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Gardasil for a male patient

  1. #1
    Location
    Lima, Ohio
    Posts
    21
    Default Gardasil for a male patient
    Medical Coding Books
    How would you bill Gardasil (HPV vaccine) for a male patient? Are they the same CPT codes?
    We are using 90649 or 90650 plus administration and finding it difficult to get paid for these codes when the patient is male.

  2. #2
    Default
    Yes the CPT code is the same for male/female patients. Alot of insurance companies are not paying for boys yet. I'm from Mass and BCBSMA is not paying for these but Tufts and Harvard are. You might want to check in your area with the big payers to see.

  3. #3
    Location
    Lima, Ohio
    Posts
    21
    Default
    Thanks.

  4. #4
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Quote Originally Posted by liz_snyder View Post
    How would you bill Gardasil (HPV vaccine) for a male patient? Are they the same CPT codes?
    We are using 90649 or 90650 plus administration and finding it difficult to get paid for these codes when the patient is male.
    Per the FDA and CDC, effective 01/01/12, Gardisil (code 90649) will be approved for both males and females, while Cervarix (code 90650) is still only approved for females. Speaking from the insurance company perspective, we will pay for 90649 for both, and 90650 for females, of the correct age range. Other carriers, of course, will have their own policies.

    Thanks,
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  5. #5
    Location
    Lima, Ohio
    Posts
    21
    Default
    That is good information to know. Thanks alot!

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