CurrentIllinois Department of Healthcare and Family ServicesPolicy N/A

Fee Schedule for Licensed Practitioners of the Healing Arts (LPHA)

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Statewide fee schedule governing reimbursement rates and billing rules for services rendered by LCSWs, LCPs, LMFTs, and LCPCs; includes code-specific unit prices, quantity limits, and special billing notes.

Policy Summary

PayerIllinois Department of Healthcare and Family Services

PolicyFee Schedule for Licensed Practitioners of the Healing Arts (LPHA)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateAug 1, 2026

Last ReviewJul 28, 2026

Next Review DateN/A

Key ActionFor dates of service on or after 08/01/2026, include either modifier U1 or U2 on CPT 96127 claims or they will reject.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

statewiderates apply statewide and do not vary by population group or region

LPHA:4licensed practitioner types covered (LCSW, LCP, LMFT, LCPC)

psychiatric add-onspsychiatric add-on payments apply to certain CPTs

modifier 8/1/26CPT 96127 modifier requirement

group excludedgroup psychotherapy services excluded

Coverage and Billing Rules Summary

Coverage and billing rules summary

Covered when billed by an eligible LPHA subject to the following billing rules and program edits:

This fee schedule applies to services rendered by LCSW, LCP, LMFT, and LCPC statewide (statewide rates; do not vary by population group or region).

Appearance of a code on this fee schedule does not guarantee payment; services lacking demonstrated medical necessity or excluded under Chapter A-200, Section 204 and other Department Medical Programs are not covered.

National Correct Coding Initiative (NCCI) procedure-to-procedure and medically unlikely edits apply; claims must comply with applicable coding edits and program policies.

Group psychotherapy services are not included on this LPHA fee schedule; group psychotherapy is billable only when rendered by an LPHA in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC).

Psychiatric add-on amounts apply to listed CPT codes for dates of service beginning 7/1/2019; the add-on amount is multiplied by the number of units billed (up to each code's max quantity) and added to the unit price.

CPT 96127 modifier requirement: for dates of service on or after 08/01/2026, CPT 96127 requires either modifier U1 or U2 (but not both); claims lacking the required modifier will reject.

Covered Codes, Unit Prices, and Quantity Limits

Covered CPT/HCPCS CodesmixedCovered

90791	Psychiatric diagnostic evaluation; Unit price = 91.58; Max Qty = 1; Psychiatric Add-On = 127.88
90792	Psychiatric diagnostic evaluation with medical services; Unit price = 93.33; Max Qty = 1; Psychiatric Add-On = 144.42
90832	Psychotherapy, 30 min with patient and/or family member; Unit price = 35.24; Max Qty = 1; Psychiatric Add-On = 66.50
90837	Psychotherapy, 60 min (listed/mapped as 45 min); Unit price examples: 68.69 and 137.38
90839	Psychotherapy for crisis, first 60 min; Unit price examples present (e.g., 66.44)
96110	Developmental screening, with scoring and interpretation, per standardized instrument; Unit price = 12.06 (single unit)
96112	Developmental test administration with interpretation and report, first 60 minutes; Unit price = 62.93
99406	Smoking and tobacco use cessation counseling, intermediate (greater than 3 min up to 10 min); Unit price = 6.02
99407	Smoking and tobacco use cessation counseling, intensive (greater than 10 min); Unit price = 12.68
G2011	Alcohol and/or substance (other than tobacco) abuse structured screening/assessment and brief intervention; Unit price = 8.58

1–10 of 15

1/2

Max quantity per date of service

Codes with Max Qty = 190791; 90792; 90832; (other listed psychotherapy and screening codes show Max Qty = 1 where indicated in the fee schedule)

Psychiatric add‑on handlingPsychiatric Add‑On amount is multiplied by the number of units billed, up to the Max Qty, and added to the Unit Price for the number of units billed.

Example: 90791Unit price 91.58; Max Qty = 1; Psychiatric Add‑On = 127.88 applied per unit billed (up to Max Qty).

Example: 90792Unit price 93.33; Max Qty = 1; Psychiatric Add‑On = 144.42 applied per unit billed (up to Max Qty).

Example: 90832Unit price 35.24; Max Qty = 1; Psychiatric Add‑On = 66.50 applied per unit billed (up to Max Qty).

Billing Caveats and Required Modifiers

Denial Risk

Code listing does not guarantee payment; NCCI/MUE and program exclusions apply

The appearance of a code on this fee schedule does not guarantee payment. National Correct Coding Initiative (NCCI) procedure-to-procedure and medically unlikely edits apply, and other exclusions in Chapter A-200, Section 204 and Department Medical Programs may render a service non-covered. Providers should not assume listing equals reimbursement and should confirm coverage and edits before billing.

Billing Rule

CPT 96127 requires U1 or U2 modifier for DOS on/after 8/1/2026

For dates of service on or after 08/01/2026, CPT code 96127 must be billed with either modifier U1 or U2 (but not both). Claims submitted without the required modifier for DOS on/after 8/1/2026 will reject.

Modifier U1 or U2 is required for CPT 96127 for DOS on/after 8/1/2026.
Do not report both U1 and U2 on the same claim line; only one applies.
Claims lacking the required modifier will reject (per provider notice).

