Commonly Administered Pediatric Vaccines - CCHAP

1 Effective 1/1/2016 Commonly Administered Pediatric Vaccines CPT Separately report the administration with Current Procedural Terminology (CPT ). # of Vaccine Product codes 90460-90461 or 90471-90474 [Please see table below] Manufacturer Brand Components Code Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose Novartis Bexsero 90620 1. schedule, for IM use 90621 Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for IM use Pfizer Trumenba 1. Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use Sanofi Pasteur Fluzone Intradermal 90630 1. Quadrivalent Hepatitis A vaccine(Hep A), Pediatric /adolescent dosage, 2 dose, for IM use GlaxoSmithKline HAVRIX. 90633 1. Merck VAQTA. Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine 90644 (MenCY-Hib), 4-dose schedule, when Administered to children 6 weeks 18 months of age, for GlaxoSmithKline MenHibrix 2.

2 IM use 90647 Hemophilus influenza B vaccine (Hib), PRP-OMP conjugate, 3 dose, for IM use Merck PedvaxHIB 1. Hemophilus influenza B vaccine (Hib), PRP-T conjugate, 4 dose, for IM use sanofi pasteur ActHIB. 90648 1. GlaxoSmithKline HIBERIX. Human Papilloma virus vaccine, types 6, 11, 16, 18 quadrivalent (HPV4), 3 dose schedule, for Merck GARDASIL. 90649 1. IM use 90650 Human Papilloma virus vaccine, types 16 and 18, bivalent (HPV2), 3 dose schedule, for IM use GlaxoSmithKline CERVARIX 1. Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (HPV), 3 dose Merck GARDASIL 9. 90651 1. schedule, for IM use Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, for children 6-35 months of sanofi pasteur Fluzone No Preservative 90655. age, for IM use Pediatric 1. Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, when Administered to 3 Merck AFLURIA. years of age and above, for IM use sanofi pasteur Fluzone No Preservative 90656 Novatis Fluvirin 1.

3 GlaxoSmithKline FLUARIX. GlaxoSmithKline FLULAVAL. 90657 Influenza virus vaccine, trivalent (IIV3), split virus, 6 35 months dosage, for IM use Sanofi Pasteur Fluzone 1. Influenza virus vaccine, trivalent (IIV3), split virus, 3 years and older dosage, for IM use Merck AFLURIA. GlaxoSmithKline FLULAVAL. 90658 1. sanofi pasteur Fluzone Novartis Fluvirin 90670 Pneumococcal conjugate vaccine, 13 valent (PCV13), for IM use Pfizer PREVNAR 13 1. 90672 Influenza virus vaccine, quadrivalent (LAIV), live, intranasal use MedImmune Flumist Quadrivalent 1. 90680 Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral use Merck RotaTeq 1. 90681 Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use GlaxoSmithKline ROTARIX 1. Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for children 6-35 months 90685 1. of age, for IM use Sanofi Pasteur Fluzone Quadrivalent Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, when Administered to 3 Sanofi Pasteur Fluzone Quadrivalent 90686 1.

4 Years of age and above, for IM use GlaxoSmithKline FLUARIX Quadrivalent 90687 Influenza virus vaccine, quadrivalent (IIV4), split virus, 6 35 months dosage, for IM use Sanofi Pasteur Fluzone Quadrivalent 1. Influenza virus vaccine, quadrivalent (IIV4), split virus, 3 years and older dosage, for IM use Sanofi Pasteur Fluzone Quadrivalent 90688 1. GlaxoSmithKline FLULAVAL. diphtheria , tetanus toxoids, and acellular pertussis vaccine and inactivated poliovirus vaccine 90696. (DTaP-IPV), when Administered to children 4 years through 6 years of age, for IM use GlaxoSmithKline KINRIX 4. diphtheria , tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, . 90697 Haemophilus influenza type b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-IPV- 6. Hib-HepB), for IM use diphtheria , tetanus toxoids, acellular pertussis vaccine, haemophilus influenza Type B, and sanofi pasteur Pentacel 90698 5. inactivated poliovirus vaccine (DTaP -IPV/Hib), for IM use diphtheria , tetanus toxoids, and acellular pertussis vaccine (DTaP), when Administered to sanofi pasteur DAPTACEL.

