MedicaidBilling CodesHigh impact
Mental Health Procedure Code and Modifier Issues
Illinois Medicaid - HFS·IL · Psychiatry·Provider Notice
Effective date
Jul 1, 2005
We identified it
Jun 21, 2026
Summary
Multiple mental health billing code changes are taking effect July 1, 2005, including replacing incorrect code T1052 with T1502 for medication administration, correcting reimbursement rates for case management code T1016 with HO modifier, and requiring new modifiers SA or 52 for CPT 90862 when performed by non-physicians. The incorrect T1052 code will be rejected for all service dates on or after July 1, 2005.
Action Required
By July 1, 2005: Billing team must immediately stop using code T1052 and switch to T1502 for all medication administration services. Update billing system to require modifier SA (for advanced practice nurses) or modifier 52 (for non-physician, non-APN staff) when billing CPT 90862 for pharmacologic management services not performed by physicians. Verify correct reimbursement rates for T1016 with HO modifier ($17.88 on-site, $19.86 off-site per quarter-hour). Claims using T1052 after July 1 will be rejected.