MedicaidAdministrativeHigh impact
Changes to Billing Procedures for Emergency Contraception, Confirmation of Coverage for Patient Care Services Provided by a Pharmacist for Contraceptives per Public Act 104-0312 and Coverage of Home Pregnancy Tests
Illinois Medicaid - HFS·IL · Pharmacy, OB-GYN, Family Medicine·Provider Notice
Effective date
Nov 1, 2025
We identified it
Jun 20, 2026
Summary
Effective November 1, 2025, pharmacies can no longer use dummy NPIs for emergency contraception billing and must instead use the Illinois Department of Public Health standing order NPI. The policy also confirms coverage for pharmacist-provided contraceptive services and adds coverage for home pregnancy tests.
Action Required
Immediately (effective November 1, 2025): Billing team must update all emergency contraception claims to use the Illinois Department of Public Health standing order NPI instead of dummy NPIs. Update billing system rules to reject dummy NPI usage for contraception claims. Verify home pregnancy test coverage is active in system (2 tests per 30 days). Claims using dummy NPIs will be rejected by the Department.