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Medicare Non-covered vaccine CPT code list


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.

The following CPT-4 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:

90476, 90477 adenovirus
90581 anthrax
90585, 90586 BCG
90636 Hepatitis A/Hepatitis B
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
90645-90648 Hemophilus influenza
90649 HPV
90650 HPV Vaccine , Types 16, 18, Bivalent 3 dose schedule for IM use
90665 Lyme disease
90680 Rotavirus
90681 Rotavirus, live attenuated, 2 dose schedule, oral
90690-90693 Typhoid
90696 DTAP-IPV
90698 DTAP P HIB IPV
90700 DTaP
90701 DPT
90704 Mumps
90705 Measles
90706 Rubella
90707 MMR
90708 Measles and rubella
90710 MMRV
90712, 90713 Poliovirus
90715 Tdap
90716 Varicella
90717 Yellow fever
90719 Diphtheria toxoid
90720 DTP-Hib
90721 DtaP-Hib
90723 DtaP-HepB-IPV
90725 Cholera
90727 Plague
90733 Meningococcal any group S
90734 Meningococcal Subgroups A, C, Y, and W-135
90735 Japanese encephalitis
90736 Zoster, (shingles) vaccine, live
90738 Japanese encephalitis virus vaccine inactivated, for IM use (Status I code will deny as not avalid code for Medicare)
90748 HepB-Hib (Status I code will deny as not valid codes for Medicare)
90749 Unlisted vaccine

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