MedicaidCoverageMedium impact
Fee-for-Service Billing of Synagis
Illinois Medicaid - HFS·IL · Pediatrics, Pulmonology, Family Medicine +1 more·Provider Notice
Effective date
Nov 1, 2014
We identified it
Jun 20, 2026
Summary
Effective November 1, 2014, hospitals can no longer bill fee-for-service for Synagis (RSV prevention drug). Only enrolled pharmacies may submit Synagis claims through the pharmacy point-of-sale system.
Action Required
Before November 1, 2014: Billing team must remove Synagis from hospital fee-for-service billing systems and encounter forms. Redirect Synagis prescriptions to enrolled pharmacies for direct billing through pharmacy point-of-sale system. Hospital claims for Synagis will be denied after this date.