Immunization/Vaccine CPT CODE LIST - Drug Administration payment

All Service Codes for Immunization/Vaccine

  • 86615 (CPT) - Antibody; Bordetella
  • 86619 (CPT) - Antibody; Borrelia (relapsing fever)
  • 86622 (CPT) - Antibody; Brucella
  • 86625 (CPT) - Antibody; Campylobacter
  • 86628 (CPT) - Antibody; Candida
  • 90281 (CPT) - Immune globulin (Ig), human, for intramuscular use
  • 90283 (CPT) - Immune globulin (IgIV), human, for intravenous use
  • 90284 (CPT) - Immune globulin (SCIg), human, for use in subcutaneous infusions, 100 mg, each
  • 90287 (CPT) - Botulinum antitoxin, equine, any route
  • 90288 (CPT) - Botulism immune globulin, human, for intravenous use
  • 90291 (CPT) - Cytomegalovirus immune globulin (CMV-IgIV), human, for intravenous use
  • 90296 (CPT) - Diphtheria antitoxin, equine, any route
  • 90371 (CPT) - Hepatitis B immune globulin (HBIg), human, for intramuscular use
  • 90375 (CPT) - Rabies immune globulin (RIg), human, for intramuscular and/or subcutaneous use
  • 90376 (CPT) - Rabies immune globulin, heat-treated (RIg-HT), human, for intramuscular and/or subcutaneous use
  • 90378 (CPT) - Respiratory syncytial virus immune globulin (RSV-IgIM), for intramuscular use, 50 mg, each
  • 90379 (CPT) - Respiratory syncytial virus immune globulin (RSV-IgIV), human, for intravenous use
  • 90384 (CPT) - Rho(D) immune globulin (RhIg), human, full-dose, for intramuscular use
  • 90385 (CPT) - Rho(D) immune globulin (RhIg), human, mini-dose, for intramuscular use
  • 90386 (CPT) - Rho(D) immune globulin (RhIgIV), human, for intravenous use
  • 90389 (CPT) - Tetanus immune globulin (TIg), human, for intramuscular use
  • 90393 (CPT) - Vaccinia immune globulin, human, for intramuscular use
  • 90396 (CPT) - Varicella-zoster immune globulin, human, for intramuscular use
  • 90465 (CPT) - Immunization administration younger than 8 years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family; first injection (single or combination vaccine/toxoid), per day
  • 90466 (CPT) - Immunization administration younger than 8 years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family; each additional injection (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure)
  • 90467 (CPT) - Immunization administration younger than age 8 years (includes intranasal or oral routes of administration) when the physician counsels the patient/family; first administration (single or combination vaccine/toxoid), per day
  • 90468 (CPT) - Immunization administration younger than age 8 years (includes intranasal or oral routes of administration) when the physician counsels the patient/family; each additional administration (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure)
  • 90471 (CPT) - Immunization administration; one vaccine (single or combination vaccine/toxoid)
  • 90472 (CPT) - Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
  • 90473 (CPT) - Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid)
  • 90474 (CPT) - Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
  • 90476 (CPT) - Adenovirus vaccine, type 4, live, for oral use
  • 90477 (CPT) - Adenovirus vaccine, type 7, live, for oral use
  • 90581 (CPT) - Anthrax vaccine, for subcutaneous use
  • 90585 (CPT) - Bacillus Calmette-Guerin vaccine (BCG) for tuberculosis, live, for percutaneous use
  • 90586 (CPT) - Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, for intravesical use
  • 90632 (CPT) - Hepatitis A vaccine, adult dosage, for intramuscular use
  • 90633 (CPT) - Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscular use
  • 90634 (CPT) - Hepatitis A vaccine, pediatric/adolescent dosage-3 dose schedule, for intramuscular use
  • 90636 (CPT) - Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use
  • 90645 (CPT) - Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose schedule), for intramuscular use
  • 90646 (CPT) - Hemophilus influenza b vaccine (Hib), PRP-D conjugate, for booster use only, intramuscular use
  • 90647 (CPT) - Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate (3 dose schedule), for intramuscular use
  • 90648 (CPT) - Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for intramuscular use
  • 90649 (CPT) - Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use
  • 90655 (CPT) - Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
  • 90656 (CPT) - Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use
  • 90657 (CPT) - Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use
  • 90658 (CPT) - Influenza virus vaccine, for 3 years of age and older, intramuscular use
