List of Vaccine Names Best ASIIS Selection and CPT CVX ...

1 List of Vaccine Names , best ASIIS Selection and CPT/CVX Codes This list matches the Vaccine name or codes in Arizona State Immunization Information System ( ASIIS ) with the brand name or other common Names of the vaccines you use most often. Vaccine Trade name or CVX. best ASIIS Selection Age (Range) Dose Route Manufacturer/ NDC Number CPT Code Common name Code Combination Vaccines GlaxoSmithKline SKB. Pediarix (VFC) DTAP-Hep B-IPV Birth - 6 years ml IM 90723 110. NDC: 58160-0811-52. Sanofi Pasteur PMC. Pentacel (VFC) DTaP-Hib-IPV Birth - 4 years ml IM 90698 120. NDC: 49281-0510-05. GlaxoSmithKline SKB. NDC: 58160-0812-11. Kinrix (VFC) DTaP-IPV 4 - 6 years ml IM (1 dose vial) 90696 130. NDC: 58160-0812-52. (1 dose T-L syringe).

2 12 months - Merck- MSD. ProQuad (VFC) MMRV ml SC 90710 94. 12 years NDC: 00006-4171-00. GlaxoSmithKline SKB. Twinrix (VFA) HepA/HepB 18 years & older ml IM NDC: 58160-0815-52 90636 104. (1 dose T-L syringes. No needle). Meningococcal C/Y-HIB 6 weeks - GlaxoSmithKline SKB. MenHibrix (VFC) ml IM 90644 148. PRP 18 months NDC: 58160-0801-11. 1/9 September 21, 2016. Complete List of Vaccine Names and CPT/CVX Codes Vaccine Trade name or CVX. best ASIIS Selection Age (Range) Dose Route Manufacturer/ NDC Number CPT Code Common name Code Diphtheria, Tetanus and Pertussis Diphtheria and tetanus toxoids Sanofi Pasteur PMC. DT (Ped) 6 weeks - 6 years ml IM 90702 28. adsorbed NDC: 49281-0225-10. Sanofi Pasteur PMC. Daptacel (VFC) DTaP 6 weeks - 6 years ml IM 106.

3 NDC: 49281-0286-10. GlaxoSmithKline SKB. NDC:58160-0810-11 90700. Infanrix (VFC) DTaP 6 weeks - 6 years ml IM (1 dose vials) 20. NDC: 58160-0810-52. (1 dose T-L syringes. No needle). Sanofi Pasteur PMC. Tenivac (VFC/VFA). NDC: 49281-0215-10. Tetanus and diphtheria toxoids Td (adult), adsorbed 7 years & older ml IM 90714 113. (1 dose vial). adsorbed NDC: 49281-0215-15 (1 dose syringe). GlaxoSmithKline SKB. Boostrix (VFC/VFA). NDC:58160-0842-11 (1 dose vial). Tetanus Diphtheria & Acellular Tdap 10 years & older ml IM. NDC: 58160-0842-52. Pertussis (1 dose syringe, no needle). 90715 115. Sanofi Pasteur PMC. Adacel (VFC/VFA). NDC: 49281-0400-10 (1 dose vial). Tetanus Diphtheria and Acellular Tdap 10 - 64 years ml IM. NDC: 49281-0400-15.

4 Pertussis (1 dose BD Luer Lock Syringe). DTaP, 5 Pertussis Antigen DTaP, 5 Pertussis Antigen 90700 106. Whenever DTaP was given, even DTaP, unspecified 90700 20. if the brand name is unknown formulation Tetanus and diphtheria toxoids Td (adult), adsorbed 7 years & older 90714 09. adsorbed Diphtheria, tetanus toxoids, &. DTP. whole cell pertussis Vaccine (will 90701 01. DTP - unspecified be from historical records). * DTAP: Either CVX code (20 or 106) is acceptable in data exchange. In regards to inventory reporting, DTaP (CVX-20) is the default Vaccine type, if no lot number is linked to the Vaccine type, it will show as DTaP, 5 Pertussis Antigen (CVXC-106). 2/9 2016-2017. Complete List of Vaccine Names and CPT/CVX Codes Vaccine Trade name or CVX.

5 best ASIIS Selection Age (Range) Dose Route Manufacturer/ NDC Number CPT Code Common name Code Hepatitis A. GlaxoSmithKline SKB. Havrix (VFC). 12 months - ml NDC: 58160-0825-11 (1 dose vial). (2 doses for Hep A, ped/adol, 2 dose IM. 18 years (720 ) NDC: 58160-0825-52. pediatric/adolescent) 90633 83. (1 dose syringes. No needle). Vaqta (VFC) Merck- MSD NDC: 00006-4831-41. 12 months - ml (2 doses for Hep A, ped/adol, 2 dose IM (1 dose vial). 18 years (25 U). pediatric/adolescents) NDC: 00006-4095-02 (1 dose syringe). Havrix 12 months - ml (3 doses for Hep A, ped/adol, 3 dose IM GlaxoSmithKline SKB 90634 84. 18 years (360 ). pediatric/adolescent). Merck- MSD NDC: 00006-4841-41. Vaqta (VFA) ml (1 dose vial). Hep A, adult 19 years & older IM.

