Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Codes

10.2.1 - Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Codes (Rev. 13677; Issued: 03-12-26; Effective: 04-13-26; Implementation: 04-13-26) Vaccines and their administration are reported using separate codes. The following codes are for reporting the vaccines only. HCPC Definition 90630 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use 90653 Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use 90654 Influenza virus vaccine, split virus, preservative-free, for intradermal use, for adults ages 18 – 64; 90655 Influenza virus vaccine, split virus, preservative free, for children 6- 35 months of age, for intramuscular use; 90656 Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use; 90657 Influenza virus vaccine, split virus, for children 6-35 months of age, for intramuscular use; 90658 Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use 90660 Influenza virus vaccine, live, for intranasal use; 90661 Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use 90662 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use 90670 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use 90671 Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use 90672 Influenza virus vaccine, live, quadrivalent, for intranasal use 90673 Influenza virus vaccine, trivalent, derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use 90674 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use 90677 Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use 90682 Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use 90685 Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use 90686 Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use 90687 Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use 90688 Influenza virus vaccine, quadrivalent, split virus, when 90694 administered to individuals 3 years of age and older, for intramuscular use Influenza virus vaccine, quadrivalent (aIIV4), inactivated, 90732 Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for us in individuals 2 years or older, for subcutaneous or intramuscular use; 90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use 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; and 90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use. 90756 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use 90759 Hepatitis B vaccine (HepB), 3-antigen (S, Pre-S1, Pre-S2), 10 mcg Note: COVID-19 vaccine and administration HCPCS are temporarily posted at: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and- monoclonal-antibodies. Note: For the Medicare-covered codes for the influenza vaccines approved by the Food and Drug Administration (FDA) for the current influenza vaccine season, please go to: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B- Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing.html The following codes are for reporting administration of the vaccines only. The administration of the vaccines is billed using: * NOTE: Beginning January 1, 2011, providers should report G0010 for billing under the OPPS rather than 90471 or 90472 to ensure correct waiver of coinsurance and deductible for the administration of hepatitis B vaccine. NOTE: COVID-19 vaccine and administration HCPCS are temporarily posted at: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/COVID-19-vaccines-and- monoclonal-antibodies. The following diagnosis code must be reported. If the sole purpose for the visit is to receive a vaccine or if a vaccine is the only service billed on a claim, the applicable following diagnosis code may be used. ICD-10-CM Diagnosis Code Description Z23 Encounter for Immunization NOTE: ICD-10-CM diagnosis code Z23 is to be used for all encounters for preventive vaccine immunizations, including COVID-19 immunizations. The following condition code must be reported on institutional claims when diagnosis code Z23 is required for a vaccination. Condition Code Description A6 Vaccine / Medicare 100% Payment All claims must have the appropriate diagnosis code, procedure, and admin code to process correctly.