knowledge/lexical/codes
Source: knowledge/lexical/codes.parquet. Source vintage: Package vintage 2026-10-01; source path partition not dated; inspect record and rule clocks separately. Grain: Packaged source record; inspect schema and linked world method before aggregation. Snapshot: 7a53af6a9beb58928d4a64dc92db09c9db65433f9909f1a10d16e302adaf86ba.
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| node_id UInt32 | code Utf8 | text Utf8 | __row_id Int64 |
|---|---|---|---|
| 6320 Filter to this value Explore graph node | Oxygen Filter to this value | Oxygen not-reimbursable: Oxygen is not covered in the following situations: • For use on an "as needed" basis • Angina pectoris without hypoxemia • Breathlessness without cor pulmonale or evidence of hypoxemia • Peripheral vascular disease from desaturation in one or more extremities • Terminal illnesses without hypoxemia and/or pulmonary involvement | 520 |
| 6322 Filter to this value Explore graph node | Standard and companion wheelchairs Filter to this value | Standard and companion wheelchairs payable-with-criteria: The rental and/or purchase of standard and companion wheelchairs are covered if medically necessary and authorized. | 521 |
| 6324 Filter to this value Explore graph node | Customized wheelchairs, specialized seating systems, and power-operated wheelchairs and scooters Filter to this value | Customized wheelchairs, specialized seating systems, and power-operated wheelchairs and scooters prior-authorization-required: Wheelchair evaluations must be submitted with requests for customized wheelchairs, specialized seating systems, and power-operated wheelchairs and scooters. Authoriza- | 522 |
| 6331 Filter to this value Explore graph node | E1399 HX Filter to this value | E1399 HX criteria: Express mail, second day air, priority mail, etc., will not be covered. criteria: Likewise cost for ground, air travel, or gasoline/mileage incurred when the supplier de- livers an item will not be reimbursed. criteria: No reimbursement for inter-island shipping is allowed. criteria: Reim- bursement for shipping is only allowed if the custom item is obtained from and Out-of- State distributor/manufacturer. criteria: Reimbursement will be based on the most cost effective method of shipment. criteria: only if clearly separately charged by the item's distributor/manufacturer criteria: shipping costs on custom items only | 523 |
| 6340 Filter to this value Explore graph node | Gloves Filter to this value | Gloves who may perform: Employed/contracted caregivers (must supply their own) who may perform: family caregivers of adults and older children | 524 |
| 6345 Filter to this value Explore graph node | NDC numbers Filter to this value | NDC numbers
criteria: in the coding of DMEPOS
disposition: not-reimbursable
effective-date: November 2008 Filter to this value | 525 |
| 6379 Filter to this value Explore graph node | HP Filter to this value | HP
who may perform: Psychologist – Licensed Clinical Filter to this value | 526 |
| 6385 Filter to this value Explore graph node | H2000 Filter to this value | H2000 accreditation required: qualifications of an MHP. disposition: payable-with-criteria effective date: April 28, 2022 effective date: February 4, 2025 effective date: July 1, 2022 effective date: June 6, 2022 effective date: September 19, 2018 medicaid-il code-disposition criteria: unless the documentation is completed with the consumer (direct interaction), as a component of the clinical intervention to enhance engagement. medicaid-il code-disposition criteria: unless the documentation is completed with the participant (direct interaction) as a component of the clinical intervention to enhance engagement. medicaid-il code-disposition disposition: payable-with-criteria medicaid-il code-disposition effective date: April 28, 2022 medicaid-il code-disposition effective date: February 4, 2025 medicaid-il code-disposition effective date: July 1, 2022 medicaid-il code-disposition effective date: June 6, 2022 medicaid-il code-disposition effective date: September 19, 2018 medicaid-il code-disposition effective-date: October 27, 2021 medicaid-il code-disposition not-reimbursable: The act of documentation or report writing is not reimbursable. medicaid-il code-disposition not-reimbursable: The act of documentation, or “completion of the form," is not reimbursable, unless the documentation is completed with the customer (direct interaction), as a component of the clinical intervention to enhance engagement. medicaid-il code-disposition not-reimbursable: The act of documentation, or “completion of the form,” is not reimbursable medicaid-il code-disposition not-reimbursable: The act of documentation, or “completion of the form,” is not reimbursable, with the following exceptions medicaid-il