MedicaidCoverageHigh impact
Non-Coverage of Specified Services for Hospice-Enrolled Participants
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jul 1, 2012
We identified it
Jun 20, 2026
Summary
Effective July 1, 2012, Medicaid will no longer cover a wide range of services (including dental, physical therapy, medical equipment, and home health) for patients enrolled in hospice programs when provided by non-hospice providers. Physician and nurse practitioner services will only be reimbursed if marked as unrelated to terminal illness using the 'GW' modifier.
Action Required
Immediately: Billing team must update system to use 'GW' modifier for all physician and nurse practitioner services provided to hospice-enrolled Medicaid patients when the service is unrelated to terminal illness. Stop billing Medicaid for dental, optometry, nursing, therapy, audiology, clinic, psychiatric, equipment, transportation, social work, and home health services for hospice patients. Claims for eliminated services will be denied with error codes R89 (institutional) or G52 (non-institutional).