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Elizabeth M. Whitehorn, Director

Provider Notice issued 10/18/2023

 

Date: October 18, 2023
​To: All Medical Assistance Providers 
​Re: Coverage of Acupuncture Services per Public Act 102-103

Pursuant to Public Act 102-1037, this notice announces coverage of acupuncture services for dates of service on or after April 1, 2023. This notice applies to the Medicaid fee-for-service (FFS) program and the HealthChoice Illinois (HCI) managed care organizations (MCOs). 

Provider Enrollment

Acupuncture services are reimbursable to licensed acupuncturists enrolled in the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) provider enrollment system as follows:

 

IMPACT Provider Type

IMPACT Specialty

IMPACT Subspecialty

Acupuncturist

Acupuncturist

No subspecialty

Primary specialty

Acupuncturists should review the IMPACT Account Activation Instructions for New External IMPACT Users and the Individual Sole Proprietor PowerPoint Presentation. Acupuncturists must enroll as an Individual/Sole Proprietor.      

Medical Necessity Requirements

Coverage of acupuncture services is limited to treatment of specific diagnoses relating to chronic low back pain and breech baby presentation as listed in the Acupuncture Fee Schedule.

Reimbursement

Procedure codes and corresponding rates for reimbursable acupuncture services can be found on the published Acupuncture Fee Schedule. Acupuncture services are reimbursed at 60% of the Medicare fee schedule.

Allowable Diagnosis Codes for Acupuncture Services.

To support medical necessity for acupuncture services, providers must report one of the diagnosis codes listed on the second tab of the Acupuncture Fee Schedule.

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

             

Kelly Cunningham, Administrator
Division of Medical Programs