Summary & Overview
CPT 90738: Inactivated Japanese Encephalitis Vaccine, IM
CPT code 90738 denotes administration of an inactivated Japanese encephalitis virus vaccine via intramuscular injection to protect against mosquito-borne encephalitis. This immunization is important for travelers to endemic areas and for public health prevention of a serious neurologic infection. Nationally, vaccine administration codes like 90738 are used across outpatient, travel medicine, and public health clinics and have implications for coverage policy, prior authorization practices, and preventive care benefit design.
Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage tendencies, common billing and coding considerations, and the clinical context for vaccine use. The report highlights benchmarks for utilization and reimbursement where available, summarizes recent policy updates affecting vaccine coverage, and situates 90738 within immunization practice patterns. The content is intended for providers, billing professionals, and policy analysts seeking a concise national view of how this vaccine administration code is used and reimbursed across major payers.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
CPT code 90738 describes administration of an inactivated Japanese encephalitis virus vaccine given by intramuscular injection to protect against encephalitis caused by mosquito-borne Japanese encephalitis virus. This service is a vaccine administration for active immunization against a viral encephalitis.
-
Service type: Vaccine administration / immunization
-
Typical site of service: Ambulatory clinic, travel medicine clinic, public health clinic, or other outpatient settings where intramuscular vaccinations are provided
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 35-year-old international traveler presents to a primary care travel clinic for pre-travel vaccination prior to a two-week trip to rural Southeast Asia during the wet season. The patient has no prior history of Japanese encephalitis (JE) vaccination and requests protection against mosquito-borne encephalitis. The clinic nurse reviews travel itinerary, immunization history, and contraindications (egg allergy, prior severe vaccine reaction, immunocompromised status). After informed consent, the provider administers the inactivated Japanese encephalitis vaccine intramuscularly (90738) in the deltoid. The visit includes screening for acute illness, documentation of lot number and vaccine manufacturer, observation for immediate adverse reaction (typically 15 minutes), and scheduling of any required follow-up doses per vaccine guidance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier applicable | Use when no specific modifier applies to the vaccine administration claim |
23 | Unusual procedural services | Use only if administration required substantially greater service due to unusual circumstances unrelated to vaccine itself |