cpt travel code

CINDY HUGHES, CPC, CFPC

Fam Pract Manag. 2021;28(3):34

Author disclosure: no relevant financial affiliations disclosed.

HOME HEALTH OR HOSPICE CARE SUPERVISION

Advance care planning via telehealth, ambulatory blood pressure monitoring, counseling patients about foreign travel, catching up on children's vaccines.

WE WANT TO HEAR FROM YOU

Send questions and comments to  [email protected] , or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.

Continue Reading

More in FPM

Copyright © 2021 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions  for copyright questions and/or permission requests.

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

• Become a Member
• Everyday Coding Q&A
• Can I get paid
• Coding Guides
• Quick Reference Sheets
• E/M Services
• How Physician Services Are Paid
• Prevention & Screening
• Care Management & Remote Monitoring
• Surgery, Modifiers & Global
• Diagnosis Coding
• New & Newsworthy
• Practice Management
• E/M Rules Archive

April 20, 2024

Can I Get Paid for…Travel Counseling

So your patient is going to the Galapagos, and wants your advice. Can you get paid for travel counseling? This short video has the answer.

Download slides

Back to list

Unlock CodingIntel’s Online Library

Are you a coder, biller, administrator, office manager or physician?

Learn more about the benefits of a CodingIntel membership

click here!

Last revised April 9, 2024 - Betsy Nicoletti

CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

All content on CodingIntel is copyright protected. Any resource shared within the permissions granted here may not be altered in any way, and should retain all copyright information and logos.

• What is CodingIntel
• Terms of Use
• Privacy Policy

Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions.

Copyright © 2024, CodingIntel A division of Medical Practice Consulting, LLC Privacy Policy

Soar to new heights of coding accuracy with CodingIntel's new courses

From April 15, 2024 the day I'm speaking at the AAPC meeting until April 21, 2024 my Dad's Birthday

Enroll Today at codingintel.com/courses/ Use code APRIL for savings

Disclaimer » Advertising

• HealthyChildren.org
• Previous Article

Coding for Pretravel Counseling

• Split-Screen
• Article contents
• Figures & tables
• Supplementary Data
• Peer Review
• CME Quiz Close Quiz
• Open the PDF for in another window
• Get Permissions
• Cite Icon Cite
• Search Site

American Academy of Pediatrics; Coding for Pretravel Counseling. AAP Pediatric Coding Newsletter August 2012; 7 (11): No Pagination Specified. 10.1542/pcco_book100_document007

Download citation file:

• Ris (Zotero)
• Reference Manager

Many physicians provide “travel medicine,” which may include counseling about precautions to avoid common maladies associated with travel such as traveler's diarrhea, management of existing conditions while traveling, pretravel immunization including potential acceleration of immunization schedules for young children, health risks endemic to certain locations, and when indicated, malaria prevention. These services are typically not covered by health benefit plans, and many practices adopt a policy to charge the patient at the time of the visit.

Diagnosis codes may include

If immunizations are provided, the related codes from categories V03–V06 to identify the need for prophylactic vaccination should also be reported.

Counseling about travel to specific regions may be reported with time-based preventive medicine counseling and riskfactor reduction codes 99401–99404.

Documentation to support these codes will include the approximate time spent counseling the patient and a summary of the discussion. These codes represent services provided to patients without symptoms or an established illness. Because these codes have the Current Procedural Terminology (CPT ® ) designation “separate procedure,” they may not be reported with related services on the same date (eg, preventive services described by codes 99381–99397 ). However, CPT instructs, “They are distinct from evaluation and management (E/M) services that may be reported separately when performed.” A separate E/M service should only be reported if a significant and separately identifiable service is rendered and documented (add modifier 25 to the problem-oriented E/M code). If the focus of the visit is on the patient's medical problems and management of these while traveling rather than on travel precautions unrelated to symptoms or illness, a time-based E/M service may be reported.

Advisory Committee on Immunization Practices (ACIP)-recommended immunizations and their administration are likely covered as preventive services under the patient's health plan and should be additionally reported with appropriate CPT codes for the vaccine ( 90476–90749 ) and administration ( 90471–90474 ). Vaccine administration codes 90460–90461 , which include physician counseling on vaccine components, would not apply because the time spent counseling the patient about the vaccine would be included in the total time reported with codes 99401–99404 . Some vaccines indicated for travel (especially longer stays) to certain parts of the world that are not recommended by ACIP for the general US population, such as vaccines to prevent Japanese encephalitis or yellow fever, may be non-covered and not stocked in general pediatric practices but are often offered by local health departments.

Recipient(s) will receive an email with a link to 'Coding for Pretravel Counseling' and will not need an account to access the content.

Subject: Coding for Pretravel Counseling

(Optional message may have a maximum of 1000 characters.)

Citing articles via

Email alerts.

Advertising Disclaimer »

Affiliations

• CEU Quizzes
• Coding Hotline
• Online ISSN 1934-5143
• Print ISSN 1934-5135
• Pediatrics Open Science
• Hospital Pediatrics
• Pediatrics in Review
• AAP Grand Rounds
• Latest News
• Pediatric Care Online
• Red Book Online
• Pediatric Patient Education
• AAP Toolkits
• AAP Pediatric Coding Newsletter

First 1,000 Days Knowledge Center

Institutions/librarians, group practices, licensing/permissions, integrations, advertising.

• Privacy Statement | Accessibility Statement | Terms of Use | Support Center | Contact Us
• © Copyright American Academy of Pediatrics

This Feature Is Available To Subscribers Only

Sign In or Create an Account

COVID-19: Vaccine Program | Testing |  Visitor Guidelines | Information for Employees MONKEYPOX: UConn Health is NOT currently offering the monkeypox vaccine. Please visit the CT DPH website for more information or contact your health provider directly. -->

Infectious Diseases

Important information for travel visits.

• This appointment will consist of a travel consultation and possible immunizations. The final decision to administer vaccinations lies with the physician after careful review of the situation.
• Before you arrive, please fill out the Travel Clinic Questionnaire. Once you schedule an appointment, the questionnaire can be found in your MyChart account , our secure online patient portal. If you don’t yet have a MyChart account through UConn Health, enrollment only takes a few minutes and will allow you to access all your patient information in one place. If you cannot create a MyChart account, you can complete a fillable questionnaire , print it, and bring it to your appointment.
• Minors must have a parent present at the appointment.
• Visits typically last at least one hour. Thirty minutes with the provider and then an additional 15 to 30 minutes with the nurse.
• It is important to have details of your itinerary so the doctor can make a thorough assessment of the health risks.
• Bring prior immunization records with you (even if you have been seen at UConn Health before) to this appointment, including prior travel-related vaccination records (yellow card) as well as pediatric immunization records for any children who are being seen. If you do not bring these immunization records, you or your child may not be seen.
• The travel consultation with the doctor will be billed as Preventive Counseling. It cannot be billed as an office visit.
• The Preventive Counseling fee for each person will average $145.00. The cost may be higher (up to $260.00) depending on complexity of travel consultation.
• The CPT codes used for Preventive Counseling are 99401, 99402, 99403, 99404, 99411 or 99412. One code will be billed depending on how detailed your visit is and how many people are involved in the visit (i.e., two or more people traveling together). You should check for coverage of each of these codes with your insurance company prior to your visit.
• You will be charged an immunization fee for each immunization given.
• Cost of immunizations vary greatly but typically range from $50.00 to $160.00 per shot.
• In general, your visit will cost between $200.00 and $500.00.
• You will be billed for any services your insurance does not cover.
• If your insurance requires you to obtain a referral from your primary care physician be sure to follow-through; if a required referral is not obtained you cannot be seen.

• Revenue Cycle Management
• Reimbursement
• Diabetes Awareness Month
• Risk Management
• Patient Retention
• Medical Economics® 100th Anniversary
• Coding and documentation
• Business of Endocrinology
• Physicians Financial News
• Cybersecurity
• Cardiovascular Clinical Consult
• Locum Tenens, brought to you by LocumLife®
• Weight Management
• Business of Women's Health
• Practice Efficiency
• Finance and Wealth
• Remote Patient Monitoring
• Sponsored Webinars
• Medical Technology
• Billing and collections
• Acute Pain Management
• Exclusive Content
• Value-based Care
• Business of Pediatrics
• Concierge Medicine 2.0 by Castle Connolly Private Health Partners
• Practice Growth
• Concierge Medicine
• Business of Cardiology
• Implementing the Topcon Ocular Telehealth Platform
• Malpractice
• Sexual Health
• Chronic Conditions
• Legal and Policy
• Practice Management
• Patient Relations

How to code for travel-related counseling; coding for preoperative clearance in the hospital

Learn how to code for travel-related counseling and preoperative clearance in the hospital.

Telehealth's long-term impact on the business of medicine

Value-based care adoption is a journey, not a destination. And the map you follow can make all the difference

Finding financing for medical practices

Exclusive: 6 steps to eliminate burnout in your organization (free signup required)

‘Tremendous financial strain’ – Physicians struggling after Change Healthcare cyberattack

2 Commerce Drive Cranbury, NJ 08512

609-716-7777

Journal of Urgent Care Medicine

Practice Management

Travel Immunizations

Q . what is the best way to code for and bill patients who come in because they are planning to travel out of the country and need to know what immunizations they should have before traveling we advise them on preventive measures to take in relation to where they are traveling, provide literature if appropriate, and even try to find health-care facilities close to where they will be staying while abroad. i know we can bill for any vaccines that are administered, but can we also bill an evaluation and management (e/m) code.

