Provider Notice Issued 01/07/2021

To:       Enrolled Physicians, Advanced Practice Nurses, Physician Assistants, Local Health Departments, Federally Qualified Health Centers, Rural Health Clinics, and Encounter Rate Clinics

Re:      COVID-19 Vaccine and Vaccine Administration Billing Information for Practitioners          

This notice provides information to practitioners on current coding and rates, as well as billing guidance for Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Encounter Rate Clinics (ERCs) related to the COVID-19 vaccine and its administration. Practitioners may bill at the time the vaccine becomes available. This billing guidance applies to claims for participants covered under both traditional Medicaid fee-for-service and the HealthChoice Illinois Medicaid managed care plans.

COVID-19 vaccine administration procedure codes are billable by physicians, advanced practice nurses (APNs), physician assistants (PAs), local health departments, FQHCs, RHCs, and ERCs.

The Department will reimburse the above clinics for the COVID-19 vaccine administration fee-for-service outside the normal encounter rate methodology, even if the vaccine is administered during a face-to face encounter with a practitioner. FQHCs, RHCs and ERCs must submit COVID-19 vaccine administration codes on a claim separate from any other codes.  COVID-19 vaccine administration codes submitted as detail codes along with a T1015 or S5190 encounter will result in a rejection of the encounter claim with error code G70.

The Department will use the rates below established for the Medicare program for reimbursement of the administration fees for the first and second doses of the currently approved vaccines. These administration rates are applicable only to these specific vaccines.  Going forward, providers should refer to the COVID-19 Fee Schedule, available on the

COVID-19 Updates webpage, for future guidance as new vaccine and vaccine administration codes are approved by the Centers for Medicare & Medicaid Services (CMS) and the Federal Drug Administration (FDA).

Currently approved COVID-19 vaccine product procedure codes are included below as a reference but should not be billed when the vaccine is obtained at zero cost to the provider.