 43.18 92601 04 N I 55.01 92602 04 N I 38.72 92603 04 N I 37.18 92604 04 N I 25.49 92605 04 N I 24.90 92606 04 N I 24.90 92607 04 N I 45.85 92608 04 N N 9.25 92609 04 N I 24.90 Wednesday, April 01, 2009 Page 378 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 92610 04 N I 18.00 92611 04 N I 19.55 92612 04 N I 30.25 92613 04 N I 30.25 92614 04 N I 30.25 92615 04 N I 30.25 92616 04 N I 44.00 92617 04 N I 44.00 92620 04 N I 24.46 92621 04 N I 6.63 92625 04 N I 24.06 92626 09 Y N 92627 09 Y N 92630 09 Y N 92633 09 Y N 92640 04 N N 26.67 92700 04 Y I 92950 04 N I Y Y 112.50 92953 04 Y I Y Y 92960 04 N I 112.40 92961 04 N I 112.40 Wednesday, April 01, 2009 Page 379 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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