Provider Notice issued 05/02/2023

This notice informs home health agencies (HHAs) and local health departments (LHDs) enrolled for home health services that the Department of Healthcare and Family Services (HFS) has completed programming to reimburse for administration of IV infused monoclonal antibody medication in the home setting for the treatment of COVID-19. These provider types may also be reimbursed for COVID-19 vaccine administration and vaccine counseling in the home setting.

These reimbursement changes apply to claims paid under Medicaid fee-for-service (FFS) and the HealthChoice Illinois managed care organizations (MCOs). Home health claims must be billed on the 837 Institutional claim format.  

• Monoclonal Antibody IV Administration

Effective immediately, HHAs and LHDs may be reimbursed for IV infused monoclonal antibody administration rendered by skilled nursing staff only when provided separately from an all-inclusive intermittent or in-home shift nursing visit already being provided to patients under their care in accordance with a curative or rehabilitative plan of care. No other nursing visit, RN or LPN, can be billed on the same date of service as an IV infused monoclonal antibody treatment.  

As noted in the October 6, 2022 notice, HFS will cover Monoclonal Antibody IV Administration codes for a specific subset of the uninsured population. Providers should follow these steps at the time an uninsured person presents for services:

1. Check the MEDI system to verify if the person has an existing Recipient Identification Number (RIN) assigned.
2. If a RIN is found, the "Special Information" under the "COVID-19 Testing" eligibility in MEDI will show "Title XIX".
3. This uninsured population will have medication treatment coverage and are eligible to have their monoclonal antibody administration billed to HFS through the fee-for-service (FFS) claims processing system.
4. Those with a "Special Information" message of "State-funded" are not eligible, and medication treatment services are not billable to HFS.
5. Individuals with no eligibility can be uploaded to the COVID Portal for RIN assignment.

All IV infused monoclonal antibody administration procedure codes and rates are identified in the COVID-19 Fee Schedules.

·         COVID-19 Vaccine Administration

HHAs have been added to the COVID-19 fee schedule as providers eligible to bill for vaccine administration. Both HHAs and LHDs may bill for COVID-19 vaccine administration in the home setting. No other nursing visit, RN or LPN, can be billed on the same date of service as COVID-19 vaccine administration.

Current procedure codes and rates are identified in the COVID-19 Fee Schedule.

·         COVID-19 Vaccine Counseling Procedure Code

HHAs and LHDs may bill the following preventive medicine code in the home setting that may be used to counsel customers regarding the benefits of receiving the COVID-19 vaccine:

Ø  99402 – Preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 30 minutes

This code is limited to billing face-to-face visits for children ages 6 months through 20 years. Parents, guardians, or the child as appropriate may be counseled on the benefit of receiving the COVID-19 vaccination, even if the parent or guardian is not enrolled for Medicaid coverage. Reimbursement of counseling code 99402 will not be tied to the child receiving the vaccination.   

Providers who require a time override for services rendered while HFS programming changes were completed should follow the Timely Filing Override Submittal Instructions found on the Non-Institutional Providers webpage. 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