Immunizations Fee Schedule Rates Effective July 1 ... - Colorado
Immunizations Fee Schedule Rates Effective July 1, 2021-June 30, 2022
Procedure Code
Service Description
Age From
0001A ADM SARSCOV2 30MCG/0.3ML 1ST 12
0002A ADM SARSCOV2 30MCG/0.3ML 2ND 12
0003A FEE COVID-19 VAC 1 BOOSTER
12
0004A ADM SARSCOV2 30MCG/0.3ML BST 12
0011A ADM SARSCOV2 100MCG/0.5ML1ST 18
0012A ADM SARSCOV2 100MCG/0.5ML2ND 18
0013A FEE COVID-19 VAC 2 BOOSTER
18
0031A ADM SARSCOV2 VAC AD26 .5 ML
18
0034A ADM SARSCOV2 VAC AD26 .5ML B
18
0051A
ADM SARSCV2 30MCG TRS-SUCR 1
12
0052A
ADM SARSCV2 30MCG TRS-SUCR 2
12
0053A
ADM SARSCV2 30MCG TRS-SUCR 3
12
0054A
ADM SARSCV2 30MCG TRS-SUCR B
12
0064A
ADM SARSCOV2 50MCG/0.25MLBST
18
0071A
ADM SARSCV2 10MCG TRS-SUCR 1
5
0072A
ADM SARSCV2 10MCG TRS-SUCR 2
5
90281
Human ig im
0
90283
Human ig iv
0
90284
Human ig sc
0
90287
Botulinum antitoxin
0
90288
Botulism ig iv
0
90291
Cmv ig iv
0
90296
Diphtheria antitoxin
0
90371
Hep b ig im
0
90375
Rabies ig im/sc
0
90376
Rabies ig heat treated
0
90378
Rsv mab im 50mg
0
90384
Rh ig full-dose im
0
90385
Rh ig minidose im
0
90386
Rh ig iv
0
90389
Tetanus ig im
0
90393
Vaccina ig im
0
90396
Varicella-zoster ig im
0
90399
Immune globulin
0
90460
Im admin 1st/only component
0
90461 Im admin each addl component
0
90471
Immunization admin
0
90472 Immunization admin each addl
0
90473
Immune admin oral/nasal
0
90474 Immune admin oral/nasal addl
0
90476
Adenovirus vaccine type 4
17
90477
Adenovirus vaccine type 7
0
90619
MENACWY-TT Vaccine IM
0
90619
MENACWY-TT Vaccine IM
19
90620 Meningococcal recombiant vac 2 dose 0
90620 Meningococcal recombiant vac 2 dose 19
90621
MenB 3 dose
0
90621
MenB 3 dose
19
90632
Hepa vaccine adult im
19
90633
Hepa vacc ped/adol 2 dose im
0
90636
Hep a/hep b vacc adult im
18
90647
Hib prp-omp vacc 3 dose im
0
90647
Hib prp-omp vacc 3 dose im
18
90648
Hib prp-t vaccine 4 dose im
0
90649
4vhpv vaccine 3 dose im
9
90649
4vhpv vaccine 3 dose im
19
Age To
999 999 999 999 999 999 999 999 999 999 999 999 999
999 11 11 999 999 999 999 999 999 999 999 999 999 3 999 999 999 999 999 999 999 18 18 999 999 999 999 999 999 18 999 18 999 18 999 999 18 999 18 999 4 18 45
Special Instructions
Rate Effective 7/1/20206/30/2021
$
41.18
New Rate
Effective 7/1/2021-
Notes
6/30/2022
$
61.77 New rate effective 9/1/2021
$
41.18 $
61.77 New rate effective 9/1/2021
$
41.18 $
41.18
$
-$
41.18 New age range effective 1/5/22
$
41.18 $
61.77 New rate effective 9/1/2021
$
41.18 $
61.77 New rate effective 9/1/2021
$
41.18 $
41.18
$
41.18 $
61.77 New rate effective 9/1/2021
$
-$
41.18
$
-$
61.77 New code effective 9/29/2021
$
-$
61.77 New code effective 9/29/2021
$
-$
41.18 New code effective 9/29/2021
