Illinois Medicaid Fee Schedule 2026–2027: HFS Rates, CPT Codes & MCO Pay by Provider Type

Illinois Medicaid pays providers using official fee schedules. These schedules are set by the Illinois Department of Healthcare and Family Services (HFS), and there isn’t one master document — HFS publishes rates through more than 40 separate, provider-specific fee schedules, each covering a different license type or service category.

Every fee schedule is tied to a provider type enrolled through IMPACT, the state’s Medicaid provider enrollment system.

Rates get updated on a rolling basis throughout the year — sometimes more than once for the same provider type — so the file that applies to a claim depends on the date of service, not the date you happen to download it.

Quick Summary

• HFS publishes rates through 40+ separate fee schedules — not one master document — all indexed from the HFS Medicaid Reimbursement page.
• The current Practitioner Fee Schedule takes effect July 1, 2026, and was last updated August 11, 2026.
• Hospital, dental, FQHC, and nursing facility rates are also current for 2026, but each runs on its own separate schedule and update cycle.
• No dental rate-increase bill has been enacted. Both SB1580 (33%) and HB2552 (50%) remain stalled in committee as of September 2026 — see below.
• ABA therapy rates are unchanged since January 2022, even after HFS reissued the schedule in May 2026.
• Want to know if you qualify for coverage? Try our Medicaid eligibility calculator for 2026 to check in minutes.

Illinois Medicaid Fee Schedule by Provider Type (2026)

HFS doesn’t publish one Illinois Medicaid fee schedule — it publishes more than 40 of them, one per provider type, all indexed from the Medicaid Reimbursement page.

Each schedule has its own effective date, its own update history, and in some cases its own payment methodology entirely (per-diem hospital rates work nothing like per-unit ABA rates, for example).

To make more than 40 schedules usable, we’ve split them into two tiers: the categories most people search for, and the full list of everything else HFS publishes.

Tier 1: Core Provider Fee Schedules

These are the provider types most patients and providers look up — physicians, hospitals, dentists, and the other high-volume categories.

Most Tier 1 rates get reissued whenever the underlying CPT/HCPCS code set changes or the state budget calls for an update.

One statewide rule worth knowing: HFS applies a 2.7% rate reduction to a broad set of practitioner-based codes, but it explicitly exempts physicians, physician assistants, dentists, advanced practice nurses, FQHCs, RHCs, ERCs, and local health departments.

If your provider type isn’t on that exemption list, confirm whether the reduction applies before assuming a listed rate is your final payment.

Tier 2: Additional Provider Categories

Beyond the nine core categories above, HFS maintains fee schedules for more than two dozen additional provider and service types. If your provider type isn’t in Tier 1, it’s almost certainly here.

Some Tier 2 categories don’t have a truly standalone rate document — renal dialysis add-on drugs and individual practitioner billing, for instance, both route through the Practitioner Fee Schedule rather than a separate spreadsheet.

And if you’re dually eligible for Medicare and Medicaid, or enrolled in a Medicare-Medicaid Alignment plan, check the Medicare Physician Fee Schedule too — for services where Medicare is the primary payer, the Illinois Medicaid rate above generally acts as the secondary-payer floor, not the full payment.

Practitioner Fee Schedule: Sample CPT Rates

The Practitioner Fee Schedule is the one most people actually want a dollar figure from — it covers office visits, evaluation and management (E/M) codes, and psychotherapy codes billed by physicians, advanced practice nurses, and physician assistants. Here’s what a few commonly billed codes have paid:

These figures are illustrative, not guaranteed. They reflect the rate in effect as of the vintage listed for each code — not necessarily the current 07/01/2026 file — and Illinois re-prices codes individually rather than all at once. Always confirm the live rate on the HFS Practitioner Fee Schedule spreadsheet before billing.

