How To Use CPT Code 90750

CPT 90750 refers to the administration of the zoster (shingles) vaccine, specifically the recombinant, subunit, adjuvanted 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 90750 procedures.

1. What is CPT 90750?

CPT 90750 is a medical billing code used to represent the administration of the zoster (shingles) vaccine. This code specifically refers to the recombinant, subunit, adjuvanted vaccine that is administered intramuscularly. The vaccine is used to protect patients against varicella zoster infection, which causes shingles.

2. 90750 CPT code description

The official description of CPT code 90750 is: “Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use.”

3. Procedure

The 90750 procedure involves the following steps:

1. The provider discusses the vaccine options with the patient, guardian, or parent, reviewing the risks, benefits, and potential side effects.
2. The patient is appropriately prepped for the vaccine administration.
3. The provider administers the recombinant, subunit, adjuvanted zoster vaccine intramuscularly.
4. Post-vaccination, the provider monitors the patient for any immediate adverse reactions and provides necessary care if needed.

4. Qualifying circumstances

Patients eligible to receive CPT code 90750 services are typically adults aged 60 and older, as they are at a higher risk of developing shingles. However, the vaccine may also be recommended for individuals aged 50 and older, depending on their medical history and risk factors. It is essential for healthcare providers to evaluate each patient’s individual circumstances and medical history to determine if the zoster vaccine is appropriate for them.

5. When to use CPT code 90750

It is appropriate to bill the 90750 CPT code when a healthcare provider administers the recombinant, subunit, adjuvanted zoster vaccine to a patient intramuscularly. This code should be used for patients who meet the qualifying age and risk criteria and have been properly informed about the vaccine’s risks, benefits, and potential side effects.

6. Documentation requirements

To support a claim for CPT 90750, the following information should be documented:

• Patient’s age and relevant medical history
• Provider’s discussion with the patient, guardian, or parent about the vaccine’s risks, benefits, and potential side effects
• Consent for the vaccine administration
• Specific vaccine product administered
• Administration route (intramuscular)
• Date of vaccine administration
• Any observed adverse reactions and subsequent care provided, if applicable

7. Billing guidelines

When billing for CPT code 90750, it is essential to follow the appropriate guidelines and rules. These include reporting separate codes for the vaccine administration, the actual vaccine, and an office visit if applicable. Ensure that the documentation provided by the healthcare provider contains all the necessary information to support the claim, as outlined in the documentation requirements section.

8. Historical information

CPT 90750 was added to the Current Procedural Terminology system on January 1, 2017. The code was updated on January 1, 2018, with a change in the descriptor from “Zoster (shingles) vaccine (HZV), recombinant, sub-unit, adjuvanted, for intramuscular injection” to the current description.

9. Similar codes to CPT 90750

Five similar codes to CPT 90750 and how they differ are as follows:

1. CPT 90670: This code is used for the administration of the pneumococcal conjugate vaccine, which protects against pneumonia and meningitis.
2. CPT 90715: This code represents the administration of the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, which protects against three bacterial infections.
3. CPT 90732: This code is for the administration of the pneumococcal polysaccharide vaccine, which also protects against pneumonia and meningitis but is a different formulation than the conjugate vaccine.
4. CPT 90746: This code refers to the administration of the hepatitis B vaccine for adults, which protects against the hepatitis B virus.
5. CPT 90662: This code is used for the administration of the high-dose influenza virus vaccine, which provides enhanced protection against the flu for older adults.

10. Examples

Here are 10 detailed examples of CPT code 90750 procedures:

1. A 65-year-old patient with no history of shingles receives the zoster vaccine after discussing the risks and benefits with their healthcare provider.
2. A 58-year-old patient with a weakened immune system due to an autoimmune disease receives the zoster vaccine as a precautionary measure.
3. A 62-year-old patient with a history of shingles receives the zoster vaccine to reduce the risk of recurrence.
4. A 70-year-old patient with no history of shingles receives the zoster vaccine during their annual wellness visit.
5. A 55-year-old patient with a family history of shingles receives the zoster vaccine after discussing the risks and benefits with their healthcare provider.
6. A 60-year-old patient with a history of chickenpox receives the zoster vaccine to reduce the risk of developing shingles.
7. A 66-year-old patient with a weakened immune system due to cancer treatment receives the zoster vaccine as a precautionary measure.
8. A 75-year-old patient with no history of shingles receives the zoster vaccine during a routine check-up.
9. A 50-year-old patient with a high risk of developing shingles due to their occupation receives the zoster vaccine after discussing the risks and benefits with their healthcare provider.
10. A 68-year-old patient with a history of shingles receives the zoster vaccine to reduce the risk of postherpetic neuralgia, a complication of shingles.