MedicaidPrior AuthMedium impact
Removal of Certain Prior Approval Requirements and Changes to Quantity Limits
Illinois Medicaid - HFS·IL · Orthopedics, PM&R (Physical Medicine & Rehab), General Practice·Provider Notice
Effective date
Nov 1, 2008
We identified it
Jun 21, 2026
Summary
Illinois Medicaid removed prior authorization requirements for 138 durable medical equipment (DME) and orthotic/prosthetic codes and increased quantity limits on 14 supply items. These changes reduce administrative burden for affected equipment and supplies by eliminating the need for pre-approval.
Action Required
Review the specific HCPCS codes listed in the 'Changes from Previous Posted Listing' document at http://www.hfs.illinois.gov/reimbursement/dme.html and update billing workflows to remove prior authorization steps for the 138 affected DME and orthotic/prosthetic codes when billing Illinois Medicaid. Update quantity limit settings for the 14 supply item codes in billing system.