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MP 2.01.199 Immunizations

Medical Policy 
Original Policy Date
Last Review Status/Date
Created local policy/6:2011
Return to Medical Policy Index


Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.


To clarify coverage for immunizations as preventive services.


All routine immunizations that are recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention, and administered within the recommendations of ACIP, are considered medically necessary and covered as a preventive or wellness benefit.  Immunizations that have a permissible or provisional (may be administered) recommendation are considered non-covered services.  Recommendations for vaccine administration may include an age or gender specific guideline. 


Policy History

Date Action Reason
06/30/11 New policy; add to Medicine section new policy

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