MedicaidReimbursementMedium impact
Administration of Flu Vaccine
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
We identified it
Jun 21, 2026
Summary
The Department of Healthcare and Family Services will reimburse pharmacies for flu vaccine administration to adults 21+ starting with the 2007-2008 influenza season, with a maximum reimbursement of $3.70. Pharmacies must submit both vaccine and administration fee on the same claim using specific NCPDP 5.1 fields.
Action Required
Pharmacies must update billing procedures to submit flu vaccine and administration fee on same claim using NCPDP 5.1 Pricing Segment Professional Service Fee Submitted field (477-BE). Enter usual charge for administration with maximum reimbursement of $3.70. For dual eligible patients, bill Medicare first. Cannot bill administration fee separately without vaccine on claim.