MedicaidBilling CodesMedium impact
Pharmacy COVID-19 Vaccination and Booster Update
Illinois Medicaid - HFS·IL · Pharmacy, Pediatrics, Family Medicine·Provider Notice
Effective date
May 17, 2022
We identified it
Jun 20, 2026
Summary
Illinois Medicaid updated COVID-19 vaccination coverage to include pediatric boosters for ages 5-11, primary vaccinations for children 6 months-5 years with Pfizer and Moderna vaccines, and new Novavax vaccines for adults 18+. All vaccines are reimbursed at $42.14 administration fee through NCPDP billing with specific submission codes.
Action Required
Immediately: Pharmacy billing staff must update NCPDP claim submission procedures for COVID-19 vaccines. Use Basis of Cost Determination code '15', Ingredient Cost $0.00, Professional Service Code 'MA', and submit $42.14 administration fee in Incentive Amount field. Use specific Submission Clarification Codes: '02' for first dose, '06' for second dose, '10' for booster dose. Note that pharmacies can only administer to children 3+ years old per Illinois regulations.