89 Ill. Adm. Code 146.130
Reimbursement for Services
Section 146
Section 146.130
Reimbursement for Services
Effective for dates of service
on or after July 1, 2014:
a) With respect to all non-EAPG procedures, reimbursement levels
shall be at the lower of the ASTC's usual and customary charge to the public or
the Department's Statewide maximum reimbursement screen.
b) With respect to EAPG procedures described in 89 Ill. Adm. Code
148.140(b)(1), reimbursement for those services shall be in accordance with 89
Ill. Adm. Code 148.140(d)(7).
c) Laboratory, x-ray, prescription, physician or dental services,
provided in connection with a covered surgical procedure, must be billed by the
providers rendering those services. If the ASTC provides the laboratory or
x-ray service, then:
1) Separate billing is NOT allowed if provided on the day of
surgery; or
2) Separate billing IS allowed if provided on other than the day
of surgery.
d) The providers described in subsection (c) must meet all
applicable license, enrollment and reimbursement conditions of the Department
of Healthcare and Family Services, the Department of Public Health and the
Department of Financial and Professional Regulation-Division of Professional
Regulation.