Hepatitis A Vaccine
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Defines Aetna's medical necessity, coverage limitations, and coding guidance for hepatitis A vaccination and post-exposure prophylaxis for members in alignment with ACIP/AAP recommendations.
No material clinical or coverage changes in this revision.
Coverage Criteria for Hepatitis A Vaccine
Routine and Risk-based Vaccination Criteria
Covered when ANY of the following risk-based or exposure conditions are met (per ACIP/AAP):
Post-Exposure Prophylaxis
Post-exposure prophylaxis (PEP) coverage criteria:
Covered Indications (ACIP)
Covered when ANY of the following ACIP-recommended indications apply
Postexposure Prophylaxis
PEP and special circumstances
Travel-related Vaccination
Travel and age-specific recommendations
Immunocompromised / Transplant Candidates
Immunocompromised and transplant considerations
Schedule Effectiveness and Durability
Evidence on schedule effectiveness
Most Aetna HMO plans exclude coverage of immunizations that are required solely for travel or work. Before providing or billing for hepatitis A vaccination for travel- or employment-related reasons, verify the member’s benefit plan description to confirm whether that immunization is covered under their specific plan.
Vaccination of persons who receive blood products for clotting disorders (for example, hemophilia) is no longer routinely recommended because modern recombinant clotting factor concentrates are treated to eliminate HAV contamination; the risk of HAV transmission in this population is now considered similar to the general population.
Certain occupational or setting-based groups—such as food handlers, child care centers, schools, and health care personnel—are generally considered low risk for hepatitis A transmission and are not routinely indicated for HepA vaccination solely because of those roles. Routine childhood vaccination and community risk factors drive most prevention efforts rather than routine occupational immunization for these groups.
Although this policy includes persons with chronic liver disease (including hepatitis C virus infection) among groups for whom HepA vaccination is recommended, published analyses have questioned the cost-effectiveness of routine HAV vaccination for all persons with HCV. One meta-analysis estimated a very large number needed to vaccinate and high cost per death prevented, concluding that routine universal vaccination of all HCV-infected persons may not be cost-effective; clinical judgment and benefit considerations should inform decisions for individual members.
Coding and Billing Codes
| 90632 | Hepatitis A vaccine (Hep A), adult dosage, for intramuscular use. |
| 90633 | Hepatitis A vaccine (Hep A), pediatric/adolescent dosage-2 dose schedule, for intramuscular use. |
| 90634 | Hepatitis A vaccine (Hep A), pediatric/adolescent dosage-3 dose schedule, for intramuscular use. |
| 90636 | Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use. |
| 38240 | Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor. |
| 38241 | Hematopoietic progenitor cell (HPC); autologous transplantation. |
| 84450 | Transferase; aspartate amino (AST) (SGOT). |
| 84466 | Transferase; alanine amino (ALT) (SGPT). |
| S2150 | Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic or autologous, harvesting, transplantation, and related complications; including: pheresis and cell preparation/storage; marrow ablative therapy; drugs, supplies, hospitalization with outpatient follow-up; medical/surgical, diagnostic, emergency services, and rehabilitative services; and the number of days of pre- and post-transplant care in the global definition. |
| B15.0-B15.9 | Acute hepatitis A. |
| B16.0-B16.9 | Acute hepatitis B. |
| B17.0 | Acute delta-(super) infection of hepatitis B carrier. |
| B17.10 | Acute hepatitis C without hepatic coma. |
| B17.11 | Acute hepatitis C with hepatic coma. |
| B18.0 | Chronic viral hepatitis B with delta-agent. |
| B18.1 | Chronic viral hepatitis B without delta-agent. |
| B18.2 | Chronic viral hepatitis C. |
| B19.1 | Unspecified viral hepatitis B. |
| B19.20 | Unspecified viral hepatitis C without hepatic coma. |
Provider Actions, Prior Authorization, and Documentation
Codes clinicians may need to reference for authorization
Codes clinicians may need to reference for authorization and billing include covered HepA vaccine CPT codes and related ICD-10/HCPCS codes. Examples in this bulletin include: 90632, 90633, 90634, 90636 (HepA and HepA-HepB vaccine codes); ICD-10 codes for hepatitis, HIV, exposure, homelessness and encounter for immunization (e.g., B15.*-B19.*, B20, Z20.828, Z23, Z59.00-Z59.02, Z94.*); and related CPT/HCPCS listed in the bulletin. Verify coverage and prior-authorization requirements with the member’s benefit plan.
