MedicaidPrior AuthMedium impact
Clarification of Prior Approval for Children’s Physical and Occupational Therapy Services Effective with Dates of Service Beginning November 16, 2015
Illinois Medicaid - HFS·IL · Physical Therapy, Occupational Therapy, Pediatrics +1 more·Provider Notice
Effective date
Nov 16, 2015
We identified it
Jun 20, 2026
Summary
This policy clarifies that children ages 0-3 who are eligible for Illinois Early Intervention (EI) Program services do not need prior authorization through HFS for physical and occupational therapy. However, if a child is not eligible for EI services, providers must submit a prior authorization request to HFS before providing therapy services.
Action Required
Immediately: Billing team must implement workflow to verify EI Program eligibility for children ages 0-3 before billing physical/occupational therapy services. If child is EI-eligible, no prior auth needed. If child is not EI-eligible, obtain HFS prior authorization before providing services. Update intake forms to capture EI status and train front desk staff on eligibility verification process.