MedicaidCoverageMedium impact
COVID-19 Vaccine Counseling Coverage Updates
Illinois Medicaid - HFS·IL · Family Medicine, General Practice, Pediatrics +1 more·Provider Notice
Effective date
Jun 17, 2022
We identified it
Jun 20, 2026
Summary
COVID-19 vaccine counseling coverage has been expanded for Medicaid patients. The age range for CPT 99402 counseling has been lowered from 5 years to 6 months (now 6 months through 20 years), and the counseling can now be billed separately regardless of whether the patient receives the vaccination.
Action Required
Immediately: Update billing system to allow CPT 99402 (COVID-19 vaccine counseling) for patients aged 6 months through 20 years on Medicaid plans. Configure system to allow billing of 99402 independently of vaccination administration. Update encounter forms and staff training to reflect expanded age range and standalone billing capability.