Practitioner Fee Schedule Key - Illinois Department Of Healthcare And Family Services
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5Illinois Department of Healthcare and Family Services
Practitioner Fee Schedule Key
Revised 2/3/2017
The Practitioner Fee Schedule applies to charges submitted by the following providers:
•
Advanced Practice Nurses
•
Dentists Providing Medical Services
•
Encounter Rate Clinics
•
Fee-For-Service Hospitals
•
Imaging Centers
•
Independent Diagnostic Testing Facilities (IDTFs)
•
Independent Laboratories
•
Local Health Departments
•
Optometrists Providing Medical Services
•
Physicians
•
Portable X-ray Companies
Instructions For Billing Multiples
For providers listed above with the exception of Portable X-ray companies and
Note is A
Independent Laboratories:
Quantity up to and including 5:
•
Claim may be submitted electronically
•
Enter the number of tests performed on a single date of service in the days/units
field
Quantity greater than 5:
•
Claim must be submitted on the paper HFS 2360 with all test results attached
•
Enter in the days/units field the number of tests performed on a single date of
service
For Portable X-ray companies and Independent Laboratories:
Quantity up to and including 5:
•
Claim may be submitted electronically
•
Enter in the days/units field the number of tests performed on a single date of
service
Quantity exceeding 5:
•
Claim must be submitted on the paper HFS 2211 with all test results attached
•
Enter the specific procedure code on one service section for the first test
•
Enter the unlisted procedure code for any quantity beyond one in the next service
section and include the total number and name of additional tests in the description
field for the unlisted code
*The number listed in the days/units field must be “1” and procedures are:
Note is B or
Bilateral:
C, any of
•
Enter the procedure code with modifier RT and quantity “1” in days/units field
the above
•
Enter the procedure code with modifier LT and quantity “1” in days/units field on the
providers
subsequent service section
Not Bilateral:
•
Enter the specific procedure code on one service section
•
Enter the unlisted procedure code for quantities greater than one in the next service
section
•
List the total number and name of additional tests in the description field
•
Attach documentation for all tests
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