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 21930 04 N M 149.80 21935 04 Y M Y Y 22010 04 N M Y 453.30 22015 04 N M Y 449.25 22100 04 N M Y 311.40 22101 04 N M Y 315.50 22102 04 N M Y 299.70 22103 04 Y M Y Y 22110 04 N M Y 718.70 22112 04 N M Y 718.70 22114 04 N M Y 718.70 22116 04 Y M Y Y 22206 04 1/1/2008 N M Y Y 1270.13 22207 04 1/1/2008 N M Y Y 1253.30 22208 04 1/1/2008 N M Y Y 325.80 22210 04 N M Y Y 973.90 22212 04 N M Y Y 973.90 22214 04 N M Y Y 973.90 22216 04 Y M Y Y 22220 04 N M Y Y 973.90 22222 04 N M Y Y 973.90 Wednesday, April 01, 2009 Page 48 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 22224 04 N M Y Y 973.90 22226 04 Y M Y Y 22305 04 N M 259.40 22310 04 N I 98.80 22315 04 N M 276.20 22318 04 N M Y Y 1,417.20 22319 04 N M Y Y 1,558.90 22325 04 N M Y 599.35 22326 04 N M Y 627.30 22327 04 N M Y 608.50 22328 04 Y M Y Y 22505 04 N I 149.80 22520 04 N M Y Y 353.85 22521 04 N M Y 331.90 22522 04 N M Y 116.00 22523 04 N M Y 343.13 22524 04 N M Y 328.66 22525 04 N M Y 158.82 22526 04 1/1/2007 N M 509.95 22527 04 1/1/2007 Y M 22532 04 N M Y 876.68 Wednesday, April 01, 2009 Page 49 of 458
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Healthcare and Family Services Prac
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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 55: 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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