Pediatric Coding Alert

Question: We have heard conflicting advice about who can receive an HPV vaccine. One consultant told us that the patient had to be at least nine and the other said any patient under 26 years old can get the vaccine. Can you advise?

Codify Subscriber

Answer: Both sources are partially right, since most payers will only reimburse HPV vaccinations for patients ages nine through 26. The Aetna policy, for instance, states, “Aetna considers Gardasil, Gardasil 9, and Cervarix a medically necessary preventive service for girls and women age 9 to 26 years. Aetna considers Gardasil and Gardasil 9 a medically necessary preventive service for boys and men age 9 to 26 years.”

Therefore, if your patient is age nine or older, most insurers will reimburse you for the vaccination. Keep in mind, however, that you can’t typically collect for a Gardasil 9 vaccination if the patient has already completed a three-dose series with Gardasil or Cervarix.

For your HPV vaccine patients, you’ll report the appropriate administration code such as 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]) or the 90460 for counseling administration codes, along with the vaccine code, such as 90649 (Human Papilloma vaccine, types 6, 11, 16, 18, quadrivalent [4vHPV], 3 dose schedule, for intramuscular use). You’ll use Z23 as the ICD-10 code.