Vaccines and vaccine administration

Page last updated on: 6/22/25

Also see:

Vaccine administration

Flu vaccines

Medicare vaccines, B vs. D

Vaccine codes and medical coverage by plan

  • Routine vaccines listed as NO (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 in-network providers. For self-funded plans, a dollar limit may apply to preventive services. Check individual plan benefits.
  • Age limits are based on FDA-approved indications. Exceptions to age limits are evaluated retrospectively by case. Example: Post bone marrow transplant, catch up.
  • Vaccines provided at no cost by the government are still billable but wouldn't be separately payable. Vaccine administration is payable.
  • 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). Reported NDCs must be valid and match the vaccines administered.
  • # = Coverage of these vaccines will be evaluated once FDA approval granted
  • * = Special conditions. Certain vaccines will be allowed for payment for ages outside of the approved age range for conditions related to altered immunocompetence such as splenectomy, certain cancers, bone marrow transplant, renal disease, make-up for vaccines never received for standard age.
  • N/A = No product available to be billed with this code

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

90589

Chikungunya virus vaccine, live attenuated, for intramuscular use

BN: IXCHIQ

NO

YES

NO

90593#

Chikungunya virus vaccine, recombinant, for intramuscular use

N/A

N/A

N/A

90611

Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous use
Ages: 18 years & older
BN: JYNNEOS

YES

YES (adults)
VFC (children)

NO

90619

Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier (MenACWY-TT), for intramuscular use
Ages: 2 years & older
BN: MenQuadfi

YES

YES (adults)
VFC (children)

NO

90620

Meningococcal recombinant protein and outer membrane vesicle vaccine, Serogroup B (MenB-4C), 2 dose schedule, for intramuscular use
Ages: 10-25 years
BN: BEXSERO

YES

YES (adults)
VFC (children)

NO

90621

Meningococcal recombinant lipoprotein vaccine, Serogroup B (MenB-FHbp), 2 or 3 dose schedule, for intramuscular use
Ages: 10-25 years
BN: TRUMENBA

YES

YES (adults)
VFC (children)

NO

90622

Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use

NO

NO

NO

90623

Meningococcal pentavalent vaccine, conjugated Men A, C, W, Y-tetanus toxoid carrier, and Men B-FHbp, for intramuscular use
Ages: 10-25 years
BN: PENBRAYA

YES

YES (adults)
VFC (children)

NO

90625

Cholera vaccine, live, adult dosage, 1 dose 
BN VAXCHORA

NO

YES (adults)

NO

90632

Hepatitis A vaccine (Hep A), adult dosage, for intramuscular use
Ages: 19 years & older
BN: HAVRIX, VAQTA

YES

YES (adults)

Covered under Medicare Part B only for the following diagnoses:
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, VAQTA

YES

VFC only

Covered under Medicare Part B only for the following diagnoses:
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: 18 years & older
BN: TWINRIX

YES

YES (adults)
VFC (children)

NO

90637
#

Influenza virus vaccine, quadrivalent (qIRV), mRNA; 30 mcg/0.5 mL dosage, for intramuscular use

Awaiting FDA approval

NO

NO

NO

90638
#

Influenza virus vaccine, quadrivalent (qIRV), mRNA; 60 mcg/0.5 mL dosage, for intramuscular use

Awaiting FDA approval

NO

NO

NO

90644

Meningococcal conjugate vaccine, serogroups C & Y, and hemophilus influenza type b vaccine (Hib-MenCY), 4-dose schedule, when administered to children 6 weeks - 18 months of age, for intramuscular use
BN: No product available

N/A

N/A

N/A

Code

Description

HMO/EPO,
POS, PPO

Medicaid /Healthy Michigan Plan

Medicare
Advantage plans

90647

Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate (3 dose schedule), for intramuscular use
Ages: 2 months - 5 years
BN: PEDVAX HIB

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

90649

Human Papilloma virus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV4), 3 dose schedule, for intramuscular use
BN: No product available

N/A

N/A

N/A

90650

Human Papillomavirus (HPV) vaccine, types 16 and 18, bivalent (2vHPV), 3 dose schedule, for intramuscular use
BN: No product available

N/A

N/A

N/A

90651

Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule, for intramuscular use.
Ages: 9-45 years
BN: GARDASIL 9

YES

YES (adults)
VFC (children)

NO

90653

Influenza virus vaccine (IIV), inactivated, subunit, adjuvanted, for intramuscular use
BN:FLUAD

YES

YES (adults)
VFC (children)

YES

90655

Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 dosage for intramuscular use
BN: No product available

