Date: December 16, 2021
To: All Medical Assistance Program Providers
Re: Immunization Administration Rate Increase Effective January 1, 2022 Per Public Act 102-0043
This notice informs providers of an immunization administration fee increase effective January 1, 2022, per Public Act 102-0043. This increase affects vaccine administration fees under the Vaccines for Children (VFC) program for both Medicaid fee-for-service and the HealthChoice Illinois managed care plans for children from birth through 17 years of age.
Per the Act, the Department is increasing the immunization administration rate to no lower than 70% of the median regional maximum administration fee for the State of Illinois as established by the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services. The increase raises the Department's VFC vaccine administration fee to $12.56.
The following immunization administration procedure codes are impacted by the rate increase:
The Department is awaiting approval from the federal Centers for Medicare & Medicaid Services (CMS) before implementing the rate increase for fee-for-service (FFS) claims. Applicable FFS claims with dates of service beginning January 1, 2022 will be held by HFS until CMS approval is given and then released into processing. HealthChoice Illinois managed care plans will be ready to process claims beginning January 1, 2022.
Questions regarding this notice may be directed to a billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 or the applicable managed care plan.
Kelly Cunningham, Administrator
Division of Medical Programs