MedicaidBilling CodesMedium impact
Instructions for COVID-19 Vaccine Additional Dose and Booster Dose
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Oct 14, 2021
We identified it
Jun 20, 2026
Summary
Illinois Medicaid has updated billing instructions for COVID-19 vaccine additional doses (for immunocompromised patients) and booster doses (for eligible populations), allowing pharmacies to bill through NCPDP claims with specific submission clarification codes and a $42.14 administration fee per dose. Effective October 14, 2021, providers can bill for services dating back to September 24, 2021.
Action Required
Effective October 14, 2021: Pharmacies administering COVID-19 vaccines must update NCPDP billing procedures to include specific submission clarification codes (02 for first dose, 06 for second dose, 07 for additional dose, 10 for booster dose), set Basis of Cost Determination to '15' with $0.00 ingredient cost, submit administration fee of $42.14 in incentive amount field, and include prescriber NPI. Begin billing immediately for dates of service back to September 24, 2021.