MedicaidPrior AuthHigh impact
Changes for Physical, Occupational and Speech Therapy Services
Illinois Medicaid - HFS·IL · Physical Therapy, Occupational Therapy, Speech Therapy +1 more·Provider Notice
Effective date
Jul 1, 2012
We identified it
Jun 20, 2026
Summary
Beginning July 1, 2012, Medicaid implemented a 20-visit annual cap per therapy discipline for patients 21+ and requires prior authorization for all therapy services except initial evaluations. Medicare crossover claims are exempt from prior auth if Medicare approves the service.
Action Required
Immediately: Update billing system to require prior authorization for all physical, occupational, and speech therapy services for Medicaid patients 21+ (except initial evaluations CPT 97001, 97003, 92506). Track annual visit counts per discipline with 20-visit cap per fiscal year (July 1-June 30). Contact Bureau of Comprehensive Health Services at 1-877-782-5565 for prior authorization requests. Claims without required prior auth will be denied.