Skip to main content
  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 04/15/09

Update to the Expensive Drugs and Devices (EDD) Listing for January 1, 2009

To:​ 

 Enrolled Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers; and Ambulatory Surgical Treatment Centers (ASTCs)​
Date:​ April 15, 2009​
Re:​ Update to the Expensive Drugs and Devices (EDD) Listing for January 1, 2009​

Hospitals and ASTCs are eligible for additional payment termed an “outlier payment” for specified expensive drugs and devices provided in conjunction with a procedure from the Ambulatory Procedures Listing (APL). The purpose of this notice is to communicate changes regarding the Expensive Drugs and Devices Listing:

 

• The prior approval requirement has been removed for all drugs and devices effective with dates of service on and after January 1, 2009. Prior approval requirements for dates of service prior to January 1, 2009, are outlined in an Informational Notice dated March 10, 2004, on the department’s Web site at: <http://www.hfs.illinois.gov/hospitals/>. Please note, future updates to the Expensive Drugs and Devices Listing may contain codes that will require prior approval.

• “C” codes have been added for pacemakers and cardioverter-defibrillators and neurostimulators.

• Codes have been revised to denote skin replacement.

The revised EDD Listing is effective for dates of service on and after January 1, 2009, and is available on the department’s Web site at: <http://www.hfs.illinois.gov/reimbursement/>. Codes that have been defined as obsolete via the CPT or HCPCS coding systems have been removed. Providers are reminded that any code that has been determined obsolete by the CPT or HCPCS coding systems will not be payable, even if the department experiences a delay in updating the EDD Listing on the Web site.

 

In the future, the department will not send a formal notice to announce an EDD Listing update. Providers that are registered to receive notification when new information is posted to the Web site will be informed electronically when new listings are available. 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/>.

 

Updated instructions for billing of an expensive drug or device are included on the Web site with this notice. Any questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

 

 /s/

 

Theresa A. Eagleson, Administrator

Division of Medical Programs 

 

Billing Process for Expensive Drugs and Devices 

Outpatient Cost Outlier