School Based/Linked Health Center Fee Schedule
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Statewide fee schedule listing CPT/HCPCS procedure codes, descriptions, effective dates, and statewide maximum reimbursement rates for services rendered by physicians, APNs, or physician assistants at Illinois School Based/Linked Health Centers.
No material clinical or coverage changes in this revision.
Coverage & Fee-Schedule Scope
Coverage notes
Covered when ALL of the following are met:
Coverage stance from these chunks
Summary of coverage stance from the listed fee-schedule entries:
Fee schedule entries (partial)
Representative fee-schedule rate entries and variables shown in the excerpt:
Codes, Rates, and Quantity Limits
| 87491 | INF AGENT DETECTN,NUCLC ACID;CHLAMYDIA TRACHOMATIS,AMP PROBE |
| 87501 | INFECT AGT DETECT NUCLEIC ACIDFLU VIRUS,REV TRANSC EA TYPE |
| 87650 | AGENT DETECTN,NUCLEIC ACID;STREPTOCOCUS,GROUP A,DIRECT PROBE |
| 90611 | SMALLPOX & MONKEYPOX VACCINE, LIVE, NONREPLICATING, 0.5ML SUBCUT |
| 90670 | PNEUMOCOCCAL CONJUGATE VACCINE 13 VALENT, FOR IM USE |
| 90707 | IMMUNIZATION MEASLES-MUMPS-RUB VIRUS VAC, LIVE, SUB-Q |
| 90791 | Psychiatric diagnostic evaluation; entry shows statewide unit price effective 04/01/25, max qty and reimbursement rate (STATEWIDE MAXIMUM REIMBURSEMENT RATE = 122.11) |
| 90837 | Psychotherapy, 60 mins; reimbursement rate = 183.16 |
| 99203 | Office/other outpatient visit, new patient, detailed/low complexity; reimbursement rate = 55.95 |
| 99213 | Office/other outpatient visit, established patient, expanded focus; reimbursement rate = 44.67 |
| J7307 | Etonogestrel implant system; statewide unit price = 1275.36; max qty = 1; reimbursement rate = 1275.36 |
| S4993 | Contraceptive pills for birth control; statewide unit price = 0.45; max qty = 364; reimbursement rate = 163.80 |
Billing, Authorization, and Medical Necessity
Payment not guaranteed — medical necessity required
The appearance of a code on this fee schedule does not guarantee payment. Services for which medical necessity is not clearly established are not covered by the department's Medical Programs; providers must refer to the General Handbook for Providers of Medical Services and the Handbook for Providers of School Based/Linked Health Centers for exclusions, noncovered services, and certification requirements for psychiatric services.
- All fees are statewide rates and do not vary by population group or geographical region.
- Psychiatric services are subject to policy limitations and certification requirements as outlined in the Chapter 200 Practitioner Handbook.
Fee schedule entries show rates and effective dates (no auth rules listed)
This document lists procedure and vaccine codes with effective dates and statewide maximum reimbursement rates for billing; the excerpted fee schedule rows do not specify prior authorization requirements.
- Examples in the excerpt show code entries with EFFECTIVE DATE, STATEWIDE UNIT PRICE, MAX QTY, and STATEWIDE MAXIMUM REIMBURSEMENT RATE fields (e.g., 87491 with EFFECTIVE DATE = 04/01/24 and STATEWIDE MAXIMUM REIMBURSEMENT RATE = 35.09).
- Providers should bill using the listed statewide maximum reimbursement rates but note no authorization rules are stated in these chunks.
Authorization requirements not specified in excerpt
No prior authorization rules or requirements are specified in this excerpt; only fee schedule entries and related notes are presented.
- Rate rows include fields such as STATEWIDE UNIT PRICE, MAX QTY, and STATEWIDE MAXIMUM REIMBURSEMENT RATE (e.g., 90791 shows EFFECTIVE DATE = 04/01/25 and STATEWIDE MAXIMUM REIMBURSEMENT RATE = 122.11).
- For any authorization needs, providers must consult other program handbooks referenced on the fee schedule.
Fee Schedule Definitions & Notes
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