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UnitedHealthcareCommercial · Coverage · Medical Policy · Pediatrics, Family Medicine, Internal Medicine +2 moreMedium impact

Preventive Vaccines (Immunizations)

Effective date
Dec 1, 2026
Identified
Nov 7, 2026

Previous versions

Summary

Effective 2026-12-01, the Surest preventive vaccine coverage criteria change so that a vaccine is covered as a preventive care service when it has explicit (should/shall/is) recommendations from AAFP, AAP, or ACOG; the prior requirement that the recommendation not be permissive ('may') has been removed. The policy also adds a reference to the applicable vaccine codes list, covering CPT 90616, 90657, and 90658.

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What to do

Action · 4 steps
01By 2026-12-01: Billing team, update charge entry and claim edits for vaccine CPT 90616, 90657, and 90658 for Surest members so vaccines with explicit recommendations from AAFP, AAP, or ACOG are billed under the preventive care benefit, and confirm the vaccine is FDA-approved and not excluded in the member's plan document.
02Providers and front desk staff should be told that vaccines with 'may' (permissive) recommendations now meet this criterion only if another listed organization issues an explicit recommendation, and that travel-specific vaccines are generally excluded.
03Claims for vaccines that do not meet the preventive criteria will be processed under the plan's other benefits, so verify benefit assignment before submission.
04Watch for the payer's next bulletin for any further changes.

Codes mentioned

906169065790658

Original notice

Preventive Vaccines (Immunizations)
uhcprovider.com · Always check the source before changing claims.
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Related changes

See all UnitedHealthcare changes →
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Related policy hubs

UnitedHealthcare policiesPediatricsFamily MedicineInternal MedicineOB-GYNGeneral PracticeCode 90616Code 90657Code 90658

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