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 20931 09 Y M 20936 09 Y M 20937 09 Y M 20938 09 Y M 20950 04 N I 44.80 20955 04 Y M Y Y 20956 04 Y M Y Y 20957 04 Y M Y Y 20962 04 Y M Y Y 20969 04 Y M Y Y 20970 04 Y M Y Y 20972 04 Y M Y Y 20973 04 Y M Y Y 20974 09 Y M 20975 04 N I Y 82.90 20979 04 N I 176.70 20982 04 N M Y 220.57 20985 04 1/1/2008 N M Y 83.23 20999 04 Y M Y 21010 04 N M Y 374.55 21015 04 N M Y 224.36 Wednesday, April 01, 2009 Page 38 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 21025 04 N M Y Y 299.70 21026 04 N M Y Y 299.70 21029 04 Y M Y 21030 04 N M Y 299.70 21031 04 N M Y 299.70 21032 04 N M Y 299.70 21034 04 N M Y 421.10 21040 04 N M Y 299.70 21044 04 N M Y 350.55 21045 04 N M Y Y 1,678.65 21046 04 N M Y Y 397.20 21047 04 Y M Y Y 21048 04 Y M Y Y 21049 04 Y M Y Y 21050 04 N M Y 524.40 21060 04 N M Y 524.40 21070 04 N M Y 299.70 21073 04 1/1/2008 N M Y 188.93 21076 04 Y I 21077 04 Y I 21079 04 Y I Wednesday, April 01, 2009 Page 39 of 458
Page 1 and 2: Healthcare and Family Services Prac
Page 3 and 4: Q State maximum amount now includes
Page 5 and 6: MODIFIERS RECOGNIZED IN PROCESSING
Page 7 and 8: HO Masters degree level; added 0601
Page 9 and 10: Health Care and Family Services Rev
Page 11 and 12: Hcpcs Note ProgCov Eff Date HP NDC
Page 45: 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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