5 90700. younger than seven years, for IM use GlaxoSmithKline INFANRIX 3. CPT . Separately report the administration with codes 90460-90461 or 90471-90474 # of Vaccine Product Manufacturer Brand [Please see table below] Components Code diphtheria and tetanus toxoids (DT), adsorbed when Administered to younger than seven diphtheria and Tetanus 90702. years, for IM use sanofi pasteur Toxoids adsorbed 2. 90707 Measles, mumps, and rubella virus vaccine (MMR), live, for subcutaneous use Merck M-M-R II 3. 90710 Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use Merck ProQuad 4. 90713 Poliovirus vaccine (IPV), inactivated, for subcutaneous or IM use sanofi pasteur IPOL 1. Tetanus and diphtheria toxoids (Td) adsorbed , preservative free, when Administered to seven 90714 sanofi pasteur TENIVAC 2. years or older, for IM use Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when Administered to 7 sanofi pasteur ADACEL. 90715 3. years or older, for IM use GlaxoSmithKline BOOSTRIX.

6 90716 Varicella virus vaccine (VAR), live, for subcutaneous use Merck VARIVAX 1. diphtheria , tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and inactivated poliovirus 90723 GlaxoSmithKline PEDIARIX 5. vaccine (DTaP-Hep B-IPV), for IM use Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed 90732 Merck PNEUMOVAX 23 1. patient dosage, when Administered to 2 years or older, for subcutaneous or IM use Meningococcal polysaccharide vaccine, serogroups A, C, Y, W-135, quadrivalent (MenACWY. 90733 sanofi pasteur Menomune 1. or MPSV4), for subcutaneous use Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 quadrivalent (MenACWY or sanofi pasteur Menactra 90734 1. MCV4) , for IM use Novartis Menveo 90740 Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose, for IM use Merck RECOMBIVAX HB 1. 90743 Hepatitis B vaccine (HepB), adolescent, 2 dose, for IM use Merck RECOMBIVAX HB 1. Merck RECOMBIVAX HB. 90744 Hepatitis B vaccine (HepB), Pediatric /adolescent dosage, 3 dose, for IM use GlaxoSmithKline ENERGIX-B 1.

7 Merck RECOMBIVAX HB. 90746 Hepatitis B vaccine (HepB), adult dosage, for IM use GlaxoSmithKline ENERGIX-B 1. 90747 Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 4 dose, for IM use GlaxoSmithKline ENERGIX-B 1. 90748 Hepatitis B and Hib (Hep B-Hib), for IM use Merck COMVAX 2. 90749 Unlisted vaccine or toxoid Please See CPT Manual Immunization Administration (IA) Codes IA Through Age 18 With Counseling^. IA through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each 90460. vaccine or toxoid component Administered (Do not report with 90471 or 90473). IA through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid +90461. component Administered Immunization Administration 90471 IA, one injection (Do not report with 90460 or 90473). +90472 IA, each additional injection 90473 IA by intranasal/oral route; one vaccine (Do not report with 90460 or 90471).

8 +90474 IA by intranasal/oral route; each additional vaccine On October 1, 2015 ICD-10-CM was implemented. Code Z23 is reported for all vaccine related encounters for all Vaccines given. You will link both the CPT vaccine product code and the CPT vaccine administration code to the Z23. Remember that the Z23 is also reported in addition to any health exam codes. Vaccine pending FDA approval [ ]. + Denotes add-on code. Report code only with appropriate primary procedure. Report 90461 with 90460 only. Report 90472 and 90473 in addition to 90460 or 90471 or 90473. Developed and maintained by the American Academy of Pediatrics. For reporting purposes only. CPT Copyright 2015 American Medical Association. All rights reserved.