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HCPCS code for Zostavax ??

  1. #1
    Salt Lake North
    Default HCPCS code for Zostavax ??
    Medical Coding Books
    Patient came to clinic and received an IM injection of "Zosavax". I'm trying to find a code to bill this with but there is no HCPCS code listed. There does not seem to be another name that this may be listed under. Any suggestions?

  2. #2
    Duluth, Minnesota
    do you mean Zoztavax? The immunization?
    CPT 90736 (with a GY modifier for Medicare patients)
    and dx code of V04.89

    I've not heard of "Zosavax"
    Donna, CPC, CPC-H

  3. Default
    For thie shingles vaccine you bill 90736 and 90471 with the gy mod on the admin code and dx v05.4 you dont have to put any modifier on the 90736 medicare will automatically deny but you want to put it on the admin code because medicare will pay for this and they are not supposed to so you have to tell them they should not be paying for the code. Hope this helps.
    Nicole wessell, bs, cpc

  4. #4
    If it's not a Medicare patient, bill 90736 and the administration. For Medicare, the vaccine is covered under Part D. The patient could be billed for it and then they forward the bill to Part D for reimbursement. The administration isn't covered. The patient would be responsible for that charge.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  5. Default
    90736 is the cpt code for zostavax. you can also bill an administration fee.

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