Section 146.130  Reimbursement for Services

a)         With respect to all non-APL 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 APL procedures described in 89 Ill. Adm. Code 148.140(b)(1), reimbursement for such services shall be an all-inclusive rate for facility services, and shall be calculated at 75 percent of the applicable group rate paid for that same procedure in a hospital outpatient setting, as described under 89 Ill. Adm. Code 148.140(b).

c)         Laboratory, x-ray, prescription,  physicians' or dentists' services, in connection with a covered surgical procedure, must be billed by the providers rendering such services. If the ASTC provides the lab 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) of this Section 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.

(Source:  Amended at 31 Ill. Reg. 5589, effective April 1, 2007)