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 99471 04 2/1/2009 N 510.67 99472 04 2/1/2009 N 249.51 99475 04 1/1/2009 N 84.90 99476 04 1/1/2009 N 42.35 99477 04 2/1/2009 N N 220.73 99478 04 2/1/2009 N 88.85 99479 04 1/1/2009 N 81.22 99480 04 2/1/2009 N 79.04 99499 04 Y N 99500 04 Y N 99501 04 Y N 99502 04 Y N 99503 04 Y N 99504 04 Y N 99505 04 Y N 99506 04 Y N 99507 04 Y N 99509 04 Y N 99510 04 N N 24.25 99511 04 Y N 99512 04 Y N Wednesday, April 01, 2009 Page 410 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 99600 04 Y N 99999 04 Y N Y Y A4206 04 N N 0.13 5 0.65 A4207 04 N N 0.05 5 0.25 A4208 04 N N 0.27 5 1.35 A4209 04 N N 0.26 5 1.30 A4212 04 N N 2.53 1 2.53 A4213 04 N N 0.32 5 1.60 A4215 04 N N 0.05 5 0.25 A4261 04 N N 61.17 A4267 04 N N 0.45 30 13.62 A4268 04 N N 1.12 30 33.82 A4269 04 Y Y N A9502 09 Y N A9503 09 Y N A9507 09 Y N A9526 09 Y N A9527 04 1/1/2007 Y N A9528 09 Y N A9529 09 Y N A9530 09 Y N Wednesday, April 01, 2009 Page 411 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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