Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois
Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois
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
- 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
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Hcpcs Note ProgCov Eff Date HP NDC Ind SurgInd M1 (26) M2 (TC) Assist Surg Co-Surg Unitprice MaxQty <strong>State</strong>Max Surg Child Adult<br />
22224 <strong>04</strong> N M Y Y 973.90<br />
22226 <strong>04</strong> Y M Y Y<br />
22305 <strong>04</strong> N M 259.40<br />
22310 <strong>04</strong> N I 98.80<br />
22315 <strong>04</strong> N M 276.20<br />
22318 <strong>04</strong> N M Y Y 1,417.20<br />
22319 <strong>04</strong> N M Y Y 1,558.90<br />
22325 <strong>04</strong> N M Y 599.35<br />
22326 <strong>04</strong> N M Y 627.30<br />
22327 <strong>04</strong> N M Y 608.50<br />
22328 <strong>04</strong> Y M Y Y<br />
22505 <strong>04</strong> N I 149.80<br />
22520 <strong>04</strong> N M Y Y 353.85<br />
22521 <strong>04</strong> N M Y 331.90<br />
22522 <strong>04</strong> N M Y 116.00<br />
22523 <strong>04</strong> N M Y 343.13<br />
22524 <strong>04</strong> N M Y 328.66<br />
22525 <strong>04</strong> N M Y 158.82<br />
22526 <strong>04</strong> 1/1/2007 N M 5<strong>09</strong>.95<br />
22527 <strong>04</strong> 1/1/2007 Y M<br />
22532 <strong>04</strong> N M Y 876.68<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 49 <strong>of</strong> 458
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