VFC Public Clinic CPT Code CVX NDC PRESENTATION ...

1 CPT CodeCVXNDCANTIGEN(S)BRAND NAMEVFC COVERED?317 Adults Covered? Public Clinic "Billables"?9070228 Single Dose Vial, 10 Pack 49281-0225-10DT; diphtheria and tetanus toxoids, adsorbed, for use in individuals younger than 7 years, for intramuscular useDiphtheria and Tetanus Toxoids Adsorbed (no brand name)YesNoYes9070020 Infanrix Syringes, 10 Pack 58160-0810-52 DTaP; diphtheria, tetanus toxoids, and acellular pertussis vaccine for use in individuals younger than seven years, for intramuscular useInfanrixYesNoYes90700106 Single Dose Vial, 10 Pack 49281-0286-10 DTaP.

2 Diphtheria, tetanus toxoids, and acellular pertussis vacine for use in individuals younger than seven years, for intramuscular useDAPTACEL YesNoYes90723110 Syringes, 10 Pack 58160-0811-52 DTaP-Hep B-IPV; diphtheria, tetanus toxoids, acellular pertussis, hepatitis B, inactivated polio virus vaccinePediarixYesNoYes90698120 Single Dose Vial, 5 Pack 49281-0511-05 DTaP-Hib-IPV; diphtheria, tetanus toxoids, acellular pertussis, haemophilus influenza type B, inactivated polio virus vaccinePentacelYesNoYes90696130 Quadracel Multi-dose Vial 49281-0562-10 Quadracel Syringes, 10 Pack 49281-0564-15 Kinrix Syringes, 10 Pack 58160-0812-52 Dtap-IPV; combined Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine, inactivated, when administered to children 4 years through 6 years of age, for intramuscular useKinrix.

3 QuadracelYesNoYes90697146 Pre-filled syringes, 10 Pack 63361-243-15 Multidose Vial, 63361-0243-10 DTaP-IPV-Hib-HepB; diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b PRP-OMP conjugate vaccine, and hepatitis B vaccine, for intramuscular useVaxelisYesNoYes9063252 Havrix Syringes, 10 Pack 58160-0826-52 Vaqta Single Dose Vial, 10 Pack 00006-4096-02 Hepatitis A, adult dosageHavrix; VaqtaAge 18 onlyYesYes9063383 Havrix Syringes, 10 Pack 58160-0825-52 Vaqta Syringes, 10 Pack 00006-4095-02 Hepatitis A, pediatric/adolescent, 2 dose seriesHavrix; VaqtaYesNoYes90636104 Syringes, 10 Pack 58160-0815-52 HepA-HepB; Hepatitis A, Hepatitis B Adult, 3 dose seriesTwinrixAge 18 onlyYesYes9074408 Recombivax Single Dose Vial, 10 Pack 00006-4981-00 Recombivax Syringes, 10 Pack 00006-4093-02 Engerix-B Syringes, 10 Pack 58160-0820-52 Hepatitis B pediatric/adolescent, 3 dose seriesRecombivax HB.

4 Engerix-BYesNoYesPUBLIC HEALTH DIVISIONI mmunization ProgramState-Supplied Vaccine Billing CodesLast Updated: August 10, 2022 ICD-10 code for all routine immunizations is Z23 CPT CodeCVXNDCANTIGEN(S)BRAND NAMEVFC COVERED?317 Adults Covered? Public Clinic "Billables"?Recombivax Single Dose Vial, 10 Pack 00006-4995-41 NoNoNoEngerix-B Single Dose Vial, 10 Pack 58160-0821-11 Engerix-B Syringe, 10 Pack 58160-0821-52 Age 18 onlyYesYes90739189 Single Dose Vial, 5 pack 43528-0003-05 Hepatitis B Vaccine, Recombinant, Adjuvanted, adult dosageHeplisav-BAge 18 onlyYesYes90759220 Single Dose Vial, 10-pack 75052-0001-10 Hepatitis B Vaccine, Recombinant, 3-antigen, Al(OH)

5 3 PreHevbrioNoNoNo9064749 Single Dose Vial, 10 Pack 00006-4897-00 Hib, PRP-OMP conjugate, 3 dose seriesPedvaxHIBYesYesYes9064848 ActHib Single Dose Vial, 5 Pack 49281-0545-03 Hiberix Single Dose Vial, 10 Pack 58160-0818-11 Hib, PRP-T conjugate, 4 dose seriesActHIB; HiberixYesYesYes90651165 Syringes, 10 Pack 00006-4121-02 HPV; human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalentGardasil 9 YesNoYes9071310 Multi-dose Vial, 49281-0860-10 IPV; Poliovirus, InactivatedIPOLYesNoYes90734114 Single Dose Vial, 5 Pack 49281-0589-05 Meningococcal Conjugate A,C,Y, W-135 MenactraYesNoYes90619203 Single Dose Vial, 5 Pack 49281-0590-05 Meningococcal Conjugate A,C,Y, WMenQuadfiYesNoYes90734136 Single Dose Vial, 5 Pack 58160-0955-09 Meningococcal Conjugate A,C,Y, W-135 MenveoYesNoYesSyringes, 10 Pack 00005-0100-10 YesNoYesSyringes, 5 Pack 00005-0100-05 NoNoNo90620163 Syringes, 10 Pack 58160-0796-20 Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule.

