MedicaidBilling CodesHigh impact
Hospital Rate Reform - Removing Inpatient-Only Procedures from the Ambulatory Procedures Listing (APL)
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jul 1, 2014
We identified it
Jun 20, 2026
Summary
Illinois Medicaid removed CMS-designated inpatient-only procedure codes from the Ambulatory Procedures Listing (APL), effective retroactively to July 1, 2014. These procedures will now pay zero when billed as outpatient services through the EAPG payment system.
Action Required
Immediately: Billing team must review the attached HCPCS listing of removed codes and update billing practices to ensure inpatient-only procedures are not billed as outpatient services to Illinois Medicaid. Verify current claims do not include these procedures in outpatient settings as they will be paid at zero. Contact Bureau of Hospital and Provider Services at 1-877-782-5565 with questions.