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Provider Notice Issued 04/13/2021


Date:   April 13,2021


To:       Enrolled Durable Medical Equipment and Supplies Providers; Hospitals; and Pharmacies


Re:      Chapter M-200, Handbook for Providers of Medical Equipment and Supplies

            New Topic M-213.4 - Medical Foods



This bulletin announces coverage of medical foods for persons from birth through age 20 with inborn errors of metabolism. This coverage policy applies to participants covered under Medicaid fee-for-service as well as participants enrolled in a HealthChoice Illinois managed care plan. Contact the applicable managed care plan for specific approval and billing requirements.  


Effective retroactively to November 25, 2020, medical foods may be requested for participants age 0-20 affected by the following inborn errors of metabolism:

  1. Phenylketonuria
  2. Maple Syrup Urine Disease
  3. Homocystinuria


Form HFS 1313, Medical Food Nutrition Review Questionnaire, must be completed by the prescribing practitioner and submitted with the HFS 1409 - Prior Approval Request, a copy of the prescription, and other supporting material as noted in the HFS 1313.


The Handbook for Providers of Medical Equipment and Supplies has been updated with Topic M-213.4 – Medical Foods and is available on the Department’s website. Questions regarding this bulletin may be directed to a DME medical assistance consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.


Instructions for updating the Handbook for Providers of Medical Equipment and Supplies:


Topic M-213.4

Remove page HFS M-213 (1) and replace with pages HFS M-213 (1) and (2).



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Illinois Department of Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director