MedicaidCoverageLow impact
COVID-19 Vaccine Counseling Coverage Change
Illinois Medicaid - HFS·IL · Family Medicine, Pediatrics, General Practice·Provider Notice
Effective date
Oct 29, 2021
We identified it
Jun 20, 2026
Summary
COVID-19 vaccine counseling using CPT 99402 can now be billed for children aged 5 through 20 (expanded from 5 through 17) for both Medicaid fee-for-service and HealthChoice Illinois managed care plans. The counseling can be provided to parents, guardians, or children and does not require the child to actually receive the vaccination.
Action Required
Update billing system age eligibility for CPT 99402 COVID-19 vaccine counseling from children 5-17 to children 5-20 for Illinois Medicaid patients. Ensure billing staff know vaccination is not required for reimbursement of counseling services.