MedicaidPrior AuthHigh impact
Billing and Payment Changes for Occupational, Physical, and Speech Therapy Services
Illinois Medicaid - HFS·IL · Physical Therapy, Occupational Therapy, Speech Therapy·Provider Notice
Effective date
Jul 1, 2012
We identified it
Jun 20, 2026
Summary
Illinois Healthcare and Family Services (HFS) is implementing major billing changes for therapy services effective July 1, 2012, including annual caps of 20 visits per discipline for adult patients, new prior authorization requirements, and mandatory billing under individual therapist NPIs starting January 2013. All therapy services for adults 21+ will require prior approval, and specific CPT codes must be used with designated modifiers.
Action Required
By July 1, 2012: Implement 20-visit annual caps for adult therapy services and obtain prior authorization for all adult therapy treatment services (CPT 97110, 92507). Stop using modifier U6. By January 1, 2013: Begin billing all therapy services under individual therapist NPIs instead of hospital NPIs. Update billing system to require modifiers GP (physical therapy), GO (occupational therapy), and GN (speech therapy) for respective services. Enroll all salaried therapists with HFS as soon as possible.