CPT 90623: Pentavalent Meningococcal Vaccine, Intramuscular - OpenPayer

Summary & Overview

CPT 90623: Pentavalent Meningococcal Vaccine, Intramuscular

CPT code 90623 denotes a pentavalent meningococcal vaccine administered intramuscularly to protect against five serogroups of Neisseria meningitidis. This vaccine is relevant nationally for routine and catch-up immunization strategies, outbreak response, and prevention in high-risk populations. Vaccination against meningococcal disease reduces incidence of invasive infections that can lead to severe morbidity and mortality, making coverage and reimbursement policies important for public health access.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. The review outlines payer coverage considerations and common administrative elements associated with vaccine billing and service delivery. Readers will find a concise clinical context for the vaccine, typical sites of service and administration, and an overview of what to expect in terms of benchmarks and policy-relevant topics. Where payer-specific data are available, the publication summarizes coverage patterns and common billing practices; where data are not provided in the input, the text indicates that the information is not available.

This national-level summary is intended for clinicians, billing professionals, and policy analysts seeking a focused reference on CPT code 90623, including clinical purpose, service setting, and the types of topics addressed in depth elsewhere in the publication.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicare90623CPTMeningococcal VaccineImmunizationIntramuscularPreventive CareVaccine AdministrationPublic HealthOutpatient Services

Billing Code Overview

CPT code 90623 represents a pentavalent meningococcal vaccine administered intramuscularly to protect against five serogroups of meningococcal disease. The product is a vaccine formulation intended for active immunization to prevent invasive meningococcal infections.

Service Type

Immunization / Vaccine Administration

Typical Site of Service

Outpatient clinics, primary care offices, public health vaccination clinics, and pharmacies where intramuscular vaccines are administered

Clinical & Coding Specifications

Clinical Context

A 16-year-old adolescent presents to a primary care clinic for routine immunization prior to starting college. The patient has no acute illness, is not febrile, and has completed vaccine screening for contraindications. After verification of immunization history and informed consent, a licensed nurse prepares the pentavalent meningococcal intramuscular vaccine 90623 (protecting against five serogroups). The nurse documents lot number, expiration date, vaccine administration site (typically deltoid muscle for adolescents and adults), route (intramuscular), and patient tolerance. The visit includes education on expected local and systemic reactions, observation for 15 minutes for syncope or immediate allergic reaction, and updating the immunization registry and the patient’s medical record. Billing uses the vaccine product code 90623 for the administered dose; if applicable, an administration code (per payer rules) may be appended according to payer billing policies.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier; standard reporting	Use when no special circumstance applies to the vaccine administration.

CPT 90732: Pneumococcal Polysaccharide Vaccine Administration, Age 2+

cpt-90686-quadrivalent-influenza-vaccine-preservative-free-im

CPT 90686: Quadrivalent Influenza Vaccine, Preservative-Free, IM

cpt-90622-smallpox-vaccine-percutaneous-03ml

CPT 90622: Smallpox Vaccine, Percutaneous 0.3 mL

cpt-90655-preservative-free-trivalent-influenza-vaccine-025ml-im-immunization

CPT 90655: Preservative-Free Trivalent Influenza Vaccine, 0.25 mL IM

cpt-90681-rotavirus-live-oral-two-dose-vaccine

CPT 90681: Live Oral Rotavirus Vaccine, Two-Dose Schedule

cpt-90611-smallpox-monkeypox-vaccine-subcutaneous-05ml

CPT 90611: Combined Smallpox and Monkeypox Vaccine, 0.5 mL

cpt-91304-sars-cov-2-vaccine-5mcg-intramuscular

CPT 91304: SARS–CoV–2 Vaccine, 5 mcg/0.5 mL Intramuscular

cpt-90697-six-way-dtap-ipv-hib-hepb-vaccine-immunization

CPT 90697: Six‑disease Combination Vaccine, Intramuscular

cpt-90733-quadrivalent-meningococcal-polysaccharide-vaccine-subcutaneous

CPT 90733: Quadrivalent Meningococcal Polysaccharide Vaccine, Subcutaneous

cpt-90632-adult-hepatitis-a-vaccine-immunization

CPT 90632: Adult Hepatitis A Vaccine, Intramuscular

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care physicians commonly order and administer routine immunizations.
`208000000X`	Pediatrics	Pediatricians frequently administer adolescent and childhood vaccines including meningococcal products.
`363A00000X`	Nurse Practitioner	NPs often provide vaccine counseling and administration in outpatient settings.
`374H00000X`	Physician Assistant	PAs commonly administer vaccines under supervising physician protocols.
`390200000X`	Registered Nurse	RNs typically prepare and administer intramuscular vaccines and document administration.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Primary diagnosis code for routine vaccine administration visits and appropriate for billing vaccine `90623`.
`Z00.129`	Encounter for routine child health examination without abnormal findings	Used when vaccination occurs during a routine adolescent/young adult preventive visit.
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Used for adult preventive visits that include vaccination.
`Z71.89`	Other specified counseling	Used when vaccine counseling is provided as a significant part of the visit.
`T78.40XA`	Allergy, unspecified, initial encounter	Used if an immediate allergic reaction occurs during or after vaccine administration and requires treatment.

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	Often billed with vaccine product codes for pediatric/adolescent patients when counseling and administration occur (check payer rules for bundling).
`90461`	Immunization administration through 18 years of age; each additional vaccine or toxoid administered	Used when multiple vaccines are given during the same encounter in patients ≤18 years.
`90471`	Immunization administration (intramuscular, single or first component)	Used for adult vaccine administration when counseling is not separately reported per payer policy.
`90472`	Immunization administration (intramuscular, each additional component)	Used when more than one vaccine is administered during the same adult visit.
`90732`	Pneumococcal polysaccharide vaccine; 23-valent (PPSV23), adult or specified	May be administered during the same preventive visit; listed to show other commonly coadministered vaccines and billing relationships.

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