Date: May 23, 2022
To: Enrolled Physicians, Advanced Practice Nurses, Physician Assistants, Local Health Departments, Federally Qualified Health Centers, Rural Health Clinics, Encounter Rate Clinics, and Hospitals
Re: COVID-19 Vaccine Counseling Coverage Change
This notice revises earlier published information in the provider notice dated November 18, 2021, regarding COVID-19 vaccine counseling services for children. These policies apply to claims for participants covered under both traditional Medicaid fee-for-service and the HealthChoice Illinois Medicaid managed care plans.
Effective with dates of service beginning October 29, 2021, the vaccine counseling code (CPT 99402) may be billable for face-to-face vaccine counseling services for children aged 5 through 20 (instead of 5 through 17). Parents, guardians, or the child as appropriate may be counseled on the benefit of receiving the COVID-19 vaccination, even if the parent or guardian is not enrolled for Medicaid coverage. Reimbursement of counseling code 99402 will not be tied to the child receiving the vaccination.
As a reminder, reimbursement separate from the all-inclusive encounter payment for vaccine counseling code 99402 is not available to federally qualified health centers, rural health clinics, and other entities billing an encounter rate.
The Department's COVID-19 Fee Schedule has been updated. 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