BEXSERO, a vaccine designed to safeguard against Meningococcal Group B disease caused by Neisseria meningitides bacteria, requires specific documentation and billing codes in order to be reimbursed by health authorities and insurance carriers. The BEXSERO CPT code 90620 specifically identifies this product as a Meningococcal Group B vaccine product, but it is ineligible for health record billing or invoice submission.
Vaccine Administration Codes:
When administering vaccines to minors under the age of 18 who require counseling before receiving them (i.e., requiring face-to-face counseling), healthcare providers use specific codes. In these cases, codes 90460 and 90461 will apply. Otherwise, codes 90471 are for initial vaccine administration, with subsequent ones designated 90472.
| CPT Code | Description | Counseling Requirement | Age Requirement |
Usage |
| 90460 | Administration with counseling for each vaccine component, first component. | Required | Under 18 | Once for each vaccine |
| 90461 | For each additional component of a vaccine, is administered with counseling. | Required | Under 18 | Used with 90460 |
| 90471 | Vaccine administration without counseling, first vaccine. | Not required | Any age | First vaccine administered |
| 90472 | For each additional vaccine administered without counseling. | Not required | Any age | Used after 90471 |
Diagnosis Codes (ICD-10 Codes):
Z23: This ICD-10 code indicates an encounter for immunization. It is a generic code used for any vaccine administration, regardless of the disease being immunized against.
Indication of BEXSERO:
BEXSERO can protect against the devastating side effects of Neisseria meningitides serogroup B infections that could become life-threatening infections, providing important protection in an emergency health situation that could become critical.
Age Group: Children between 10 and 25 years old should strongly consider receiving this vaccine to protect them against meningococcal infections, which are particularly at risk.
Approval Basis: BEXSERO was widely admired due to its ability to prompt an immunological response, with evaluation being measured against its ability to boost serum’s antimicrobial effect in killing bacteria. This measurement provides valuable data regarding BEXSERO’s success as an aid against infectious disease.
Effectiveness Across Strains: BEXSERO has been shown to cause an immune response against three serogroup B strains found across the US. However, its efficacy against different serogroup B strains remains uncertain.
Limitations and Precautions of the BEXSERO Vaccine:
BEXSERO represents an exciting development in treating meningitis B. However, as with any prescription medicine, there can be important aspects and potential adverse side effects. Here is what you should keep an eye out for:
Important Precautions and Contraindications:
Allergic Reactions: Individuals with severe reactions to any of the components that make up BEXSERO should refrain from getting it, including those who experienced intensely allergic reactions after past doses of it.
Natural Rubber Latex: The tip caps of the prefilled syringes in this vaccine contain natural rubber latex that could potentially trigger allergic reactions in those allergic to latex.
Risk of Fainting: As vaccination can trigger syncope (fainting), precautionary steps must be put in place to minimize injuries caused by falls while giving out vaccines.
Observation After Vaccination:
The need for immediate observation after vaccination is vital in preventing allergic reactions effectively.
Common Side Effects of BEXSERO:
- The most commonly mentioned side effects reported during clinical trials include:
- There is pain at the injection site (over 80 percent of patients)
- The pain of the muscles (myalgia) along with redness around the injection location (erythema) in approximately half of recipients.
- The headache and fatigue of one-third of recipients
- The injection site may become hardened nausea, as well as joint discomfort (arthralgia) is also very common.
Limited Strain Coverage: BEXSERO cannot protect against all strains of meningococcal serogroup.
Reduced Immune Response: Patients with weak immune systems or specific medical conditions might not benefit fully from vaccinations, while medications that alter immune function could increase their chance of infection after being immunized.
