Date: May 11, 2022
To: Enrolled Physicians; Advanced Practice Nurses; Physician Assistants; and Hospitals
Re: Abortion Services
This notice is a reminder that Illinois is a freedom of choice state and all medical program claims for abortion services must be billed directly to the Department, including claims for managed care plan enrollees.
Freedom of Choice
Illinois is a freedom of choice state. Under Public Act 101-0013, Illinois state law affirmatively provides a right to reproductive healthcare, including abortion and maternity care. This state law ensures access to abortion services in Illinois even if Roe v. Wade were overturned.
Direct Billing for Abortion Services
All abortion services for both fee-for-service and managed care customers are state-only funded. Consequently, all claims that contain abortion procedures must be billed directly to the Department. This applies to claims submitted for customers covered under a HealthChoice Illinois managed care plan as well as traditional fee-for-service.
- 837 Professional: Providers must identify the abortion procedure code in Loop 2400, Segment SV101. Specific procedure code modifiers are not required.
- 837 Institutional: Hospitals must identify the abortion procedure code in Loop 2300, Reference HI*BG*AH~. Specific condition codes are not required
Procedure Coding for Practitioner Claims
Surgical abortion: The Department uses a global rate reimbursement structure. No ancillary services are billable.
Medication-assisted abortion: The Department uses a global rate reimbursement structure under the protocol for the use of Mifepristone. No ancillary services are billable.
- S0199 is open to allow for the global reimbursement of the required visits, laboratory services, and ultrasounds. S0199 by definition specifically excludes reimbursement for drugs.
- The procedure coding for the medications is: S0190 – Mifepristone,1st pill, and S0191 – Misoprostol, four pills.
Questions regarding this notice may be directed to a billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.
Kelly Cunningham, Administrator
Division of Medical Programs