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Medicare Non-covered vaccine CPT code list

cpt 90707

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:

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

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