MedicaidCoverageMedium impact
Coverage of the Measles, Mumps, and Rubella (MMR) Vaccination for Children Aged 6-11 Months
Illinois Medicaid - HFS·IL · Pediatrics, Family Medicine, General Practice·Provider Notice
Effective date
May 5, 2025
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers MMR vaccination for children aged 6-11 months during measles outbreaks, effective May 5, 2025. Providers can bill $16.71 for vaccine administration when doses are supplied through the VFC program for eligible children in outbreak areas or with exposure risk.
Action Required
Immediately: Billing team must update system to allow MMR vaccine administration billing for children 6-11 months old when supplied by VFC program. Verify patient eligibility criteria (outbreak area residence, travel plans, exposure risk, or clinical determination) before administration. Bill $16.71 administration fee using appropriate CPT codes for this age group. Contact MCO or call 877-782-5565 for billing questions.