Pediatric Flu Vaccine: Special Situations
In the event a Medicaid provider does not have VFC pediatric influenza vaccine on hand tovaccinate a high priority VFC eligible Medicaid enrolled child, the provider should use pediatric influenza vaccine from private stock, if available. If a provider does use vaccine from private stock for a high priority VFC eligible Medicaid enrolled child, the provider would then replace dose(s) used from private stock with replacement dose(s) from VFC stock when VFC vaccine becomes available. The provider should not turn away, refer or reschedule a high priority VFC eligible Medicaid enrolled child for a later date if vaccine is available. Louisiana Medicaid will update Medicaid enrolled providers through remittance advices and the Louisiana Medicaid Provider Update regarding availability of vaccine through the VFC program and any billing issues. Please contact the Louisiana VFC Program office at (504)838-5300 for vaccine availability information.
* indicates the vaccine is available from the Vaccines For Children (VFC) program
^ indicates the vaccine is payable for QMB Only and QMB Plus recipients Vaccine
Code Description
90476^ Adenovirus vaccine, type 4, live, for oral use
90477^ Adenovirus vaccine, type 7, live, for oral use
90581^ Anthrax vaccine, for subcutaneous use
90585 Bacillus Calmette-Guerin vaccine (BCG) for tuberculosis, live, for percutaneous use
90586 Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, for intravesical use
90632 Hepatitis A vaccine, adult dosage, for intramuscular use
90633* Hepatitis A vaccine pediatric/adolescent dosage, 2-dose schedule, for intramuscular use
90634* Hepatitis A vaccine, pediatric/adolescent dosage, 3-dose schedule, for intramuscular use
90636 Hepatitis A and Hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use
90645 Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose schedule), for intramuscular use
90646 Hemophilus Influenza b vaccine (Hib), PRP-D conjugate, for booster use only, intramuscular use
90647* Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate (3 dose schedule), for intramuscular use
90648* Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for intramuscular use
90649* Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use
90655* Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for
intramuscular use
90656* Influenza virus vaccine, split virus, preservative free, when administered to 3 years and older, for intramuscular use
90657* Influenza Virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use
90658* Influenza Virus vaccine, split virus, when administered to 3 years of age and older, for intramuscular use
90660* Influenza Virus vaccine, live, for intranasal use
90665^ Lyme Disease vaccine, adult dosage, for intramuscular use
90669* Pneumococcal conjugate vaccine, polyvalent, when administered to children younger than 5 years, for intramuscular use
90675^ Rabies vaccine, for intramuscular use
90676^ Rabies vaccine, for intradermal use
90680* Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use
90690^ Typhoid vaccine, live, oral
2007 Louisiana Medicaid Professional Services Provider Training 100
Vaccine Codes
Code Description
90691^ Typhoid vaccine, Vi capsular polysaccharide (ViCPS), for intramuscular use
90692^ Typhoid vaccine, heat-and phenol-inactivated (H-P) for subcutaneous or intradermal use
90693 Typhoid vaccine, acetone-killed, dried (AKD), for subcutaneous use (US Military)
90698 Diphtheria, tetanus toxoids, acellular pertussis vaccine, haemophilus influenza Type B, and poliovirus vaccine, inactivated, (DTaP-Hib-IPV), for intramuscular use
90700 * Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to younger than 7 years, for intramuscular use
90701 Diphtheria, tetanus toxoids, and whole cell pertussis vaccine (DTP), for intramuscular use
90702* Diphtheria and tetanus toxoids (DT) absorbed when administered to younger than 7 years, for intramuscular use
90703 Tetanus toxoid adsorbed, for intramuscular use
90704 Mumps virus vaccine, live, for subcutaneous use
90705 Measles virus vaccine, live, for subcutaneous use
90706 Rubella virus vaccine, live, for subcutaneous use
90707* Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous
90708 Measles and rubella virus vaccine, live, for subcutaneous use
90710* Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use
90712 Poliovirus vaccine, (any type(s)) (OPV), live, for oral use
90713* Poliovirus vaccine, inactivated, (IPV), for subcutaneous or intramuscular use
90714* Tetanus and diphtheria toxoids, (Td) absorbed, preservative free, when administered to 7 years or older, for intramuscular use
90715* Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to 7 years or older, for
intramuscular use
90716* Varicella virus vaccine, live, for subcutaneous use
90717 Yellow fever vaccine, live, for subcutaneous use
90718* Tetanus and diphtheria toxoids (Td) adsorbed when administered to7 years or older, for intramuscular use
90719 Diphtheria toxoid, for intramuscular use
90720 Diphtheria, tetanus toxoids, and whole cell pertussis vaccine and Hemophilus influenza B vaccine (DTP-Hib), for intramuscular use
90721* Diphtheria, tetanus toxoids, and acellular pertussis vaccine and Hemophilus influenza B vaccine (DTaP-Hib), for intramuscular use
90723* Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine, inactivated (DTaP-HepB-IPV), for intramuscular use
90725 Cholera vaccine for injectable use
90727 Plague vaccine, for intramuscular use
90732 Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to 2 years or older, for subcutaneous or intramuscular use
90733 Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use
90734* Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 (tetravalent), for
2007 Louisiana Medicaid Professional Services Provider Training 101
Vaccine Codes
* indicates the vaccine is available from the Vaccines For Children (VFC) program
^ indicates the vaccine is payable for QMB Only and QMB Plus recipients
90735 Japanese Encephalitis Virus vaccine, for subcutaneous use
90736 Zoster (shingles) vaccine, live, for subcutaneous injection
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
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
90748* Hepatitis B and Hemophilus influenza b vaccine (HepB-Hib), for intramuscular use
• Procedure code 90703 (Tetanus toxoid – for trauma) will be payable at the rate of $2.42, and it is not available through the VFC program.
• If the administration units for 90466, 90468, 90472 or 90474 are greater than the number of vaccines reported for the administration codes, the units will be cutback to reflect the number of vaccine codes being reported.
• If the administration units for 90466, 90468, 90472 or 90474 are less than the number of vaccines reported the claim will be processed based on the units listed for administration.
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