MedicaidReimbursementHigh impact
Important Family Planning Policy Change and Payment Increases- Updated from 10/10/14
Illinois Medicaid - HFS·IL · OB-GYN, Family Medicine, General Practice +1 more·Provider Notice
Effective date
Oct 1, 2014
We identified it
Jun 20, 2026
Summary
Illinois Medicaid has significantly increased reimbursement rates for long-acting reversible contraceptive (LARC) procedures and allows billing E/M visits with modifier 25 on the same day as LARC insertion/removal when separately identifiable services are documented. Vasectomy reimbursement increased to $408 and emergency contraceptive pills must now be billed using S4993 instead of J8499.
Action Required
Immediately: Billing team must update fee schedules with new LARC reimbursement rates (CPT 11981 to $88.00, 11982 to $99.00, 11983 to $143.00, 58300 to $88.00, removal/reinsertion 58300+58301 to $106.70, and vasectomy 55250 to $408.00). Update billing system to allow E/M visits with modifier 25 on same day as LARC procedures when separately documented. Change all emergency contraceptive pill billing from J8499 to S4993 for dates of service July 1, 2014 and after. Ensure vasectomy claims are submitted on paper with HFS 2189 consent form. Add modifier UD for 340B purchased contraceptives to receive $35 dispensing fee.