MedicaidCoverageMedium impact
Change to Group Psychotherapy Effective July 1, 2012
Illinois Medicaid - HFS·IL · Psychiatry·Provider Notice
Effective date
Jul 1, 2012
We identified it
Jun 20, 2026
Summary
Effective July 1, 2012, Illinois Medicaid (HFS) eliminated coverage for group psychotherapy services (CPT codes 90853 and 90857) for patients residing in nursing facilities, including institutions for mental diseases or facilities licensed under the Specialized Mental Health Rehabilitation Act. This change was implemented as part of the SMART Act to reduce Medicaid costs.
Action Required
Immediately: Stop billing CPT codes 90853 and 90857 for group psychotherapy services provided to patients residing in nursing facilities for Illinois Medicaid claims. Billing team must update system to flag these scenarios and prevent claim submission. Update encounter forms to alert providers of this restriction for nursing facility residents.