Summary & Overview
CPT 90736: Varicella Live Vaccine, Subcutaneous Administration
CPT code 90736 denotes subcutaneous administration of a live vaccine to protect against varicella zoster infection. This code documents the clinical act of delivering a varicella vaccine and is central to immunization delivery, public health prevention efforts, and routine outpatient care. Accurate use of this code ensures that providers record vaccine administration separate from vaccine product reporting and supports surveillance and reimbursement processes nationwide.
Key payers in national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and payment policies for vaccine administration can affect provider billing workflows, patient access to immunization services, and public health vaccine uptake.
Readers will find clinical context for the service, an overview of typical sites of service and operational considerations, and a concise look at payer coverage landscape. Content addresses benchmarking and policy-relevant issues at a national level where available. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 90736 describes administration of a live vaccine, given subcutaneously, to protect against varicella zoster infection. This service is a vaccine administration encounter focused on delivering the varicella (chickenpox/shingles-related) live attenuated vaccine.
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Service type: Vaccine administration (live, subcutaneous)
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Typical site of service: Ambulatory clinic, physician office, community health center, public health clinic, or other outpatient settings where immunizations are provided.
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Clinical & Coding Specifications
Clinical Context
A 4-year-old child presents to a primary care clinic for routine immunization and receives the varicella (chickenpox) live attenuated vaccine subcutaneously, code 90736. The visit is scheduled during standard outpatient hours at a pediatric or family medicine office. The clinical workflow includes patient arrival and registration, review of immunization history and contraindications (e.g., immunocompromise, pregnancy in household contacts), verification of consent, screening for recent febrile illness or recent blood products, preparation and reconstitution of the vaccine as per manufacturer instructions, administration subcutaneously in the anterolateral thigh or upper arm, documentation of vaccine lot number, manufacturer, site and route, and observation for 15 minutes for immediate adverse reactions. The encounter may be billed with an evaluation and management service if an exam or medical decision-making beyond routine immunization counseling occurs, or as a stand-alone vaccine administration when given during a dedicated immunization visit.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Used when no special modifier applies. |
11 |