Provider Notice issued 11/03/2025

Changes to Billing Procedures for Emergency Contraception, Confirmation of Coverage for Patient Care Services Provided by a Pharmacist for Contraceptives per Public Act 104-0312 and Coverage of Home Pregnancy Tests 

This notice serves to inform providers of changes to billing procedures for emergency contraception and confirms the Department of Healthcare and Family Services’ (HFS) coverage of patient care services provided by a pharmacist for contraceptives, including emergency contraceptives. This coverage is required under Public Act 104-0312.  This notice also provides information regarding coverage of home pregnancy testing.  

The Act requires HFS to provide coverage for patient care services provided by a pharmacist for contraceptives, including emergency contraceptives. Coverage includes all FDA-approved contraceptives, including Opill, which is an over-the-counter birth control pill, and external condoms, as well as emergency contraception, including prescription and over-the-counter Plan B. As HFS already provides this coverage under the fee-for-service (FFS) program and managed care organizations (MCOs), without a prescription for individuals of childbearing age, no coverage changes are necessary.

Prior to the signing of Public Act 104-0312, use of a dummy NPI was required to process fee-for-service claims when billing emergency contraception without a prescriber.  Now pharmacies may use the Illinois Department of Public Health (IDPH) standing order to bill all contraception including emergency contraception. 

Usage of that dummy NPI must now be replaced with the NPI of the IDPH standing order for contraception. Beginning with dates of service on or after November 1, 2025, the Department will no longer accept claims billed under the dummy NPI.

Additionally, in accordance with Public Act 103-0870 and effective January 1, 2025, HFS began providing reimbursement for two at-home, urine-based pregnancy tests every 30 days under the Medicaid FFS program and the MCOs.

These tests have been added to the OTC coverage list available on the HFS website. Pharmacies may utilize a standing order for the prescribing provider NPI.

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

Laura Phelan, Administrator 
Division of Medical Programs