  • 90660 (CPT) - Influenza virus vaccine, live, for intranasal use
  • 90661 (CPT) - Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use
  • 90662 (CPT) - Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
  • 90663 (CPT) - Influenza virus vaccine, pandemic formulation
  • 90665 (CPT) - Lyme disease vaccine, adult dosage, for intramuscular use
  • 90669 (CPT) - Pneumococcal conjugate vaccine, polyvalent, when administered to children younger than 5 years, for intramuscular use
  • 90675 (CPT) - Rabies vaccine, for intramuscular use
  • 90676 (CPT) - Rabies vaccine, for intradermal use
  • 90680 (CPT) - Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use
  • 90690 (CPT) - Typhoid vaccine, live, oral
  • 90691 (CPT) - Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use
  • 90692 (CPT) - Typhoid vaccine, heat- and phenol-inactivated (H-P), for subcutaneous or intradermal use
  • 90693 (CPT) - Typhoid vaccine, acetone-killed, dried (AKD), for subcutaneous use (U.S. military)
  • 90698 (CPT) - Diphtheria, tetanus toxoids, acellular pertussis vaccine, haemophilus influenza Type B, and poliovirus vaccine, inactivated (DTaP - Hib - IPV), for intramuscular use
  • 90700 (CPT) - Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use
  • 90701 (CPT) - Diphtheria, tetanus toxoids, and whole cell pertussis vaccine (DTP), for intramuscular use
  • 90702 (CPT) - Diphtheria and tetanus toxoids (DT) adsorbed when administered to individuals younger than 7 years, for intramuscular use
  • 90703 (CPT) - Tetanus toxoid adsorbed, for intramuscular use
  • 90704 (CPT) - Mumps virus vaccine, live, for subcutaneous use
  • 90705 (CPT) - Measles virus vaccine, live, for subcutaneous use
  • 90706 (CPT) - Rubella virus vaccine, live, for subcutaneous use
  • 90707 (CPT) - Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use
  • 90708 (CPT) - Measles and rubella virus vaccine, live, for subcutaneous use
  • 90710 (CPT) - Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use
  • 90712 (CPT) - Poliovirus vaccine, (any type[s]) (OPV), live, for oral use
  • 90713 (CPT) - Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use
  • 90714 (CPT) - Tetanus and diphtheria toxoids (Td) adsorbed, preservative free, when administered to individuals 7 years or older, for intramuscular use
  • 90715 (CPT) - Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use
  • 90716 (CPT) - Varicella virus vaccine, live, for subcutaneous use
  • 90717 (CPT) - Yellow fever vaccine, live, for subcutaneous use
  • 90718 (CPT) - Tetanus and diphtheria toxoids (Td) adsorbed when administered to individuals 7 years or older, for intramuscular use
  • 90719 (CPT) - Diphtheria toxoid, for intramuscular use
  • 90720 (CPT) - Diphtheria, tetanus toxoids, and whole cell pertussis vaccine and Hemophilus influenza B vaccine (DTP-Hib), for intramuscular use
  • 90721 (CPT) - Diphtheria, tetanus toxoids, and acellular pertussis vaccine and Hemophilus influenza B vaccine (DtaP-Hib), for intramuscular use
  • 90723 (CPT) - Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine, inactivated (DtaP-HepB-IPV), for intramuscular use
  • 90725 (CPT) - Cholera vaccine for injectable use
  • 90727 (CPT) - Plague vaccine, for intramuscular use
  • 90732 (CPT) - Pneumococcal polysaccharide vaccine (PPV23), adult dose
  • 90733 (CPT) - Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use
  • 90734 (CPT) - Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 (tetravalent), for intramuscular use
  • 90735 (CPT) - Japanese encephalitis virus vaccine, for subcutaneous use
  • 90736 (CPT) - Zoster (shingles) vaccine, live, for subcutaneous injection
  • 90740 (CPT) - Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
  • 90743 (CPT) - Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
  • 90744 (CPT) - Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
  • 90746 (CPT) - Hepatitis B vaccine, adult dosage, for intramuscular use
  • 90747 (CPT) - Hepatitis B vaccine, dialysis or immunosuppressed patient dosage
  • 90748 (CPT) - Hepatitis B and Hemophilus influenza b vaccine (HepB-Hib), for intramuscular use
  • 90749 (CPT) - Unlisted vaccine/toxoid
  • G0008 (CPT) - Flu Vaccine
  • G0009 (CPT) - Pneumonia Vaccine
  • G0010 (CPT) - Hepatitis Vaccine
  • S0195 (CPT) - PNEUMOCOCCAL CONJUGATE VACCINE, POLYVALENT, INTRAMUSCULAR, FOR CHILDREN FROM; FIVE YEARS TO NINE YEARS OF AGE WHO HAVE NOT PREVIOUSLY RECEIVED THE VACCINE
Billing and Payment for Drugs and Drug Administration

