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UHC coverage for Gardasil vaccine


CPT code 90649 - Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use

HPV4 vaccine is recommended for routine vaccination in males aged 11 or 12 years. ACIP has also recommended vaccination with HPV4 for males aged 13 through 21 years who have not been vaccinated previously or who have not completed the 3-dose series; males aged 22 through 26 years may be vaccinated. Therefore, in addition to coverage of Gardasil in females aged 9 through 26, UnitedHealthcare will cover Gardasil for males aged 9 through 26 years of age and will not cover Gardasil for persons under the age of 9 or over the age of 26.

UnitedHealthcare coverage of Gardasil for males went into effect February 1, 2012. As is true for other policy revisions, there will be no retroactive adjustment of claims for coverage for males prior to February 1, 2012.

Additional details of the ACIP recommendations for HPV vaccination may be found on the MMWR (Morbidity and Mortality Weekly Report) publication entitled, Recommendations on the Use of Quadrivalent Human Papillomavirus Vaccine in Males - Advisory Committee on Immunization Practices (ACIP), 2011.

For additional information please refer to:

UnitedHealthcare Vaccine Policy or (UnitedHealthcareOnline.com > Tools & Resources > Policies and Protocols > Medical & Drug Policies and Coverage Determination Guidelines > Vaccine Policy).

ACIP Recommendation:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6050a3.htm

CDC Updates on Vaccines and Immunizations:

http://www.cdc.gov/vaccines/default.htm

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