A. You are correct that you can bill for any immunization(s) provided, as well as for the administration of the immunization(s). Bill the appropriate code in the medicine section of the Current Procedural Terminology (CPT) manual. For example, you verified that all routine immunizations are up-to-date except for tetanus, and on the basis of the destination of the patient, you discuss preventive measures to take regarding what foods and activities to avoid, how to self-treat minor ailments (such as diarrhea), provide information on medical facilities in the area and guidance on safe contact with animals indigenous to the area. You determine that the patient should receive the tetanus, yellow fever, typhoid, and polio vaccines. You would bill procedures as follows:

• 90715 : “Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years and older, for intramuscular use”
• 90717 : “Yellow fever vaccine, live, for subcutaneous use”
• 90690 : “Typhoid vaccine, live, oral”
• 90713 : “Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use”
• 90460 : “Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional;first or only component of each vaccine or toxoid administered”
• 90461 : “Each additional vaccine or toxoid component administered (list separately in addition to code for primary procedure)”

You will notice that the codes for the immunization administration include a counseling component. However, if you are researching information regarding the travel destination of the patient, offering guidance on which immunizations are needed and guidance on how to avoid sickness and injury while traveling, that is more counseling than is required for just administering those immunizations.

According to CPT guidelines, if you are seeing a patient for a visit and more than 50% of the time spent in the visit is attributed to counseling, you may select the visit level on the basis of the typical time shown for each level of visit:

• • 99201: 10 minutes
• • 99202: 20 minutes
• • 99203: 30 minutes
• • 99204: 45 minutes
• • 99205: 60 minutes
• • 99211: 5 minutes
• • 99212: 10 minutes
• • 99213: 15 minutes
• • 99214: 25 minutes
• • 99215: 40 minutes

If the patient comes to the clinic only for counseling regarding immunizations required for foreign travel and preventive travel measures, then you might consider codes from the preventive medicine section of CPT:

• 99401: “Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes”
• 99402: “Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes”
• 99403: “Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes”
• 99404: “Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes”

As always, when the code you choose is based on time, that time spent must be documented, as well as what topics were discussed and the advice you gave. Please note that some payors deny these services as uncovered services. This is especially true for payors with urgent care contracts that specifically exclude preventative or primary-care services

The diagnosis code(s) to use will be determined by the services performed in the clinic. If the patient received immunizations, you would use ICD-10 [International Classification of Diseases, 10th revision, Clinical Modification] code Z23, “encounter for immunization,” no matter how many immunizations were administered. This is one area where ICD-10 decreased the number of codes used to report the reason for the encounter. It was decided that one diagnosis code would be used to represent any immunization, as opposed to ICD-9 [International Classification of Diseases, Ninth Revision, Clinical Modification], where there were diagnosis codes that specified many different types of immunization, (i.e., V04.61, “need for prophylactic vaccination and inoculation against tetanus pertussis combined vaccine,” or V04.4, “need for prophylactic vaccination and inoculation against yellow fever,” etc.). If only counseling was provided and no vaccines were administered, you would just code Z71.89, “other specified counseling.”

Be sure to check with payors regarding their policies for any of these services. DAVID STERN, MD ( Practice Velocity )

David Stern, MD

• ← Abstracts in Urgent Care: November, 2015
• An Urgent Care Approach to Burns →
• Clinical Feature Articles
• Case Reports
• Orthopedic Case Report
• Clinical Image Challenges
• Web Exclusive Images Challenges
• Abstracts in Urgent Care
• JUCM Webinars Archive
• Letters from the Editor-in-Chief
• From the UCA CEO
• Practice Management Articles
• Perspectives
• Occupational Medicine
• Revenue Cycle Management
• Developing Data
• Web Exclusive Articles
• Buyer’s Guide
• Author Bios
• Author Instructions
• Submit An Article
• Individual Articles
• Full Issue PDFs

Remember Me

Lost your password?

Username or E-mail:

Vaccines for Travel

• Clinical Policy Bulletins
• Medical Clinical Policy Bulletins

Number: 0473

Table Of Contents

Footnotes †   Persons who are immunocompromised because of immune deficiency diseases, leukemia, lymphoma, generalized cancer, or the acquired immunodeficiency syndrome, or who are receiving immunosuppressive therapy with corticosteroids, alkylating agents, anti-metabolites, or radiation.

Footnotes ††   LYMErix was withdrawn from the U.S. market in February 2002.

Footnotes *   Most Aetna benefit plans exclude coverage of vaccines for work.  Please check benefit plan descriptions.

Note : The Advisory Committee on Immunization Practices (1996) states that plague vaccination is not indicated for most travelers to countries in which cases of plague have been reported.

Experimental and Investigational

The following vaccines for travel are considered experimental and investigational (not an all-inclusive list):

• Malaria vaccine for travel because an effective malaria vaccine has yet to be developed.
• Oral or skin-patch cholera vaccine for prevention of entero-toxigenic Escherichia coli diarrhea because their clinical value has not been established.

Policy Limitations and Exclusions  

Note:  Most Aetna HMO plans exclude coverage of vaccines for travel.  Most Aetna traditional plans cover medically necessary travel vaccines for members of plans with preventive services benefits.  Please check benefit plan descriptions.

Note : Many of these vaccines may also be considered medically necessary for reasons other than travel, and may be covered when medically necessary in members with preventive benefits, regardless of whether the plan excludes coverage of travel vaccines.

The Centers for Disease Control and Prevention (CDC)'s recommended vaccinations for travelers can be found at the following website: Destinations and Travelers Health .

In a Cochrane review on vaccines for preventing malaria, Graves and Gelband (2006a) concluded that there is no evidence for protection by SPf66 vaccines against P. falciparum in Africa.  There is a modest reduction in attacks of P. falciparum malaria following vaccination with SPf66 in South America.  There is no justification for further trials of SPf66 in its current formulation.  Further research with SPf66 vaccines in South America or with new formulations of SPf66 may be justified.

In another Cochrane review, Graves and Gelband (2006b) concluded that the MSP/RESA (Combination B) vaccine shows promise as a way to reduce the severity of malaria episodes, but the effect of the vaccine is MSP2 variant-specific.  Pre-treatment for malaria during a vaccine trial makes the results difficult to interpret, particularly with the relatively small sample sizes of early trials.  The results show that blood-stage vaccines may play a role and merit further development.

Vaughan et al (2009) presented a comprehensive meta-analysis of more than 500 references, describing nearly 5,000 unique B cell and T cell epitopes derived from the Plasmodium genus, and detailing thousands of immunological assays.  This was the first inventory of epitope data related to malaria-specific immunology, plasmodial pathogenesis, and vaccine performance.  The survey included host and pathogen species distribution of epitopes, the number of antibody versus CD4(+) and CD8(+) T cell epitopes, the genomic distribution of recognized epitopes, variance among epitopes from different parasite strains, and the characterization of protective epitopes and of epitopes associated with parasite evasion of the host immune response.  The results identified knowledge gaps and areas for further investigation.  This information has relevance to issues, such as the identification of epitopes and antigens associated with protective immunity, the design and development of candidate malaria vaccines, and characterization of immune response to strain polymorphisms.

Currently, there is an ongoing phase III clinical trial of a candidate vaccine for malaria, but the study has not been completed (Birkett, 2010).

The Advisory Committee on Immunization Practices (ACIP) of the CDC provided the following recommendations regarding the prevention of plague (1996):

• Routine plague vaccination is not necessary for individuals living in areas in which plague is enzootic.
• Plague vaccination is not indicated for hospital staff or other medical personnel in such areas.
• Plague vaccination is not indicated for most travelers to countries in which cases of plague have been reported.

In a Cochrane review, Ahmed et al (2013) evaluated the safety, effectiveness, and immunogenicity of vaccines for preventing entero-toxigenic Escherichia coli (ETEC) diarrhea.  These investigators searched the Cochrane Infectious Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, and ClinicalTrials up to December 2012.  Randomized controlled trials (RCTs) and quasi-RCTs comparing use of vaccines to prevent ETEC with use of no intervention, a control vaccine (either an inert vaccine or a vaccine normally given to prevent an unrelated infection), an alternative ETEC vaccine, or a different dose or schedule of the same ETEC vaccine in healthy adults and children living in endemic regions, intending to travel to endemic regions, or volunteering to receive an artificial challenge of ETEC bacteria were included for analysis.  Two authors independently assessed each trial for eligibility and risk of bias.  Two independent reviewers extracted data from the included studies and analyzed the data using Review Manager (RevMan) software.  They reported outcomes as risk ratios (RR) with 95 % confidence intervals (CI) and assessed the quality of the evidence using the GRADE approach.  A total of 24 RCTs, including 53,247 participants, met the inclusion criteria – 4 studies assessed the protective efficacy of oral cholera vaccines when used to prevent diarrhea due to ETEC and 7 studies assessed the protective efficacy of ETEC-specific vaccines.  Of these 11 studies, 7 studies presented efficacy data from field trials and 4 studies presented efficacy data from artificial challenge studies.  An additional 13 trials contributed safety and immunological data only.  The currently available, oral cholera killed whole cell vaccine (Dukoral®) was evaluated for protection of people against "travelers' diarrhea" in a single RCT in people arriving in Mexico from the USA.  These researchers did not identify any statistically significant effects on ETEC diarrhea or all-cause diarrhea (1 trial, 502 participants; low-quality evidence).  Two earlier trials, one undertaken in an endemic population in Bangladesh and one undertaken in people travelling from Finland to Morocco, evaluated a precursor of this vaccine containing purified cholera toxin B subunit rather than the recombinant subunit in Dukoral®.  Short-term protective efficacy against ETEC diarrhea was demonstrated, lasting for around 3 months (RR 0.43, 95 % CI: 0.26 to 0.71; 2 trials, 50,227 participants).  This vaccine is no longer available.  An ETEC-specific, killed whole cell vaccine, which also contains the recombinant cholera toxin B-subunit, was evaluated in people traveling from the USA to Mexico or Guatemala, and from Austria to Latin America, Africa, or Asia.  These investigators did not identify any statistically significant differences in ETEC-specific diarrhea or all-cause diarrhea (2 trials, 799 participants), and the vaccine was associated with increased vomiting (RR 2.0, 95 % CI: 1.16 to 3.45; 9 trials, 1,528 participants).  The other ETEC-specific vaccines in development have not yet demonstrated clinically important benefits.  The authors concluded that there is currently insufficient evidence from RCTs to support the use of the oral cholera vaccine Dukoral® for protecting travelers against ETEC diarrhea.  Moreover, they stated that further research is needed to develop safe and effective vaccines to provide both short- and long-term protection against ETEC diarrhea.

