Complete List of Vaccine Names and CPT/CVX Codes

Complete List of Vaccine Names and CPT/CVX Codes

A list that matches the vaccine name or codes in Washington State Immunization Information System (WA IIS) with the brand name or other common names of the

vaccines you use most often.

Vaccine trade name or

common name

Best WAIIS

Selection

State

Supplied

Age

(Range)

Dose

Route

Manufacturer/

NDC Number

CPT

code

CVX

code

90723

110

90698

120

90710

94

90696

130

90748

51

90636

104

90644

148

90702

28

Combination Vaccines

Pediarix

DTAP/HepB/IPV

??

6 weeks +

0.5 ml

IM

Pentacel

DTaP/HIB/IPV

??

6 weeks - 5

yrs

0.5 ml

IM

ProQuad

MMR/V

??

1 yr +

0.5 ml

SQ

Kinrix

DTaP/IPV

??

4 - 6 yrs

0.5 ml

IM

Comvax

HEPB/HIB

?

6 weeks +

0.5 ml

IM

Twinrix

HepA/HepB

18 + yrs

1.0 ml

IM

MenHibrix

Meningococcal C/Y-HIBPRP

0.5ml

IM

6weeks ¨C

18 months

GlaxoSmithKline ¨C

SKB

NDC: 58160-0811-52

Sanofi Pasteur ¨C PMC

(AKA: Aventis)

NDC: 49281-0510-05

Merck- MSD

NDC: 00006-4999-00

GlaxoSmithKline ¨C

SKB

NDC: 58160-0812-11

Merck- MSD

NDC: 00006-4898-00

GlaxoSmithKline ¨C

SKB

GlaxoSmithKline ¨C

SKB

Diphtheria, Tetanus and Pertussis

Diphtheria and tetanus toxoids

adsorbed

DT (Pediatric)

?

6 weeks +

0.5 ml

IM

Sanofi Pasteur ¨C PMC

(AKA: Aventis)

NDC: 49281-0225-10

Daptacel*

DTaP or

DTaP, 5 Pertussis

Antigen

??

6 weeks +

0.5 ml

IM

Sanofi Pasteur ¨C PMC

(AKA: Aventis)

NDC: 49281-0286-10

Infanrix*

DTaP

??

6 weeks +

0.5 ml

IM

GlaxoSmithKline ¨C

SKB

NDC:58160-0810-11

Decavac

Tetanus and diphtheria toxoids

adsorbed Note: To be discontinued

after supply runs out

Td Adult, Preserv free

?

7+ yrs

0.5 ml

IM

Sanofi Pasteur ¨C PMC

(AKA: Aventis)

NDC: 49281-0291-83

106

90700

20

90718

113

* DTAP: Either CVX code (20 or 106) is acceptable in data exchange. In regards to inventory reporting, DTaP (CVX-20) is the default vaccine type that will be shown, in

the event no lot number is not linked to the vaccine type, it will show as DTaP, 5 Pertussis Antigen (CVXC-106).

Complete List of Vaccine Names and CPT/CVX Codes

Vaccine trade name or

common name

Diphtheria, Tetanus and Pertussis

(conti.)

Tenivac

Tetanus and diphtheria toxoids

adsorbed Note: New after Decavac is

used up

Boostrix

Tetanus Diphtheria & Acellular Pertsussis

Adacel

Best WAIIS

Selection

State

Supplied

Age

(Range)

Dose

Route

Manufacturer/

NDC Number

CPT

code

CVX

code

Sanofi Pasteur ¨C PMC

(AKA: Aventis)

NDC: 49281-0215-10

90718

113

GlaxoSmithKline ¨C

SKB

NDC:58160-0842-11

Sanofi Pasteur ¨C PMC

(AKA: Aventis)

NDC: 49281-0400-10

90715

115

Sanofi Pasteur ¨C PMC

90700

20

Td Adult, Preserv free

??

7+ yrs

0.5 ml

IM

Tdap

??

7-65+ yrs

0.5 ml

IM

Tdap

??

Tripedia

DTaP

?

DTaP, 5 Pertussis Antigen

DTaP, 5 Pertussis

Antigen

90700

106

DTaP

90700

20

90714

09

90633

83

90634

84

90632

52

Tetanus Diphtheria and Acellular Pertussis

Whenever DTaP was given, even if the

brand name is unknown

Tetanus and diphtheria toxoids

adsorbed

Diphtheria, tetanus toxoids, & whole

cell pertussis vaccine (will be from

historical records)

Td Adult

?

7-65+yrs

0.5 ml

IM

6 weeks +

0.5 ml

IM

7+ yrs

0.5 ml

IM

??

12 months 18 yrs

0.5 ml

(720 EL.U)

IM

??

