MedicaidPrior AuthMedium impact
Prior Approval Required on All Wheelchair Repairs Greater Than $750.00 Effective July 6, 2021
Illinois Medicaid - HFS·IL · PM&R (Physical Medicine & Rehab), Orthopedics·Provider Notice
Effective date
Jul 6, 2021
We identified it
Jun 20, 2026
Summary
The prior authorization threshold for wheelchair repairs under Illinois Medicaid fee-for-service has increased from $400 to $750, effective July 6, 2021. DME providers must obtain prior approval for any wheelchair repair exceeding $750 and cannot split repairs into separate claims to avoid this requirement.
Action Required
Immediately: DME billing team must update prior authorization procedures to require approval for wheelchair repairs exceeding $750 (previously $400) for Illinois Medicaid fee-for-service patients. Update billing system alerts and staff training. Do not split wheelchair repair claims to avoid the $750 threshold as HFS will monitor for compliance violations.