CommercialCoverageMedium impact
Varicella and Herpes Zoster Vaccines (CPB 0115, reviewed 2026-03-19)
Aetna·Allergy & Immunology, Family Medicine, Internal Medicine +4 more·Medical Policy
Effective date
Mar 19, 2026
We identified it
Aug 19, 2026
Summary
Aetna updated its varicella and herpes zoster vaccine policy (CPB 0115) effective March 19, 2026. Key changes include: Shingrix (recombinant herpes zoster vaccine) is now covered as a two-dose series for adults 50+ and immunocompromised patients 18+; booster doses beyond the primary series are considered experimental; and Zostavax (live zoster vaccine) is no longer available in the U.S. as of November 18, 2020. Billing teams must ensure claims use correct CPT codes (90750 for Shingrix, not 90736 for discontinued Zostavax) and verify patient age/clinical criteria for coverage.
Action Required
By March 19, 2026: (1) Billing team must update billing system to REMOVE CPT 90736 (Zostavax) from active billing codes—this vaccine is no longer available in the U.S. and claims using this code will be denied. (2) Ensure CPT 90750 (Shingrix) is properly configured in the system with age/clinical criteria verification: coverage requires patient age 50+ OR age 18+ with immunocompromise/immunosuppression. (3) Update encounter forms and provider templates to reflect that Shingrix is a TWO-DOSE series and document patient eligibility (age, immunocompromised status, CD4 counts if applicable, or prior Zostavax receipt). (4) Train front desk and billing staff to verify patient meets coverage criteria before scheduling/billing—claims lacking proper documentation of medical necessity will be denied. (5) Flag any pending claims still using CPT 90736 and resubmit with CPT 90750 or contact providers to cancel if patient ineligible. Failure to update billing system will result in claim denials and rework.