Fee Schedule Key: How to Read Illinois Medicaid Rate Columns

The Practitioner Fee Schedule spreadsheet isn’t self-explanatory, which is why HFS publishes a separate “Key to Practitioner Fee Schedule” document alongside it. A few columns cause the most confusion:

Max Qty is the maximum number of units payable for that code per day or per claim. State Max is the full reimbursement ceiling — professional plus technical components combined — for codes that can be split.

Global versus component billing trips up a lot of new billers. Codes flagged with Note A, B, or C on the schedule have their payment split between a professional component and a technical component.

Note A and Note B split the payment 50/50 between the two; Note C uses a different, code-specific ratio instead. If you’re billing only the physician’s interpretation, you’d use the M1 (26) rate — the professional-component-only amount, billed with modifier 26. If you’re billing only for the equipment or facility side, you’d use the M2 (TC) rate, billed with modifier TC.

Modifiers more broadly change how a claim gets processed, not just the amount paid. The most common Illinois-specific ones include EP (Healthy Kids/EPSDT service), FP (family planning service), GT (telehealth delivered via interactive audio-video), 26 (professional component only), TC (technical component only), and 50 (a bilateral procedure billed as a single line with quantity “1”). National Correct Coding Initiative (NCCI) edits apply across HFS fee schedules as well — these are the federal rules that block certain code combinations from being billed together on the same date of service, and they’re explicitly referenced on schedules like the Podiatric Fee Schedule.

Hospital Rate Sheets

Illinois doesn’t pay hospitals off a flat fee schedule the way it pays physicians. Hospital reimbursement runs on per-diem and DRG-based rate sheets instead, and those sheets update whenever a new rate period takes effect. The current Hospital Rate Sheets are effective January 1, 2026; the prior version was effective April 1, 2025.

These rate sheets — along with related documents like Directed Payment Calculations and Hospital Add-on Payments — live under HFS’s dedicated Hospital Reimbursement Notifications section, not the general Medicaid Reimbursement index. If you’re looking for a specific hospital’s rate sheet, that’s the section to check.

Dental Fee Schedule and the SB1580/HB2552 Rate-Increase Bills

The current HFS Dental Program Fee Schedule for Child and Adult Beneficiaries is effective January 1, 2026, updated January 20, 2026, with a newer version effective July 1, 2026, updated July 21, 2026.

Rates vary by who’s receiving care — children, adults, and pregnant women can each have a different maximum allowance for the same procedure code — and many codes require prior approval before HFS will pay the claim.

DentaQuest has administered Illinois’ dental program since 1999: it processes dental claims for Medical Assistance and All Kids on HFS’s behalf, but HFS is still the one that sets the underlying rates.

Two bills currently in the Illinois General Assembly would raise those rates, and neither has passed as of September 2026:

• SB1580 (“Medicaid-Dental Comprehensive”), sponsored by Sen. Karina Villa, would raise rates for children’s comprehensive and periodic oral exams, problem-focused exams, behavior-management codes, sealants, posterior resin-based composites, and extraction/surgical-extraction codes by 33% above the December 31, 2025 rates, effective January 1, 2026 as written. Its last recorded action was June 2, 2025, when it was re-referred to the Senate Assignments Committee under Rule 3-9(a) — it has been stalled there since and was never enacted.
• HB2552 (“Medicaid-Children’s Dental”), sponsored by Rep. Joyce Mason, is broader: it would raise reimbursement for all dental services for children by 50% above the December 31, 2025 rates, also effective January 1, 2026 as written. Its last recorded action was March 21, 2025, re-referred to the House Rules Committee under Rule 19(a), with no committee or floor action recorded since.

In short: no legislatively mandated across-the-board dental rate increase has taken effect in Illinois Medicaid. Whatever changes show up in the January and July 2026 dental fee schedules reflect HFS’s routine rate maintenance — not SB1580 or HB2552 becoming law. Providers and advocates tracking either bill can check current status directly at ilga.gov.

