← Back to list
Ambulatory Procedures Listing (APL) Conversion to Health Care Procedure Coding System (HCPCS) Procedure Codes Policy and Billing Changes for HIPAA Compliance
Act
immediately
Effective date
Not stated in the notice
Identified
Jun 21, 2026
Summary
Illinois Medicaid is implementing HIPAA-compliant changes requiring hospitals and ambulatory surgical treatment centers to submit both HCPCS/CPT codes and APL ICD-9 CM procedure codes on claims, while eliminating several state-specific billing practices. Multiple billing form requirements are changing including spenddown reporting, Medicare crossover claims, and physician identification fields.
Get alerts when payers change rules like this one
We check Illinois Medicaid - HFS and other payers every day and email you when a change matches your specialty and state.
Get Illinois Medicaid - HFS alertsPolicy Monitoring is free. No card required.
What to do
immediately · 6 steps
01Update billing systems to require both HCPCS/CPT codes in FL 44 of UB-92 forms (Loop ID 2400 for electronic claims) AND APL ICD-9 CM procedure codes for all hospital outpatient and ASTC services.
02Stop billing state procedure code 0098 for DCFS screening exams - use Source of Admission 8 instead.
03Replace FL 54P spenddown reporting with value code 66 in FLs 39-41 A-D.
04Update Medicare crossover claims to use value code 24 for units reporting.
05Remove AMA Medical Education Numbers from physician ID fields.
06Claims missing required HCPCS/CPT codes will be rejected.
Original notice
Ambulatory Procedures Listing (APL) Conversion to Health Care Procedure Coding System (HCPCS) Procedure Codes Policy and Billing Changes for HIPAA Compliance
hfs.illinois.gov · Always check the source before changing claims.
Related changes
See all Illinois Medicaid - HFS changes →HIPAA Implementation Status Update and Contingency Plan InformationHighEffective Oct 16, 2003 · Provider NoticeHIPAA Readiness February 2004 UpdateHighEffective Apr 1, 2004 · Provider NoticeAmbulatory Procedures Listing (APL) Code Additions Retroactive to July 1, 2004MediumEffective Jul 1, 2004 · Provider NoticeBrowse every Illinois Medicaid - HFS change in the policy list