Illinois Medicaid Telehealth Billing for Therapists

Before billing an Illinois Medicaid telehealth therapy visit, identify the member’s plan and the service/provider rules that apply. HFS publishes a GT/93 and 02/10 table for community-based behavioral services, but that is not a universal claim recipe for every therapy practice. HFS CBS handbook, section 207.3.7

Source check: October 9, 2026. This guide helps therapists frame the billing checks without substituting a generic commercial-payer rule for Illinois Medicaid guidance. Bomi can help organize the payer-specific workflow.

First check eligibility and the plan for the visit

HFS tells providers to check eligibility on the service date and identifies MEDI as a way to confirm managed care enrollment. Start there before choosing a state fee-for-service or MCO billing route. HFS eligibility and plan guidance

1. Identify the visit’s coverage and assigned plan.

2. Identify the billed service and the provider’s enrollment context.

3. Use the corresponding state handbook and fee schedule or the plan’s applicable billing guidance.

What the HFS CBS handbook says about GT, 93, 02 and 10

For services governed by the CBS handbook, section 207.3.7 lists GT for video and 93 for audio-only delivery for dates beginning July 1, 2022. It distinguishes POS 10 for the patient’s home from POS 02 for other locations. CBS telehealth table, printed page 25

The community-based behavioral health fee schedule also labels GT as video-and-audio delivery and 93 as audio-only, with the corresponding telehealth place-of-service codes. Read those keys alongside the covered service row and required additional modifiers. CBS fee schedule and modifier key

A modifier’s presence in a table does not by itself establish that every service is covered in that mode. Confirm the specific service and provider context before turning the table into a practice-wide billing default.

Does that mean every private-practice 90837 uses GT?

The cited table belongs to the community-based behavioral services handbook. We have not established a universal private-practice professional-claim or MCO modifier combination from that source. For a professional therapy claim, ask the responsible payer to identify the guidance for your service, provider type and date.

Do not replace that missing answer with 95 simply because a commercial payer accepts it. Use a written payer answer or the applicable current manual to set the claim configuration.

Separate audio-only coverage from the coding label

The HFS fee-schedule key identifies 93 as the audio-only indicator. Before a phone session, ask the responsible payer whether the specific service is covered in that mode and whether other billing or authorization requirements apply. HFS audio-only reporting key

Record the answer with the service code, provider context and policy date. If the payer cannot confirm coverage, treat it as an unresolved billing question rather than a reason to assume that the modifier guarantees reimbursement.

For MCO claims, confirm the plan instructions

HFS directs managed care billing questions to the member’s plan. Ask that plan to confirm the applicable procedure code, modifier, place of service, authorization and claim destination for your enrollment context. HFS managed care billing FAQ

1. Record whether the encounter was video with audio or audio-only and where the patient was located.

2. Check the actual service against the guidance for the billing provider and plan.

3. Review the claim configuration against that guidance before submission, and retain the policy reference with the billing instructions.

This is a recommended billing review, not a blanket authorization, coverage decision or rate promise. The encounter record and the payer guidance should support the configuration you choose.

Keep rate questions separate from telehealth coding

For reimbursement context, see the Illinois 90837 rate-increase article. Use that article for the rate topic and verify telehealth coding independently for the visit.

MEDI eligibility verification · HealthChoice participation and routing

Frequently Asked Questions

What telehealth modifiers are listed in the Illinois CBS handbook?

Section 207.3.7 lists GT for video and 93 for audio-only for services in its scope. Check the applicable service and provider guidance before using them.

What is the difference between POS 02 and POS 10?

In the cited HFS CBS table, 10 indicates the patient’s home and 02 indicates telehealth elsewhere.

Does modifier 93 guarantee audio-only therapy reimbursement?

No. The coding label alone does not establish coverage for every service or provider. Confirm the applicable payer requirements.