Billing Codes for VAXELIS

Product and administration codes to help you bill for VAXELIS

Billing Codes, National Drug Codes, and Immunization Registry Codes for VAXELIS

Included are lists of codes that may be relevant for VAXELIS and its administration. This information is current as of December 2023. The information provided here is compiled from sources believed to be accurate, but Merck and Sanofi make no representation that it is accurate. Consult the relevant manual and/or other guidelines for a description of each code to determine the appropriateness of a particular code and for information on additional codes. This information is subject to change. Merck and Sanofi caution that payer coding requirements vary and can frequently change, so it is important to regularly check with each payer as to payer-specific requirements.

You are solely responsible for determining the appropriate codes and for any action you take in billing. The information provided here is not intended to be definitive or exhaustive, and is not intended to replace the guidance of a qualified professional advisor. Merck and Sanofi and their agents make no warranties or guarantees, expressed or implied, concerning the accuracy or appropriateness of this information for your particular use given the frequent changes in public and private payer billing. The use of this information does not guarantee payment or that any payment received will cover your costs. Diagnosis codes should be selected only by a health care professional.

Billing codes

Common CPT Codes1

Description

Vaccine product:
90697Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-IPV-Hib-HepB), for intramuscular use
Administration of vaccine:
90460Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified HCP; first or only component of each vaccine or toxoid administered

(Bill 1 unit for the first component of VAXELIS)
and
+90461Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified HCP; each additional vaccine or toxoid component administered (list separately in addition to code for primary procedure)

(Bill 5 units; 1 unit for each additional component within VAXELIS)
or
90471Immunization administration; 1 injected vaccine (single or combination vaccine/toxoid)

(Assuming VAXELIS is administered first during child’s visit, bill 1 unit)
+90472Immunization administration; each additional injected vaccine (single or combination vaccine/toxoid)

(Assuming VAXELIS is administered subsequent to other vaccine[s] during child’s visit, bill 1 unit)

Common ICD-10-CM Code2Description
Z23aEncounter for immunization

aZ23 is reported for all vaccine-related encounters for all vaccines given, and in addition to any health exam ICD-10-CM codes.1

CPT, Current Procedural Terminology; HCP, health care provider; ICD-10-CM, International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification.

CPT is a registered trademark of the American Medical Association. The use of this information does not guarantee payment or that payment received will cover your costs. Diagnosis codes should be selected only by a health care professional.

National Drug Codes (NDC) and Immunization Registry Codes

Supplied PackagesNDC Unit of UseNDC Carton
10 single-dose vialsN463361024358 ML0.5N463361024310 ML0.5
10 single-dose prefilled syringesN463361024388 ML0.5N463361024315 ML0.5
CVX Code3146N463361024315 ML0.5
MVX Code3MSP

NDC, National Drug Code.

Please note: The NDCs above are the billable NDCs that appear on the carton and the unit of use, when NDC is required by the payer.

CVX Code, indicates the product used in a vaccination; MVX Code, indicates the manufacturer of a vaccine.

Codes for Administration4

If a vaccination is the only service provided, a visit should not be billed. If a vaccination is provided during a visit with other services, consult payer-specific requirements.

Additional topics to explore

Schedule for VAXELIS

Schedule for VAXELIS

Administration guide

Administration guide

Downloadable resources

Downloadable resources

Order VAXELIS now

Order directly at: VaccineShop.com
List of authorized distributors: VaxelisContract.com

References: 1. American Academy of Pediatrics. Coding for pediatric preventive care 2022. Published 2022. Accessed November 17, 2023. https://downloads.aap.org/AAP/PDF/Coding%20Preventive%20Care.pdf 2. Centers for Disease Control and Prevention. ICD-10-CM tabular list of diseases and injuries 2022. Last modified May 26, 2022. Accessed November 17, 2023. https://www.cms.gov/medicare/icd-10/2022-icd-10-cm 3. Centers for Disease Control and Prevention. IIS: HL7 standard code set: Mapping product names to CVX and MVX. Last reviewed June 9, 2023. Accessed November 17, 2023. https://www2a.cdc.gov/vaccines/iis/iisstandards/downloads/tradename_list.pdf 4. Centers for Medicare & Medicaid Services. NCCI Policy Manual for Medicare: Chapter XI medicine evaluation and management services CPT codes 90000-99999 for national correct coding initiative policy manual for Medicare services. Revised May 1, 2022. Accessed November 17, 2023. https://www.cms.gov/files/document/chapter11cptcodes90000-99999final11.pdf

What is VAXELIS?

VAXELIS is a vaccine indicated for active immunization to prevent diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B, and invasive disease due to Haemophilus influenzae type b (Hib). VAXELIS is approved for use as a 3-dose series in children 6 weeks through 4 years of age (prior to the 5th birthday).

