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New Benefit: 9-Valent Human Papillomavirus

July 29, 2016

Effective retroactively for dates of service on or after October 1, 2015, 9-valent human papillomavirus (HPV9) (Gardasil 9©) is a new benefit for the Child Health and Disability Prevention (CHDP) program. This vaccine is reimbursable for children and youth ages 9 years thru 20 years, 11 months.

Providers should not bill for the vaccine until notified to do so in a future CHDP Update bulletin. However, based on the October 1, 2015, effective date, providers can dispense the HPV9 vaccine to Vaccines For Children (VFC) and non-VFC recipients in the preceding age ranges. More information about the vaccine is forthcoming (please also see “Resources” below).

Three new CHDP local procedure codes have been created to bill for the vaccine:

    One for the administration fee for Vaccines For Children (VFC) program HPV9 vaccine for recipients ages 9 years thru 18 years, 11 months

    Two combined procedure codes for reimbursement of HPV9 vaccine for non-VFC recipients, 19 years thru 20 years, 11 months

After being notified with a future CHDP Update, providers will be encouraged to bill retroactively for HPV9 dispensed on or after October 1, 2015. A CHDP Program Letter and Provider Information Notice about the vaccine will be released at a future date.

Manual pages reflecting this policy will be released in a future CHDP Update.

Resources
Information about HPV9 is available from the California Department of Public Health Immunization Branch.

The Morbidity and Mortality Weekly Report (MMWR) titled Use of 9-Valent Human Papillomavirus (HPV) Vaccine: Updated HPV Vaccination Recommendations of the Advisory Committee on Immunization Practices is available on the Centers for Disease Control and Prevention (CDC) website.