MedicaidPrior AuthMedium impact
Wound Care Treatment
Illinois Medicaid - HFS·IL · Wound Care, General Surgery, Plastic Surgery +1 more·Provider Notice
Effective date
Apr 30, 2003
We identified it
Jun 21, 2026
Summary
This Illinois Medicaid policy requires providers to use routine wound care for at least 30 days before requesting specialized treatments like Negative Pressure Wound Therapy (Wound V.A.C.) or Warm-Up Therapy. Prior authorization is required for specialized wound care with documentation of medical necessity including wound measurements and treatment history.
Action Required
For Illinois Medicaid patients: Update billing workflows to require 30-day routine wound care trial before requesting prior authorization for specialized wound treatments (Wound V.A.C., Warm-Up Therapy). Documentation must include initial wound measurements, current measurements, and detailed history of routine care attempts. LTC facilities cannot bill Medicaid for preventable decubitus ulcer treatment. Contact Bureau of Comprehensive Health Services at 217-782-5565 for billing questions.