CPT 90740, 90743, 90744, G0010 & 90472

 Hepatitis B Virus (HBV) Vaccine

Hepatitis B is a serious disease caused by the hepatitis B virus (HBV). The virus can affect people of all ages. Hepatitis B attacks the liver and can cause chronic (life-long) infection, resulting in cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. The virus is found in the blood and body fluids of infected people and can be spread through sexual contact, the sharing of needles and other drug paraphernalia, razors, tattoos, body piercing, from a mother to her infant during birth, and by living in a household with a chronically infected person. Hepatitis B can be prevented with the vaccine. Medicare provides coverage of the hepatitis B vaccine and its administration for certain beneficiaries at intermediate to high risk for HBV.

Coverage Information

Coverage of the hepatitis B vaccine and its administration was added to the Medicare Program in 1984. Medicare provides coverage for the hepatitis B vaccine and its administration for beneficiaries at high or intermediate risk of contracting HBV. Medicare requires that the hepatitis B vaccine be administered under a physician’s order with supervision.

Medicare provides coverage for the hepatitis B vaccine as a Part B benefit. The Medicare Part B deductible and coinsurance or copayment applies.

Coding and Diagnosis Information

Procedure Codes and Descriptors

The following Healthcare Common Procedure Coding System/Current Procedural Terminology (HCPCS/CPT) codes listed here.

90740 -  Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use

90743 - Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use

90744 - Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use

90746 - Hepatitis B vaccine, adult dosage, for intramuscular use

90747 - Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use

G0010* -  Administration of Hepatitis B vaccine

90471* Immunization Administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid)

(Do not report 90471 in conjunction with 90473)

90472* 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)

(Use 90472 in conjunction with 90471 or 90473)

Payable Diagnosis Requirements

When a Medicare provider files a claim, they must report the appropriate diagnosis code. If the sole purpose of the visit was to receive the hepatitis B vaccine or if the hepatitis B vaccine is the only service billed on a claim, diagnosis code V05.3 must be reported.

Posted in: CPT and HCPCS codes,Diagnosis code (DX),Injection CPT codes