PDF GSK Vaccines in Your Practice.

GSK Vaccines in Your Practice.

A vaccines coding and reporting resource for healthcare professionals.

Use this handy summary of CPT and NDC codes for proper coding and reporting of GSK vaccines.

For more information, visit and:

? Access the most current product codes for GSK pediatric, adolescent, and adult vaccines ? Find common diagnosis and administration codes ? Explore the claims process as it relates to GSK vaccines ? Get information on special coding circumstances ? Understand the process for appealing denied claims ? Find additional resources for your practice

For specific questions related to any GSK vaccine products, please refer to the full Prescribing Information for the product.

is not intended to serve as comprehensive training on medical billing and coding nor is it intended to direct the use of specific vaccine products for individual patients. Only a trained medical professional using professional judgment and clinical skills can make the informed decision on when to administer a specific vaccine to a particular patient.

CPT and NDC Codes for GSK Vaccines

Codes are believed to be accurate as of the date of publication. Users should independently verify accuracy.

BRAND

CPT CODE DOSAGE

DESCRIPTION NDCs*

90620

0.5 mL

Syringe in Package of 1 Syringe:

Outer Carton:

Syringe in Package of 10 Syringe:

Outer Carton:

NDC 58160-976-02 NDC 58160-976-06

NDC 58160-976-02 NDC 58160-976-20

90715

0.5 mL

Vial in Package of 10 Vial:

Outer Carton:

Syringe in Package of 1 Syringe:

Outer Carton:

Syringe in Package of 10 Syringe:

Outer Carton:

NDC 58160-842-01 NDC 58160-842-11

NDC 58160-842-05 NDC 58160-842-34

NDC 58160-842-43 NDC 58160-842-52

90744

10 mcg/ 0.5 mL

Vial in Package of 10 Vial:

Outer Carton:

Syringe in Package of 10 Syringe:

Outer Carton:

NDC 58160-820-01 NDC 58160-820-11

NDC 58160-820-43 NDC 58160-820-52

90746

20 mcg/mL

90747

(Dialysis or immunosuppressed patient)

Vial in Package of 10 Vial:

Outer Carton:

Syringe in Package of 1 Syringe:

Outer Carton:

Syringe in Package of 10 Syringe:

Outer Carton:

NDC 58160-821-01 NDC 58160-821-11

NDC 58160-821-05 NDC 58160-821-34

NDC 58160-821-43 NDC 58160-821-52

90686

0.5 mL

Syringe in Package of 10 Syringe:

Outer Carton:

NDC 58160-896-41 NDC 58160-896-52

90686

0.5 mL

Syringe in Package of 10 Syringe:

Outer Carton:

NDC 19515-906-41 NDC 19515-906-52

*Note that some payers require an 11-digit NDC, which involves adding a "0" immediately after the first hyphen in each GSK NDC. For example, when reporting NDC 58160-820-11 to TRICARE, it becomes NDC 58160-0820-11.

Continued on next page.

BRAND

CPT CODE 90633

DOSAGE

720 EL.U./ 0.5 mL

90632

1440 EL.U./mL

90648

0.5 mL

90700

0.5 mL

90696

0.5 mL

90734

0.5 mL

DESCRIPTION NDCs*

Vial in Package of 10 Vial:

Outer Carton:

Syringe in Package of 10 Syringe:

Outer Carton:

NDC 58160-825-01 NDC 58160-825-11

NDC 58160-825-43 NDC 58160-825-52

Vial in Package of 10 Vial:

Outer Carton:

Syringe in Package of 1 Syringe:

Outer Carton:

Syringe in Package of 10 Syringe:

Outer Carton:

NDC 58160-826-01 NDC 58160-826-11

NDC 58160-826-05 NDC 58160-826-34

NDC 58160-826-43 NDC 58160-826-52

Supplied as package of 10 doses:

Vial of lyophilized vaccine in Package of 10

Saleable Unit: Outer Carton:

