HPV Vaccine Coverage
As of December 2006 the only HPV vaccine currently available
is the quadrivalent HPV vaccine manufactured by Merck under
the name Gardasil®. Currently Gardasil® is covered
by the following commercial health plans in California -
- Aetna
- Blue Cross
- Blueshield of California
- CIGNA
- Health Net
- Kaiser Permanente – Northern and Southern California
- PacifiCare
- United Healthcare
As coverage continues to expand, this information will be
posted on the CMA Foundation website, www.thecmafoundation.org,
on the Cervical Cancer/HPV web page under HPV Vaccine Coverage.
Adolescent patients not covered by private insurance may
be eligible for coverage through MediCal. MediCal currently
covers the HPV vaccine for adolescents and teens up to the
age of 18. Coverage of women 19-26 years of age is pending.
Some adolescents and teens may also qualify for coverage
through the Vaccines for Children [VFC] Program - www.vfc-ca.org.
Females 9 through 18 years of age are eligible for quadrivalent
HPV vaccine provided by the VFC program. VFC providers can
order the vaccine using the VFC Order Form [DHS 8501 (11/06)]
found on the VFC Program website.
Billing for the VFC vaccine may be done through the CHDP
Program. The CHPD administration fee is $9.00 using CHDP Code
76. CHDP Provider Information notices can
be found at http://www.dhs.ca.gov/pcfh/cms/onlinearchive/chdppl.htm.
MediCal Fee-for-Service can be billed using the CPT code
for administration of the quadrivalent HPV vaccine using 90649-SL.
Other codes for the use of the quadrivalent HPV vaccine that
is not supplied by VFC include –
- CPT code for the quadrivalent HPV vaccine is 90649.
- The CPT code for administration of the quadrivalent HPV
vaccine is 90471 if given alone, and +90472 if given after
[an] additional vaccine[s] at the same visit. [For example,
if Tdap and HPV vaccine are given at the same visit, then
one of the vaccine administration codes is 90471 and the
other is +90472.]
- The ICD-9 –CM code for the quadrivalent HPV vaccine
is V05.8.
CHDP Provider Information Notice No.: 06-13
Addition of HPV Vaccine as a CHDP Benefit
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