Clinical Policy Bulletins constitute neither offers of coverage nor medical advice
Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. They contain only a partial, general description of plan or program benefits and do not constitute a contract. Providers should not treat the bulletin as a guarantee of payment and must verify member-specific benefits and any plan-level exclusions (for example, many Aetna HMO plans exclude travel- or work-required immunizations).
- Clinical Policy Bulletins do not guarantee coverage or payment.
- Participating providers are independent contractors and are responsible for medical advice and treatment.
- Check the member’s benefit plan description for exclusions or requirements before billing.
Coding and documentation guidance
Coding and documentation guidance: document the member’s exposure status, risk factors (if disclosed), indication for vaccination or PEP, and the vaccine product and dose administered. Use appropriate ICD-10 codes for exposure, encounter for immunization, homelessness, occupational exposure, chronic liver disease, or HIV as applicable. Ensure CPT/HCPCS vaccine administration and vaccine product codes match the service provided.
No additional documentation requirements specified in the bulletin
No specific documentation requirements are stated in this Clinical Policy Bulletin beyond standard medical record documentation; however, providers should retain records supporting the medical necessity and indication for vaccination and any authorization submitted.
- The bulletin does not list additional document submission requirements for HepA vaccine.
- Maintain medical record documentation of exposure, risk factors, consent, vaccine product, dose, lot, and administration site.
Documentation and provider responsibility
Documentation and provider responsibility: treating providers are solely responsible for medical advice and treatment. Providers must verify member eligibility and benefits, confirm any prior-authorization requirements with Aetna or the member’s plan, and follow ACIP guidance for indications and PEP recommendations.
- Verify member eligibility and benefit coverage before delivering and billing for vaccine.
- Confirm any prior-authorization or plan exclusions that may affect coverage (e.g., travel/work-related vaccines).
- Follow ACIP guidance and document clinical rationale for vaccine versus immune globulin when applicable.
PEP preference guidance (vaccine vs immune globulin)
Post-exposure prophylaxis (PEP) preference guidance: ACIP recommends single-antigen hepatitis A vaccine for healthy persons aged 12 months to 40 years as preferred PEP when initiated within 2 weeks after exposure; immune globulin is preferred for persons >40 years and for infants <12 months, immunocompromised persons, those with chronic liver disease, or those allergic to vaccine components. Consider vaccine if immune globulin is unavailable and weigh exposure risk when deciding for persons >40 years.
- For healthy persons 12 months–40 years: vaccine preferred for PEP within 2 weeks of exposure.
- For >40 years, <12 months, immunocompromised, chronic liver disease, or vaccine allergy: immune globulin preferred.
- If immune globulin unavailable, vaccine may be used after clinical consideration.
Step therapy not described
No step therapy requirements or sequencing are described in this Clinical Policy Bulletin for hepatitis A vaccination.
- No step therapy or prior-treatment requirements specified for HepA vaccine in this bulletin.
Background and Evidence Summary
Hepatitis A vaccine is approved for persons aged 12 months and older and is typically administered as a 2-dose single-antigen series with doses separated by at least 6 months. The combined hepatitis A–hepatitis B vaccine (Twinrix) is licensed for adults ≥18 years and is provided as a standard 3-dose schedule (0, 1, and 6 months) or an accelerated 4-dose schedule (0, 7, 21–30 days with a booster at 12 months) when rapid protection is needed.
Schedule Effectiveness and Durability — Evidence on effectiveness and durability (VE, antibody persistence)
Evidence on schedule effectiveness
Definitions and Schedule Notes
Policy Dates and Revision History
Policy originally became effective on August 3, 1995.
Clinical policy last reviewed on March 17, 2023.
Next scheduled policy review on January 11, 2024.
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