MedicaidBilling CodesMedium impact
Change in Social Work Services Procedure Codes
Illinois Medicaid - HFS·IL · Psychiatry·Provider Notice
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Social work services CPT codes 96152 and 96153 have been replaced with new time-based codes (96158, 96159, 96164, 96165) for Local Education Agency providers. Providers must resubmit previously rejected claims using the new codes with bill type '1'.
Action Required
Immediately: LEA providers must resubmit electronic claims using bill type '1' for any services that were rejected for C31 edit (obsolete procedure code) or S99 (Missing SBHS Cost Data/Pricing Rate). Replace old codes 96152 and 96153 with new time-based codes 96158/96159 for individual services and 96164/96165 for group services. Update billing software to use new codes and maximum quantity limits. Remember timely filing is 18 months from date of service.