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New CHDP Benefits: Meningococcal B Vaccines

February 26, 2016

Effective for dates of service on or after October 1, 2015, meningococcal recombinant protein and outer membrane vesicle vaccine (Bexsero) and meningococcal recombinant lipoprotein vaccine (Trumenba) are new benefits for the Child Health and Disability Prevention (CHDP) program. These vaccines are reimbursable for recipients 10 years through 20 years, 11 months of age who are at increased risk for meningococcal disease attributable to Serogroup B, including:

  • Individuals who have persistent complement component deficiencies (including inherited or chronic deficiencies in C3, C5 – C9, properdin, factor D, factor H) or who are taking eculizumab
  • Individuals who have anatomic or functional asplenia, including sickle cell disease
  • Individuals identified to be at increased risk because of meningococcal disease outbreak attributable to Serogroup B
  • Children 16 through 18 years of age without high risk conditions may also be vaccinated.

Providers should bill according to the information in the following table and note the new alpha-numeric format of the service codes:

Vaccine Local Code Vaccine Source Age Restriction
Meningococcal B Recombinant Lipoprotein Vaccine (Trumenba) M4 VFC 10 years thru 18 years, 11 months
M5 + M6 Non-VFC 19 years thru 20 years, 11 months
Meningococcal B Recombinant Protein and Outer Membrane Vesicle Vaccine (Bexsero) M1 VFC 10 years thru 18 years, 11 months
M2 + M3 Non-VFC 19 years thru 20 years, 11 months

The dosing schedule for Trumenba (codes M4, M5 + M6) is three doses, with a minimum of a 60-day series interval between the first and second dose and a minimum of a 180-day series interval between the second and third dose (0, 2 and 6 month schedule). The dosing schedule for Bexsero (codes M1, M2 + M3) is two doses, with a minimum of a 30-day series interval between the first and second dose.

Bexsero and Trumenba should not be administered together.

Providers are encouraged to bill retroactively if they provided these services on or after October 1, 2015. A CHDP program letter and Provider Information Notice about these two vaccines will be released shortly.

Manual pages reflecting this policy will be released in a future Medi-Cal Update.