Don’t wait. Measles vaccine is covered as preventive

According to the Centers for Disease Control and Prevention (CDC), measles is one of the most highly contagious diseases, frequently causes severe illness and can potentially be fatal. Recently, measles cases in the United States surged past 700, hitting a 25-year record and topping the highest number of cases reported since 2000, when measles was thought to be eliminated in the country.

A high-profile measles outbreak in New York City has captured national headlines, and outbreaks have been reported in California, Georgia, Maryland, Michigan, New Jersey and Washington, as well as in 18 other states.

Many customers have asked about the measles vaccination policy at UnitedHealthcare. The measles vaccine is covered at no cost-share for members on plans that follow UnitedHealthcare’s standard preventive benefits. Members should review their plan documents or call the number on their health plan ID card to understand what their benefits include. 

Coverage and billing

The CDC recommends the measles, mumps and rubella (MMR) or measles, mumps, rubella and varicella (MMRV) vaccine. Children are recommended to have 2 doses of the MMRV vaccine, and teens and adults should be up to date with the MMR vaccine.

Vaccinations are available at network doctors’ offices, health care clinics, pharmacies and convenience clinics. The measles vaccine is covered as preventive on plans that follow UnitedHealthcare’s standard preventive benefits and when administered by a network provider in accordance with the Preventive Care Services Coverage Determination Guideline (CDG).

UnitedHealthcare’s Preventive CDG (page 34) references coverage for measles at 0 cost-share when billed by a network provider as follows: 

Preventive Immunization

These codes do not have a diagnosis code requirement for preventive benefits to apply.

Category

Code(s)

Description

Trade Name(s)

See note above

Age Group

(pediatric, adult, both)

Benefit Limits Age/Other

See note above

Measles, Mumps, Rubella (MMR)

90707

Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use

MMR II®

Both

 

90710

Measles, mumps, rubella and varicella  vaccine (MMRV), live, for subcutaneous use

ProQuad®

Both

 

 

The MMRV vaccine, which protects against measles, mumps, rubella and varicella, is licensed for use on children who are 12 months through 12 years of age. The MMR vaccine is for adults and children.

In its MMR vaccine recommendations, the CDC includes guidance regarding testing adults for MMR immunity prior to having the vaccine.  Please note that UnitedHealthcare does not require blood work for adults prior to receiving the MMR vaccine.

Vaccination guidance

Vaccinations provide protection against a number of illnesses, including measles. Individuals should talk with their health care provider about any health concerns, which vaccinations are up-to-date vaccinations or may need a booster, and which vaccinations are right for them based on age, health history or other risk factors. NurseLine and Health Care Advisors (1-800-357-1371) can answer questions and concerns about the measles outbreak and vaccinations, as well as offer guidance to members.