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Provider Notice Issued 07/27/2022

Date:    July 27, 2022      

To:       Enrolled Physicians, Advanced Practice Nurses, Physician Assistants, Local Health Departments, Encounter Rate Clinics, Federally Qualified Health Centers, Rural Health Clinics, and Hospitals

Re:      COVID-19 Vaccine Counseling Coverage Updates

________________________________________________________________________________________________________  This notice provides updates regarding coverage for COVID-19 vaccination counseling. These updates apply to claims for participants covered under both traditional Medicaid fee-for-service (FFS) and the HealthChoice Illinois (HCI) managed care organization (MCO) plans.

HFS initially identified coverage for COVID-19 vaccination counseling in a
provider notice dated November 18, 2021. Below are updates to that coverage:

  • Effective October 29, 2021, the age range for Procedure Code 99402 - Preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 30 minutes, has been expanded from ages 5 through 17 years to ages 5 through 20 years. 
  • Effective October 29, 2021, Procedure Code 99402 will not be tied to the child receiving the vaccination. It may be billed separately regardless of the child receiving the vaccination.  
  • Effective June 17, 2022, the age range for Procedure Code 99402 has been lowered to 6 months through 20 years. 

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 for FFS claims, or the applicable HCI MCO plan.

Kelly Cunningham, Administrator
Division of Medical Programs 


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