MedicaidCoverageMedium impact
Change in Coverage of Group Psychotherapy
Illinois Medicaid - HFS·IL · Psychiatry·Provider Notice
Effective date
Feb 1, 2013
We identified it
Jun 20, 2026
Summary
Illinois Medicaid has updated requirements for group psychotherapy services in FQHCs and RHCs, limiting coverage to maximum 2 sessions per 7-day rolling period with specific provider qualification and documentation requirements. Providers must use procedure code T1015 with appropriate modifiers based on practitioner type and ensure proper enrollment.
Action Required
Immediately: Billing team must verify Illinois Medicaid group psychotherapy claims use procedure code T1015 with correct modifiers (AJ for LCSW, AH for psychologist, HO for LCPC/LMFT). Ensure sessions are limited to maximum 2 per 7-day period and groups don't exceed 12 patients. Verify proper provider enrollment and documentation requirements are met in patient records.