MedicaidBilling CodesMedium impact
Pharmacy Billing of Subcutaneous Monoclonal Antibody Treatment
Illinois Medicaid - HFS·IL · Pharmacy, Infectious Disease·Provider Notice
Effective date
Nov 1, 2021
We identified it
Jun 20, 2026
Summary
Illinois pharmacies can now bill Medicaid for administering subcutaneous monoclonal antibody treatment (REGEN-COV) to COVID-19 positive patients, with incentive fees of $750 for home administration and $450 for pharmacy administration. Claims must be submitted via NCPDP with specific field requirements including zero ingredient cost and appropriate professional service codes.
Action Required
Illinois pharmacies only: Update NCPDP billing system to submit REGEN-COV claims with Basis of Cost Determination '15', Ingredient Cost $0.00, Professional Service Code 'MA', Days Supply '1', and appropriate incentive amount ($450 or $750) in field 438-E3. Ensure proper documentation is maintained for all administrations.