TL;DR: Aetna, a CVS Health company, modified CPB 0410 covering hepatitis B vaccine coverage policy, effective September 26, 2025. Billing teams should confirm ICD-10 alignment across 11 CPT codes and HCPCS G0010 before submitting claims.
Aetna updated CPB 0410 to affirm hepatitis B vaccine as a medically necessary preventive service, aligned with CDC Advisory Committee on Immunization Practices (ACIP) recommendations. The policy covers 11 CPT codes—90636, 90739 through 90748—plus HCPCS G0010 for vaccine administration. With 218 covered ICD-10-CM diagnosis codes spanning conditions from diabetes and HIV to chronic liver disease and drug dependence, this policy has broad reach across primary care, infectious disease, and specialty practices billing Aetna.
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Hepatitis B Vaccine |
| Policy Code | CPB 0410 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | Medium |
| Specialties Affected | Primary care, infectious disease, internal medicine, endocrinology, gastroenterology, behavioral health, pediatrics |
| Key Action | Audit your ICD-10-CM codes against CPB 0410's covered diagnosis list before billing CPT 90744 or any hepatitis B vaccine code to Aetna |
Aetna Hepatitis B Vaccine Coverage Criteria and Medical Necessity Requirements 2025
Under CPB 0410 Aetna system, the payer considers hepatitis B vaccine medically necessary as a preventive service when the vaccination follows CDC ACIP recommendations. That framing matters. Aetna isn't making an independent clinical judgment here — it's tying its coverage policy directly to ACIP guidance. When ACIP updates its schedules or indications, Aetna's coverage posture moves with it.
The policy lists coverage across a wide risk population. That includes patients with HIV (B20, B97.35), diabetes mellitus (E08.00–E13.9), chronic liver disease (K70.x, K73.x, K74.x), coagulation defects and hemophilia (D65–D68.9), sexually transmitted infections (A50.01–A64), and patients with drug dependence diagnoses (F11.10–F19.99). Intellectual disabilities (F70–F79) and specific developmental speech and language disorders (F80.0–F80.9) are also listed, which is less obvious and worth noting for providers serving those populations.
The coverage policy requires selection criteria to be met for all 11 CPT codes and HCPCS G0010. "Covered if selection criteria are met" means ICD-10-CM diagnosis code matching is the gating mechanism. A claim without a covered diagnosis code is a claim denial waiting to happen.
There's no explicit prior authorization requirement listed in this policy for standard hepatitis B vaccine administration. But Aetna's plan-level benefit designs can layer prior auth requirements on top of CPB-level policy. If your patients are on commercial fully insured Aetna plans, verify prior authorization requirements at the plan level before the September 26, 2025 effective date.
Coverage Indications at a Glance
| Indication | Status | Relevant ICD-10 Codes | Notes |
|---|---|---|---|
| Preventive vaccination per ACIP recommendations (general population) | Covered | Varies by age/schedule | Must follow CDC ACIP schedule |
| HIV disease | Covered | B20, B97.35 | Selection criteria required |
| Hepatitis C | Covered | B17.10–B17.11, B18.2, B19.20–B19.21 | Selection criteria required |
| Diabetes mellitus | Covered | E08.00–E13.9 | Selection criteria required |
| Chronic liver disease and cirrhosis | Covered | K70.0–K70.9, K73.x, K74.x | Selection criteria required |
| Coagulation defects / hemophilia | Covered | D65–D68.9, D69.1 | Selection criteria required |
| Drug dependence / injecting drug users | Covered | F11.10–F19.99 | Selection criteria required |
| Sexually transmitted infections | Covered | A50.01–A64 | Selection criteria required |
| Intellectual disabilities | Covered | F70–F79, F78.A1–F78.A9 | Selection criteria required |
| Specific developmental disorders of speech/language | Covered | F80.0–F80.9 | Selection criteria required |
Aetna Hepatitis B Vaccine Billing Guidelines and Action Items 2025
Hepatitis B vaccine billing against Aetna's CPB 0410 is straightforward in concept but messy in execution. The policy lists 11 distinct CPT codes for the vaccine itself, each representing a different formulation, dosage, or patient population. Billing the wrong code for the formulation administered is a fast path to a claim denial. Here's what your team needs to do before and after September 26, 2025.