ABA Therapy Rates

Illinois covers ABA therapy under its Adaptive Behavior Support (ABS) benefit, billed under a two-tier provider structure.

Level 1 providers — Board Certified Behavior Analysts and certified Developmental Clinicians such as LPCs, LCSWs, LCPCs, LMFTs, OTs, and SLPs — bill the analyst-level codes.

Level 2 providers — Registered Behavior Technicians and Developmental Technicians — bill the technician-level codes.

The fee schedule pays technician-delivered direct treatment (CPT 97153) at $13.00 per 15-minute unit, and analyst-delivered treatment with protocol modification (CPT 97155) at $20.39 per 15-minute unit, with per-code daily maximums capping total reimbursement for the day.

These rates haven’t moved since January 15, 2022. When HFS reissued the ABS fee schedule on May 14, 2026, every unit price and daily maximum stayed exactly the same — the update expanded which provider categories can bill at each level (including adding Licensed Assistant Behavior Analyst billing) rather than changing what anyone gets paid.

Home Health Fee Schedule

The current Home Health Fee Schedule is effective January 1, 2025, updated December 29, 2025 — superseding the prior version, which was effective January 1, 2024, updated June 11, 2024.

It’s the oldest fee schedule on this page relative to today’s date, with no 2026 update yet published. Home health billing also includes EPSDT in-home shift nursing services, which the state plan separately lists as effective January 1, 2024, under the broader home health category.

Illinois Medicaid Fee Schedule Dates: What “Effective” and “Updated” Actually Mean

Illinois Medicaid fee schedules show more than one date, and mixing them up can cost you money. The effective date tells you which rates actually apply. The update date just tells you when HFS last touched the file — it doesn’t always mean the rates changed.

Here’s what each date on an HFS file really means:

Here’s an example. Say a doctor sees a patient on June 20, 2026. The practitioner schedule effective July 1, 2026 does not cover that visit — an earlier file does.

HFS keeps those older files too, including versions effective April 1, 2026, January 1, 2026, December 31, 2025, and October 1, 2025. Source: HFS Practitioner Fee Schedule

Has Illinois Released a 2027 Medicaid Fee Schedule?

No — but that’s actually the wrong question. Illinois HFS doesn’t publish one statewide fee schedule that covers every provider for the whole year.

It publishes dozens of separate schedules, one per provider category, and each one updates on its own timeline. Source: HFS Medicaid Reimbursement

So instead of asking “Is there a 2027 fee schedule yet,” ask:

• Has HFS released a 2027 practitioner fee schedule?
• Has HFS released a 2027 DME fee schedule?
• Has HFS released a 2027 dental, therapy, home health, transportation, or long-term care rate file?
• Does the schedule’s effective date actually cover your date of service?

Until HFS posts a category’s next file with a 2027 effective date, use whichever schedule matches your date of service — the tables earlier on this page show the current version for each category.

How we keep this page current: we check the HFS Medicaid Reimbursement directory and each category’s page for new postings, and we review this page monthly. Every category-specific date cited on this page was checked against HFS’s live site as of September 1, 2026.

HFS’s official schedule, provider notices, and coverage rules always control — a rate listed on this page, or even on an HFS spreadsheet, doesn’t by itself guarantee payment.

The final amount can depend on the code, date of service, provider type, modifier, place of service, units billed, coverage rules, and whether the claim is fee-for-service or managed care.

How to Find Your Exact Illinois Medicaid Rate

To find your exact rate, you need three things: the billing code, the date of service, and the right HFS category. The newest fee schedule you can find isn’t always the correct one for your claim.

