MedicaidPrior AuthMedium impact
Prior Approval Required on All Wheelchair Repairs Greater Than $1,500.00 Effective March 1, 2026
Illinois Medicaid - HFS·IL · PM&R (Physical Medicine & Rehab), Orthopedics·Provider Notice
Effective date
Mar 1, 2026
We identified it
Jun 16, 2026
Summary
Effective March 1, 2026, prior approval will be required for wheelchair repairs exceeding $1,500 (increased from the previous $750 threshold). Providers cannot split repairs into multiple claims to avoid the threshold.
Action Required
By March 1, 2026: Billing team must update DME billing processes to obtain prior approval for all wheelchair repairs over $1,500. Update billing system alerts and staff training. Contact DME billing consultant at 1-877-782-5565 Option 3, then Option 2 for fee-for-service questions or applicable MCO for managed care questions. Claims over $1,500 without prior approval will be denied.