Molina Healthcare Illinois policies

Search Molina Healthcare Illinois's public medical, payment and drug policies by CPT or HCPCS code, keyword or policy number, with links to the payer's own documents. Links open the payer's own document; check its current version before relying on it.

683 public policies Substrate tracks for Molina Healthcare Illinois, by title.

Molina Healthcare Illinois policies
PolicyDetailsCodesSource
001 CPT and Place of Service Invalid CombinationMedicaid · IL—Original policy ↗
002 Critical Care Billed Same Day as Emergency Room ServicesMedicaid · IL4Original policy ↗
003 New Patient Visits Incorrect CodingMedicaid · IL3Original policy ↗
004 Global Surgery PeriodMedicaid · IL—Original policy ↗
005 Medical Management versus PsychotherapyMedicaid · IL6Original policy ↗
006 Evaluation & Management Services with Injection(s) and Infusion ServicesMedicaid · IL6Original policy ↗
007 Not Otherwise Specified CodesMedicaid · IL2Original policy ↗
008 CPT HCPCS and Modifier CombinationMedicaid · IL—Original policy ↗
009 Overlapping Room and Board plus Other Institutional ServicesMedicaid · IL—Original policy ↗
010 Overlapping Room and BoardMedicaid · IL—Original policy ↗
011 ESRD Bundling End-Stage Renal DiseaseMedicaid · IL2Original policy ↗
012 Bundling Pre-Dialysis UltrafiltrationMedicaid · IL1Original policy ↗
013 E&M Services Billed With Revenue Code 0761Medicaid · IL—Original policy ↗
014 Self-Administered DrugsMedicaid · IL—Original policy ↗
015 Always Therapy CodesMedicaid · IL1Original policy ↗
016 Claim Condition Codes D and RMedicaid · IL—Original policy ↗
017 Claims With Incarceration Diagnosis CodeMedicaid · IL—Original policy ↗
018 CPAP and BiPAP Compliance With Month Four and BeyondMedicaid · IL3Original policy ↗
019 Definitive Drug Testing Yearly Same Day LimitMedicaid · IL2Original policy ↗
020 Device Dependent Procedure Without Device Billed On ClaimMedicaid · IL1Original policy ↗
021 Direct IP Admit from ER Condition Code P7Medicaid · IL—Original policy ↗
022 DME Air Fluidized Mattress Missing Qualifying Diagnosis CodeMedicaid · IL1Original policy ↗
023 Hospice Overlapping With Room and BoardMedicaid · IL—Original policy ↗
024 Injections and Infusions Billed With ERMedicaid · IL2Original policy ↗
025 Labs Overlapping With FacilityMedicaid · IL1Original policy ↗
026 Medicaid MUE Edit DME ServicesMedicaid · IL1Original policy ↗
027 Modifier Q7 Q8 Q9 UsageMedicaid · IL5Original policy ↗
028 Molecular PathologyMedicaid · IL48Original policy ↗
029 Multiple ER Visits On Same Day With Same ProviderMedicaid · IL2Original policy ↗
030 Multiple Surgical Procedure ReductionMedicaid · IL2Original policy ↗
031 Presumptive Drug Testing Yearly LimitsMedicaid · IL1Original policy ↗
032 Questionable OB Admit MCE EditMedicaid · IL—Original policy ↗
033 Respiratory Pathogen Panel TestMedicaid · IL1Original policy ↗
034 Tomography Scans Without Tracer CodesMedicaid · IL20Original policy ↗
035 Vitamin DMedicaid · IL1Original policy ↗
3D Interpretation and Reporting of Imaging StudiesCommercial, Medicaid56Original policy ↗
3D Interpretation and Reporting of Imaging Studies MEDICARE56Original policy ↗
Abecma (idecabtagene vicleucel)Commercial, Medicaid9Original policy ↗
Abilify MyCite Kit (aripiprazole with biosensor) MNR MHIMedicaid · IL—Original policy ↗
Acthar gel (repository corticotropin injection) MHIMedicaid · IL, MS2Original policy ↗
ActigraphyCommercial, Medicaid1Original policy ↗
Adakveo (crizanlizumab-tmca)C17920-A · Effective Sep 17, 2026 · Medicaid · IL, MS1Original policy ↗
Adbry (tralokinumab) MHIMedicaid · IL, MS—Original policy ↗
Add On Coding PolicyMedicaid11Original policy ↗
Add-On Code Coding PolicyPI_Code Coding Policy 13 · Effective Nov 1, 2020 · Medicaid · IL9Original policy ↗
Add-on CodingCommercial, Medicaid11Original policy ↗
Add-on CodingMedicaid · AZ, FL, ID, IL, MA, NE, NM, NV, NY, SC, TX, UT, WA11Original policy ↗
Adstiladrin (nadofaragene firadenovec vncg)Commercial, Medicaid1Original policy ↗
Adstiladrin (nadofaragene firadenovec vncg) MEDICARE1Original policy ↗
Advanced Beneficiary Notice ABN Modifiers GA GX GY GZCommercial—Original policy ↗

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Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.