MedicaidBilling CodesHigh impact
Ambulatory Procedures Listing (APL) Conversion to Health Care Procedure Coding System (HCPCS) Procedure Codes Policy and Billing Changes for HIPAA Compliance
Illinois Medicaid - HFS·IL·Provider Notice
We identified it
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.
Action Required
Immediately: Update 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. Stop billing state procedure code 0098 for DCFS screening exams - use Source of Admission 8 instead. Replace FL 54P spenddown reporting with value code 66 in FLs 39-41 A-D. Update Medicare crossover claims to use value code 24 for units reporting. Remove AMA Medical Education Numbers from physician ID fields. Claims missing required HCPCS/CPT codes will be rejected.