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 22864 04 1/1/2009 N M Y 1051.39 22865 04 1/1/2007 N M Y 1166.35 22899 04 Y M Y Y 22900 04 N M Y 224.70 22999 04 Y M Y 23000 04 N M Y 359.30 23020 04 N M Y 299.70 23030 04 N I 125.50 17.00 23031 04 N I 99.10 17.00 23035 04 N M Y 317.40 23040 04 N M Y 599.35 23044 04 N M Y 599.35 23065 04 N I 113.60 17.00 23066 04 N I 149.25 17.00 23075 04 N M 224.70 23076 04 N M Y 449.50 23077 04 Y M Y Y 23100 04 N M Y 374.55 23101 04 N M Y 599.35 23105 04 N M Y 599.35 23106 04 N M Y 599.35 Wednesday, April 01, 2009 Page 52 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 23107 04 N M Y Y 473.50 23120 04 N M Y 362.00 23125 04 N M Y 718.70 23130 04 N M Y 362.00 23140 04 N M Y 264.90 23145 04 N M Y 480.00 23146 04 N M Y 480.00 23150 04 N M Y 275.80 23155 04 N M Y 480.00 23156 04 N M Y 480.00 23170 04 N M Y 240.00 23172 04 N M Y 240.00 23174 04 N M Y 480.00 23180 04 N M Y 299.70 23182 04 N M Y 480.00 23184 04 N M Y 480.00 23190 04 N M Y 480.00 23195 04 N M Y 599.35 23200 04 N M Y 718.70 23210 04 N M Y 718.70 23220 04 N M Y 718.70 Wednesday, April 01, 2009 Page 53 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
Page 9 and 10: Health Care and Family Services Rev
Page 11 and 12: Hcpcs Note ProgCov Eff Date HP NDC
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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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