How To Use CPT Code 90619

CPT 90619 refers to the meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier (MenACWY-TT), for intramuscular use. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 90619 procedures.

1. What is CPT 90619?

CPT 90619 is a code used to report the administration of the meningococcal conjugate vaccine, which protects against four common forms of the meningococcal virus. This vaccine is administered intramuscularly and helps prevent the patient from contracting meningococcal diseases such as meningitis and septicemia.

2. 90619 CPT code description

The official description of CPT code 90619 is: “Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier (MenACWY-TT), for intramuscular use.”

3. Procedure

1. The provider presents the parent, guardian, or patient with the options for immunization with a meningococcal conjugate vaccine in a tetanus toxoid carrier (MenACWY–TT) that provides immunity for the serogroups A, C, W, and Y, which are known to cause most meningococcal diseases.
2. The provider reviews the risks and benefits along with the potential side effects.
3. When the patient is appropriately prepared, the provider administers one of the different brands of the vaccine (based upon availability, the age of the patient, and approved licensing), intramuscularly, usually in the deltoid muscle of the upper arm.

4. Qualifying circumstances

Meningococcal disease occurs most often in infants less than one year of age and in older patients 16 to 21 years of age. Two doses of the meningococcal conjugate vaccine, or MCV4, are given to adolescents 11 through 18 years old, with the first shot at 11 or 12 years old and a booster dose at age 16. Adolescents with HIV in these age groups get three doses; two shots, two months apart at 11 or 12 years of age, and then a booster dose at age 16. If the patient doesn’t receive the first dose or series until between the ages of 13 to 15, then the booster shot is given between 16 and 18 years of age. If the patient does not receive the first dose or series until after he is 16, then a booster is not necessary.

5. When to use CPT code 90619

It is appropriate to bill the 90619 CPT code when the provider administers the meningococcal conjugate vaccine in a tetanus toxoid carrier (MenACWY-TT) for intramuscular use, following the recommended immunization schedule for the specific age group and medical condition of the patient.

6. Documentation requirements

When billing for CPT 90619, it is essential to include sufficient documentation from the provider explaining the product administered, administration route, and purpose. Additionally, any significant, separately identifiable evaluation and management (E/M) service provided during the visit should be documented to support the use of modifier 25, if required by the payer.

7. Billing guidelines

When coding for immunizations, report separate codes for the supply of the vaccine, vaccine administration, and an appropriate E/M code for the office visit. Some insurance companies require modifier 25 (Significant, separately identifiable evaluation and management service by the same provider on the same day of the procedure or another service) to be appended to the associated E/M code. Don’t report two or more initial administration vaccine codes during the same visit. Instead, report an initial code for one vaccine and subsequent administration codes for other immunizations. Medicare and private insurance companies might have different guidelines for reporting any vaccines, or for reporting certain vaccines during the same visit, such as flu and pneumonia vaccines. Check with the individual payers for their specific guidelines and have the policy in writing to protect your practice in the event the payer questions your modifier use, which is not consistent with CPT® guidelines.

8. Historical information

CPT 90619 was added to the Current Procedural Terminology system on July 1, 2019. There have been no updates since its addition.

9. Similar codes to CPT 90619

There are other types of meningococcal conjugate vaccines, such as:

• CPT 90644: Meningococcal conjugate vaccine, serogroups C and Y, for intramuscular use in infants and young children.
• CPT 90734: Meningococcal conjugate vaccine, serogroups A, C, W, Y, for intramuscular use in individuals aged 11 years and older.
• CPT 90620: Meningococcal conjugate vaccine, serogroups A, C, W, Y, for intramuscular use in individuals aged 2 months through 55 years.
• CPT 90621: Meningococcal conjugate vaccine, serogroups A, C, W, Y, for intramuscular use in individuals aged 9 months through 55 years.
• CPT 90622: Meningococcal conjugate vaccine, serogroups A, C, W, Y, for intramuscular use in individuals aged 2 months through 18 years.

10. Examples

Here are 10 detailed examples of CPT code 90619 procedures:

1. A 12-year-old patient receives their first dose of the MenACWY-TT vaccine during a routine check-up.
2. An 11-year-old patient with HIV receives their first dose of the MenACWY-TT vaccine, followed by a second dose two months later.
3. A 16-year-old patient receives a booster dose of the MenACWY-TT vaccine after having their initial dose at age 12.
4. A 14-year-old patient receives their first dose of the MenACWY-TT vaccine and is scheduled for a booster dose at age 16.
5. A 17-year-old patient receives their first dose of the MenACWY-TT vaccine, with no booster dose necessary.
6. A 13-year-old patient receives their first dose of the MenACWY-TT vaccine and is scheduled for a booster dose at age 18.
7. An 18-year-old patient receives their first dose of the MenACWY-TT vaccine, with no booster dose necessary.
8. A 15-year-old patient receives their first dose of the MenACWY-TT vaccine and is scheduled for a booster dose at age 17.
9. A 16-year-old patient with HIV receives a booster dose of the MenACWY-TT vaccine after having their initial two doses at age 11.
10. A 19-year-old patient receives their first dose of the MenACWY-TT vaccine, with no booster dose necessary.