MedicaidReimbursementMedium impact
Important Family Planning Policy Change and Payment Increases
Illinois Medicaid - HFS·IL · OB-GYN, Family Medicine, General Practice·Provider Notice
Effective date
Oct 1, 2014
We identified it
Jun 20, 2026
Summary
Illinois Medicaid increased reimbursement rates for long-acting reversible contraceptive (LARC) insertion and removal procedures, with most rates nearly doubling. New billing guidelines allow same-day E/M visits with LARC procedures when properly documented and coded with modifier 25.
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, and combination 58300+58301 to $106.70. Update billing system to allow same-day E/M visits with LARC procedures using modifier 25 when separately identifiable services are documented. Stop billing emergency contraceptive pills with J8499 and use S4993 instead for all ECPs dispensed after July 1, 2014.