bCoverage is dependent on the terms and
conditions of each patient's insurance benefit. Reimbursement
may not always result
in your costs being covered for individual patients due to
various factors, including your contract with the health plan
and the plan's reimbursement rate.
cCurrent Procedural Terminology © 2008 American
Medical Association. All rights reserved.
This information is intended to help your office:
- Access commonly
used codes that may apply to private payer
reimbursement claims
The CPT and ICD-9-CMc codes below are
commonly used codes that may apply to private payer reimbursement
claims for
vaccinations
with RotaTeq.
Remember! Plan coding requirements
vary
Plan coding requirements may vary and are subject to change
at any time, so it is important
to check with each plan as to plan-specific requirements.
For
claim submission procedures regarding government programs
(eg, Vaccines for Children), contact the appropriate program
representative.
The above information
is not intended to be conclusive or exhaustive. You are
solely responsible for determining the appropriate codes
and for any action you take in billing for a Merck vaccine.
Diagnosis codes should be selected only by a health care
professional.
Consult the ICD-9-CM
2008 manual to check the appropriateness of a particular
code and for information on additional codes. Merck makes
no warranties, expressed or implied, concerning the accuracy
or appropriateness of this information for any particular
use. The use of this information does not guarantee payment
or that any payment received will cover your costs.
CPT codes are used for billing professional
services. Note that the CPT administration code(s)
must be reported in addition to the vaccine product
code 90680.
Report
codes 90467-90468 only when the physician provides face-to-face
counseling of the patient and family during
the administration of a vaccine. For immunization administration
of any vaccine that is not accompanied by face-to-face physician
counseling to the patient/family, report codes 90473–90474.
ICD-9-CM
codes may be utilized or mandated by payers to describe the
viral disease for which the prophylactic vaccination
is administered. There is not currently an ICD-9-CM code
specific to the rotavirus vaccine (this reflects
information available to Merck as of June 2007).
Note that CPT 90474 is expected to apply when more than
one vaccine is administered during the same office visit.
For additional
information regarding CPT product and administration codes
and ICD-9-CM codes concerning RotaTeq, go to the Merck
Vaccine Reimbursement Support Center (MVRSC) through www.vaccinesupportservices.com or
call the MVRSC directly at
1-800-REIMBVAX (1-800-734-6282).
RotaTeq
is indicated for the prevention of rotavirus gastroenteritis
in infants and children caused by the serotypes G1, G2, G3,
and G4 when administered as a 3-dose series to infants between
the ages of 6 to 32 weeks. The first dose of RotaTeq should
be administered between 6 and 12 weeks of age.
dPhysicians ICD-9-CM © 2008
American Medical Association. All rights reserved.
Select safety information
RotaTeq should not be administered
to infants with a demonstrated history of hypersensitivity
to the vaccine or any component
of the vaccine.
No safety or efficacy data are available
for the administration of RotaTeq to infants who are potentially
immunocompromised
or to infants with a history
of
gastrointestinal disorders.
Caution is advised when considering whether
to administer RotaTeq to individuals with immunodeficient
contacts.
In clinical trials, the most common adverse events
included diarrhea, vomiting, irritability, otitis media,
nasopharyngitis, and bronchospasm.
In post-marketing experience,
cases of intussusception and Kawasaki disease have been reported
in infants who
have received RotaTeq.
RotaTeq may not protect all vaccine
recipients against rotavirus.
Before administering RotaTeq, please read the Prescribing
Information and Patient
Product Information.
RotaTeq is a registered trademark of Merck & Co., Inc.
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