Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111

MassHealth
Physician Bulletin 69
September 1999

TO:      Physicians Participating in MassHealth

FROM:      Mark E. Reynolds, Acting Commissioner

RE:      LYME DISEASE VACCINE

Background                       The Food and Drug Administration (FDA) recently approved the use of LYMErix, the Lyme disease vaccine manufactured by Smith Kline Beecham.  The Advisory Committee on Immunization Practices (ACIP) has issued recommendations identifying the groups of persons for whom vaccination against Lyme disease should be considered.  In addition, the Massachusetts Department of Public Health (DPH) has issued recommendations identifying the areas of the state that should be considered as areas of high risk for Lyme disease.

Guidelines for                    The Lyme disease vaccine is FDA approved for use in persons 15 to 70
Vaccine Administration      years of age. The ACIP recommends that decisions about the use of LYMErix should be based on individual clinical assessment of the risk for exposure to infected ticks.  Vaccination against Lyme disease should be considered for persons who reside, work, or recreate in areas of high or moderate risk.  DPH has designated the entire state of Massachusetts as being at moderate to high risk for exposure to infected ticks.  Providers should consult the ACIP recommendations directly for additional important information about other clinical criteria to consider when determining whether or not to administer the vaccine.

Reimbursement                 The Division will cover the LYMErix vaccine when administered according to the guidelines for vaccine administration identified above, for dates of service on or after June 4, 1999, except in instances in which the vaccine is available free of charge through DPH.

Until the Division has a service code specific to the LYMErix vaccine, providers must use Service Code 90749 (unlisted immunization) to bill for the vaccination.  Reimbursement will be on an individual consideration basis (see 130 CMR 433.406).

MassHealth
Physician Bulletin 69
September 1999
Page 2

Questions                         If you have questions about the LYMErix vaccine and recommendations for administration of the vaccine, call DPH’s Massachusetts Epidemiology Program at (617) 983-6800.  For questions about billing for the vaccine, call the Unisys Provider Services Department at (617) 628-4141 or
1-800-325-5231.