VACCINES FOR CHILDREN (VFC), IMMUNIZATION SERVICE CPT CODES Up To 18 YEARS 11 MONTHS OF AGE All Claims MUST Be Billed with an “SL” MODIFIER
|
CPCS/CPT Code |
Description |
Vaccine Fee Schedule Q1 2024 |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injection(s); one vaccine (single or combination vaccine/toxoid). Service limit 1 per day. | $20.64 |
| 90472 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injection(s); each additional vaccine (single or combination vaccine/toxoid). Code first initial vaccine/toxoid). | $14.65 |
| 90473 | Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid). | $16.64 |
| 90474 | Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure). | $22.97 |
| 90620 | Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use. | $211.32 |
| 90621 | Meningococcal recombinant lipoprotein vaccine, serogroup B, 2 or 3 dose schedule, for intramuscular use. | $179.70 |
| 90633 | Hepatitis A vaccine, pediatric/adolescent dosage, 2-dose schedule for intramuscular use. | $55.00 |
| 90647 | Hemophilus influenza B vaccine (Hib), PRP-OMP conjugate, 3-dose schedule for intramuscular use. | $28.87 |
| 90648 | Hemophilus influenza B vaccine (Hib), PRP-T conjugate, 4 dose schedule, for intramuscular use. | $18.00 |
| 90651 | Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (HPV). | $268.77 |
| 90670 | Pneumococcal conjugate vaccine, 13 valent, for intramuscular use. | $257.99 |
| 90672 | Influenza virus vaccine, quadrivalent, live, for intranasal use. | $27.79 |
| 90680 | Rotavirus vaccine, pentavalent, 3 dose schedule, lives, for oral use (Rotateq). | $128.00 |
| 90681 | Rotavirus vaccine, human, attenuated, 2-dose schedule, live, for oral use (Rotarix). | $120.95 |
| 90686 | Influenza virus vaccine, quadrivalent, split virus, preservative free, 0.5 ml dosage, for intramuscular use. | $22.35 |
| 90696 | Diphtheria, tetanus toxoids, acellular pertussis vaccine, and poliovirus vaccine, inactivated (DTaP-IPV), when administered to children 4 years through 6 years of age, for intramuscular use. | $75.00 |
| 90698 | Diphtheria, tetanus toxoids, acellular pertussis vaccine, hemophilus influenza Type B, and poliovirus vaccine, inactivated (DTaP-HIB-IPV), for intramuscular use. | $112.00 |
| 90700 | Diphtheria, tetanus toxoids, acellular pertussis vaccine (DtaP), when administered to individuals younger than 7 years, for intramuscular use. | $34.00 |
| 90707 | Measles, mumps, and rubella vaccine (MMR), live, for subcutaneous use. | $89.87 |
| 90710 | Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use. | $377.00 |
| 90713 | Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use. | $40.64 |
| 90714 | Tetanus and diphtheria toxoids (Td) adsorbed, preservative free, when administered to individuals 7 years or older, for intramuscular use. | $39.74 |
| 90715 | Tetanus, diphtheria toxoids, and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use. | $52.41 |
| 90716 | Varicella virus vaccine, live, for subcutaneous use. | $159.99 |
| 90723 | Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine, inactivated (DtaP-HepB-IPV), for intramuscular use. | N/A |
| 90732 | Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use. | $133.47 |
| 90734 | Meningococcal conjugate vaccine, serogoups A, C, Y and W-135 (quadtivalent), for intramuscular use (Menactra). | $148.89 |
| 90744 | Hepatitis B vaccine, pediatric/adolescent dosage; 3 dose schedules, for intramuscular use. | $30.77 |
References:
- BEXSERO Prescribing Information.
- Centers for Medicare & Medicaid Services 2021 ICD-10-CM Official Coding Guidelines.
- Centers for Disease Control and Prevention’s Immunization Information Systems (IIS). Standard code set HL7 standard code set, manufacturers (MVX).
- Centers for Disease Control and Prevention. Immunization Information Systems (IIS). Current HL7 standard code set, CVX vaccine administration records.
- American Medical Association. CPT Category I new vaccine codes with ACIP abbreviation listings long descriptors.
Frequently Asked Questions (FAQ):
What is the CPT code 90620?
CPT code 90620 appears to refer to Meningococcal protein recombinant and outer membrane vesicle vaccination serogroup B administered intramuscularly.
What age is 90620 CPT for?
CPT code 90620 has been designed specifically to protect those aged 10-25 against meningococcal virus serogroup B infection.
What is the NDC code for BEXSERO?
BEXSERO, a vaccine against meningitis B, may have multiple National Drug Codes (NDC). Each may vary based on packaging or shape, one example would be its NDC in 0.5 milliliter dose form. It could be either 4628-201-01 depending on how it has been packaged; to ensure its accuracy it should always be checked against its most recent packaging version.
What is procedure code 90621?
CPT Code 90621 identifies a Meningococcal Recombinant Lipoprotein vaccine designed for serogroup A (MenB-FHbp). Two doses should be administered intramuscularly over several months for maximum effectiveness.
What is the CPT code for meningococcal B vaccine?
Notable among Meningococcal B vaccination are CPT codes 90620 and 90621 which correspond with MenB-4C vaccines while CPT code 90621 covers MenB-FHbp vaccination.
What age is CPT code 90621 for?
CPT code 90621 has been assigned for MenB-FHbp vaccination, recommended for people between the ages of 10-25. Two doses should be administered according to this schedule which is identically structured as CPT code 90620 used to administer another form of MenB vaccine.
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