Agencies
Services
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:
Therapy
| 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