MedicaidCoverageMedium impact
Coverage of Human Papillomavirus (HPV) Vaccination Ages 46 and Up per Public Act 103-0102
Illinois Medicaid - HFS·IL · Family Medicine, Internal Medicine, OB-GYN +1 more·Provider Notice
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers HPV vaccination for patients ages 46 and up who have cervical dysplasia with high risk of recurrence or progression, effective January 1, 2025. Claims must include CPT 90651 with ICD-10 diagnosis code N87.9 linked to the service line.
Action Required
By January 1, 2025: Update billing system to allow CPT 90651 (HPV vaccine) for Illinois Medicaid patients ages 46+ when linked to ICD-10 code N87.9 (Cervical Dysplasia). Ensure diagnosis pointer connects N87.9 to the vaccine service line on claims. Train billing staff on new age eligibility requirements for HPV vaccination coverage.