2025 CPT code 90736

Subcutaneous injection of live zoster (shingles) vaccine.

* Report code 90736 along with the appropriate administration code (e.g., 90460-90474).* Do not use modifier 51 with 90736 when used with administration codes.* Separate codes for the components of combination vaccines are not appropriate.Use the specific code for the combination vaccine, if available.* If there is no specific vaccine code, use an unlisted procedure code.

Modifier 51 (multiple procedures) is generally not applicable with vaccine codes,with exceptions only if multiple distinct vaccines are administered.

Medical necessity for the zoster vaccine is established based on the patient's age (typically 50 years or older, or younger with immunocompromise),lack of prior zoster infection, and absence of contraindications. The CDC and other public health bodies provide guidelines on vaccine recommendations which can be used as supporting documentation.

The provider's responsibilities include educating the patient or guardian about the vaccine, including risks, benefits and side effects, obtaining informed consent, preparing the injection site, and administering the vaccine subcutaneously. Post-injection monitoring for adverse reactions might also be part of the provider's duties.

IMPORTANT For combination vaccines (e.g., containing other components besides the zoster vaccine), separate codes are not used.If no specific vaccine code exists for a particular vaccine, an unlisted procedure code should be utilized until an appropriate code is released.

In simple words: The doctor gives a shot of a live shingles vaccine under the skin to help protect against getting shingles.

This CPT code, 90736, represents the administration of a live zoster (shingles) vaccine via subcutaneous injection.The vaccine is used for the prevention of varicella zoster virus (VZV) infection and its associated complications, such as shingles and postherpetic neuralgia. The procedure involves the subcutaneous administration of the vaccine to a patient, typically after appropriate education regarding risks, benefits, and potential side effects.

Example 1: A 62-year-old patient presents for a shingles vaccine. The provider explains the benefits and risks, administers the vaccine subcutaneously, and documents the procedure, vaccine lot number, and patient's reaction., An immunocompromised 25-year-old patient requires a shingles vaccine. The physician carefully assesses the patient's medical history and current immunosuppression status to determine the appropriate vaccine and administration approach.Thorough documentation of patient's immune status, the vaccine administration, and any post-injection monitoring is required for correct billing., A 70-year-old patient receives a second dose of the shingles vaccine. Proper documentation includes the date of the first dose, vaccine lot numbers, and the reaction to the first dose.

* Patient demographics.* Date of service.* Vaccine administered (including manufacturer and lot number).* Route of administration (subcutaneous).* Patient's reaction to the vaccine.* Informed consent documentation.* Provider's signature.

** Always refer to the most up-to-date CPT manual and payer-specific guidelines for the most accurate coding and billing practices.Specific payer requirements related to modifiers might vary. Ensure compliance with all applicable regulations, including those related to informed consent and vaccine administration protocols.

  • Revenue Code: P6C (Medicare Fee Schedule: MINOR PROCEDURES - OTHER)
  • RVU: This information is not provided in the source.
  • Global Days : Not applicable to vaccines.
  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Fee Schedule : This information is not available in the source.
  • Specialties:Infectious Disease, Family Medicine, Internal Medicine, Geriatrics
  • Place of Service:Office, Clinic, Hospital (Inpatient and Outpatient)
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