Meningococcal Vaccines (CPB 0356, reviewed 2026-05-22)

By May 22, 2026: Billing team must update claims submission rules in billing software to ensure meningococcal vaccine codes (90619, 90620, 90621, 90623, 90624, 90644, 90733, 90734) are only submitted when medical necessity criteria are documented. Create or update encounter templates for providers to document: (1) patient age and risk category (routine adolescent, asplenia, complement deficiency, HIV, college student, traveler, outbreak exposure, microbiologist, military recruit, or transplant recipient); (2) vaccination history and dosing intervals; (3) for MenB vaccines, confirmation that patient is age 10+ and meets risk criteria or is age 16-23 with shared clinical decision-making documented. Implement system validation to reject claims for MenABCWY vaccines (90623, 90624) unless both MenACWY and MenB are indicated at the same visit. Flag vaccine product interchangeability rules (Bexsero and Trumenba are not interchangeable). Train providers and front desk staff that boosters are covered only when patients remain at increased risk and meet specified time intervals (3-5 years depending on age and risk factor). Claims submitted without proper medical necessity documentation or violating dosing intervals will be denied by Aetna.