MedicaidCoverageMedium impact
Billing for Preventive Services
Illinois Medicaid - HFS·IL · Family Medicine, General Practice, Pediatrics +1 more·Provider Notice
Effective date
May 9, 2011
We identified it
Jun 21, 2026
Summary
This policy reminds providers of billing requirements for preventive services under Medicaid, specifying that children age 0-20 can receive visits based on AAP/AAFP periodicity schedules, while adults 21+ are limited to one preventive visit per provider per year using age-appropriate CPT codes.
Action Required
Immediately: Review current preventive service billing practices to ensure compliance with AAP/AAFP periodicity schedules for pediatric patients and annual visit limits for adults. Billing team should verify that preventive E&M codes follow AMA guidelines and that adult patients are not scheduled for more than one preventive visit per provider per year to avoid claim denials.