← Back to list
Changes to Billing Procedures for Emergency Contraception, Confirmation of Coverage for Patient Care Services Provided by a Pharmacist for Contraceptives per Public Act 104-0312 and Coverage of Home Pregnancy Tests
Effective date
Nov 1, 2025
Identified
Jun 20, 2026
Summary
Effective November 1, 2025, pharmacies can no longer use dummy NPIs for emergency contraception billing and must instead use the Illinois Department of Public Health standing order NPI. The policy also confirms coverage for pharmacist-provided contraceptive services and adds coverage for home pregnancy tests.
Get alerts when payers change rules like this one
We check Illinois Medicaid - HFS and other payers every day and email you when a change matches your specialty and state.
Get Illinois Medicaid - HFS alertsPolicy Monitoring is free. No card required.
What to do
Action · 4 steps
01Immediately (effective November 1, 2025): Billing team must update all emergency contraception claims to use the Illinois Department of Public Health standing order NPI instead of dummy NPIs.
02Update billing system rules to reject dummy NPI usage for contraception claims.
03Verify home pregnancy test coverage is active in system (2 tests per 30 days).
04Claims using dummy NPIs will be rejected by the Department.
Original notice
Changes to Billing Procedures for Emergency Contraception, Confirmation of Coverage for Patient Care Services Provided by a Pharmacist for Contraceptives per Public Act 104-0312 and Coverage of Home Pregnancy Tests
hfs.illinois.gov · Always check the source before changing claims.