MedicaidCoverageMedium impact
Change in Vaccines for Children (VFC) Plus Coverage for 19 and 20 year olds
Illinois Medicaid - HFS·IL · Family Medicine, Pediatrics, General Practice +1 more·Provider Notice
Effective date
Jan 1, 2009
We identified it
Jun 21, 2026
Summary
Effective January 1, 2009, Illinois providers must now bill HFS directly for vaccinations given to Medicaid-enrolled 19 and 20 year olds using CPT codes, as these patients are no longer covered under the VFC Plus program. Providers should bill the vaccine CPT code plus 99211 for administration if the visit is solely for vaccination.
Action Required
Immediately: Billing team must update procedures to bill HFS directly for vaccinations provided to Medicaid-enrolled 19 and 20 year olds. Use appropriate vaccine CPT codes according to State Max rates on Practitioner Fee Schedule. If visit is solely for vaccination, bill vaccine code plus 99211 for administration. For MCO patients, bill the MCO directly instead of using VFC Plus program.