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 93888 A 04 N I 31.53 31.52 63.05 93890 A 04 N I 84.30 84.30 168.60 93892 A 04 N I 70.87 70.86 141.73 93893 A 04 N I 69.56 69.56 139.12 93922 A 04 N I 25.03 25.02 50.05 93923 A 04 N I 25.47 25.47 50.95 93924 A 04 N I 28.00 28.00 56.00 93925 A 04 N I 39.40 39.40 78.80 93926 A 04 N I 26.35 26.35 52.70 93930 A 04 N I 40.07 40.08 80.15 93931 A 04 N I 26.60 26.60 53.20 93965 A 04 N I 25.03 25.02 50.05 93970 C 04 N I 17.38 70.17 87.55 93971 C 04 N I 10.77 47.48 58.25 93975 A 04 N I 59.60 59.60 119.20 93976 A 04 N I 39.85 39.85 79.70 93978 A 04 N I 41.15 41.15 82.30 93979 A 04 N I 27.40 27.40 54.80 93980 A 04 N I 45.83 45.82 91.65 93981 A 04 N I 33.65 33.65 67.30 93982 04 1/1/2008 N N 22.25 Wednesday, April 01, 2009 Page 388 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 93990 A 04 N I 40.93 40.92 81.85 94002 04 N I 46.34 94003 04 N I 33.61 94004 04 N I 24.47 94010 C 04 N I 7.65 29.75 37.40 94014 04 N I 52.90 94015 04 N I 29.90 94016 04 N I 23.00 94060 C 04 N I 12.50 40.20 52.70 94070 C 04 N I 15.25 37.45 52.70 94150 C 04 N I 1.60 6.00 7.60 94200 C 04 N I 1.55 15.10 16.65 94240 C 04 N I 4.50 26.00 30.50 94250 C 04 N I 3.20 4.40 7.60 94260 C 04 N I 4.45 10.75 15.20 94350 C 04 N I 1.60 51.10 52.70 94360 C 04 N I 1.60 21.20 22.80 94370 C 04 N I 4.45 10.75 15.20 94375 C 04 N I 7.70 36.70 44.40 94400 C 04 N I 4.45 17.70 22.15 94450 C 04 N I 4.45 17.70 22.15 Wednesday, April 01, 2009 Page 389 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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