Keywords: Oldsmobile Anthem
Description: The most recent recommendations of the American Academy of Family Physicians (AAFP), or the American Academy of Pediatrics (AAP), or the affirmative recommendations of the Advisory Committee on
The most recent recommendations of the American Academy of Family Physicians (AAFP), or the American Academy of Pediatrics (AAP), or the affirmative recommendations of the Advisory Committee on Immunization Practices (ACIP) for the Centers for Disease Control and Prevention (CDC) for childhood immunizations are considered medically necessary.
The most recent recommendations of the American Academy of Family Physicians (AAFP) or affirmative recommendations of the Advisory Committee on Immunization Practices (ACIP) for the Centers for Disease Control and Prevention (CDC) for adult immunizations are considered medically necessary.
Generally, immunizations are among the safest and most effective medicines. The overwhelming majority of medical experts in the United States and abroad believe that the benefits of complete immunization far outweigh the risks. The health experts in many countries are in full accord with the concept that everyone who is healthy should be immunized as recommended.
ACIP (Advisory Committee on Immunization Practices), a United States federal advisory committee, provides guidance to the Secretary and the Assistant Secretary for Health and Human Services, and the Director, Centers for Disease Control and Prevention (CDC), regarding vaccines and related agents for control of vaccine-preventable diseases within the United States. As a result of the Omnibus Budget Reconciliation Act of 1993, ACIP assumed the role of developing a list of vaccines for administration to children eligible to receive vaccines through the Vaccines for Children (VFC) Program, along with schedules regarding correct dosages, dosing intervals and contraindications applicable to pediatric vaccines. VFC resolutions passed by ACIP form the basis for VFC program policies on vaccine availability and usage.
Recommendations developed by ACIP may be either affirmative or permissive recommendations. Affirmative recommendations are characterized as routine, catch-up and risk based. Routine vaccinations are most commonly implemented for a specific age group; catch-up vaccinations are usually for defined periods of time and cohorts; and risk-based recommendations are typically those for a high risk population. A permissive recommendation is issued to reflect situations where vaccination may be effective, but ACIP is not recommending routine use.
Immunization is the process of inducing or providing immunity artificially by administering an immunobiologic. Immunization can be active or passive. Active immunization is the production of antibody or other immune responses through the administration of a vaccine or toxoid. Passive immunization means the provision of temporary immunity by the administration of preformed antibodies. Recommendations for vaccinating infants, children, and adults are based on characteristics of immunobiologics, scientific knowledge about the principles of active and passive immunization and the epidemiology of diseases, and judgments by public health officials and specialists in clinical and preventive medicine.
Immunization programs help build defenses against disease. Immunizations should be started early and carried out on a regular and routine basis. Immunizations are important, for example, with the childhood diseases (measles, mumps, rubella, diphtheria, tetanus, pertussis, haemophilus influenzae type b, and polio) that are preventable by immunization.
Childhood immunizations consist of a series of intramuscular, subcutaneous injections or oral dosing of inactivated bacteria, toxoids, live attenuated viruses, or inactive viral antigens against several diseases: diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, haemophilus influenzae type b, human papilloma virus, hepatitis A, hepatitis B, influenza, varicella, pneumococcus and rotavirus. Many of the immunizations are given as combined vaccines during routine well-child checks in the first two years of life. Immunizations against diseases for which risk factors are related to adolescent issues are recommended at ages prior to when exposure most frequently occurs. These include meningitis, hepatitis B and human papillomavirus.
Most of the adult immunizations are administered in primary series (in previously unimmunized persons), booster doses, and periodic doses. Agents include toxoids (diphtheria and tetanus), live virus vaccines (measles, mumps, and rubella), influenza, inactive viral particles (hepatitis B), highly purified virus-like particles (HPV) and inactivated bacterial polysaccharide vaccine (pneumococcal).
Recommended Immunization Schedules are grouped by types of vaccine and the recipient's age. Certain vaccinations are present on both childhood and adult schedules, while others may be limited to a specific schedule. Examples of age specific ACIP recommendations include:
- Both 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) are recommended for all adults aged 65 years of age and older.
- Both PCV13 and PPSV23 are recommended for adults aged 19 years of age and older with immunocompromising conditions.
- Human papillomavirus (HPV) vaccination is recommended for those aged 9 through 26.
- Live attenuated influenza vaccine (FluMist В® ) is recommended for healthy non pregnant persons aged 2 years through 49 years.
- Zoster vaccine is recommended as a single dose for adults aged 60 years and older.
Antibody: A type of protein produced by the immune system in response to foreign substances that may be a threat to the body -- such as chemicals, virus particles, spores, or bacterial toxins. These foreign substances are called antigens. Each type of antibody is unique and defends the body against one specific type of antigen.
Antigen: Any substance that, when introduced into the body, evokes an immune response and stimulates the production of antibodies.
Coding edits for medical necessity review are not implemented for this administrative policy. Where a more specific policy or guideline exists, that document will take precedence and may include specific coding edits and/or instructions. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.
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