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Elizabeth M. Whitehorn, Director

Provider Notice issued 05/13/2026

Mifepristone/Misoprostol Billing

To:
 Enrolled Physicians, Advanced Practice Nurses, Physician Assistants, Local Health Departments, Hospitals, Federally Qualified Health Centers, Rural Health Clinics, Encounter Rate Clinics, and Pharmacies 
​Re:
 Mifepristone/Misoprostol Billing
Date: May 13, 2026

This notice provides guidance regarding billing procedures for mifepristone and misoprostol when used for medical termination of early pregnancy. Mifepristone and misoprostol continue to be covered by Illinois Medicaid without prior authorization and are carved out of Managed Care Organization (MCO) plans for medication abortions. 

Coding for Practitioner Claims   
 

Medication abortion – Mifepristone/Misoprostol protocol: The Department uses a global rate reimbursement structure under the protocol for the use of Mifepristone. No ancillary services are billable.  
  

 

 

Applicable Code

 

 

 

 

Code Description

 

 

 

 

Dosage/Notes

 

 

 

 

S0199

 

 

 

 

Global reimbursement, incl. visits, laboratory services, ultrasounds

 

 

 

 

Does not include drug

 

 

 

 

S0190

 

 

 

 

Mifepristone

 

 

 

 

1st pill

 

 

 

 

S0191

 

 

 

 

Misoprostol

 

 

 

 

16 pills (200 mcg)

 

 

 

Medication abortion – Misoprostol protocol only: The Department uses a global rate reimbursement structure for the use of Misoprostol. No ancillary services are billable.  
  

 

 

Applicable Code

 

 

 

 

Code Description

 

 

 

 

Dosage/Notes

 

 

 

 

S0199

 

 

 

 

Global reimbursement, incl. visits, laboratory services, ultrasounds

 

 

 

 

Does not include drug

 

 

 

 

S0191

 

 

 

 

Misoprostol

 

 

 

 

16 pills (200 mcg)

 

 

 

Billing for Pharmacy Dispensed Medications 

Claims for mifepristone or misoprostol dispensed through a pharmacy for medication abortion must be submitted through the FeeForService (FFS) pointofsale (POS) system under the following guidelines:

  • Mifepristone 200 mg 

  • Dispensing is limited to pharmacies certified under the FDA REMS program.

  • Misoprostol when used as an abortifacient, including:

  • When prescribed together with mifepristone.

  • When prescribed alone at doses, such as:

  • 800 mcg, with possible repeat dosing every 3–4 hours for up to 4 doses.

  • When prescribed alone for incomplete miscarriage, typically:

  • A single 600–800 mcg dose, possibly repeated once.

These prescriptions reflect short term use, limited quantities, and higher dose regimens, indicating abortifacient use.

What is not Carved Out of Managed Care Billing

  • Prescriptions for Misoprostol provided as a monotherapy for its FDA-approved gastrointestinal indication may continue to be billed through the MCO. Typical dosing: 100–200 mcg, up to four times daily.

These prescriptions typically involve multi‑day supplies and lower tablet strengths, indicating gastrointestinal use.

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