MedicaidReimbursementHigh impact
Re: Hospital Outpatient Claims for Sexual Assault Treatment Services per Public Act 102-0699
Illinois Medicaid - HFS·IL · Emergency Medicine·Provider Notice
Effective date
Jul 1, 2022
We identified it
Jun 20, 2026
Summary
Illinois hospitals providing sexual assault forensic examinations must now receive minimum $1,000 reimbursement for outpatient services, effective July 1, 2022. Claims must include specific sexual assault diagnosis codes, E&M codes (99201-99295), and Modifier 32 to trigger the enhanced payment rate.
Action Required
Immediately: Illinois hospitals must update billing systems to apply Modifier 32 to all E&M codes (99201-99295) for sexual assault forensic exams to trigger minimum $1,000 reimbursement. Billing team must verify hospital is IDPH-approved for these services, ensure sexual assault diagnosis codes from the specified list are included, and hold Medicaid FFS claims until system pricing updates are complete. For non-Medicaid patients, submit UB-04 claims to ISAETP via mail.