MedicaidBilling CodesMedium impact
Influenza Vaccines Billed by Pharmacies
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Sep 25, 2024
We identified it
Jun 20, 2026
Summary
The 2024-2025 influenza vaccine NDCs are now active in Illinois Medicaid's billing system. Pharmacies must enter the administration fee amount in the Incentive Amount Submitted field (438-E3) and 'MA' in the Professional Service Code field (440-E5) to receive up to $6.40 administration fee.
Action Required
Immediately: Pharmacy billing staff must update influenza vaccine claims to include administration fee amount in field 438-E3 (max $6.40) and enter 'MA' in Professional Service Code field 440-E5. For MCO claims, contact the specific MCO for billing instructions. Claims will reject or receive no administration fee without proper field completion.