MedicaidReimbursementMedium impact
Reimbursement for Human Papillomavirus (HPV) Vaccine and Enrollment in the Vaccines for Children (VFC) Program
Illinois Medicaid - HFS·IL · Family Medicine, Pediatrics, OB-GYN·Provider Notice
Effective date
Jan 1, 2007
We identified it
Jun 21, 2026
Summary
Illinois Medicaid now covers HPV vaccine (Gardasil®) with specific billing codes and reimbursement rates. VFC Program participants receive $6.40 administration fee for ages 9-20, while non-VFC providers can bill up to $149.33 per dose using modifier SL.
Action Required
Immediately: Update billing system to use CPT code 90649 for HPV vaccine administration. For VFC participants treating females 9-20: bill without modifier. For non-VFC providers or females 21-26: add modifier SL to CPT 90649. Providers who incorrectly billed since January 1st must submit adjustment forms to rebill at higher rate.