by Miss Kimberly Legros II
Published 2 years ago
Updated 1 year ago
3 min read
ICD-10-CM diagnosis code required for billing is Z23 - Encounter for immunization. Providers must bill with CPT code: 90750 - Zoster (shingles) vaccine, (HZV), recombinant, sub-unit, adjuvanted, for intramuscular injection. One Medicaid unit of coverage is 0.5 mL. The maximum reimbursement rate per unit is $144.20.Feb 7, 2018
What is the ICD-10 code for Shingrix vaccine?
CPT Code (Product):90750ICD-10-CM Code (Encounter for Immunization):Z23Administration Modifier for Medicare:GYMVX Code:SKBCVX Code:187†1 more row
What is the ICD-10 code for vaccine?
ICD-10 requires only one code (Z23) per vaccination, regardless if single or combination. Report Z23 for all vaccination diagnoses.
What is the age limit for CPT code 90750?
POLICY Shingrix (90750) (zoster vaccine) does not require a prior authorization for ages 50 and above. Zostavax (90736) (zoster vaccine) does not require a prior authorization for ages 60 and above.
When do you use code Z23?
encounter for a vaccinationCode Z23 is used to indicate any encounter for a vaccination. The procedure codes are used to identify the type of the immunization given and how it was administered. All Z codes must be accompanied by a corresponding procedure code.
What is diagnosis code Z71 89?
Other specified counselingICD-10 code Z71. 89 for Other specified counseling is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
Zostavax is a live virus vaccine. It can be administered concurrently with all other live and inactivated vaccines, including those routinely recommended for people 60 years old and older, such as influenza and pneumococcal vaccines.
What is the ICD 10 code for shingles?
ICD-10 code B02 for Zoster [herpes zoster] is a medical classification as listed by WHO under the range - Certain infectious and parasitic diseases .
Does Medicare pay for administration of Zostavax?
Medicare coverage for Shingrix and Zostavax, the two commercially available shingles vaccines, is provided only if you are enrolled in a stand-alone Part D drug plan or a Medicare Advantage plan that includes Part D drug coverage.
Is Z23 a primary diagnosis?
Z23 may be used as a primary diagnosis for immunizations in the OP and physician setting.
Is Z23 a billable code?
Z23 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z23 became effective on October 1, 2021.
What is the appropriate coding for injections immunizations and vaccines?
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.
Does Medicare pay for 90750?
Coverage for shingles vaccine Original Medicare doesn't pay for this immunization under Part A or Part B. That means, medical practice can't give it to Medicare patients and be reimbursed for it.
What is the age for CPT 90700?
90700 diphtheria, tetanus toxoids, acellular pertussis vaccine (DtaP), when administered to individuals younger than 7 years, for intramuscular use.
How do I bill my Shingrix vaccine?
CPT Code (Product is SHINGRIX), use CPT Code 90750 - Zoster (shingles) vaccine, (HZV), recombinant, sub-unit, adjuvanted, for intramuscular injection.
Is 90714 covered by Medicare?
Claims for CPT codes 90702, 90714, J1670 are payable under Medicare Part B in the following places of service: office (11), urgent care facility (20) , nursing facility (32), and independent clinic (49).
Dosage Forms and Strengths
Zostavax is a lyophilized preparation of live, attenuated varicella-zoster virus (Oka/Merck) to be reconstituted with sterile diluent to give a single dose suspension with a minimum of 19,400 PFU (plaque forming units) when stored at room temperature for up to 30 minutes.
Hypersensitivity Do not administer Zostavax to individuals with a history of anaphylactic/anaphylactoid reaction to gelatin, neomycin or any other component of the vaccine. Neomycin allergy manifested as contact dermatitis is not a contraindication to receiving this vaccine. {1}
Immunosuppression Do not administer Zostavax to individuals who are immunodeficient or immunosuppressed due to disease or therapy, as serious or fatal disseminated vaccine strain varicella-zoster virus disease may occur. Causes of immunodeficiency or immunosuppression may include, but are not limite…
Hypersensitivity Reactions Serious adverse reactions, including anaphylaxis, have occurred with Zostavax. Adequate treatment provisions, including epinephrine injection (1:1,000), should be available for immediate use should an anaphylactic/anaphylactoid reaction occur.
Transmission of Vaccine Virus Transmission of vaccine virus may occur between vaccinees and susceptible contacts.
Concomitant Administration with Other Vaccines In a randomized clinical study, a reduced immune response to Zostavax as measured by gpELISA was observed in individuals who received concurrent administration of PNEUMOVAX® 23 and Zostavax compared with individuals who received these vaccines 4 weeks apart. Consider admi…
Antiviral Medications Concurrent administration of Zostavax and antiviral medications known to be effective against VZV has not been evaluated.
Pregnancy Risk Summary Zostavax is contraindicated for use in pregnant women because the vaccine contains live, attenuated varicella-zoster virus, and it is known that wild-type varicella-zoster virus, if acquired during pregnancy, can cause congenital varicella syndrome [see Contraindications (4…
Lactation Risk Summary It is not known whether varicella-zoster vaccine virus is excreted in human milk. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for Zostavax, and any potential adverse effects on the breastfed child fro…
Zostavax is a lyophilized preparation of the Oka/Merck strain of live, attenuated varicella-zoster virus (VZV). Zostavax, when reconstituted as directed, is a sterile suspension for subcutaneous administration. Each 0.65-mL dose contains a minimum of 19,400 PFU (plaque-forming units) of Oka/Merck strain of VZV when reconstituted and stored at room temperature for up to 30 minut…
Mechanism of Action The risk of developing zoster appears to be related to a decline in VZV-specific immunity. Zostavax was shown to boost VZV-specific immunity, which is thought to be the mechanism by which it protects against zoster and its complications. [See Clinical Studies (14).] Herpes zoster …
Carcinogenesis, Mutagenesis, Impairment of Fertility Zostavax has not been evaluated for its carcinogenic or mutagenic potential, or its potential to impair fertility.