MedicaidBilling CodesMedium impact
Chapter U-200, Handbook for Local Education Agencies Updates to Appendix U-2, Procedure Codes Billable by Local Education Agencies
Illinois Medicaid - HFS·IL · Pediatrics, Psychiatry·Provider Notice
We identified it
Jun 20, 2026
Summary
Illinois Medicaid has updated procedure codes for Local Education Agencies (school-based health services). Several developmental testing and social work CPT codes became obsolete in 2019-2020 and were replaced with new codes that have different time increments and billing structures.
Action Required
Immediately: Billing teams at Local Education Agencies must stop using obsolete codes 96111, 96152, and 96153. Update billing systems to use replacement codes: 96112/96113 for developmental testing (60-minute and 30-minute increments) and 96158/96159 for individual social work, 96164/96165 for group social work (30-minute initial, 15-minute additional). Update encounter forms and staff training materials with the new code structure.