Key Terms

Psychiatric Add‑On

DefinitionPsychiatric Add‑On: an additional payment amount applied to certain CPT codes for services rendered on or after 7/1/2019; the add‑on amount is multiplied by the number of units billed (up to the max quantity) and added to the unit price.

Effective dateApplies to services rendered on or after 7/1/2019.

ApplicationAdd‑on is paid in addition to the unit price rate and is multiplied by units billed (subject to Max Qty limits).

Licensed Practitioner of the Healing Arts (LPHA)

DefinitionLicensed Practitioner of the Healing Arts (LPHA): includes the specified licensed behavioral health practitioner types covered by this fee schedule.

Included practitioner typesLicensed Clinical Social Worker (LCSW); Licensed Clinical Psychologist (LCP); Licensed Marriage and Family Therapist (LMFT); Licensed Clinical Professional Counselor (LCPC).

ScopeThis fee schedule applies statewide to services rendered by the LPHA types listed; group psychotherapy services are not included on this LPHA fee schedule (see fee schedule notes).

Policy Summary

PayerIllinois Department of Healthcare and Family Services

PolicyFee Schedule for Licensed Practitioners of the Healing Arts (LPHA)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateAug 1, 2026

Last ReviewJul 28, 2026

Next Review DateN/A

Key ActionFor dates of service on or after 08/01/2026, include either modifier U1 or U2 on CPT 96127 claims or they will reject.

SourceLink

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Fee Schedule for Licensed Practitioners of the Healing Arts (LPHA)

Customize your policy alerts

Sign up for all Illinois Department of Healthcare and Family Services policy alerts

Know when Illinois Department of Healthcare and Family Services releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Coverage and Billing Rules Summary

Coverage and billing rules summary

Covered when billed by an eligible LPHA subject to the following billing rules and program edits:

This fee schedule applies to services rendered by LCSW, LCP, LMFT, and LCPC statewide (statewide rates; do not vary by population group or region).

National Correct Coding Initiative (NCCI) procedure-to-procedure and medically unlikely edits apply; claims must comply with applicable coding edits and program policies.

CPT 96127 modifier requirement: for dates of service on or after 08/01/2026, CPT 96127 requires either modifier U1 or U2 (but not both); claims lacking the required modifier will reject.

Covered Codes, Unit Prices, and Quantity Limits

Covered CPT/HCPCS CodesmixedCovered

90791	Psychiatric diagnostic evaluation; Unit price = 91.58; Max Qty = 1; Psychiatric Add-On = 127.88
90792	Psychiatric diagnostic evaluation with medical services; Unit price = 93.33; Max Qty = 1; Psychiatric Add-On = 144.42
90832	Psychotherapy, 30 min with patient and/or family member; Unit price = 35.24; Max Qty = 1; Psychiatric Add-On = 66.50
90837	Psychotherapy, 60 min (listed/mapped as 45 min); Unit price examples: 68.69 and 137.38
90839	Psychotherapy for crisis, first 60 min; Unit price examples present (e.g., 66.44)
96110	Developmental screening, with scoring and interpretation, per standardized instrument; Unit price = 12.06 (single unit)
96112	Developmental test administration with interpretation and report, first 60 minutes; Unit price = 62.93
99406	Smoking and tobacco use cessation counseling, intermediate (greater than 3 min up to 10 min); Unit price = 6.02
99407	Smoking and tobacco use cessation counseling, intensive (greater than 10 min); Unit price = 12.68
G2011	Alcohol and/or substance (other than tobacco) abuse structured screening/assessment and brief intervention; Unit price = 8.58

1–10 of 15

1/2

Max quantity per date of service

Codes with Max Qty = 190791; 90792; 90832; (other listed psychotherapy and screening codes show Max Qty = 1 where indicated in the fee schedule)

Psychiatric add‑on handlingPsychiatric Add‑On amount is multiplied by the number of units billed, up to the Max Qty, and added to the Unit Price for the number of units billed.

Example: 90791Unit price 91.58; Max Qty = 1; Psychiatric Add‑On = 127.88 applied per unit billed (up to Max Qty).

Example: 90792Unit price 93.33; Max Qty = 1; Psychiatric Add‑On = 144.42 applied per unit billed (up to Max Qty).

Example: 90832Unit price 35.24; Max Qty = 1; Psychiatric Add‑On = 66.50 applied per unit billed (up to Max Qty).

Billing Caveats and Required Modifiers

Denial Risk

Code listing does not guarantee payment; NCCI/MUE and program exclusions apply

Billing Rule

CPT 96127 requires U1 or U2 modifier for DOS on/after 8/1/2026

Modifier U1 or U2 is required for CPT 96127 for DOS on/after 8/1/2026.
Do not report both U1 and U2 on the same claim line; only one applies.
Claims lacking the required modifier will reject (per provider notice).

Key Terms

Psychiatric Add‑On

Effective dateApplies to services rendered on or after 7/1/2019.

ApplicationAdd‑on is paid in addition to the unit price rate and is multiplied by units billed (subject to Max Qty limits).

Licensed Practitioner of the Healing Arts (LPHA)

DefinitionLicensed Practitioner of the Healing Arts (LPHA): includes the specified licensed behavioral health practitioner types covered by this fee schedule.

ScopeThis fee schedule applies statewide to services rendered by the LPHA types listed; group psychotherapy services are not included on this LPHA fee schedule (see fee schedule notes).