Quarterly Claim Editing Update: Second Quarter 2019

The U.S. Food and Drug Administration (FDA) recently approved an expanded age indication for GARDASIL9® (Human Papillomavirus 9-valent Vaccine, Recombinant). This vaccine is now approved for use in appropriate patients ages 9 through 45 years to help protect against certain HPV-related cancers and diseases. The previous indication for GARDASIL9 was for ages 9 through 26 years.

Based on this recent FDA approval, CPT® code 90651 included on claims for services provided on and after October 5, 2018 to your eligible Horizon BCBSNJ patients age 27 through 45 years will be considered for reimbursement.¹

GARDASIL9 is a vaccine indicated in:

• Females 9 through 45 years of age for the prevention of cervical, vulvar, vaginal, and anal cancers caused by human papillomavirus (HPV) Types 16, 18, 31, 33, 45, 52 and 58; precancerous or dysplastic lesions caused by HPV Types 6, 11, 16, 18, 31, 33, 45, 52 and 58; and genital warts caused by HPV Types 6 and 11.
• Males 9 through 45 years of age for the prevention of anal cancer caused by HPV Types 16, 18, 31, 33, 45, 52, and 58; precancerous or dysplastic lesions caused by HPV Types 6, 11, 16, 18, 31, 33, 45, 52 and 58; and genital warts caused by HPV Types 6 and 11.

For more information, visit FDA.gov.

¹Claim reimbursement is subject to member eligibility and all member and group benefit limitations, conditions and exclusions.

CPT® is a registered trademark of the American Medical Association.
GARDASIL9® is a registered trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.