Important Safety Information

  • Do not administer VAXELIS to anyone with a history of severe allergic reaction to a previous dose of VAXELIS, any ingredient of VAXELIS, or any other diphtheria toxoid, tetanus toxoid, pertussis-containing vaccine, inactivated poliovirus vaccine, hepatitis B vaccine, or Hib vaccine.
  • Do not administer VAXELIS to anyone with a history of encephalopathy within 7 days of a pertussis-containing vaccine with no other identifiable cause.
  • Do not administer VAXELIS to anyone with a history of progressive neurologic disorder until a treatment regimen has been established and the condition has stabilized.
  • Carefully consider benefits and risks before administering VAXELIS to persons with a history of: fever ≥40.5°C (≥105°F), hypotonic-hyporesponsive episode (HHE), or persistent, inconsolable crying lasting ≥3 hours within 48 hours after a previous pertussis-containing vaccine; and/or seizures within 3 days after a previous pertussis-containing vaccine.
  • If Guillain-Barré syndrome occurred within 6 weeks of receipt of a prior vaccine containing tetanus toxoid, the risk for Guillain-Barré syndrome may be increased following VAXELIS.
  • Apnea following intramuscular vaccination has been observed in some infants born prematurely. Consider the individual infant’s medical status and potential benefits and possible risks of intramuscular vaccination in deciding when to administer VAXELIS to an infant born prematurely.
  • Vaccination with VAXELIS may not protect all individuals.
  • The solicited adverse reactions 0-5 days following any dose were irritability (≥55%), crying (≥45%), injection site pain (≥44%), somnolence (≥40%), injection site erythema (≥25%), decreased appetite (≥23%), fever ≥38.0°C (≥19%), injection site swelling (≥18%), and vomiting (≥9%).
  • The 3-dose immunization series consists of a 0.5 mL intramuscular injection, administered at 2, 4, and 6 months of age.
  • A 3-dose series of VAXELIS does not constitute a primary immunization series against pertussis; an additional dose of pertussis-containing vaccine is needed to complete the primary series.

Before administering VAXELIS, please read the accompanying Prescribing Information. The Patient Information also is available.

What is VAXELIS® (Diphtheria and Tetanus Toxoids and Acellular Pertussis, Inactivated Poliovirus, Haemophilus b Conjugate and Hepatitis B Vaccine)?

VAXELIS is a vaccine indicated for active immunization to prevent diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B, and invasive disease due to Haemophilus influenzae type b (Hib). VAXELIS is approved for use as a 3-dose series in children 6 weeks through 4 years of age (prior to the 5th birthday).

VAXELIS is a vaccine indicated for active immunization to prevent diphtheria, tetanus,

VAXELIS is a vaccine indicated for active immunization to prevent diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B, and invasive disease due to Haemophilus influenzae type b (Hib). VAXELIS is approved for use as a 3-dose series in children 6 weeks through 4 years of age (prior to the 5th birthday).

Important Safety Information for VAXELIS® (Diphtheria and Tetanus Toxoids and Acellular Pertussis, Inactivated Poliovirus, Haemophilus b Conjugate and Hepatitis B Vaccine)

  • Do not administer VAXELIS to anyone with a history of severe allergic reaction to a previous dose of VAXELIS, any ingredient of VAXELIS, or any other diphtheria toxoid, tetanus toxoid, pertussis-containing vaccine, inactivated poliovirus vaccine, hepatitis B vaccine, or Hib vaccine.
  • Do not administer VAXELIS to anyone with a history of encephalopathy within 7 days of a pertussis-containing vaccine with no other identifiable cause.
  • Do not administer VAXELIS to anyone with a history of progressive neurologic disorder until a treatment regimen has been established and the condition has stabilized.
  • Carefully consider benefits and risks before administering VAXELIS to persons with a history of: fever ≥40.5°C (≥105°F), hypotonic-hyporesponsive episode (HHE), or persistent, inconsolable crying lasting ≥3 hours within 48 hours after a previous pertussis-containing vaccine; and/or seizures within 3 days after a previous pertussis-containing vaccine.
  • If Guillain-Barré syndrome occurred within 6 weeks of receipt of a prior vaccine containing tetanus toxoid, the risk for Guillain-Barré syndrome may be increased following VAXELIS.
  • Apnea following intramuscular vaccination has been observed in some infants born prematurely. Consider the individual infant’s medical status and potential benefits and possible risks of intramuscular vaccination in deciding when to administer VAXELIS to an infant born prematurely.
  • Vaccination with VAXELIS may not protect all individuals.
  • The solicited adverse reactions 0-5 days following any dose were irritability (≥55%), crying (≥45%), injection site pain (≥44%), somnolence (≥40%), injection site erythema (≥25%), decreased appetite (≥23%), fever ≥38.0°C (≥19%), injection site swelling (≥18%), and vomiting (≥9%).
  • The 3-dose immunization series consists of a 0.5 mL intramuscular injection, administered at 2, 4, and 6 months of age.
  • A 3-dose series of VAXELIS does not constitute a primary immunization series against pertussis; an additional dose of pertussis-containing vaccine is needed to complete the primary series.

Before administering VAXELIS, please read the accompanying Prescribing Information. The Patient Information also is available.

  • Do not administer VAXELIS to anyone with a history of severe allergic reaction to a previous dose of VAXELIS, any ingredient of VAXELIS, or any other diphtheria toxoid,
  • Do not administer VAXELIS to anyone with a history of severe allergic reaction to a previous dose of VAXELIS, any ingredient of VAXELIS, or any other diphtheria toxoid, tetanus toxoid, pertussis-containing vaccine, inactivated poliovirus vaccine, hepatitis B vaccine, or Hib vaccine.
  • Do not administer VAXELIS to anyone with a history of encephalopathy within 7 days of a pertussis-containing vaccine with no other identifiable cause.
  • Do not administer VAXELIS to anyone with a history of progressive neurologic disorder until a treatment regimen has been established and the condition has stabilized.