How To Use CPT Code 90736

CPT 90736 describes the administration of a live vaccine subcutaneously to protect against varicella zoster infection. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 90736?

CPT 90736 can be used to describe the administration of a live vaccine subcutaneously to protect against varicella zoster infection. This code is used when a healthcare provider administers a single dose of the shingles vaccine to adults aged 60 and older.

2. Official Description

The official description of CPT code 90736 is: ‘Zoster (shingles) vaccine (HZV), live, for subcutaneous injection.’

3. Procedure

1. The healthcare provider presents the options for immunization to the parent, guardian, or patient.
2. He reviews the risks, benefits, and potential side effects of the vaccine.
3. The patient is appropriately prepped for the vaccine administration.
4. The healthcare provider administers the vaccine subcutaneously.

4. Qualifying circumstances

Patients eligible to receive CPT 90736 are adults aged 60 and older who require protection against varicella zoster infection. The vaccine is administered by a healthcare provider subcutaneously.

5. When to use CPT code 90736

CPT code 90736 should be used when a healthcare provider administers a single dose of the shingles vaccine to adults aged 60 and older. It is important to follow the recommended guidelines for the administration of this vaccine.

6. Documentation requirements

To support a claim for CPT 90736, the healthcare provider must document the following information:

• Product administered (shingles vaccine)
• Administration route (subcutaneous)
• Purpose of the vaccine (protection against varicella zoster infection)

7. Billing guidelines

When billing for CPT 90736, ensure that the vaccine is administered by a healthcare provider subcutaneously. Follow the specific guidelines of Medicare and private insurance companies for reporting this vaccine. It is important to have the policy in writing to protect your practice in case of any questions regarding modifier use.

8. Historical information

CPT 90736 was added to the Current Procedural Terminology system on January 1, 2006. The code was previously described as ‘Zoster (shingles) vaccine, live, for subcutaneous injection.’ There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider administers the shingles vaccine to a 65-year-old patient to protect against varicella zoster infection.
2. An elderly patient visits a clinic and receives the shingles vaccine from a nurse practitioner.
3. A healthcare provider administers the shingles vaccine to a 70-year-old patient during a routine check-up.
4. An adult patient receives the shingles vaccine from a physician to prevent varicella zoster infection.
5. A healthcare provider administers the shingles vaccine to a 62-year-old patient at a community health fair.
6. An elderly patient visits a pharmacy and receives the shingles vaccine from a pharmacist.
7. A healthcare provider administers the shingles vaccine to an 80-year-old patient in a long-term care facility.
8. An adult patient receives the shingles vaccine from a nurse at a local health department.
9. A healthcare provider administers the shingles vaccine to a 68-year-old patient during a home visit.
10. An elderly patient visits a hospital and receives the shingles vaccine from a physician assistant.