Hepatitis B Virus (HBV) Vaccine and Administration
HCPCS/CPT Codes
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 (3 dose schedule), for intramuscular use
90747 – Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
G0010 – Administration
ICD-10-CM Codes
Z23
Who Is Covered
Certain Medicare beneficiaries at intermediate or high risk for contracting hepatitis B
NOTE: Medicare beneficiaries who are currently positive for antibodies for hepatitis B are not eligible for this benefit
Frequency
Scheduled dosages required
Beneficiary Pays
• Copayment/coinsurance waived
• Deductible waived
Coding Clarification:
Vaccines listed as Medicare Covered for Hepatitis B are eligible for Medicare Part B coverage if there has been a documented exposure, injury or risk factor. For Hepatitis B, coverage is limited to those who are at high or intermediate risk of contracting Hepatitis B.
High risk groups are identified as:
o ESRD patients
o Hemophiliacs who receive Factor VIII or IX concentrates
o Clients of institutions for the mentally retarded
o Persons who live in the same household as a hepatitis B virus (HBV) carrier
o Homosexual men
o Illicit injectable drug abusers
o Persons diagnosed with diabetes mellitus. (Rev. 170, 01-01-13)
Intermediate risk groups are identified as:
o Staff in institutions for the mentally retarded
o Workers in health care professions who have frequent contact with blood or blood-derived body fluids during routine work (V05.3)
Can I roster bill the seasonal influenza virus, pneumococcal, and hepatitis B vaccines?
You may roster bill the seasonal influenza virus and pneumococcal vaccines. You cannot roster bill the hepatitis B vaccine
What is a mass immunizer?
A mass immunizer offers seasonal influenza virus vaccination, pneumococcal vaccination, or both to a large number of individuals. A mass immunizer may be a traditional Medicare provider or supplier or a nontraditional provider or supplier (such as a senior citizens’ center, a public health clinic, or a community pharmacy). Mass immunizers must submit claims for immunizations on roster bills and must accept assignment on both the vaccine and its administration. A mass immunizer should enroll with the Medicare Administrative Contractor (MAC) prior to each influenza season.
Q: Where is the Medicare sourcing for coverage of the Hepatitis B vaccine? I thought it was covered for everyone.
A: The CMS sourcing for a list of indications that support payment of the Hepatitis B series can be found at any of the locations listed in the References section of this policy.
Q: Can I charge an administration fee?
A: Yes. Administration fees for vaccines could be handled in the following manner:
Part D vaccines, including the associated administration costs could be billed on one claim to the beneficiary or to the Part D plan.
Note: CMS believes that Part D vaccines, including the associated administration costs, should be billed on one claim for both in- and out-of-network situations. Part D vaccine administration costs are a component of the negotiated price for a Part D-covered vaccine.