MedicaidCoverageHigh impact
Billing for Psychiatric Services
Illinois Medicaid - HFS·IL · Psychiatry·Provider Notice
Effective date
Nov 16, 2005
We identified it
Jun 21, 2026
Summary
This policy clarifies that Illinois Medicaid psychiatric services must be personally provided by the billing physician - services by psychologists, social workers, or nurse practitioners are not reimbursable under fee-for-service Medicaid. Billing is limited to actual direct patient care time only, excluding documentation time.
Action Required
Immediately: Billing team must ensure all psychiatric service claims to Illinois Medicaid are billed only by the physician who personally provided the service. Stop billing for psychiatric services provided by psychologists, social workers, or nurse practitioners under fee-for-service Medicaid. Update billing procedures to limit psychiatric service time to actual direct patient care only, excluding documentation time. Non-compliance may result in payment recoupment during audits.