The Rates plan
$29/mo7-day free trialThe table on this page is a common-procedure sample. The full Illinois physician schedule has 6,469 codes.
- Every code on all 51 published schedules
- Full-schedule CSV export
- Full state Medicaid dental network lists
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Published codes
6,469
Physician procedures on the 2026 schedule
Median % of Medicare
72.6%
vs national Medicare, GPCI-neutral
PA required
10
codes flagged by the state
Common physician procedures and what Illinois Medicaid pays
A curated sample of recognizable procedures from the 6,469-code schedule. Rates are the state's published fee-for-service amounts; the percentage compares each rate with the national Medicare amount for the same code.
| Code | Procedure | Illinois rate | % of Medicare |
|---|---|---|---|
| 10021 | Fine needle aspiration biopsy, first lesion, no imaging | $48.46 | 48% |
| 10060 | Drainage of a skin abscess, simple | $69.25 | 53.9% |
| 10061 | Drainage of a skin abscess, complicated or multiple | $121.25 | 55.1% |
| 10120 | Removal of a foreign body from tissue, simple | $68.85 | 43.8% |
| 10140 | Drainage of a blood or fluid collection under the skin | $77.91 | 44.7% |
| 11042 | Wound debridement, skin and tissue below, first 20 sq cm | $57.37 | 43.3% |
| 11043 | Wound debridement to muscle, first 20 sq cm | $146.62 | 61.2% |
| 11044 | Wound debridement to bone, first 20 sq cm | $213.43 | 66.6% |
| 11102 | Skin biopsy, tangential, first lesion | $24.80 | 26% |
| 11104 | Skin biopsy, punch, first lesion | $30.95 | 25.5% |
| 11106 | Skin biopsy, incisional, first lesion | $37.52 | 24.8% |
| 11200 | Removal of skin tags, up to 15 | $49.54 | 53.7% |
| 11300 | Shave removal of a skin lesion, trunk/arm/leg, 0.5 cm or less | $22.46 | 23.3% |
| 11305 | Shave removal of a skin lesion, scalp/neck/genitals, 0.5 cm or less | $24.88 | 24.6% |
| 11400 | Removal of a benign skin growth, trunk/arm/leg, 0.5 cm or less | $54.89 | 42.9% |
| 11402 | Removal of a benign skin growth, trunk/arm/leg, 1.1-2 cm | $75.82 | 44.3% |
| 11720 | Trimming of thickened nails, 1-5 | $13.55 | 41.4% |
| 11721 | Trimming of thickened nails, 6 or more | $17.61 | 39.1% |
| 11730 | Removal of a nail plate, partial or complete | $35.54 | 31.9% |
| 11750 | Permanent removal of part or all of a nail | $66.70 | 42.3% |
| 11976 | Removal of a contraceptive implant | $89.96 | 61.4% |
| 11981 | Insertion of a medication-releasing implant | $85.62 | 79.6% |
| 12001 | Simple wound repair, scalp/trunk/limbs, 2.5 cm or less | $43.68 | 38.4% |
| 12002 | Simple wound repair, scalp/trunk/limbs, 2.6-7.5 cm | $56.82 | 40.8% |
| 12011 | Simple wound repair, face/ears/lips, 2.5 cm or less | $54.37 | 38.9% |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * show the schedule's representative published variant.
More Illinois Medicaid fee schedules
- Illinois lab & imaging fee schedule · 2,095 codes
- Illinois dme & supplies fee schedule · 1,563 codes
- Illinois drugs fee schedule · 782 codes
- Illinois other services fee schedule · 185 codes
- Illinois vision fee schedule · 82 codes
- Illinois hearing fee schedule · 45 codes
Physician rates in neighboring states
Frequently asked questions
What does Illinois Medicaid pay for physician and professional services?
Illinois Medicaid publishes 6,469 physician procedure rates effective 2026, paying a median 72.6% of the national Medicare amount for the same services. The schedule covers office visits, preventive care, surgery, and evaluation and management services. The table on this page shows published rates for common procedures; the complete all-codes schedule is available as a CSV download with a ProviderSignal Rates subscription.
How do Illinois's physician rates compare with Medicare?
Across physician codes with a national Medicare comparator, Illinois Medicaid pays a median 72.6% of the Medicare amount (GPCI-neutral national comparison). Individual codes vary widely, so check the per-code percentage in the table.
Do physician services need prior authorization in Illinois?
Illinois publishes prior-authorization flags on its schedule: 10 physician codes are marked as always requiring PA. Codes without a flag carry no published PA indicator.
Where do these rates come from?
Directly from Illinois's published Medicaid fee-for-service schedule (effective 2026), collected and normalized by ProviderSignal across all 50 states + DC. Rates are re-collected on a rolling schedule and this page updates automatically. Procedure descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.
Get an email the next time Illinois changes these rates.