Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Codes (Rev. 2824, 04-07-14)

by  Jared Staheli
June 25th, 2015

Vaccines and their administration are reported using separate codes. The following codes are for reporting the vaccines only.

HCPCS Definition
90653 Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90654 Influenza virus vaccine, split virus, preservative-free, for intradermal use, for adults ages 18 – 64;
90655 Influenza virus vaccine, split virus, preservative free, for children 6- 35 months of age, for intramuscular use;
90656 Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use;
90657 Influenza virus vaccine, split virus, for children 6-35 months of age, for intramuscular use;
90660 Influenza virus vaccine, live, for intranasal use;
90661 Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use
90662 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
90669 Pneumococcal conjugate vaccine, polyvalent, for children under 5 years, for intramuscular use
90670 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use
90672 Influenza virus vaccine, live, quadrivalent, for intranasal use
90673 Influenza virus vaccine, trivalent, derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
90685 Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
90686 Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use
90687 Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use
90688 Influenza virus vaccine, quadrivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use
90732 Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use;
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;
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use;
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use;
90746 Hepatitis B vaccine, adult dosage, for intramuscular use; and
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use.

The following codes are for reporting administration of the vaccines only. The administration of the vaccines is billed using:

HCPCS Definition
G0008 Administration of influenza virus vaccine;
G0009 Administration of pneumococcal vaccine; and
*G0010 Administration of hepatitis B vaccine.
*90471 Immunization administration. (For OPPS hospitals billing for the hepatitis B vaccine administration)
*90472 Each additional vaccine. (For OPPS hospitals billing for the hepatitis B vaccine administration)

* NOTE: For claims with dates of service prior to January 1, 2006, OPPS and nonOPPS hospitals report G0010 for hepatitis B vaccine administration. For claims with dates of service January 1, 2006 until December 31, 2010, OPPS hospitals report 90471 or 90472 for hepatitis B vaccine administration as appropriate in place of G0010. Beginning January 1, 2011, providers should report G0010 for billing under the OPPS rather than 90471 or 90472 to ensure correct waiver of coinsurance and deductible for the administration of hepatitis B vaccine.

One of the following diagnosis codes must be reported as appropriate. If the sole purpose for the visit is to receive a vaccine or if a vaccine is the only service billed on a claim the applicable following diagnosis code may be used.

Diagnosis Code Description
V03.82 Pneumococcus
V04.81** Influenza
V06.6*** Pneumococcus and Influenza
V05.3 Hepatitis B

**Effective for influenza virus claims with dates of service October 1, 2003 and later.

***Effective October 1, 2006, providers may report diagnosis code V06.6 on claims for pneumococcus and/or influenza virus vaccines when the purpose of the visit was to receive both vaccines.

If a diagnosis code for pneumococcus, hepatitis B, or influenza virus vaccination is not reported on a claim, contractors may not enter the diagnosis on the claim. Contractors must follow current resolution processes for claims with missing diagnosis codes.

If the diagnosis code and the narrative description are correct, but the HCPCS code is incorrect, the carrier or intermediary may correct the HCPCS code and pay the claim. For example, if the reported diagnosis code is V04.81 and the narrative description (if annotated on the claim) says "flu shot" but the HCPCS code is incorrect, contractors may change the HCPCS code and pay for the flu vaccine. Effective October 1, 2006, carriers/AB MACs should follow the instructions in Pub. 100-04, Chapter 1, Section 80.3.2.1.1 (Carrier Data Element Requirements) for claims submitted without a HCPCS code.

Claims for hepatitis B vaccinations must report the I.D. Number of the referring physician. In addition, if a doctor of medicine or osteopathy does not order the influenza virus vaccine, the intermediary claims require:

• UPIN code SLF000 to be reported on claims submitted prior to May 23, 2008, when Medicare began accepting NPIs, only

• The provider’s own NPI to be reported in the NPI field for the attending physician on claims submitted on or after May 23, 2008, when NPI requirements were implemented.

References:

Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Codes (Rev. 2824, 04-07-14). (2015, June 25). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/healthcare-common-procedure-coding-system-hcpcs-and-diagnosis-codes-rev-2824-04-07-14-26897.html

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