All PlansAdministrativeMedium impact
Utilization Review – Changes to Diagnosis Codes Subject to Review
Illinois Medicaid - HFS·IL · Endocrinology, Wound Care, Pulmonology +1 more·Provider Notice
Effective date
Jan 1, 2005
We identified it
Jun 21, 2026
Summary
ICD-9-CM diagnosis codes subject to utilization review are being updated effective January 1, 2005. Certain manifestation codes are being removed from review requirements, while new codes including diabetic complications and pressure ulcers are being added to concurrent review requirements.
Action Required
By January 1, 2005: Billing and coding staff must update utilization review processes to reflect new ICD-9-CM code requirements. Remove deleted manifestation codes (310.1, 293.0, 293.81, 293.82, 293.83, 293.84, 293.9, 294.0, 294.8, 294.9, 707.0) from review workflows. Add new codes requiring concurrent review (250.81, 453.40-453.42, 491.22, 707.00-707.07, 707.09) to pre-authorization and review processes. Update coding software and staff training materials accordingly.