Complete List of Vaccine Names and CPT/CVX Codes
嚜澧omplete 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 每
18 months
GlaxoSmithKline 每
SKB
NDC: 58160-0811-52
Sanofi Pasteur 每 PMC
(AKA: Aventis)
NDC: 49281-0510-05
Merck- MSD
NDC: 00006-4999-00
GlaxoSmithKline 每
SKB
NDC: 58160-0812-11
Merck- MSD
NDC: 00006-4898-00
GlaxoSmithKline 每
SKB
GlaxoSmithKline 每
SKB
Diphtheria, Tetanus and Pertussis
Diphtheria and tetanus toxoids
adsorbed
DT (Pediatric)
?
6 weeks +
0.5 ml
IM
Sanofi Pasteur 每 PMC
(AKA: Aventis)
NDC: 49281-0225-10
Daptacel*
DTaP or
DTaP, 5 Pertussis
Antigen
??
6 weeks +
0.5 ml
IM
Sanofi Pasteur 每 PMC
(AKA: Aventis)
NDC: 49281-0286-10
Infanrix*
DTaP
??
6 weeks +
0.5 ml
IM
GlaxoSmithKline 每
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 每 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 每 PMC
(AKA: Aventis)
NDC: 49281-0215-10
90718
113
GlaxoSmithKline 每
SKB
NDC:58160-0842-11
Sanofi Pasteur 每 PMC
(AKA: Aventis)
NDC: 49281-0400-10
90715
115
Sanofi Pasteur 每 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 每
SKB
NDC: 58160-0825-11
Merck- MSD
NDC: 00006-4831-41
GlaxoSmithKline 每
SKB
IM
Merck- MSD
IM
GlaxoSmithKline 每
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 每
SKB
NDC: 58160-0820-11
Merck- MSD
NDC: 00006-4981-00
90744
08
IM
GlaxoSmithKline 每
SKB
NDC: 58160-0820-11
90747
44
IM
Merck- MSD
90743
43
IM
GlaxoSmithKline 每
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 每
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 每
4 years
0.5 ml
IM
0.5ml
IM
0.5ml
IM
Sanofi Pasteur 每 PMC
(AKA: Aventis)
NDC: 49281-0545-05
Merck- MSD
NDC: 00006-4897-00
GlaxoSmithKline 每
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 每
SKB
0.5ml
IM
Wyeth Ayerst 每 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 每 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 每 MED
90378
93
IM
Talecris
Biotherapeutics - TAL
90389
13
See pkg insert for
dosage and admin
recommendations
IM
Cangene Corporation
(Canada) 每 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 每
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 每 PMC
(AKA: Aventis)
NDC: 49281-0113-25
Sanofi Pasteur 每 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 每
SKB
NDC: 58160-0900-52
MedImmune 每 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 每
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 每
SKB
Protein Sciences Corp
每 PSC
Novartis
Pharmaceutical Corp.
每 NOV
GlaxoSmithKline 每
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.
每 NOV
90658
141
Fluzone
Preservative Free
Influ Split, 36+ mos, pres
free
3+ yrs
IM
Sanofi Pasteur 每 PMC
(AKA: Aventis)
90656
140
Fluzone
Contains Preservative
Influ Split, 36+ mos
3+ yrs
IM
Sanofi Pasteur 每 PMC
(AKA: Aventis)
90658
141
5/8
0.5ml
SDV;
PFS
0.5ml
MDV
MedImmune - MED
Novartis
Pharmaceutical Corp.
每 NOV
Updated: 09/11/2013 V5.13.8
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