MedicaidBilling CodesMedium impact
Billing Procedures for Fee-For-Service Reimbursement and Telehealth Billing Clarification
Illinois Medicaid - HFS·IL · Family Medicine, OB-GYN, General Practice·Provider Notice
Effective date
May 20, 2020
We identified it
Jun 20, 2026
Summary
This policy clarifies billing procedures for FQHCs, RHCs, and ERCs regarding fee-for-service reimbursement of LARCs and virtual services, and corrects telehealth billing instructions to require GT modifiers on ALL service lines including T1015 encounter codes. The policy specifically excludes HealthChoice Illinois managed care and MMAI plans.
Action Required
Immediately: Billing teams at FQHCs, RHCs, and ERCs must update telehealth claim processing to include GT modifier on ALL service lines including T1015 encounter codes, not just detail codes. For FFS LARC and virtual services billing, report only CPT/HCPCS codes without T1015 and include appropriate taxonomy codes (261QF0400X for FQHC, 261QR1300X for RHC, 261QP2300X for ERC) in billing loop 2010AA. Ensure behavioral health modifier is first modifier on T1015 for behavioral health encounters.