code-disposition not-reimbursable: cannot be billed using the modifier "SF.” medicaid-il code-disposition payable-with-criteria: Documentation is reimbursable when completed with the customer (direct interaction) as a component of the clinical intervention to enhance engagement. medicaid-il code-disposition payable-with-criteria: Documentation is reimbursable when rating IM+CANS domain or modular items or when prioritizing IM+CANS needs and strengths for treatment planning utilizing the IM+CANS form as a component of the clinician's case formulation. medicaid-il code-disposition payable-with-criteria: For customers assessed but for whom it is determined that ongoing MRO-MH or TCM services are not medically necessary, the provider may submit their claim for IATP services pursuant to Section 207.3.4 of this handbook. medicaid-il code-disposition payable-with-criteria: Initial IATPs and a full re-assessment of a customer's IATP shall only be reimbursed to a single service provider once every 180 days medicaid-il code-disposition payable-with-criteria: Initial IATPs and a full re-assessment of a customer's IATP shall only be reimbursed to a single service provider once every 180 days, and cannot be billed using the modifier "SF.” medicaid-il code-disposition payable-with-criteria: Initial IATPs and a full re-assessment of a customer's IATP shall only be reimbursed to a single service provider once every 180 days, and should not be billed using the modifier "SF.” medicaid-il code-disposition payable-with-criteria: Medical Necessity for this service is established by the need to assess the customer for the delivery or continuation of community-based clinical services under the MRO-MH or TCM Option. For customers assessed but for whom it is determined that ongoing MRO-MH or TCM services are not medically necessary, the provider may submit their claim for IATP services pursuant to Section 207.3.4 of this handbook. medicaid-il code-disposition payable-with-criteria: The HFS approved IATP instruments must be submitted via the web-based IATP Provider Portal pursuant to the guidelines provided by the Department; submission is required to receive service reimbursement. medicaid-il code-disposition payable-with-criteria: The act of documentation, or “completion of the form,” is not reimbursable, unless the documentation is completed with the customer (direct interaction), as a component of the clinical intervention to enhance engagement. medicaid-il code-disposition payable-with-criteria: The time spent by the authorizing LPHA clinically reviewing the IATP, including any necessary consultation with the staff who completed the IATP, is reimbursable effective with dates of service on or after July 1, 2022. medicaid-il code-disposition payable-with-criteria: Updates of a customer's IATP using the “SF” modifier may be reimbursed at any time during the 180-day IATP timeframe to any service provider delivering MRO-MH and TCM services to a customer. medicaid-il code-disposition payable-with-criteria: unless the documentation is completed with the customer (direct interaction), as a component of the clinical intervention to enhance engagement. medicaid-il furnishing-rule accreditation required: qualifications of an MHP. medicaid-il furnishing-rule supervision level: must be reviewed, approved, and signed by an LPHA medicaid-il furnishing-rule supervision level: under the supervision of, an LPHA medicaid-il furnishing-rule who may perform: staff who completed the IATP medicaid-il furnishing-rule who may perform: staff who minimally meet the qualifications of an MHP medicaid-il furnishing-rule who may perform: staff who minimally meet the qualifications of an MHP. not-reimbursable: The act of documentation or report writing is not reimbursable. not-reimbursable: The act of documentation, or “completion of the form," is not reimbursable, unless the documentation is completed with the customer (direct interaction), as a component of the clinical intervention to enhance engagement. not-reimbursable: The act of documentation, or “completion of the form,” is not reimbursable not-reimbursable: The act of documentation, or “completion of the form,” is not reimbursable, unless the documentation is completed with the customer (direct interaction) as a component of the clinical intervention to enhance engagement. not-reimbursable: The act of documentation, or “completion of the form,” is not reimbursable, unless the documentation is completed with the participant (direct interaction) as a component of the clinical intervention to enhance engagement. not-reimbursable: The act of documentation, or “completion of the form,” is not reimbursable, with the following exceptions not-reimbursable: cannot be billed using the modifier "SF.” payable-with-criteria: Documentation is