Provider Manual

Vaccine and vaccine administration billing

Also see:

Vaccine administration services

Only one initial administration code can be reported per day, regardless of vaccine administration method.
CPT codes 90460 (18 years and younger), 90471 and 90473 are initial administration codes and cannot be billed together on the same date of service.
When one of these initial administration codes is billed, report all additional vaccine/toxoid components administered with the appropriate add-on code (i.e. 90461, 90472 or 90474). Reference your CPT book for coding guidelines if you have additional questions.
When billing for multiple vaccine administrations, you can either report administration add-on codes per line or report as multiple units on one line.

Vaccine codes and medical coverage by plan

Self-funded plan coverage may vary by employer group.
Coinsurance may apply.
Routine vaccines listed as NO (not covered) under Medicare may be covered under Medicare Part D pharmacy benefit. Learn which ones.
All covered vaccines are considered preventive. Deductible, if applicable, will be waived for in-network providers. For self-funded plans, a dollar limit may apply to preventive services. Check individual plan benefits.
VFC = Covered, BUT you must use the VFC program for members under 19 years of age
VFC only = Not covered for adult Medicaid/Healthy Michigan Plan members
BN = Brand-name drugs available (not an all-inclusive listing)
# = Coverage of these vaccines will be evaluated once FDA approval granted

