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 93231 04 N I 135.90 93232 04 N I 44.40 93233 04 N I 44.40 93235 04 N I 180.30 93236 04 N I 44.40 93237 04 N I 44.40 93268 04 N I 73.70 93270 04 N I 21.60 93271 04 N I 39.50 93272 04 N I 21.60 93278 04 N I 27.00 93279 C 04 1/1/2009 N N 20.88 10.77 31.65 93280 C 04 1/1/2009 N N 24.99 12.22 37.21 93281 C 04 1/1/2009 N N 29.15 14.38 43.53 93282 C 04 1/1/2009 N N 27.37 13.05 40.42 93283 C 04 1/1/2009 N N 34.44 14.76 49.20 93284 C 04 1/1/2009 N N 40.86 16.67 57.53 93285 C 04 1/1/2009 N N 17.11 10.19 27.30 93286 C 04 1/1/2009 N N 8.92 6.62 15.54 93287 C 04 1/1/2009 N N 12.86 7.72 20.58 93288 C 04 1/1/2009 N N 13.95 10.38 24.33 Wednesday, April 01, 2009 Page 382 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 93289 C 04 1/1/2009 N N 25.21 12.22 37.43 93290 C 04 1/1/2009 N N 12.50 6.00 18.50 93291 C 04 1/1/2009 N N 14.21 9.17 23.38 93292 C 04 1/1/2009 N N 13.95 7.33 21.28 93293 C 04 1/1/2009 N N 9.93 23.46 33.39 93294 04 1/1/2009 N N 21.33 93295 04 1/1/2009 N N 38.37 93296 04 1/1/2009 N N 19.30 93297 04 1/1/2009 N N 15.02 93298 04 1/1/2009 N N 17.11 93299 04 1/1/2009 Y N 93303 B 04 N I 49.05 49.05 98.10 93304 B 04 N I 26.50 26.50 53.00 93306 C 04 1/1/2009 N N 27.30 63.70 91.00 93307 B 04 N I 45.50 45.50 91.00 93308 B 04 N I 26.35 26.35 52.70 93312 B 04 N I 81.85 81.85 163.70 93313 B 04 N I 55.50 55.50 111.00 93314 B 04 N I 47.15 47.15 94.30 93315 B 04 N I 81.85 81.85 163.70 93316 B 04 N I 55.50 55.50 111.00 Wednesday, April 01, 2009 Page 383 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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