Provider Notice Issued 03/30/2021
Date: March 30, 2021
To: Enrolled Physicians, Advanced Practice Nurses,Physician Assistants, Local Health Departments, Federally Qualified Health Centers,Rural Health Clinics, Encounter Rate Clinics, and Pharmacies
Re: COVID-19 Vaccine Administration RateIncrease
This notice provides updated information regarding theMarch 15, 2021 Centers for Medicare & Medicare Services (CMS) rate increasefor the administration of COVID-19 vaccines. This guidance applies to claimsfor participants covered under both traditional Medicaid fee-for-service andthe HealthChoice Illinois Medicaid managed care plans.
Effective with dates of service on and after March 15,2021, the Department will continue to follow the rates established for theMedicare program for reimbursement of the administration fees. Reimbursementis increased to $42.14 for the administration of each dose of a COVID-19vaccine.
Department COVID-19 vaccine administration rates fordates of service prior to March 15, 2021 remain at $16.94 for the initial dosein a two-dose series, and $28.39 for the second dose in a two-dose series, orfor a single-dose vaccine.
The COVID-19 Fee Schedule has been updated with the new vaccine administration rate.Providers should refer to the COVID-19 Updates webpage for the most up to date information related to theCOVID-19 public health emergency.
Per CMS, as a condition of receiving free COVID-19vaccines from the federal government, vaccine providers are prohibited fromcharging patients any amount for administration of the vaccine and may not denya vaccine to anyone regardless of income, immigration, or insurance status. Forindividuals who are uninsured, providers may submit claims for reimbursement ofCOVID-19 vaccine administration through the federal HRSA COVID-19 ClaimsReimbursement Portal.
Questionsregarding this notice may be directed to the Bureau of Professional andAncillary Services at 877-782-5565.
Divisionof Medical Programs