CPT 90636: Adult Intramuscular Hepatitis A and B Combined Vaccine - OpenPayer

Summary & Overview

CPT 90636: Adult Intramuscular Hepatitis A and B Combined Vaccine

CPT code 90636 denotes an adult-dose, intramuscular combined hepatitis A and hepatitis B vaccine. This vaccine provides protection against two viral liver infections with a single product and is used in outpatient and ambulatory settings. Nationally, vaccination codes like 90636 matter for public health planning, immunization program administration, and claims adjudication.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical use and service context for 90636, typical sites of service, and the payer landscape relevant to vaccine billing. The publication also outlines common billing modifiers and operational considerations, and provides benchmark and policy context where available.

This summary is intended to orient clinicians, billing staff, and policy analysts to the purpose of CPT code 90636, its role in adult immunization, and the payer coverage environment at a national level. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare90636CPTvaccinehepatitis Ahepatitis Bimmunizationadult immunizationintramuscular injectionoutpatient

Billing Code Overview

CPT code 90636 represents an adult-dose vaccine administered intramuscularly to protect against hepatitis A and hepatitis B, a combined vaccine that prevents two liver infections. The code denotes the vaccine product itself and its administration via a muscle injection for adult patients.

Service type: Vaccine administration (combined hepatitis A and B), intramuscular
Typical site of service: Outpatient clinics, primary care offices, occupational health clinics, and other ambulatory care settings where adult immunizations are provided.

Clinical & Coding Specifications

Clinical Context

A typical adult patient presents to a primary care clinic or occupational health clinic for routine immunization prior to travel to a region with hepatitis A or B exposure risk, or for completion of a combined hepatitis A/hepatitis B adult vaccination series. The patient registration includes verification of identity, insurance (examples: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare), allergy history, prior vaccine record review, and informed consent. The clinician (primary care physician, family medicine nurse practitioner, or occupational health nurse) confirms indication and documents contraindications. The vaccine 90636 (adult formulation, administered intramuscularly) is prepared and administered into the deltoid muscle. Observation for 15 minutes for adverse reactions is performed. Vaccine lot number, manufacturer, expiration date, site and route (intramuscular), and VIS publication and date are documented in the medical record and immunization registry per state law. Billing uses CPT code 90636 with applicable modifier(s) as needed and an appropriate ICD-10 diagnosis reflecting vaccine administration or patient risk status listed on the claim.

Coding Specifications

Modifier	Description	When to Use
`25`

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

cpt-90685-quadrivalent-flu-vaccine-0-25ml-im-injection

CPT 90685: Quadrivalent Influenza Vaccine, 0.25 mL IM Dose

cpt-90748-hepatitis-b-hib-combination-vaccine-im-admin

CPT 90748: Hepatitis B and Haemophilus influenzae b Combination Vaccine, IM

cpt-90695-h5n8-adjuvanted-cell-culture-influenza-vaccine

CPT 90695: H5N8 Adjuvanted Cell-Culture Influenza Vaccine

cpt-90635-h5n1-cell-culture-adjuvanted-influenza-vaccine-injection

CPT 90635: H5N1 Cell-Culture Adjuvanted Influenza Vaccine

cpt-90738-japanese-encephalitis-vaccine-im-injection

CPT 90738: Inactivated Japanese Encephalitis Vaccine, IM

cpt-90644-meningococcal-hib-combination-vaccine-infant-im-immunization

CPT 90644: Infant Meningococcal and Hib Combination Vaccine, IM

cpt-90667-influenza-vaccine-split-virus-adjuvanted-im-admin

CPT 90667: Split-Virus Adjuvanted Influenza Vaccine, Intramuscular

cpt-90672-quadrivalent-live-intranasal-influenza-vaccine

CPT 90672: Quadrivalent Live Intranasal Influenza Vaccine

cpt-90658-trivalent-influenza-vaccine-split-virus-0-5ml-im

CPT 90658: Trivalent Influenza Vaccine, Split Virus, 0.5 mL

Showing 1–10 of 101

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary setting for routine adult vaccination and pre-travel immunization.
`207R00000X`	Internal Medicine	Adult primary care clinicians who administer adult vaccines.
`363A00000X`	Nurse Practitioner	NPs commonly administer vaccines in ambulatory and occupational health clinics.
`363L00000X`	Registered Nurse	RNs typically perform vaccine preparation, administration, and observation.
`208800000X`	Preventive Medicine	Clinicians specializing in preventive care and immunization programs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Primary diagnosis code used to indicate administration of a vaccine, including `90636`.
`Z29.2`	Need for prophylactic vaccination and inoculation against single disease	Used when documenting need for hepatitis A/B prophylaxis in an adult.
`Z20.9`	Contact with and (suspected) exposure to unspecified communicable disease	Used when vaccination is given because of potential exposure risk.
`Z76.89`	Persons encountering health services in other specified circumstances	Used for administrative encounters related to travel or occupational health services when vaccine is given.
`B16.9`	Acute hepatitis B without hepatic coma	Relevant as background diagnosis when vaccinating non-immune contacts; used rarely as context for prophylaxis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90471`	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular), one vaccine (single or combination vaccine/toxoid)	Often billed for the administration component when separate administration code is required alongside vaccine product code `90636` depending on payer rules.
`90472`	Each additional vaccine (if required)	Billed when more than one vaccine administration is given at the same visit in addition to the first administration service.
`90715`	Tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, intramuscular	Commonly administered at the same preventive visit or travel clinic encounter with `90636` if indicated.
`90714`	Hepatitis A vaccine, adult dosage, intramuscular	May be used if hepatitis A vaccine is administered separately rather than combined product `90636`.
`90460`	Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component	Not typically used for adults but relevant in mixed-age clinics; adult equivalent is `90471`.
`99070`	Supplies and materials (except spectacles), provided by physician over and above those usually included with the office visit	Used to bill for non-covered vaccine administration supplies in specific payer situations.

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