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Provider Notice Issued 04/04/2023

Date:    April 4, 2023

To:       Enrolled Durable Medical Equipment and Supplies Providers; Physical, Occupational, and Speech Therapists; Home Health Agencies; Local Health Departments; and Hospitals

Re:       Resumption of Prior Approval Requirements at Public Health Emergency End ___________________________________________________________________________________________________________________________________________________

This notice provides information regarding prior approval (PA) requirements that will resume at the end of the COVID-19 public health emergency (PHE). The PHE is scheduled to end on May 11, 2023. The PA requirements discussed in this notice apply to the Department of Healthcare and Family Services' (HFS) fee-for-service (FFS) program, HealthChoice Illinois managed care organizations (MCOs) and the Medicare/Medicaid Alignment Initiative (MMAI) plans.

HFS provider notices dated April 6, 2020, and May 18, 2020, informed providers of temporary changes in PA requirements intended to promote social distancing, reduce barriers to participant access to services, and ease the administrative burden on providers during the PHE. These temporary changes will no longer be in effect after the end of the PHE, and all PA requests will require clinical justification and a valid practitioner order. Detailed PA policies for therapy, home health, and durable medical equipment and supplies are contained in those programs' provider handbooks. Providers should refer to their applicable handbook for specifics regarding their usual PA process.

Effective with dates of service on and after May 12, 2023, prior approval requirements will resume with the same requirements in place prior to the PHE for the following items and services:


Procedure Code Description
97110 Individual therapy procedure using exercise to develop strength, endurance, range of motion and flexibility, each 15 minutes. Billed by Physical Therapists and Occupational Therapists.
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual. Billed by Speech Therapists.

Home Health
Reminder: Per existing home health policy,  PA requirements do not apply to skilled nursing and home health aide services for the first 60 days following an inpatient hospital discharge, if start of care begins within 14 days of an inpatient discharge date from an acute care or rehabilitation hospital.


Procedure Code Description
G0299 Direct skilled nursing services, registered nurse, each 15 minutes
G0300 Direct skilled nursing services, licensed practical nurse, each 15 minutes
G0151 Physical therapist services, each 15 minutes
G0152 Occupational therapist services, each 15 minutes
G0153 Speech pathologist services, each 15 minutes
G0156 Home health aide services, each 15 minutes 

Durable Medical Equipment (DME)
Reminder: HFS will normally only rent equipment for ten (10) months. Once the patient has had the piece of equipment in the home for ten months, it is considered purchased and patient-owned and should not be submitted for consideration of additional rental.

Procedure Code Description
E0260 Hospital bed, semi-electric, with rails, with mattress 
E0431 Portable gaseous oxygen system, rental, with portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing
E0434 Portable liquid oxygen system, rental; with portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing.
E0439 Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing
E0441 Stationary oxygen contents, gaseous, 1 month's supply = 1 unit
E0442 Stationary oxygen contents, liquid, 1 month's supply = 1 unit
E0443 Portable oxygen contents, gaseous, 1 month's supply = 1 unit
E0444 Portable oxygen contents, liquid, 1 month's supply = 1 unit
E0445 Oximeter device for measuring blood oxygen  levels non-invasively
E0465 Home ventilator, any type, used with invasive interface e.g., tracheostomy tube
E0466 Home ventilator, any type, used with non-invasive interface e.g., mask, chest shell
E0470 BiPap without backup rate feature, used with noninvasive interface e.g., nasal or facial mask
E0471 BiPap with backup rate feature, used with noninvasive interface e.g., nasal or facial mask
E0472 BiPap with backup rate feature, used with invasive interface, e.g., tracheostomy tube
E0562 Humidifier, heated, used with positive airway pressure device
E0565 Compressor, air power source for equipment which is not self-contained or cylinder driven
E0600 Respiratory suction pump, home model, portable or stationary, electric
E0601 Continuous positive airway pressure (CPAP) device
E0776 IV pole                                          
E0779 Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater
E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate
E1392 Portable oxygen concentrator, rental
K0738 Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing.                       
S8999 Resuscitation bag (for use by patient on artificial respiration during power failure or other catastrophic event)    

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS prior approvals, or the applicable managed care plan.

Kelly Cunningham, Administrator
Division of Medical Programs