MedicaidAdministrativeMedium impact
Policy for Billing Multiple Visits and Procedures on the Same Day
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
May 21, 2018
We identified it
Jun 20, 2026
Summary
This policy clarifies Illinois Medicaid billing rules for multiple visits and procedures performed on the same day. Key points include using modifier 25 for separately identifiable E/M services, documentation requirements for medical necessity, and specific reimbursement rules when combining office visits with therapeutic or diagnostic procedures.
Action Required
Immediately: Review current billing practices for same-day multiple visits to ensure compliance with Illinois Medicaid guidelines. Billing team must verify use of modifier 25 for separately identifiable E/M services during same-day visits. Update billing workflows to ensure HFS 2360 forms include proper documentation for medical necessity when billing multiple same-day visits. Train staff on exceptions for therapeutic procedures, preventive medicine visits, and LARC insertion/removal billing rules.