MedicaidBilling CodesMedium impact
Pharmacists Billing for Hormonal Contraceptive Assessment and Consultation per Public Act 102-0103 Effective August 1, 2022
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 now reimburses pharmacists for hormonal contraceptive assessment and consultation services at 85% of physician rates, effective August 1, 2022. Pharmacists must complete ACPE-accredited training, have a standing physician order, and bill using CPT 99401 with FP modifier through pharmacy billing systems.
Action Required
Immediately for Illinois practices: Pharmacies billing for pharmacist contraceptive consultations must submit claims using CPT 99401 with FP modifier in 837P format. Include pharmacist NPI as rendering provider, physician NPI as ordering provider, and pharmacy NPI as billing provider. Use Place of Service code 01. Pharmacists must complete ACPE training and update IMPACT system enrollment to add Category of Service 103 before billing.