Date: June 16, 2022
To: Participating Physicians; Advanced Practice Registered Nurses; Physician Assistants; Local Health Departments; Encounter Rate Clinics; Federally Qualified Health Centers; Rural Health Clinics; and School Based/Linked Health Centers
Re: COVID-19 Pediatric Booster Coverage Effective May 17, 2022
This notice confirms coverage for the Pfizer COVID-19 pediatric booster vaccination. The booster was FDA-approved and is covered for children aged five years through 11 years under Medicaid fee-for-service (FFS) and HealthChoice Illinois managed care plans.
The booster has been assigned CPT code 0074A and is effective with dates of service beginning May 17, 2022. The vaccine is government-supplied at no cost to the provider. The Department of Healthcare and Family Services (HFS) will reimburse an administration fee of $41.80.
The COVID-19 Fee Schedule has been updated to include the pediatric booster. Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims or to the applicable managed care plan.
Kelly Cunningham, Administrator
Division of Medical Programs