Summary & Overview
CPT 90647: Haemophilus influenzae type b (Hib) PRP–OMP Vaccine, IM
CPT code 90647 denotes a Haemophilus influenzae type b (Hib) vaccine using a PRP–OMP conjugate formulation administered intramuscularly on a three-dose schedule. This preventive vaccine code is nationally relevant as Hib remains a vaccine-preventable cause of invasive bacterial disease in young children; accurate coding supports population immunization tracking, public health reporting, and appropriate payer reimbursement for routine pediatric vaccination.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage considerations, typical sites of service, and commonly applied modifiers where available. It is intended for a national audience of billing professionals, practice administrators, and policy analysts.
Readers will learn the clinical context for CPT code 90647, how it is used in outpatient and ambulatory settings for pediatric immunization programs, and what to expect in terms of coding practice. The report summarizes benchmark topics such as service type classification, typical sites of service, and common modifiers listed in the input. Where specific payer policies, ICD-10 linkages, or taxonomies are not provided in the source data, the summary notes that additional payer-specific guidance should be consulted. Data not available in the input is identified in-line where relevant.
Billing Code Overview
CPT code 90647 represents a Haemophilus influenzae type b (Hib) vaccine product formulated as a PRP–OMP conjugate. The vaccine is administered by intramuscular injection and is intended to provide active immunization against Hib disease following a three-dose schedule.
Service type: Vaccine administration (preventive immunization)
Typical site of service: Outpatient clinics, pediatrician offices, community immunization centers, and other ambulatory care settings.
Clinical & Coding Specifications
Clinical Context
A typical patient is an infant presenting to a pediatric clinic or community immunization center for routine childhood vaccinations on the recommended Hib schedule. The patient is generally between 2 and 15 months of age receiving a PRP–OMP conjugate formulation in a three–dose series, administered intramuscularly. The clinical workflow includes verification of patient identity, review of immunization history and contraindications (eg, severe allergy to vaccine components), informed consent from the parent or guardian, preparation of the single‑dose syringe or vial, aseptic intramuscular injection (typically into the anterolateral thigh for infants), documentation of vaccine lot number, manufacturer, administration site, and date in the medical record and immunization registry, and provision of vaccine information statements to the caregiver. Billing is submitted using 90647 for the vaccine product; appropriate diagnosis code(s) are added to support medical necessity, and relevant modifiers may be appended per payer or circumstance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier specified | Rarely used; default billing with no special modifier required |
| 11 | Professional component | Use when only the professional component is reported (rare for vaccine administration)