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 27495 04 Y M Y Y 27496 04 N M Y 374.55 27497 04 N M Y 374.55 27498 04 N M Y 383.45 27499 04 N M Y 383.45 27500 04 N M 257.40 27501 04 N M 263.20 27502 04 N M Y 338.50 27503 04 N M Y 338.50 27506 04 N M Y Y 910.10 27507 04 N M Y 910.10 27508 04 N M 209.00 27509 04 N M Y 524.40 27510 04 N M 524.40 27511 04 N M Y 836.55 27513 04 N M Y 826.30 27514 04 N M Y 836.55 27516 04 N M 599.35 27517 04 N M 599.35 27519 04 N M Y 836.55 27520 04 N M 191.50 Wednesday, April 01, 2009 Page 88 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 27524 04 N M Y 629.90 27530 04 N M 288.50 27532 04 N M 321.90 27535 04 N M Y 839.35 27536 04 N M Y 839.35 27538 04 N M 213.65 27540 04 N M Y 958.60 27550 04 N M 194.25 27552 04 N M 227.40 27556 04 N M Y 656.20 27557 04 N M Y 749.20 27558 04 N M Y 749.20 27560 04 N I 149.80 27562 04 N M 187.80 27566 04 N M Y 383.25 27570 04 N I 66.70 27580 04 N M Y 1384.60 27590 04 N M Y 649.25 27591 04 N M Y 749.20 27592 04 N M Y 574.35 27594 04 N M Y 224.70 Wednesday, April 01, 2009 Page 89 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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