6 For intramuscular useBexseroYesNoYes9070703 Single Dose Vial, 10 Pack 00006-4681-00 MMR; Measles, Mumps, RubellaMMRIIYesSomeYes9070703 Single Dose Vial, 10 Pack 58160-0824-15 MMR; Measles, Mumps, RubellaPriorixComing SoonSome, Coming SoonComing Soon9071094 Single Dose Vial, 10 Pack 00006-4171-00 MMRV; Measles, Mumps, Rubella, VaricellaPROQUADYesNoYesSyringe, 10 Pack 00006-4943-03 YesYesYesSingle Dose Vials, 10 Pack 00006-4943-00 NoNoNoSyringe, 10 Pack 00005-1971-02 YesNoYesSyringe, 1 Pack 00005-1971-05 NoNoNo90671215 Syringe, 10 Pack 00006-4329-03 PCV15; pneumococcal conjugate, 15 valentVaxneuvanceNoYesYes90677216 Syringe, 10 Pack 00005-2000-10 PCV20.

7 Pneumococcal conjugate vaccine, 20 valentPrevnar 20 NoYesYes90681119 Engerix-B Syringes, 10 Pack 58160-0821-52 RotavirusRotarixYesNoYes90680116 Single Dose Tubes, 10 Pack 00006-4047-41 Single Dose Tubes, 25 Pack 00006-4047-20 RotavirusROTATEQYesNoYes9074643 Hepatitis B, adult dosage for IM use, 3 dose seriesRecombivax HB; Engerix-B90621162 Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular useTrumenba9073233 PPSV23; pneumococcal polysaccharide, 23 valentPneumovax 2390670133 PCV13; pneumococcal conjugate vaccine, 13 valentPrevnar13 CPT CodeCVXNDCANTIGEN(S)BRAND NAMEVFC COVERED?

8 317 Adults Covered? Public Clinic "Billables"?90715115 Adacel Single Dose Vial, 10 Pack 49281-0400-20 Boostrix Single Dose Vial, 10 Pack 58160-0842-11 Boostrix Syringes, 10 Pack 58160-0842-52 Tdap; tetanus, diphtheria toxoids and acellular pertussis vaccineAdacel; BoostrixYesYesYes90714113 Tenivac Single Dose Vial, 1 Pack 49281-0215-10 Tenivac Syringes, 10 Pack 49281-0215-15 TDVAX Single Dose Vial, 10 Pack 135330-0131-01Td; preservative-free tetanus and diphtheria toxoidsTenivac; TDVAXYesYesYes9071621 Single Dose Vial, 10 Pack 00006-4827-00 VaricellaVarivaxYesSomeYes90611206 Single Dose Vial, 20 Pack 50632-0001-01 Vaccinia, smallpox monkeypox vaccine, live attenuated, preservative freeJynneosNoYesNoNoNoYesNoNoYes90750187 2 Components, Single Dose 58160-0819-122 Components, Multidose Vial 58160-0823-11 Zoster Vaccine Recombinant, AdjuvantedShingrixCPT CodeCVXNDCANTIGEN(S)BRAND NAMEC omments9063484 Hepatitis A, 3 dose seriesHavrix.

9 Vaqta9064547 Hib, HbOC conjugate, 4 dose seriesHibTITTER (no longer on the market)9064646 Hib, PRP-D conjugate, booster dose onlyProHibit (no longer on market)(no longer on the market)90654144 Microinjection System, 10 Pack 49281-709-55 Influenza virus vaccine, split virus, preservative free, for intradermal use - trivalentFluzone, intradermalTrivalent no longer being used90655140 Influenza virus vaccine, split virus, preservative free, for use in individuals 6-35 months of age, for intramuscular use - trivalentFluzone, preservative-free, pediatricTrivalent no longer being used90655140 Influenza virus vaccine, split virus, preservative free, for use in individuals 6-35 months of age.

10 For intramuscular use - trivalentpreservative-free, pediatricFluzoneTrivalent no longer being used90657141 Fluzone Multi-dose Vial 49281-0396-15 Influenza virus vaccine, split virus - trivalent - when given as a doseFluzone Trivalent Multidose VialsTrivalent no longer being used9066011166019-0108-10 - 10 prefilled, single-use sprayers66019-0107-01 - 10 prefilled, single-use sprayers66019-1019-01 Influenza virus vaccine, live, for intranasal use - trivalentFlumistTrivalent no longer being used906611531 dose syringe, 10 pack 62577-0614-01 Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use - trivalentFlucelvaxTrivalent no longer being used9067214966019-0302-10 Influenza virus vaccine, quadrivalent, live, for intranasal useFluMist QuadrivalentCurrently not recommended for use in 2016-17 season9070335 Tetanus toxoid absorbed9070407 Mumps virus vaccine9070505 Measles virus vaccine9070606 Rubella virus vaccine, live9070804 Measles and rubella virus vaccineHISTORICAL ONLYCPT CodeCVXNDCANTIGEN(S)