MedicaidReimbursementHigh 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
Illinois Medicaid - HFS·IL · Nephrology, Geriatrics·Provider Notice
Effective date
Jun 1, 2026
We identified it
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.
Action Required
By June 1, 2026: (1) Billing team must update billing software to require revenue codes 0821 (hemodialysis), 0831 (peritoneal dialysis), 0841 (CAPD), or 0851 (CCPD) based on dialysis type. (2) Configure system to automatically append Condition Code 74 for home dialysis claims and Condition Code 80 for long-term care facility claims. (3) Update claim submission workflow to verify nursing facility coverage in HFS Recipient Data Base before billing. (4) For fee-for-service claims: No rebilling needed for 3/7 rate adjustment—HFS will adjust automatically. (5) For 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. (6) Train billing and coding staff on new revenue code requirements and condition code placement. Failure to use correct codes will result in claim denials or loss of $95.00 add-on reimbursement. Contact Bureau of Professional and Ancillary Services at 877-782-5565 (fee-for-service) or applicable MCO for questions.