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These steps are provided to help explain the claims reimbursement
process for patients who receive health benefits through
an employer or as part of their retirement. The attached
resource has been designed for and is intended only for health
care providers and their office staffs. It is not intended
for use by patients and/or consumers, and should not be used
by, or relied upon, by patients or consumers. Private
health insurance for employed individuals is generally primary
insurance and may reimburse for ZOSTAVAX. Private
health insurance for retired seniors is generally secondary
insurance to Medicare and may
also reimburse for ZOSTAVAX.
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Medicare supplemental
insurance, often referred to as Medigap, is generally
designed to reimburse patient
Medicare deductibles and co-insurance, but does not
generally cover additional services such as vaccines.
Following these steps does not guarantee
that reimbursement will cover your costs for individual
patients. You should
contact health plans directly to ensure that you have
the most accurate and timely information on reimbursement,
patient out-of-pocket costs, and correct billing processes.
For patients covered by Medicaid who are not Medicare
eligible, contact the patient's state Medicaid agency
to determine if they have made a coverage decision on
ZOSTAVAX. |
CPT®b Code 90736
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Current Procedural Terminology © 2008
American Medical Association.
All Rights Reserved.
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| c |
Physician ICD-9-CM © 2008 American
Medical Association. All Rights Reserved.
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For ICD-9-CMc code or more information, visit MVRSC at www.vaccinesupportservices.com
Select Safety Information
ZOSTAVAX is contraindicated in persons with a history of anaphylactic/anaphylactoid
reaction to gelatin, neomycin, or any other component of the vaccine; with
a history of primary or acquired immunodeficiency states including leukemia;
lymphomas of any type, or other malignant neoplasms affecting the bone marrow
or lymphatic system; or with AIDS or other clinical manifestations of infection
with human immunodeficiency viruses. ZOSTAVAX is a live attenuated varicella-zoster
vaccine and administration may result in disseminated disease in individuals
who are immunosuppressed. ZOSTAVAX is also contraindicated in persons on immunosuppressive
therapy. ZOSTAVAX is not indicated in women of childbearing
age and should not be administered to pregnant females.
Vaccine-related, injection-site and systemic adverse events in >1%
of individuals in the Adverse Event Monitoring Substudy (AEMS), a subgroup
of individuals from the Shingles Prevention Study (SPS) who received ZOSTAVAX
(n=3,345), included headache (1.4%) and the following injection-site reactions:
erythema
(33.7%),
pain/tenderness
(33.4%), swelling (24.9%), hematoma (1.4%), pruritus (6.6%), and warmth
(1.5%). Most of these adverse experiences were reported as mild in intensity.
From Day 0 to 42 postvaccination, in the overall (SPS) study population, serious
adverse experiences (SAEs) occurred at a similar rate (1.4%) in subjects vaccinated
with ZOSTAVAX or placebo. In the AEMS, the rate of SAEs was increased in the
group who received ZOSTAVAX (1.9%) as compared to the placebo group (1.3%)
from Day 0 to 42 postvaccination. Over the course of the entire study, in the
overall study population, investigator-determined, vaccine-related serious
adverse experiences were reported for 2 subjects vaccinated with ZOSTAVAX (asthma
exacerbation and polymyalgia rheumatica) and 3 subjects who received placebo
(Goodpasture's syndrome, anaphylactic reaction, and polymyalgia rheumatica).
Among reported serious adverse events in the SPS (Days 0–42 postvaccination),
serious cardiovascular events occurred more frequently in subjects who received
ZOSTAVAX (20 [0.6%]) than in subjects who received placebo (12 [0.4%]) in the
AEMS. The frequencies of serious cardiovascular events were similar in subjects
who received ZOSTAVAX (81 [0.4%]) and in subjects who received placebo (72
[0.4%]) in the entire SPS study cohort (Days 0–42 postvaccination).
Transmission of vaccine virus may occur rarely between vaccinees and susceptible
contacts.
ZOSTAVAX is not indicated for prevention of primary varicella infection (Chickenpox).
Vaccination with ZOSTAVAX may not result in protection of all vaccine recipients.
Before administering ZOSTAVAX, please read the Prescribing
Information and Patient
Product Information.
ZOSTAVAX is a registered trademark of Merck & Co., Inc.
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