MedicaidBilling CodesHigh impact
COVID-19 Vaccination Administration Billing for Pharmacies
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Jan 7, 2021
We identified it
Jun 20, 2026
Summary
Illinois Medicaid will now reimburse pharmacies for COVID-19 vaccine administration through NCPDP claims submission. Pharmacies must submit claims with specific NCPDP codes, $0.00 ingredient cost, and administration fees of $16.94 for first doses and $28.39 for final/single doses.
Action Required
Immediately: Pharmacy billing teams must update NCPDP claim submission procedures for COVID-19 vaccines. Set Basis of Cost Determination (423-DN) to '15', Ingredient Cost (409-D9) to $0.00, Professional Service Code (440-E5) to 'MA', Days Supply (405-D5) to '1'. Use Submission Clarification Code '02' for first doses ($16.94 fee) and '06' for second doses ($28.39 fee). Single-dose vaccines require blank SCC with $28.39 fee. Include prescriber NPI in field 411-DB.