MedicaidCoverageMedium impact
Lactation Consultant Enrollment and Billing per Public Act 102-0665 Effective January 1, 2024
Illinois Medicaid - HFS·IL · OB-GYN, Family Medicine, Pediatrics·Provider Notice
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers lactation consultant services under Public Act 102-0665, requiring certified lactation consultants to enroll in IMPACT system and use specific billing codes. Coverage applies to both fee-for-service and managed care Medicaid programs.
Action Required
Immediately: Lactation consultants must enroll in Illinois IMPACT system as either Rendering/Servicing Provider or Regular Individual Sole Proprietor. Upload certification from appropriate board (IBCLC, CLC, or CLS) with unique certification number and expiration date. Obtain NPI if not already enrolled. Use procedure code S9443 with appropriate modifiers (HD for IBCLC, no modifier for CLC/CLS, HQ for group services). Bill under birthing person's or child's Medicaid RIN. Document use of standing recommendation or physician referral for audit purposes.