$
-$
41.18 New code effective 9/29/2021
$
-$
41.18
$
-$
61.77 New rate effective 11/2/2021
$
-$
61.77 New rate effective 11/2/2021
$
15.78 $
16.17
$
276.36 $
283.27
$
622.24 $
637.80
$
206.78 $
211.95
$
485.65 $
497.79
$
385.50 $
395.14
$
43.53 $
44.62
$
177.28 $
181.71
$
101.97 $
104.52
$
100.88 $
103.40
Refer to Physician Administered Drugs Fee Schedule
$
121.44 $
124.48
$
55.27 $
56.65
$
169.08 $
173.31
$
119.94 $
122.94
$
122.28 $
125.34
$
116.16 $
119.06
$
60.11 $
61.61
$
19.27 $
19.75
$
-$
-
$
19.27 $
19.75
$
11.19 $
11.47
$
19.27 $
19.75
$
11.19 $
11.47
$
36.82 $
37.74
$
36.82 $
37.74
V
$
-$
-
*
$
141.43 $
141.43 New Code, Effective 11/01/20
V
$
-$
-
*
$
169.04 $
191.75
V
$
-$
-
*
$
148.39 $
157.35
*
$
68.88 $
73.75
V
$
-$
-
*
$
102.96 $
112.35
V
$
-$
-
$
25.97 $
27.25
V
$
-$
-
V
$
-$
-
$
167.92 $
172.12
Version: 1.8 Updated: 01/19/2022
Immunizations Fee Schedule Rates Effective July 1, 2021-June 30, 2022
90650
2vhpv vaccine 3 dose im
9
18
90650
2vhpv vaccine 3 dose im
19
45
90651
9vhpv vaccine 3 dose im
9
18
90651
9vhpv vaccine 3 dose im
19
45
90654
Flu vacc iiv3 no preserv id
19
999
90655
Iiv3 vacc no prsv 0.25 ml im
0
18
90656
Flu Vaccine IIV3 im
0
18
90656
Flu Vaccine IIV3 im
19
999
90657
Iiv3 vaccine splt 0.25 ml im
0
18
90658
Iiv3 vaccine splt 0.5 ml im
0
18
90658
Iiv3 vaccine splt 0.5 ml im
19
999
90661
CCiv3 flu vac, im
0
18
90661
CCiv3 flu vac, im
19
999
V9A06C6C2INE FOR INFLUENZA FOR INJECTION INTO MUS6C5LE 999
90670
Pcv13 vaccine im
0
18
90670
Pcv13 vaccine im
19
999
90672
Laiv4 vaccine intranasal
2
18
90672
Laiv4 vaccine intranasal
19
49
90673
Riv3 vaccine no preserv im
19
49
90674 CCIIV4 VAC NO PRSV 0.5 ML IM
0
18
90674 CCIIV4 VAC NO PRSV 0.5 ML IM
19
999
90675
Rabies vaccine im
0
999
90677
PCV20 VACCINE IM
18
18
90677
PCV20 VACCINE IM
19
999
V
$
$
V
$
*
$
F
$
F V
$
F V
$
F
$
V
$
V
$
$
F V
$
F
$
$
V
$
*
$
V
$
$
$
V
$
F
$
$
V
$
-$ 167.92 $
-$ 225.65 $
19.70 $ -$ -$
17.18 $ -$ -$
15.80 $ -$
14.82 $ 55.62 $
-$ 199.98 $
-$ 22.43 $ 34.39 $
-$ 21.52 $ 241.13 $
-$ $
90680
Rv5 vacc 3 dose live oral
8 weeks 32 weeks
V
$
-$
90681
Rotavirus vaccine, line, oral
8 weeks 32 weeks
V
$
90682Influenza virus vaccine for intramuscular use 18
999
$
90685
Iiv4 vacc no prsv 0.25 ml im
19
999
$
90685
Iiv4 vacc no prsv 0.25 ml im 6 months 18
F V
$
90686
Iiv4 vacc no prsv 0.5 ml im
6 months 18
V
$
90686
Iiv4 vacc no prsv 0.5 ml im
19
999
F
$
35
90687
Iiv4 vaccine splt 0.25 ml im
6 months months
F V
$
90688
Iiv4 vaccine splt 0.5 ml im
3
18
F V
$
90688
Iiv4 vaccine splt 0.5 ml im
19
999
F
$
90696
DTaP-IPV vaccine
4
6
V
$
90697
DTaP-IPV-HIB-HEPB im
6 weeks
4
V
$
90698
Dtap-ipv/hib vaccine im
0
4
V
$
90700
Dtap vaccine < 7 yrs im
0
6
V
