The following uses and restrictions for Human Papilloma Virus (HPV) vaccines CPT code 90649 (Gardasil®) and CPT code 90650 (Cervarix®) are effective for claims dates of service on/after Oct.
The ICD-10-CM coding for this virus begins with vaccine administration. The code for vaccine administration or immunization is Z23 (Encounter for immunization).
Use 90472 in conjunction with 90460, 90471, or 90473. There can be only 1 first administration during a given visit. Effective for dates of service on or after October 1, 2020, encounter for immunization. Report 90461 in conjunction with 90460.
ICD-10 requires only one code (Z23) per vaccination, regardless if single or combination. Report Z23 for all vaccination diagnoses.
Group 1CodeDescriptionZ11.51*Encounter for screening for human papillomavirus (HPV)
If the immunization is related to exposure (eg, the administration of a Tdap vaccine as a part of wound care), the ICD-10 code describing the exposure should be used as the primary diagnosis code for the vaccine, and Z23 should be used as the secondary code.
--In order to prevent duplicate payment by the same carrier, CWF will edit by line item on the carrier number, the HIC number, the date of service, the flu procedure codes 90657, 90658, or 90659, the pneumonia procedure code 90732, and the administration code G0008 or G0009.
Technically, per CPT you should not need to use a modifier and payers should allow you to report additional vaccines by unit (+90472 x 2, for example). Payers that do not accept units may require you to report +90472 once, then distinguish additional vaccinations with +90472-59.
90471: Immunization administration for percutaneous, intra-dermal, subcutaneous or intramuscular injections, initial.
Use HCPCS Level II code M0201 for the additional payment for administering the COVID-19 vaccine to certain Medicare patients in their homes.
For immunization administration other than COVID-19, codes 90460–90474 are reported for the administration of the vaccine, along with the appropriate vaccine/toxoid code (90476–90756) targeting the organism.
G0312 - Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5-15 minutes.
(Gardasil®9) The administration fee for CPT code 90651(Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent [9vHPV], 2 or 3 dose schedule, for intramuscular use) is reimbursable when billed with modifier SL for males and non-pregnant females 9 through 18 years of age.
90686=Inactivated Influenza Vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5-mL dosage, for intramuscular use.
CPT® 90651 in section: Human Papilloma virus (HPV) vaccine.
Gardasil 9 is covered by most insurance plans for those in the approved age range—9 to 26—because it counts as preventive care, which is supposed to involve no charge or copay.