MedicaidPrior AuthMedium impact
Therapy Prior Approval Request Change and Therapy Modifier Billing Reminder
Illinois Medicaid - HFS·IL · Physical Therapy, Occupational Therapy, Speech Therapy·Provider Notice
Effective date
Oct 31, 2013
We identified it
Jun 20, 2026
Summary
Therapy prior authorization requests must now specify quantity as number of visits (not quarter-hour units) on HFS 1409 forms. Claims submission remains in quarter-hour units with required modifiers (GN, GO, GP) for proper reimbursement.
Action Required
Immediately: Update prior authorization request process to submit quantity as number of visits (not units) on HFS 1409 forms. Ensure billing staff continue using quarter-hour units for claim submission. Verify all therapy claims include required modifiers: GN for speech therapy (92507, 92506), GO for occupational therapy (97110, 97003), GP for physical therapy (97110, 97001). Claims may not process at correct reimbursement without proper modifiers.