6 (2 doses for adults) (50u) NDC: 00006-4096-02. (1 dose prefilled syringe) 90632 52. GlaxoSmithKline SKB. Havrix (VFA) ml (1440 NDC: 58160-0826-11 (1 dose vial). Hep A, adult 19 years & older IM. (2 doses for adults) ) NDC: 58160-0826-52. (1 dose syringes. No needle). Hepatitis B. GlaxoSmithKline SKB NDC: 58160-0820- Engerix-B Ped/Adol (VFC/VFA) Hep B - Ped/Adol - presv. ml 11 (1 dose vial). Birth - 19 years IM. (3 dose schedule) free 10 g NDC: 58160-0820-52. (1 dose T-L syringe, no needle) 90744 08. Merck- MSD NDC: 00006-4981-00. Recombivax HB (VFC/VFA) Hep B - Ped/Adol - presv. ml Birth - 19 years IM (1 dose vial). Ped/Adol free 10 g NDC: 00006-4093-02 (1 dose syringes). Merck - MSD NDC: 00006-4995-41. Recombivax - Dialysis Hepatitis B - Dialysis 18 years & older 10 g IM (1 dose vial).

7 (3 dose schedule). NDC: 00006-4093-02 (1 dose syringe). Merck- MSD NDC: 00006-4995-41. ml Recombivax HB Hep B, 2 Adol/Adult 11-15 years IM (1 dose vial) 90743 43. 10 g NDC: 00006-4094-02 (1 dose syringe). 3/9 2016-2017. Complete List of Vaccine Names and CPT/CVX Codes Vaccine Trade name or CVX. best ASIIS Selection Age (Range) Dose Route Manufacturer/ NDC Number CPT Code Common name Code Hepatitis B - Continued GlaxoSmithKline SKB. ml NDC: 58160-0821-11 (1 dose vial). Engerix-B (VFA) for adults 20 years & older IM. 20 g NDC: 58160-0821-52. Hep B, adult (1 dose T-L syringe, no needle) 90746 43. Merck- MSD NDC: 00006-4995-41. ml Recombivax HB (VFA) for adults 20 years & older IM (1 dose vial). 10 g NDC: 00006-4094-02 (1 dose syringe).

8 Various dosages depending on Note: there are various specific individual cases, such as choices available to reflect high risk or dialysis. the specific situation Hib 2 months - Sanofi Pasteur PMC. ActHIB (VFC) Hib-PRP-T ml IM 90648 48. 5 years NDC: 49281-0545-05. 2 months - Merck- MSD. PedvaxHIB (VFC) Hib-PRP-OMP ml IM 90647 49. 5 years NDC: 00006-4897-00. 6 weeks - GlaxoSmithKline SKB. Hiberix (VFC) (4 dose) Hib-PRP-T ml IM 90648 48. 4 years NDC:58160-0818-11. Meningococcal C/Y-HIB 6 weeks - GlaxoSmithKline - SKB. Menhibrix (VFC) (4 dose) ml IM 90644 148. PRP 18 months NDC: 58160-0801-11. OmniHib Hib-PRP-T 90648 48. HibTITER Hib (HbOC) 90645 47. 4/9 2016-2017. Complete List of Vaccine Names and CPT/CVX Codes Vaccine Trade name or CVX.

9 best ASIIS Selection Age (Range) Dose Route Manufacturer/ NDC Number CPT Code Common name Code human Papilloma Virus Merck- MSD. NDC: 0006-4119-03. Gardasil9 (VFC/VFA) HPV9 9 - 26 years ml IM 90651 165. (10 pack, 1 dose vial). immune globulin Products HyperHEP B S/D or HBIG (Hepatitis B immune Talecris Biotherapeutics HepaGam B IM 90371 30. globulin ) TAL or Cangene Corp - CNJ. (Hepatitis B immune globulin ). GamaSTAN S/D ( immune globulin ). Note: Used for post-exposure IG ( immune globulin IM) IM Talecris Biotherapeutics - TAL 90281 86. prophylaxis for Hep A and MMR. exposure immune globulin , intravenous See pkg insert Note: Rarely used for post- IGIV for dosage IV Many Manufacturers 90283 87. exposure prophylaxis and admin recommendati HyperRAB S/D (Rabies immune ons RIG IM Talecris Biotherapeutics - TAL 90375 34.)

10 globulin ). Synagis (Respiratory Syncytial RSV-IGIM Birth - 24 months IM MedImmune MED 90378 93. Virus immune globulin ). HyperTET S/D (Tetanus immune TIG IM Talecris Biotherapeutics - TAL 90389 13. globulin ). VariZIG (Varicella Zoster immune globulin ) Note: Used for post VZIG IM Cangene Corporation (Canada) CNJ 90396 36. exposure prophylaxis to Chickenpox 5/9 2016-2017. Complete List of Vaccine Names and CPT/CVX Codes Vaccine Trade name or CVX. best ASIIS Selection Age (Range) Dose Route Manufacturer/ NDC Number CPT Code Common name Code Influenza - Reflects the Vaccine for the 2016-2017 Flu Season ml 90687. Fluzone (VFC/VFA) Quadrivalent Influenza, injectable, MDV Sanofi Pasteur PMC. 6 months & older IM 158. 6+ mos (IIV4) quadrivalent ml NDC: 49281-0625-15 (10 dose vial).