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 24130 04 N M Y 492.55 24134 04 N M Y 351.00 24136 04 N M Y 262.80 24138 04 N M Y 254.80 24140 04 N M Y 480.00 24145 04 N M Y 480.00 24147 04 N M Y 480.00 24149 04 Y M Y 24150 04 N M Y 1198.70 24151 04 N M Y 1198.70 24152 04 N M Y 958.60 24153 04 N M Y 1048.85 24155 04 N M Y 749.20 24160 04 N M Y 299.70 24164 04 N M 492.55 24200 04 N M 169.30 24201 04 N M Y 245.55 24220 04 N I 105.15 24300 04 N I 66.70 24301 04 N M Y 453.70 24305 04 N M Y 359.30 Wednesday, April 01, 2009 Page 58 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 24310 04 N M Y 188.70 24320 04 N M Y 599.35 24330 04 N M Y 599.35 24331 04 N M Y 599.35 24332 04 N M Y 326.30 24340 04 N M Y 299.70 24341 04 N M Y 274.20 24342 04 N M Y 535.45 24343 04 N M Y 430.15 24344 04 N M Y 651.95 24345 04 N M Y 430.15 24346 04 N M Y 651.95 24357 04 1/1/2008 N M Y 233.94 24358 04 1/1/2008 N M Y 275.71 24359 04 1/1/2008 N M Y 341.04 24360 04 N M Y 718.70 24361 04 N M Y 1123.70 24362 04 N M Y 1123.70 24363 04 N M Y 1123.70 24365 04 N M Y 1123.70 24366 04 N M Y 1123.70 Wednesday, April 01, 2009 Page 59 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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