MedicaidBilling CodesHigh impact
COVID-19: Children Age 5-11 Vaccination Coverage; Vaccine Counseling Coverage; and Vaccine Additional Dose and Booster Dose Clarification
Illinois Medicaid - HFS·IL · Pediatrics, Family Medicine, General Practice·Provider Notice
Effective date
Oct 29, 2021
We identified it
Jun 20, 2026
Summary
COVID-19 vaccination coverage expanded for children ages 5-11 with new Pfizer vaccine codes and administration codes effective October 29, 2021. New counseling code 99402 ($30) can be billed for face-to-face COVID vaccine counseling for children 5-17, and clarifies timing for additional and booster doses for adults 18+.
Action Required
Immediately: Update billing system to include new COVID vaccine codes 91307, 0071A, and 0072A for children ages 5-11. Add counseling code 99402 for face-to-face COVID vaccine counseling (children 5-17) at $30 rate. Train billing team on proper use of 99402 with appropriate visit codes when vaccine is administered, but only E&M codes when vaccine is declined. Note: FQHCs and RHCs cannot bill 99402 separately.