CPT 90619: Meningococcal Conjugate Vaccine, Tetanus Toxoid Carrier - OpenPayer

Summary & Overview

CPT 90619: Meningococcal Conjugate Vaccine, Tetanus Toxoid Carrier

CPT code 90619 denotes a meningococcal conjugate vaccine formulated with a tetanus toxoid carrier for intramuscular administration that protects against four common meningococcal serogroups. This vaccine is a key preventive intervention against invasive meningococcal disease, including meningitis and septicemia, conditions that carry high morbidity and mortality. Nationally, immunization coding for meningococcal vaccines influences public health vaccination programs, clinical workflows, and payer coverage decisions.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical use and service setting for CPT code 90619, typical payer coverage considerations, and the common modifiers associated with vaccine administration claims. The publication outlines billing and coding context, typical sites of service, and areas where policy updates or payer-specific rules can affect claim adjudication.

The report is intended for healthcare administrators, billing professionals, and clinicians who manage immunization services. It provides practical context on the vaccine’s clinical purpose and coding identification, plus pointers about where to seek payer-specific coverage details. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare90619CPTmeningococcal vaccineimmunizationvaccine administrationambulatory carepreventive medicineintramuscular injection

Billing Code Overview

CPT code 90619 represents a meningococcal conjugate vaccine in a tetanus toxoid carrier administered intramuscularly to protect against four common meningococcal serogroups. The vaccine is indicated to prevent meningococcal disease, including meningitis and septicemia (sepsis), by inducing immunity against the encapsulated bacteria that cause these life‑threatening infections.

Service Type: Immunization / Vaccine Administration

Typical Site of Service: Outpatient clinic, physician office, public health clinic, or other ambulatory care settings where intramuscular vaccines are routinely given.

Clinical & Coding Specifications

Clinical Context

A 16-year-old adolescent presents to a primary care clinic for routine immunization prior to entering college. The patient requests the meningococcal conjugate vaccine with a tetanus toxoid carrier to protect against serogroups A, C, W, and Y. The clinical workflow includes verification of immunization history, review of contraindications (severe allergy to vaccine components), informed consent, administration via intramuscular injection (typically deltoid for older children and adults), and documentation of vaccine lot number, expiration date, manufacturer, site, route, and VIS (Vaccine Information Statement) provided. Billing staff assign 90619 for the vaccine product. Routine observation for 15 minutes post-vaccination for adverse reactions is performed. Examples of settings where this service is delivered include ambulatory primary care clinics, pediatric offices, student health centers, and community vaccination clinics.

Coding Specifications

Modifier	Description	When to Use
`00`	Default/Unspecified	Rarely used; placeholder when no other modifier applies and payer requires a two-character modifier field.
`25`

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians commonly administer routine adolescent and adult vaccines.
`208000000X`	Pediatrics	Pediatricians administer immunizations for adolescents and children, including meningococcal conjugate vaccines.
`363LP0800X`	Public Health	Public health providers and immunization clinics deliver mass vaccination and community immunization services.
`207R00000X`	Internal Medicine	Internists may provide adult immunizations and documentation for college-bound or high-risk adults.
`3336C0002X`	College Health	Student health clinicians administer vaccines for university and college populations.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Indicates the visit is for vaccine administration and is commonly used when reporting routine meningococcal vaccination.
`Z28.1`	Immunization not carried out because of patient decision for reasons of belief or group attitude	Used if the patient declines vaccination after counseling.
`Z20.9`	Contact with and (suspected) exposure to unspecified communicable disease	Used in contexts of potential exposure where vaccination may be indicated as prophylaxis.
`A39.0`	Meningococcal meningitis	Diagnosis for confirmed disease; relevant when documenting reasons for post-exposure vaccination or outbreak response.
`A39.2`	Meningococcemia	Relevant for cases of invasive meningococcal disease in contacts or outbreak control where vaccination may be administered.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90460`	Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered	Used when counseling is provided and combined with vaccine administration for pediatric/adolescent patients; often billed with product code when required by payer.
`90461`	Immunization administration through 18 years of age via any route of administration, with counseling; each additional vaccine/toxoid administered	Billed when multiple vaccines are given in the same visit.
`90471`	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid)	Used for vaccine administration when age or payer requires this administration code instead of the counseling-specific codes.
`90472`	Each additional vaccine (single or combination vaccine/toxoid) administered in a single visit	Used when more than one vaccine is administered during the same encounter.
`90630`	Pneumococcal conjugate vaccine, 13 valent, for intramuscular use	Commonly administered in the same immunization visit for at-risk patients; listed as an example of another vaccine product given alongside `90619`.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	May be reported if a medically necessary E/M service is provided separate from routine vaccine administration.

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