Family Planning Program Covered Services
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Defines procedure codes and coverage status for services covered under the Illinois Family Planning Program and specifies provider types eligible to render and bill those services.
No material clinical or coverage changes in this revision.
Coverage Criteria and Code-level Rules
Code-level coverage criteria
Procedure codes are listed with: 1 = Coverage Effective Date; 2 = whether a family planning/reproductive health related diagnosis is required (Y/N); 3 = End Date when applicable. Codes marked with an asterisk (*) are reimbursable only to a designated eligible/approved facility and must be billed by the eligible/approved rendering provider with the 'FP' modifier and the approved facility listed as the billing provider/payee.
Examples (selected codes from the list)
- 00851 — Effective Date: 11/30/22; Diagnosis required: N
- 0102U — Effective Date: 01/01/25; Diagnosis required: Y
- 11981 — Effective Date: 05/01/24; Diagnosis required: Y
- 17000 — Effective Date: 11/30/22; Diagnosis required: Y
- 56441 — Effective Date: 11/30/22 = 01/01/25; Diagnosis required: Y
- 57452 — Effective Date: 11/30/22; Diagnosis required: Y
- 59821 — Effective Date: 05/01/24; Diagnosis required: N
- 77046 — Effective Date: 05/01/24 = 01/01/25; Diagnosis required: N
- 99202 — Effective Date: 05/01/24 = 11/30/22; Diagnosis required: Y
- 99397 — Effective Date: 11/30/22 = 05/01/24; Diagnosis required: Y
- J0694 — Effective Date: 11/30/22 = 05/01/24; Diagnosis required: Y
- J8499 — Effective Date: 11/30/22 = 01/01/25; Diagnosis required: Y
- T1015 — Effective Date: 11/30/22; Diagnosis required: Y
COVID-19 vaccine & related codes
- M0201 — Effective Date: 11/30/22; Diagnosis required: N
- 91304 — Effective Date: 11/30/22; Diagnosis required: N
- 91323 — Effective Date: 08/27/25; Diagnosis required: N
- 90480 — Effective Date: 09/11/23; Diagnosis required: N
- 99402 (COVID-19 vaccine counseling) — Effective Date: 11/30/22; Diagnosis required: N
Covered Procedure Codes and Diagnosis Rules
Billing and Provider Instructions
Reference Practitioner Fee Schedule for billing
Providers must reference the Practitioner Fee Schedule and key for rates and all other billing instructions applicable to their provider type.
Provider Types and Modifiers
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