How To Use CPT Code 90651

CPT 90651 refers to the administration of the nonavalent human papillomavirus (HPV) vaccine for intramuscular use. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT code 90651 procedures.

1. What is CPT 90651?

CPT 90651 is a medical billing code used to describe the administration of the nonavalent human papillomavirus (HPV) vaccine. This vaccine is designed to protect patients from infection by nine strains of the human papillomavirus and is administered intramuscularly in two or three doses. The code is used by healthcare providers to bill for the vaccine administration service.

2. 90651 CPT code description

The official description of CPT code 90651 is: Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule, for intramuscular use.

3. Procedure

1. The provider counsels the patient and their family about the risks and benefits of the nonavalent HPV vaccine, providing instructions and precautions before administration.
2. The provider preps the injection site, typically the deltoid muscle, for intramuscular injection.
3. The first dose of the nonavalent HPV vaccine is administered intramuscularly.
4. The second dose is administered two months after the first dose.
5. The third dose, if applicable, is administered six months after the first dose.

4. Qualifying circumstances

Patients eligible to receive CPT code 90651 services are those who require protection against the nine strains of human papillomavirus covered by the nonavalent HPV vaccine. This includes individuals who are at risk of developing HPV-related diseases, such as cervical cancer, genital warts, and other HPV-associated cancers. The vaccine is typically recommended for adolescents and young adults, but the specific age range and eligibility criteria may vary depending on the patient’s medical history and the healthcare provider’s recommendations.

5. When to use CPT code 90651

It is appropriate to bill the 90651 CPT code when a healthcare provider administers the nonavalent HPV vaccine to an eligible patient. The code should be used for each of the two or three doses administered as part of the vaccine schedule. It is essential to ensure that the patient meets the eligibility criteria and that the vaccine administration follows the recommended dosing schedule.

6. Documentation requirements

To support a claim for CPT 90651, healthcare providers must document the following information:

• Patient’s demographic information, including age and gender.
• Medical history and risk factors for HPV-related diseases.
• Provider’s recommendation for the nonavalent HPV vaccine, including the rationale for the 2 or 3 dose schedule.
• Date and location of each vaccine administration.
• Lot number and expiration date of the vaccine used.
• Any adverse reactions or side effects experienced by the patient.

7. Billing guidelines

When billing for CPT code 90651, healthcare providers should follow the appropriate billing guidelines and rules. This includes ensuring that the patient meets the eligibility criteria for the vaccine and that the dosing schedule is followed correctly. Additionally, providers should be aware of any payer-specific requirements or restrictions related to the billing of CPT code 90651.

8. Historical information

CPT 90651 was added to the Current Procedural Terminology system on January 1, 2015. There have been updates to the code since its addition, with changes to the descriptor on January 1, 2016, and January 1, 2017.

9. Similar codes to CPT 90651

There are several other CPT codes related to the administration of different types of HPV vaccines. These codes differ from CPT 90651 in the number of HPV strains they protect against and their dosing schedules. Some examples include:

• CPT 90649: Quadrivalent HPV vaccine (4vHPV) for intramuscular use.
• CPT 90650: Bivalent HPV vaccine (2vHPV) for intramuscular use.
• CPT 90656: Influenza virus vaccine, trivalent, for intramuscular use.
• CPT 90670: Pneumococcal conjugate vaccine, 13-valent, for intramuscular use.
• CPT 90715: Tetanus, diphtheria, and acellular pertussis vaccine (Tdap) for intramuscular use.

10. Examples

Here are ten detailed examples of CPT code 90651 procedures:

1. A 12-year-old female patient receives her first dose of the nonavalent HPV vaccine as part of her routine immunization schedule.
2. An 18-year-old male patient receives the nonavalent HPV vaccine to protect against genital warts and other HPV-related diseases.
3. A 26-year-old female patient with a history of abnormal Pap smears receives the nonavalent HPV vaccine to reduce her risk of cervical cancer.
4. A 15-year-old male patient receives the nonavalent HPV vaccine as part of a catch-up immunization schedule.
5. A 22-year-old female patient receives the second dose of the nonavalent HPV vaccine two months after her first dose.
6. A 16-year-old female patient receives the third dose of the nonavalent HPV vaccine six months after her first dose.
7. A 20-year-old male patient with a history of sexual activity receives the nonavalent HPV vaccine to protect against HPV-related diseases.
8. A 14-year-old female patient receives the nonavalent HPV vaccine as part of a school-based immunization program.
9. A 23-year-old female patient with a family history of cervical cancer receives the nonavalent HPV vaccine to reduce her risk of developing the disease.
10. A 19-year-old male patient receives the nonavalent HPV vaccine as part of a college-based immunization program.