Vaccine code 90620

jweigel

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I have an out of state Blue Cross and Blue Shield plan that doesn't cover this vaccine if billed as routine. Representative said it is covered with certain diagnosis codes. I thought there might be a high risk diagnosis code that would apply since the vaccine is for college students living in dorms. I can't find one. Any suggestions?

Thank you.

Jamie Weigel
 
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I looked at numerous carrier's websites and every single one, including CMS, state that 90620 is excluded. One website mentioned age range up to 25, but I'm not sure if they actually pay for it. If I had to take a guess, I'd bet more likely than not the vaccine isn't covered because it's new.
 

CodingKing

True Blue
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There are multiple versions of the vaccine. Maybe its just the wrong version for coverage or wrong code all together. For instance the most popular 90734 Meningococcal conjugate (MenACWY). The second dose is given between the ages of 16-18. Here is MA its supplied by the state free of charge.
 

ljhaley@gmail.com

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90620 Meningococcal B vaccine

Sorry to be so late to this party, I work in Pediatrics, land of vaccines, I can clear up a few things:

As far as that out of state Blue plan that wouldn't cover 90620 with routine Z23- Been there, done that. It was a very interesting conversation with that plan, The representative went through the following codes with us : Q89.01, Z90.81, D68.4, D68.2, Z20.811, all not routine, and also not covered. The ONLY code that plan would cover for 90620, was "D84.1, Defects in complement systems" which is a rare diagnosis, but possible. I hope this info helps others.

90620 is to be given from age 16 and up, given in two doses for Bexsero (* there is also a 3 dose regimen product available out there-90621).

90734 is NOT the same thing, in ANY way to 90620. They are TWO different products, used in two different age groups, comprised of different "serogroups".
90620 Meningococcal Serogroup B vaccine by Bexsero AND 90734 Meningococcal Conjugate vaccine, serogroups A.C.Y. and W-135 (tetravalent) (Menactra/Menveo)

CDC recommends vaccination with a meningococcal conjugate vaccine 90734 for all preteens and teens at 11 to 12 years old, with a booster dose at 16 years old. Young adults (16 through 23 year olds) also may be vaccinated with a serogroup B meningococcal vaccine 90620

Good luck!
 
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I'm also in Peds and the providers want to start billing 90621. Are you having a problem getting it paid with the out of state blue plan only or other payers as well? And if other payers are reimbursing, is it with Z23?



Sorry to be so late to this party, I work in Pediatrics, land of vaccines, I can clear up a few things:

As far as that out of state Blue plan that wouldn't cover 90620 with routine Z23- Been there, done that. It was a very interesting conversation with that plan, The representative went through the following codes with us : Q89.01, Z90.81, D68.4, D68.2, Z20.811, all not routine, and also not covered. The ONLY code that plan would cover for 90620, was "D84.1, Defects in complement systems" which is a rare diagnosis, but possible. I hope this info helps others.

90620 is to be given from age 16 and up, given in two doses for Bexsero (* there is also a 3 dose regimen product available out there-90621).

90734 is NOT the same thing, in ANY way to 90620. They are TWO different products, used in two different age groups, comprised of different "serogroups".
90620 Meningococcal Serogroup B vaccine by Bexsero AND 90734 Meningococcal Conjugate vaccine, serogroups A.C.Y. and W-135 (tetravalent) (Menactra/Menveo)

CDC recommends vaccination with a meningococcal conjugate vaccine 90734 for all preteens and teens at 11 to 12 years old, with a booster dose at 16 years old. Young adults (16 through 23 year olds) also may be vaccinated with a serogroup B meningococcal vaccine 90620

Good luck!
 
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