CommercialCoverageMedium impact
Dengue Vaccine (CPB 1010, reviewed 2026-02-25)
Aetna·Pediatrics, Allergy & Immunology, Infectious Disease +2 more·Medical Policy
Effective date
Feb 25, 2026
We identified it
Aug 13, 2026
Summary
Aetna's updated Dengue Vaccine policy (CPB 1010, effective 2026-02-25) establishes coverage for Dengvaxia only in patients aged 9-16 years with laboratory-confirmed previous dengue infection living in endemic areas. The vaccine is considered not medically necessary for previously uninfected individuals and experimental for travelers to endemic areas. Billing teams must implement strict pre-authorization requirements verifying prior dengue infection status before claims processing.
Action Required
By 2026-02-25: Billing team must implement prior authorization controls for CPT codes 90584 and 90587 (Dengvaxia vaccine administration). Create mandatory pre-claim verification requiring: (1) Patient age documented as 9-16 years, (2) Laboratory-confirmed previous dengue infection verified (via dengue RT-PCR, dengue NS1 antigen, or positive results on both anti-dengue IgG tests per CDC algorithm), (3) Patient residence or documented living status in dengue-endemic areas (Puerto Rico, US Virgin Islands, American Samoa, Guam, or freely associated states). Reject claims lacking this documentation with denial reason 'Medical necessity criteria not met.' Update encounter forms and billing system to require providers to attach proof of prior dengue infection before vaccine administration codes 90584/90587 are processed. Do not cover vaccine administration for uninfected or unknown-status patients or for non-endemic area travelers. Flag all claims for patients outside 9-16 age range for automatic denial. Train front-desk staff to screen patient eligibility during scheduling.