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; 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; QuadracelYesNoYes90697146 Pre-filled syringes, 10 Pack 63361-243-15 Multidose Vial, 63361-0243-10 DTaP-IPV-Hib-HepB.

2 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; 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?

3 317 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)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.

4 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, 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.

5 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?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.

6 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; 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, for intramuscular use - trivalentpreservative-free, pediatricFluzoneTrivalent no longer being used90657141 Fluzone Multi-dose Vial 49281-0396-15 Influenza virus vaccine.

7 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)BRAND NAMEC omments9071809 Tetanus and diphteria toxoids (TD) absorbed for use in individuals 7 years or older, for intramuscular useDiphteria and Tetanus Toxoids Absorbed for Adults Use90719N/ADiphtheria toxoid9072022 Diphtheria, tetanus toxoids, whole cell pertussis and HibTetramune9073549281-680-30 Japanese EncephalitisJE-VAX90738134 Japanese encephalitis virus vaccine, inactivatedIxiaro49281-562-58 Diphtheria, tetanus, pertussis and polioQuadracel58160-830-34.

8 58160-830-52 HPV2 Cervarix1531 dose syringe, 10 pack 62577-0614-01 Influenza virus vaccine, split virus, preservative-free, for intramuscular use - trivalent - 18+ years FlucelvaxTrivalent no longer being used14449281-0709-55 Influenza, split virus, preservative-free, intradermal - trivalentFluzone IDTrivalent no longer being used9074851 Single Dose Vial, 10 Pack 00006-4898-00 (discontinued)Hepatitis B and HibComvaxNo longer on the market9063016610 single dose microinjectorsseasonal influenza, quadrivalent, intradermal, preservative freeFluzone Intradermal QuadrivalentNo longer on the market9067315510 single dose vialsseasonal influenza, trivalent, derived from recombinant DNA, preservative freeFlublok TrivalentTrivalent no longer being used9065614010 pre-filled syringesseasonal influenza, trivalent, preservative freeFluvirin TrivalentTrivalent no longer being used90658141multi-dose vial, 5 mLseasonal influenza, trivalent, with preservativeFluvirin TrivalentTrivalent no longer being used90650118 Syringes, 10 pack 58160-0830-52 Human Papilloma virus (HPV), types 16, 18 (bivalent)

9 CervarixNo longer on the Dose Vial, 1 Pack 00006-4963-41 Zoster Vaccine LiveZostavaxNo longer on the mL 10 pre-filled syringes; 33332-0221-20seasonal influenza, quadrivalent, preservative freeAFLURIA PFS no longer on the market90688158multi-dose vial, 5 mL; 19515-0897-11seasonal influenza, quadrivalent, with preservativeFluLaval QuadrivalentMultidose vial no longer on the marketCPT CodeCVXNDCANTIGEN(S)BRAND mL 10 pre-filled syringes; 49281-0519-25seasonal influenza, quadrivalent, preservative freeFluzone PFS no longer on the market9064848 ActHib Single Dose Vial, 5 Pack 49281-0545-05 Hib, PRP-T conjugate, 4 dose seriesActHIBThis NDC no longer on the market90715115 Adacel Syringes, 5 Pack 49281-0400-15 Tetanus, diphtheria toxoids and acellular pertussis vaccine (TdaP)Adacel.

10 BoostrixThis NDC no longer on the market90620163 Syringes, 1 Pack 58160-0796-06 Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscularBexseroThis NDC no longer on the market9070228 Single Dose Vial, 1 Pack 49281-0278-10 Diphtheria and tetanus toxoids, (DT), absorbed for use in individuals younger than 7 years, for intramuscular and Tetanus Toxoids AbsorbedThis NDC no longer on the market90651165 Single Dose Vial, 1 Pack 00006-4119-02 Single Dose Vial, 10 Pack 00006-4119-03 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (HPV)Gardasil 9 This NDC no longer on the market9063252 Havrix Single Dose Vial, 10 Pack 58160-0826-11 Vaqta Single Dose Vial, 10 Pack 00006-4841-41 Hepatitis A, adult dosageHavrix; VaqtaThis NDC no longer on the market9074408 Engerix-B Single Dose Vial, 10 Pack 58160-0820-11 Hepatitis B pediatric/adolescent, 3 dose seriesRecombivax HB; Engerix-BThis NDC no longer on the market9074643 Recombivax Single Dose Vial, 1 Pack 00006-4995-00 Hepatitis B, adult dosage for IM use, 3 dose seriesRecombivax HBThis NDC no longer on the market9063383 Havrix Single Dose Vial, 10 Pack 58160-0825-11 Vaqta Single Dose Vial, 10 Pack 00006-4831-41 Hepatitis A, pediatr