Practitioner Fee Schedule Key - Illinois Department Of Healthcare And Family Services Page 2
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5Providers billing multiples on the HFS 2360:
Note is H
•
Claim may be submitted electronically
•
Enter the specific procedure code and the number of tests performed on a single date
of service, up to the max quantity, in the days/units field
Provider Type 061 Independent laboratory billing multiples on the HFS 2211:
•
Claim may be submitted electronically
•
Enter the specific procedure code on one service section for the first test
•
Enter the unlisted procedure code for any quantities greater than one in the next
service section
•
Include the total number of additional tests, up to the max quantity, and name of
additional tests in the description/note field
Maximum
Quantity is
Submit the number of units performed or dispensed on a single date of service, up to the listed
greater
max quantity, in the days/units field.
than 1
PLEASE NOTE: The number listed in the days/units field must be “1”
Practitioner purchased and administered drugs:
•
Claim may be submitted electronically or on paper
•
HP=Y
Enter the name of the drug, strength of the drug, and the amount given in the
description or note field/NTE segment according to NDC billing guidelines available in
Chapter A-200 Practitioner Handbook
Appendix A-8
Medical/surgical procedures:
•
Claim must be submitted on the paper HFS 2360 with the specific procedure code and
quantity of one in the days/units field of one service section with documentation
attached
•
When billing quantities greater than one, enter the unlisted procedure code in the next
service section and the number of times performed in the description/note field
Provider Type 061 Independent laboratory billing multiples on the HFS 2211:
•
Claims must be submitted on paper
•
Enter the specific procedure code on one service section for the first test
•
Enter the unlisted procedure code for quantities greater than one on the second service
section and include the total number and name of the additional tests in the
description/note field
•
Attach documentation for all tests
HP = N;
Bilateral:
•
Max qty is
Enter the procedure code with modifier RT and quantity ‘1’ in days/units field in one
“1” or
service section
•
blank, and
Enter the same procedure code with modifier LT and quantity ‘1’ in the days/units field
note fields
in the next service section
are blank,
Not Bilateral:
and
•
Enter the specific procedure code on one service section
procedures
•
Enter the unlisted procedure code for quantities greater than one in the next service
section and list the total number and name of additional tests in the description field
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