The CPT® code for Shingrix is 90750, and of course, there is only one ICD-10 code to remember for immunizations, Z23. The patient needs two doses, separated by at least 2 months.
Providers must bill with CPT code: 90750 - Zoster (shingles) vaccine, (HZV), recombinant, sub-unit, adjuvanted, for intramuscular injection.
The Affordable Care Act (ACA) requires all Health Insurance Marketplace plans and most other private health insurance plans to cover all ACIP-recommended vaccines, including SHINGRIX, with no cost sharing (deductibles, copayments, or coinsurance) if administered in-network.
That's because the federal program that insures most seniors in the U.S. provides poor coverage for some recommended vaccines, including shingles, and could leave some people paying $200 or more for protection.
ICD-10 code B02 for Zoster [herpes zoster] is a medical classification as listed by WHO under the range - Certain infectious and parasitic diseases .
The 90460 code is used when a physician is present and performs face-to-face counseling to the caregiver or parent. This code can only be used for patients through age 18. Code 90471 is used when the drug is administrated by a medical assistant or nurse and the patient does not see the physician at all.
However, Medicare Part B may cover a doctor's visit to get a prescription for the shingles vaccine. Most Medigap plans, also called Medicare supplement plans, don't cover the shingles vaccine because they don't include prescription drug coverage.
Yes. 100% of Medicare prescription drug plans cover this drug.
Does Medicare cover Shingrix? Yes, all Medicare Part D plans cover this drug, and Medicare Advantage plans with built-in Part D coverage will also cover Shingrix. Also, you may not need a prescription if you are paying for this drug yourself.
CPT Code (Product):90750ICD-10-CM Code (Encounter for Immunization):Z23Administration Modifier for Medicare:GYMVX Code:SKBCVX Code:187†1 more row
Medicare Part A (inpatient hospital insurance) or Medicare Part B (outpatient medical insurance), components of Original Medicare, won't cover shingles vaccines. Other Medicare supplement plans, like Medigaps, don't cover shingles vaccines either.
Depending on the plan, those with Medicare may have to pay upfront and receive reimbursement or pay a non-reimbursable copay. If you have not yet satisfied your Medicare deductible, you may have to pay the entire amount out-of-pocket. The cost for the Shingrix vaccine ranges from $0 to $164.