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Rotavirus Vaccine (CPB 0723, reviewed 2026-10-20)
Effective date
Not stated in the notice
Identified
Oct 27, 2026
Summary
Aetna Clinical Policy Bulletin 0723 (last review 10/20/2026) considers the FDA-approved rotavirus vaccines RotaTeq and Rotarix medically necessary for prevention of rotavirus gastroenteritis in infants less than 8 months of age, based on ACIP recommendations. It considers rotavirus vaccines experimental, investigational, or unproven for all other indications. CPT 90680 and 90681, and ICD-10 Z23, are listed as covered if selection criteria are met.
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What to do
Action · 5 steps
01REQUIREMENTS: Billing team: Bill CPT 90680 (RotaTeq, 3 dose schedule) or CPT 90681 (Rotarix, 2 dose schedule) with ICD-10 Z23 when the selection criteria are met, for prevention of rotavirus gastroenteritis in infants less than 8 months of age.
02Billing team: Check benefit plan descriptions before billing, because some plans exclude coverage of preventive services.
03Billing team: Do not bill rotavirus vaccines as medically necessary for any other indication, since the policy considers them experimental, investigational, or unproven for all other indications.
04Billing team: Apply the policy's dosing recommendations: RotaTeq is given orally starting at 6 to 12 weeks of age, with subsequent doses 4 to 10 weeks apart, and the third dose should not be given after 32 weeks of age.
05Rotarix is given orally with the first dose from 6 weeks of age, with the second dose at least 4 weeks after the first and before 24 weeks of age.
Codes mentioned
9068090681Z23
Original notice
Rotavirus Vaccine (CPB 0723, reviewed 2026-10-20)
aetna.com · Always check the source before changing claims.
Related changes
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