Code	Description	HMO/EPO, POS, PPO	Medicaid /Healthy Michigan Plan	Medicare Advantage plans
90476	Adenovirus vaccine, type 4, live, for oral use BN: No product available	N/A	N/A	N/A
90477	Adenovirus vaccine, type 7, live, for oral use BN: No product available	N/A	N/A	N/A
90581	Anthrax vaccine, for subcutaneous use BN: BIOTHRAX	NO	NO	NO
90585	Bacillus Calmette-Guerin vaccine (BCG) for tuberculosis, live, for percutaneous use BN: BCG vaccine	YES	NO	NO
90586	Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, for intravesical use BN: TICE BCG, THERACYS	YES	NO	NO
90620	Meningococcal recombinant protein and outer membrane vesicle vaccine, Serogroup B, 2 dose schedule, for intramuscular use Ages: 10-25 years BN: BEXSERO	YES	YES VFC	NO
90621	Meningococcal recombinant lipoprotein vaccine, Serogroup B, 2 or 3 dose schedule, for intramuscular use Ages: 10-25 years BN: TRUMENBA	YES	YES VFC	NO
90625 #	Cholera vaccine, live, adult dosage, 1 dose	NO	NO	NO
90630¹	Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use Ages: 18-64 years BN: FLUZONE INTRADERMAL QUADRIVALENT	NO	NO	YES
90632	Hepatitis A vaccine (Hep A), adult dosage, for intramuscular use Ages: 10-99 years BN: HAVRIX, VAQTA	YES	YES VFC	Covered under Medicare Part B only for the following diagnoses: ICD-9: V01.79, Contact with or exposure to communicable diseases; other viral diseases ICD-10: Z20.5, Contact with and (suspected) exposure to viral hepatitis; Z20.828, Contact with and (suspected) exposure to other viral communicable diseases
90633	Hepatitis A vaccine (Hep A), pediatric/adolescent dosage - 2 dose schedule, for intramuscular use Ages: 0-18 years BN: HAVRIX Pediatric, VAQTZ Pediatric	YES	VFC only	Covered under Medicare Part B only for the following diagnoses: ICD-9: V01.79, Contact with or exposure to communicable diseases; other viral diseases ICD-10: Z20.5, Contact with and (suspected) exposure to viral hepatitis; Z20.828, Contact with and (suspected) exposure to other viral communicable diseases
90634	Hepatitis A vaccine (Hep A), pediatric/adolescent dosage-3 dose schedule, for intramuscular use BN: No product available	N/A	N/A	N/A
90636	Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use Ages: 10-99 only BN: TWINRIX	YES	YES VFC	NO
90644	Meningococcal conjugate vaccine, serogroups C & Y, and hemophilus influenza B vaccine (Hib-MenCY), 4-dose schedule, when administered to children 6 weeks - 18 months of age, for intramuscular use BN: Menhibrix	YES	VFC only	NO
Code	Description	HMO/EPO, POS, PPO	Medicaid /Healthy Michigan Plan	Medicare Advantage plans
90646	Hemophilus influenza b vaccine (Hib), PRP-D conjugate, for booster use only, intramuscular use BN: No product available	N/A	N/A	N/A
90647	Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate (3 dose schedule), for intramuscular use Ages: 0-6 years BN: PEDVAXHIB	YES	VFC only	NO
90648	Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for intramuscular use Ages: 6 weeks - 5 years BN: ACTHIB, HIBERIX	YES	VFC only	NO
90649³	Human Papilloma virus vaccine, types 6, 11, 16, 18, quadrivalent (HPV4), 3 dose schedule, for intramuscular use Ages: 9-26 only BN: GARDISIL	YES	YES VFC	NO
90650³	Human Papillomavirus (HPV) vaccine, types 16 and 18, bivalent (HPV2), 3 dose schedule, for intramuscular use Ages: Females 9-26 only BN: CERVARIX	YES	YES VFC	NO
90651	Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (HPV), 3 dose schedule, for intramuscular use. 2 dose schedule, for 11 and 12 year olds must be administered at least 146 days apart. Ages 9-26 BN: GARDASIL 9	YES	YES VFC	NO
90653	Influenza virus vaccine (IIV), inactivated, subunit, adjuvanted, for intramuscular use Ages 65 years and older BN: FLUAD	YES	YES	YES
90654¹	Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, for intradermal use, ages 18-64 years only BN: FLUZONE INTRADERMAL	NO	NO	YES
90655	Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, for children 6-35 months of age, for intramuscular use BN: FLUZONE PEDIATRIC	YES	VFC only	YES
90656	Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, for use in individuals 3 years and above, for intramuscular use BN: AFLURIA, FLUZONE, FLUARIX, FLUVIRIN	YES	YES VFC	YES
90657	Influenza virus vaccine, trivalent (IIV3), split virus, for children 6-35 months of age, for intramuscular use BN: FLUZONE	YES	VFC only	YES
