MedicaidBilling CodesHigh impact
Coding Update for Behavioral Health Screenings Effective August 1, 2026
Illinois Medicaid - HFS·IL · Psychiatry, Pediatrics, Family Medicine +2 more·Provider Notice
Effective date
Aug 1, 2026
We identified it
Jul 8, 2026
Summary
Effective August 1, 2026, providers must add modifier U1 (negative screening) or U2 (positive screening with follow-up plan) to CPT code 96127 for behavioral health screenings. Claims submitted without one of these modifiers will be rejected with error code L54. This applies to Illinois Medicaid FFS and HealthChoice Illinois MCO plans. Depression screening codes G8431 and G8510 continue unchanged.
Action Required
By July 31, 2026: Billing team must update billing system to REQUIRE either modifier U1 or U2 on all CPT 96127 claims for Illinois Medicaid FFS and HCI MCO patients. Update encounter forms and templates to include U1/U2 modifier selection for behavioral health screenings. Add validation rules to reject claims missing these modifiers before submission. Train all providers, PAs, APRNs, and clinical staff on proper modifier usage (U1 = negative result; U2 = positive result with documented follow-up plan). For positive screenings, ensure providers document follow-up plans in the medical record (e.g., ongoing monitoring, referral to behavioral health clinician, referral to CCSO for youth under 21, or Early Intervention referral for children under 3). Failure to include modifiers will result in claim denials with error code L54. Contact HFS.BBH@illinois.gov for policy questions or 1-877-782-5565 for billing support.