MedicaidReimbursementMedium impact
Rate Increases for Custom Orthotic and Prosthetic Devices Effective November 1, 2019
Illinois Medicaid - HFS·IL · Orthopedics, PM&R (Physical Medicine & Rehab)·Provider Notice
Effective date
Nov 1, 2019
We identified it
Jun 20, 2026
Summary
Illinois Medicaid increased reimbursement rates for custom orthotic and prosthetic devices effective November 1, 2019. New rates are calculated as Medicare rates (July 1, 2019) minus 6%, with an additional 2.7% SMART Act reduction applied.
Action Required
Billing team should update fee schedules in billing system to reflect new Illinois Medicaid rates for custom orthotic and prosthetic devices (Medicare rate minus 6% minus 2.7% SMART Act reduction). Download updated Durable Medical Equipment and Supplies Fee Schedule from Illinois Medicaid. Verify billing system calculates payments as lesser of provider charge or new maximum allowable rate.