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Elizabeth M. Whitehorn, Director

Provider Notice Issued 05/15/2025

    

To: Enrolled Physicians; Advanced Practice Nurses: Physician Assistants; Local Health Departments; Hospitals; Federally Qualified Health Centers; Rural Health Clinics; Encounter Rate Clinics; and Pharmacies
​Date May 15, 2025
​Re:
 Coverage of the Measles, Mumps, and Rubella (MMR) Vaccination for Children Aged 6-11 Months

This notice provides updated guidance regarding coverage of the measles, mumps, and rubella (MMR) vaccine for children aged 6 months through 11 months during the current measles outbreak in Illinois. These policies apply to customers covered under both the Medicaid fee-for-service (FFS) program and HealthChoice Illinois managed care organizations (MCOs).

MMR Vaccination for Children Aged 6 through 11 Months
Effective May 5, 2025, the Department of Healthcare and Family Services (HFS) will provide coverage for the administration of the MMR vaccine for children aged 6 months through 11 months under the following circumstances:

  • The child resides in, or is anticipated to travel to, a domestic or international area currently experiencing a measles outbreak.
  • The child has had potential measles exposure and is eligible for post-exposure prophylaxis (PEP) within 72 hours of exposure.
  • A clinician determines that the child’s individual risk of measles exposure warrants early vaccination.

In all such cases, providers may administer an early or extra dose of the MMR vaccine to eligible children aged 6 months through 11 months. This dose does not count toward the two-dose routine MMR vaccine schedule, which remains due at:

  • 12–15 months of age (first routine dose), and
  • 4–6 years of age (second routine dose).

Billing and Reimbursement

HFS will reimburse the vaccine administration fee of $16.71 for each dose of the MMR vaccine administered when supplied by the Vaccines for Children (VFC) program. Providers should use the appropriate CPT codes when billing for vaccine administration in this age group.

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

Kelly Cunningham, Administrator
Division of Medical Programs