Gardasil has been an HFS covered service since 2007, but providers often report having the claim rejected with the error code notes saying "more information needed."
To avoid this rejection, providers should make sure to enter the word "Gardasil" in addition to CPT code 90649 on the claims when sending to HFS. If providers are using the 2360 paper claims form, "Gardasil" should be entered in field 24C in the description area. In the 837P electronic format, "Gardasil" should be entered in the NTE segment of Loop 2400.
For providers who participate in the Vaccines For Children program, the reimbursement for CPT 90649 will be $6.40 per dose for female patients ages 9-20.
For female patients ages 21-26, all providers are eligible to bill HFS at rate of $149.33 per dose using CPT code 90649 with modifier SL.
Gardasil is also a billable HFS service for male patients ages 9-26, effective October 21, 2009. For boys ages 9-18, use CPT code 90649. The reimbursement rate is $6.40 per dose for VFC providers. For boys ages 19-26, use modifier SL along with CPT code 90649 and the rate is $149.33 per dose.
