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) Policy:
- Vaccine and vaccine administration services for infants & children up to age of 6 Years are generally covered under DHA compliant policies.
- Below schedule is followed based on the recommendation of the Dubai Health Authority (DHA):
- Other vaccines which are not mentioned in the below schedule are not covered.
| DHA immunization schedule for children between 0-6 years |
| Age |
Vaccines |
| At Birth |
BCG, Hep B. |
| Two months |
DPT, Hib, Hep B, OPV, PCV. |
| Four months |
DPT, Hib, Hep B, OPV, PCV. |
| Six months |
DPT, Hib, Hep B, OPV, PCV. |
| 12 months |
MMR, varicella |
| 18 months |
DTaP, Hib, OPV, PCV. |
| Five to six years |
DPT, OPV, MMR, varicella. |
Reference for DHA:
https://www.dha.gov.ae/Documents/HRD/Immunization%20Guidelines.pdf
Abu Dhabi (DOH) Policy:
Vaccine and vaccine administration services are mostly Excluded under DOH compliant policies.
Northern Emirates (Non-DHA & Non-DOH Policies):
Vaccine and vaccine administration services are covered according to the table of benefits respective to every policy, please always call Nextcare to check if vaccines are covered.
For Healthcare Providers
- To correctly report vaccine counselling and administration with these codes, it is important to recognize what the codes are include.
- These codes are limited to immunization administration only.
- Any purchased vaccine products must be separately
- Cost of Vaccine/s is not a part of the Pharmacy limit.
| CPT |
Description |
| 90460 |
This Code is used when a Physician is present and performs face-to-face counselling to the patient and/or parent. This code can only be used for patients up-to the age of 18. |
| 90461 |
Following each additional vaccine/toxoid component administered , this code is additionally reported along with code 90460 |
| 90471 |
This Code is used when the vaccine/toxoid component is administered by a medical assistant or nurse and the patient does not see the physician at all. |
| 90472 |
Following each additional vaccine/toxoid component administered, this code is additionally reported along with code 90471 |
- A face-to-face service where a Physician or other qualified healthcare professional (qualified per Emirate`s Licensing Authority) provides counselling to the patient (patients under 18 years of age and below) and/or to parent, it is required to report 90460-90461.
- In the absence of counselling, the administrations must be reported with codes 90471-90474.
- Code 90460 is reported for each separate administration of single component vaccines and/or first component of a combination vaccine.
- When reporting administration of combination vaccines, code 90460 is reported for the first component and add-on code 90461 is reported for each additional component (modifier-51 is not required).
- All above mentioned codes include “via any route of administration”, that is; regardless of the route of administration (e.g. Subcutaneous, Intramuscular, Injection, Oral, or Intranasal).
