Medicaid Vaccine Administration Codes

[Pages:1]Medicaid Vaccine Administration Codes

vaccine supplied through the Virginia VFC program

VACCINE

DT-Pediatric DTAP DTAP-Hep B-IPV DTaP-IPV-Hib DTaP-IPV-Hib-Hep B DTaP-IPV Hep A Hep B-2 (2 Dose Series) Hep B-Ped HIB HPV Influenza (INTRANASAL) (Quadrivalent) Influenza-PF .25mL (Quadrivalent)

Influenza-PF .5mL syringe (Quadrivalent)

Influenza 5mL vial [.25mL dose] (Quadrivalent) Influenza 5mL vial [.5mL dose] (Quadrivalent) IPV

Meningococcal (Conjugate)

Meningococcal B MMR MMRV Pneumococcal (Conjugate) Pneumococcal (Polysaccharide) Rotavirus TD TDAP Varicella

Brand

Diphtheria and Tetanus Infanrix, Daptacel Pediarix Pentacel VAXELIS Kinrix, Quadracel Havrix, Vaqta Recombivax

Engerix B, Recombivax PedvaxHib, ActHib Hiberix

Gardasil 9 FluMist Fluzone

Fluzone FluLaval Fluarix Afluria Fluzone

Fluzone FluLaval IPOL

Menactra Menveo, MenQuadfi

Bexsero, Trumenba MMR II ProQuad Prevnar

Pneumovax Rotateq, Rotarix

Tenivac Boostrix Adacel

Varivax

CPT CODE

90702 90700 90723 90698 90697 90696 90633 90743 90744 90647, 90648 90651 90672 90685

90686

90687 90688 90713 90734, 90619 90620, 90621 90707 90710 90670 90732 90680, 90681 90714 90715 90716

06/1/2021

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