MedicaidBilling CodesHigh impact
Hospital Rate Reform – Clarification Regarding Observation Billing
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jul 1, 2014
We identified it
Jun 20, 2026
Summary
Illinois Medicaid clarifies that observation services billing requires two Revenue Code 0762 lines: one with appropriate HCPCS codes from the APL and service hours in FL 46, and a second line with HCPCS code G0378. This applies to both Medicaid claims and Medicare Part B crossover claims.
Action Required
Immediately: Billing team must ensure all observation services claims include two Revenue Code 0762 lines - first line with appropriate HCPCS code from APL and observation hours in FL 46, second line with HCPCS code G0378. Update UB-04 billing templates and train staff on dual-line requirement. Claims missing G0378 will not process correctly through EAPG pricing logic.