Follow these steps in order:

1. Find your exact code. Get the CPT, HCPCS, CDT (dental), revenue code, or NDC that will actually go on the claim. A plain description of the service isn’t enough to look up a rate.
2. Check the date of service. The schedule that applies is the one that was in effect that day — not the newest one posted.
3. Pick the right category. Illinois Medicaid doesn’t use one schedule for everything. Choose practitioner, DME, dental, home health, therapy, transportation, optometric, long-term care, or another category from the HFS Medicaid Reimbursement page.
4. Open the file effective for that date. A file can be updated after its own effective date. An older, archived version may still be the right one for a past claim, correction, or appeal.
5. Read the fee schedule key. HFS’s Practitioner Fee Schedule key and modifier list explain what each column and code note actually means — see the Fee Schedule Key section above for the basics.
6. Check your modifier, place of service, and units. These can change whether a claim gets paid at all. For example, starting August 1, 2026, claims billed with CPT code 96127 need modifier U1 or U2. Without one of those, HFS can reject the claim for a “Missing/Invalid Modifier” — even though the code itself is covered. Source: HFS Provider Notice, 07/07/2026
7. Check coverage rules separately. A rate on the fee schedule doesn’t mean every service is automatically covered. Check the HFS provider handbooks for medical necessity, documentation, and prior authorization rules.
8. Confirm fee-for-service or managed care. HFS fee schedules mainly apply to fee-for-service claims. A HealthChoice Illinois managed care claim can follow different plan rules — see the next section.
9. Use the official source to confirm. For fee-for-service, that’s the current HFS schedule and provider notices. For managed care, that’s your contract and the plan’s provider portal.

A code alone often isn’t enough to predict your rate. Here’s what else can change the result:

Don’t Assume the Newest File Is Right

The newest posted schedule isn’t always the correct one for your claim. Match the schedule to the date of service first — then check whether HFS issued a later correction for that period.

• A visit on June 20, 2026 may need the schedule in place before July 1, 2026.
• A visit on July 15, 2026 falls under the schedule effective July 1, 2026.
• A corrected claim for an older visit may need an archived schedule, not the current one. Source: HFS Practitioner Fee Schedule

Fee-for-Service vs. Illinois Medicaid Managed Care Rates

HFS fee schedules mostly apply to fee-for-service Medicaid. If your patient is in a Medicaid managed care plan, your actual payment may be different — set by your contract with that plan, not by the state’s public fee schedule.

Here’s why: Illinois pays managed care plans (MCOs) a flat monthly amount for each member they cover, called capitation. That payment isn’t tied to the cost of any one visit. What the MCO then pays your practice depends on your contract with that plan, not directly on the HFS fee schedule. Source: HFS Managed Care

Important: A posted HFS rate is not a payment guarantee. It doesn’t confirm coverage, prior authorization, or your final payment amount. Managed care plans set their own contract terms and billing rules.

When the HFS Fee Schedule Is Your Best Source

• Your patient has fee-for-service Illinois Medicaid on the date of service.
• You need the state-published rate, code description, or modifier rule.
• You’re reviewing a fee-for-service claim, remittance, or claim adjustment.
• An HFS notice specifically says a change applies to fee-for-service claims.

When Your MCO Contract Controls Instead

Check these directly with the plan before you bill:

• Your provider contract and any payment amendments
• Your network status with that plan
• The plan’s own fee schedule or negotiated rates
• Prior authorization and referral requirements
• Filing deadlines for claims and corrections
• The plan’s billing portal instructions
• The plan’s appeals and payment-dispute process

HFS often points providers to different places depending on coverage type — fee-for-service billing questions go to HFS, while managed care billing questions go to the member’s specific MCO. Source: HFS Provider Notice, 07/07/2026

Are MCO Rates the Same as HFS Rates?

Not always. Some HFS rate changes apply to both fee-for-service and MCO claims — but you shouldn’t assume an HFS-listed rate is automatically your final MCO payment.

Here’s a real example: in 2024, HFS raised certain practitioner rates for both fee-for-service and MCO claims. But the two didn’t move at the same speed. MCOs updated their systems on their own schedule, while fee-for-service claims needed state reprocessing after CMS approval. Source: HFS Provider Notice, 04/02/2024 That’s a good example of why you should confirm your specific plan’s current rate rather than relying on the HFS number alone.