12 months 18 yrs

12 months 18 yrs

0.5 ml

(25 U)

0.5 ml

(360 EL.U)

1.0 ml

(50u)

1.0 ml

(1440 EL.U)

MercK - MSD

DTP

Hepatitis A

Havrix

(2 doses for pediatric/adolescent)

Vaqta

(2 doses for pediatric/adolescents)

Havrix

(3 doses for pediatric/adolescent)

Vaqta

(2 doses for adults)

Havrix

(2 doses for adults)

2/8

Hep A 2 dose - Ped/Adol

Hep A 2 dose - Ped/Adol

Hep A 3 dose - Ped/Adol

Hep A 2 dose - Adult

19+ yrs

Hep A 2 dose - Adult

19+ yrs

IM

IM

GlaxoSmithKline ¨C

SKB

NDC: 58160-0825-11

Merck- MSD

NDC: 00006-4831-41

GlaxoSmithKline ¨C

SKB

IM

Merck- MSD

IM

GlaxoSmithKline ¨C

SKB

Updated: 09/11/2013 V5.13.8

Complete List of Vaccine Names and CPT/CVX Codes

Vaccine trade name or

common name

Best WAIIS

Selection

State

Supplied

Age

(Range)

Dose

Manufacturer/

NDC Number

CPT

code

CVX

code

GlaxoSmithKline ¨C

SKB

NDC: 58160-0820-11

Merck- MSD

NDC: 00006-4981-00

90744

08

IM

GlaxoSmithKline ¨C

SKB

NDC: 58160-0820-11

90747

44

IM

Merck- MSD

90743

43

IM

GlaxoSmithKline ¨C

SKB

90746

43

IM

Merck- MSD

90648

48

90647

49

90648

48

90645

47

Route

Hepatitis B

Engerix-B Ped/Adol

(3 dose schedule)

HepB Ped/Adol Preserv.

Free

??

Birth - 19

yrs

0.5 ml

10?g

Recombivax HB Ped/Adol

HepB Ped/Adol Preserv.

Free

??

Birth - 19

yrs

Engerix-B

(4 dose schedule)

Hepatitis B - dialysis

??

0.5 ml

5?g

2.0 ml

40?g

Recombivax HB for adults

Hep B 2 dose ¨C

Adol/Adult

Two X 20 ?g in 1 or 2

injections

11-15 years

1.0 ml

10?g

IM

IM

Hepatitis B (conti.)

Engerix-B for adults

20 + yrs

Hep B Adult

Recombivax HB for adults

Various dosages depending on specific

individual cases, such as high risk or

dialysis.

20 + yrs

1.0 ml

20?g

1.0 ml

10?g

Note: there are various

choices available to

reflect the specific

situation

HIB

ActHib

Hib-PRP-T

??

2 months 5 yrs

PedvaxHib

Hib-PRP-OMP

?

Hiberix

Hib-PRP-T

2 months 5 yrs

12 months ¨C

4 years

0.5 ml

IM

0.5ml

IM

0.5ml

IM

Sanofi Pasteur ¨C PMC

(AKA: Aventis)

NDC: 49281-0545-05

Merck- MSD

NDC: 00006-4897-00

GlaxoSmithKline ¨C

SKB

NDC:58160-0806-05

OmniHib

Hib-PRP-T

HibTITER

Hib-Hboc

ProHIBit (discontinued)

Hib-PRP-D

3/8

2 months 5 yrs

2 months 5 yrs

0.5 ml

IM

GlaxoSmithKline ¨C

SKB

0.5ml

IM

Wyeth Ayerst ¨C WAL

Updated: 09/11/2013 V5.13.8

Complete List of Vaccine Names and CPT/CVX Codes

Vaccine trade name or

common name

Best WAIIS

Selection

State

Supplied

Age

(Range)

CPT

code

CVX

code

90649

62

90650

118

IM

Talecris

Biotherapeutics ¨C TAL

OR

Cangene Corp - CNJ

90371

30

IM

Talecris

Biotherapeutics - TAL

90281

86

IV

Many Manufacturers

90283

87

IM

Talecris

Biotherapeutics - TAL

90375

34

IM

MedImmune ¨C MED

90378

93

IM

Talecris

Biotherapeutics - TAL

90389

13

See pkg insert for

dosage and admin

recommendations

IM

Cangene Corporation

(Canada) ¨C CNJ

90396

36

90655

140

90658

141

Dose

Route

Manufacturer/

NDC Number

Human Papilloma Virus

Gardasil

HPV, quadrivalent

??

9 - 26 yrs

0.5ml

IM

Cervarix?

HPV, bivalent

??

