Illinois Medicaid to Cut Physician Reimbursement by 16.75%

Illinois Department of Healthcare and Family ServicesAccording to a notice from the Illinois Dept. of Healthcare and Family Services, physicians who bill Medicaid directly and/or are paid according to the current Illinois Medicaid fee schedule will experience a 16.75 percent cut in reimbursement rates, for services rendered between May 1 and June 30, 2015, significantly impacting Illinois physicians and other mid-level/ancillary providers for these two months. In April, lawmakers passed a bill (H.B. 318) to “plug a $1.6 billion hole” for the current budget ending June 30. A portion of this budget deficit will be met by a 2.25 percent across-the-board cut to most government programs, including Medicaid’s reimbursement rates to physicians. In order to cover Medicaid’s budget shortfall, Illinois is implementing $106 million in cuts. The cuts must account for the entire fiscal year in just two months, thus the 2.25 percent cut will actually be a cut of 16.75 as the reimbursement rates will be annualized for services rendered between May 1 and June 30, 2015. The rate reduction includes all services provided by a physician, mid-level or ancillary staff services billed under the physician’s NPI and services rendered by an advanced practice nurse. The revised Illinois Medicaid Fee Schedule effective May 1, 2015 can be found here. However, reimbursement rates for some codes will not be reduced due to a previous court decision protecting specific primary care services.  These CPT codes are as follows:

  • 99213 Office or Other Outpatient Visit, Established Patient, Expanded Focus
  • 99214 Office or Other Outpatient Visit, Established Outpatient, Detailed to Moderate Complex
  • 99381 Initial Evaluation Healthy Infant less than one Year; Preventative
  • 99382 Initial Evaluation Healthy Child, one Year through four Years; Preventative
  • 99383 Initial Evaluation Healthy Child, five Years through eleven Years; Preventative
  • 99384 Initial Evaluation Healthy Adolescent 12 through 17 Years; Preventative
  • 99385 Initial Evaluation Healthy. 18-39 Years; Preventative
  • 99391 Periodic Re-Evaluation Establish Infant, Preventative less than one Year
  • 99392 Periodic Re-Evaluation Healthy Child one through four Years; Preventative
  • 99393 Periodic Re-Evaluation Healthy Child 5 through 11 Years; Preventative
  • 99394 Periodic Re-Evaluation Healthy Adolescent 12 through 17 Years; Preventative
  • 99395 Periodic Comprehensive Preventive. Evaluation Management; 18-39 Years

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