Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois

Assist
Surg
Assistant
Surgeon
“Y” indicates services of an assistant at surgery may be
paid.
CoSurg Co-Surgeon “Y” indicates services of a co-surgeon may be paid.
Unit Price
Price for each unit when multiple quantities are billable or
base amount payable for ages 0-20 years when followed
by “©”.
Max Qty Maximum
Quantity
The maximum quantity payable for the code.
To bill quantities when the maximum quantity is
greater than 1:
Submit number of units performed or dispensed on a
single date of service in the days/units field
To bill quantities when the maximum quantity is 1,
note field is blank, and HP is “N”:
For bilateral procedures, submit the procedure code, use
modifier “RT” and show quantity “1” in days/units field and
in the subsequent service section submit the procedure
code, use modifier “LT”, and show quantity “1” in
days/units field.
For multiples that are not bilateral, claims must be
submitted on paper. Submit the procedure code on one
service section, and in the next service section submit the
unlisted procedure code for any quantity beyond the first,
listing total # and name of additional procedures in the
description field, and attach documentation of all
State Max
Add-ons
State
Maximum
Surgical addon
Child add-on
Adult add-on
procedures performed.
The maximum allowable reimbursement (reflects
combined professional and technical components where
applicable).
or base amount payable for ages 21 years and older
when followed by “(A)”.
Surg: The amount added to the state maximum when the
procedure is performed in the practitioner’s office. This
amount covers such items as casting and surgical
supplies.
Child: The amount added to the state maximum for
services rendered to ages 0-20 years. Preventive
medicine and Evaluation and Management code add-ons
are payable only to Primary Care Providers.
Adult: The amount added to the state maximum for
services rendered to ages 21 years and older. Preventive
medicine and Evaluation and Management code add-ons
are payable only to Primary Care Providers.
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