Provider Notice Issued 03/30/2021

Date:    March 30, 2021

 

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

 

Re:      COVID-19 Vaccine Administration Rate Increase    

 

 

This notice provides updated information regarding the March 15, 2021 Centers for Medicare & Medicare Services (CMS) rate increase for the administration of COVID-19 vaccines. This guidance applies 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 on and after March 15, 2021, the Department will continue to follow the rates established for the Medicare program for reimbursement of the administration fees. Reimbursement is increased to $42.14 for the administration of each dose of a COVID-19 vaccine.

 

Department COVID-19 vaccine administration rates for dates of service prior to March 15, 2021 remain at $16.94 for the initial dose in a two-dose series, and $28.39 for the second dose in a two-dose series, or for a single-dose vaccine.

 

The COVID-19 Fee Schedule has been updated with the new vaccine administration rate. Providers should refer to the COVID-19 Updates webpage for the most up to date information related to the COVID-19 public health emergency.

 

Per CMS, as a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers are prohibited from charging patients any amount for administration of the vaccine and may not deny a vaccine to anyone regardless of income, immigration, or insurance status. For individuals who are uninsured, providers may submit claims for reimbursement of COVID-19 vaccine administration through the federal HRSA COVID-19 Claims Reimbursement Portal.

 

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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