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Provider Notice Issued 09/06/2022

Date:   September 6, 2022

To:       All Medical Assistance Program Providers

Re:      Abortion Services - Rate Increase and Billing Change    

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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 CodeDescriptionNew Rate
59840Induced abortion by dilation and curettage$792.00
59841Induced abortion by dilation and evacuation$1,920.00
S0199Medically 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

 



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