Medicaid Illinois: Provider Notice Issued 07/15/2020

This notice informs providers that the Department is updating physician services’ rates effective with dates of service beginning July 1, 2020, to comply with Public Act 101-0650. The rates apply to services provided by specified provider types under both traditional fee-for-service and Medicaid managed care plans.

 New rates have been set at 60% of the Medicare rate in effect as of January 1, 2020, utilizing the rates of Illinois Locality 99 facility rates. The updated rates do not apply to anesthesia services, as those services already meet the percentage threshold. Updated rates also are not applicable to time-based assistant surgeon rates.

The rate updates are applicable to the following provider types:

• Physicians
• Advanced Practice Nurses
• Physician Assistants
• Local Health Departments

 Until the Department finalizes updates to the reimbursement system, claims affected by the rate updates for these and other provider types have been temporarily placed on hold. The Practitioner Fee Schedule will be updated with a new tab specifying the provider types and codes affected by these rate changes and an email notification will be sent when the new rates have been added.

Source: https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200715a.aspx