MedicaidCoverageMedium impact
Removal of Caps for Adult Therapy Services
Illinois Medicaid - HFS·IL · Physical Therapy, Occupational Therapy, Speech Therapy·Provider Notice
Effective date
Oct 1, 2014
We identified it
Jun 20, 2026
Summary
Illinois Medicaid removed the 20 visits per year cap for physical, occupational, and speech therapy services for adults age 21 and older, effective October 1, 2014. Prior authorization for medical necessity is still required for all adult therapy services using specific forms and submission processes.
Action Required
For Illinois Medicaid patients age 21+: Continue obtaining prior authorization for all therapy services using HFS 3701T form (outpatient providers) or HFS 1409 form (home health agencies) along with practitioner orders and therapy plans. Submit requests via fax to 217-524-0099. Verify patient eligibility before each service and check if patients are enrolled in MCOs/MCCNs as prior auth requirements differ for managed care plans.