MedicaidBilling CodesHigh impact
Correction to submittal of Behavioral Health Encounter Claims for Sub-Clinical Behavioral Health Professional Services working under the supervision of a physician or advanced practice nurse in Federally Qualified Health Centers and Rural Health Clinics E
Illinois Medicaid - HFS·IL · Psychiatry, Family Medicine, General Practice·Provider Notice
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Illinois corrected billing guidance for behavioral health services provided by sub-clinical professionals under physician/APN supervision in FQHCs and RHCs. Claims must now use T1040 with specific behavioral health modifiers (AJ, AH, or HO) based on the professional's education to avoid C31 rejections.
Action Required
Immediately: Billing team must update all T1040 behavioral health encounter claims to include required modifiers: AJ for LCSW education, AH for LCP education, or HO for LCPC/LMFT education. Update billing system rules to prevent T1040 submission without these modifiers. For claims rejected with C31 errors since January 1, 2025, submit timely filing override requests within 180 days (by June 20, 2026) following instructions on the Non-Institutional Providers webpage.