Shingrix is a vaccine for shingles. Shingrix can be billed using CPT code 90750, CPT code 90471 and CPT code 90472. The ICD 10 code for Shingrix is Z23 Let me provide you with a description of the CPT codes for Shingrix and the relevant billing guidelines.
As per the American Medical Association, CPT 90750 refers to toxoids and vaccinations. It involves a physician administering an adjuvanted vaccination into a muscle to protect the patient against varicella zoster. The Shingrix kit contains two single-use vials; one with lyophilized glycoprotein E antigen powder and the other with suspension liquid as described by AAPC.
For types of injections (subcutaneous, intradermal or percutaneous) of vaccines (alone or in combination with toxins) into a patient’s body you can utilize CPT code 90471.
You can utilize the CPT code 90472 for administering vaccinations whether they are combination vaccines/toxins. This code covers injections given intramuscularly, intradermally, subcutaneously or percutaneously.
ICD 10 CM Z23
The ICD 10 CM code Z23 indicates that immunizations were given during a medical encounter and can be used for Shingrix.
- When billing for the Zoster (shingles) vaccination, healthcare providers should use the CPT code 90750.
- For immunization consultations, make sure to include the ICD 10 CM code Z23 when submitting a Shingrix shot.
- When invoicing for the Zoster (shingles) vaccine (HZV) sub unit adjuvanted, for injection, providers must use the correct CPT code.
- The Medicaid coverage unit for the Shingrix vaccine is half a milliliter.
- Providers must ensure they use the 11-digit National Drug Code (NDC) units.
- Reimbursement per Shingrix unit is capped at $144.20.
- The acceptable format to report NDC units is “UN1.”
Below are three billing examples of situations when Shingrix can be billed.
Example 1: A man goes to his doctor for a checkup. He is diagnosed with herpes zoster, commonly known as shingles. Since the patient is, over 50, the doctor recommends getting the Shingrix vaccine against shingles. With the patients consent, the doctor will administer the vaccine through a muscle injection.
In this case, the CPT 90750 can be used to record the administration of the Shingrix vaccine.
Example 2: The school nurse often provides four vaccines to adolescents during an immunization consultation session. These include vaccinations for disease, measles, mumps, rubella (MMR) human papillomavirus (HPV) and influenza.
To document these four immunizations given to adolescents, the CPT code 90750 for Shingrix was billed.
Example 3: During a well-child visit a pediatrician administers three vaccines to an infant. The DTaP vaccine protects against diphtheria, tetanus and pertussis; PCV13 guards against disease; and Hib vaccine protects against Hemophilus influenza type b infection.
If all three of these immunizations are given together by a pediatrician, during one appointment they can use CPT code 90750 for Shingrix for documentation purposes.