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Elizabeth M. Whitehorn, Director

Provider Notice issued 11/09/10

Revisions to the Influenza Vaccine Administration Billing Requirements

To:​

Participating Pharmacies​

Date:​ November 9, 2010​
Re:​ Revisions to the Influenza Vaccine Administration Billing Requirements​

On November 15, 2007, the Illinois Department of Healthcare and Family Services (HFS) issued an informational notice to pharmacies and long term care providers regarding adult coverage for influenza vaccines and influenza vaccine administration fees. In that provider notice the department had provided specific billing instructions for pharmacies to follow in order to receive reimbursements from HFS for influenza vaccines and corresponding vaccine administration fees. However, HFS has since received additional billing guidance from the National Council for Prescription Drug Programs (NCPDP), thus necessitating that HFS revise its billing instructions for influenza vaccine administration charges.

As a result of the additional NCPDP guidance, effective December 1, 2010, HFS shall require pharmacies billing for influenza vaccine administration fees to submit their usual and customary vaccine administration fees in the NCPDP 5.1 Pricing Segment, Incentive Amount Submitted (438-E3) field. In addition, the Professional Service Code (440-E5) field must be submitted with the value “MA” to denote medication administration. HFS will subsequently reimburse for influenza vaccine administration fees up to a maximum rate of $6.40.

Please note that for influenza vaccines and administration fees submitted prior to December 1, 2010, pharmacies should adhere to the billing instructions specified in the November 15, 2007, informational notice.  

Any questions regarding this notice should be directed to the Bureau of Pharmacy Services at 877-782-5565, Option 7. 

Theresa A. Eagleson, Administrator

Division of Medical Programs