Carriers base the timing of coverage for new vaccines (and revised recommendations) on various steps involved in the process from vaccine licensure to publication of national recommendations. Understanding this process is an important element in understanding when a vaccine may be covered by a health plan.

The American Medical Association (AMA) electronically releases Current Procedural Terminology (CPT®) codes for new vaccine products twice a year, on July 1 and January 1. The vaccine product codes released on July 1 have a 6-month implementation period and therefore become effective the following January 1. The vaccine products released on January 1 are also subject to a 6-month implementation period and therefore become effective the following July 1.

This system allows development of new vaccine codes prior to Food and Drug Administration (FDA) licensing of new vaccine products, thereby eliminating the potential for any gaps in reporting. The vaccine product codes that are...

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