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Elizabeth M. Whitehorn, Director

Provider Notice Issued 09/30/2022

Date:    September 30, 2022           

To:       Enrolled Physicians, Advanced Practice Registered Nurses, Physician Assistants, Local Health Departments, Encounter Rate Clinics, Federally Qualified Health Centers, Rural Health Clinics, and Hospitals        

Re:      New COVID-19 Booster Vaccinations Effective August 31, 2022

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This notice provides an update for coverage of new COVID-19 boosters. The Illinois Department of Healthcare and Family Services (HFS) reimburses providers an administration fee for all federally allocated COVID-19 vaccines. These updates apply to claims for customers covered under traditional Medicaid fee-for-service (FFS) and the HealthChoice Illinois (HCI) managed care organization (MCO) plans.

All COVID-19 vaccines should be given in accordance with Centers for Disease Control (CDC) guidance.

New Pfizer-BioNTech Booster Vaccine for Persons Aged 12 and Older
The Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product booster dose is available effective with dates of service beginning August 31, 2022, for persons aged 12 years and older.

New Moderna Booster Vaccine for Persons Aged 18 and Older
The Moderna COVID-19 Vaccine, Bivalent Product booster dose is available effective with dates of  service beginning August 31, 2022, for persons aged 18 years and older.

Per the CDC, the updated COVID-19 boosters add Omicron BA.4 and BA.5 spike protein components to the current vaccine composition, helping to restore protection that has waned since previous vaccination by targeting variants that are more transmissible and immune-evading.

The HFS COVID-19 Fee Schedule has been updated. Questions regarding vaccine administration may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for the FFS program, or the applicable HCI MCO plan.

 
Kelly Cunningham, Administrator
Division of Medical Programs