Updated Preventive Coverage of Human Papillomavirus (HPV) Vaccine and Serogroup B Meningococcal (MenB) Vaccines




    Policies Impacted:

    00.06.02ac Preventive Care Services (Independence)
    08.01.04v Immunizations

    Purpose

    Effective August 15, 2019, the purpose of this communication is to provide advance notice regarding updated preventive coverage positions for human papillomavirus (HPV) vaccine and serogroup B meningococcal (MenB) vaccine for individuals enrolled in the Company's Commercial Products.

    Background

    Human Papillomavirus (HPV) Vaccine

    Previously, Advisory Committee of Immunization Practices (ACIP) considered HPV vaccine preventive for individuals aged 9 through 26 years. On August 15, 2019, the ACIP updated their recommendation for HPV vaccine to expand age recommendation for vaccination. In addition to previous recommendations, ACIP also recommends HPV vaccine based on shared clinical decision making for individuals aged 27 through 45 years who are not adequately vaccinated.

    Serogroup B Meningococcal (MenB) Vaccine

    In June 2019, ACIP updated their recommendation of serogroup B meningococcal (MenB) vaccine to include recommendations for a booster for individuals at increased risk for serogroup B meningococcal disease. ACIP recommends a booster vaccine for the following scenarios:

    • A MenB booster dose 1 year following completion of a MenB primary series followed by MenB booster doses every 2-3 years thereafter, for as long as increased risk remains.
    • individuals aged 10 years or older determined by public health officials to be at increased risk during an outbreak

    Individuals with any of the following are considered at increased risk:
    • Persistent complement component deficiencies (including inherited or chronic deficiencies in C3, C5-9, properdin, factor D, factor H, or who are taking eculizumab [Soliris®])
    • Complement inhibitor use disease
    • Anatomic or functional asplenia including sickle cell disease
    • Identified at increased risk because of a serogroup B meningococcal disease outbreak

    Coverage Statement

    HUMAN PAPILLOMAVIRUS VACCINE

    MEDICALLY NECESSARY

    9-valent human papillomavirus vaccine (9vHPV) is considered medically necessary and, therefore, covered for the following individuals:

    • Routine two-dose regimen of 9vHPV for individuals 11 years or 12 years of age administered 6-12 months. The vaccination series is covered beginning at 9 years.
    • Individuals who begin the vaccination series at age 15 years through 26 years are covered for the three dose regimen of 9vHPV vaccine.
    • Catch-up vaccination for females age 13 years through 26 years who have not been vaccinated previously, who have not completed the three-dose series, or with primary or secondary immunocompromising conditions that might reduce immunity. If a female reaches age 26 years before the vaccination series is complete, remaining doses will be covered after age 26 years.
    • Catch-up vaccination for males 13 years through 26 years of age who have not been vaccinated previously, who have not completed the three-dose series, or with primary or secondary immunocompromising conditions that might reduce immunity.
    • Vaccination when indicated by shared clinical decision-making for individuals 27 years through 45 years who are not adequately vaccinated

    PREVENTIVE

    Human papillomavirus (HPV) vaccine is covered as a preventive service when the medically necessary criteria are met.

    SEROGROUP B MENINGOCCAL (MenB) VACCINE

    MEDICALLY NECESSARY

    Serogroup B meningococcal (MenB) vaccine is considered medically necessary and, therefore, covered for the following:
    • Two-dose series to individuals 10 years or older who are not at increased risk for meningococcal disease
    • Two-dose series or three dose series to individuals 10 years or older who are at increased risk for meningococcal disease with any of the following:
      • Persistent complement component deficiencies (including inherited or chronic deficiencies in C3, C5-9, properdin, factor D, factor H, or who are taking eculizumab [Soliris®])
      • Complement inhibitor use disease
      • Anatomic or functional asplenia including sickle cell disease
      • Identified at increased risk because of a serogroup B meningococcal disease outbreak
    • Individuals 16 through 23 years are covered when vaccinated with a 2 dose series or a 3 dose series to provide short-term protection against most strains of serogroup B meningococcal disease. The same product must be used for all doses.
    • A booster vaccine for the following individuals:
      • Individuals at increased risk, a MenB booster dose 1 year following completion of a MenB primary series followed by MenB booster doses every 2-3 years thereafter, for as long as increased risk remains.
      • Individuals aged 10 years or older determined by public health officials to be at increased risk during an outbreak

    PREVENTIVE

    Serogroup B meningococcal (MenB) vaccine is covered as a preventive service when the medically necessary criteria are met.

    Coding

    90620

    90621

    90651


    Issued on - 08/22/2019


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