MedicaidReimbursementMedium impact
Pharmacy Instructions for COVID-19 Vaccine for Children Ages 5-11
Illinois Medicaid - HFS·IL · Pharmacy, Pediatrics·Provider Notice
Effective date
Nov 2, 2021
We identified it
Jun 20, 2026
Summary
Illinois Medicaid will now reimburse pharmacies for administering COVID-19 vaccines to children ages 5-11 (two 10mcg Pfizer doses) with specific NCPDP billing requirements. Claims can be submitted retroactively from November 2, 2021 with a $42.14 administration fee per dose.
Action Required
Immediately: Pharmacies must update NCPDP billing systems to submit COVID-19 vaccine claims for children 5-11 using Basis of Cost Determination '15', Ingredient Cost $0.00, Professional Service Code 'MA', Days Supply '1', and Incentive Amount $42.14. Use Submission Clarification Code '02' for first dose and '06' for second dose. Include prescriber NPI or pharmacist NPI with SCC '42' if pharmacist is prescriber.