MedicaidBilling CodesMedium impact
Pharmacists Billing for Evaluation and Management Procedure Codes Related to Hormonal Contraceptive Assessment
Illinois Medicaid - HFS·IL · Pharmacy, OB-GYN, Family Medicine·Provider Notice
Effective date
Aug 1, 2022
We identified it
Jun 20, 2026
Summary
Illinois Medicaid expanded billing opportunities for pharmacists providing hormonal contraceptive services. Pharmacies can now bill additional E&M codes (99202, 99203, 99211, 99212) with FP modifier alongside the existing 99401 code, all reimbursed at 85% of physician rates.
Action Required
Immediately: Pharmacy billing teams must update systems to include new E&M codes 99202, 99203, 99211, and 99212 with FP modifier for pharmacist hormonal contraceptive assessment services. Verify billing software applies 85% physician rate and ensure documentation protocols meet audit requirements for all contraceptive consultation services.