MedicaidCoverageMedium impact
Pharmacy COVID-19 Booster Update
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Aug 31, 2022
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers new Pfizer-BioNTech COVID-19 bivalent booster for ages 12+ and Moderna bivalent booster for ages 18+, effective August 31, 2022. Pharmacies must use specific NCPDP billing codes and submit a $42.14 administration fee with $0.00 ingredient cost for all COVID-19 vaccine doses.
Action Required
Immediately: Pharmacy billing staff must update NCPDP claim submission procedures for COVID-19 vaccines. Submit Basis of Cost Determination (423-DN) as '15', Ingredient Cost (409-D9) as $0.00, Professional Service Code (440-E5) as 'MA', Days Supply (405-D5) as '1', and include $42.14 administration fee in Incentive Amount field (438-E3). Use appropriate Submission Clarification Codes: '02' for first dose, '06' for second dose, '10' for booster dose.