Before You Bill a Managed Care Claim, Confirm:

1. The member’s MCO enrollment on the exact date of service
2. Your network status and current contract terms
3. The plan’s fee schedule or payment methodology
4. Whether prior authorization or a referral is required
5. Your code, modifier, place of service, and diagnosis support
6. The plan’s claim submission method and filing deadline
7. What to do if a payment doesn’t match what you expected

Bottom line: for fee-for-service claims, start with the right HFS category and match the schedule to your date of service. For managed care claims, use the HFS schedule as background — but confirm your actual payment directly with the plan.

Illinois Medicaid Fee Schedule FY 2027: What We Know So Far

No 2027 fee schedule has been released for any provider type as of August 21, 2026. This includes practitioner, hospital, dental, audiology, home health, FQHC, and nursing facility rates.

Even without new fee schedules, other 2027 changes are coming. Illinois Medicaid expansion adults will face new work requirements starting January 1, 2027. This means 80 hours a month of work, school, or volunteering. Redeterminations will also happen every six months instead of once a year.

Some 2027 groundwork is already underway. Hospitals had to submit 2024 cost reports by July 1, 2026, for Rate Year 2027 DSH and MPA payment decisions.

A tiered Fiscal Year 2027 MCO Assessment Program also took effect July 1, 2026, though this affects managed care organizations, not provider fee schedules directly.

FAQ: Provider Billing & Rate Lookup Questions

Official Sources and References

CheckMedicaid reviews Illinois Medicaid fee-schedule information against official Illinois Department of Healthcare and Family Services (HFS) resources.

Fee schedules can change by provider type, service category, effective date, billing rule, and program, so providers should always verify the current HFS document that applies to the claim’s date of service before billing.

Primary Illinois HFS Sources

The HFS Medicaid Reimbursement directory confirms that Illinois uses separate reimbursement resources for many categories, including practitioner services, dental, DME, home health, therapy, transportation, managed care, optometric and optical services, long-term care, pharmacy, FQHCs, rural health clinics, behavioral-health-related programs, and other specialized provider types.[hfs.illinois]

Current Practitioner Schedule Reference

For professional-practitioner rate lookup, HFS currently lists the following 2026 resources:

These files show why providers should select a schedule based on the date of service, rather than automatically using the latest file online. HFS also provides historical practitioner schedules for earlier claims and prior rate periods.[hfs.illinois]

How to Use These Sources

Use official HFS resources in this order:

1. Find the service category through the HFS Medicaid Reimbursement Directory.
2. Open the fee schedule or rate resource for the relevant provider/service type.
3. Select the file effective on the claim’s date of service.
4. Review the schedule key, notes, and recognized modifier guidance.
5. Check the applicable HFS provider handbook for coverage, coding, authorization, documentation, and billing instructions.
6. Review HFS provider notices for recent changes that could affect the service or claim.
7. If the patient is enrolled in an MCO, verify the provider contract, plan portal, plan-specific fee schedule, authorization rules, and billing guidance.

HFS explains that its provider handbooks provide the policies, procedures, covered-service descriptions, and billing instructions needed for providers to receive reimbursement for covered services. HFS also states that participating providers are responsible for following the applicable policies and procedures.[hfs.illinois]

Important Source Disclaimer

This guide summarizes official Illinois Medicaid fee-schedule resources for informational purposes. CheckMedicaid is not the Illinois Department of Healthcare and Family Services, Illinois Medicaid, CMS, or a Medicaid managed-care organization.

The official HFS fee schedule, provider handbook, provider notice, managed-care plan policy, provider contract, and claim-adjudication decision control when they differ from this page. A published fee-schedule amount is not a guarantee of coverage, authorization, network eligibility, or final payment.

For a broader directory of official state resources, visit Medicaid fee schedules by state.