Date: September 6, 2022
To: All Medical Assistance Program Providers
Re: Abortion Services - Rate Increase and Billing Change
This notice announces rate increases and a billing change related to abortion procedures. All abortion procedures continue to be billed directly to the Department of Healthcare and Family Services (HFS), regardless if the customer is covered under the Medicaid fee-for-service (FFS) program, a HealthChoice Illinois (HCI) managed care organization (MCO) plan, or a Medicare-Medicaid Alignment Initiative (MMAI) plan.
Effective with dates of service beginning August 1, 2022, providers will not be required to bill Medicare as the primary insurance for abortion procedures for MMAI plan customers (dual Medicare and Medicaid coverage). Since Medicare provides abortion coverage only in limited circumstances, HFS claim editing has been modified to allow a claim to process without Medicare payer information.
Effective with dates of service beginning September 1, 2022, rates for surgical abortion and medication abortion services will be increased as follows:
|Procedure Code||Description||New Rate|
|59840||Induced abortion by dilation and curettage||$792.00|
|59841||Induced abortion by dilation and evacuation||$1,920.00|
|S0199||Medically induced abortion by oral ingestion of medication including all associated services and supplies except drugs||$558.00|
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.
Kelly Cunningham, Administrator
Division of Medical Programs