Hepatitis A Vaccine (CPB 0048, reviewed 2026-03-11)

By 2026-03-11, billing team must: (1) Update billing system to recognize CPT codes 90632, 90633, 90634, and 90636 as covered services under Aetna plans when medical necessity criteria are met; (2) Configure system to accept ICD-10 diagnosis codes B15.0-B15.9, B18.0-B18.2, B20, K70.0-K74.69, K75.4, K75.81, K76.0, O98.411-O98.419, Z23, Z59.00-Z59.02, and Z76.82 as qualifying for vaccine coverage; (3) Ensure providers document risk factors or qualifying conditions in patient records (homelessness, chronic liver disease, HIV, occupational exposure, MSM status, international adoption contact, international travel, or drug use); (4) Train billing staff and front desk to recognize that Aetna does not require explicit risk factor disclosure—any person aged 12 months or older without prior complete HepA vaccine series may receive vaccination; (5) Note that most Aetna HMO plans exclude coverage for travel or work-related immunizations per benefit plan descriptions—verify member eligibility before billing. Failure to apply correct criteria may result in claim denials or retroactive payment recovery.