Also see:
Billing for vaccine administration services
- Only one initial administration code can be reported per day, regardless of vaccine administration method.
- CPT codes 90465, 90467, 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, all additional vaccine administration services should be reported with the appropriate add-on code (i.e. 90466, 90468, 90472 or 90474). Reference your CPT book for coding guidelines if you have additional questions.
- When billing for multiple vaccine administrations, bill each administration code on a separate line, with one unit and the corresponding diagnosis code for the vaccine given. This is needed in order to properly apply benefits.
Vaccine codes and medical coverage by plan
- Self-funded plan coverage may vary by employer group.
- Coinsurance may apply.
- Routine vaccines listed as NOT COVERED under Medicare may be covered under Medicare Part D pharmacy benefit.
- All covered vaccines are considered preventive. Deductible, if applicable, will be waived. For self-funded plans, a dollar limit may apply to preventive services.
- VFC = Covered, BUT you must use the VFC program for members under 19 years of age
- VFC only = Not covered for adult Medicaid members
- # = Coverage of these vaccines will be evaluated once FDA approval granted
Code
|
Description
|
HMO/EPO,
POS, PPO,
MiChild |
Medicaid
|
Medicare
(all products)
|
| 90476 |
Adenovirus vaccine, type 4, live, for oral use |
NOT COVERED
|
NOT COVERED
|
NOT COVERED |
| 90477 |
Adenovirus vaccine, type 7, live, for oral use |
NOT COVERED
|
NOT COVERED |
NOT COVERED |
| 90581 |
Anthrax vaccine, for subcutaneous use |
NOT COVERED |
NOT COVERED |
NOT COVERED |
| 90585 |
Bacillus Calmette-Guerin vaccine (BCG) for tuberculosis, live, for percutaneous use |
Covered |
NOT COVERED |
NOT COVERED |
| 90586 |
Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, for intravesical use |
Covered |
NOT COVERED |
NOT COVERED |
90632
|
Hepatitis A vaccine, adult dosage, for intramuscular use |
Covered |
VFC |
NOT COVERED
Medicare Part B - covered only with diagnosis code of V01.79, contact with/or exposure to communicable diseases; other viral diseases
|
90633
|
Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscular use |
Covered |
VFC only
|
NOT COVERED
Medicare Part B - covered only with diagnosis code of V01.79, contact with/or exposure to communicable diseases; other viral diseases
|
90634
|
Hepatitis A vaccine, pediatric/adolescent dosage-3 dose schedule, for intramuscular use |
Covered |
NOT COVERED |
NOT COVERED
Medicare Part B - covered only with diagnosis code of V01.79, contact with/or exposure to communicable diseases; other viral diseases |
90636
|
Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use |
Covered |
Covered |
NOT COVERED |
90644
#
|
Meningococcal conjugate vaccine,
serogroups C & Y and Hemophilus influenza b vaccine, tetanus toxoid conjugate (Hib-MenCY-TT), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use
Code release 01-Jan-2010 |
NOT COVERED
|
NOT COVERED |
NOT COVERED |
90645
|
Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose schedule), for intramuscular use |
Covered |
VFC only
|
NOT COVERED |
Code
|
Description
|
HMO/EPO,
POS, PPO,
MiChild |
Medicaid
|
Medicare
(all medicare products)
|
90646
|
Hemophilus influenza b vaccine (Hib), PRP-D conjugate, for booster use only, intramuscular use |
Covered |
NOT COVERED |
NOT COVERED |
90647
|
Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate (3 dose schedule), for intramuscular use |
Covered |
VFC only
|
NOT COVERED |
90648
|
Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for intramuscular use |
Covered |
VFC only
|
NOT COVERED |
90649
|
Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use, ages 9-26 only, female only
|
Covered
|
VFC
|
NOT COVERED |
90650
#
|
Human Papillomavirus (HPV) vaccine, types 16 and 18, bivalent, 3 dose schedue, for intramuscular use
|
NOT COVERED
|
NOT COVERED |
NOT COVERED |
| 90655 |
Influenza virus vaccine, split virus, preservative free, for children 6-35 months of age, for intramuscular use |
Covered |
VFC only |
Covered |
| 90656 |
Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use |
Covered |
VFC only |
Covered |
| 90657 |
