MedicaidReimbursementMedium impact
Occupational Therapy Evaluation Rate Increases Effective March 1, 2022
Illinois Medicaid - HFS·IL · Occupational Therapy·Provider Notice
Effective date
Mar 1, 2022
We identified it
Jun 20, 2026
Summary
Illinois Medicaid increased reimbursement rates for occupational therapy evaluation services (CPT 97165, 97166, 97167) effective March 1, 2022. Providers who billed these services on or after March 1, 2022 before the rate update must submit replacement claims to receive the higher payment amounts.
Action Required
Within 12 months of original paid voucher date: Billing team must submit replacement claims (bill type/claim frequency '7') for CPT 97165, 97166, and 97167 with dates of service March 1, 2022 or later that were adjudicated before rate updates. Submit electronic replacement claims through MEDI or 837P files. Refer to Chapter 300 Companion Guide for 837P replacement claim instructions.