Also, an UpToDate review on "Travelers' diarrhea" (Wanke, 2014) states that "Use of vaccines to protect against travelers’ diarrhea is hindered by the varied pathogens that can cause it. Although enterotoxigenic E. coli (ETEC) predominates as an etiology of travelers’ diarrhea, vaccination strategies that have focused on this pathogen as a target have been suboptimal.  Although vaccination to protect against cholera is not routinely recommended for travelers, a number of trials suggest that the oral, killed whole-cell vaccine given with the nontoxic B subunit of cholera toxin (Dukoral) provides protection for travelers against ETEC infection.  The rationale for such protection is that the B subunit of cholera is antigenically similar to the heat-labile enterotoxin of ETEC.  In two randomized trials, the killed whole-cell vaccine combined with the B subunit of cholera toxin reduced the incidence of diarrhea caused by ETEC by 67 percent in a trial in Bangladesh and 52 percent among travelers to Morocco.  The Dukoral vaccine was approved in the United States in late 2006 for use as a travelers' diarrhea vaccine.  However, a conservative estimate that took into account the incidence of ETEC infection throughout the world and the efficacy of the vaccine suggested that it may prevent ≤7 percent of travelers' diarrhea cases.  The 2006 guidelines on travel medicine from the Infectious Diseases Society of America concluded that the decision to use the vaccine to prevent travelers' diarrhea must balance its cost, adverse effects, and limited utility against the known effectiveness and costs of self-treatment as described above.  A separate vaccination strategy for ETEC also appears to have limited utility.  Despite initial promising data on vaccination with heat-labile enterotoxin from ETEC via a skin patch, it was not effective in decreasing the incidence of moderate to severe diarrhea due to either ETEC or any cause in a randomized, placebo controlled trial that included 1,644 individuals who traveled to Mexico or Guatemala.  In a subgroup analysis, the vaccine provided modest protection against ETEC that produced only heat-labile enterotoxin (vaccine efficacy 61 percent [95 % CI, 7 to 84 percent]), but not ETEC that produced heat-stable toxin or both.  This highlights the limitations of a single-antigen vaccine for travelers’ diarrhea".

An UpToDate review on "Immunizations for travel" (Freedman and Leder, 2015) states that "In general, severely immunocompromised patients should not receive live vaccines.  Live vaccines include yellow fever vaccine, oral typhoid vaccine, nasal influenza vaccine, oral polio vaccine (OPV), MMR, and varicella vaccine.  Inactivated vaccines include meningococcal vaccine, parenteral typhoid vaccine, hepatitis A and B vaccines, rabies vaccine, Japanese encephalitis vaccine, inactivated influenza vaccine, inactivated polio vaccine (IPV), Tdap, and Td".

Chikungunya Vaccine

Chikungunya is primarily a mosquito-borne alphavirus caused by the chikungunya virus (CHIKV) that is often associated with fever and debilitating joint pain. Rarely, the virus can be transmitted via blood products, laboratory and maternal-fetal transmission. Outbreaks typically occur in tropical and subtropical regions of Africa, Asia, Oceania, and parts of the Americas and Europe where chikungunya virus-carrying mosquitos are endemic (Bettis et al, 2022; Wilson and Lenschow, 2022). Between 2014 and 2016, 3,941 cases were reported in the United States among travelers; 92% were associated with travel in the Americas (most commonly the Dominican Republic, Puerto Rico, and Haiti). The remaining 8% had traveled to Asia, Africa, or the Western Pacific (Lindsey et al, 2018; Wilson and Lenschow, 2022).

Management of the chikungunya virus is supportive (i.e., rest, fluids, antiinflammatory and analgesic agents). Systemic glucocorticoids or treatment with a disease-modifying antirheumatic drug (DMARD) has been used in refractory or chronic arthritis cases. The cornerstone of prevention has been minimizing mosquito exposure (Lenschow and Wilson, 2023). In November 2023, the FDA approved the first chikungunya vaccine (Ixchiq, Valneva Scotland Ltd) for the prevention of disease caused by chikungunya virus (CHIKV) in individuals 18 years of age and older who are at increased risk of exposure to CHIKV. "This indication is approved under accelerated approval based on anti-CHIKV neutralizing antibody titers. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory studies" (Valneva, 2023).

FDA approval was based on two clinical trials conducted in North America that evaluated the safety of Ixchiq in adults 18 years or older. In clinical studies, the most common solicited injection site reaction (greater than 10%) was tenderness (10.6%). The most common solicited systemic adverse reactions (greater than 10%) were headache (31.6%), fatigue (28.5%), myalgia (23.9%), arthralgia (17.2%), fever (13.5%) and nausea (11.2%). The effectiveness was based on immune response data from a clinical study conducted in the US in adults. "In this study, the immune response of 266 participants who received the vaccine was compared to the immune response of 96 participants who received placebo. The level of antibody evaluated in study participants was based on a level shown to be protective in non-human primates that had received blood from people who had been vaccinated. Almost all vaccine study participants achieved this antibody level" (FDA, 2023).

Ixchiq is administered as a single intramuscular injection. Ixchiq contains a live, weakened version of the chikungunya virus and may cause symptoms in the vaccine recipient similar to those experienced by people who have chikungunya disease. It is contraindicated in immunocompromised individuals or those with a history of a severe allergic reaction to any component of Ixchiq. Vertical transmission of wild-type CHIKV from pregnant individuals with viremia at delivery is common and can cause potentially fatal CHIKV disease in neonates. Vaccine viremia occurs in the first week following administration of Ixchiq, with resolution of viremia by 14 days after vaccination. It is not known if the vaccine virus can be vertically transmitted and cause fetal or neonatal adverse reactions. A decision to administer during pregnancy should take into consideration the individual’s risk of wild-type CHIKV infection, gestational age, and risks to the fetus or neonate from vertical transmission of wild-type CHIKV. Labeled warnings and precautions also include risk of syncope associated with administration of injectable vaccines (Valneva, 2023).

The Centers for Disease Control's (CDC) Advisory Committee on Immunization Practices (ACIP) met in October 2023 to discuss recommendations for the chikungunya vaccine. Draft recommendations include chikungunya vaccine recommendation for persons 18 years of age and older traveling to a country or territory where there is a chikungunya outbreak. In addition, the vaccine may be considered for persons traveling to a country or territory without an outbreak but with evidence of chikungunya virus transmission among humans within the last 5 years:

• Older persons (e.g., >65 years), particularly those with underlying medical conditions, who are likely to have at least moderate exposure (moderate exposure could include travelers who might have at least 2 weeks (cumulative) of exposure to mosquitoes in indoor and/or outdoor settings) to mosquitoes
• Persons staying for a cumulative period of 6 months or more during a 2-year period

Japanese Encephalitis Vaccine for Pediatric Travelers

Taucher and colleagues (2020) stated that in an initial study among children from non-Japanese encephalitis (JE)-endemic countries, sero-protection rates (SPRs) remained high 6 months following completion of the primary series with IXIARO. In an open-label, follow-up study, a subset of 23 children who received a 2-dose primary series of IXIARO in the parent study, were examined for safety and neutralizing antibody persistence for 36 months.  SPRs remained high but declined from 100 % 1 month after primary immunization to 91.3 % at month 7 and 89.5 % at month 36. Geometric mean titers (GMTs) declined considerably from 384.1 by day 56-60.8 at month 36.  No long-term safety concerns were identified.  The authors concluded that the substantial decline in GMT observed in this study, together with previously published data on children vaccinated with IXIARO supported the recommendation for a booster dose in children who remain at risk of JE from 1 year after the primary series of IXIARO, consistent with the recommendation for adults.

Jost and colleagues (2015) evaluated the relevance of travel-related measles, a highly transmissible and vaccine-preventable disease. Between 2001 and 2013, surveillance and travel-related measles data were systematically reviewed according to the PRISMA guidelines with extraction of relevant articles from Medline, Embase, GoogleScholar and from public health authorities in the Region of the Americas, Europe and Australia.  From a total of 960 records, 44 articles were included and they comprised 2,128 imported measles cases between 2001 and 2011.  The proportion of imported cases in Europe was low at 1 to 2 %, which reflected the situation in a measles-endemic region.  In contrast, imported and import-related measles accounted for up to 100 % of all cases in regions with interrupted endemic measles transmission; 11 air-travel related reports described 132 measles index cases leading to 47 secondary cases.  Secondary transmission was significantly more likely to occur if the index case was younger or when there were multiple infectious cases on board.  Further spread to health care settings was found.  Measles cases associated with cruise ship travel or mass gatherings were sporadically observed.  The authors concluded that within both, endemic and non-endemic home countries, pre-travel health advice should assess MMR immunity routinely to avoid measles spread by non-immune travelers.  They stated that to identify measles spread as well as to increase and sustain high vaccination coverages, joint efforts of public health specialists, health care practitioners and travel medicine providers are needed.

