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Illinois Medicaid - HFSMedicaid · Coverage · Provider Notice · IL · Pediatrics, OB-GYN, Family Medicine +2 moreMedium impact

Upcoming Respiratory Syncytial Viral (RSV) Season

Effective date
Oct 1, 2026
Identified
Oct 7, 2026

Summary

This provider notice confirms continued Medicaid coverage (both FFS and MCOs) for RSV immunizations during the 2026-2027 RSV season (October 1 through March 31). Coverage includes monoclonal antibodies (Beyfortus and Enflonsia) for eligible infants under 8 months, Beyfortus for high-risk children 8-19 months, maternal RSV vaccine (Abrysvo) for pregnant individuals at 32-36 weeks gestation, and adult RSV vaccines (Abrysvo, mResvia, Arexvy) for seniors 75+ and specified high-risk populations. Prior authorization is not required for these covered immunizations.

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What to do

Action · 4 steps
01Effective October 1, 2026: Billing team should verify that billing systems reflect no prior authorization requirement for RSV immunizations (Beyfortus, Enflonsia, Abrysvo, mResvia, Arexvy) for eligible populations covered under this notice.
02Update internal coverage criteria to reflect eligibility for maternal RSV vaccination only during weeks 32-36 of gestation and for adult vaccines per IDSA guidelines.
03Verify that front-end staff and providers understand that these vaccines do not require prior authorization through HFS or applicable MCOs, reducing claim denial risk.
04For questions, providers may contact the Bureau of Professional and Ancillary Services at 877-782-5565 or their applicable MCO.

Original notice

Upcoming Respiratory Syncytial Viral (RSV) Season
hfs.illinois.gov · Always check the source before changing claims.
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Related changes

See all Illinois Medicaid - HFS changes →
Upcoming Respiratory Syncytial Viral (RSV) SeasonMediumEffective Dec 31, 2025 · Provider NoticeBrowse every Illinois Medicaid - HFS change in the policy list

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Illinois Medicaid - HFS policiesIL policy changesPediatricsOB-GYNFamily MedicineInternal MedicinePharmacy

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