Section 2017.30  Definitions

CDT Codes means the current dental terminology prescribed by the American Dental Association.

CPT Codes means the current procedural terminology published by the American Medical Association.

HCFA means the Health Care Financing Administration of the U.S. Department of Health and Human Services.

HCFA Form 1500 means the current health insurance claim form published by HCFA, or its revision following the effective date of this Part, for use by health care practitioners.

HCPCS Codes means the HCFA's Common Procedure Coding System that is based upon the current American Medical Association's (AMA) Physician Current Procedural Terminology.

HCPCS Level 1 Codes means the AMA's current CPT codes with the exception of anesthesiology services.

HCPCS Level 2 Codes means the codes for physician and non-physician services that are not included in current CPT.

Health Care Practitioner means:

A chiropractor licensed under The Medical Practice Act of 1987, [225 ILCS 60] to treat human ailments without the use of drugs and without operative surgery.

A dentist licensed under The Illinois Dental Practice Act, [225 ILCS 25].

A nurse licensed under The Illinois Nursing Act of 1987, [225 ILCS 65].

An occupational therapist licensed under The Illinois Occupational Therapy Practice Act, [225 ILCS 75].

An optometrist licensed under The Illinois Optometric Practice Act of 1987, [225 ILCS 80].

A pharmacist licensed under the Pharmacy Practice Act of 1987, [225 ILCS 85].

A physical therapist licensed under The Illinois Physical Therapy Act, [225 ILCS 90].

A physician licensed under The Medical Practice Act of 1987, [225 ILCS 60] to practice medicine in all of its branches.

A podiatrist licensed under The Podiatric Medical Practice Act of 1987, [225 ILCS 100].

A psychologist licensed under The Clinical Psychologist Licensing Act, [225 ILCS 15].

A social worker licensed under The Clinical Social Work and Social Work Practice Act, [225 ILCS 20].

A speech-language pathologist and/or audiologist licensed under The Illinois Speech-Language Pathology and Audiology Practice Act, [225 ILCS 110].

Other Health Care Practitioners licensed by the Illinois Department of Professional Regulation.

A supplier of health care services not described herein, including but not limited to a physician assistant, nurses aide, or supplier of durable medical equipment.

Health Plan means an insurance company, fraternal benefit society, dental service plan, limited health service organization, pharmaceutical service plan, vision service plan, voluntary health services plans, health maintenance organization, workers' compensation insurance, third party administrator, third party prescription program administrator, and any other entity paying or reimbursing the costs of health care expenses.

ICD-CM Codes means the disease codes in the current International Classification of Diseases, clinical modifications published by the U.S. Department of Health and Human Services.

Institutional Health Care Provider means:

Ambulatory Surgical Treatment Center licensed under the Ambulatory Surgical Treatment Center Act, [210 ILCS 5].

Home Health Agency licensed under the Home Health Agency Licensing Act, [210 ILCS 55].

Hospice licensed under the Hospice Program Licensing Act, [210 ILCS 60].

Hospital licensed under the Hospital Licensing Act, [210 ILCS 85].

Skilled Nursing and Intermediate Care Facility licensed under the Nursing Home Care Act, [210 ILCS 45].

Trauma Center licensed under the Emergency Medical Services (EMS) Systems Act, [210 ILCS 50].

Other Institutional Health Care Providers licensed by the Illinois Department of Public Health.

J510, J511 or J512 Form means the current uniform dental claim form or its revision following the effective date of this Part, approved by the American Dental Association for use by dentists.

Medicare means the Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

Medical Assistance or Medicaid means Title XIX of the federal Social Security Act (42 U.S.C. 1396, et seq.) as then constituted or later amended.

Revenue Codes means the current codes established for use by institutional health care providers by the National Uniform Billing Committee and the Illinois Uniform Billing Committee.

UB92/HCFA Form 1450 means the current health insurance claim form, or its revision following the effective date of this Part, developed by the National Uniform Billing Committee for use by institutional health care providers.

(Source:  Amended at 20 Ill. Reg. 8497, effective June 5, 1996)