An UpToDate review on "Immunizations for travel" (Freedman and Leder, 2016) states that "Children traveling outside the United States should receive MMR vaccination sooner than the standard immunization schedule. Prior to departure, children 12 months of age or older should have received 2 doses of MMR vaccine separated by at least 28 days, with the first dose administered on or after the first birthday.  Children aged 6 to 11 months should receive 1 dose of MMR before departure.  MMR vaccination for adults is indicated for individuals born in 1957 or later in the United States (before 1970 in Canada; before 1966 in Australia) without evidence of immunity or without evidence of 2 doses of an adequate live vaccine at any time after age 12 months.  Although individuals born before 1957 in the United States are presumed to be immune (exceptions include United States healthcare workers and women of childbearing age), 2 doses of MMR vaccine spaced by 1 month should be strongly considered for unvaccinated individuals without other evidence of immunity who were born before 1957 (in the United States) and are traveling for purposes of healthcare or humanitarian work potentially entailing close contact with ill individuals.  MMR vaccination is contraindicated in pregnant and immunocompromised patients".

The CDC (2015) states that anyone who is not protected against measles is at risk of getting infected when they travel internationally. It recommends the following: Centers for Disease Control and Prevention .

• Infants 6 months through 11 months of age should receive 1 dose of MMR vaccine Footnotes for MMR vaccines for infants †
• Children 12 months of age and older should receive 2 doses of MMR vaccine separated by at least 28 days.
• Teenagers and adults who do not have evidence of immunity Footnotes for Acceptable presumptive evidence of immunity against measles * against measles should get 2 doses of MMR vaccine separated by at least 28 days.

Footnotes † Infants who get 1 dose of MMR vaccine before their first birthday should get 2 more doses (1 dose at 12 through 15 months of age and another dose at least 28 days later).

Footnotes * Acceptable presumptive evidence of immunity against measles includes at least one of the following: written documentation of adequate vaccination, laboratory evidence of immunity, laboratory confirmation of measles, or birth in the United States before 1957.

Contraindications and Precautions: Vaccine Recommendations and Guidelines of the ACIP .

Contraindications

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
• Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy Footnotes for deferred vaccine † or patients with human immunodeficiency virus [HIV] infection who are severely immunocompromised) Footnotes for HIV infected children *

Footnotes † Vaccine should be deferred for the appropriate interval if replacement immune globulin products are being administered.

Footnotes * HIV-infected children may receive varicella and measles vaccine if CD4+ T-lymphocyte count is greater than 15 %.

Precautions

• Moderate or severe acute illness with or without fever
• Recent (within 11 months) receipt of antibody-containing blood product (specific interval depends on product) Footnotes for immune globulin products †
• History of thrombocytopenia or thrombocytopenic purpura
• Need for tuberculin skin testing Footnotes for Measles vaccination *

Footnotes † Vaccine should be deferred for the appropriate interval if replacement immune globulin products are being administered

Footnotes * Measles vaccination might suppress tuberculin reactivity temporarily. Measles-containing vaccine can be administered on the same day as tuberculin skin testing. If testing cannot be performed until after the day of MMR vaccination, the test should be postponed for at least 4 weeks after the vaccination. If an urgent need exists to skin test, do so with the understanding that reactivity might be reduced by the vaccine.

Tick-Borne Encephalitis Vaccine

Rampa et al (2020) state that tick-borne encephalitis (TBE) is increasing in Europe and has become one of the most important causes of viral encephalitis, as well as the most frequent cause of viral meningitis, in Europe. The authors note that there is no antiviral treatment against TBE and that active vaccination is a practical preventive measure to reduce the number of cases. There are two inactivated virus vaccines licensed in Europe: FSME-Immun® (Pfizer), in some countries distributed as Ticovac®, and Encepur® (Bavarian Nordic). FSME-Immun is based on the TBE virus strain Neudoerfl (Nd), whereas Encepur is based on the TBE virus strain Karlsruhe-23 (K23). Both vaccines have a pediatric TBE vaccine variant. Thus, the authors conducted a systematic review (registered at PROSPERO (#CRD42020155737) and conducted in accordance with PRISMA guidelines) of the immunogenicity and safety of the tick-borne encephalitis vaccine (2009-2019). Of a total of 2464 records, 49 original research publications included evaluation for immunogenicity and safety. The authors found that TBE-vaccines showed adequate immunogenicity, good safety and interchangeability in adults and children with some differences in long-term protection (seropositivity in 90.6–100% after primary vaccination; 84.9%–99.4% at 5 year follow up). Primary conventional vaccination schedule (days 0, 28, and 300) demonstrated the best immunogenic results (99–100% of seropositivity). Mixed brand primary vaccination presented adequate safety and immunogenicity with some exceptions. After booster follow-ups, accelerated conventional and rapid vaccination schedules were shown to be comparable in terms of immunogenicity and safety. First booster vaccinations five years after primary vaccination were protective in adults aged less than 50 years, leading to protective antibody levels from at least 5 years up to 10 years after booster vaccination. In older vaccinees, 50 years and older, lower protective antibody titers were found. Allergic individuals showed an adequate response and immunosuppressed individuals a diminished response to TBE-vaccination. The authors concluded that the TBE-vaccination with Encepur or FSME-Immun to be highly immunogenic, well tolerated and in all studies except one to be interchangeable. Schedules should, if possible, use the same vaccine brand (non-mixed). TBE-vaccines are immunogenic in terms of antibody response but less so when vaccination is started after the age of 50 years. Age at priming is a key factor in the duration of protection. In terms of safety, the European, licensed vaccines were found to be well tolerated in both children (aged 1–17 years) and in adults, with local injection site reactions in 24.8% (4.3–54%) and systematic reactions in 30% (0.6–45.9%) of vaccinees. Vaccine related serious adverse events (SAE) were rare.

In February 2021, the U.S. FDA accepted for Priority Review Pfizer’s Biologics License Application (BLA) for TicoVac, its tick-borne encephalitis (TBE) vaccine for active immunization to prevent TBE in individuals 1 year of age and older. If approved, TicoVac would be the first vaccine in the U.S. to help protect adults and children who are visiting or living in TBE endemic areas. In line with Priority Review designation, the FDA will target an action within six months of the application submission date, with the anticipated Prescription Drug User Fee Act (PDUFA) action date expected for August 2021.

The BLA is based on results from "more than 40 years of experience and evidence outside the U.S. In clinical trials, the safety and immunogenicity of TicoVac was assessed across two age groups (1-15 years of age and 16-65 years of age). In these studies, pooled seropositivity rates were 99-100% in 1-15 year olds and 94-99% in adults >15 years following three doses. Clinical studies demonstrated that TicoVac was well-tolerated with no unexpected adverse events or vaccine-related serious adverse events observed. Subsequent real-world studies have shown that the vaccine is 96-99% effective in people who have received at least two doses of the vaccine, and two to three doses of the vaccine were shown to be sufficient to provide a long-lasting immune memory” (Pfizer, 2021b).

On August 13, 2021, the U.S. FDA approved Ticovac (Pfizer Inc.), tick-borne encephalitis (TBE) vaccine, for active immunization to prevent TBE in individuals 1 year of age and older. FDA approval was based on the safety and immunogenicity of Ticovac that were assessed cross two age groups (Study 209: 1 to15 years of age and Studies 213 and 690601: persons 16 years of age and older). In these studies, seropositivity rates were 99.5% in the group of 1 to 15 year olds and 98.7-100% in persons older than 15 years following three primary doses. Clinical studies demonstrated that Ticovac was generally well-tolerated with no unexpected adverse events or vaccine-related serious adverse events observed. The most common adverse reactions across both age groups were local tenderness, headache, local pain, fever, restlessness, fatigue, and muscle pain. Real-world studies from Austria have shown that the vaccine is 96-98.7% effective in people who have received at least three doses of the vaccine (Pfizer, 2021a, 2021c).

Two open-label, multi-center, follow-up studies which enrolled subjects who were seropositive 1 month after the third vaccination from Studies 213 (N=252, ages 16 through 65 at the time of first TICOVAC dose) and 209 (N=358, ages 1 through 15 at the time of first Ticovac dose) were conducted to assess the seropersistence of TBE antibodies after completion of the primary vaccination series and the antibody response to a booster administration. Three years after the primary series of Ticovac , neutralization test (NT) seropositivity in follow-up studies 223 and 700401 ranged from 82.9% to 100% depending on age. Following a booster dose the NT seropositivity rates were 100% (Pfizer, 2021a).

Vaccines for Pregnant Travelers

Nasser and colleagues (2020) noted that pregnant travelers and their offspring are vulnerable to severe outcomes following a wide range of infections. Vaccine-preventable diseases can have a particularly severe course in pregnant women, but little is known about the safety of travel vaccines in pregnant women. These investigators carried out a systematic review of all published literature concerning the safety of vaccines frequently given to travelers such as yellow fever, MMR (mumps, measles and rubella), influenza, Tdap (tetanus, diphtheria and pertussis), meningococcus, hepatitis A and B, rabies, polio, typhoid fever, tick-borne encephalitis and Japanese encephalitis vaccines.  They included case series, cohort studies and RCTs. For the meta-analysis, these researchers included only RCTs that compared the administration of a vaccine to placebo or to no vaccine.  Outcome measures included severe systemic adverse events (AEs), maternal outcomes related to the course of pregnancy, neonatal outcomes and local AEs. They calculated the RR and its 95 % CI as the summary measure. The safety of influenza vaccine is supported by high-quality evidence.  For Tdap vaccine, no evidence of any harm was found in the meta-analysis of RCTs. A slight increase in chorioamnionitis rate was reported in 3 out of 12 observational studies.  However, this small possible risk is far out-weighed by a much larger benefit in terms of infant morbidity and mortality. Meningococcal vaccines are probably safe during pregnancy, as supported by RCTs comparing meningococcal vaccines to other vaccines.  Data from observational studies support the safety of hepatitis A, hepatitis B and rabies vaccines, as well as that of the live attenuated yellow fever vaccine.  The authors found little or no data about the safety of polio, typhoid, Japanese encephalitis, tick-borne encephalitis and MMR vaccines during pregnancy.

