Provider Notice Issued 04/08/2021

This notice informs hospitals of theappropriate process for billing COVID-19 vaccine administration performed inhospital-based outpatient settings. The billing direction applies to claims forpersons covered under both traditional fee-for-service and a HealthChoice Illinois managed care plan. 

As an exception to current hospitaloutpatient billing policy, the Department will reimburse COVID-19 vaccineadministration in hospital-based outpatient settings via the 837 Professional claimformat. While any qualified practitioner can administer the vaccine, hospitals mustuse the Medical Director, Chief Medical Officer, or other authorizedpractitioner name and NPI as the Rendering Provider in NM1, Rendering ProviderName, Loop 2310B, on the 837P claim. This authorized practitioner must be registeredin IMPACT. Thebilling information in NMI, Billing Provider Name, Loop 2010AA must be linkedto the Rendering Provider Name and NPI..

Institutionalclaims for vaccine administration that have already been submitted and paid shouldbe voided and the service rebilled through the professional claim format. 

Thechart below identifies the current coding and rate structure for vaccineadministration. Hospitals are encouraged to refer to the COVID-19 Updates webpage for the most up-to-date COVID-19 provider information, including updatedCOVID-19 fee schedules.

Per the Centers for Medicare & Medicaid Services, as a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers are prohibited from charging patients any amount for administration of the vaccine and may not deny a vaccine to anyone regardless of income, immigration, or insurance status. For individuals who are uninsured, providers may submit claims for reimbursement of COVID-19 vaccine administration through the federal HRSA COVID-19 Claims Reimbursement Portal.

Vaccine administration billing questions should be directed to a professional billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565. 

Kelly Cunningham, Administrator
Division of Medical Programs