MedicaidCoverageMedium impact
COVID-19 Pediatric Booster Coverage Effective May 17, 2022
Illinois Medicaid - HFS·IL · Pediatrics, Family Medicine, General Practice·Provider Notice
Effective date
May 17, 2022
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers Pfizer COVID-19 pediatric booster vaccinations for children ages 5-11 using CPT code 0074A, with an administration fee of $41.80. This coverage applies to both Medicaid fee-for-service and HealthChoice Illinois managed care plans.
Action Required
Immediately: Billing teams serving Illinois Medicaid patients should update billing systems to include CPT code 0074A for COVID-19 pediatric booster administration with reimbursement rate of $41.80. Update encounter forms and vaccination protocols for children ages 5-11. Contact Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims questions or applicable managed care plan for other inquiries.