Yellow Fever Vaccine Safety in Immunocompromised Individuals

de Araujo Lagos et al (2023) stated that yellow fever (YF) is an arbovirus with variable severity, including severe forms with high mortality; and vaccination is the most effective measure to protect against the disease . Non-serious and serious AEs have been described in immunocompromised individuals; however, previous studies have failed to show this association.  In a systematic review, these investigators examined the risk of AEs following YF vaccination in immunocompromised individuals compared with its use in non-immunocompromised individuals.  They carried out a literature search in the Medline, LILACS, Embase, SCOPUS, DARE, Toxiline, Web of Science and grey literature databases for publications until February 2021.  Randomized and quasi-randomized clinical trials and observational studies that included immunocompromised subjects (individuals with HIV infection, organ transplantation, cancer, who used immunosuppressive drugs for rheumatologic diseases and those on immunosuppressive therapy for other diseases) were selected.  The methodological quality of observational or non-randomized studies was assessed by the ROBINS-I tool.  These researchers carried out 2 meta-analyses, proportion and risk factor analyses, to identify the summary measure of RR in the studies that had variables suitable for combination.  A total of 25 studies were included, most with risk of bias classified as critical; 13 studies had enough data to perform the proposed meta-analyses; 7 studies without a comparator group had their results aggregated in the proportion meta-analysis, identifying an 8.5 % (95 % CI: 0.07 to 21.8] risk of immunocompromised individuals presenting AEs following vaccination; 6 cohort studies were combined, with an RR of 1.00 (95 % CI: 0.78 to 1.29).  Subgroup analysis was conducted according to the etiology of immunosuppression and was also unable to identify an increased risk of AEs following vaccination.  The authors concluded that it was not possible to affirm that immunocompromised individuals, regardless of etiology, had a higher risk AEs, following receiving the YF vaccine.

Zaire Ebolavirus Vaccine

The Ebola virus [Zaire ebolavirus (EBOV)] vaccine is a replication-competent, live, attenuated recombinant vesicular stomatitis virus (rVSV) vaccine. It contains a gene from the Ebola virus, not the whole virus, which means persons cannot become infected with EBOV from the vaccine. The vaccine is known as rVSVΔG-ZEBOV-GP Ebola vaccine, brand name Ervebo (manufactured by Merck). The vaccine was approved by the U.S. FDA on December 19, 2019, for the prevention of Ebola virus disease (EVD) caused by EBOV in people 18 years of age and older, based on the data from 12 clinical trials that included a total of 15,399 adults (CDC, 2021).

Study 3 (Ring vaccination study) was an open-label, randomized cluster (ring) vaccination study conducted in the Republic of Guinea during the 2014 outbreak. Each cluster was composed of contacts and contacts of contacts of individuals with laboratory-confirmed Ebola virus disease (EVD). Clusters were randomized to receive either an “immediate” vaccination or a 21-day “delayed” vaccination. In the primary efficacy analysis, 3,537 subjects 18 years of age and older were considered contacts and contacts of contacts of an index case with laboratory-confirmed EVD. Of these, 2,108 were included in 51 immediate vaccination clusters, and 1,429 were included in 46 delayed vaccination clusters. In the primary efficacy analysis, the number of cases of laboratory-confirmed EVD in subjects vaccinated in immediate vaccination clusters was compared to the number of cases in subjects in delayed vaccination clusters. Cases of EVD that occurred between Day 10 and Day 31 post-randomization of the cluster were included in the analysis. Vaccine efficacy was 100%; no cases of confirmed EVD were observed in the immediate vaccination clusters, and 10 confirmed cases of EVD were observed in a total of 4 delayed vaccination clusters between Day 10 and Day 31 post-randomization (Merck, 2019).

On February 26, 2020, the Advisory Committee on Immunization Practices (ACIP) recommended pre-exposure vaccination with Ervebo® for adults aged 18 years or older in the U.S. population who are at potential risk of exposure to EBOV. This recommendation includes adults who are responding or may respond to an outbreak of EVD; laboratorians or other staff working at biosafety-level 4 facilities in the United States; or healthcare personnel (HCP) working at federally designated Ebola Treatment Centers in the United States. HCP refers to all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body substances (e.g., blood, tissue, and specific body fluids); contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air. These HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, physicians, technicians, clinical laboratory personnel, autopsy personnel, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel) (CDC, 2021).

Ervebo (Merck Sharp & Dohme Corporation) is a vaccine indicated for the prevention of disease caused by Zaire ebolavirus in individuals 18 years of age and older. Immunization with Ervebo results in an immune response and protection from disease caused by Zaire ebolavirus. The relative contributions of innate, humoral and cell-mediated immunity to protection from Zaire ebolavirus are unknown.

Limitations of use include:

• The duration of protection conferred by Ervebo is unknown;
• Ervebo does not protect against other species of Ebolavirus or Marburgvirus;
• Effectiveness of the vaccine when administered concurrently with antiviral medication, immune  globulin (IG), and/or blood or plasma transfusions is unknown.

Ervebo is available as 1 mL suspension for injection supplied as a single-dose vial and is to be administered intramuscularly.

Ervebo label carries warnings and precautions for anaphylaxis. Vaccinated individuals should continue to adhere to infection control practices to prevent Zaire ebolavirus infection and transmission. Vaccine virus RNA has been detected in blood, saliva, urine, and fluid from skin vesicles of vaccinated adults; transmission of vaccine virus is a theoretical possibility. The most common injection-site adverse events were injection-site pain (70%), swelling (17%), and redness (12%). The most common systemic adverse events reported were headache (37%), feverishness (34%), muscle pain (33%), fatigue (19%), joint pain (18%), nausea (8%), arthritis (5%), rash (4%) and abnormal sweating (3%) (Merck, 2019).

The above policy is based on the following references:

