CommercialBilling CodesMedium impact
22-072m Protect Your Pediatric Patients with Vaxelis and MenQuadfi Vaccines
Health Net·CA · Pediatrics, Family Medicine·Coding
We identified it
Jun 20, 2026
Summary
Health Net has issued coding and billing guidance for two new pediatric vaccines: Vaxelis (CPT 90697) and MenQuadfi (CPT 90619). The policy provides financial responsibility categories and pricing information for Participating Physician Groups (PPGs) serving HMO and Point-of-Service members.
Action Required
Immediately: Billing team must update vaccine coding procedures to use CPT 90697 for Vaxelis vaccine and CPT 90619 for MenQuadfi vaccine. Review Division of Financial Responsibility (DOFR) categories to identify proper financial responsibility assignment - Vaxelis under pediatric immunizations not subject to H&S Code Section 1367.36, MenQuadfi under meningococcal vaccine category. If no pricing exists in Provider Participation Agreement, Health Net will pay lesser of acquisition cost or average wholesale price from Drug Topics Red Book.