Tuesday, December 9, 2014

Vaccines and administration - CPT code and DX list

Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Codes

Vaccines and their administration are reported using separate codes. The following codes are for reporting the vaccines only.

HCPCS     Definition

90653    Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90654     Influenza virus vaccine, split virus, preservative-free, for intradermal use, for adults ages 18–64;
90655   Influenza virus vaccine, split virus, preservative free, for children 6-35 months of age, for intramuscular use;
90656   Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use;
90657   Influenza virus vaccine, split virus, for children 6-35 months of age, for intramuscular use;
90660   Influenza virus vaccine, live, for intranasal use;
90661   Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use
90662   Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
90669   Pneumococcal conjugate vaccine, polyvalent, for children under 5 years, for intramuscular use
90670    Pneumococcal conjugate vaccine, 13 valent, for intramuscular use
90672    Influenza virus vaccine, live, quadrivalent, for intranasal use
90673    Influenza virus vaccine, trivalent, derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
90685    Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6 -35 months of age, for intramuscular use
90686    Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use
90687   Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use
90688   Influenza virus vaccine, quadrivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use
90732  Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use;
90739   Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
90740   Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use;
90743  Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use;
90744  Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use;
90746  Hepatitis B vaccine, adult dosage, for intramuscular use; and
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use.

The following codes are for reporting administration of the vaccines only. The administration of the vaccines is billed using:

HCPCS    Definition
G0008   Administration of influenza virus vaccine;
G0009  Administration of pneumococcal vaccine; and
*G0010  Administration of hepatitis B vaccine.
*90471  Immunization administration. (For OPPS hospitals billing for the hepatitis B vaccine administration)
*90472  Each additional vaccine. (For OPPS hospitals billing for the hepatitis B vaccine administration

* NOTE: For claims with dates of service priorto January 1, 2006, OPPS and non-OPPS hospitals report G0010 for hepatitis B vaccine administration. For claims with dates of service January 1, 2006
until December 31, 2010, OPPS hospitals report 90471 or 90472 for hepatitis B vaccine administration as
appropriate in place of G0010. Beginning January 1, 2011, providers should report G0010 for billing under the OPPS rather than 90471 or 90472 to ensure correct waiver of coinsurance and deductible for the administration of hepatitis B vaccine.
One of the following diagnosis codes must be reported as appropriate. If the sole purpose for the visit is to receive a vaccine or if a vaccine is the only service billed on a claim the applicable following diagnosis code may be used.

Diagnosis Code   Description
V03.82          Pneumococcus
V04.81**      Influenza
V06.6***      Pneumococcus and Influenza
V05.3       Hepatitis B

**Effective for influenza virus claims with dates of service October 1, 2003 and later.
***Effective October 1, 2006, providers may report diagnosis code V06.6 on claims for
pneumococcus and/or influenza virus vaccines when the purpose of the visit was to
receive both vaccines.
If a diagnosis code for pneumococcus, hepatitis B, or influenza virus vaccination is not reported on a claim, contractors may not enter the diagnosis on the claim. Contractors must follow current resolution processes for claims with missing diagnosis codes.

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