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Elizabeth M. Whitehorn, Director

Provider Notice issued 06/26/2023

 

Date: June 26, 2023
​To: Enrolled Physicians; Physician Assistants; Advanced Practice Registered Nurses; and Hospitals 
​Re: Rate Increase for Breast Tomosynthesis Procedures Effective January 1, 2023, per Public Act 102-1018

This notice confirms rate increases for breast tomosynthesis procedures in accordance with Public Act 102-1018. These changes affect both Medicaid fee-for-service (FFS) and the HealthChoice Illinois (HCI) managed care organizations (MCOs).

The federal Centers for Medicare & Medicaid Services (CMS) recently approved the Department of Healthcare and Family Services’ (HFS) State Plan Amendment for the increased rates. Per the Act, the rates have been increased to the Medicare Chicago Metropolitan rate for those practitioners participating in the Breast Cancer Quality Screening and Treatment Initiative. The rate increases will be reflected on the next posted update of the Practitioner Fee Schedule.

 

Procedure Code

Description

Rate Effective 01/01/23

 

G0279

Diagnostic digital breast tomosynthesis, unilateral/bilateral

$56.06

77063

Screening digital breast tomosynthesis; bilateral

$56.06

 

Providers may submit a replacement claim for any claim that has already been reimbursed at the old rate. Replacement claim instructions are found in the Chapter 300 Companion Guide for Professional 837P transactions.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS customers, or the applicable HCI MCO.

 

Kelly Cunningham, Administrator
Division of Medical Programs