Vaccines for Travel
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Defines Aetna's medical necessity, coverage limitations, and coding for vaccines commonly considered for international travel; applies to providers submitting claims for Aetna members seeking travel-related immunizations.
No material clinical or coverage changes in this revision.
Coverage Criteria for Travel Vaccines
General medical necessity criteria
Covered when ALL of the following are met for each vaccine:
See vaccine-specific entries in policy for age limits, contraindications, and timing.
Experimental / Investigational
Not covered (considered experimental/investigational):
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:
Approval under accelerated pathway based on immunogenicity; continued approval may require confirmatory studies.
ACIP deliberations noted (anticipated vote Feb 2024).
Three-dose primary series; better immunogenicity when started younger than age 50 in trials.
Infants vaccinated before 12 months still require routine doses at 12–15 months and again at least 28 days later.
Counsel travelers on self-treatment and preventive measures rather than routine vaccination.
Travel vaccine clinical guidance and evidence
Informational coverage stance and recommended use per ACIP and trial evidence
ACIP recommended pre-exposure vaccination for at-risk adults; vaccine is FDA-approved.
Counsel patients on limitations and continue infection-control measures.
Monitor for adverse events and advise patients accordingly.
Live vaccines generally contraindicated in pregnancy; individual risk assessment required.
Consider individual etiology of immunosuppression and travel risk when deciding vaccination.
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
| 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. |
| 90625 | Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use. |
| G0010 | Administration of hepatitis B vaccine. |
| 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). |
| 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). |
| Z23 | Encounter for immunization |
| No codes listed |
Provider Actions, Documentation, and Authorization
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
Revision History
Policy originally became effective.
FDA approved Ervebo (rVSVΔG-ZEBOV-GP) for prevention of Zaire ebolavirus disease in persons 18 years and older.
ACIP recommended pre-exposure vaccination with Ervebo for adults 18 years and older at potential risk of exposure to Zaire ebolavirus.
Policy last reviewed (routine review).
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