90658	Influenza virus vaccine, trivalent (IIV3), split virus, for use in individuals 3 years of age and above, for intramuscular use BN: FLUZONE, FLUVIRIN, AFLURIA, FLULAVAL	YES	YES VFC	NO (see Q codes)
90660	Influenza virus vaccine, trivalent, live, for intranasal use, ages 2-49 only BN: No product available	N/A	N/A	N/A
90661	Influenza virus vaccine (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use Ages: 4-99 only BN: FLUCELVAX	NO	YES	YES
90662	Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use Ages: 65+ only BN: FLUZONE HIGH DOSE	YES	YES	YES
90664	Influenza virus vaccine, live (LAIV) pandemic formulation, live, for intranasal use BN: No product available	N/A	N/A	N/A
90666 #	Influenza virus vaccine (IIV), pandemic formulation, split virus, preservative free, for intramuscular use	NO	NO	NO
90667 #	Influenza virus vaccine (IIV), pandemic formulation, split virus, adjuvanted, for intramuscular use	NO	NO	NO
90668 #	Influenza virus vaccine (IIV), pandemic formulation, split virus, for intramuscular use	NO	NO	NO
Code	Description	HMO/EPO, POS, PPO	Medicaid /Healthy Michigan Plan	Medicare Advantage plans
Q2034	Influenza virus vaccine, split virus, for intramuscular use (AGRIFLU) Ages: 18-99 years BN: No product available	N/A	N/A	N/A
Q2035	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (AFLURIA) BN: AFLURIA	YES	YES VFC	YES
Q2036	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (FLULAVAL) BN: FLULAVAL	YES	YES VFC	YES
Q2037	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (FLUVIRIN) BN: FLUVIRIN	YES	YES VFC	YES
Q2038	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone) BN: FLUZONE	YES	VFC	YES
Q2039	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)	YES	YES VFC	YES
90670	Pneumococcal conjugate vaccine, 13 valent, for intramuscular use Ages: 0-99 years BN: PREVNAR 13	YES	YES VFC	YES
90672	Influenza virus vaccine, quadrivalent (LAIV4), live, for intranasal use Ages: 2-49 years only BN: FLUMIST QUADRIVALENT	NO	NO	NO
90673¹	Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use Ages: 18-49 years BN: Flublok	NO	YES	YES
90674	Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5mL dosage, for intramuscular use Ages: 4-99 years BN: FLUCELVAX QUADRIVALENT	NO	YES	YES
90675	Rabies vaccine, for intramuscular use BN: IMOVAX, RABAVERT	YES	YES	Covered under Medicare Part B only for the following diagnoses: A82.0, Sylvatic rabies; A82.1, Urban rabies; A82.9, Rabies, unspecified; Z20.3, Contact with and (suspected) exposure to rabies
90676	Rabies vaccine, for intradermal use BN: No product available	N/A	N/A	N/A
90680	Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral use Ages: 6 weeks-8 months only BN: ROTATEQ	YES	VFC only	NO
90681	Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use Ages: 6 weeks-6 months only BN: ROTARIX	YES	VFC only	NO
90685	Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use BN: FLUZONE QUADRIVALENT	YES	VFC only	YES
90686	Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use BN: FLUZONE QUADRIVALENT, FLUARIX QUADRIVALENT	YES	YES VFC	YES
90687	Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to children 6-35 months, for intramuscular use BN: FLUZONE QUADRIVALENT	YES	VFC only	NO
90688	Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to individuals 3 years and older, for intramuscular use BN: FLUVALAL QUADRIVALENT, FLUZONE QUADRIVALENT	YES	YES VFC⁴	YES
Code	Description	HMO/EPO, POS, PPO	Medicaid /Healthy Michigan Plan	Medicare Advantage plans
90690	Typhoid vaccine, live, oral BN: VIVOTIF, BERNA	NO	NO	NO
90691	Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use BN: TYPHIM VI, TYPHOID VI POLYSACCHARIDE	NO	NO	NO
90696	Diphtheria, tetanus toxoids, acellular pertussis and poliovirus vaccine, inactivated (DTaP - IPV) when administered to children 4 through 6 years of age, for intramuscular use BN: KINRIX, QUADRACEL	YES	VFC only	NO
90697 #	Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenza type b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-IPV-HibHepB), for intramuscular use	NO	NO	NO
90698	Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenza Type b, and inactivated poliovirus vaccine (DtaP-IPV/Hib), for intramuscular use Ages: 6 weeks-4 years only BN: PENTACEL	YES	VFC only	NO
