50 Ill. Adm. Code 2017.40
Requirements for Use of HCFA Form 1500
Section 2017
Section 2017.40 Requirements
for Use of HCFA Form 1500
a) Health plans shall accept an appropriately completed HCFA Form
1500 from health care practitioners. Health care practitioners, other than
dentists, shall use the HCFA Form 1500 when filing claims with health plans for
professional services.
b) Health plans shall not require health care practitioners to
use any coding system for the filing of claims for health care services other
than the following:
1) current HCPCS Codes or current CPT Codes;
2) current ICD-CM Codes; and
3) For anesthesia services, current HCPCS Level 1 Codes.
c) Health plans shall not require health care practitioners to
use any other descriptor with a code or to furnish additional information with
the submission of an HCFA Form 1500 except under the following circumstances:
1) When the procedure code used describes a treatment or service
that is not otherwise classified; or
2) When the procedure code is followed by the CPT modifier 22, 52
or 99. Health care practitioners may use Box 19 of the HCFA Form 1500 to
explain multiple modifiers.
d) Health care practitioners may use Box 19 of the HCFA Form 1500
to indicate the form is an amended version of a form previously submitted to
the health plan by inserting the word "amended" in the space
provided.
e) Health care practitioners billing for services based on the
amount of time involved shall define in Box 19 the time interval in Box 24 G of
the HCFA Form 1500. If not defined, units will be assumed to be days of
treatment.