MedicaidBilling CodesMedium impact
Mifepristone/Misoprostol Billing
Illinois Medicaid - HFS·IL · OB-GYN, Family Medicine·Claims & Billing
Effective date
May 13, 2026
We identified it
Jun 16, 2026
Summary
Illinois Medicaid has updated billing procedures for mifepristone and misoprostol used for medical termination of early pregnancy. The policy specifies global reimbursement codes and clarifies that these medications are carved out of Managed Care Organization plans for abortion use but remain billable through MCOs for gastrointestinal indications.
Action Required
Immediately: Billing team must update system to use global reimbursement code S0199 for medication abortion procedures (includes visits, lab, ultrasounds but excludes drugs). Use S0190 for mifepristone and S0191 for misoprostol separately. Ensure pharmacy claims for these medications go through Fee-For-Service point-of-sale system, not MCO billing. Update encounter forms to reflect that no ancillary services are separately billable under the global rate.