TRANSMITTAL #: 128

DATE:   12/23/2011

TRICARE CHANGE #: N/A

CHAMPVA POLICY MANUAL

CHAPTER: 2

SECTION: 23.3

TITLE: IMMUNIZATION INJECTIONS

AUTHORITY: 38 CFR 17.270(a) and 17.272(a)(31)

RELATED AUTHORITY:  32 CFR 199.4(g)(37)

I. EFFECTIVE DATE(S)

October 12, 1984.

II. PROCEDURE CODE(S)

CPT Codes: 90281-90283, 90287-90378, 90384-90399, 90632-90649, 90651-90660, 90669, 90680, 90700-90716, 90718-90723, 90732-90734, 90736, 90740, 90743-90744, 90746-90749

III. DESCRIPTION(S)

A.      The process of rendering a subject immune, most frequently accomplished by immunization with either live or inactivated viral agents or bacterial antigens, (active immunization) or by administration of preformed antibody after an exposure to a disease has occurred (passive immunization).

IV. POLICY

A.      Coverage is extended for the age appropriate dose of vaccines that have been recommended by the ACIP (Advisory Committee on Immunization Practices) and accepted by the Director of the CDC (Centers for Disease Control) and Prevention.

B.      Administration of the appropriate vaccines for the following diseases: diphtheria, haemophilus influenza type b, hepatitis A, hepatitis B, inactivated polio, influenza, tetanus, measles, meningococcal, mumps, pertussis, pneumococcal, rotavirus, rubella, shingles (herpes zoster), varicella, quadrivalent human pappillomavirus HPV Types 6, 11, 16, and 18 recombinant vaccine Gardasil found at Addendum 1 and 2 of this section are in accordance with current CDC recommendations.

C.      Well-child immunizations are covered for beneficiaries from birth to age 6 (see Chapter 2, Section 12.1, Well-Child Care).

D.      The CDC provides immunization recommendations only.  The physician will determine the appropriateness of immunizations for the patient based on CDC recommendations and other specific factors.  Catch-up immunizations should be done during any physician visit when feasible.

E.       Refer to CDC’s home page (http://www.cdc.gov) for current schedule of recommended vaccines.  

V. EXCLUSION(S)

A.      Immunizations for the sole purpose of travel outside the United States.

*END OF POLICY*