MedicaidPrior AuthHigh impact
Chapter H-200, Handbook for Providers of Hospital Services Prior Approval Requirements for Physical and Occupational Therapy Services for Children through Age 20 Effective November 16, 2015
Illinois Medicaid - HFS·IL · Physical Therapy, Occupational Therapy, Pediatrics·Provider Notice
Effective date
Nov 16, 2015
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now requires prior authorization for physical and occupational therapy services for children through age 20, effective November 16, 2015. Hospitals must obtain prior approval for medical necessity before providing these services to avoid claim denials.
Action Required
By November 16, 2015: Billing team must implement prior authorization requirements for all physical and occupational therapy services for children through age 20 covered by Illinois Medicaid. Update billing system to flag these services for prior auth verification. Refer to the Therapy Releases page and Handbook for Providers of Therapy Services for specific prior approval and billing instructions. Claims submitted without prior authorization will be denied.