NOTICE OF PROPOSED POLICY

							                            MICHIGAN DEPARTMENT OF COMMUNITY HEALTH

                                  NOTICE OF PROPOSED POLICY

  Public Act 280 of 1939, as amended, and consultation guidelines for Medicaid policy
  provide an opportunity to review proposed changes in Medicaid policies and procedures.

  Please review the policy summary and the attached materials that describe the specific
  changes being proposed. Let us know why you support the change or oppose the change.

  Submit your comments to the analyst by the due date specified. Your comments must be
  received by the due date to be considered for the final policy bulletin.

  Thank you for participating in the consultation process.



  Director, Program Policy Division
  Bureau of Medicaid Policy and Actuarial Services


Project                       Comments                                   Proposed
            1001-Pharm                         February 19, 2010                            As Indicated
Number:                       Due:                                       Effective Date:

 Mail Comments to:          Carla Patrick-Fagan
                            Bureau of Medicaid Policy & Actuarial Services
                            Medical Services Administration
                            P.O. Box 30479
                            Lansing, Michigan 48909-7979

 Telephone Number: (517) 241-9170                               Fax Number: (517) 335-5136
                                                                E-mail Address: patrickfaganc@michigan.gov

 Policy Subject: Human Papillomavirus Vaccine (HPV) Coverage Update

 Affected Programs: Adult Benefits Waiver (ABW), Maternity Outpatient Medical Services (MOMS) and
 Medicaid

 Distribution: Practitioners, Federally Qualified Health Centers, Hospitals, Local Health Departments, Rural
 Health Clinics, Tribal Health Centers, Medical Clinics and Medicaid Health Plans

 Policy Summary: The Michigan Department of Community Health (MDCH) is extending existing coverage of
 the Gardasil (HPV2) vaccine to males and activating the Common Procedural Terminology (CPT) code for the
 Cervarix (HPV4) vaccine to females for dates of service on or after January 1, 2010. MDCH covers vaccines
 in accordance with the Advisory Committee on Immunization Practices (ACIP). ACIP’s provisional
 recommendations for the HPV vaccine were effective October 21, 2009.

 Purpose: The purpose of this bulletin is to notify providers of new coverage for an immunization code and
 extended population coverage for an existing immunization code that will be implemented by MDCH.


 The public comment phase of this policy is being conducted concurrently with final.



                                                                                                   Public Comment Cover (11/03)
                                                      Bulletin
                                                           Michigan Department of Community Health

              Bulletin: MSA 10-02

         Distribution: Practitioners, Federally Qualified Health Centers, Hospitals, Local Health
                       Departments, Rural Health Clinics, Tribal Health Centers, Medical Clinics and
                       Medicaid Health Plans

               Issued: January 21, 2010

              Subject: Human Papillomavirus Vaccine (HPV) Coverage Update

             Effective: As Indicated

  Programs Affected: Adult Benefits Waiver (ABW), Maternity Outpatient Medical Services (MOMS) and
                     Medicaid


The purpose of this bulletin is to notify providers of the activation of an HPV immunization code and
extended coverage for an existing HPV immunization code that will be implemented by the Michigan
Department of Community Health (MDCH).

Activation of an Existing Current Procedural Terminology (CPT) Procedure Code

Immunization code 90650 (Cervarix HPV2) will be activated effective for dates of service on or after
January 1, 2010, for use in adult females ages 19 through 25.

Extension of Coverage for an Existing CPT Procedure Code

New coverage effective for dates of service on or after January 1, 2010, is extended for immunization code
90649 (Gardasil HPV4) for adult males ages 19 through 26. Coverage for adult females ages 19 through 26
remains unchanged.

Vaccines for Children (VFC) Program

The VFC Program covers HPV2 for females ages 10 through 18 and HPV4 for both females and males ages
9 through 18.

Wrap Around Codes

MDCH will cover these CPT codes differently than Medicare under its Outpatient Prospective Payment
System (OPPS).

Refer to your CPT code book and references and the Centers for Medicaid and Medicare Services (CMS)
website (www.cms.hhs.gov) for full descriptions of the codes. Information regarding the fee screens of
these codes is located in the appropriate database and under the MDCH OPPS Wrap Around List posted on
the MDCH website at www.michigan.gov/medicaidproviders >> Billing and Reimbursement >> Provider
Specific Information >> Outpatient.
                                                                                                  MSA 10-02
                                                                                                  Page 2 of 2


Public Comment

The public comment portion of the policy promulgation process is being conducted concurrently with the
implementation of the change noted in this bulletin. Any interested party wishing to comment on the change
may do so by submitting comments in writing to:
                                             Carla Patrick-Fagan
                                  Michigan Department of Community Health
                                       Medical Services Administration
                                               P.O. Box 30479
                                        Lansing, Michigan 48909-7979
                                                    Or
                                   E-mail: patrickfaganc@michigan.gov

If responding by e-mail, please include "HPV Coverage Update" in the subject line.

Manual Maintenance

Retain this bulletin until applicable information has been incorporated into the Michigan Medicaid Provider
Manual. Providers should refer to the MDCH website at www.michigan.gov/medicaidproviders >> Billing
and Reimbursement >> Provider Specific Information for additional code information.

Questions

Any questions regarding this bulletin should be directed to Provider Inquiry, Department of Community
Health, P.O. Box 30731, Lansing, Michigan 48909-8231, or e-mail at ProviderSupport@michigan.gov.
When you submit an e-mail, include your name, affiliation, and phone number so you may be contacted if
necessary. Providers may phone toll-free 1-800-292-2550.

APPROVED




Stephen Fitton, Director
Medical Services Administration