90700	Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), for use in individuals younger than 7 years, for intramuscular use BN: DAPTACEL, TRIPEDIA	YES	VFC only	NO
90702	Diphtheria and tetanus toxoids adsorbed (DT) for use in individuals younger than 7 years, for intramuscular use, BN: No product available	N/A	N/A	N/A
90707	Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use Ages: 1-99 years BN: M-M-R-II	YES	YES VFC	NO
90710	Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use Ages: 1-12 years BN: PROQUAD	YES	VFC only	NO
Code	Description	HMO/EPO, POS, PPO	Medicaid /Healthy Michigan Plan	Medicare Advantage plans
90713	Poliovirus vaccine, inactivated, (IPV), for subcutaneous or intramuscular use Ages: 0-99 years BN: IPOL	YES	YES VFC	NO
90714	Tetanus and diphtheria toxoids adsorbed (Td), preservative free, for use in individuals, for intramuscular use Ages: 7-99 years BN: Diptheria/tetanus toxoids DECAVAC, TENIVAC	YES	YES VFC	Covered by Medicare Part B only for the following ICD-10 diagnoses: Reference WPS LCD L34596
90715	Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), for use in individuals 7 years or older, for intramuscular use BN: ADACEL, BOOSTRIX	YES	YES VFC	Covered by Medicare Part B only for the following ICD-10 diagnoses: Reference WPS LCD L34596
90716	Varicella virus vaccine (VAR), live, for subcutaneous use Ages: 0-99 years BN: VARIVAX	YES	YES VFC	NO
90717	Yellow fever vaccine, live, for subcutaneous use Ages: 0-99 years BN: YF-VAX	NO	NO	NO
90723	Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DtaP-HepB-IPV), for intramuscular use Ages: 0-6 only BN: PEDIARIX	YES	VFC only	NO
Code	Description	HMO/EPO, POS, PPO	Medicaid /Healthy Michigan Plan	Medicare Advantage plans
90732	Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use BN: PNEUMOVAX 23	YES	YES VFC	YES
90733	Meningococcal polysaccharide vaccine serogroups A,C, Y, W-135, quadrivalent (MenACWY), for subcutaneous use Ages: 2-99 years BN: MEMOMUNE-A/C/T/W 135	YES	YES	NO
90734	Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent (MenACWY), for intramuscular use Ages: 2-55 years BN: MENACTRA, MENVEO	YES	VFC	NO
90736²	Zoster (shingles) vaccine, live (HZV), for subcutaneous injection Ages: 60+ only BN: ZOSTAVAX	YES	YES	NO
90738	Japanese encephalitis virus vaccine, inactivated, for intramuscular use BN: IXIARO	NO	NO	NO
90739 #	Hepatitis B vaccine (HepB), adult dosage (2 dose schedule), for intramuscular use	NO	NO	NO
90740	Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use Ages: 18-99 years BN: RECOMBIVAX HB	YES	YES VFC	YES
90743	Hepatitis B vaccine (HepB), adolescent (2 dose schedule), for intramuscular use Ages: 0-99 years BN: RECOMBIVAX HB	YES	NO	YES
90744	Hepatitis B vaccine (HepB), pediatric/adolescent dosage (3 dose schedule), for intramuscular use Ages: 0-20 years BN: ENGERIX B PEDIATRIC	YES	YES VFC	YES
90746	Hepatitis B vaccine (HepB), 3 dose schedule, for intramuscular use Ages: 0-99 years BN: RECOMBIVAX HB, ENGERIX B	YES	YES VFC	YES
90747	Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use Ages: 0-99 years BN: ENGERIX B	YES	YES VFC	YES
90748	Hepatitis B and Hemophilus influenza b vaccine (Hib-HepB), for intramuscular use Ages: 6 weeks - 15 months only BN: COMVAX	YES	VFC only	NO
90749	Unlisted vaccine/toxoid	YES Explanatory notes must accompany claim	YES Explanatory notes must accompany claim	NO

¹Intradermal Fluzone (90654), Flublok (90673) Flucelvax (90661) and Fluzone Intradermal Quadrivalent (90630) will not be covered for Priority Health commercial members for the 2015-2016 flu season due to the number of effective alternative products available at this time. These products will continue to be evaluated by the health plan.

²At this time Zostavax (90736) is covered for members 60 and older only, absent a recommendation to reduce the age by ACIP.

³HPV vaccines are not covered as a preventive benefit by Priority Health individual plans.

⁴Coverage of new vaccine formulations for Medicaid and VFC will be dependent on the publication of such coverage information for VFC and the publication of fees for Medicaid.

Last modified: 1/6/2017

Provider Manual

Vaccine and vaccine administration billing

Vaccine administration services

Vaccine codes and medical coverage by plan

Sites

Plans

Welcome

About

Contact

Social