Date: March 10, 2022
To: Enrolled Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers
Re: Hospital Taxonomy Codes for Outpatient Physical Therapy Billing
This notice clarifies to hospitals the correct taxonomy codes to use for outpatient physical therapy claims. The information applies to claims billed under Medicaid fee-for-service (FFS) and HealthChoice Illinois managed care organization plans (MCOs).
The Department publishes Category of Service (COS)/Taxonomy Default Tables for both the 837 Professional (837P) and 837 Institutional (837I) claim transactions. Prior to July 1, 2020, hospital providers billed therapy through the 837P claim format and were instructed to use the General Acute Care taxonomy code 282N00000X. Effective with dates of service beginning July 1, 2020, the Department transitioned hospital therapy billing to the 837I claim transaction.
For 837I billing:
- If a hospital is enrolled for COS 29 – Physical Rehabilitation, the hospital should be using the appropriate taxonomy code identified in the 837I COS/Taxonomy Default Table for physical rehabilitation.
- If a hospital is not enrolled for COS 29, then the hospital should be using the appropriate taxonomy code identified in the 837I COS/Taxonomy Default Table for COS 24 - general acute care.
Providers billing the appropriate taxonomy code allows the Department to better identify and track services being rendered. Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 or the appropriate managed care plan.
Kelly Cunningham, Administrator
Division of Medical Programs