MedicaidAdministrativeMedium impact
Billing Update for Diabetes Prevention and Management Programs
Illinois Medicaid - HFS·IL · Endocrinology, Family Medicine, Internal Medicine +1 more·Provider Notice
Effective date
Jul 1, 2022
We identified it
Jun 20, 2026
Summary
Illinois updated billing guidance for Diabetes Prevention Program (DPP) and Diabetes Self-Management Education and Support (DSMES) services. Key changes include eliminating paper claims requirement (all claims must be electronic), removing formal referral requirements, adding new place of service codes for hospital settings, and introducing new telehealth modifiers and place of service codes effective July 1, 2022.
Action Required
Immediately: Illinois billing teams must update diabetes prevention and management program billing to submit all claims electronically (no paper claims accepted). Update billing system to remove referral requirements for DPP and DSMES services - only provider recommendation needed. Add Place of Service Codes 19 (Off Campus Outpatient Hospital) and 22 (On Campus Outpatient Hospital) for diabetes programs. Implement new Modifier 93 for synchronous telemedicine via audio-only and Place of Service Code 10 for telehealth in patient's home for dates of service July 1, 2022 and later.