MedicaidPrior AuthHigh impact
Oxygen Reimbursement Changes Effective December 1, 2012
Illinois Medicaid - HFS·IL · Pulmonology, Internal Medicine, Family Medicine·Provider Notice
Effective date
Dec 1, 2012
We identified it
Jun 20, 2026
Summary
Effective December 1, 2012, HFS (Illinois Medicaid) implemented new oxygen therapy reimbursement rates based on Medicare rates minus 6%, except for code E0425 which remains unchanged. All oxygen systems and contents now require prior approval, with reimbursement moving to a flat monthly rate structure.
Action Required
By December 1, 2012: DME providers must obtain prior approval for all oxygen systems and contents (except long-term care residents excluding SLF). Update billing system with new flat monthly rates for all oxygen HCPCS codes. Submit medical documentation substantiating medical necessity with all prior approval requests. For existing approvals beyond December 1, submit new prior approval requests for portable systems and contents.