MedicaidBilling CodesMedium impact
Reimbursement of Gardasil® for Males and Cervarix® for Females
Illinois Medicaid - HFS·IL · Family Medicine, Pediatrics, Internal Medicine +2 more·Provider Notice
Effective date
Oct 21, 2009
We identified it
Jun 21, 2026
Summary
This policy establishes reimbursement guidelines for HPV vaccines: Gardasil® for males ages 9-26 and Cervarix® for females ages 9-26. VFC participating providers receive $6.40 administration fees for ages 9-18, while non-VFC providers and services for ages 19-26 use modifier SL with higher reimbursement rates ($149.33 for Gardasil®, $153.10 for Cervarix®).
Action Required
Immediately: Update billing system to use CPT 90649 for Gardasil® (males 9-26) and CPT 90650 for Cervarix® (females 9-26). For VFC providers: bill without modifier for ages 9-18, add modifier SL for ages 19-26. For non-VFC providers: always use modifier SL. Train billing team on age-based coding requirements and reimbursement rates.