Medical Billing for HPV Vaccine Administration

by | Last updated Jul 5, 2023 | Published on Oct 22, 2014 | Medical Billing

HVP Vaccine
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VFC (Vaccines for Children) program is federally funded and provides vaccines free of cost to children who are enrolled in Medicaid, underinsured, uninsured, or an Alaska or American Indian Native through age 18. Facilitating access to vaccines and vaccine activities is among Medicaid’s top priorities. All ACIP (Advisory Committee on Immunization Practice) recommended vaccines are provided to children under the age of 21 who are eligible for the Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Under the VFC program, the Centers for Disease Control and Prevention purchases vaccines at a discounted rate and distributes them to state health departments and local/territorial public health agencies that in turn distribute them at no cost to public health clinics and private physicians’ offices that are registered as VFC providers. Providers can bill for an administration fee for the cost they incur in administering the vaccine. Medicaid covers the vaccine administration fee for children enrolled in its program, whereas the uninsured and underinsured children enrolled in VFC program, the parents have to pay. This administration fee varies from one state to another.

HPV Vaccine to Ward off Varied Cancer Types

HPV or the human papilloma virus is known to cause several types of cancer such as those of the cervix and throat. HPV infection can be prevented with the administration of HPV vaccine. Medical billing for HPV vaccine should contain the following information:

  • Human Papilloma Virus Quadrivalent Vaccine (Gardisil®) CPT code 90649 (Human Papilloma Virus [HPV] vaccine, types 6, 11, 16, 18 [quadrivalent]). This code is billed with modifier SL for both sexes ages 9 through 26 of age, females who are not pregnant. The vaccine is to be administered as a 3-dose regimen at 0, 2 and 6 month intervals. Providers should keep a vaccination log, and clearly document in the patient’s medical records details such as vaccination dates, sites of vaccination, dosage given and the lot number of the vaccine administered.

The newly licensed Gardasil vaccine provides protection against cervical cancer caused by HPV. However, not all insurance plans cover this vaccine administration. Medicaid covers this vaccine for females 19 – 26 years old. Females in the age group 9 – 18 who are Medicaid eligible or have no insurance can obtain the vaccine from clinics enrolled in the VFC program or at local Health Departments.

  • Human Papilloma Virus Bivalent Vaccine (Cervarix®) CPT code 90650 (Human Papilloma virus [HPV vaccine], types 16, 18, bivalent, 3 dose schedule, for intramuscular use)

This is a VFC program benefit available for female recipients 9 – 18 years of age.

Providers have to verify the insurance information of those approaching for vaccine administration.

HPV Vaccines in Children – Safe to be Administered with Other Vaccines

Many parents are concerned about the safety and adverse reaction of HPV vaccination for children and think that it is not needed. Federal health officials have found that only few kids are getting HPV vaccines that protect them from a range of cancers, including cervical cancer and cancers of the throat and mouth.

A new study, published online by the Centers for Disease Control and Prevention notes that a HPV vaccine added to the child’s other immunizations does not affect the safety or efficacy of any of the vaccines involved. The review included 9 studies, 4 of quadrivalent HPV vaccine and 5 of bivalent HPV vaccine. 1 double-blind and 8 open-label, randomized controlled trials of multiple vaccine co-administration published between 2008 and 2012 were reviewed by the team. The studies demonstrated non-inferiority of immune response and an acceptable safety profile when HPV vaccine was co-administered with other vaccines. Co-administered vaccines included: meningococcal conjugate, hepatitis A, hepatitis B, combined hepatitis A and B, tetanus, diphtheria, acellular pertussis, and inactivated poliovirus vaccines.

Each study assessed immune response by measuring seroconversion or seroprotection that is the percentage of participants with antibody concentration or titers above a predetermined threshold.

To determine safety, the study participants were asked to report symptoms 30 minutes after vaccine administration and at various intervals thereafter. The most commonly reported symptoms were adverse events at the injection sites such as pain, swelling, and bruising. The authors concluded that the available data suggests [the] HPV vaccine is safe and effective when administered with other vaccines. The team also noted that the HPV vaccine coverage is below target levels in the United States.

HPV vaccination coverage indicated receipt of any HPV vaccine and does not distinguish between HPV2 and HPV4. Vaccination coverage was assessed for each dose of the HPV vaccination series. According to the CDC, if healthcare providers increase HPV vaccination coverage to 80%, it is estimated that an additional 53,000 cases of cervical cancer could be prevented during the lifetime of those younger than 12 years.

Most pediatricians recommend routine vaccination against HPV for girls, and to a lesser extent, for boys. It is important for healthcare providers to educate patients and parents of children in the target age range for HPV vaccination about HPV-related diseases and be prepared to respond to questions regarding HPV vaccination, including its benefits, limitations, and safety, as discussed earlier. If the patient is tested for HPV DNA and the results are positive, vaccination is still recommended because the chance that the patient has been exposed to all vaccine-preventable HPV genotypes is low.

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