• Ahmed T, Bhuiyan TR, Zaman K, et al. Vaccines for preventing enterotoxigenic Escherichia coli (ETEC) diarrhoea. Cochrane Database Syst Rev. 2013;7:CD009029.
• American Academy of Pediatrics Committee on Infectious Diseases. Poliovirus. Pediatrics. 2011;128(4):805-808.
• Arguin PM, Kozarsky PE, Reed C, eds. CDC Health Information for International Travel, 2008. St. Louis, MO: Mosby; 2007. 
• Bettis AA, L'Azou Jackson M, et al. The global epidemiology of chikungunya from 1999 to 2020: A systematic literature review to inform the development and introduction of vaccines. PLoS Negl Trop Dis. 2022;16(1):e0010069.
• Birkett A. MVI discusses what's on the horizon for malaria vaccine development. Bethesda, MD: The PATH Malaria Vaccine Initiative; 2010.
• Carroll ID, Williams DC. Pre-travel vaccination and medical prophylaxis in the pregnant traveler. Travel Med Infect Dis. 2008;6(5):259-275.
• Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of High-Consequence Pathogens and Pathology (DHCPP), Viral Special Pathogens Branch (VSPB). Ebola vaccine: Information about Ervebo. Atlanga, GA: CDC; February 25, 2021. Available at:  https://www.cdc.gov/vhf/ebola/clinicians/vaccine/index.html. Accessed June 6, 2021.
• Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Evidence to recommendations for chikungunya vaccine use among adult travelers. ACIP meeting; October 26, 2023. Available at: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-10-25-26/02-Chikungunya-Hills-508.pdf. Accessed November 20, 2023.
• Centers for Disease Control (CDC). Rabies prevention -- United States, 1984. MMWR Morbid Mortal Wkly Rep. 1984;33(28):393-402, 407-408.
• Centers for Disease Control and Prevention (CDC). Inactivated Japanese encephalitis virus vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1993;42(RR-1):1-15.
• Centers for Disease Control and Prevention (CDC). Prevention and control of meningococcal disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbid Mortal Wkly Rep. 2000;49(RR-7):1-10.
• Centers for Disease Control and Prevention (CDC). Prevention of hepatitis A through active or passive immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbid Mortal Wkly Rep. 1999;48(RR-12):1-37.
• Centers for Disease Control and Prevention (CDC). Recommendations for the use of Lyme disease vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1999;48(RR-7):1-17, 21-25.
• Centers for Disease Control and Prevention (CDC). Recommendations of the Advisory Committee on Immunization Practices: Revised recommendations for routine poliomyelitis vaccination. MMWR Morbid Mortal Wkly Rep. 1999;48(27):590.
• Centers for Disease Control and Prevention (CDC). The Yellow Book. CDC Health Information for International Travel 2012. New York, NY: Oxford University Press; 2011.
• Centers for Disease Control and Prevention (CDC). The Yellow Book. CDC Health Information for International Travel 2018. New York, NY: Oxford University Press; 2017.
• Centers for Disease Control and Prevention (CDC). Travelers' health: Chapter 4: Travel-related infectious diseases: Hepatitis B. The Yellow Book. Atlanta, GA: CDC; reviewed July 1, 2019. Available at: https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/hepatitis-b. Accessed April 12, 2022.
• Centers for Disease Control and Prevention (CDC). Typhoid immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbid Mortal Wkly Rep. 1990;39(RR-10):1-5.
• Centers for Disease Control and Prevention (CDC). Update: Recommendations to prevent hepatitis B virus transmission -- United States. MMWR Morbid Mortal Wkly Rep. 1995:44(30):574-575.
• Centers for Disease Control and Prevention (CDC). Update: Recommendations to prevent hepatitis B virus transmission -- United States. MMWR Morbid Mortal Wkly Rep. 1999;48(2):33-34.
• Centers for Disease Control and Prevention. Prevention of plague: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 1996;45(No. RR-14).
• Cetron MS, Marfin AA, Julian KG, et al. Yellow fever vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2002. MMWR Morbid Mortal Wkly Rep. 2002;51(RR-17):1-11.
• de Araujo Lagos LW, de Jesus Lopes de Abreu A, Caetano R, Braga JU. Yellow fever vaccine safety in immunocompromised individuals: A systematic review and meta-analysis. J Travel Med. 2023;30(2):taac095.
• Fischer M, Lindsey N, Staples JE, Hills S; Centers for Disease Control and Prevention (CDC). Japanese encephalitis vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010;59(RR-1):1-27.
• Fraser A, Goldberg E, Acosta CJ, et al. Vaccines for preventing typhoid fever. Cochrane Database Syst Rev. 2007;(3):CD001261.
• Freedman D, Leder K. Immunizations for travel. UpToDate [online serial]. Waltham, MA: UpToDate; reviewed March 2015; March 2016.
• Garcia Garrido HM, Wieten RW, Grobusch MP, Goorhuis A. Response to hepatitis A vaccination in immunocompromised travelers. J Infect Dis. 2015;212(3):378-385.
• Gautret P, Wilder-Smith A. Vaccination against tetanus, diphtheria, pertussis and poliomyelitis in adult travellers. Travel Med Infect Dis. 2010;8(3):155-160.
• Graves P, Gelband H. Vaccines for preventing malaria (blood-state). Cochrane Database Syst Rev. 2006b;(4):CD006199.
• Graves P, Gelband H. Vaccines for preventing malaria (SPf66). Cochrane Database Syst Rev. 2006a;(2):CD005966.
• Graves PM, Deeks JJ, Demicheli V, Jefferson T. Vaccines for preventing cholera: Killed whole cell or other subunit vaccines (injected). Cochrane Database Syst Rev. 2001;(1):CD000974.
• Houle SKD, Eurich DT. Completion of multiple-dose travel vaccine series and the availability of pharmacist immunizers: A retrospective analysis of administrative data in Alberta, Canada. PLoS One. 2019;14(1):e0211006.
• Hyle EP, Rao SR, Bangs AC, et al. Clinical practices for measles-mumps-rubella vaccination among US pediatric international travelers. JAMA Pediatr. 2020;174(2):e194515.
• Jelinek T. Ixiaro: A new vaccine against Japanese encephalitis. Expert Rev Vaccines. 2009;8(11):1501-1511.
• Jost M, Luzi D, Metzler S, et al. Measles associated with international travel in the region of the Americas, Australia and Europe, 2001-2013: A systematic review. Travel Med Infect Dis. 2015;13(1):10-18.
• Lamarche L, Taucher C. Travel vaccines: Update. Can Pharm J (Ott). 2020;153(2):72-73.
• Lenchow DJ, Wilson ME. Chikungunya fever: Treatment and prevention. UpToDate [online serial]. Waltham, MA: UpToDate; reviewd October 2023.
• Lindsey NP, Staples JE, Fischer M. Chikungunya Virus Disease among Travelers-United States, 2014-2016. Am J Trop Med Hyg. 2018;98(1):192-197.
• Marfin AA, Eidex RS, Kozarsky PE, Cetron MS. Yellow fever and Japanese encephalitis vaccines: Indications and complications. Infect Dis Clin North Am. 2005;19(1):151-168, ix.
• Merck Sharp & Dohme Corporation. Ervebo (Ebola Zaire vaccine, live) suspension for intramuscular injection. Prescribing Information. Whitehouse Station, NJ: Merck; 2019.
• Nasser R, Rakedzon S, Dickstein Y, et al. Are all vaccines safe for the pregnant traveller? A systematic review and meta-analysis. J Travel Med. 2020;27(2).
• Nelson NP, Link-Gelles R, Hofmeister MG, et al. Update: recommendations of the Advisory Committee on Immunization Practices for use of hepatitis A vaccine for postexposure prophylaxis and for preexposure prophylaxis for international travel. MMWR Morb Mortal Wkly Rep. 2018;67(43):1216-1220. 
• No authors listed. Cholera vaccine. MMWR Morbid Mortal Wkly Rep. 1988;37(40):617-618, 623-624.
• Pfizer Inc. Ticovac (tick-borne encephalitis vaccine), suspension for intramuscular injection. Prescribing Information. New York, NY: Pfizer; revised August 2021a.
• Pfizer Inc. U.S. FDA accepts for priority review Pfizer’s application for TicoVac (tick-borne encephalitis vaccine). Press Release. New York, NY: Pfizer; February 23, 2021. Available at: https://www.pfizer.com/news/press-release/press-release-detail/us-fda-accepts-priority-review-pfizers-application. Accessed June 7, 2021b.
• Pfizer Inc. U.S. FDA approves Ticovac, Pfizer's tick-borne encephalitis (TBE) vaccine. Press Release. New York, NY: Pfizer; August 13, 2021c.
• Rampa JE, Askling HH, Lang P, et al. Immunogenicity and safety of the tick-borne encephalitis vaccination (2009–2019): A systematic review. Travel Medicine and Infectious Disease. 2020;37:101876.
• Ritz N, Connell TG, Curtis N. To BCG or not to BCG? Preventing travel-associated tuberculosis in children. Vaccine. 2008;26(47):5905-5910.
• Schioler KL, Samuel M, Wai KL Vaccines for preventing Japanese encephalitis. Cochrane Database Syst Rev. 2007;(3):CD004263.
• Staples JE, Gershman M, Fischer M; Centers for Disease Control and Prevention (CDC). Yellow fever vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010;59(RR-7):1-27.
• Taucher C, Barnett ED, Cramer JP, et al. Neutralizing antibody persistence in pediatric travelers from non-JE-endemic countries following vaccination with IXIARO® Japanese encephalitis vaccine: An uncontrolled, open-label phase 3 follow-up study. Travel Med Infect Dis. 2020;34:101616. 
• U.S. Food and Drug Administration (FDA). FDA approves first vaccine to prevent disease caused by chikungunya virus. FDA News Release. Silver Spring, MD: FDA; November 13, 2023.
• Valneva Scotland Ltd. Ixchiq (chikungunya vaccine, live) solution for intramuscular injection. Prescribing Information. Livingston, United Kingdom; revised November 2023.
• Vaughan K, Blythe M, Greenbaum J, et al. Meta-analysis of immune epitope data for all Plasmodia: Overview and applications for malarial immunobiology and vaccine-related issues. Parasite Immunol. 2009;31(2):78-97.
• Wanke CA. Travelers' diarrhea. UpToDate [online serial]. Waltham, MA: UpToDate; reviewed March 2014.
• Wilder-Smith A. Meningococcal disease in international travel: Vaccine strategies. J Travel Med. 2005;12 Suppl 1:S22-S29.
• Wilson ME, Lenschow DJ. Chikungunya fever: Epidemiology, clinical manifestations, and diagnosis. UpToDate [online serial]. Waltham, MA: UpToDate; reviewed January 2022.
• Wong KK, Burdette E, Mahon BE, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Cholera Vaccine. MMWR. 2017;66(18):482-485.

Policy History

Effective: 04/13/2001

Next Review: 05/09/2024

Review History

Definitions

Additional Information

Clinical Policy Bulletin Notes

You are now leaving the Aetna website .

Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.

• Company Information

• Network Participation
• How to Join Our Networks
• Update Your Information
• Change of Ownership
• Claims and Eligibility
• BlueCard Program
• Electronic Commerce
• Eligibility and Benefits
• Prior Authorization Services For Fully Insured and ASO
• Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO)
• Prior Authorizations Lists for Designated Groups
• Recommended Clinical Review Option
• Prior Authorization Exemptions (Texas House Bill 3459)
• Claims Filing Tips
• Claim Status
• Claim Review Process
• Interactive Voice Response (IVR) System
• Medicare Advantage Private Fee For Service
• Eligibility and Benefits Inquiry (HIPAA 270/271)

Education and Reference

• Education and Reference Center
• 2024 Blue Review
• Identification Cards
• 2024 News and Updates
• Provider Tools
• Provider Training
• Blue Review Archive
• Fraud and Abuse
• Clinical Resources
• Behavioral Health Care Management Program
• Clinical Practice Guidelines
• Quality Care – Partner With Your Patients
• eviCore Prior Authorization Program
• Special Beginnings - Maternity Program
• Preventive Care Guidelines/Patient Wellness Guidelines
• Quality Improvement Tip Sheet
• Telemedicine and Telehealth Services
• Health Equity and Social Determinants of Health (SDoH)
• Pharmacy Program
• Dispensing (Quantity vs. Time) Limits
• Medicare Part D Pharmacy Updates
• Prescription Drug List and Prescribing Guidelines
• Specialty Pharmacy Programs
• Prior Authorization and Step Therapy Programs
• Split Fill Program
• Standards and Requirements
• Affordable Care Act (ACA)
• Clinical Payment and Coding Policies
• Consolidated Appropriations Act and Transparency in Coverage Final Rule
• 2024 Disclosure Notices
• Federal Employee Program (FEP)
• General Reimbursement Information
• Medical Policies
• Medical Policy and Pre-certification/Pre-authorization Information for Out-of-Area Members
• Physician Efficiency, Appropriateness, & Quality (PEAQ) Program

Annual Review: CPCP018 OP Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT ® , HCPCS and/or NDC Codes Updated

Blue Cross and Blue Shield of Texas has updated the CPCP0018 Outpatient Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes Clinical Payment and Coding Policy effective April 24, 2024, with minor revisions as part of its annual review, and posted it to the provider website.

