Provider Notice issued 05/01/2026

The Department of Healthcare and Family Services (HFS) received approval from Federal Centers of Medicare & Medicaid Services (CMS) to provide coverage for Licensed Certified Professional Midwife (LCPM) services required under Public Act 103-0720. Providers may enroll and bill for midwifery services as of May 1, 2026. This coverage applies to the Medicaid fee-for-service (FFS) program and the HealthChoice Illinois managed care organizations (MCOs).

Medicaid Provider Educational Materials and Webinars for LCPMs

The Medicaid Technical Assistance Center (MTAC), in partnership with HFS, has prepared enhanced Medicaid onboarding educational materials and supports to aid LCPMs in the enrollment process. This includes a Medicaid provider overview specifically for LCPMs, how to obtain a National Provider Identifier (NPI), and how to enroll in IMPACT, the Illinois Medicaid provider enrollment system.

Please visit the MTAC Learning Center to register for an MTAC Learning Center account and access training registration links. Available training dates and times can also be found on the MTAC Calendar of Events located at the following link: mtaccalendar   LCPMs may also reach MTAC for technical assistance support at mtac.maternalhealth@uillinois.edu.

Covered Services

Licensed Certified Professional Midwives (LCPM) offer care, education, counseling and support to pregnant individuals and their families throughout pregnancy and birth, as well as maternal and well-baby care through the postpartum period. 

The following maternity services are covered when performed within the LCPM’s scope of practice and training:  

·         Initial and ongoing comprehensive assessment, diagnosis, and treatment during pregnancy, labor and delivery, postpartum, and newborn care;  

·         Conducting physical examinations;  

·         Administering medications and use devices, as permitted with the Licensed CPM’s scope of practice and training;  

·         Ordering and interpreting allowable laboratory and diagnostic tests; and,   

·         Consultation, referral, and/or linkage to other healthcare professionals.   

Provider Enrollment through HFS

LCPMs may enroll and receive reimbursement for covered maternity services. For the purposes of enrolling as a LCPM in the Medical Assistance Program, practitioners must be at least 18 years of age and meet the following qualifications: 

·         Licensed by the Illinois Department for Financial and Professional Regulations (IDFPR), or equivalent licensing body in the LCPM’s state of practice  

To enroll with HFS as a LCPM, practitioners must upload a copy of the license issued by IDFPR during the provider enrollment process with HFS.

LCPM services are reimbursable to those enrolled in the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) provider enrollment system. LCPMs should review the IMPACT Account Activation Instructions for New External IMPACT Users.

In IMPACT, an LCPM must select an Enrollment Type of either:

1.)  Rendering/Servicing Provider – An individual provider who will be rendering services to Medicaid customers but will not be submitting claims directly to the State for reimbursement. Enrolling as a Rendering provider requires that you associate with a Group Practice or Facility, Agency, Organization (FAO) as a billing provider in the IMPACT system and would not allow you to bill for yourself.

2.)  Regular Individual/Sole Proprietor – A provider that owns his/her own practice. A Sole Proprietor may receive payments directly or associate to Billing Providers and/or Billing Agents. If you enroll as a Sole Proprietor, you can still also associate with a Group Practice or FAO as your Billing Provider(s) and they may bill on your behalf, but this is optional. You can use this enrollment option to work as part of an organization and/or bill for yourself.

LCPMs must have a National Provider Identifier (NPI) in order to enroll. Information about obtaining an NPI is located on the CMS website.

Billable Procedure Codes

The LCPM fee schedule, found on the Medicaid Reimbursements webpage, provides detailed information on billable codes, modifiers, services allowed via telehealth delivery and rates.  For further information and details regarding maternity care billing please refer to the ‘Billing Guidelines for Changes to Maternity Care Reimbursement’ document found on the Non-Institutional Provider Services webpage.

Claim Submission

Claim Format

LCPM services are billed electronically on the 837 Professional transaction. Information regarding electronic 837P transactions may be found in the Chapter 300 Companion Guide. Claims may also be submitted via direct data entry within the MEDI system.

Please note: The postpartum visit incentive payment for CPT 59430 is reimbursable only when the visit occurs within 26 days from delivery date, and/or between 27-89 days of the delivery date. The actual delivery date must be reported on the claim to receive the incentive payment for the postpartum visit(s), provided the above timelines are met.  Providers must include the actual delivery date in Loop 2300, Segment DTP*454 ‘Initial Treatment Date’, of the 837P, or via Direct Data Entry (DDE) in MEDI.

Taxonomy Code

Taxonomy code for Certified Professional Midwife services: 176B00000X   This is the correct taxonomy that should be used on claims submitted for LCPM services.

Telehealth

The telehealth delivery method is allowable for services as indicated on the LCPM fee schedule modifier GT (Via Audio and Video Telecommunications Systems) or 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system) and place of service 02 (Telehealth Provided Other than in Patient’s Home) or 10 (Telehealth Provided in Patient’s Home), as applicable.

Questions regarding this notice, fee-for-service (FFS) billing and claim support, or requests to schedule a MEDI training for FFS billing, may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.  Providers should contact the applicable MCO plan for questions, claims assistance, or billing guidance for customers enrolled in managed care.

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