MedicaidReimbursementHigh impact
Update to Therapy Services Provided by Hospitals and APL Policy Change
Illinois Medicaid - HFS·IL · Physical Therapy·Provider Notice
Effective date
Jul 1, 2012
We identified it
Jun 20, 2026
Summary
Illinois Medicaid reverted physical therapy reimbursement rates for hospitals back to higher APL rates ($115-130 per visit) and suspended the requirement for hospitals to enroll salaried therapists. Hospitals can now bill therapy services fee-for-service in addition to APL procedures on the same date.
Action Required
Immediately: Update billing system to use higher physical therapy rates ($115 per visit for general hospitals, $130 for children's/rehab hospitals) with 3.5% SMART Act reduction applied. Continue requiring prior approval (HFS 1409 form) for CPT 97110 after 20 visits per year for adults 21+. Bill therapy services under hospital NPI with GP modifier on HFS 1443 or 837P format. CPT 97001 does not require prior approval and doesn't count toward annual cap.