Medicare Part B
Seasonal Influenza
- Reimbursed once per season (2 in same calendar year is fine)
- Vaccine codes:
- 90630
- 90653-90657
- 90660-90662
- 90672-90673
- 90685-90688
- Q2035-Q2039
- Administration code: G0008
- Diagnosis code: Z23
Pneumococcal
- Reimbursed for initial vaccine and second (different) vaccine 1 year later
- Reimbursed if patient unsure of vaccine hx
- Vaccine codes:
- 90670 for 13-valent (give first in series)
- 90732 for 23-valent (recommended ≥1y later, minimum window is 8 weeks)
- (If patient previously received PCV23, PCV13 is recommended ≥1y after previous PCV23, with booster PCV23 ≥5y after previous PCV23 and ≥1y after PCV13)
- Administration code: G0009
- Diagnosis code: Z23
Hepatitis B
- Covered for health care providers (exposed to blood)
- Covered for pt w ESRD, live w HepB carrier, DM
- Vaccine codes:
- 90739 – Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
- 90740 – Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
- 90746 – Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
- 90747 – Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
- Administration cose: G0010
- Diagnosis code: Z23
Vaccines related to treatment of an injury or exposure
- Requires a documented exposure to justify reimbursement
- Tetanus and diphtheria toxoids (CPT 90702, 90714, 90718)
- Tetanus toxoid (CPT 90703)
- Hepatitis A (CPT 90632-90634)
- Diptheria antitoxin (CPT 90296)
- Rabies prophylaxis (CPT 90675-90676)