TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 140 MEDICAL PAYMENT
SECTION 140.459 PAYMENT FOR THERAPY SERVICES


 

Section 140.459  Payment for Therapy Services

 

a)         Therapy services shall be paid at an all-inclusive rate that shall be the lower of the following. The rate shall not exceed the upper limits set in federal regulations at 42 CFR 447.321 (2012) and reimbursement is based upon the applicable modifier billed by the provider.

 

1)         The provider's usual and customary charge for services.

 

2)         The maximum reimbursement rate established by the Department.

 

b)         Maximum Reimbursement Rates.  The maximum reimbursement rate:

 

1)         For outpatient physical rehabilitation services provided by a hospital (paid per visit and limited to one visit per day):

 

A)        That is a children's hospital, as defined in 148.25(d)(3)(A), enrolled with the Department to provide outpatient physical rehabilitation shall be $130.00.

 

B)        Enrolled with the Department to provide outpatient physical rehabilitation shall be $130.00.

 

C)        Not enrolled with the Department to provide outpatient physical rehabilitation shall be $115.00.

 

D)        That is a Critical Access Hospital, as defined in 89 Ill. Adm. Code 148.25(g), the rate shall be based on costs set as of June 30, 2012, pursuant to Public Act 96-1382, and exempt from the 3.5% rate reduction identified in Public Act 97-689.

 

2)         For all other therapy services (paid per quarter hour), rates shall be as published on the Department's website in the Therapy Fee Schedule located at http://www2.illinois/gov/hfs/MedicalProvider/Medicaid

Reimbursement/Pages/TherapyFeeSchedule.aspx.

 

(Source:  Amended at 38 Ill. Reg. 15081, effective July 2, 2014)