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Provider Notice issued 06/30/12

Changes for Physical, Occupational and Speech Therapy Services

To:​ Participating: Physical, Occupational, and Speech Therapists; Physicians; Advanced Practice Nurses; Health Departments; and Home Health Agencies
​Date: ​June 30, 2012
​Re: Changes for Physical, Occupational and Speech Therapy Services​

As a result of Public Act 097-0689(pdf), referred to as the Save Medicaid Access and Resources Together (SMART) Act, effective July 1, 2012 HFS is implementing an annual cap of 20 visits per discipline per fiscal year (July 1- June 30) for physical, occupational and speech therapy services for participants 21 years of age and older.


This cap applies to all settings except inpatient, and includes those therapy services provided by home health agencies. Initial evaluations (CPT’s 97001, 97003 and 92506) and Medicare crossover claims will not be counted as part of the 20-visit cap.

Effective with dates of service on, and after July 1, 2012, providers must submit prior approval requests for all therapy services for participants 21 years of age and older. Initial evaluations as referenced above will not require prior approval. Please note this requirement includes therapy services provided to the following:

  • Participants who have been hospitalized within the last 30 days and were receiving therapy services while hospitalized.

  • Participants within a 60 day calendar day immediately following discharge from an acute care or rehabilitation hospital.

For Medicare/Medicaid crossover claims, if Medicare approves the service, claims will cross over without need for a prior approval. If Medicare denies the service, the service will require a prior approval.

Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs

Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director