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Provider Notice Issued 05/23/2022

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

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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

 

 

 


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Illinois Department of Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director