Aetna travel vaccine Coverage Update

Coverage Criteria for Travel Vaccines

General medical necessity criteria

Covered when ALL of the following are met for each vaccine:

General coverage logic: Vaccine is considered medically necessary when the specific vaccine's indications (e.g., travel to an endemic area or documented high-risk exposure) and the policy's standard administration schedule are met, and the member's benefit plan includes coverage for preventive/travel vaccines.

See vaccine-specific entries in policy for age limits, contraindications, and timing.

Experimental / Investigational

Not covered (considered experimental/investigational):

Experimental vaccines: Malaria vaccines for travel (no effective malaria vaccine developed) and oral or skin-patch cholera vaccines for prevention of entero-toxigenic Escherichia coli (ETEC) diarrhea are considered experimental/investigational and not medically necessary.

Clinical value has not been established per policy background (Cochrane reviews and trial evidence).

Vaccine-specific coverage considerations (informational)

Key vaccine-specific indications and considerations referenced:

Chikungunya vaccine (Ixchiq): Indicated for prevention of chikungunya disease in individuals 18 years of age and older who are at increased risk of exposure; administered as a single intramuscular dose; contraindicated in immunocompromised individuals and those with severe allergy to components; vaccine viremia typically occurs in the first week and resolves by 14 days.age >= 18 years and increased exposure risk

Approval under accelerated pathway based on immunogenicity; continued approval may require confirmatory studies.

ACIP draft considerations for chikungunya: Draft ACIP recommendations propose vaccination for adults traveling to areas with outbreaks or transmission within the last 5 years, and consideration for older persons or those with extended stays or greater exposure (e.g., cumulative ~2+ weeks).travel to outbreak area or evidence of recent transmission; older age or prolonged exposure

ACIP deliberations noted (anticipated vote Feb 2024).

Travel vaccine clinical guidance and evidence

Informational coverage stance and recommended use per ACIP and trial evidence

Ervebo indication: Pre-exposure vaccination with Ervebo (rVSVΔG-ZEBOV-GP) is indicated for prevention of disease caused by Zaire ebolavirus in individuals 18 years of age and older who are at potential risk of exposure (outbreak responders, BSL‑4 laboratorians, and healthcare personnel at designated Ebola Treatment Centers).age >= 18 years

ACIP recommended pre-exposure vaccination for at-risk adults; vaccine is FDA-approved.

Ervebo limitations: Duration of protection is unknown; Ervebo does not protect against other species of Ebolavirus or Marburgvirus; effectiveness when given concurrently with antivirals, immune globulin, or blood/plasma transfusions is unknown.

Counsel patients on limitations and continue infection-control measures.

Ervebo safety considerations: Label includes warnings for anaphylaxis; common adverse events include injection-site pain, swelling, redness and systemic events such as headache, feverishness, myalgia, fatigue, arthralgia, nausea and arthritis; vaccine virus RNA has been detected in bodily fluids post-vaccination and theoretical transmission is possible.

Coverage for vaccines administered for travel is plan-dependent. Most Aetna HMO plans exclude coverage of vaccines for travel; coverage for medically necessary travel vaccines may be available in traditional plans that include preventive benefits. Providers should verify the member's benefit plan before billing or administering travel-related vaccines.

Live, attenuated vaccines are contraindicated in certain populations. Specifically, live vaccines should not be given during pregnancy, and they are contraindicated in persons with known severe immunodeficiency (for example, from hematologic or solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long‑term immunosuppressive therapy).

Ervebo (rVSVΔG‑ZEBOV‑GP) has important limitations that must be communicated to recipients: the duration of protection is unknown, and Ervebo does not protect against other species of Ebolavirus or Marburgvirus. Effectiveness when given with antivirals, immune globulin, or blood/plasma transfusions is also unknown; counsel patients accordingly.

The policy lists CPT code 90625 (cholera vaccine, live, adult dosage, oral) among procedure codes included in the CPB's coding table and identifies it as a code that is not covered for indications listed in this Clinical Policy Bulletin.

Randomized trial data and systematic reviews indicate limited utility for some travelers' diarrhea vaccines. Evidence does not support routine use of vaccines such as Dukoral® (killed whole‑cell oral cholera vaccine with B subunit) or other ETEC‑specific vaccines for broad traveler protection; while some trials showed reduced ETEC diarrhea in select settings, overall preventive impact for general travelers is limited and must be balanced against cost and adverse effects.

These sections do not include explicit statements labeling travel vaccines as 'not medically necessary' across the board. Rather, systematic review conclusions are presented—for example, the yellow fever vaccine safety review concluded it was not possible to affirm a higher risk of adverse events in immunocompromised individuals, reflecting uncertainty rather than a blanket non‑coverage determination.

Billing Codes and Coding Guidance

Covered CPT Codes (when selection criteria met)CPTCovered

90589	Chikungunya virus vaccine, live attenuated, for intramuscular use.
90626	Tick-borne encephalitis virus vaccine, inactivated; 0.25 mL dosage, for intramuscular.
90627	Tick-borne encephalitis virus vaccine, inactivated; 0.5 mL dosage, for intramuscular use.
90632	Hepatitis A vaccine (HepA), adult dosage, for intramuscular use.
90633	Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use.
90634	Hepatitis A vaccine (HepA), pediatric/adolescent dosage-3 dose schedule, for intramuscular use.
90636	Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use.
90675	Rabies vaccine, for intramuscular use.
90676	Rabies vaccine, for intradermal use.
90690	Typhoid vaccine, live, oral.

