Summary & Overview
CPT 90716: Varicella Vaccine, Subcutaneous Administration
CPT code 90716 represents the subcutaneous administration of a live varicella vaccine to prevent varicella (chickenpox). As a routinely used preventive immunization in ambulatory care, this code is central to pediatric and adult immunization programs and impacts billing workflows, coverage determinations, and public health vaccination efforts nationwide. Coverage and payment practices for vaccine administration codes influence provider reimbursement and patient access to routine immunizations.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The review outlines payer coverage approaches, common billing modifiers and procedural considerations, and operational benchmarks for administration of live varicella vaccine in outpatient settings.
Readers will find a concise clinical and billing context for CPT code 90716, guidance on typical sites of service and service type, and summaries of payer coverage patterns. The publication also provides information useful for coding accuracy, claims submission, and reconciliation of common administrative issues related to vaccine administration. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 90716 describes the administration of a live varicella (chickenpox) vaccine given subcutaneously. The service involves a healthcare provider delivering a preventive immunization to protect patients against varicella infection.
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Service type: Preventive vaccine administration, single-dose subcutaneous injection
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Typical site of service: Outpatient clinic, physician office, community health center, or other ambulatory care settings
Clinical & Coding Specifications
Clinical Context
A typical patient is a school-aged child or susceptible adult presenting for immunization against varicella (chickenpox) to prevent primary varicella infection. The workflow begins with verification of immunization history and screening for contraindications (e.g., severe immunocompromise, pregnancy, allergy to vaccine components). Consent is obtained, vaccine is prepared and administered subcutaneously by a licensed clinician (pediatrician, family medicine physician, nurse practitioner, or registered nurse) in a clinic, pediatric office, community health center, or occupational health setting. Post-vaccination observation for 15 minutes for immediate adverse reactions is performed, and documentation includes vaccine lot number, manufacturer, administration site, route, dose, and the specific vaccine given. Billing uses 90716 for administration of live varicella vaccine; relevant diagnosis code(s) supporting preventive immunization or exposure risk are appended as appropriate. Typical sites of service are outpatient clinic, physician office, public health clinic, or community vaccination event.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service | Use when a separate E/M visit is provided the same day as and documentation supports a distinct E/M service |