Medicaid Vaccine and Immunization CPT code list

Pediatric Flu Vaccine: Special Situations 

In the event a Medicaid provider does not have VFC pediatric influenza vaccine on hand tovaccinate a high priority VFC eligible Medicaid enrolled child, the provider should use pediatric influenza vaccine from private stock, if available. If a provider does use vaccine from private stock for a high priority VFC eligible Medicaid enrolled child, the provider would then replace dose(s) used from private stock with replacement dose(s) from VFC stock when VFC vaccine becomes available. The provider should not turn away, refer or reschedule a high priority VFC eligible Medicaid enrolled child for a later date if vaccine is available. Louisiana Medicaid will update Medicaid enrolled providers through remittance advices and the Louisiana Medicaid Provider Update regarding availability of vaccine through the VFC program and any billing issues. Please contact the Louisiana VFC Program office at (504)838-5300 for vaccine availability information.



* indicates the vaccine is available from the Vaccines For Children (VFC) program

^ indicates the vaccine is payable for QMB Only and QMB Plus recipients Vaccine

Code Description

90476^ Adenovirus vaccine, type 4, live, for oral use

90477^ Adenovirus vaccine, type 7, live, for oral use

90581^ Anthrax vaccine, for subcutaneous use

90585 Bacillus Calmette-Guerin vaccine (BCG) for tuberculosis, live, for percutaneous use

90586 Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, for intravesical use

90632 Hepatitis A vaccine, adult dosage, for intramuscular use

90633* Hepatitis A vaccine pediatric/adolescent dosage, 2-dose schedule, for intramuscular use

90634* Hepatitis A vaccine, pediatric/adolescent dosage, 3-dose schedule, for intramuscular use

90636 Hepatitis A and Hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use

90645 Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose schedule), for intramuscular use

90646 Hemophilus Influenza b vaccine (Hib), PRP-D conjugate, for booster use only, intramuscular use

90647* Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate (3 dose schedule), for intramuscular use

90648* Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for intramuscular use

90649* Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use

90655* Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for
intramuscular use

90656* Influenza virus vaccine, split virus, preservative free, when administered to 3 years and older, for intramuscular use

90657* Influenza Virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use

90658* Influenza Virus vaccine, split virus, when administered to 3 years of age and older, for intramuscular use

90660* Influenza Virus vaccine, live, for intranasal use

90665^ Lyme Disease vaccine, adult dosage, for intramuscular use

90669* Pneumococcal conjugate vaccine, polyvalent, when administered to children younger than 5 years, for intramuscular use

90675^ Rabies vaccine, for intramuscular use

90676^ Rabies vaccine, for intradermal use

90680* Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use

90690^ Typhoid vaccine, live, oral

2007 Louisiana Medicaid Professional Services Provider Training 100


Vaccine Codes

Code Description

90691^ Typhoid vaccine, Vi capsular polysaccharide (ViCPS), for intramuscular use

90692^ Typhoid vaccine, heat-and phenol-inactivated (H-P) for subcutaneous or intradermal use

90693 Typhoid vaccine, acetone-killed, dried (AKD), for subcutaneous use (US Military)

90698 Diphtheria, tetanus toxoids, acellular pertussis vaccine, haemophilus influenza Type B, and poliovirus vaccine, inactivated, (DTaP-Hib-IPV), for intramuscular use

90700 * Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to younger than 7 years, for intramuscular use

90701 Diphtheria, tetanus toxoids, and whole cell pertussis vaccine (DTP), for intramuscular use

90702* Diphtheria and tetanus toxoids (DT) absorbed when administered to younger than 7 years, for intramuscular use

90703 Tetanus toxoid adsorbed, for intramuscular use

90704 Mumps virus vaccine, live, for subcutaneous use

90705 Measles virus vaccine, live, for subcutaneous use

90706 Rubella virus vaccine, live, for subcutaneous use

90707* Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous

90708 Measles and rubella virus vaccine, live, for subcutaneous use

90710* Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use

90712 Poliovirus vaccine, (any type(s)) (OPV), live, for oral use

90713* Poliovirus vaccine, inactivated, (IPV), for subcutaneous or intramuscular use

90714* Tetanus and diphtheria toxoids, (Td) absorbed, preservative free, when administered to 7 years or older, for intramuscular use

90715* Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to 7 years or older, for
intramuscular use

90716* Varicella virus vaccine, live, for subcutaneous use

90717 Yellow fever vaccine, live, for subcutaneous use

90718* Tetanus and diphtheria toxoids (Td) adsorbed when administered to7 years or older, for intramuscular use

90719 Diphtheria toxoid, for intramuscular use

90720 Diphtheria, tetanus toxoids, and whole cell pertussis vaccine and Hemophilus influenza B vaccine (DTP-Hib), for intramuscular use

90721* Diphtheria, tetanus toxoids, and acellular pertussis vaccine and Hemophilus influenza B vaccine (DTaP-Hib), for intramuscular use

90723* Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine, inactivated (DTaP-HepB-IPV), for intramuscular use

90725 Cholera vaccine for injectable use

90727 Plague vaccine, for intramuscular use

90732 Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to 2 years or older, for subcutaneous or intramuscular use

90733 Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use

90734* Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 (tetravalent), for

2007 Louisiana Medicaid Professional Services Provider Training 101

Vaccine Codes

* indicates the vaccine is available from the Vaccines For Children (VFC) program

^ indicates the vaccine is payable for QMB Only and QMB Plus recipients


90735 Japanese Encephalitis Virus vaccine, for subcutaneous use

90736 Zoster (shingles) vaccine, live, for subcutaneous injection

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

90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use

90748* Hepatitis B and Hemophilus influenza b vaccine (HepB-Hib), for intramuscular use



• Procedure code 90703 (Tetanus toxoid - for trauma) will be payable at the rate of $2.42, and it is not available through the VFC program.

• If the administration units for 90466, 90468, 90472 or 90474 are greater than the number of vaccines reported for the administration codes, the units will be cutback to reflect the number of vaccine codes being reported.

• If the administration units for 90466, 90468, 90472 or 90474 are less than the number of vaccines reported the claim will be processed based on the units listed for administration.



No comments:

Top Medicare billing tips