How To Use CPT Code 90649

CPT 90649 refers to the administration of the quadrivalent human papillomavirus (HPV) vaccine, which provides immunity against four types of HPV. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 90649.

1. What is CPT 90649?

CPT 90649 is a medical billing code used to describe the administration of the quadrivalent human papillomavirus (HPV) vaccine. This vaccine provides immunity against four types of HPV, which are known to cause genital warts and cervical cancer. The vaccine is administered as part of a three-dose schedule, with each dose being given intramuscularly.

2. 90649 CPT code description

The official description of CPT code 90649 is: “Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use.”

3. Procedure

The 90649 procedure involves the following steps:

1. The patient is appropriately prepped for the vaccine administration.
2. The provider injects the quadrivalent HPV vaccine into the muscle belly of the upper arm.
3. The vaccine is administered as part of a three-dose schedule, with four weeks between doses.
4. The provider counsels the patient and/or their family, providing instructions and precautions before the administration of the vaccine.

4. Qualifying circumstances

Patients eligible to receive CPT code 90649 services are those who meet the following criteria:

• Individuals aged 9 to 26 years, as recommended by the Centers for Disease Control and Prevention (CDC).
• Both males and females can receive the vaccine, as it protects against genital warts and cervical cancer.
• Patients who have not previously completed the HPV vaccine series or have not received the recommended doses.
• Patients without contraindications or precautions to the vaccine, such as severe allergic reactions to any component of the vaccine or a previous dose.

5. When to use CPT code 90649

It is appropriate to bill the 90649 CPT code when the quadrivalent HPV vaccine is administered to eligible patients as part of the recommended three-dose schedule. The code should be used for each dose of the vaccine given, and it is essential to ensure that the patient meets the qualifying circumstances for receiving the vaccine.

6. Documentation requirements

To support a claim for CPT 90649, the following information needs to be documented:

• Patient’s age and gender, confirming their eligibility for the vaccine.
• Date of vaccine administration and the specific dose number (1st, 2nd, or 3rd) in the three-dose schedule.
• Confirmation that the patient has no contraindications or precautions to the vaccine.
• Details of the vaccine product administered, including the manufacturer and lot number.
• Route of administration (intramuscular).
• Site of administration (e.g., muscle belly of the upper arm).
• Provider’s signature and credentials.

7. Billing guidelines

When billing for CPT code 90649, it is important to follow these guidelines:

• Report separate codes for vaccine administration, the actual vaccine, and an office visit if applicable.
• Ensure that sufficient documentation is provided to support the claim, as outlined in the documentation requirements section.
• Be aware of any payer-specific rules or requirements related to billing for HPV vaccines.

8. Historical information

CPT 90649 was added to the Current Procedural Terminology system on January 1, 2006. The code was changed on January 1, 2016, with the previous descriptor being “Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use.”

9. Similar codes to CPT 90649

Five similar codes to CPT 90649 and how they differentiate are:

• CPT 90650: This code is for the bivalent HPV vaccine, which protects against only two types of HPV (types 16 and 18).
• CPT 90651: This code is for the nonavalent HPV vaccine, which protects against nine types of HPV.
• CPT 90460: This code is for the administration of vaccines to patients under 18 years of age, with counseling by the physician or other qualified healthcare professional.
• CPT 90471: This code is for the administration of a single vaccine without counseling.
• CPT 90472: This code is for the administration of each additional vaccine without counseling.

10. Examples

Here are 10 detailed examples of CPT code 90649 procedures:

1. A 12-year-old female patient receives her first dose of the quadrivalent HPV vaccine.
2. A 16-year-old male patient receives his second dose of the quadrivalent HPV vaccine.
3. An 18-year-old female patient receives her third and final dose of the quadrivalent HPV vaccine.
4. A 22-year-old male patient receives his first dose of the quadrivalent HPV vaccine after discussing the benefits and risks with his healthcare provider.
5. A 24-year-old female patient receives her second dose of the quadrivalent HPV vaccine, four weeks after her first dose.
6. A 26-year-old male patient receives his third and final dose of the quadrivalent HPV vaccine, completing the three-dose schedule.
7. A 14-year-old female patient receives her first dose of the quadrivalent HPV vaccine during a routine well-child visit.
8. A 20-year-old male patient receives his second dose of the quadrivalent HPV vaccine during a follow-up visit for an unrelated condition.
9. A 23-year-old female patient receives her third and final dose of the quadrivalent HPV vaccine during a visit to discuss contraceptive options.
10. A 25-year-old male patient receives his first dose of the quadrivalent HPV vaccine after being counseled on the importance of vaccination for preventing genital warts and cervical cancer.