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Provider Notice Issued 05/11/2022

Date:    May 11, 2022 

To:       Enrolled Physicians; Advanced Practice Nurses; Physician Assistants; and Hospitals 

Re:      Abortion Services

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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



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Illinois Department of Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director