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 26352 04 N M Y 480.00 26356 04 N M Y 359.30 26357 04 N M Y Y 359.30 26358 04 N M Y 599.35 26370 04 N M Y 307.20 26372 04 N M Y 480.00 26373 04 N M Y 480.00 26390 04 N M Y 480.00 26392 04 N M Y 480.00 26410 04 N M Y 222.00 26412 04 N M Y 299.70 26415 04 N M Y Y 306.95 26416 04 N M Y Y 414.90 26418 04 N M Y 201.65 26420 04 N M Y 299.70 26426 04 N M Y 480.00 26428 04 N M Y 599.35 26432 04 N M Y 359.30 26433 04 N M Y 222.00 26434 04 N M Y 359.30 26437 04 N M Y 225.10 Wednesday, April 01, 2009 Page 72 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 26440 04 N M Y 417.60 26442 04 N M Y 627.05 26445 04 N M Y 240.00 26449 04 N M Y 359.30 26450 04 N M Y 240.00 26455 04 N M Y 240.00 26460 04 N M Y 240.00 26471 04 N M Y 299.70 26474 04 N M Y 359.30 26476 04 N M Y 359.30 26477 04 N M Y 359.30 26478 04 N M Y Y 359.30 26479 04 N M Y Y 359.30 26480 04 N M Y 480.00 26483 04 N M Y 480.00 26485 04 N M Y 480.00 26489 04 N M Y 561.85 26490 04 N M Y 356.60 26492 04 N M Y 449.50 26494 04 N M Y 356.60 26496 04 Y M Y Wednesday, April 01, 2009 Page 73 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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