MedicaidBilling CodesHigh impact
Change in Billing for Behavioral Health Encounters Effective December 1, 2022
Illinois Medicaid - HFS·IL · Psychiatry, Family Medicine, General Practice·Provider Notice
Effective date
Dec 1, 2022
We identified it
Jun 20, 2026
Summary
Effective December 1, 2022, behavioral health encounters at FQHCs, ERCs, and RHCs must be billed using procedure code T1040 instead of T1015 with behavioral health modifiers. This change applies to both Medicaid fee-for-service and HealthChoice Illinois managed care plans to comply with CMS billing requirements.
Action Required
By December 1, 2022: Billing team must update billing system to use procedure code T1040 (instead of T1015) for all behavioral health encounters at FQHCs, ERCs, and RHCs. Continue using modifiers AJ, AH, and HO with T1040. Update encounter forms and train staff that billing T1015 with behavioral health modifiers after December 1st will result in P03 error code denials.