MassHealth Adult Vaccine Procedure Codes effective July 1 2013.pdf
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- Solicitation number
- BD-15-1039-EHS01-EHS02-00000004399
- Issued by
- Massachusetts
About this file
This document outlines the Massachusetts MassHealth Adult Vaccine Procedure Codes effective July 1, 2013. It details the various vaccine administration codes, the corresponding administration fees, and the use of the SL modifier for state-supplied vaccines. The document pertains to the Massachusetts Flu and Adult Vaccine Program for Local Public Health Providers (MHFAVP), a state and local contract opportunity that enrolls and pays local public health departments and public school districts to purchase and administer influenza and adult vaccines to MassHealth members. The goal of this initiative is to increase access to these vaccines for MassHealth members in areas where they may have difficulty accessing them.
The document provides the specific procedure codes, descriptions, and administration fees for various adult vaccines, including Hepatitis A, Hepatitis A/B, Human Papillomavirus, Pneumococcal, Tetanus, Measles-Mumps-Rubella, Tetanus-Diphtheria-Acellular Pertussis, Varicella, and Meningococcal vaccines. The administration fees range from $8.83 to $101.97, with some vaccines priced on an individual consideration basis. The SL modifier is to be used only when administering state-supplied vaccines.
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CODE DESCRIPTION
90471 $18.23 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid)
90471-SL*
Age 19+ $15.78
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
90472 $8.83
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid)
(List separately in addition to code for primary procedure)
90472-SL*
Age 19+ $8.83
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid)
(List separately in addition to code for primary procedure)
90473 $18.23 Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid)
90473-SL*
Age 19+ $15.78
Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)
90474 $8.83 Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
90474-SL*
Age 19+ $8.83
Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
90632 $45.32 Hepatitis A vaccine, adult dosage, for intramuscular use
90636 $101.97 Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use
90649 $137.59 Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use
90670 **I.C. Pneumococcal conjugate vaccine, 13 valent, for intramuscular use
90703 $22.77 Tetanus toxoid adsorbed, for intramuscular use
90707 $47.07 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use
90715 $33.81 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use
90716 $81.67 Varicella virus vaccine, live, for subcutaneous use
90732 $43.25
Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
90733 $103.41 Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use
90734 **I.C.
Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 (tetravalent), for intramuscular use
90736 **I.C. Zoster (shingles) vaccine, live, for subcutaneous injection
90746 $59.71 Hepatitis B vaccine, adult dosage, for intramuscular use
** I.C. (individual consideration) - claims to be priced upon receipt of manufacturer invoice for the exact number of dosage and price per dose
A d u lt
A d m in is tr a ti o n
C o d e s
MassHealth Adult Vaccine Program for Local Public Health Departments ONLY
Rates effective
July 1, 2013
A d u lt
V a c c in e C o d e s
* SL: to be used only if administering State-supplied vaccine
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