10-25 yrs

0.5ml

IM

Immune Globuline Products

(This list is not comprehensive by brand name or manufacturer)

HyperHEP B S/D or

HepaGam B

(Hepatitis B Immune Globulin)

HBIG (Hepatitis B

Immune Globulin)

GamaSTAN S/D (Immune Globulin)

Note: Used for post-exposure prophylaxis

for Hep A and MMR exposure

Immune Globulin, intravenous

Note: Rarely used for post-exposure

prophylaxis

See pkg insert for

dosage and admin

recommendations

See pkg insert for

dosage and admin

recommendations

See pkg insert for

dosage and admin

recommendations

See pkg insert for

dosage and admin

recommendations

See pkg insert for

dosage and admin

recommendations

See pkg insert for

dosage and admin

recommendations

IG (Immune Globulin IM)

IGIV

HyperRAB S/D (Rabies Immune Globulin)

RIG

Synagis (Respiratory Syncytial Virus

Immune Globulin)

RSV-IGIM

HyperTET S/D (Tetanus Immune

Globulin)

TIG

VariZIG (Varicella Zoster Immune

Globulin)

Note: Used for post exposure prophylaxis

to Chickenpox

VZIG

Merck- MSD

NDC: 00006-4045-41

GlaxoSmithKline ¨C

SKB

NDC: 58160-0830-52

Influenza

Fluzone

Preservative Free (state supplied)

Influ Split, 6-35 mos, pres

free

??

6 - 35 mos

0.25 ml

PFS

IM

Fluzone

Contains Preservative

Influ Split, 36+ mos

??

3 -18 yrs

0.5ml

MDV

IM

4/8

Sanofi Pasteur ¨C PMC

(AKA: Aventis)

NDC: 49281-0113-25

Sanofi Pasteur ¨C PMC

(AKA: Aventis)

NDC: 49281-0392-15

Updated: 09/11/2013 V5.13.8

Complete List of Vaccine Names and CPT/CVX Codes

Vaccine trade name or

common name

Best WAIIS

Selection

State

Supplied

Age

(Range)

Dose

Route

Manufacturer/

NDC Number

CPT

code

CVX

code

90686

150

90672

149

Influenza Conti.

FLUARIX Quadrivalent

Flumist Quadrivalent

Afluria

Contains Preservative

Afluri

Preservative Free

FLUARIX

FLUARIX Quadrivalent

Flublok

Influenza, inj, quad PF,

36+ mos

?

3+ yrs

Influenza, live intranasal,

quadrivalent

Influ Inact 9 + yrs

w/Thimerosol

Influ Inact 9+yrs

pres free

??

2 - 18 yrs

Influ Split, 36+ mos pres

free

Influenza, inj, quad PF,

36+ mos

Inf, recomb, inj, 18+ yrs,

PF

9+ yrs

9+ yrs

3+ yrs

3+ yrs

18-49 yrs

0.5ml

PFS

IM

GlaxoSmithKline ¨C

SKB

NDC: 58160-0900-52

MedImmune ¨C MED

NDC: 66019-0300-10

0.2 ml

PIS

0.5ml

MDV

0.5ml

PFS

IM

CSL Biotherapies, INC

90658

141

IM

CSL Biotherapies, INC

90656

140

0.5ml

PFS

IM

GlaxoSmithKline ¨C

SKB

90656

140

90686

150

90673

155

90661

153

90658

141

90672

149

90656

140

0.5ml

PFS

0.5ml

SDV

IN

IM

IM

GlaxoSmithKline ¨C

SKB

Protein Sciences Corp

¨C PSC

Novartis

Pharmaceutical Corp.

¨C NOV

GlaxoSmithKline ¨C

SKB

NDC: N/A

Flucelvax

Influ split, 18+ yrs, PF

18+ yrs

0.5ml

PFS

IM

FluLaval

Influ split, 18+ years

18+ yrs

0.5 ml

MDV

IM

Flumist Quadravalent

Influenza, live intranasal,

quadrivalent

2 - 49 yrs

0.2 ml

PIS

IN

Fluvirin PF

Influ Inact 48+ mos pres

free

3 - 18 yrs

0.5ml

PFS

IM

Fluvirin

Contains preservative

Influ Inact. 48+ mos,

w/Thimerosol

4+ yrs

0.5ml

MDV

IM

Novartis

Pharmaceutical Corp.

¨C NOV

90658

141

Fluzone

Preservative Free

Influ Split, 36+ mos, pres

free

3+ yrs

IM

Sanofi Pasteur ¨C PMC

(AKA: Aventis)

90656

140

Fluzone

Contains Preservative

Influ Split, 36+ mos

3+ yrs

IM

Sanofi Pasteur ¨C PMC

(AKA: Aventis)

90658

141

5/8

0.5ml

SDV;

PFS

0.5ml

MDV

MedImmune - MED

Novartis

Pharmaceutical Corp.

¨C NOV

Updated: 09/11/2013 V5.13.8

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