Routine Immunizations - Cigna
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Drug and Biologic Coverage Policy
Effective Date ............................................... 7/1/2021
Next Review Date......................................... 4/1/2022
Coverage Policy Number .................................. 9001
Routine Immunizations
Table of Contents Related Coverage Resources
Coverage Policy...................................................1 Preventive Care Services
General Background ............................................2 Covid-19 Vaccine
Coding/Billing Information ....................................3
References ..........................................................7
INSTRUCTIONS FOR USE
The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of
business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan
language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting
certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document
[Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may
differ significantly from the standard benefit plans upon which these Coverage Policies are based. For example, a customer’s benefit plan
document may contain a specific exclusion related to a topic addressed in a Coverage Policy. In the event of a conflict, a customer’s benefit
plan document always supersedes the information in the Coverage Policies. In the absence of a controlling federal or state coverage
mandate, benefits are ultimately determined by the terms of the applicable benefit plan document. Coverage determinations in each specific
instance require consideration of 1) the terms of the applicable benefit plan document in effect on the date of service; 2) any applicable
laws/regulations; 3) any relevant collateral source materials including Coverage Policies and; 4) the specific facts of the particular
situation. Coverage Policies relate exclusively to the administration of health benefit plans. Coverage Policies are not recommendations for
treatment and should never be used as treatment guidelines. In certain markets, delegated vendor guidelines may be used to support
medical necessity and other coverage determinations.
Coverage Policy
The Affordable Care Act (ACA) requires individual and group health plans to cover in-network routine
immunizations without cost sharing (e.g., deductibles, coinsurance, copayments) unless the plan
qualifies under the grandfather provision or for an exemption.
Coverage of routine immunizations is generally subject to the terms, conditions and limitations of a
preventive services benefit as described in the applicable plan’s schedule of copayments. Please refer to
the applicable benefit plan document to determine benefit availability and the terms and conditions of
coverage.
Many benefit plans specifically exclude immunizations that are for the purpose of travel or to protect
against occupational hazards and risks. For any benefit exclusion, coverage will not be provided even if
the medical necessity criteria described below are met. Please refer to the applicable benefit plan
document to determine benefit availability and the terms, and conditions of coverage.
This Coverage Policy does not pertain to Therapeutic Vaccines (such as those used for treatment of
infectious disease and oncology) nor does it apply to Respiratory Syncytial Virus, non-routine vaccines
and immune globulins [such as, but not limited to Rabies or Rho(D) immune globulins].
If coverage is available for routine immunizations, the following conditions of coverage apply:
Page 1 of 8
Drug and Biologic Coverage Policy: 9001Routine immunizations with a U.S. Food and Drug Administration (FDA) licensed vaccine are covered as medically necessary when used in accordance with a recommendation by the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP). Routine immunizations are covered according to the provisional recommendations of the ACIP until the recommendations are officially published in the Morbidity and Mortality Weekly Report (MMWR). General Background Disease prevention vaccines are those products which are designed to trigger acquired immunity against certain infectious diseases. Disease prevention vaccines are administered to healthy individuals to prevent a disease. In most cases these vaccines are administered prior to exposure to the disease, but in some cases, the vaccine is administered after an exposure has occurred. Routine vaccines are those recommended for everyone in the United States, depending on age and vaccine history and are available for the prevention of 18 diseases: Chickenpox (Varicella) Mumps Diphtheria Pneumococcal Flu (Influenza) Polio (Poliomyelitis) Hepatitis A Rotavirus Hepatitis B Rubella (German Measles) Hib (Haemophilus influenzae type b) Shingles (Herpes Zoster) HPV (Human Papillomavirus) Tetanus (Lockjaw) Measles Whooping cough (Pertussis) Meningococcal A therapeutic vaccine by definition is a vaccine which prevents or eases the severity of the problems from an infection or disease that has already occurred. Therapeutic vaccines are also under development in oncology such as for prostate cancer. Vaccines