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 S0034 04 N Y N 27.50 2 55.00 S0039 04 N Y N 5.86 12 70.32 S0040 04 N Y N 15.64 10 156.40 S0073 04 N Y N 14.90 16 238.40 S0074 04 N Y N 7.28 12 87.36 S0077 04 N Y N 2.74 6 16.44 S0078 04 N Y N 109.50 2 219.00 S0080 04 N Y N 40.10 1 40.10 S0081 04 N Y N 2.16 12 25.92 S0088 04 N Y N 25.42 6 152.52 S0092 04 N Y N 97.36 1 97.36 S0093 04 N Y N 9.05 1 9.05 S0142 04 Y Y N S0145 04 Y Y N S0146 04 Y Y N S0155 04 Y Y N S0162 04 N N 341.92 S0166 04 N Y N 6.07 4 24.28 S0190 04 N Y N 306.10 S0191 04 N Y N 2.40 S0195 04 N N 72.27 Wednesday, April 01, 2009 Page 456 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 S0630 04 N I 24.35 S1015 04 Y N S1016 04 Y N S2066 04 1/1/2008 Y M S2067 04 1/1/2008 Y M S2068 04 Y M Y S2070 04 N I 198.98 S2075 04 Y M Y S2079 04 Y M Y Y S2080 04 N M Y 388.70 S2083 04 N N 10.00 S2118 04 1/1/2009 Y N S2225 04 N I 43.80 17.00 S2270 04 1/1/2009 Y N S2325 04 Y M Y S3626 04 Y N S3628 04 4/1/2008 S3711 04 1/1/2009 Y N S4981 04 Y I S4989 04 Y N S4990 09 Y N Wednesday, April 01, 2009 Page 457 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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