HFS Relaxes DME, HH, Therapy Prior Authorization

April 7, 2020

Yesterday, the Illinois Dept. of Healthcare & Family Services (HFS) announced that it would temporarily lift certain prior authorization requirements to promote social distancing and enhance access to care during the COVID-19 public health emergency. Effective March 1, 2020 through the end of the emergency period, HFS will remove prior authorization requirements for specific CPT/HCPCS codes used to report physical, occupational, and speech therapies; home health (HH) agency and local health department services; and durable medical equipment (DMS) and supplies. HFS will also identify and extend existing authorizations for certain codes and lift face-to-face encounter requirements for ordering DME, HH and therapy services.

Providers/suppliers must still obtain prior authorization to exceed quantity limits for COVID-19-related items, but HFS will expedite the processing of such requests. In addition, HFS has not changed prior authorization requirements for bariatric surgery and gender affirming services.  Additional flexibilities for physical, occupational, and speech therapy, HH and DME and a link to the applicable CPT/HCPCS codes are outlined in the HFS Provider Notice.