MedicaidBilling CodesMedium impact
Procedure Code S5190
Illinois Medicaid - HFS·IL · Family Medicine, Internal Medicine, General Practice·Provider Notice
Effective date
Apr 23, 2012
We identified it
Jun 20, 2026
Summary
Illinois Medicaid requires FQHCs, ERCs, and RHCs to use procedure code S5190 for wellness assessments by non-physicians when visits don't meet face-to-face encounter requirements. Claims with S5190 must include at least one additional covered procedure code and cannot be billed with evaluation/management codes or T1015.
Action Required
For Illinois Medicaid claims: Billing team must configure system to use S5190 for wellness assessments by non-physicians at FQHCs/ERCs/RHCs when face-to-face encounters aren't met. Ensure S5190 claims always include at least one additional covered procedure code. Update system to prevent billing S5190 with T1015 or E&M codes (99201-99215, 99381-99395) to avoid H47 rejection errors.