Date: November 19, 2021
To: All Medical Assistance Program Providers
Re: Confirmation of Treatment for Port-Wine Stains Not Solely for Cosmetic Purposes per Public Act 102-0642
This notice confirms the Department's coverage of treatment for port-wine stains, not limited to children and not solely for cosmetic purposes, as required by Public Act 102-0642. Coverage is provided under both Medicaid fee-for-service and the managed care plans.
The Act requires the Department to follow the Illinois Insurance Code, which states a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after January 1, 2022 shall provide coverage for treatment to eliminate or provide maximum feasible treatment of nevus flammeus, also known as port-wine stains, including, but not limited to, port-wine stains caused by Sturge-Weber syndrome. Treatment or maximum feasible treatment shall include early intervention treatment, including topical, intralesional, or systemic medical therapy and surgery, and laser treatments approved by the U.S. Food and Drug Administration in children aged 18 years and younger that are intended to prevent functional impairment related to vision function, oral function, inflammation, bleeding, infection, and other medical complications associated with port-wine stains. Coverage for treatment required shall not include treatment solely for cosmetic purposes.
The Department already covers all medically necessary treatment services, and no coverage changes are necessary.
Questions regarding this notice may be directed to a billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565, or to the applicable managed care plan.
Kelly Cunningham, Administrator
Division of Medical Programs