CPT 90648: Haemophilus influenzae type b (Hib) PRP–T Conjugate Vaccine - OpenPayer

Summary & Overview

CPT 90648: Haemophilus influenzae type b (Hib) PRP–T Conjugate Vaccine

CPT code 90648 identifies a Haemophilus influenzae type b (Hib) PRP–T conjugate vaccine administered intramuscularly on a four-dose schedule. This preventive immunization is a routine component of pediatric vaccine programs and contributes to national efforts to reduce invasive Hib disease, including meningitis and epiglottitis. Coverage and coding for Hib vaccines affect outpatient pediatrics, family medicine, and public health immunization strategies.

Key payers commonly involved in coverage and reimbursement for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find in this publication a concise overview of CPT code 90648, context on clinical use and typical sites of service, and benchmarking content relevant to payer coverage patterns and administration settings. The report highlights coding considerations, common modifiers used in vaccine billing (listed separately), and where to look for policy updates affecting vaccine reimbursement.

This summary is intended for national audiences including practice managers, coding professionals, and policy analysts seeking a clear reference for CPT code 90648 and its role in routine immunization delivery. Data not available in the input will be noted in relevant sections of the full publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare90648CPTHib vaccineimmunizationpediatricsvaccine administrationPRP-T conjugateoutpatient

Billing Code Overview

CPT code 90648 represents a Haemophilus influenzae type b (Hib) vaccine product formulated as a PRP–T conjugate and administered intramuscularly. The code denotes a vaccine intended to protect against invasive Hib disease and is described as following a four-dose schedule.

Service Type: Vaccine administration (immunization)

Typical Site of Service: Outpatient clinic, pediatric office, or other ambulatory care settings

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 2-month-old infant presents to a pediatric clinic for routine immunizations during a well-child visit. The infant receives the Haemophilus influenzae type b (Hib) vaccine formulation containing a PRP–T conjugate administered intramuscularly in the anterolateral thigh. The clinical workflow includes vaccine screening for contraindications and allergies, parental consent, preparation of the single-dose syringe, administration with aseptic technique, documentation of lot number, expiration date, manufacturer, site and route of administration, and provision of the Vaccine Information Statement (VIS). Observation for 15 minutes post-injection for immediate adverse reactions is completed, and the visit is coded using 90648 for the vaccine product and an appropriate evaluation and management code for the well-child visit if billed separately.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	Use when no special circumstances or modifiers apply to the vaccine administration.
`25`	Significant, separately identifiable E/M service on the same day

CPT 90623: Pentavalent Meningococcal Vaccine, Intramuscular

cpt-90714-diphtheria-tetanus-preservative-free-immunization-im

CPT 90714: Diphtheria and Tetanus Preservative‑Free Vaccine IM

cpt-90621-meningococcal-recombinant-lipoprotein-vaccine-im

CPT 90621: Meningococcal Recombinant Lipoprotein Vaccine, IM

cpt-90633-hepatitis-a-vaccine-pediatric-two-dose

CPT 90633: Hepatitis A Vaccine, Pediatric Two-Dose

cpt-90682-quadrivalent-recombinant-influenza-vaccine-im-im

CPT 90682: Quadrivalent Recombinant Influenza Vaccine, IM

cpt-90679-prefusion-f-rsv-vaccine-im-intramuscular

CPT 90679: Prefusion F (preF) RSV Vaccine, Adjuvanted, Intramuscular

cpt-90613-flu-covid19-combination-vaccine-im-injection

CPT 90613: Influenza and COVID-19 Combination Vaccine, IM

cpt-90589-chikungunya-vaccine-intramuscular-live-attenuated

CPT 90589: Chikungunya Vaccine, Intramuscular, Live Attenuated

cpt-90661-intramuscular-trivalent-influenza-vaccine-05-ml

CPT 90661: Intramuscular Trivalent Influenza Vaccine, 0.5 mL

cpt-90668-pandemic-influenza-split-virus-im-m-vaccine

CPT 90668: Influenza Vaccine, Split Virus for Pandemic Strain

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Pediatrics	Most common specialty administering routine Hib immunizations in infants and children.
`371K00000X`	Family Medicine	Family physicians administer routine childhood vaccines during well-child visits.
`364S00000X`	Physician Assistant	PAs commonly provide immunizations in ambulatory settings under supervising physician.
`163W00000X`	Nurse Practitioner	NPs administer vaccines in primary care and pediatric practices.
`3456C1001X`	Public Health Nursing	Public health nurses administer vaccines in community clinics and outreach programs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z00.121`	Encounter for routine child health examination with abnormal findings	Well-child visit code that may accompany vaccine administration when minor abnormal findings are identified.
`Z00.129`	Encounter for routine child health examination without abnormal findings	Typical diagnosis code for preventive immunization visits when `90648` is administered.
`Z23`	Encounter for immunization	Primary diagnosis code used to indicate the visit is for vaccine administration such as `90648`.
`T88.0XXA`	Allergy or adverse reaction to vaccine, initial encounter	Used if the patient experiences an adverse reaction to the Hib vaccine requiring medical attention.
`R68.89`	Other general symptoms and signs	May be used for reporting nonspecific post-immunization symptoms when clinically relevant.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common E/M code used for a well-child or sick visit during which `90648` may be administered and documented separately when applicable.
`90460`	Immunization administration through 18 years of age via any route with counseling by physician or other qualified health care professional; first vaccine/toxoid component	Used to report the administration service for the first vaccine component when counseling is provided on the same day as `90648` for pediatric patients.
`90461`	Each additional vaccine/toxoid component (List separately in addition to code for primary service)	Used when multiple vaccine components are administered during the same encounter alongside `90648`.
`96110`	Developmental screening, limited (e.g., with a standardized tool)	Often performed during well-child visits when vaccines like `90648` are administered; supports preventive care coding when applicable.
`99070`	Supplies and materials (e.g., bandages, syringes) provided by the physician over and above those usually included with the office visit	Used to bill for additional supplies related to vaccine administration when allowed by payers.

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