Payer PolicyActive
ADMIN.00007 Immunizations
ANTHEM-ADMIN.00007
Anthem
Effective: July 1, 2025
Updated: December 30, 2025
Policy Summary
This policy addresses coverage for immunizations (vaccines) for children and adults. Vaccines are medically necessary when aligned with the most recent affirmative recommendations—childhood vaccines per AAFP, AAP, or ACIP/CDC, and adult vaccines per AAFP or ACIP/CDC. All other indications are not medically necessary; ACIP permissive recommendations are reviewed individually and may be deemed not medically necessary.
Coverage Criteria Preview
Key requirements from the full policy
"For Childhood Immunizations:The most recent recommendations of the American Academy of Family Physicians (AAFP), or the American Academy of Pediatrics (AAP), or the affirmative recommendations of t..."
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