HPV Vaccine Covered for Girls and Boys

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HPV Vaccine Covered for Girls and Boys

Date Issued: 9/22/2011

Gardasil®, the quadrivalent form of the vaccine for Human Papillomavirus (HPV), protects against HPV types 6, 11, 16 and 18. Gardasil can be given starting at age 9, and it is best to vaccinate patients before their first sexual contact. The vaccine is administered in three doses over a six month period, with the second dose given two months after the initial dose and the third dose at six months.

We cover the administration of Gardasil for both females and males up to age 26 for all EmblemHealth, GHI and HIP benefit plans. However, please note that Gardasil is also covered under Vaccines for Children (VFC), the federally funded program that supplies vaccines at no cost for children under the age of 19 who are uninsured, underinsured, Native American or those who receive health care through fee-for-service Medicaid, Medicaid managed care plans or Child Health Plus. Currently, the New York State Department of Health mandates that practitioners in these programs obtain no cost vaccines through the VFC program. Practitioners may then bill for the administration fee only. For children who are not in one of the categories listed above, please submit CPT-4 code 90649 for both female and male vaccinations with a three dose schedule.

Go to our clinical practice guideline Pediatric and Adolescent Preventive Services for more information on immunizations for young people.