reimbursable when completed with the customer (direct interaction) as a component of the clinical intervention to enhance engagement. payable-with-criteria: Documentation is reimbursable when rating IM+CANS domain or modular items or when prioritizing IM+CANS needs and strengths for treatment planning utilizing the IM+CANS form as a component of the clinician's case formulation. payable-with-criteria: For customers assessed but for whom it is determined that ongoing MRO-MH or TCM services are not medically necessary, the provider may submit their claim for IATP services pursuant to Section 207.3.4 of this handbook. payable-with-criteria: If the customer has an associated IATP that has a dated LPHA signature that is over 180 days old, then the provider must complete a re-assessment. payable-with-criteria: Initial IATPs and a full re-assessment of a customer's IATP shall only be reimbursed to a single service provider once every 180 days payable-with-criteria: Initial IATPs and a full re-assessment of a customer's IATP shall only be reimbursed to a single service provider once every 180 days, and cannot be billed using the modifier "SF.” payable-with-criteria: Initial IATPs and a full re-assessment of a customer's IATP shall only be reimbursed to a single service provider once every 180 days, and should not be billed using the modifier "SF.” payable-with-criteria: Medical Necessity for this service is established by the need to assess the customer for the delivery or continuation of community-based clinical services under the MRO-MH or TCM Option. payable-with-criteria: Medical Necessity for this service is established by the need to assess the customer for the delivery or continuation of community-based clinical services under the MRO-MH or TCM Option. For customers assessed but for whom it is determined that ongoing MRO-MH or TCM services are not medically necessary, the provider may submit their claim for IATP services pursuant to Section 207.3.4 of this handbook. payable-with-criteria: Medical Necessity for this service is established by the need to assess the participant for the delivery or continuation of community-based clinical services under the MRO-MH or TCM Option. payable-with-criteria: The HFS approved IATP instruments must be submitted via the web-based IATP Provider Portal pursuant to the guidelines provided by the Department; submission is required to receive service reimbursement. payable-with-criteria: The act of documentation, or “completion of the form,” is not reimbursable, unless the documentation is completed with the consumer (direct interaction), as a component of the clinical intervention to enhance engagement. payable-with-criteria: The act of documentation, or “completion of the form,” is not reimbursable, unless the documentation is completed with the customer (direct interaction) as a component of the clinical intervention to enhance engagement. payable-with-criteria: The act of documentation, or “completion of the form,” is not reimbursable, unless the documentation is completed with the customer (direct interaction), as a component of the clinical intervention to enhance engagement. payable-with-criteria: The time spent by the authorizing LPHA clinically reviewing the IATP, including any necessary consultation with the staff who completed the IATP, is reimbursable effective with dates of service on or after July 1, 2022. payable-with-criteria: Updates of a customer's IATP using the “SF” modifier may be reimbursed at any time during the 180-day IATP timeframe to any service provider delivering MRO-MH and TCM services to a customer. payable-with-criteria: submission is required to receive service reimbursement. payable-with-criteria: unless the documentation is completed with the customer (direct interaction), as a component of the clinical intervention to enhance engagement. supervision level: must be reviewed, approved, and signed by an LPHA supervision level: under the supervision of, an LPHA who may perform: staff who completed the IATP who may perform: staff who minimally meet the qualifications of an MHP who may perform: staff who minimally meet the qualifications of an MHP. | 527 |
| 6398 Filter to this value Explore graph node | IATP: Psychological Assessment Filter to this value | IATP: Psychological Assessment who may perform: staff qualified to do so pursuant to the Clinical Psychologist Licensing Act [225 ILCS 15] who may perform: staff qualified to do so pursuant to the Clinical Psychologist Licensing Act [225 ILCS 15]. | 528 |
| 6400 Filter to this value Explore graph node | IATP: Level of Care Utilization System (LOCUS) Filter to this value | IATP: Level of Care Utilization System (LOCUS)
who may perform: staff who minimally meet the qualifications of an MHP Filter to this value | 529 |