Influenza virus vaccine, split virus, for children 6-35 months of age, for intramuscular use |
Covered |
VFC only |
Covered |
90658
|
Influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use |
Covered |
VFC |
Covered |
| 90660 |
Influenza virus vaccine, live, for intranasal use, ages 2-49 only |
Covered |
VFC |
Covered at $0 copay from in-network providers |
90661
# |
Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use
|
NOT COVERED |
NOT COVERED |
NOT COVERED |
90662
#
|
Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use |
NOT COVERED |
NOT COVERED |
NOT COVERED |
| 90663 |
Influenza virus vaccine, pandemic formulation, H1N1
($0 charge) |
Covered |
Covered |
Covered but not preferred; use G9142 |
| G9142 |
Influenza A (H1N1) vaccine, any route of administration (report for H1N1 vaccine, $0 charge)
|
Covered but not preferred; use 90663
|
Covered but not preferred; use 90663 |
Covered |
Code
|
Description
|
HMO/EPO,
POS, PPO,
MiChild |
Medicaid
|
Medicare
(all medicare products)
|
| 90665 |
Lyme disease vaccine, adult dosage, for intramuscular use |
NOT COVERED |
NOT COVERED
|
NOT COVERED |
90669
|
Pneumococcal conjugate vaccine, polyvalent, for children under 5 years, for intramuscular use |
Covered |
VFC only
|
NOT COVERED
|
90670
#
|
Pneumococcal conjugate vaccine, 13 valent, for intramuscular use
New code July 1, 2009 |
NOT COVERED
|
NOT COVERED |
NOT COVERED |
| 90675 |
Rabies vaccine, for intramuscular use |
Covered |
Covered |
NOT COVERED
Medicare Part B - covered only with diagnosis code of V01.5, contact with/or exposure to disease; rabies |
| 90676 |
Rabies vaccine, for intradermal use |
Covered |
Covered |
NOT COVERED
Medicare Part B - covered only with diagnosis code of V01.5, contact with/or exposure to disease; rabies |
90680
|
Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use, ages 6 weeks-8 months ONLY |
Covered |
VFC only
|
Not covered |
90681
|
Rotavirus vaccine, human, attenuated, 2 dose schedule, live, for oral use, ages 6 weeks-8 months ONLY |
Covered |
VFC only
|
Not covered |
| 90690 |
Typhoid vaccine, live, oral |
Not covered |
Not covered |
Not covered |
| 90691 |
Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use |
Not covered |
NOT COVERED
|
Not covered |
| 90692 |
Typhoid vaccine, heat- and phenol-inactivated (H-P), for subcutaneous or intradermal use |
Not covered |
NOT COVERED |
Not covered |
| 90693 |
Typhoid vaccine, acetone-killed, dried (AKD), for subcutaneous use (U.S. military) |
Not covered |
Not covered |
Not covered |
90696
|
Diphtheria, tetanus toxoids, acellular pertussis and poliovirus vaccine, inactivated (DTaP - IPV) when administered to children 4-6 years of age, for intramuscular use |
Covered |
VFC only
|
Not covered |
90698
|
Diphtheria, tetanus toxoids, acellular pertussis vaccine, haemophilus influenza Type B, and poliovirus vaccine, inactivated (DTaP - Hib - IPV), for intramuscular use |
Covered |
VFC only
|
Not covered |
90700
|
Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), for use in individuals younger than 7 years, for intramuscular use |
Covered |
VFC only
|
Not covered |
Code
|
Description
|
HMO/EPO,
POS, PPO,
MiChild |
Medicaid
|
Medicare
(all medicare products)
|
90701
|
Diphtheria, tetanus toxoids, and whole cell pertussis vaccine (DTP), for intramuscular use |
Covered |
Not covered |
Not covered |
90702
|
Diphtheria and tetanus toxoids (DT) adsorbed for use in individuals younger than 7 years, for intramuscular use |
Covered |
VFC only
|
NOT COVERED
Medicare Part B - covered only with diagnoses codes:
- 870.0-897.7, Open wound, traumatic amputation
- 910.00-919.9 Superficial injury
- V03.7, Tetanus toxoid alone
|
90703
|
Tetanus toxoid adsorbed, for intramuscular use |
Covered |
Not covered |
NOT COVERED
Medicare Part B - covered only with diagnoses codes:
- 870.0-897.7, Open wound, traumatic amputation
- 910.00-919.9, Superficial injury
- V03.7, Tetanus toxoid alone
|
90704
|
Mumps virus vaccine, live, for subcutaneous use |
Covered |
Covered |
Not covered |
90705
|
Measles virus vaccine, live, for subcutaneous use |
Covered |
Covered |
Not covered |
90706
|
Rubella virus vaccine, live, for subcutaneous use |
Covered |
Covered |
Not covered |
90707
|
Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use |
Covered |
VFC |
Not covered |
90708
|
Measles and rubella virus vaccine, live, for subcutaneous use |
Covered |
Covered |
Not covered |
90710
|
Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use |
Covered |
VFC only
|
Not covered |
90712
|
Poliovirus vaccine, (any type(s)) (OPV), live, for oral use |
Covered |
Not covered |
Not covered |
Code
|
Description
|
HMO/EPO,
POS, PPO,
MiChild |
Medicaid
|
Medicare
(all medicare products)
|
90713
|
Poliovirus vaccine, inactivated, (IPV), for subcutaneous or intramuscular use |
Covered |
VFC |
Not covered |
90714
|
Tetanus and diphtheria toxoids (Td) adsorbed, preservative free, for use in individuals 7 years or older, for intramuscular use |
Covered |
VFC |
NOT COVERED
Medicare Part B - covered only with diagnoses codes:
- 870.0-897.7, Open wound, traumatic amputation
- 910.00-919.9 Superficial injury
- V03.7 Tetanus toxoid alone
|
90715
|
Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), for use in individuals 7 years or older, for intramuscular use |
Covered |
VFC |
NOT COVERED
Medicare Part B - covered only with diagnoses codes:
- 870.0-897.7, Open wound, traumatic amputation
- 910.00-919.9 Superficial injury
- V03.7 Tetanus toxoid alone
|
90716
|
Varicella virus vaccine, live, for subcutaneous use |
Covered |
VFC |
Not covered |
| 90717 |
Yellow fever vaccine, live, for subcutaneous use |
Not covered
|
Not covered |
Not covered |
90718
|
Tetanus and diphtheria toxoids (Td) adsorbed for use in individuals 7 years or older, for intramuscular use |
Covered |
Covered |
NOT COVERED
Medicare Part B - covered only with diagnoses codes:
- 870.0-897.7, Open wound, traumatic amputation
- 910.00-919.9 Superficial injury
- V03.7 Tetanus toxoid alone
|
90719
|
Diphtheria toxoid, for intramuscular use |
Covered |
Not covered |
Not covered |
90720
|
Diphtheria, tetanus toxoids, and whole cell pertussis vaccine and Hemophilus influenza B vaccine (DTP-Hib), for intramuscular use |
Covered |
Not covered |
Not covered |
90721
|
Diphtheria, tetanus toxoids, and acellular pertussis vaccine and Hemophilus influenza B vaccine (DtaP-Hib), for intramuscular use |
Covered |
VFC only
|
Not covered |
90723
|
Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine, inactivated (DtaP-HepB-IPV), for intramuscular use |
Covered |
VFC only
|
Not covered |
Code
|
Description
|
HMO/EPO,
POS, PPO,
MiChild |
Medicaid
|
Medicare
(all medicare products)
|
| 90725 |
Cholera vaccine for injectable use |
Not covered |
Not covered |
Not covered |
| 90727 |
Plague vaccine, for intramuscular use |
Not covered |
Not covered |
Not covered |
90732
|
Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use |
Covered |
VFC |
Covered
|
90733
|
Meningococcal polysaccharide vaccine (any groups), for subcutaneous use |
Covered |
Covered |
Not covered |
90734
|
Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 (tetravalent), for intramuscular use |
Covered |
VFC only
|
Not covered |
| 90735 |
Japanese encephalitis virus vaccine, for subcutaneous use |
Not covered |
Covered |
Not covered |
90736
|
Zoster (shingles) vaccine, live, for subcutaneous injection
Ages 60+ only
|
Covered |
Covered |
NOT COVERED
|
|
90738
|
Japanese encephalitis virus vaccine, inactivated, for intramuscular use |
Not Covered |
Not Covered |
Not Covered |
90740
|
Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use |
Covered |
Covered |
Covered |
90743
|
Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use |
Covered |
Not covered |
Covered |
90744
|
Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use |
Covered |
VFC only
|
Covered |
Code
|
Description
|
HMO/EPO,
POS, PPO,
MiChild |
Medicaid
|
Medicare
(all medicare products)
|
90746
|
Hepatitis B vaccine, adult dosage, for intramuscular use |
Covered |
VFC |
Covered |
90747
|
Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use |
Covered |
VFC |
Covered |
90748
|
Hepatitis B and Hemophilus influenza b vaccine (HepB-Hib), for intramuscular use |
Covered |
VFC only
|
Not covered |
| 90749 |
Unlisted vaccine/toxoid
|
Covered Explanatory notes must accompany claim |
Covered
Explanatory notes must accompany claim |
Not covered
|
Last modified
10/07/09
|
