MedicaidCoverageMedium impact
Coverage of Preventive Services for Adults
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jul 1, 2007
We identified it
Jun 21, 2026
Summary
Illinois Medicaid now covers preventive evaluation and management visits for adults age 21+ effective July 1, 2007. Two CPT code ranges are covered with specific reimbursement rates: 99385-99387 at $66.40 and 99395-99397 at $42.50, limited to one visit per patient per provider per year.
Action Required
Update billing system to include preventive E&M CPT codes 99385-99387 (reimbursement $66.40) and 99395-99397 (reimbursement $42.50) for Illinois Medicaid patients age 21+. Configure system to limit billing to one preventive visit per patient per provider per year. Train staff on proper use of preventive E&M codes versus regular office visit codes.