$
90702
Dt vaccine under 7 yrs im
0
6
V
$
90707
Mmr vaccine sc
0
18
V
$
90707
Mmr vaccine sc
19
999
*
$
90710
Mmrv vaccine sc
1
12
V
$
90713
Poliovirus ipv sc/im
0
18
V
$
90713
Poliovirus ipv sc/im
19
999
*
$
90714
Td vacc no presv 7 yrs+ im
7
18
V
$
90714
Td vacc no presv 7 yrs+ im
19
999
*
$
90715
Tdap vaccine 7 yrs/> im
7
18
V
$
90715
Tdap vaccine 7 yrs/> im
19
999
*
$
90716
Var vaccine live subq
0
18
V
$
90716
Var vaccine live subq
19
999
*
$
90723
Dtap-hep b-ipv vaccine im
0
6
V
$
90732
Ppsv23 vacc 2 yrs+ subq/im
2
18
V
$
90732
Ppsv23 vacc 2 yrs+ subq/im
19
999
*
$
90733
Mpsv4 vaccine subq
0
999
$
90734
Menacwy vaccine im
0
18
V
$
90734
Menacwy vaccine im
19
999
*
$
90736
Hzv vaccine live subq
60
999
$
90739
Hepb vacc 2 dose adult im
0
999
$
-$ 52.84 $
-$ -$ -$ 17.97 $
-$ -$ 16.82 $ -$ -$ -$ -$ -$ -$ 77.89 $ -$ -$ 34.82 $ -$ 25.62 $ -$ 46.33 $ -$ 134.37 $ -$ -$ 104.14 $ 124.43 $ -$ 127.10 $ 212.65 $ 114.59 $
Version: 1.8 Updated: 01/19/2022
172.12
239.29
20.19 -
17.61 -
16.20 -
15.19 57.01
211.86
22.99 35.25
22.06 247.16
- New Code Effective 10/1/2021 211.86 New Code Effective 10/1/2021
-
54.16 17.67
18.42
17.24 82.49 36.89 36.14 48.14 142.47 110.45 127.54 140.01 217.97 117.46
Immunizations Fee Schedule Rates Effective July 1, 2021-June 30, 2022
90740 Hepb vacc 3 dose immunsup im
0
18
90740 Hepb vacc 3 dose immunsup im
0
20
90743
Hepb vacc 2 dose adolesc im
11
15
90744
Hepb vacc 3 dose ped/adol im
0
18
90746
Hepb vaccine 3 dose adult im
18
999
90746
Hepb vaccine 3 dose adult im
19
999
90747 Hepb vacc 4 dose immunsup im
0
18
90747 Hepb vacc 4 dose immunsup im
0
999
90748
Hib-HepB vaccine
0
6
90749
Vaccine toxoid
0
999
90750
Hzv vacc recombinant im
50
999
90756
CCIIV4 VACC ABX FREE IM
2
18
90756
CCIIV4 VACC ABX FREE IM
19
999
90759 HEP B VAC 3AG 10MCG 3 DOS IM
0
999
91300 SARSCOV2 VAC 30MCG/0.3ML IM
12
999
91301 SARSCOV2 VAC 100MCG/0.5ML IM 18
999
91303 ADM SARSCOV2 VAC AD26 .5 ML IM 18
999
91305
SARSCOV2 VAC 30 MCG TRS-SUCR
12
999
91306 SARSCOV2 VAC 50MCG/0.25ML IM 18
999
91307 SARSCOV2 VAC 10 MCG TRS-SUCR
5
11
M0201 COVID-19 VACCINE HOME ADMIN
0
999
V
$
-$
*
$
58.36 $
V
$
-$
V
$
-$
V
$
-$
$
45.69 $
V
$
-$
$
58.36 $
V
$
-$
V
$
-$
*
$
149.90 $
V
$
-$
$
20.31 $
$
$
-$
$
-$
$
-$
$
-$
$
-$
$
-$
-$
* Rate taken from CDC Immunization Price List, May 1, 2021 F See flu immunization special billing manual for details
V May be available through the Vaccinations for Children (VFC) program
61.86
46.83 61.86 162.01 20.82 61.86 - New Code, Effective 9/29/2021 - New Code, Effective 10/20/2021 - New Code, Effective 11/02/2021 35.00 New Code, Effective 9/01/2021
Version: 1.8 Updated: 01/19/2022
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