Illinois Medicaid (HFS fee-for-service) pediatric speech and OT coverage: prior authorization, who can bill and referrals
The short answerSLP and OT. Illinois Medicaid pays licensed speech/language and occupational therapists on a physician or LPHA order and a plan of care. Prior authorization is required for therapy, except for speech/language therapy for children under 21.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Illinois. Public policy, not the member's benefits.
Illinois Medicaid (HFS fee-for-service)
89 Ill. Adm. Code 140.457 and 140.458 · Illinois
| Where it applies | Payment is made for therapy evaluation and treatment that is rendered by a licensed therapist or supervised assistant under a plan of care, ordered by a physician or other licensed practitioner of the healing arts, and medically necessary. [1] |
|---|---|
| Prior authorization | Therapy is provided with prior authorization, except prior authorization is not required for speech/language therapy services for children under age 21. [1] |
| Referral | Therapy must be ordered by a physician or other LPHA. A licensed therapist may be an LPHA for this purpose where the therapist's practice act permits it. [1] |
| Who can bill | A physical, speech/language or occupational therapist must be licensed by the Illinois Department of Financial and Professional Regulation or an equivalent licensing body in the therapist's state of practice, and be enrolled in the Medical Assistance Program. [1] |
| Also | For dates of service from February 1, 2022, payment is made for Adaptive Behavior Support services for autism spectrum disorders under 89 Ill. Adm. Code 140.465. Section 140.458 says the Department decides a prior approval request within 21 days after receiving all necessary information. [1][2] |
- Illinois Administrative Code, Title 89, Section 140.457 Therapy Services (amended effective December 27, 2023), checked October 30, 2026
- Illinois Administrative Code, Title 89, Section 140.458 Prior Approval for Therapy Services, checked October 30, 2026
What Illinois Medicaid (HFS fee-for-service)'s documents say
The table above has every field we found for Illinois Medicaid (HFS fee-for-service), with numbered sources. In short:
- Prior authorization. Therapy is provided with prior authorization, except prior authorization is not required for speech/language therapy services for children under age 21.
- Who can bill. A physical, speech/language or occupational therapist must be licensed by the Illinois Department of Financial and Professional Regulation or an equivalent licensing body in the therapist's state of practice, and be enrolled in the Medical Assistance Program.
- Where it applies. Payment is made for therapy evaluation and treatment that is rendered by a licensed therapist or supervised assistant under a plan of care, ordered by a physician or other licensed practitioner of the healing arts, and medically necessary.
Check Illinois Medicaid (HFS fee-for-service)'s claim against the row
Before the claim goes out, compare it with the row above: the evaluation and treatment codes are ones the policy lists, the plan of care and any prior authorization cover the date, and the visit count fits the limit. The pediatric speech and OT table compares Medicaid with every other payer we checked.