Be sure to check eligibility and benefits before rendering service(s) to make sure a procedure is a covered benefit for the member and determine any prior authorization requirements.

Refer to Clinical Payment and Coding Policies under Standards and Requirements on the  provider website  to review the current CPCPs.

Clinical payment and coding policies are based on using healthcare professionals and industry standard guidelines. The clinical payment and coding guidelines are not intended to provide billing or coding advice but to serve as a reference for facilities and providers.

CPT Copyright 2023 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.      

• Book a Flight
• Manage Reservations
• Explore Destinations
• Flight Schedules
• Track Checked Bags
• International Travel
• Flight Offers
• Low Fare Calendar
• Upgrade My Flight
• Add EarlyBird Check-In
• Check Travel Funds
• Buy Carbon Offsets
• Flying with Southwest
• Book a Hotel
• Redeem Points for Hotels
• More Than Hotels
• Hotel Offers
• Best Rate Guarantee
• Rapid Rewards Partners
• Book a Vacation Package
• Manage My Vacation
• Vacation Package Offers
• Vacation Destinations
• Why Book With Us?
• FLIGHT STATUS
• CHANGE FLIGHT

Enter code SAVE25NOW in the Promo Code box when booking. Offer is valid only for continental U.S. flights. The 25 percent promotion code savings are valid for one-way or round trip Wanna Get Away® and Wanna Get Away Plus® fares booked with Rapid Rewards points during the Booking Period, flown during the Travel Period, and are applied before taxes and fees. Seats and days are limited. Savings are reflected in the price when entering the multiuse code SAVE25NOW in the Promo Code box on Southwest.com and swabiz.com. This discount is only available through Southwest.com and swabiz.com. Discount is valid on new reservations only. Discount will apply only for flights booked during the Booking Period and flown on the dates within the Travel Period. If one segment of the trip is outside the Travel Period and one is within the Travel Period, only the portion of travel falling within the Travel Period will be discounted. Changes made to the itinerary after purchase will eliminate qualification for this promotion. The discount is only valid with the provided promotion code and is not combinable with other promotion codes or fares. All reward travel is subject to taxes, fees, and other government or airport-imposed charges of at least $5.60 per one-way trip. Applicable taxes, fees, and other government or airport-imposed charges can vary significantly based on your arrival and departure destination. The payment of any taxes, fees, and other government or airport-imposed charges is the responsibility of the Passenger and must be paid at the time reward travel is booked with a credit card, flight credit, or Southwest gift card. When traveling on reward travel, you will receive all fare product features except for earning Rapid Rewards points. Any change in itinerary may result in an increase in points used. Points bookings are subject to change until ticketed. If you cancel your reservation at least ten (10) minutes prior to the scheduled departure of your flight, any remaining unused points will be returned to your Rapid Rewards account. All Rapid Rewards rules and regulations apply and can be found at Southwest.com/rrterms . Offer is not redeemable for cash, and may not be used in conjunction with other special offers, or toward the purchase of a gift card or previously booked flight, or changed to a previously booked flight. Discount is not valid on group travel, Southwest Vacations®, and government fares.

Help Center

• Terms & Conditions
• Privacy Policy
• Do Not Sell/Share My Info

© 2024 Southwest Airlines Co. All Rights Reserved.

At its Cloud Next conference, Google on Tuesday unveiled Gemini Code Assist , its enterprise-focused AI code completion and assistance tool.

If this sounds familiar, that’s likely because Google previously offered a similar service under the now-defunct Duet AI branding. That one became generally available in late 2023, but even then, Google already hinted that it would move the service away from its Codey model to Gemini in the near future. Code Assist is both a rebrand of the older service as well as a major update.

Code Assist, which Google Cloud demoed at its 30,000-attendee conference in Las Vegas, will be available through plug-ins for popular editors like VS Code and JetBrains.

Even more so than the Duet AI version, Code Assist is also a direct competitor to GitHub’s Copilot Enterprise  and not so much the basic version of Copilot. That’s because of a few Google-specific twists.

Among those is support for Gemini 1.5 Pro , which famously has a million-token context window, allowing Google’s tool to pull in a lot more context than its competitors. Google says this means more-accurate code suggestions, for example, but also the ability to reason over and change large chunks of code.

“This upgrade brings a massive 1 million-token context window, which is the largest in the industry. This allows customers to perform large-scale changes across your entire code base, enabling AI-assisted code transformations that were not possible before,” Brad Calder, Google’s VP and GM for its cloud platform and technical infrastructure, explained in a press conference ahead of Tuesday’s announcement.

Image Credits: Google

Like GitHub Enterprise, Code Assist can also be fine-tuned based on a company’s internal code base.

“Code customization using RAG with Gemini Code Assist significantly increased the quality of Gemini’s assistance for our developers in terms of code completion and generation,” said Kai Du, Director of Engineering and Head of Generative AI at Turing. “With code customization in place, we are expecting a big increase in the overall code-acceptance rate.”

This functionality is currently in preview.

Image Credits: Frederic Lardinois/TechCrunch

Another feature that makes Code Assist stand out is its ability to support codebases that sit on-premises, in GitLab, GitHub and Atlassian’s BitBucket, for example, as well as those that may be split between different services. That’s something Google’s most popular competitors in this space don’t currently offer.

Google is also partnering with a number of developer-centric companies to bring their knowledge bases to Gemini. Stack Overflow already announced its partnership with Google Cloud earlier this year. Datadog, Datastax, Elastic, HashiCorp, Neo4j, Pinecone, Redis, Singlestore and Snyk are now also partnering with Google through similar partnerships.

The real test, of course, is how developers will react to Code Assist and how useful its suggestions are to them. Google is making the right moves here by supporting a variety of code repositories and offering a massive context window, but if the latency is too high or the results simply aren’t that good, none of those features matter. And if it’s not significantly better than Copilot, which had quite a headstart, it may end up suffering the fate of AWS’ CodeWhisperer , which seems to have close to zero momentum .

It’s worth noting that in addition to Code Assist, Google today also announced the launch of CodeGemma, a new open model in its Gemma family that was fine-tuned for code generation and assistance. CodeGemma is now available through Vertex AI.

Cloud Assist

In addition to Code Assist, Google also today announced Gemini Cloud Assist to help “ cloud teams design, operate, and optimize their application lifecycle.” The tool can generate architecture configuration that are tailored to a company’s needs, for example, based on a description of the desired design outcome. It can also help diagnose issues and find their root causes, as well as optimize a company’s cloud usage to reduce cost or improve performance.

Cloud Assist will be available through a chat interface and embedded directly into a number of Google Cloud products.

Google brings Stack Overflow’s knowledge base to Gemini for Google Cloud

GitHub’s Copilot Enterprise is now generally available at $39 a month

Amazon launches CodeWhisperer, a GitHub Copilot-like AI pair programming tool

For IEEE Members

Ieee spectrum, follow ieee spectrum, support ieee spectrum, enjoy more free content and benefits by creating an account, saving articles to read later requires an ieee spectrum account, the institute content is only available for members, downloading full pdf issues is exclusive for ieee members, downloading this e-book is exclusive for ieee members, access to spectrum 's digital edition is exclusive for ieee members, following topics is a feature exclusive for ieee members, adding your response to an article requires an ieee spectrum account, create an account to access more content and features on ieee spectrum , including the ability to save articles to read later, download spectrum collections, and participate in conversations with readers and editors. for more exclusive content and features, consider joining ieee ., join the world’s largest professional organization devoted to engineering and applied sciences and get access to all of spectrum’s articles, archives, pdf downloads, and other benefits. learn more →, join the world’s largest professional organization devoted to engineering and applied sciences and get access to this e-book plus all of ieee spectrum’s articles, archives, pdf downloads, and other benefits. learn more →, access thousands of articles — completely free, create an account and get exclusive content and features: save articles, download collections, and talk to tech insiders — all free for full access and benefits, join ieee as a paying member., ai coding is going from copilot to autopilot, but so far devin ai and others still really need humans.

A new breed of AI-powered coding tools have emerged—and they’re claiming to be more autonomous versions of earlier assistants like GitHub Copilot , Amazon CodeWhisperer , and Tabnine .

One such new entrant, Devin AI , has been dubbed an “AI software engineer” by its maker, applied AI lab Cognition . According to Cognition, Devin can perform all these tasks unassisted : build a website from scratch and deploy it, find and fix bugs in codebases, and even train and fine-tune its own large language model .

Following its launch, open-source alternatives to Devin have cropped up, including Devika and OpenDevin . Meanwhile makers of established assistants have not been standing still. Researchers at Microsoft , GitHub Copilot’s developer, recently uploaded a paper to the arXiv preprint server introducing AutoDev, which uses autonomous AI agents to generate code and test cases, run tests and check the results, and fix bugs within the test cases.