must be licensed by the U.S. Food and Drug Administration’s (FDA) Center for Biologics Evaluation and Research (CBER) prior to use in the United States (U.S.). Before the FDA approves a license, vaccines are tested for safety and efficacy. Vaccines approved for marketing may also be required to undergo additional studies to further evaluate the vaccine and often to address specific questions about the vaccine's safety, effectiveness, or possible side effects. The Advisory Committee on Immunization Practices (ACIP) The ACIP is comprised of experts in fields associated with immunization, who have been selected by the Secretary of the U.S. Department of Health and Human Services to provide advice and guidance to the Secretary, the Assistant Secretary for Health, and the Centers for Disease Control and Prevention (CDC) on the control of vaccine-preventable diseases. The ACIP is the only entity in the federal government that makes such recommendations. Subsequent to the licensing of a new vaccine by the FDA, the ACIP will review the vaccine and provide advice and guidance regarding the most appropriate selection of vaccines for administration to children and adults in the U.S. Recommendations include age for vaccine administration, number of doses and dosing interval, and precautions and contraindications. Additional guidance may be provided for “catch up” age ranges, periodic re- vaccination, guidance regarding high risk sub-groups who should receive the vaccine and guidance for individual decision making. The ACIP meets three times each year and submits their recommendations to the Director of the CDC and the Department of Health and Human Services (HHS) for approval. ACIP recommendations are considered provisional until published in the CDC’s Morbidity and Mortality Weekly Report (MMWR). The MMWR represents the official CDC recommendations for immunization of the U.S. population. Page 2 of 8 Drug and Biologic Coverage Policy: 9001
NOTE: On February 21, 2018, the ACIP voted that for the 2018-19 influenza season, immunization providers
may choose to administer any licensed, age appropriate, influenza vaccine (including LAIV, IIV, and RIV). This
is a change from when LAIV was not recommended by the ACIP for the 2017-2018 influenza season.
ACIP Recommendations
The ACIP recommendations are developed using an evidence-based method based on the Grading of
Recommendations, Assessment, Development and Evaluation (GRADE) approach. Key factors considered in
development of recommendations include balance of benefits and harms, type or quality of evidence, values and
preferences of the people affected, and health economic analyses. Category A recommendations are made for
all persons in an age- or risk-factor-based group. Category B recommendations are made for individual clinical
decision making.
The Affordable Care Act (ACA) designates the ACIP as the source for recommended routine immunizations for
children, adolescents, and adults. A recommendation from the ACIP is considered in effect when it has been
adopted by the Director of the CDC and published in the MMWR or when it is listed on the Immunization
Schedules of the CDC. ACA requires coverage of routine immunizations when prescribed by a health care
professional consistent with the ACIP recommendation.
Other Vaccination Recommendations
The United States Preventive Services Task Force (USPSTF) recognizes the importance of immunizations in
primary disease prevention. However, the USPSTF does not wish to duplicate the significant investment of
resources made by others to review new evidence on immunizations in a timely fashion and make
recommendations. The USPSTF therefore will not update its 1996 recommendations.
The American Academy of Pediatrics (AAP) contributes collaboratively to the literature review, analyses of data,
and deliberations as a liaison to several of the disease specific working groups for the ACIP.
Combination Vaccines
Several of the routinely administered childhood vaccines have been combined into single products. These are
called combination vaccines. Some combination vaccines are routinely used in the United States (e.g. DTaP-
Diphtheria, Tetanus, acellular Pertussis and MMR – Measles, Mumps and Rubella). The advantage of
combination vaccines is that children get the protection of all the component vaccines while getting fewer
injections.
ACIP includes the combined vaccine in recommendations for use when any component of the combination is
indicated, and if the other components are not contraindicated. They further note that the combined vaccine is to
be used in its FDA indicated population and age range.
The American Board of Internal Medicine’s (ABIM) Foundation Choosing Wisely® Initiative
The American Academy of Allergy, Asthma & Immunology’s Choosing Wisely Initiative states do not routinely
avoid influenza vaccination in egg-allergic patients.
Centers for Medicare & Medicaid Services - National Coverage Determinations (NCDs)
There are no CMS National Coverage Determinations for Routine Immunizations.
Coding/Billing Information
Note: 1) This list of codes may not be all-inclusive.
