Date: January 26, 2022
To: Enrolled Pharmacies
Re: Emergency Instructions for COVID-19 Home Test Kits
Effective immediately, the Illinois Department of Healthcare and Family Services (HFS) will allow Medicaid participating pharmacies to prescribe and bill for the BinaxNOW COVID-19 AG Card and Lucira COVID-19 All-In-One Home Test Kits. Coverage for the home test kits applies to the Medicaid fee-for-service (FFS) program and the HealthChoice Illinois managed care plans. However, the specific billing guidance below applies only to the FFS program. Pharmacies should contact the individual managed care plan for billing guidance.
COVID-19 home tests can be billed through pharmacies at a quantity of up to four 2-packs, or eight individual tests per customer per month. Pharmacy providers billing FFS can initially expect to see a claim's rejection message "Prescriber must be enrolled in State Medicaid Program" when using the pharmacist's NPI as a prescriber. Providers will need to contact the Bureau of Professional and Ancillary Services at 877-782-5565 and request an override for all of the pharmacists' NPIs that will be used to prescribe the home test kits.
The other rapid types of over the counter COVID-19 Home Tests Kits may be dispensed to Medicaid customers now, but pharmacies will not be able to bill them until January 28, 2022, when HFS system programming is complete.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565, or the applicable managed care plan.
Kelly Cunningham, Administrator
Division of Medical Programs