Provider Notice Issued 01/07/2021

Date:    January 7, 2021

To:       EnrolledPhysicians, Advanced Practice Nurses, Physician Assistants, Local Health Departments,Federally Qualified Health Centers, Rural Health Clinics, and Encounter Rate Clinics

Re:      COVID-19Vaccine and Vaccine Administration Billing Information for Practitioners          

This notice provides information to practitionerson current coding and rates, as well as billing guidance for FederallyQualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and EncounterRate Clinics (ERCs) related to the COVID-19 vaccine and its administration. Practitionersmay bill at the time the vaccine becomes available. This billing guidance applies to claims for participants covered under bothtraditional Medicaid fee-for-service and the HealthChoice Illinois Medicaidmanaged care plans.

COVID-19 vaccine administration procedure codesare billable by physicians, advanced practice nurses (APNs), physician assistants(PAs), local health departments, FQHCs, RHCs, and ERCs.

The Department willreimburse the above clinics for the COVID-19 vaccine administrationfee-for-service outside the normal encounter rate methodology, even if thevaccine is administered during a face-to face encounter with a practitioner. FQHCs,RHCs and ERCs must submit COVID-19 vaccine administration codes on aclaim separate from any other codes. COVID-19 vaccineadministration codes submitted as detail codes along with a T1015 or S5190encounter will result in a rejection of the encounter claim with error codeG70.

The Department will use the rates below establishedfor the Medicare program for reimbursement of the administration fees for thefirst and second doses of the currently approved vaccines. These administrationrates are applicable only to these specific vaccines.  Going forward, providers should refer to theCOVID-19 Fee Schedule, available on the

COVID-19 Updates webpage, for future guidance as new vaccine and vaccineadministration codes are approved by the Centers for Medicare & MedicaidServices (CMS) and the Federal Drug Administration (FDA).

Currently approved COVID-19 vaccine productprocedure codes are included below as a reference but should not be billed whenthe vaccine is obtained at zero cost to the provider. 

Vaccine administration for the uninsured population should be billedthrough the federal HRSA COVID-19Claims Reimbursement Portal.

The COVID-19 Fee Schedule has been updated with the codes and rates above. Pleasecheck the COVID-19 Updates webpage for the most up to date information related to theCOVID-19 public health emergency.

Questions regarding this notice may be directed to the Bureau of Professionaland Ancillary Services at 877-782-5565.

Kelly Cunningham, Administrator

Division of Medical Programs