| # | Action Item |
|---|---|
| 1 | Map each CPT code to the correct formulation in your charge capture. CPT 90744 is the standard pediatric dose (recombinant, 3-dose series). CPT 90746 is the adult formulation. CPT 90747 covers dialysis or immunosuppressed patients. CPT 90739 is the two-dose adult series. Mixing these up causes denials that look like coverage issues but are really charge capture problems. Audit your EHR's vaccine order-to-code mapping now. |
| 2 | Add HCPCS G0010 to your charge capture for vaccine administration. G0010 is the administration code for hepatitis B vaccine. If your billing team is using CPT 90471 for immunization administration instead, confirm that Aetna accepts 90471 alongside these vaccine codes or whether G0010 is required for reimbursement. This is a detail that varies by plan type and can quietly suppress payment. |
| 3 | Audit your diagnosis code list against CPB 0410's 218 covered ICD-10-CM codes. Run a report on your Aetna hepatitis B vaccine claims from the last six months. Flag any claims where the ICD-10 code used doesn't appear in CPB 0410's covered diagnosis list. Those are denial-risk claims going forward. |
| 4 | Check plan-level prior authorization requirements separately. The policy itself doesn't mandate prior auth, but individual Aetna plan designs do. Pull your Aetna contracts or use Aetna's online eligibility tools to check PA requirements by plan. Do this before September 26, 2025 if you're seeing high Aetna hepatitis B vaccine volume. |
| 5 | Confirm preventive vs. diagnostic billing intent at the point of care. Aetna ties this policy to ACIP-recommended preventive services. If your provider is administering HepB vaccine as catch-up vaccination in an adult with no specific risk diagnosis, the claim still needs a covered ICD-10 code. The diagnosis "no known exposure" won't hold up. Train your clinical staff to document the risk factor or indication that prompted the vaccination so your billing team has something to code against. |
| 6 | Review your payer mix for this policy's reach. This policy applies to Aetna commercial plans. If you also bill Medicare for hepatitis B vaccine, that's governed separately under Medicare Part B coverage for at-risk patients. Don't conflate Aetna's CPB 0410 criteria with Medicare's coverage rules—they're different frameworks. |
If your practice bills high volumes of hepatitis B vaccine across multiple payers and you're unsure how CPB 0410 maps to your specific Aetna plan contracts, loop in your billing consultant or compliance officer before the effective date. The 218-code ICD-10 list is long, but coverage is not blanket—every claim still lives or dies on whether the diagnosis is on that list.
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Hepatitis B Vaccine Under CPB 0410
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 90636 | CPT | Hepatitis B vaccine |
| 90739 | CPT | Hepatitis B vaccine |
| 90740 | CPT | Hepatitis B vaccine |
| 90741 | CPT | Hepatitis B vaccine |
| 90742 | CPT | Hepatitis B vaccine |
| 90743 | CPT | Hepatitis B vaccine |
| 90744 | CPT | Hepatitis B vaccine |
| 90745 | CPT | Hepatitis B vaccine |
| 90746 | CPT | Hepatitis B vaccine |
| 90747 | CPT | Hepatitis B vaccine |
| 90748 | CPT | Hepatitis B vaccine |
Covered HCPCS Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| G0010 | HCPCS | Administration of hepatitis B vaccine |
Key ICD-10-CM Diagnosis Codes
| Code / Range | Description |
|---|---|
| A50.01–A64 | Infections with a predominantly sexual mode of transmission |
| B17.10–B17.11 | Hepatitis C (acute) |
| B18.2 | Chronic viral hepatitis C |
| B19.20–B19.21 | Unspecified viral hepatitis C |
| B20 | Human immunodeficiency virus [HIV] disease |
| B97.35 | Human immunodeficiency virus, type 2 [HIV-2] as the cause of diseases classified elsewhere |
| D65–D68.9 | Coagulation defects (hemophiliacs) |
| D69.1 | Qualitative platelet defects |
| E08.00–E13.9 | Diabetes mellitus |
| F11.10–F19.99 | Drug dependence and nondependent abuse of drugs (injecting-drug users) |
| F70 | Mild intellectual disabilities |
| F71 | Moderate intellectual disabilities |
| F72 | Severe intellectual disabilities |
| F78.A1–F78.A9 | Other intellectual disabilities |
| F79 | Unspecified intellectual disabilities |
| F80.0–F80.9 | Specific developmental disorders of speech and language |
| K70.0–K70.9 | Alcoholic liver disease (chronic liver diseases and cirrhosis) |
| K73.0–K73.9 | Chronic hepatitis, not elsewhere classified |
| K74.0–K74.29 | Fibrosis and cirrhosis of liver |
| K74.3–K74.30 and beyond | Additional chronic liver diseases and cirrhosis codes (138 additional ICD-10-CM codes covered — see full CPB 0410 policy for complete list) |
The full ICD-10-CM list under CPB 0410 runs to 218 codes. Pull the complete list directly from CPB 0410 on Aetna's clinical policy portal and build it into your denial-prevention workflow.
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