“It’s exciting to see more versions of AI coding assistants with new capabilities,” says Ben Dechrai , a coder and developer advocate at software company Sonar . “They validate the need for generative AI tools in developers’ workflows.”

Dechrai adds that these coding copilots can help software engineers write code faster, allowing them to focus on more strategic and creative tasks. Another advantage of these programming tools is the ability to create a template for code, notes Saurabh Bagchi , a professor of electrical and computer engineering at Purdue University . Much as with prompt engineering , developers must provide these assistants with “the right kind of software requirements to produce a template, and then a software engineer can fill in the gaps,” he says.

“To develop intuitive systems, you need an iterative process with humans in the loop to provide feedback” —Saurabh Bagchi, Purdue University

These gaps include safety and reliability considerations. Software engineers must look out for security vulnerabilities in AI-generated code, as well as the types of corner cases that could cause it to crash.

“Developers still need to ensure rigorous quality standards are in place when analyzing and reviewing code written with generative AI, just as they would with code developed by a human,” says Dechrai. “AI coding assistants are good at suggesting code, reflecting on the code, and reasoning about its effectiveness, but even then it’s not 100 percent accurate.”

Dechrai cautions that autonomous coders are “still so new that developers are just learning which use cases will be most beneficial.” And they’ll need to be “ironed out in the real world to see how much they’re able to deliver on their promise,” says Bagchi.

AI Coders vs. the Humans

Doom-and-gloom predictions of replacing human software engineers are also bound to follow the emergence of these “AI software engineers,” but that won’t be happening anytime soon. Devin, for instance, resolved only 14 percent of a subset of GitHub issues from real-world code repositories. “There’s still a long way to go for it to become something I can rely on blindfolded,” says Bagchi.

He notes that these autonomous programming tools have another blind spot: the fact that software development happens in collaboration. Coding copilots try to do everything, and they might do it reasonably well. On the other hand, different software engineers have their own specialties—be it front end, back end, full stack, or data, to name a few—and they all work together to build a cohesive product.

“To develop intuitive systems, you need an iterative process with humans in the loop to provide feedback,” Bagchi says. “The fundamental human intuition, depth, and imagination has to be brought to bear.”

That’s why Bagchi believes these unassisted versions won’t be dominating the space that coding assistants hold—at least for now. “The models running underneath are similar in architecture, and as technology continues to evolve, both of them will get better,” he says. “But the Copilot or CodeWhisperer model seems most promising and is better suited to complex software development where humans work with the assistance of AI.”

Yet programmers “should start using these tools if they haven’t already, or they’ll risk getting left behind,” says Dechrai. “If you want to know if an AI coding assistant is truly beneficial, you have to use it yourself, get to know it, and see where it fails.”

Bagchi echoes the sentiment: “Try them out with the use cases you have and stress them with the kinds of software you’re creating.” But because unassisted coding copilots are a nascent technology, they are likely to improve rapidly. “So you have to track them,” he adds.

Moreover, software engineers will have to “consistently ensure code is secure, reliable, and maintainable throughout its life cycle,” Dechrai says. “It will always be up to the developer to properly understand the output and how it was generated.”

• How Coders Can Survive—and Thrive—in a ChatGPT World ›
• Ownership of AI-Generated Code Hotly Disputed ›

Rina Diane Caballar is a writer covering tech and its intersections with science, society, and the environment. An IEEE Spectrum Contributing Editor, she's a former software engineer based in Wellington, New Zealand.

Incorporating A.I. assistants in our workflow should be encouraged from our employers but the general feeling still is that of loosing control over corporate data and IP

Auto pilot Coding for generation of software codes

for AI Systems like Website Design/ Development with

Clients- Servers Model or LLM/CHAT_GPT type program. Auto pilot Coding techniques is like ordering culinary Dishes in Restaurants by picking up the the menu chart and ordering the Server boy and paying the bills to have good Supper. In business

to have a successful AI Auto pilot systems we need Safe secured Closed AI developed by professional experienced

Software Developers from reputed software companies.

We can not depend on open AI

Co pilot systems for Industry

& Commercial establishments. Co pilots AI

Coding for learners

Is this an advertisement for Devin AI?

Video Friday: SpaceHopper

Led touchscreen is also a pv charger, 50 years later, this apollo-era antenna still talks to voyager 2, related stories, ai chip trims energy budget back by 99+ percent, intel’s gaudi 3 goes after nvidia, software sucks, but it doesn’t have to.

An official website of the United States government

Here's how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

CMS Newsroom

Search cms.gov.

• Physician Fee Schedule
• Local Coverage Determination
• Medically Unlikely Edits

List of CPT/HCPCS Codes

We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. We update the Code List to conform to the most recent publications of CPT and HCPCS codes and to account for changes in Medicare coverage and payment policies. Code List updates for years 2022 and earlier were published in the Federal Register as an addendum to the annual Physician Fee Schedule final rule. 

Beginning with the Code List effective January 1, 2023, updates are published solely on this webpage.  On or before December 2 nd of each year, we will publish the annual update to the Code List and provide a 30-day public comment period using www.regulations.gov . To be considered, comments must be received within the stated 30-day timeframe. We anticipate that most comments will be addressed by April 1 st ; however, a longer timeframe may be necessary to address complex comments or those that require coordination with external parties. If no comments are received, in lieu of a comment response, we will publish a note below the applicable Code List year stating so. 

2024 Annual Update to the Code List

Below you will find the Calendar Year (CY) 2024 Code List published November 29, 2023 and a description of the revisions for CY 2024, our response to comments on that Code List, and the updated CY 2024 Code List, which is effective January 1, 2024 unless otherwise indicated on the Code List.

• UPDATED list of codes effective January 1, 2024, published March 1, 2024 (all codes effective January 1, 2024 unless otherwise indicated on the Code List) (ZIP)
• List of codes effective January 1, 2024, published November 29, 2023 (ZIP)
• Annual Update to the List of CPT/HCPCS Codes Effective January 1, 2024 (PDF)

We received one comment related to the additions, deletions, and corrections to the codes on the Code List effective January 1, 2024. Our response to this comment is below. We also received one comment related to Medicare coverage for platelet-rich plasma treatments. We consider this comment to be outside the scope of the annual update. CMS does not respond to out of scope comments on the annual updates to the Code List. 

Comment : One commenter noted that, although most Hepatitis B vaccine codes are identified on the Code List as CPT/HCPCS codes to which the exception for preventive screening tests and vaccines at § 411.355(h) applies, the Hepatitis B vaccine associated with CPT code 90739 was not listed. The commenter requested that CPT code 90739 be added to the list of vaccine codes to which the exception for preventive screening tests and vaccines at §411.355(h) applies, effective retroactively to January 1, 2024.

Response : We agree with the commenter that the exception for preventive screening tests and vaccines at § 411.355(h) should apply to CPT code 90739 and are revising the Code List accordingly. The applicability of the exception for preventive screening tests and vaccines to CPT code 90739 is prospective only and effective on the date indicated on the UPDATED list of codes. 

In considering this comment, we also identified two CPT codes (90653 and 90658, both flu vaccines) that were inadvertently left off of the list of codes to which the exception for preventive screening tests and vaccines at § 411.355(h) should apply. Accordingly, we are adding these CPT codes to the list of codes to which the exception at § 411.355(h) applies, effective on the date indicated on the UPDATED list of codes.

2023 Annual Update to the Code List

Below you will find the Code List that is effective January 1, 2023 and a description of the revisions effective for Calendar Year 2023. 

• List of codes effective January 1, 2023, published December 1, 2022
• Annual Update to the List of CPT/HCPCS Codes Effective January 1, 2023, published December 1, 2022 (PDF)

The comment period ended December 30, 2022. We did not receive any comments related to the additions, deletions, and corrections to the codes on the Code List effective January 1, 2023. We received one (1) comment related to the supervision level required for specific services. We consider this comment to be outside the scope of the annual update. CMS does not respond to out of scope comments on the annual updates to the Code List. 

DHS Categories

The DHS categories defined by the Code List are:

• clinical laboratory services;
• physical therapy services, occupational therapy services, outpatient speech-language pathology services;
• radiology and certain other imaging services; and
• radiation therapy services and supplies.

The Code List also identifies those items and services that may qualify for either of the following two exceptions to the physician self-referral prohibitions: 

• EPO and other dialysis-related drugs (42 CFR § 411.355(g)).
• Preventive screening tests and vaccines (42 CFR § 411.355(h)).

NOTE: The following DHS categories are defined at 42 CFR §411.351 without reference to the Code List:

• durable medical equipment and supplies;
• parenteral and enteral nutrients, equipment and supplies;
• prosthetics, orthotics, and prosthetic devices and supplies;
• home health services;
• outpatient prescription drugs; and
• inpatient and outpatient hospital services.

Related Links

• List of codes effective January 1, 2022, published November 19, 2021
• List of codes effective January 1, 2021, issued December 1, 2020
• List of codes effective January 1, 2020, published December 2, 2019
• List of codes effective January 1, 2019, published November 23, 2018
• List of codes effective January 1, 2018, published November 3, 2017 [ZIP, 59KB]
• List of codes effective January 1, 2017, published November 16, 2016 [ZIP, 54KB]
• List of codes effective January 1, 2016, published October 30, 2015 [ZIP, 58KB]
• List of codes effective January 1, 2015, published November 13, 2014 (79 FR 67972) [ZIP, 54KB]
• List of codes effective January 1, 2014, published December 10, 2013 (78 FR 74791) [ZIP, 54KB]
• List of codes effective January 1, 2013, published November 16, 2012 (77 FR 69334) [ZIP, 54KB]