Billing

All home and community-based waiver services providers are required to bill IlliniCare Health on a medical claim form. HCBS and Supportive Living Facilities will need to bill IlliniCare Health via our online portal, or on a HCFA 1500 form. We have a variety of resources available to providers to help them bill correctly. Please visit our Waiver Resources page for more information. Below, please find a chart outlining the services, as well as corresponding codes and increments that should be used when billing for services provided to an IlliniCare Health member.

Service Code Modifier HFS Increment IlliniCare Health Increment Rate (per unit) for Claims Example
Adult Day Service S5100
  per hour 15 min $2.26 1 hour = 4 units (4 x $2.26 = $9.04)
Adult Day Service Transportation T2003   1 unit = one way trip 1 unit = one way trip $8.30 Round trip = 2 units (2 x $8.30 = $16.60)
Environmental Home Adaptations S5165   per service per service varies varies
Supported Employment T2019   per diem 15 min $11.00 1 hour = 4 units (4 x $11.00 = $44.00)
Home Health Aide – Agency T1004   per hour 15 min $3.44 1 hour = 4 units (4 x $3.44 = $13.76)
Home Health Aide – Agency – CNA T1004 SC per hour 15 min $3.44 1 hour = 4 units (4 x $3.44 = $13.76)
Home Health Aide – Individual G0156   per hour 15 min $3.63 1 hour = 4 units (4 x $3.63 = $14.52)
Home Health Aide – Individual – CNA G0156 SC per hour 15 min $3.63 1 hour = 4 units (4 x $3.63 = $14.52)
Home Health – Intermittent Nursing RN, LPN (Agency Provider) G0154   one visit up to two hours 15 min $8.16 2 hour = 8 units (8 x $8.16 = $65.28)
Home Health – Intermittent Nursing RN, LPN (Agency Provider) G0154 SC one visit up to two hours 15 min $8.16 2 hour = 8 units (8 x $8.16 = $65.28)
Nursing, Skilled – LPN Agency T1003 TE per hour 15 min $6.37 1 hour = 4 units (4 x $6.37 = $25.48)
Nursing, Skilled – LPN Individual T1000 TE per hour 15 min $5.50 1 hour = 4 units (4 x $5.50 = $22.00)
Nursing, Skilled – Multi-Customer T1002 TT per hour 15 min $5.91 2 hour = 8 units (8 x $5.91 = $47.28)
Nursing, Skilled RN Agency T1003 TD per hour 15 min $7.39 1 hour = 4 units (4 x $7.39 = $29.56)
Nursing, Skilled RN Individual T1000 TD per hour 15 min $7.13 1 hour = 4 units (4 x $7.13 = $28.52)
Occupational Therapy G0152 UC per hour 15 min $9.25 1 hour = 4 units (4 x $9.25 = $37.00)
Physical Therapy G0151 UC per hour 15 min $9.25 1 hour = 4 units (4 x $9.25 = $37.00)
Speech Therapy G0153 UC per hour 15 min $7.50 1 hour = 4 units (4 x $7.50 = $30.00)
Speech Therapy – Hospital G0153 UC per hour 15 min $12.50 1 hour = 4 units (4 x $12.50 = $50.00)
Supportive Living Facilities T2033 U1 per diem per diem - **Please see SLF section below**
Prevocational Services T2014   per diem per diem $43.25 $43.25
Habilitation – Day T2020   per diem per diem $43.25 $43.25
Homemaker S5130   per hour 15 min $4.29 1 hour = 4 units (4 x $4.29 = $17.16)
Homemaker with Insurance S5130   per hour 15 min $4.69 1 hour = 4 units (4 x $4.69 = $18.76)
Home Delivered Meals S5170   one unit = 2 meals per meal $7.50 2 meals delivered at one time – 2 x $7.50 = $15.00
Personal Assistant S5125   per hour 15 min $3.25 1 hour = 4 units (4 x $3.25 = $13)
Personal Emergency Response – Install S5160   per install per install $30.00 $30.00
Personal Emergency Response – Monthly Charge S5161   per month per month $28.00 $28.00
Respite – RN T1005 TD per hour 15 min $7.13 1 hour = 4 units (4 x $7.13 = $28.52)
Respite – LPN T1005 TE per hour 15 min $5.50 1 hour = 4 units (4 x $5.50 = $22.00)
Respite – CNA T1005 SC per hour 15 min $3.63 1 hour = 4 units (4 x $3.63 = $14.52)
Respite – Homemaker T1005 HM per hour 15 min $3.83 1 hour = 4 units (4 x $3.83 = $15.32)
Respite – Personal Assistant T1005   per hour 15 min $3.07 1 hour = 4 units (4 x $3.07 = $12.28)
Specialized Medical Equipment T2028 RR per service per service varies varies

Please note, rates are subject to change. All rates reflect the current Medicaid fee schedule for the services listed.

Example: Joe Member goes to adult day service for three hours every week day. Sunrise Day Center needs to bill for his stays for the previous month. Sunrise Day Center would need to submit a claim to IlliniCare Health with the code, S5100. In the previous month, there were 22 days that Joe went to the center. The total number of hours would be calculated by: 22 x 3 = 66 hours. However, IlliniCare Health’s units are in 15 minute increments. Since there are four 15-minute increments in an hour, that means: 66 hrs x 4 = 264 units. This is how many units Joe used in one month. To find the total cost, it would be the number of units multipled by the rate. 264 x $2.26 = $596.64.

Supportive Living Facilities’ Rates

Supportive Living Facility rates are based upon geographic area. IlliniCare Health does NOT pay for room and board, but reimburses for services provided in the SLF. Rates for our service area are included below:

  • Cook, DuPage, Lake and Kane Counties: $74.66 per day
  • Will and Kankakee Counties: $71.40 per day