MedicaidBilling CodesHigh impact
Changes to Vaccination Billing Requirements Effective with Dates of Service Beginning September 1, 2019
Illinois Medicaid - HFS·IL · Family Medicine, General Practice, Pediatrics +1 more·Provider Notice
Effective date
Sep 1, 2019
We identified it
Jun 20, 2026
Summary
For dates of service beginning September 1, 2019, providers must use VFC program vaccines (not private stock) for all CHIP and state-funded children under 19, and can only bill $6.40 administrative fee using specific vaccine CPT codes. Private vaccine costs will no longer be reimbursed for these children if the vaccine is available through VFC.
Action Required
By September 1, 2019: Billing team must update vaccine billing procedures to use VFC program vaccines for all CHIP and state-funded children under 19. Stop billing private vaccine costs for these patients - only bill $6.40 administrative fee using specific vaccine CPT codes. Update billing system to distinguish between Title XIX (Medicaid) patients who continue under old rules and CHIP/state-funded patients who must use VFC vaccines. Verify eligibility through MEDI system before services.