MedicaidCoverageMedium impact
Coverage for Diabetes Prevention and Management Programs Effective August 1, 2021
Illinois Medicaid - HFS·IL · Endocrinology, Family Medicine, Internal Medicine +1 more·Provider Notice
Effective date
Aug 1, 2021
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers Diabetes Prevention Program (DPP) and Diabetes Self-Management Education and Support (DSMES) services effective August 1, 2021. New milestone-based HCPCS codes G9873-G9880 are available for billing these services with specific eligibility criteria and reimbursement rates.
Action Required
Immediately: For providers offering diabetes prevention services in Illinois, enroll as Diabetes Prevention Provider Organization (Legacy PT 102) through IMPACT system with CDC certification. Update billing system to include new HCPCS codes G9873-G9880 with milestone-based reimbursement rates ($30-$180 per milestone). Add required ICD-10 codes for elevated blood glucose and BMI to encounter forms. Note: Fee-for-service billing awaits federal approval - managed care plans may begin immediately.