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Elizabeth M. Whitehorn, Director

Provider Notice issued 03/23/12

Practitioner-Administered Drug Reimbursement Rates Effective February 1, 2012

To:​ Participating Physicians; Advanced Practice Nurses; Podiatrists; Health Departments; and Hospitals Billing Fee-for-Service​
​Date: ​March 23, 2012
​Re: Practitioner-Administered Drug Reimbursement Rates Effective February 1, 2012​

Amendments to 89 Illinois Administrative Code Section 140.414 regarding the department's reimbursement rates for practitioner-administered drugs have been adopted and became effective February 1, 2012.

Effective February 1, 2012, practitioners will be reimbursed at the lesser of:

  1. The practitioner's usual and customary charge; or

  2. The Medicare allowable of Average Sales Price + 6%, as published by the Centers for Medicare and Medicaid Services.

In cases in which ASP is not available, the department's lowest maximum allowable pharmacy price for all covered products is assigned to the HCPCS billing code.

Hospitals billing fee-for-service are reminded that they are restricted to billing only for drugs identified in the Handbook for Practitioner Services, Topic A-202.13.

The rate methodology change affects all practitioner-administered drugs. The department has updated the rates of an initial list of drugs and that drug list is included with this notice. These rate revisions are identified in the Practitioner Fee Schedule on the department's Web site with an effective date of "01-Feb-12." Later revisions to drug code rates will be identified in updates to the Practitioner Fee Schedule.

Any questions regarding this notice should be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs

Initial Group of Drugs with Reimbursement Changes Effective February 1, 2012

Drug Code

Drug Description

J0585

Injection, onabotulinumtoxinaA, 1 unit

J0696

Injection, ceftriaxone sodium, per 250 mg.

J0881

Injection, darbepoetin alfa, 1 microgram, (non-ESRD use)

J0885

Injection, epoetin alfa, (for non-ESRD use), 1000 units

J1440

Injection, filgrastim (G-CSF), 300 mcg.

J1441

Injection, filgrastim, (G-CFS), 480 mcg.

J1642

Injection, heparin sodium, (heparin lock flush), per 10 units

J1950

Injection, leuprolide acetate (for depot suspension), per 3.75 mg.

J2323

Injection, natalizumab, 1 mg.

J2353

Injection, octreotide, depot form for intramuscular injection, 1 mg.

J2405

Injection, ondansetron hydrochloride, per 1 mg.

J2469

Injection, palonosetron HCL, 25 mcg.

J2505

Injection, pegfilgrastim, 6mg.

J2790

Injection, Rho D immune globulin, human, full dose, 300 mcg.

J8521

Capecitabine, oral, 500 mg.

J8700

Temozolomide, oral, 5 mg.

J9001

Injection, doxorubicin hydrochloride, all lipid formulations, 10 mg.

J9017

Injection, arsenic trioxide, 1 mg.

J9025

Injection, azacitidine, 1 mg.

J9035

Injection, bevacizumab, 10 mg.

J9041

Injection, bortezomib , 0.1 mg.

J9045

Injection, carboplatin, 50 mg.

J9055

Injection, cetuximab, 10 mg.

J9060

Injection, cisplatin, powder or solution, 10 mg.

J9070

Cyclophosphamide, 100 mg.

J9171

Injection, docetaxel, 1 mg.

J9178

Injection, epirubicin HCL, 2 mg.

J9181

Injection, etoposide, 10 mg.

J9201

Injection, gemcitabine hydrochloride, 200 mg.

J9206

Injection, irinotecan, 20 mg.

J9214

Injection, interferon, alfa-2b, recombinant, 1 million units

J9217

Leuprolide acetate (for depot suspension), 7.5 mg.

J9263

Injection, oxaliplatin, 0.5 mg.

J9265

Injection, paclitaxel, 30 mg.

J9266

Injection, pegaspargase, per single dose vial

J9303

Injection, panitumumab, 10 mg.

J9305

Injection, pemetrexed , 10 mg.

J9310

Injection, rituximab, 100 mg.

J9355

Injection, trastuzumab, 10 mg.

J9390

Injection, vinorelbine tartrate, 10 mg.