Vial of saline diluent in Package of 10 Saleable Unit: Outer Carton:

NDC 58160-818-11

NDC 58160-816-01 NDC 58160-816-05

NDC 58160-817-01 NDC 58160-817-05

Vial in Package of 10 Vial:

Outer Carton:

Syringe in Package of 10 Syringe:

Outer Carton:

NDC 58160-810-01 NDC 58160-810-11

NDC 58160-810-43 NDC 58160-810-52

Vial in Package of 10 Vial:

Outer Carton:

Syringe in Package of 10 Syringe:

Outer Carton:

NDC 58160-812-01 NDC 58160-812-11

NDC 58160-812-43 NDC 58160-812-52

Vial in Package of 10 5 vials containing MenA lyophilized

conjugate component: 5 vials containing

MenCYW-135 liquid conjugate component:

Outer Carton:

NDC 58160-958-01

NDC 58160-959-01 NDC 58160-955-09

*Note that some payers require an 11-digit NDC, which involves adding a "0" immediately after the first hyphen in each GSK NDC. For example, when reporting NDC 58160-820-11 to TRICARE, it becomes NDC 58160-0820-11.

Continued on next page.

BRAND

CPT CODE DOSAGE

90723

0.5 mL

DESCRIPTION NDCs*

Syringe in Package of 10 Syringe:

Outer Carton:

NDC 58160-811-43 NDC 58160-811-52

90675

90681 90750 90636

1.0 mL

RABAVERT is supplied as a 1.0 mL Single dose kit:

Package contents: 1 vial of freeze-dried

vaccine containing a single dose:

1 disposable prefilled syringe of sterile diluent for

reconstitution (1 mL):

NDC 58160-964-12 NDC 58160-966-01 NDC 58160-967-02

1 mL

Vial and applicator in Package of 10 Saleable Unit: Applicator: Outer Carton:

NDC 58160-851-01 NDC 58160-853-02 NDC 58160-854-52

0.5 mL

Outer package of 1 dose: 1 vial of adjuvant suspension: 1 vial of lyophilized gE antigen:

Outer package of 10 doses: 10 vials of adjuvant suspension: 10 vials of lyophilized gE antigen:

NDC 58160-819-12 NDC 58160-829-01 NDC 58160-828-01

NDC 58160-823-11 NDC 58160-829-03 NDC 58160-828-03

1 mL

Vial in Package of 10 Vial:

Outer Carton:

Syringe in Package of 1 Syringe:

Outer Carton:

Syringe in Package of 10 Syringe:

Outer Carton:

NDC 58160-815-01 NDC 58160-815-11

NDC 58160-815-05 NDC 58160-815-34

NDC 58160-815-43 NDC 58160-815-52

For more information about the claims process and codes for GSK vaccines, visit .

*Note that some payers require an 11-digit NDC, which involves adding a "0" immediately after the first hyphen in each GSK NDC. For example, when reporting NDC 58160-820-11 to TRICARE, it becomes NDC 58160-0820-11.

References: American Medical Association. CPT? Category I New and Revised Vaccine Codes (Including Incorporation of ACIP Abbreviations Listing) Long Descriptors. Updated January 8, 2018. . Accessed January 16, 2018. American Medical Association. Current Procedural Terminology 2018: Standard Edition. Chicago, IL: AMA Press; 2017. Medicare Claims Processing Manual Chapter 26 - Completing and Processing Form CMS-1500 Data Set. Rev. 3881, October 2017. website managed by the Centers for Medicare & Medicaid Services. . Accessed January 9, 2018. Office injectable guidelines; National drug code (NDC) pricing and filing tips. Humana Military website. . Accessed January 9, 2018. For additional questions, please contact the GSK Vaccines Reimbursement Support Center at 855-636-8291. All trademarks are the property of their respective owners.

?2018 GSK group of companies or its licensor. Printed in USA. 1006239R0 July 2018

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