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Illinois Medicaid - HFSMedicaid · Billing Codes · Provider Notice · IL · Psychiatry, Pediatrics, Family Medicine +2 moreHigh impact

Coding Update for Behavioral Health Screenings Effective August 1, 2026

Act
by Jul 31, 2026
Effective date
Aug 1, 2026
Identified
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.

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What to do

by Jul 31, 2026 · 7 steps
01Billing 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.
02Update encounter forms and templates to include U1/U2 modifier selection for behavioral health screenings.
03Add validation rules to reject claims missing these modifiers before submission.
04Train all providers, PAs, APRNs, and clinical staff on proper modifier usage (U1 = negative result; U2 = positive result with documented follow-up plan).
05For 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).
06Failure to include modifiers will result in claim denials with error code L54.
07Contact HFS.BBH@illinois.gov for policy questions or 1-877-782-5565 for billing support.

Codes mentioned

96127G8431G8510

Original notice

Coding Update for Behavioral Health Screenings Effective August 1, 2026
hfs.illinois.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Illinois Medicaid - HFS changes →
Coding Change for Depression Screenings Effective April 1, 2023HighEffective Apr 1, 2023 · Provider NoticeChanges to Current Procedural Terminology (CPT Codes)MediumEffective Jan 1, 2017 · Provider NoticeUse of Modifier GT and Place of Service Code 02 to Specify Telehealth Delivery Mode for Behavioral Health Services Effective October 1, 2021MediumEffective Oct 1, 2021 · Provider NoticeBrowse every Illinois Medicaid - HFS change in the policy list

Related policy hubs

Illinois Medicaid - HFS policiesIL policy changesPsychiatryPediatricsFamily MedicineInternal MedicineGeneral PracticeCode 96127Code G8431Code G8510

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