Illinois Medicaid Reimbursement: HFS Fee Schedule Overview

Illinois’s Medicaid program is administered by the Department of Healthcare and Family Services (HFS), publishing fee schedules at hfs.illinois.gov across more than 40 distinct provider categories, in PDF and Excel format by effective date.

What’s currently published

Current published rates tracked by MedicaidBench:

• 90791 (initial psychiatric diagnostic evaluation): $122.11 per encounter (effective 2019-07-01)
• 90837 (individual psychotherapy, ~60 min): $91.58 per session (effective 2024-04-01)
• 99213 (established-patient office visit): $44.67 per visit (effective 2024-04-01)
• 99214 (moderate-complexity office visit): $65.79 (effective 2024-04-01)

Note the gap between the 90791 effective date (2019) and the other three codes (2024) — this is a clear example of a state updating some codes without touching others in the same rate family, which is exactly why tracking “behavioral health rates” as a single category can miss the fact that individual codes within it move independently.

Format and access

With 40+ provider categories, locating the right fee schedule file in Illinois requires first identifying which provider category applies to your billing scenario — a step that’s easy to get wrong if you’re new to the state’s structure, since category boundaries don’t always map intuitively to how a service is typically described clinically.

What to watch for

The multi-year gap between when 90791 last updated and when the other codes did suggests Illinois revisits different parts of its fee schedule on different cycles rather than a single annual refresh — useful context if you’re trying to predict when a specific code might next be revisited.

Keeping current

Illinois’s per-category file structure means a comprehensive check requires knowing which of the 40+ categories to monitor for a given billing scenario. MedicaidBench tracks Illinois’s published rates across categories and normalizes them into one consistent view by code and state, regardless of which HFS category file a given rate originated from.