Reimbursable adult Hepatitis B vaccines during the shortage

Priority Health does not reimburse claims billed for adults receiving Hepatitis B vaccines when coded with the pediatric CPT code 90744. Due to the Merck Recombivax HB® vaccine shortage, we have received appeals asking us to reconsider claims coded with CPT 90744 with 2 units.

We have not located any documentation that doubling up on a pediatric formulation of a vaccine is recommended to cover an adult. After review by our medical directors, we will not reimburse this vaccine at the pediatric level. These claims will continue to hit edits for age and/or exceed units.

Recommendations

We recommend that providers switch to the Engerix-B® vaccines manufactured by Glaxo Smith Kline (GSK).

When an adult has started a Hep B series with a Merck vaccine and now needs the second dose, we will evaluate each case retrospectively.

Pediatric formulas should be reserved for pediatric populations.

CDC statement on Merck vaccine availability

On its Current vaccine shortages page, the CDC states:

Merck is not currently distributing its adult Hepatitis B vaccine and does not expect to be distributing adult Hepatitis B vaccine between now and the end of 2018. Additionally, Merck anticipates that its pediatric Hepatitis B vaccine will be unavailable between early August 2017 and early 2018. Merck's supply of the dialysis formulation of Hepatitis B vaccine, however, is not affected and is expected to remain available. GSK has sufficient supplies of adult and pediatric Hepatitis B vaccines to address these anticipated gap in Merck's supply of adult and pediatric Hepatitis B vaccines during these time periods; however, preferences for a specific presentation (i.e., vial versus syringe) may not be met consistently during this time. Updated Jul 2017