MedicaidReimbursementMedium impact
Beyfortus (nirsevimab-alip) RSV Vaccine
Illinois Medicaid - HFS·IL · Pediatrics, Family Medicine, General Practice·Provider Notice
Effective date
Dec 8, 2023
We identified it
Jun 20, 2026
Summary
Illinois HFS now allows an administration fee for VFC Program-enrolled providers who administer Beyfortus (nirsevimab-alip) RSV vaccine to eligible infants. The fee is only available for vaccines obtained through the VFC program, not through pharmacy point-of-sale or medical billing. Providers must coordinate with mothers' care teams to verify if maternal Abrysvo vaccination was received during pregnancy before administering Beyfortus.
Action Required
Immediately: VFC Program-enrolled providers in Illinois should verify eligibility for Beyfortus administration fee when obtaining vaccine through VFC program for infants under 8 months (first RSV season) or 8-19 months (second RSV season vulnerable patients). Billing team must document maternal Abrysvo vaccination status in medical records before administering Beyfortus. Contact pharmacy consultant at 877-782-5565 for FFS claims questions or appropriate MCO for managed care.