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BCBS State is denying 90651 due to patients age being over 26 years old. Sometimes this is covered with an appeal with a case-by-case concern. Has anyone been able to get this covered with BCBS State?
We occasionally give Gardasil in the office. I have yet to find any insurance carrier that will cover the vaccine for older patients, despite appeal letters. The insurance does not deny for medical necessity, simply that it is not a covered benefit. That's a very uphill battle. In our practice, if we have a patient the doc recommends Gardasil for, we have them sign a form that they understand it's not covered and are choosing to have the service and pay at the time of service. We are specifically GYNONC, and are recommending & giving the vaccine to patients who already have an abnormality, but studies have shown the vaccine can reverse the abnormal cells. Attached is the form we have the patient sign (we print on our letterhead), along with a letter explaining. They sign this form and pay before getting the first vaccine. I hope this helps.