Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Illinois Medicaid - HFSMedicaid · Reimbursement · Provider Notice · IL · Nephrology, GeriatricsHigh impact

Changes to Renal Dialysis Billing and Payment and Renal Dialysis $95.00 Add-On Payment Per Public Act 103-0593 for Long Term Care Residents

Act
by Jun 1, 2026
Effective date
Jun 1, 2026
Identified
Jul 1, 2026

Summary

Illinois HFS updated renal dialysis billing effective June 1, 2026, requiring specific revenue codes (0821, 0831, 0841, 0851) with condition codes 74 (home dialysis) or 80 (long-term care). Home-based CAPD/CCPD services now pay at full facility rates instead of 3/7th rate. A new $95.00 add-on payment per treatment day applies for nursing facility residents receiving dialysis; providers must rebill prior claims to receive this add-on.

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

by Jun 1, 2026 · 8 steps
01Billing team must update billing software to require revenue codes 0821 (hemodialysis), 0831 (peritoneal dialysis), 0841 (CAPD), or 0851 (CCPD) based on dialysis type.
02Configure system to automatically append Condition Code 74 for home dialysis claims and Condition Code 80 for long-term care facility claims.
03Update claim submission workflow to verify nursing facility coverage in HFS Recipient Data Base before billing.
04For fee-for-service claims: No rebilling needed for 3/7 rate adjustment—HFS will adjust automatically.
05For managed care and nursing facility residents: Identify all claims from June 1, 2026 forward for CAPD/CCPD home dialysis services; void and rebill with Condition Code 80 to capture the $95.00 add-on payment per treatment day.
06Train billing and coding staff on new revenue code requirements and condition code placement.
07Failure to use correct codes will result in claim denials or loss of $95.00 add-on reimbursement.
08Contact Bureau of Professional and Ancillary Services at 877-782-5565 (fee-for-service) or applicable MCO for questions.

Original notice

Changes to Renal Dialysis Billing and Payment and Renal Dialysis $95.00 Add-On Payment Per Public Act 103-0593 for Long Term Care Residents
hfs.illinois.gov · Always check the source before changing claims.
View original ↗

Related policy hubs

Illinois Medicaid - HFS policiesIL policy changesNephrologyGeriatrics

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account