Meningococcal Vaccines
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Defines Aetna's medical necessity coverage for meningococcal conjugate (MenACWY) and serogroup B (MenB) vaccines according to CDC ACIP recommendations, and lists indications, booster schedules, coding, and investigational exclusions relevant to members and providers.
No material clinical or coverage changes in this revision.
Coverage Criteria for Meningococcal Vaccines
MenACWY (conjugate) vaccine - Routine and risk-based coverage
Covered when following ACIP recommendations are met
References chunks 3,16,17
MenACWY - Increased risk indications and booster schedules
Covered for members aged 2 months and older with listed risk factors; booster intervals depend on age and indication
See chunks 3,4,16
See chunks 4,18
See chunk 4
MenB (serogroup B) vaccine - Risk-based and shared decision-making coverage
Covered when ACIP recommendations are met
See chunk 5,22
See chunks 20,21
ACIP/FDA Indications and Dosing
Covered when ACIP-recommended indications and labeled age ranges/dosing are met:
See chunks 18,17
See chunks 4,18
See chunks 4,18
See chunks 20,21
See chunks 5,22
See chunk 21
See chunks 25,30,31,33
Experimental and investigational (Not covered)
The following are considered experimental and investigational
See chunk 6
Some member benefit plans exclude coverage of immunizations for travel or work. Verify the member's benefit plan description before administering or billing for meningococcal vaccines intended primarily for travel or occupational requirements.
Administration of meningococcal vaccines or booster doses outside FDA‑licensed age ranges (for example, MenB products administered to persons >25 years or MenACWY boosters given outside the ages specified on product labeling) is considered off‑label. Such off‑label use should be clinically justified and documented when submitted for coverage review.
Salivary antibody thresholds reported in the cited study were derived from samples collected only in children aged 10 to 15 years. Because these thresholds were not established in broader age groups, they require validation in larger, age‑diverse studies before being generalized to other populations.
Use of saliva testing to measure meningococcal polysaccharide‑specific antibody levels for monitoring vaccine responses is listed as experimental and investigational and is not considered medically necessary because effectiveness and generalizability have not been established.
Routine MenB vaccination is not recommended for all adolescents. ACIP advises that a 2‑dose MenB series for persons aged 16 to 23 years may be given based on shared clinical decision‑making, with the preferred age being 16–18 years. Booster doses are not routinely recommended unless the individual later meets criteria for increased risk.
Billing and Coding
| 90619 | Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier (MenACWY-TT), for intramuscular use. |
| 90620 | Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use. |
| 90621 | Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use. |
| 90623 | Meningococcal pentavalent vaccine, conjugated Men A, C, W, Y-tetanus toxoid carrier, and Men B-FHbp, for intramuscular use. |
| 90644 | Meningococcal conjugate vaccine, serogroups C & Y and Haemophilus influenzae type b vaccine (Hib-MenCY), 4 dose schedule, when administered to children 6 weeks-18 months of age, for intramuscular use. |
| 90733 | Meningococcal polysaccharide vaccine, serogroups A, C, Y, W-135, quadrivalent (MPSV4), for subcutaneous use. |
| 90734 | Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent (MenACWY), for intramuscular use. |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vacctine/toxoid). |
| B20 | Human immunodeficiency virus [HIV] disease. |
| D57.00 - D57.819 | Sickle-cell disorders. |
| D84.1 | Defects in the complement system. |
| D89.89 | Other specified disorders involving the immune mechanism, not elsewhere classified. |
| Q89.01 | Asplenia (congenital). |
| Z20.811 | Contact with and (suspected) exposure to meningococcus. |
| Z23 | Encounter for immunization. |
| Z94.0 | Kidney transplant status. |
| Z94.1 | Heart transplant status. |
| Z94.2 | Lung transplant status. |
| Z01.84 | Encounter for antibody response examination [monitoring meningococcal vaccine responses] |
Provider Actions, Documentation, and Billing Notes
Prior authorization / plan check
The policy does not list any specific prior authorization requirements for meningococcal vaccines; check member benefit plan descriptions for exclusions (for example, some plans exclude immunizations for travel or work).
- Verify member benefit plan for travel- or work-related immunization exclusions before billing.
Prior authorization — none specified
No explicit prior authorization rules are stated in the policy excerpt; providers should follow product-labeled age indications when ordering vaccines (e.g., Menactra, Menveo, MenQuadfi, Bexsero, Trumenba).
- Confirm age is within FDA-approved range for the selected vaccine prior to administration.
Prior authorization
The document contains no specified prior authorization requirements for these vaccines.
Step therapy
No step therapy requirements are specified in this policy excerpt.
Use the same MenB product for the primary series
For MenB, all doses in a primary series must be the same product; if the prior product is unknown, the series must be restarted with a known product.
- If two different MenB products were already given, select one product and give an additional dose with that product to complete a valid series.
- When repeating MenB doses, observe a minimum interval of 4 weeks between any two repeated doses.
Document MenB product and dates when completing series
Document vaccine product name and administration dates to support series validity and coverage determination.
- If product unknown, restart MenB series and record product and dates.
- If mixed MenB products were used, document selection of product used to complete the series and the additional dose given.
Coding and claim submission
Use the applicable CPT/HCPCS procedure codes and ICD-10 diagnosis codes when submitting claims as listed in the policy code tables.
Series completion when MenB product unknown or mixed
If a MenB dose was given but the vaccine product is unknown, restart the series with a known product; if mixed products were given, an additional dose with the selected product is required to complete a valid series.
- When repeating doses, maintain a minimum 4-week interval between any two repeated doses.
- Document the product selected for series completion and dates of all doses to verify series validity.
Saliva and serum antibody testing methods reported
Research studies measured salivary and serum meningococcal polysaccharide-specific IgG using a fluorescent-bead-based multiplex immunoassay and functional serum bactericidal assay (rSBA) to evaluate saliva as a potential surrogate of protection.
- Thresholds and ROC analysis were used to compare salivary IgG with serum rSBA titers.
Benefit plan exclusions may trigger denial
Some plans exclude coverage of immunizations for travel or work; denial of coverage may result if the immunization is for travel- or occupation-related indications and the member's benefit plan excludes such coverage.
- Check the member's benefit plan description before administering or billing for travel- or work-related immunizations.
Off-label booster age risk — document rationale
Booster doses administered outside FDA-licensed age ranges (for example, MenACWY boosters beyond labeled ages for some products or MenB administered above age 25) are considered off-label; document clinical rationale if performed.
- Confirm FDA-approved age ranges for the specific product before administering booster doses and document justification for any off-label administration.
Provider actions — none specified
No additional provider actions are specified in these policy excerpts.
Background and Epidemiology
Neisseria meningitidis is the cause of invasive meningococcal disease, which can lead to substantial morbidity and mortality. Although incidence in the United States has declined, adolescents and young adults remain an important risk group; ACIP provides routine and risk‑based recommendations for MenACWY and MenB vaccines, including age‑specific dosing and booster guidance to reduce the burden of invasive meningococcal disease.
Definitions and Vaccine Names
Policy Revision History
Policy last reviewed on 2024-02-15.
Policy originally became effective on 1999-11-23.
Next scheduled policy review on 2024-04-11.
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