Wiki Cpt 90736

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pygreen

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:confused: Does CPT 90736 (Zoster vaccine) have any age specifications. BCBS denied this stating "Patient age and procedure code are incompatible". Patient was 51 at the time of service. Dx used was V05.8. I can not find anything stating that this procedure is age specific. Thanks in advance for any help with this.

Peggy Green, CPC
Rome GA chapter.
 
Try the CDC - I don't specifically remember, but there might be something there about age recommendations. It is not in CPT, but if it's recommended for a certain age group by the CDC the insurance is not going to want to cover it outside of that range...
 
90736 is for age 60 and over. That is the note we have by the CPT on our charges, so I'm thinking that came from the CDC.
 
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