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 J1205 04 N Y N 10.99 1 10.99 J1212 04 N N 50.97 1 50.97 J1230 04 N N 3.62 6 21.72 J1240 04 N N 0.27 8 2.16 J1245 04 N Y N 5.09 6 30.54 J1250 04 N Y N 3.99 1 3.99 J1260 04 N Y N 4.85 20 97.00 J1265 04 N Y N 0.06 7 0.42 J1267 04 1/1/2009 N Y N 0.95 50 47.50 J1270 04 N Y N 6.00 4 24.00 J1300 04 1/1/2008 N Y 207.34 90 18660.60 J1320 04 N N 2.62 15 39.30 J1324 04 1/1/2007 N Y N 31.46 90 2831.40 J1325 04 N Y N 22.18 3 66.54 J1327 04 N Y N 24.32 5 121.60 J1330 04 Y N J1335 04 N Y N 23.76 2 47.52 J1364 04 N Y N 12.25 8 98.00 J1380 04 N Y N 0.55 4 2.20 J1390 04 N Y N 1.12 2 2.24 J1405 04 N Y N 10.00 Wednesday, April 01, 2009 Page 428 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 J1410 04 N Y N 68.03 4 272.12 J1430 04 N Y N 41.74 1 41.74 J1435 04 N Y N 0.19 5 0.95 J1436 04 Y Y N J1438 04 N Y N 186.86 4 747.44 J1440 04 N Y N 197.17 2 394.34 J1441 04 N Y N 363.48 1 363.48 J1450 04 N Y N 103.11 2 206.22 J1451 04 N Y N 13.79 1 13.79 J1452 04 Y Y N J1453 04 1/1/2009 N Y N 1.89 115 217.35 J1455 04 N Y N 88.16 2 176.32 J1457 04 Y Y N J1458 04 1/1/2007 Y Y N J1459 04 1/1/2009 N Y N 45.87 112 5137.44 J1460 04 N Y N 14.21 156 2216.76 J1470 04 Y Y N J1480 04 Y Y N J1490 04 Y Y N J1500 04 Y Y N J1510 04 Y Y N Wednesday, April 01, 2009 Page 429 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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