MedicaidBilling CodesMedium impact
Perinatal Human Immunodeficiency Virus (HIV) Testing
Illinois Medicaid - HFS·IL · OB-GYN, Pediatrics, Family Medicine·Provider Notice
We identified it
Jun 21, 2026
Summary
Illinois Healthcare and Family Services now covers rapid HIV testing for pregnant women and newborns with specific billing requirements. The policy establishes reimbursement at $11.60 using CPT code 86701 with QW modifier for eligible providers including physicians, laboratories, and healthcare facilities.
Action Required
Immediately: Billing team must ensure rapid HIV testing is billed using CPT code 86701 with QW modifier for pregnant women and newborns. Verify reimbursement rate is set to $11.60 in billing system. FQHCs, RHCs and ERCs must include detailed CPT codes when billing encounters. Update encounter forms to include this code for eligible providers (physicians, laboratories, FQHCs, RHCs, ERCs, hospitals).