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CPT codes not covered for indications listed in the CPBCPTNot Covered

90625

Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use.

HCPCS covered if selection criteria are metHCPCSCovered

G0010

Administration of hepatitis B vaccine.

Other HCPCS related codesHCPCS

G0310	Immunization counseling by physician when vaccine not administered same date, 5-15 mins (Medicaid).
G0311	Immunization counseling when vaccine not administered same date, 16-30 mins (Medicaid).
G0312	Immunization counseling when vaccine not administered same date for ages under 21, 5-15 mins (Medicaid).
G0313	Immunization counseling when vaccine not administered same date for ages under 21, 16-30 mins (Medicaid).

Other HCPCS related codesHCPCS

G0310	Immunization counseling by physician when vaccine not administered same date, 5-15 mins (Medicaid).
G0311	Immunization counseling when vaccine not administered same date, 16-30 mins (Medicaid).
G0312	Immunization counseling when vaccine not administered same date for ages under 21, 5-15 mins (Medicaid).
G0313	Immunization counseling when vaccine not administered same date for ages under 21, 16-30 mins (Medicaid).

ICD-10 CodesICD-10

Z23	Encounter for immunization

Referenced vaccines and regulatory notes (no explicit billing codes provided in this excerpt)mixed

No codes listed

Age and timing thresholds — selected examples

Cholera (Vaxchora)Indicated for persons 2 through 64 years of age traveling to endemic areas (single-dose, live oral).

Rabies (pre-exposure schedule)Pre-exposure dosing per policy: days 0, 7, and booster on day 21 or 28 (standard pre-exposure schedule).

Yellow feverPrimary: single 0.5 mL subcutaneous dose given 10 days to 10 years before travel; booster: every 10 years.

Typhoid (live, oral)Primary: 4 oral doses; re-immunize every 5 years (attenuated live bacteria formulation).

Chikungunya (Ixchiq)Indicated for persons 18 years and older (single intramuscular dose); safety/effectiveness not established <18 years.

Provider Actions, Documentation, and Authorization

Documentation Required

Provider Actions, Documentation, and Authorization

None specified in this excerpt.

Providers should confirm member plan benefits and coverage for travel vaccines prior to administration; many Aetna HMO plans exclude travel vaccine coverage while some traditional plans cover medically necessary travel vaccines for members with preventive benefits.
Use appropriate CPT/HCPCS and ICD-10 codes when billing; report ICD-10 Z23 for encounters for immunization where applicable.
When criteria in the policy are met, use the listed CPT/HCPCS codes for vaccine administration and vaccine products.
Document clinical indication for travel-related vaccination (including destination/risk, medical history, contraindications such as pregnancy or severe immunodeficiency for live vaccines, and prior immunity/vaccination history e.g., measles) and any prior authorization or benefit-verification outcomes.
Prior authorization may be required for newly approved travel vaccines (e.g., chikungunya vaccine) or for specific products per the member’s plan; obtain and retain documentation supporting medical necessity if PA is required.
No step therapy rules are specified in this excerpt.

Background and Context

The Centers for Disease Control and Prevention (CDC) provides destination‑specific vaccine recommendations for travelers. Commonly considered travel vaccines referenced in the policy include yellow fever, typhoid, cholera, Japanese encephalitis, tick‑borne encephalitis, rabies, hepatitis A and B, meningococcal, measles/mumps/rubella, polio, and Zaire ebolavirus (Ervebo). Providers should consult CDC guidance and the member's benefit plan when determining indication and timing for travel immunizations.

Definitions and Key Terms

Experimental and investigational vaccines — definition & examples

DefinitionVaccines for which clinical value has not been established or for which effective vaccines have not yet been developed (examples cited: malaria vaccine for travel; oral or skin‑patch cholera vaccines for prevention of ETEC diarrhea).

Example — Malaria vaccinesMalaria vaccines for travel are considered experimental/investigational because an effective malaria vaccine has yet to be developed (Cochrane reviews cited).

Example — Oral/skin‑patch cholera/ETEC vaccinesOral or skin‑patch cholera vaccines for prevention of entero‑toxigenic E. coli (ETEC) diarrhea are considered experimental/investigational because clinical value has not been established.

Ixchiq (chikungunya vaccine) — key facts

Product and formulationIxchiq (Valneva) — live, weakened chikungunya virus formulation administered as a single intramuscular injection.

Revision History

2001-04-13effective_date

Policy originally became effective.

2019-12-19vaccine_approval_note

FDA approved Ervebo (rVSVΔG-ZEBOV-GP) for prevention of Zaire ebolavirus disease in persons 18 years and older.

2020-02-26acip_recommendation

ACIP recommended pre-exposure vaccination with Ervebo for adults 18 years and older at potential risk of exposure to Zaire ebolavirus.

OpenPayer

Vaccines for Travel

Coverage Criteria for Travel Vaccines

Billing Codes and Coding Guidance

Provider Actions, Documentation, and Authorization

Background and Context

Definitions and Key Terms

Revision History