Traditional MedicareBilling CodesMedium impact
Medicare Part D Copayment Billing for SLF and CILA Residents REVISED INSTRUCTIONS
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Jun 6, 2006
We identified it
Jun 21, 2026
Summary
Illinois Medicaid has revised billing instructions for Medicare Part D copayment claims for residents of Skilled Living Facilities (SLF) and Community Integrated Living Arrangements (CILA). The key change is that the Usual and Customary Charge Field (426-DQ) should now contain the amount charged to cash customers for the prescription, not $0 as previously instructed.
Action Required
Immediately: Pharmacy billing staff must update billing system to populate the Usual and Customary Charge Field (426-DQ) with the actual amount charged to cash customers for prescriptions (excluding sales tax) when billing copay-only claims for Medicare Part D enrollees in SLF and CILA facilities. Do not enter $0 in this field. Ensure all other NCPDP fields remain configured per existing instructions. Contact HFS Pharmacy Billing Consultants at 217-782-5565 with questions.