MedicaidCoverageMedium impact
Confirmation of Treatment for Port-Wine Stains Not Solely for Cosmetic Purposes per Public Act 102-0642
Illinois Medicaid - HFS·IL · Dermatology, Plastic Surgery, Pediatrics +1 more·Provider Notice
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers treatment for port-wine stains (nevus flammeus) for all ages when medically necessary, not just cosmetic purposes, effective January 1, 2022. This confirms existing coverage under both fee-for-service Medicaid and managed care plans per Public Act 102-0642.
Action Required
Immediately: Billing team should verify that port-wine stain treatments (laser therapy, topical/systemic medications, surgery) are being submitted with appropriate medical necessity documentation for Illinois Medicaid patients. Ensure claims emphasize functional impairment prevention (vision, oral function, bleeding, infection) rather than cosmetic improvement. Contact Illinois Medicaid billing consultant at 877-782-5565 for specific coding questions.