Rabies Prophylaxis (CPT codes 90675, 90676) Rabies is a disease that rarely affects humans. It is carried by animals, and transmitted by bite or scratch. The most common carriers are skunks, foxes, bats, raccoons, or domestic animals that have had infectious encounters with a carrier. When a human has had an encounter with an animal, the physician can determine if the encounter was at high risk for rabies exposure. See policy INJ-012, for immune globulin coverage.

1. Postexposure prophylaxis treatment utilizes two rabies immunizing products concurrently:
      a.  Vaccines – induce an active immune response that requires about 7-10 days to develop, but persists for as long as a year or more. Types can include:
       • Human Diploid Cell Rabies Vaccine (HDCV)
       • Rabies Vaccine, Adsorbed (RVA)
   b. Globulins – provide rapid passive immunity that persists for a short time (half-life of about 21 days). Types can include:
      • Rabies Immune Globulin (RIG)
      • Antirabies Serum, Equine (ARS) – preferred over RIG due to less side effects than RIG.

2. Post-exposure injections are given in the following way:
      a. When the patient has not been previously immunized
          • RIG; half the dose IM, the other half in the wound (bite), on the day of the exposure; and
          • HDCV, IM, on the day of exposure and days 3, 7, 14, and 28.
    b. When the patient has been previously immunized
          • HDCV on the day of the exposure and day 3.