Payor
Illinois Medicaid (HFS)
Rubrica tracks 101 sourced coverage rules across 101 CPT codes for Illinois Medicaid (HFS) — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): Medicaid, medicaid. 1-state regional policy (sample: il).
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Every Rubrica record cites a specific Illinois Medicaid (HFS) policy document with last-reviewed date and (where available) verbatim source text. Aggregate coverage breakdown by procedure category is shown below; full payor-specific criteria require sign-in.
Coverage by category
Illinois Medicaid (HFS)'s coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Electrodiagnostic Testing | 9 | 9 | 0 | 0 |
| Lumbar Fusion | 8 | 8 | 8 | 0 |
| Epidural Injection with Imaging | 5 | 5 | 0 | 0 |
| Spine Surgery | 5 | 5 | 5 | 0 |
| Joint Injection - Hyaluronic Acid | 4 | 4 | 4 | 0 |
| Nerve Ablation | 4 | 4 | 4 | 0 |
| Nerve Block | 4 | 4 | 0 | 0 |
| Epidural Injection | 3 | 3 | 0 | 0 |
| Joint / Bursa Injection | 3 | 3 | 0 | 0 |
| Chemodenervation | 2 | 2 | 2 | 0 |
| Cryoablation | 2 | 2 | 2 | 0 |
| Facet Joint Injection | 2 | 2 | 0 | 0 |
Top tracked procedures
First 15 CPT codes in the Illinois Medicaid (HFS) catalog. Sign in for verbatim criteria, source links, and the rest of the catalog.
| CPT | Procedure | Coverage |
|---|---|---|
27447 | Total Knee Arthroplasty (TKA) | Covered |
27130 | Total Hip Arthroplasty (THA) | Covered |
23472 | Total Shoulder Arthroplasty (TSA / Reverse TSA) | Covered |
29827 | Arthroscopic Rotator Cuff Repair | Covered |
29888 | Arthroscopic ACL Reconstruction | Covered |
22551 | ACDF — Anterior Cervical Discectomy and Fusion | Covered |
22612 | PLF — Posterior Lumbar Fusion (Posterolateral) | Covered |
22558 | ALIF — Anterior Lumbar Interbody Fusion | Covered |
63030 | Laminotomy with Disc Excision — Lumbar | Covered |
63047 | Laminectomy with Facetectomy and Foraminotomy — Lumbar | Covered |
0200T | Percutaneous sacroiliac joint stabilization/fusion with percutaneous needle placement, including imaging guidance, stereotactic localization, injection of bone void filler, imaging supervision and interpretation | Covered |
0201T | Percutaneous sacroiliac joint stabilization/fusion with percutaneous needle placement, including imaging guidance, stereotactic localization, injection of bone void filler, imaging supervision and interpretation - each additional sacroiliac joint stabilization/fusion device (list separately in addition to code for primary procedure) | Covered |
0232T | Injection(s), platelet rich plasma (PRP), any joint, any route of administration, including imaging guidance if performed | Covered |
0275T | Resequencing code - see 0276T for description | Not covered |
0627T | Percutaneous trigeminal nerve radiofrequency ablation | Covered |
0629T | Percutaneous uterosacral ligament radiofrequency ablation with laparoscopic guidance | Covered |
0779T | Implantation of a permanent electrical signal generator/receiver in the subclavian/axillary region for selective peripheral nerve stimulation | Covered |
11980 | Subcutaneous hormone pellet implantation (includes subcutaneous injection of local anesthetic) | Not covered |
20526 | Injection, therapeutic (including small joint(s)) and/or bursa(e), any route; with needle visualization guidance (ultrasound, fluoroscopy, or other imaging modality) | Covered |
20552 | Injection, therapeutic (including small joint(s)) and/or bursa(e), any route; single or multiple joints and/or bursa(e), any route | Covered |
20553 | Injection, therapeutic (including small joint(s)) and/or bursa(e), any route; single or multiple joints and/or bursa(e), each additional joint or bursa (list separately in addition to code for primary procedure) | Covered |
20610 | Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance | Covered |
20611 | Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting | Covered |
22510 | Percutaneous posterolateral interbody fusion (PLIF) or transforminal lumbar interbody fusion (TLIF) with disc decompression, single interspace, lumbar | Covered |
22511 | Percutaneous posterolateral interbody fusion (PLIF) or transforminal lumbar interbody fusion (TLIF) with disc decompression, each additional interspace, lumbar (list separately in addition to code for primary procedure) | Covered |
See every policy for Illinois Medicaid (HFS).
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