MedicaidCoverageMedium impact
Confirmation of Genetic Testing Coverage per Public Act 103-0914
Illinois Medicaid - HFS·IL · Genetics, Oncology, Family Medicine +1 more·Provider Notice
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Illinois Medicaid will now cover additional genetic testing codes for inherited gene mutations in patients with personal or family history of cancer, effective January 1, 2025. This adds 17 new billable procedure codes to the covered services list under Public Act 103-0914.
Action Required
By January 1, 2025: Billing team must update Illinois Medicaid billing system to include the 17 new genetic testing procedure codes (0101U-0135U, 0162U, 0238U, 0340U, 81422, 81432-81438) as covered services. Update encounter forms and billing software to recognize these codes for reimbursement. Ensure providers document personal or family history of cancer and evidence-based clinical practice guideline recommendations for proper coverage.