This section provides billing guidance and payment instructions for hospitals when providing drugs and drug administration services in the hospital outpatient department.

Coding and Payment for Drugs and Biologicals, and Radiopharmaceuticals

This section provides hospitals with coding instructions and payment information for drugs paid under OPPS. For additional information on coding and payment for drugs and biologicals under the OPPS, see the Medicare Claims Processing Manual, Chapter 17 “Drugs and Biologicals.”


Coding and Payment for Drug Administration


A. Overview

Drug administration services furnished under the Hospital Outpatient Prospective Payment System (OPPS) during CY 2005 were reported using Procedure  codes 90780, 90781, and 96400-96459.

Effective January 1, 2006, some of these Procedure  codes were replaced with more detailed Procedure  codes incorporating specific procedural concepts, as defined and described by the Procedure  manual, such as initial, concurrent, and sequential.

Hospitals are instructed to use the full set of Procedure  codes, including those codes referencing concepts of initial, concurrent, and sequential, to bill for drug administration services furnished in the hospital outpatient department beginning January 1, 2007. In addition, hospitals are instructed to continue billing the HCPCS codes that most accurately describe the service(s) provided.

Hospitals are reminded to bill a separate Evaluation and Management code (with modifier 25) only if a significant, separately identifiable E/M service is performed in the same encounter with OPPS drug administration services.

B. Billing for Infusions and Injections 

Beginning in CY 2007, hospitals were instructed to use the full set of drug administration Procedure  codes (90760-90779; 96401-96549), (96413-96523 beginning in CY 2008) (96360-96549 beginning in CY 2009) when billing for drug administration services provided in the hospital outpatient department. In addition, hospitals are to continue to bill HCPCS code C8957 (Intravenous infusion for therapy/diagnosis; initiation of prolonged infusion (more than 8 hours), requiring use of portable or implantable pump) when appropriate. Hospitals are expected to report all drug administration Procedure  codes in a manner consistent with their descriptors, Procedure  instructions, and correct coding principles. Hospitals should note the conceptual changes between CY 2006 drug administration codes effective under the OPPS and the Procedure  codes in effect beginning January 1, 2007, in order to ensure accurate billing under the OPPS. Hospitals should report all HCPCS codes that describe the drug administration services provided, regardless of whether or not those services are separately paid or their payment is packaged.

Medicare’s general policy regarding physician supervision within hospital outpatient departments meets the physician supervision requirements for use of Procedure  codes 90760-90779, 96401-96549, (96413-96523 beginning in CY 2008).
Drug administration services are to be reported with a line item date of service on the day they are provided. In addition, only one initial drug administration service is to be reported per vascular access site per encounter, including during an encounter where observation services span more than 1 calendar day.


C. Payments For Drug Administration Services

For CY 2007, OPPS drug administration APCs were restructured, resulting in a six-level hierarchy where active HCPCS codes have been assigned according to their clinical coherence and resource use. Contrary to the CY 2006 payment structure that bundled payment for several instances of a type of service (non-chemotherapy, chemotherapy by infusion, non-infusion chemotherapy) into a per-encounter APC payment, structure introduced in CY 2007 provides a separate APC payment for each reported unit of a separately payable HCPCS code.

Hospitals should note that the transition to the full set of Procedure  drug administration codes provides for conceptual differences when reporting, such as those noted below.

• In CY 2006, hospitals were instructed to bill for the first hour (and any additional hours) by each type of infusion service (non-chemotherapy, chemotherapy by infusion, non-infusion chemotherapy). Beginning in CY 2007, the first hour concept no longer exists. Procedure  codes in CY 2007 and beyond allow for only one initial service per encounter, for each vascular access site, no matter how many types of infusion services are provided; however, hospitals will receive an APC payment for the initial service and separate APC payment(s) for additional hours of infusion or other drug administration services provided
that are separately payable.

• In CY 2006, hospitals providing infusion services of different types (non-chemotherapy, chemotherapy by infusion, non-infusion chemotherapy) received payment for the associated per-encounter infusion APC even if these infusions occurred during the same time period. Beginning in CY 2007, hospitals should report only one initial drug administration service, including infusion services, per encounter for each distinct vascular access site, with other services through the same vascular access site being reported via the sequential, concurrent or additional hour codes. Although new Procedure  guidance has been issued for reporting initial drug administration services, Medicare contractors shall continue to follow the guidance given in this manual.

(NOTE: This list above provides a brief overview of a limited number of the conceptual changes between CY 2006 OPPS drug administration codes and CY 2007 OPPS drug administration codes - this list is not comprehensive and does not include all items hospitals will need to consider during this transition)

For APC payment rates, refer to the most current quarterly version of Addendum B on the CMS Web site at http://www.cms.hhs.gov/HospitalOutpatientPPS/.


D. Infusions Started Outside the Hospital

Hospitals may receive Medicare beneficiaries for outpatient services who are in the process of receiving an infusion at their time of arrival at the hospital (e.g., a patient who arrives via ambulance with an ongoing intravenous infusion initiated by paramedics during transport). Hospitals are reminded to bill for all services provided using the HCPCS code(s) that most accurately describe the service(s) they provided. This includes hospitals reporting an initial hour of infusion, even if the hospital did not initiate the infusion, and additional HCPCS codes for additional or sequential infusion services if needed.

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