In this post, we’ll review the top 7 things anyone interested in billing Medicaid for addiction treatment services in Illinois needs to know to get the job done. Unlike some states, Illinois makes a lot of its billing and insurance information readily available on the internet - you just have to know where to look.
What is Medicaid called in Illinois?
Medicaid in Illinois doesn’t have a special nickname, like “Medical.” Sometimes the children’s plans are referred to as “All Kids” and many people simply call Medicaid “the medical card” in Illinois. Medicaid in Illinois is delivered through managed care plans, so often patients will refer to their individual plan names instead of talking about “Medicaid.” You can screen patients for Medicaid eligibility in Illinois online at Get Covered Illinois.
Where can I find a billing manual for addiction treatment billing for Medicaid patients in Illinois?
You can find the Illinois Association of Medicaid Health Plans (or IAMHP) Comprehensive Billing Manual on the IAMHP website. This manual provides a centralized core of billing information for Medicaid billing in Illinois, informing billing departments of billing and claims procedures that are static across all providers. No need to look up each health plan’s rules independently - the information in this manual is good for all Medicaid patients.
Does Medicaid cover addiction treatment services in Illinois?
Yes. Illinois refers to this type of care as “Substance Use Prevention and Recovery Services'' or SUPR for short. Illinois Medicaid covers residential, IOP and outpatient addiction treatment services. Specifically, Illinois Medicaid covers the following behavioral health services:
Mental health assessments
Treatment planning
Case management
Crisis intervention
Mental health intensive outpatient care (IOP)
Rehabilitation
Prescriptions to addressed mental health and behavioral health
Therapy and counseling
Day treatment services
Detox services
Ancillary psychiatric diagnosed services
Community-based behavioral health services
Residential treatment
MAT
Naloxone/Narcan
What are the best CPT codes to use for addiction treatment billing for Medicaid patients in Illinois?
The best codes to use for Medicaid-friendly addiction treatment billing in Illinois are the ones that are based on medical necessity and have received prior authorization, where necessary. The Behavioral Health Provider Manual offers a list of all of the allowable CPT codes for Medicaid billing in Illinois:
Admission and discharge assessment (H0002)
Psychiatric evaluation (90791)
Psychotropic medication monitoring (H2010)
Individual therapy/counseling, substance abuse (H0004)
Group therapy/counseling, substance abuse (H0005)
Individual-intensive outpatient, substance abuse (H0004)
Group-intensive outpatient, substance abuse (H0005)
Medication assisted treatment (MAT) methadone (H0020)
Case management waiver SUD, 21 and over (H0006)
Case management waiver SUD, 20 and under (H0006)
Peer recovery support, 21 and over (H2014)
Peer recovery support 20 and under (H2014)
Rehabilitation, 21 and over (H0047)
Rehabilitation, 20 and under (H0047)
Adolescent residential (H2036)
Detoxification (H0010)
Withdrawal management, 21 and over (H0012)
Withdrawal management, 20 and under (H0012)
Contains examples of correct and incorrectly coded claims.
You can see all the provider manuals here.
Does Illinois Medicaid cover peer support services?
Yes. The state began covering peer recovery support services in a pilot program initiated in 2019. This program supports peer recovery coaches who are supervised by licensed clinicians to help counsel and support those working a recovery program.
Peer recovery support can be billed under CPT code H2014, which represents on 15 minute unit of service.
Does Illinois Medicaid cover sober living homes?
No, Illinois Medicaid does not cover sober living homes. It does cover residential treatment but it does not cover recovery housing per se. While ASAM recently updated their criteria to support and encourage recovery housing, it is still not considered to be a part of the proper continuum of care for addiction treatment, for better or for worse. Medicaid programs typically use the ASAM criteria to establish their guidelines for eligible and ineligible services. For this reason, you’ll be hard pressed to find a state Medicaid program that does cover sober living.
How can I file Medicaid claims in Illinois for addiction treatment?
There are several ways to file a claim for addiction treatment services in Illinois. One of the most popular ways to do it is to use a third party billing service like Behave Health’s all-in-one EHR. However, you can still submit paper claims if you prefer. If you opt for paper, you can file an original CMS 1500 (red form), an 837P, or an 8371.
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PS. Just getting started with behavioral health? Need help with certification, too? Behave Health can also help direct you to the right resources for help with Licensing or Accreditation by either The Joint Commission or CARF. Mention to your product specialist that you’re interested in this service after you start your free trial!