N/A

N/A

N/A

90656

Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5ml dose, for intramuscular use
BN: AFLURIA, FLUZONE, FLUVARIX, FLULAVAL

YES

YES (adults)
VFC (children)

YES

90657

Influenza virus vaccine, trivalent (IIV3), split virus, for intramuscular use
BN: AFLURIA, FLUZONE

YES

YES (adults)
VFC (children)

YES

90658

Influenza virus vaccine, trivalent (IIV3), split virus, 0.5ml dose, for intramuscular use
BN: AFLURIA, FLUZONE

YES

YES (adults)
VFC (children)

YES

90660

Influenza virus vaccine, trivalent, live, for intranasal use
BN: FLUMIST

YES

YES (adults)
VFC (children)

YES

90661

Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, antibiotic free, 0.5ml dosage for intramuscular use
BN: FLUCELVAX

YES

YES (adults)
VFC (children)

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

Agriflu influenza virus vaccine, split virus, for intramuscular use (AGRIFLU)
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 (adults)
VFC (children)

YES

Q2036

Flulaval influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (FLULAVAL)
BN: No product available

N/A

N/A

N/A

Q2037

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (FLUVIRIN)
BN: No product available

N/A

N/A

N/A

Q2038

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)
BN: FLUZONE

YES

YES (adults)
VFC (children)

YES

Q2039

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
BN: FLUCELVAX

YES

YES (adults)
VFC (children)

YES

90670

Pneumococcal conjugate vaccine, 13 valent, for intramuscular use
BN: No product available

N/A

N/A

N/A

90671

Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use
Ages: 6 weeks & older
BN: VAXNEUVANCE

 YES

YES

YES

90672

Influenza virus vaccine, quadrivalent (LAIV4), live, for intranasal use
BN: No product available

N/A

N/A

N/A

90673

Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
Ages: 18 years and older
BN: FLUBLOK

YES

YES (adults)
VFC (children)

YES

90674

Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5mL dosage, for intramuscular use
BN: No product available

N/A

N/A

N/A

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

90677

Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use
Ages: 6 weeks & older
BN: PREVNAR 20

YES

YES (adults)
VFC (children)

YES

90678

Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use (Code Price is per dose = 0.5 mL)
Ages: 60 years & older, pregnant women
BN: ABRYSVO

YES

YES

NO

90679

Respiratory syncytial virus vaccine, preF, recombinant, subunit, adjuvanted, for intramuscular use (Code Price is per dose = 0.5 mL)
Ages: 60 years & older
BN: AREXVY

YES

YES

NO

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

90682

Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use 
BN: No product available        

N/A

N/A

N/A

90683

Respiratory syncytial virus vaccine, mRNA lipid nanoparticles, for intramuscular use
Ages: 60 years & older
BN: MRESVIA

NO

YES

NO

90684

Pneumococcal conjugate vaccine, 21 valent (PCV21), for intramuscular use
Ages: 18 years & older
BN: CAPVAXIVE

YES

YES

YES

90685

Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25ml dose for intramuscular use
BN: No product available

N/A

N/A

N/A

90686

Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5ml dose for intramuscular use
BN: No product available 

N/A

N/A

N/A

90687

Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25ml dose for intramuscular use
BN: No product available

N/A

N/A

N/A

90688

Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5ml dose for intramuscular use
BN: No product available

N/A

N/A

N/A

90689

Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use
BN: No product available

N/A

N/A

N/A

Code

Description

HMO/EPO,
POS, PPO

Medicaid /Healthy Michigan Plan

Medicare
Advantage plans

90690

Typhoid vaccine, live, oral
BN: VIVOTIF CPDR

NO

NO

NO

90691

Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use
BN: TYPHIM VI

NO

YES

NO

90694

Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use
BN: No active product

N/A

N/A

N/A

90695
#

Influenza virus vaccine, H5N8, derived from cell cultures, adjuvanted, for intramuscular use

Awaiting FDA approval

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
Age: 6 weeks through 4 years
BN:VAXELIS

YES

VFC only

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 to 4 years
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
Ages: 6 weeks to 6 years
BN: DAPTACEL, INFANRIX

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: 12 months & older
BN: M-M-R-II

YES

YES (adults)
VFC (children)

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: 6 weeks & older
BN: IPOL

YES

YES (adults)
VFC (children)

NO

90714

Tetanus and diphtheria toxoids adsorbed (Td), preservative free, for use in individuals, for intramuscular use
Ages: 7 years & older
BN: TDVAX, TENIVAC

YES

YES (adults)
VFC (children)

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; Ages: 10 to 64 years
BOOSTRIX; Ages: 10 years & older

YES

YES (adults)
VFC (children)

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: 1 year & older
BN: VARIVAX

YES

YES (adults)
VFC (children)

NO

90717

Yellow fever vaccine, live, for subcutaneous use
Ages: 0-99 years
BN: YF-VAX, STAMARIL

NO

NO

NO

90723

Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DtaP-HepB-IPV), for intramuscular use
Ages: 6 weeks to 6 years
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, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
BN: PNEUMOVAX 23

YES

YES (adults)
VFC (children)

YES

90733

Meningococcal polysaccharide vaccine serogroups A,C, Y, W-135, quadrivalent (MenACWY), for subcutaneous use
BN: No product available

N/A

N/A

N/A

90734

Meningococcal conjugate vaccine, serogroups A, C, W,  Y, quadrivalent (MenACWY-CRM), for intramuscular use
BN: MENACTRA; Ages: 9 months to 55 years
MENVEO; Ages: 2 months to 55 years

YES

YES (adults)
VFC (children)

NO

90736

Zoster (shingles) vaccine, live (HZV), for subcutaneous injection
BN: No Active Product 

N/A

N/A

N/A

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
Ages: 18 years & older
BN: HEPLISAV-B

YES

YES (adults)
VFC (children)

YES

90740

Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
Ages: 18 years & older
BN: RECOMBIVAX HB

YES

YES (adults)
VFC (children)

YES

90743

Hepatitis B vaccine (HepB), adolescent (2 dose schedule), for intramuscular use
Ages: 11-15 years
BN: RECOMBIVAX HB

YES

VFC only

YES

90744

Hepatitis B vaccine (HepB), pediatric/adolescent dosage (3 dose schedule), for intramuscular use
Ages: 0-18 years
BN: ENGERIX B, RECOMBIVAX HB             

YES

YES (adults)
VFC (children)

YES

90746

Hepatitis B vaccine (HepB), 3 dose schedule, for intramuscular use
Ages: 11 years & older
BN: RECOMBIVAX HB, ENGERIX B

YES

YES

YES

90747

Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
Ages: 18 years & older
BN: ENGERIX B

YES

YES (adults)
VFC (children)

YES

90748

Hepatitis B and Hemophilus influenza b vaccine (Hib-HepB), for intramuscular use
BN: No product available

N/A

N/A

N/A

90749

Unlisted vaccine/toxoid

YES
Explanatory notes must accompany claim

YES
Explanatory notes must accompany claim

NO

90750

Zoster (shingles) vaccine (HZV), recombinant, sub-unit, adjuvanted, for intramuscular injection
Ages: 18 years & older
BN: SHINGRIX

YES

YES

NO

90756

Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5ml dose, for intramuscular use
BN: No product available

N/A

N/A

N/A

90758

Zaire ebolavirus vaccine, live, for intramuscular use

NO

NO

NO

90759

Hepatitis B vaccine (HepB), 3-antigen (S, Pre-S1, Pre-S2), 10 mcg dosage, 3 dose schedule, for intramuscular use
Ages: 18 years & older
BN: PREHEVBRIO

YES

YES (adults)
VFC (children)

YES

 Code

Description

HMO/EPO, POS, PPO

Medicaid/Healthy Michigan Plan

 Medicare Advantage Plans

 91304

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5mL dosage, for intramuscular use (Novavax)
Ages: 12 years & up

YES

YES (adults)
VFC (children)

YES

91318

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use (Pfizer)
Ages: 6 months to 4 years

YES

VFC only

YES

91319

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 10 mcg/0.2 mL dosage, tris-sucrose formulation, for intramuscular use (Pfizer)
Ages: 5 to 11 years

YES

VFC only

YES

91320

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use (Pfizer)
Ages: 12 years & older
BN: COMIRNATY

YES

YES (adults)
VFC (children)

YES

91321

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25 mL dosage, for intramuscular use (Moderna)
Ages: 6 months to 11 years

YES

VFC only

YES

91322

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use (Moderna)
Ages: 12 years & older

YES

YES (adults)
VFC (children)

YES

     

The following codes are not vaccines, they are monoclonal antibodies recommended by ACIP for use as prevention treatment:

90380

Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use
Ages: 0-24 months
BN: Beyfortus

YES (Prior authorization required for patients over 8 months)

NO (Adults)
VFC (Children)

YES (Prior authorization required)

90381

Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscular use
Ages 0-24 months
BN: Beyfortus

YES (Prior authorization required for patients over 8 months)

NO (Adults)
VFC (Children)

YES (Prior authorization required)