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Elizabeth M. Whitehorn, Director

Provider Notice issued 12/30/05

To: Participating Physicians, Advanced Practice Nurses and Local Health Departments

Date: December 30, 2005

Re: Reimbursement for Birth Control Pills

The purpose of this notice is to announce that effective with dates of service on or after January 1, 2006, the department will begin system pricing birth control pills rather than hand pricing. This change will eliminate the suspension of provider claims, therefore expediting the processing of claims . Providers must bill procedure code S4993 (Contraceptive Pills for Birth Control) for birth control pills dispensed. The exact quantity of pills dispensed is to be reported in the days/units field. Providers are allowed to bill a maximum quantity of a three-month supply per visit. The reimbursement rate for birth control pills will be $1.35 per pill.

The system pricing does not apply to the morning after pills, Plan B and Preven Kit. For Plan B and Preven Kit, providers must bill J8499 ( Prescription drug, oral, nonchemotherapeutic, NOS ), the product name and the number of pills dispensed in the description field, days/ units quantity of 1 and charges.

 

In addition to S4993 or J8499, providers must report the NDC as outlined in an Informational Notice titled "Requirement of National Drug Codes (NDC)" dated June 16, 2005.

 

Providers wishing to receive e-mail notification, when new provider information is posted by the department, may register at the following HFS Web site:

 

                                   http://www.hfs.illinois.gov/provrel

 

Electronic claim submission via the Internet is available by registering on the department’s Medical Electronic Data Interchange, Internet Electronic Claims (MEDI/IEC) System:

 

                                    <http://www.myhfs.illinois.gov/>.

 

The MEDI/IEC System is available to enrolled providers and their authorized staff, claim submitting agents and payees. During the registration process, you will be given access to specific claim formats based upon your enrollment status with the department.

 

If you have questions regarding this notice, please contact the Bureau of Comprehensive Health Services at 1-877-782-5565.

 

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs