MedicaidBilling CodesMedium impact
Additional Instructions for COVID-19 Vaccine 3rd Booster Dose
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Sep 9, 2021
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers COVID-19 third booster doses for immunocompromised patients (at least 28 days after second dose) and general population (8 months after second dose). Pharmacies can bill through NCPDP claims with specific submission codes and receive $42.14 administration fee per dose.
Action Required
Pharmacies administering COVID-19 third doses should: Update billing systems to use Submission Clarification Code 07 for third doses, set Basis of Cost Determination to '15' with $0.00 ingredient cost, submit Professional Service Code 'MA', enter $42.14 in Incentive Amount field, and ensure proper prescriber NPI is included. Claims can be submitted for dates of service beginning August 12, 2021.