HPV Vaccination CPT CODES
There are three different CPT® codes developed for reporting of HPV vaccination:
90649 Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use
90650 Human Papillomavirus vaccine, types 16, 18, bivalent (2vHPV), 3 dose schedule, for intramuscular use
90651 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule, for intramuscular use
Understand HPV Vaccination and Coding
HPV vaccinations are most effective when given prior to the initia-tion of sexual activity. Therefore, the CDC recommends initiating HPV vaccination for girls and boys between 11 and 12 years old. Vaccines approved by the Food and Drug Administration (FDA) are considered safe for children as young as nine and as old as 45 however, the vaccination schedule differs depending on patient age. Patients between the ages of 27 and 45 should discuss with their healthcare provider whether they are good candidates for vaccination.
Genital human papillomavirus (HPV) is the most common sexually transmitted infection (STI). HPV is a group of more than 200 related viruses. There are more than 40 types of HPV that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. HPV can cause serious health problems, including genital warts and certain cancers of the anus, penis, cervix, vulva and vagina.
Three vaccines that prevent infection with disease-causing HPV types have been licensed for use in the United States: Gardasil®, Gardasil® 9, and Cervarix®. All three vaccines prevent infection with HPV types 16 and 18. HPV types 16 and 18 are believed responsible for about 70% of cervical cancers and an even higher percentage of some of the other HPV-caused cancers. Gardasil also prevents infection with HPV types 6 and 11, which cause 90% of genital warts. Gardasil 9 prevents infection with the same four HPV types plus five additional cancercausing types that together account for 10 to 20% of cervical cancers. Gardasil nine-valent is effective against HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58.
Gardasil 9 is now the only HPV vaccine available for use in the United States. Cervarix and Gardasil has been removed from the U.S. market, however they are still used in other countries. In October 2018, the FDA approved an age expansion for Gardasil 9 (human papillomavirus (HPV) 9-valent vaccine, recombinant) vaccine to include women and men 27 through 45 years of age. On June 2019 the CDC’s Advisory Committee for Immunization Practices (ACIP) recommended that person 27 through 45 years of age to engage in shared decision-making when considering the 9-valent HPV vaccine.
Gardasil 9 is indicated in girls and women 9 through 45 years of age for the prevention of the following diseases:
** Cervical, vulvar, vaginal, and anal cancer caused by Human Papillomavirus (HPV) types 16, 18, 31, 33, 45, 52, and 58.
** Genital warts (condyloma acuminata) caused by HPV types 6 and 11.
In addition, the following precancerous or dysplastic lesions caused by HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58:
** Cervical intraepithelial neoplasia (CIN) grade 2/3 and cervical adenocarcinoma in situ (AIS).
** Cervical intraepithelial neoplasia (CIN) grade 1.
** Vulvar intraepithelial neoplasia (VIN) grade 2 and grade 3.
** Vaginal intraepithelial neoplasia (VaIN) grade 2 and grade 3.
** Anal intraepithelial neoplasia (AIN) grades 1, 2, and 3.
Gardasil nine‐valent is indicated in boys 9 through 45 years of age for the prevention of the following diseases:
** Anal cancer caused by HPV types 16, 18, 31, 33, 45, 52, and 58.
Genital warts (condyloma acuminata) caused by HPV types 6 and 11.
In addition, the following precancerous or dysplastic lesions caused by HPV types 6, 11, 16, 18, 31, 33, 45,
52, and 58:
** Anal intraepithelial neoplasia (AIN) grades 1, 2, and 3.
Uses and Restrictions for HPV Codes 90649 and 90650
The following uses and restrictions for Human Papilloma Virus (HPV) vaccines CPT code 90649 (Gardasil®) and CPT code 90650 (Cervarix®) are effective for claims dates of service on/after Oct. 21, 2009.
• CPT code 90649, formerly for females only, may be used for boys and young men age 9-26. Please note that for recipients age 9-18, code 90649 is reimbursed through the Vaccines For Children (VFC) program.
• CPT code 90650 is an FDA-approved HPV vaccine for females only age 9-26. For recipients age 9-18, code 90650 is reimbursed through the VFC program.
• The three-dose schedule for either code for recipients over age 18 must begin and end before the recipient turns 27. Medicaid cannot reimburse for any dose(s) given after the recipient turns 27, because the vaccine is not approved by the FDA for recipients over the age of 26.
• Any claims for CPT codes 90649 and 90650 submitted on/after Oct. 21, 2009, that denied inappropriately have been reprocessed and the adjudication is reported on remittance advices.
• Gardasil is contraindicated in individuals who are hypersensitive to the active substances or to any of the excipients of the vaccine.
• It is not recommended to be given during pregnancy.
• If pregnancy is detected after vaccination has been given, the subsequent dosing should be delayed until the pregnancy has been completed.
• The vaccine does not replace routine cervical cancer screening as per national guidelines for screening.
Effective July 1st, Aetna Better Health of Florida will implement a new payment methodology for vaccines administered to its Florida Healthy Kids and MediKids members. As of this date, ABH
will reimburse all vaccines not covered by Vaccines for Children at 100% of the vaccine’s wholesale acquisition cost (WAC).
This change is necessary to ensure providers receive reimbursement that aligns with the current market price for vaccines, and in most cases, will result in additional payment to providers. Please be advised that CPT codes 90650 and 90649 are no longer valid and have been replaced with 90651 – Gardasil 9.