Provider Notice Issued 01/07/2021

Date:    January 7, 2021

 

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

 

Re:      COVID-19 Vaccine and Vaccine Administration Billing Information for Practitioners          

 

 

This notice provides information to practitioners on current coding and rates, as well as billing guidance for Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Encounter Rate Clinics (ERCs) related to the COVID-19 vaccine and its administration. Practitioners may bill at the time the vaccine becomes available. This billing guidance applies to claims for participants covered under both traditional Medicaid fee-for-service and the HealthChoice Illinois Medicaid managed care plans.

 

COVID-19 vaccine administration procedure codes are billable by physicians, advanced practice nurses (APNs), physician assistants (PAs), local health departments, FQHCs, RHCs, and ERCs.

 

The Department will reimburse the above clinics for the COVID-19 vaccine administration fee-for-service outside the normal encounter rate methodology, even if the vaccine is administered during a face-to face encounter with a practitioner. FQHCs, RHCs and ERCs must submit COVID-19 vaccine administration codes on a claim separate from any other codes.  COVID-19 vaccine administration codes submitted as detail codes along with a T1015 or S5190 encounter will result in a rejection of the encounter claim with error code G70.

 

The Department will use the rates below established for the Medicare program for reimbursement of the administration fees for the first and second doses of the currently approved vaccines. These administration rates are applicable only to these specific vaccines.  Going forward, providers should refer to the COVID-19 Fee Schedule, available on the

COVID-19 Updates webpage, for future guidance as new vaccine and vaccine administration codes are approved by the Centers for Medicare & Medicaid Services (CMS) and the Federal Drug Administration (FDA).

 

Currently approved COVID-19 vaccine product procedure codes are included below as a reference but should not be billed when the vaccine is obtained at zero cost to the provider. 


Procedure Code

Effective Date

Description

State Max Amount

91300

12/11/2020

Pfizer-Biontech COVID-19 Vaccine

N/A (currently government-supplied at no cost to the provider)

0001A

12/11/2020

Pfizer-Biontech COVID-19 Vaccine Administration – First Dose

$16.94

0002A

12/11/2020

Pfizer-Biontech COVID-19 Vaccine Administration – Second Dose

$28.39

91301

12/18/2020

Moderna COVID-19 Vaccine

N/A (currently government-supplied at no cost to the provider)

0011A

12/18/2020

Moderna COVID-19 Vaccine Administration – First Dose

$16.94

0012A

12/18/2020

Moderna COVID-19 Vaccine Administration – Second Dose

$28.39

 

Vaccine administration for the uninsured population should be billed through the federal HRSA COVID-19 Claims Reimbursement Portal.

 

The COVID-19 Fee Schedule has been updated with the codes and rates above. Please check the COVID-19 Updates webpage for the most up to date information related to the COVID-19 public health emergency.

 

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.

 

 

Kelly Cunningham, Administrator

Division of Medical Programs

 

 


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Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director


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