2) Deleted codes and codes which are not effective at the time the service is rendered may not be eligible
for reimbursement.
Routine Disease Prevention Vaccines
Considered Medically Necessary when criteria in the applicable policy statements listed above are met:
Page 3 of 8
Drug and Biologic Coverage Policy: 9001CPT®* Description
Codes
90619 Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier
(MenACWY-TT), for intramuscular use
90620 Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB-
4C), 2 dose schedule, for intramuscular use
90621 Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB-FHbp), 2 or 3 dose
schedule, for intramuscular use
90630 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use
90632 Hepatitis A vaccine (HepA), adult dosage, for intramuscular use
90633 Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use
90634 Hepatitis A vaccine (HepA), pediatric/adolescent dosage-3 dose schedule, for intramuscular use
90636 Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use
90644 Meningococcal conjugate vaccine, serogroups C & Y and Haemophilus influenzae type b
vaccine (Hib-MenCY), 4 dose schedule, when administered to children 6 weeks -18 months of
age, for intramuscular use
90647 Haemophilus influenzae type b vaccine (Hib), PRP-OMP conjugate, 3 dose schedule, for
intramuscular use
90648 Haemophilus influenza type b vaccine (Hib), PRP-T conjugate, 4 dose schedule, for
intramuscular use
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
90653 Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
90654 Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use
90655 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for
intramuscular use
90656 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for
intramuscular use
90657 Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use
90658 Influenza virus vaccine, trivalent (IIV3), split virus,0.5 mL dosage, for intramuscular use
90660 Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use
90661 Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and
antibiotic free, 0.5 mL dosage, for intramuscular use
90662 Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via
increased antigen content, for intramuscular use
90670 Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use
90672 Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90673 Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA)
protein only, preservative and antibiotic free, for intramuscular use
90674 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative
and antibiotic free, 0.5 mL dosage, for intramuscular use
90680 Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral use
90681 Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use
90682 Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin
(HA) protein only, preservative and antibiotic free, for intramuscular use
90685 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for
intramuscular use
90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for
intramuscular use
90687 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
Page 4 of 8
Drug and Biologic Coverage Policy: 9001CPT®* Description
Codes
90688 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
90694 Influenza virus vaccine, quadrivalent (allV4), inactivated, adjuvanted, preservative free, 0.5 mL
dosage, for intramuscular use
90696 Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine
(DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use
90697 Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine,
Haemophilus influenzae type b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-
IPV-Hib-HepB), for intramuscular use
90698 Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenzae type B, and
inactivated poliovirus vaccine (DTap-IPV/Hib), for intramuscular use
90700 Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP) when administered to
individuals younger than 7 years, for intramuscular use
90702 Diphtheria and tetanus toxoids adsorbed (DT) when administered to individuals younger than 7
years, for intramuscular use
90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use
90710 Measles, mumps, rubella and varicella vaccine (MMRV), live, for subcutaneous use
90713 Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use
90714 Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to
individuals 7 years or older, for intramuscular use
90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to
individuals 7 years or older, for intramuscular use
90716 Varicella virus vaccine (VAR), live, for subcutaneous use
90723 Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus
vaccine (DTaP-HepB-IPV), for intramuscular use
90732 Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed
patient dosage, when administered to individuals 2 years or older, for subcutaneous or
intramuscular use
90733 Meningococcal polysaccharide vaccine, serogroups A, C, Y, W-135,quadrivalent (MPSV4), for
subcutaneous use
90734 Meningococcal conjugate vaccine, serogroups A, C, W,Y, quadrivalent, diphtheria toxoid carrier
(MenACWY-D), or CRM197 carrier (MenACWY-CRM), for intramuscular use
90736 Zoster (shingles) vaccine (HZV), live, for subcutaneous injection
90739 Hepatitis B vaccine (HepB), adult dosage, 2 dose schedule, for intramuscular use
90740 Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for
intramuscular use
90743 Hepatitis B vaccine (HepB), adolescent, 2 dose schedule, for intramuscular use
90744 Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular
use
90746 Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use
90747 Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 4 dose schedule, for
intramuscular use
90748 Hepatitis B and Haemophilus influenzae type b vaccine (Hib-HepB), for intramuscular use
90750 Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular injection
90756 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free,
0.5mL dosage, for intramuscular use
HCPCS Description
Codes
Q2034 Influenza virus vaccine, split virus, for intramuscular use (Agriflu)
Q2035 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older,
for intramuscular use (Afluria)
Page 5 of 8
Drug and Biologic Coverage Policy: 9001HCPCS Description
Codes
Q2036 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older,
for intramuscular use (Flulaval)
Q2037 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older,
for intramuscular use (Fluvirin)
Q2038 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older,
for intramuscular use (Fluzone)
Q2039 Influenza virus vaccine not otherwise specified
Vaccine administration codes:
CPT®* Description
Codes
90460 Immunization administration through 18 years of age via any route of administration, with
counseling by physician or other qualified health care professional; first or only component of
each vaccine or toxoid administered
90461 Immunization administration through 18 years of age via any route of administration, with
counseling by physician or other qualified health care professional; each additional vaccine or
toxoid component administered (List separately in addition to code for primary procedure)
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or
intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, or
intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List
separately in addition to code for primary procedure)
90473 Immunization administration by intranasal or oral route; 1 vaccine (single or combination
vaccine/toxoid)
90474 Immunization administration by intranasal or oral route; each additional vaccine (single or
combination vaccine/toxoid) (List separately in addition to code for primary procedure)
HCPCS Description
Codes
G0008 Administration of influenza virus vaccine
G0009 Administration of pneumococcal vaccine
G0010 Administration of hepatitis B vaccine
J3530 Nasal vaccine inhalation
Not Covered-pending FDA approval, pending ACIP recommendation or not recommended by ACIP:
CPT®* Description
Codes
90587 Dengue vaccine, quadrivalent, live, 3 dose schedule, for subcutaneous use
90626 Tick-borne encephalitis virus vaccine, inactivated; 0.25 mL dosage, for intramuscular use
90627 Tick-borne encephalitis virus vaccine, inactivated; 0.5 mL dosage, for intramuscular use
90660 Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use (Effective for Dates of Service
09/15/2016 through 06/30/2018)
90664 Influenza virus vaccine live (LAIV), pandemic formulation, for intranasal use
90666 Influenza virus vaccine (IIV), pandemic formulation, split virus, preservative free, for
intramuscular use
90667 Influenza virus vaccine (IIV), pandemic formulation, split virus, adjuvanted, for intramuscular use
90668 Influenza virus vaccine (IIV), pandemic formulation, split virus, for intramuscular use
90671 Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use
90677 Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use
Page 6 of 8
Drug and Biologic Coverage Policy: 9001CPT®* Description
Codes
90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL
dosage, for intramuscular use
Not Covered- Immunizations for the purpose of travel are excluded under most benefit plans:
CPT®* Description
Codes
90625 Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use
90690 Typhoid vaccine, live, oral
90691 Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use
90717 Yellow fever vaccine, live, for subcutaneous use
90738 Japanese encephalitis virus vaccine, inactivated, for intramuscular use
*Current Procedural Terminology (CPT®) ©2020 American Medical Association: Chicago, IL.
References
1. Centers for Disease Control and Prevention (CDC). ACIP Recommendations. GRADE Evidence Tables.
Accessed February 26, 2021. Available at: http://www.cdc.gov/vaccines/acip/recs/grade/table-refs.html
2. Centers for Disease Control and Prevention (CDC). ACIP Vaccine Recommendations. Accessed June
18, 2021. Available at: http://www.cdc.gov/vaccines/hcp/acip-recs/index.html
3. Centers for Disease Control and Prevention (CDC). Current Vaccine Shortages and Delays. Accessed
February 26, 2021. Available at: https://www.cdc.gov/vaccines/hcp/clinical-
resources/shortages.html#chart
4. Centers for Disease Control and Prevention (CDC). Human Papillomavirus (HPV) ACIP Vaccine
Recommendations. Accessed March 1, 2021. Available at: https://www.cdc.gov/vaccines/hcp/acip-
recs/vacc-specific/hpv.html
5. Centers for Disease Control and Prevention (CDC). Immunization Schedules. Accessed March 1, 2021.
Available at: http://www.cdc.gov/vaccines/schedules/hcp/index.html
6. Centers for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report. Advisory
Committee on Immunization Practices Recommended Immunization Schedule for Children and
Adolescents Aged 18 Years or Younger —United States, 2021. February 12, 2021. Accessed March 1,
2021. Available at: https://www.cdc.gov/mmwr/volumes/70/wr/mm7006a1.htm
7. Centers for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report. Advisory
Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years
or Older —United States, 2021. February 12, 2021. Accessed March 1, 2021. Available at:
https://www.cdc.gov/mmwr/volumes/70/wr/mm7006a2.htm
8. Centers for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report. Human
Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on
Immunization Practices. August 16, 2019. Accessed March 1, 2021. Available at:
https://www.cdc.gov/mmwr/volumes/68/wr/mm6832a3.htm
9. Centers for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report. Licensure of
a Diphtheria and Tetanus Toxoids and Acellular Pertussis, Inactivated Poliovirus, Haemophilus
influenzae Type b Conjugate, and Hepatitis B Vaccine, and Guidance for Use in Infants. February 7,
2020. Accessed March 1, 2021. Available at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6905a5.htm
Page 7 of 8
Drug and Biologic Coverage Policy: 900110. Centers for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report. Prevention
and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on
Immunization Practices —United States, 2012-21 Influenza Season. Accessed March 1, 2021. Available
at: https://www.cdc.gov/mmwr/volumes/69/rr/rr6908a1.htm
11. Centers for Disease Control and Prevention (CDC). Recommended Vaccines by Disease. Accessed
March 1, 2021. Available at: https://www.cdc.gov/vaccines/vpd/vaccines-diseases.html
12. Centers for Disease Control and Prevention (CDC). Routine Vaccines. Accessed March 1, 2021.
Available at: https://wwwnc.cdc.gov/travel/diseases/routine
13. Centers for Disease Control and Prevention (CDC). Supplemental information and guidance for
vaccination providers regarding use of 9-valent HPV. Accessed March 1, 2021. Available
at:https://www.cdc.gov/hpv/downloads/9vhpv-guidance.pdf
14. Centers for Disease Control and Prevention (CDC). Vaccines and Immunizations/Vaccine Information
Statements (VIS)/ May 8, 2017 Gardasil-4 is no longer available. Accessed March 1, 2021. Available
at:https://www.cdc.gov/vaccines/hcp/vis/what-is-new.html#gard4
15. Centers for Disease Control and Prevention (CDC). Vaccine Information Statements (VISs), Dates of
Current and Past Vaccine Information Materials. Accessed March 1, 2021. Available at:
https://www.cdc.gov/vaccines/hcp/vis/vis-dates.html
16. Health and Human Services. Center for Consumer Information and Insurance Oversight. Affordable
Care Act Implementation. FAQs-Set 12. Accessed March 1, 2021. Available at:
https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs12.html
17. U. S. Food and Drug Administration (FDA). Vaccines, Blood and Biologics. Vaccines Licensed for
Immunization and Distribution in the US with Supporting Documents. Accessed June 18, 2021. Available
at: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm093833.htm
18. U.S. Preventive Services Task Force. Recommendations for Primary Care Practice. Published
Recommendations. Immunizations for adults. Accessed March 1, 2021. Available
at:https://www.uspreventiveservicestaskforce.org/BrowseRec/ReferredTopic/232
19. U.S. Preventive Services Task Force. Recommendations for Primary Care Practice. Published
Recommendations. Immunizations for children. Accessed March 1, 2021. Available
at:https://www.uspreventiveservicestaskforce.org/BrowseRec/ReferredTopic/233
“Cigna Companies” refers to operating subsidiaries of Cigna Corporation. All products and services are provided exclusively by or through
such operating subsidiaries, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna
Behavioral Health, Inc., Cigna Health Management, Inc., QualCare, Inc., and HMO or service company subsidiaries of Cigna Health
Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. © 2021 Cigna.
Page 8 of 8
Drug and Biologic Coverage Policy: 9001You can also read
