Happy Thanksgiving!

We at CPP would like to extend a heartfelt thanks to all of our members and vendor partners that have made this year a banner year for CPP!  It is only through collaboration with our partners and sharing information and resources among our members that we are able to maximize opportunities for in-office immunizations for all patients.  Thank you for all you do to minimmize vaccine-preventable diseases in our communities!

Pfizer Vaccine Updates

On November 1, 2016, Pfizer announced new pricing (effective January 27, 2017) and payment terms (effective December 1, 2016) for their Prevnar 13 and Trumenba vaccines.  For details and updated pricing sheets, CPP members can contact the CPP office at 614-722-2145 or cpp@nationwidechildrens.org.

In addition, the Advisory Committee on Immunization Practices (ACIP) met in October and provided additional guidance on the updated dosing schedules for one serogroup B meningococcal vaccine, MenB-FHbp (Trumenba).

  • For persons at increased risk for meningococcal disease and during serogroup B outbreaks, 3 doses of MenB-FHbp administered at 0, 1-2, and 6 months.
  • When given to healthy adolescents not at increased risk for meningococcal disease, 2 doses of MenB-FHbp at 0 and 6 months.

If approved by the CDC Director, the recommendations will become official once published in MMWR.

Immunization Administration Coding Update for 90461

The AAP has received some emails concerning a new policy that was implemented by some payers  in relation to the Medically Unlikely Edit (MUE) for CPT code 90461. The per day MUE  edit was changed to 5. As soon as AAP staff and the Committee on Coding and Nomenclature  became aware of this, they worked with Correct Coding Solutions (CCS) to have this edit increased to a number that was more clinically appropriate. CCS (as the CMS contractor for the National Correct Coding Initiative) worked with CMS directly and they agreed the number should be increased.

Here is an excerpt from the letter from CCS:
CMS will increase the MUE value from five (5) to eight (8) for this code.  The new MUE value for this code will appear in the MUE version scheduled for January 1, 2017 and will be retroactive to the implementation date of…July 1, 2016.

Some AAP members have reported issues with the UnitedHealthcare (UHC) Maximum Frequency policy limit for CPT code 90461. The AAP is currently working with UHC  to resolve this and determine what their course of action will be in light of the change by CMS. If you have any other payers denying, please email the coding hotline aapcodinghotline@aap.org.

New Dosing Regimen Approved for Gardasil 9

In October, the FDA approved a 2-dose vaccination regimen for Gardasil 9, for use in girls and boys 9 through 14 years of age.   For adolescents, Gardasil 9 can be administered using the 3-dose (0, 2, 6 months) or the 2-dose schedule (0, 6-12 months).  For patients 15 through 26 years of age, Gardasil 9 is administered using the 3-dose regimen.  For more information about the FDA’s approval, click here.

Additionally, the Advisory Committee on Immunization Practices (ACIP) discussed this schedule modification at their October meeting.  The ACIP approved the following recommendation for the human papillomavirus vaccine by majority vote:
– 2-dose schedule for boys and girls initiating HPV vaccination series at 9 to 14 years (0,6-12 months)
– 3-dose schedule for persons initiating HPV vaccination series at older ages
– 3-dose schedule for immunocompromised persons

If the committee’s recommendation is approved by the CDC Director, it will become official once published in MMWR.  For more information about the ACIP recommendations, please click here.

Discontinuation of Gardasil

Since the FDA approval of Gardasil 9 in late 2014, CPP members have been steadily converting from Gardasil to Gardasil 9 as the preferred HPV vaccine for their patients.

Effective October 31, 2016, Merck will no longer sell Gardasil. This decision is not related to any product safety or manufacturing issues with Gardasil and all existing inventories will be depleted.  Any unused Gardasil doses can be returned to Merck for credit after their expiration date, in accordance with the Merck Return Policy.

Please note that GARDASIL® 9 (Human Papillomavirus 9-valent Vaccine, Recombinant) is available and is not impacted by this action.