(2022) Medicare Non-Covered Vaccines – CPT Codes List & Billing Guidelines
With the exception of vaccinations for pneumococcal pneumonia, hepatitis B, and influenza, which are specifically covered under the law, vaccinations or inoculations are generally excluded as immunizations unless, they are directly related to the treatment of an injury or direct exposure such as antirabies treatment, tetanus antitoxin or booster vaccine, botulin antitoxin, antivenin, or immune globulin.
Immunizations, vaccinations, or inoculations are covered by Medicare only when there has been direct exposure of the associated disease to the patient and there is significant risk that the patient could contract the disease as a result of the exposure.
They are not covered as routine immunizations.
List With CPT Codes For Medicare Non-Covered Vaccines
The following CPT codes represent immunizations that are considered routine preventative immunizations or they are not a disease entity endemic in the United States and therefore are not covered by Medicare.
CPT 90476 & CPT 90477
Description of CPT 90476 & CPT 90477: Adenovirus.
CPT 90581
Description of CPT 90581: Anthrax.
CPT 90585 & CPT 90586
Description of CPT 90585 & CPT 90586: BCG.
CPT 90636
Description of CPT 90636: Hepatitis A/Hepatitis B.
CPT 90644
Description of CPT 90644: Meningococcal conjugate vaccine, serogroups c & y and hemophilus influenza b vaccine, tetanus toxoid conjugate (hib-mency-tt), 4-dose schedule, when administered to children 2-15 months of age, for intramuscular use.
CPT 90645 – CPT 90648
Description of CPT 90645 – CPT 90648: Hemophilus influenza.
CPT 90649
Description of CPT 90649: HPV.
CPT 90650
Description of CPT 90650: HPV Vaccine , Types 16, 18, Bivalent 3 dose schedule for IM use.
CPT 90665
Description of CPT 90665: Lyme disease.
CPT 90680
Description of CPT 90680: Rotavirus.
CPT 90681
Description of CPT 90681: Rotavirus, live attenuated, 2 dose schedule, oral.
CPT 90690 – CPT 90693
Description of CPT 90690 – CPT 90693: Typhoid.
CPT 90696
Description of CPT 90696: DTAP-IPV.
CPT 90698
Description of CPT 90698: DTAP P HIB IPV.
CPT 90700
Description of CPT 90700: DTaP.
CPT 90701
Description of CPT 90701: DPT.
CPT 90476
Description of CPT 90476: Mumps.
CPT 90705
Description of CPT 90705: Measles.
CPT 90706
Description of CPT 90706: Rubella.
CPT 90707
Description of CPT 90707: MMR.
CPT 90708
Description of CPT 90708: Measles and rubella.
CPT 90710
Description of CPT 90710: MMRV.
CPT 90712 & CPT 90713
Description of CPT 90712 & CPT 90713: Poliovirus.
CPT 90715
Description of CPT 90715: Tdap.
CPT 90716
Description of CPT 90716: Varicella.
CPT 90717
Description of CPT 90717: Yellow fever.
CPT 90719
Description of CPT 90719: Diphtheria toxoid.
CPT 90720
Description of CPT 90720: DTP-Hib.
CPT 90721
Description of CPT 90721: DtaP-Hib.
CPT 90723
Description of CPT 90723: DtaP-HepB-IPV.
CPT 90725
Description of CPT 90725: Cholera.
CPT 90727
Description of CPT 90727: Plague.
CPT 90733
Description of CPT 90733: Meningococcal any group S.
CPT 90734
Description of CPT 90734: Meningococcal Subgroups A, C, Y, and W-135.
CPT 90735
Description of CPT 90735: Japanese encephalitis.
CPT 90736
Description of CPT 90736: Zoster, (shingles) vaccine, live.
CPT 90738
Description of CPT 90738: Japanese encephalitis virus vaccine inactivated, for IM use (Status I code will deny as not avalid code for Medicare).
CPT 90748
Description of CPT 90748: HepB-Hib (Status I code will deny as not valid codes for Medicare).
CPT 90749
Description of CPT 90749: Unlisted vaccine.