Provider Notice issued 06/22/07

Radiation Therapy and Chemotherapy On the Same Service Date

The purpose of this notice is to inform providers of a billing policy change related to outpatient chemotherapy and outpatient radiation therapy services performed on the same date.

The department’s current policy requires that a hospital providing an outpatient service from the Ambulatory Procedures Listing (APL), to bill all outpatient services provided on that day on a single outpatient institutional claim.  For example, if a patient received radiation and chemotherapy on the same day, both services must be billed on one institutional claim and the hospital would receive an all-inclusive rate based on the APL radiation procedure. 

The department recently changed this billing policy for chemotherapy services provided in conjunction with radiation therapy services.  The change has been codified in the department’s administrative rule at 89 Ill. Admin. Code Section 148.140(b)(2)(F).  The rules can be found on the department’s Web site at: 

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

Effective with service dates on and after April 1, 2007, hospitals will continue to bill outpatient radiation therapy on the institutional claim format and be reimbursed at the APL rate.  Outpatient chemotherapy services, provided in conjunction with radiation therapy, should be billed under the hospital’s fee-for-service provider number on the professional claim format.  Please note, this policy change only applies to outpatient radiation and outpatient chemotherapy services.  All other APL billing policies remain in effect.

For dates of service on and after April 1, 2007, any hospital that has already billed and received reimbursement for an institutional claim containing both chemotherapy and radiation therapy charges may submit a late ancillary claim to remove the chemotherapy charges.  The chemotherapy charges may then be submitted separately on the professional claim format.

Late ancillary claims for overcharges cannot be submitted electronically, as Type of Bill Frequency Digit 5 specifies its use for late charges (undercharges) only.  At this time, late ancillary claims that indicate an overcharge must be submitted on the paper UB-92 claim format.

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

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

If you have any questions concerning this notice, please contact your billing consultant in the Bureau of Comprehensive Health Services toll-free at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs