Immunization

 

Immunization is one of the most effective preventive healthcare measures. Vaccines help protect individuals and communities against infectious diseases and support long-term health.

 

 

Coverage overview

 

Coverage of vaccines depends on your policy benefits, applicable regulatory requirements, and medical necessity for certain vaccines.

 

 

Regulatory Alignment

 

This section is aligned with DHA, DOH, and UAE National Immunization Program. Providers are responsible for following the latest updates published by regulatory authorities.

 

 

 

For Members

 

Immunization

• Immunization is one of the most cost-effective health preventive measure.
• Vaccines are given to build immunity and defense against infections and infectious diseases.
• Vaccines are safe and effective.
• Immunization also slows down or stops disease outbreaks and improves quality of life for societies.
• Some vaccines are effective for lifetime after one (1) dose (e.g. BCG), some require repetitive administrations at prescribed intervals (e.g. Polio) whereas some vaccines require boosters regularly (e.g. Hepatitis-B).
• Administration of vaccine require prior approval from Nextcare.
• All children should receive Vaccination.

 

Dubai (DHA) policies
Routine childhood vaccinations are generally covered under DHA-compliant policies in line with the approved immunization program. Coverage should be considered in line with the applicable schedule and policy terms.

 

National updates
Recent national updates include the addition of seasonal influenza recommendations for eligible groups, RSV-related immunization updates for defined populations, and continued school-based vaccination elements such as HPV in relevant programs.

 

Abu Dhabi (DOH) policies
Vaccines are generally excluded unless specifically covered under the member’s policy benefits.

Northern Emirates / other policies
Coverage depends on the Table of Benefits. Members should check their policy details with Nextcare before receiving vaccination services.

 

Important notes
Vaccines may require prior approval depending on policy terms.

Emergency vaccines such as tetanus or rabies may be considered when medically necessary. Coverage remains subject to policy terms and conditions.

Adult Vaccination: Recommended vaccines include Flu, Pneumococcal, Hepatitis, HPV, Tetanus boosters. Coverage depends on policy and medical indication.

 

 

 

For Healthcare Providers

 

General adjudication guidance

Diagnosis code: Z23 (Encounter for immunization). FOC: Preventive Care & Checkups. Prior approval may be required depending on policy and benefit configuration.

 

 

Billing principles

Vaccine products and vaccine administration should be billed separately. Vaccine cost is not part of the pharmacy limit.

 

 

Administration coding

Use 90460–90461 when documented counselling is provided by a physician or other qualified healthcare professional for eligible patients. In the absence of counselling, use 90471–90474 as applicable.

 

 

Compliance reminder

Providers should follow applicable DHA guidance, national immunization schedules, and any policy-specific requirements before submission.

 

 

Operational note

Where appropriate, correct submission category/FOC should be used to support correct claims calculation rather than rejecting purely due to miscoding.

 

 

Billing and Coding Guidelines for Providers

 

Code	Description
90460	Administration with counselling by physician / qualified healthcare professional for eligible patients up to 18 years.
90461	Each additional vaccine / toxoid component reported with 90460.
90471	Administration without counselling.
90472	Each additional vaccine / toxoid component reported with 90471.

 

 

Self-Administered Vaccines

 

Should be billed as medication only. No administration or counseling codes unless given by provider.

 

 

Consultation

 

Consultation should not be billed unless medically justified and documented.

 

 

Billing Rules (Quick References)

Scenario	Billing Guidance
Vaccine administered in clinic	Bill vaccine + administration code
Self-administered vaccine (e.g. pharmacy)	Bill vaccine only
Vaccine with physician counseling(≤18 years)	Bill 90460–90461 (with documentation)
Vaccine without counseling or age >18	Bill 90471–90472
Consultation with vaccination	May be billed if medically justified and documented as a separate clinical service
Administrative / non-medical request	Not billable

 

 

Additional Billing Notes

 

*  Counseling codes (90460–90461) require face-to-face interaction and proper documentation

* Codes 90471–90474 are billed per vaccine product (injection), not per antigen component

* In the absence of counseling OR for patients above 18 years, administration should be billed using 90471–90474

* For vaccines with counseling (≤18 years), use 90460–90461 per component as applicable

* Combination vaccines should follow standard coding practice (first component + additional components where applicable)

* All administration codes apply regardless of route of administration (e.g. IM, SC, oral, intranasal

 

 

Regulatory References

 

DHA: https://www.dha.gov.ae
DOH: https://www.doh.gov.ae
MOHAP: https://www.mohap.gov.ae