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Elizabeth M. Whitehorn, Director

Provider Notice issued 12/27/2024

 

To:  Enrolled Physicians; Physician Assistants; Advanced Practice Registered Nurses; Local Health Departments; Federally Qualified Health Centers; Encounter Rate Clinics; and Rural Health Centers
​Date December 27, 2024
​Re:
 Coverage of Human Papillomavirus (HPV) Vaccination Ages 46 and Up per Public Act 103-0102

 

This notice announces an expansion to coverage for the Human Papilloma Virus (HPV) vaccination, in accordance with Public Act 103-0102, effective with service dates beginning January 1, 2025. This applies to customers covered under the Medicaid fee-for-service (FFS) program and the managed care organizations (MCOs).

The Department of Healthcare and Family Services (HFS) recently received Federal approval from the Centers for Medicare & Medicaid Services (CMS) to allow HPV vaccination for persons ages 46 and up, who have been diagnosed with cervical dysplasia with a high risk of recurrence or progression.

X12 837P or electronic equivalent claims must contain HPV vaccine Procedure Code 90651 and ICD-10 Diagnosis Code N87.9 – Cervical Dysplasia. Diagnosis Code N87.9 does not need to be the primary diagnosis at the claim level, but the service line must have a diagnosis pointer to the N87.9.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services for the FFS program, or the applicable MCO. 

                                 

Kelly Cunningham, Administrator
Division of Medical Programs