Illinois pharmacists do not have independent prescriptive authority to furnish self-administered hormonal contraceptives.
Standing Order
Illinois pharmacists are authorized to prescribe and dispense hormonal contraception under a statewide standing order issued by the Illinois Department of Public Health (IDPH).
Eligible Medications: Contraceptive pills, patches, and vaginal rings, and depot injections.
Prescription Limitations: Dispense up to a 12-month supply of hormonal contraceptives per standing order.
Age Restrictions:
Available for patients 18 years and older without a prior prescription.
Minors under 18 require prior prescription from a healthcare provider.
Documentation Requirements: Maintain patient records for 5 years; comply with HIPAA regulations.
Training Requirements: Pharmacists must complete an Accreditation Council for Pharmacy Education (ACPE)-approved training program covering: Patient
self-screening risk assessment, Contraindication identification, Contraceptive counseling and education, and the proper dispensation of hormonal
contraceptives.
Reimbursement Details
Eligibility
In Illinois, pharmacists are eligible for reimbursement for providing patient care services related to contraceptives under both Illinois Medicaid and HealthChoice Illinois Managed Care Organizations
(MCOs).
Office and Outpatient Evaluation & Management Codes:
99202 – New patient evaluation and management (15-29 min) | $27.38
99203 – New patient evaluation and management (30-44 min) | $47.56
99211 – Established patient evaluation and management (<10 min) | $7.17
99212 – Established patient evaluation and management (10-19 min) | $20.61
Preventive Medicine Counseling:99401 – Preventive Medicine Counseling (~15 min) | $25.50
Modifier FP – Required for contraceptive assessment and consultation services to distinguish these services from HIV assessment and consultation services.
Submission Process
The pharmacist must be listed as the rendering provider, and the associated pharmacy must be the billing provider. Claims must be submitted via the 837P electronic format.
Pharmacists must be enrolled with the Category of Service 103 to bill for contraceptive assessment
and consultation services in the 837P electronic format.
FP Modifier is still required for contraceptive assessment and consultation services.
Pharmacists must be enrolled with the correct Category of Service (103 for contraceptive services, 132 for HIV services) to bill using 837P Electronic Format.
837P Electronic Format Resources:
CMS (Medicare Billing Guide for 837P format): CMS 837P Guide
