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Elizabeth M. Whitehorn, Director

Provider Notice Issued 12/16/2021

Date:   December 16, 2021

To:       All Medical Assistance Program Providers

Re:      Immunization Administration Rate Increase Effective January 1, 2022 Per Public Act 102-0043 

_________________________________________________________________________________________________________

This notice informs providers of an immunization administration fee increase effective January 1, 2022, per Public Act 102-0043. This increase affects vaccine administration fees under the Vaccines for Children (VFC) program for both Medicaid fee-for-service and the HealthChoice Illinois managed care plans for children from birth through 17 years of age.

Per the Act, the Department is increasing the immunization administration rate to no lower than 70% of the median regional maximum administration fee for the State of Illinois as established by the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services. The increase raises the Department's VFC vaccine administration fee to $12.56. 
 
The following immunization administration procedure codes are impacted by the rate increase:

90619 90620 90621 90630 90633 90636 90647 90648
90651 90657 90658 90670 90672 90674 90680 90681
90682 90685 90686 90687 90688 90696 90697 90698
90700 90702 90707 90710 90713 90714 90715 90716
90723 90732 90734 90739 90743 90744 90756  

 
The Department is awaiting approval from the federal Centers for Medicare & Medicaid Services (CMS) before implementing the rate increase for fee-for-service (FFS) claims. Applicable FFS claims with dates of service beginning January 1, 2022 will be held by HFS until CMS approval is given and then released into processing. HealthChoice Illinois managed care plans will be ready to process claims beginning January 1, 2022.

Questions regarding this notice may be directed to a billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 or the applicable managed care plan.

 

Kelly Cunningham, Administrator
Division of Medical Programs