CPT 90740: Hepatitis B Vaccine for Immunosuppressed and Dialysis Patients - OpenPayer

Summary & Overview

CPT 90740: Hepatitis B Vaccine for Immunosuppressed and Dialysis Patients

CPT code 90740 represents an intramuscular hepatitis B vaccine product formulated for patients who are immunosuppressed or receiving dialysis and is given as a three-dose series. This vaccine plays a critical role in preventing hepatitis B infection among high-risk populations who may have an attenuated immune response and require tailored dosing. Nationally, immunization of these groups reduces morbidity from chronic liver disease and limits transmission within healthcare settings.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for 90740, typical sites of service, and the population it targets. The publication also provides benchmarking information where available, common billing and coding considerations, and summaries of recent policy updates that affect coverage and administration practices. Where specific input data is missing, the text notes that information is not available in the input. The content is intended to inform billing staff, compliance officers, and clinical administrators about how CPT code 90740 is used in practice and what issues commonly arise when vaccinating immunosuppressed or dialysis patients.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare90740CPThepatitis-bvaccineimmunizationdialysisimmunosuppressedoutpatient

Billing Code Overview

CPT code 90740 describes an intramuscular hepatitis B vaccine formulation intended for patients who are immunosuppressed or are undergoing dialysis. The vaccine is administered on a three-dose schedule to provide active immunization against hepatitis B virus, a liver infection that can lead to chronic disease.

Service Type: Vaccine administration / Immunization

Typical Site of Service: Outpatient clinics, dialysis centers, physician offices, and other ambulatory care settings

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult undergoing hemodialysis or receiving immunosuppressive therapy who requires the Hepatitis B vaccine series using the higher-dose or specialized formulation for immunocompromised or dialysis patients. The patient presents to an outpatient dialysis unit, primary care clinic, or community health center. The clinical workflow includes verification of prior Hepatitis B immunization status and serology (HBsAg, anti-HBs), informed consent, medication reconciliation for bleeding risk, and screening for acute illness or allergy. The licensed nurse prepares the 90740 vaccine and administers it intramuscularly (typically into the deltoid); documentation includes vaccine lot number, expiration, manufacturer, site and route of administration, VIS date, and adverse event counseling. Scheduling for the next dose in the three-dose series is arranged per immunization schedule adjusted for dialysis/immunosuppressed patients. Billing is submitted using 90740 with applicable modifier(s) reflecting the context of the encounter and any billing peculiarities (for example, professional vs technical components or payer-specific requirements).

Coding Specifications

Modifier	Description	When to Use
`00`	Default/No modifier	Use when no other modifier applies to the service.

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Common site for adult vaccine administration and documentation.
`208000000X`	Internal Medicine	Manages chronic disease patients and vaccines for immunosuppressed adults.
`3336C0002X`	Nephrology	Often administers `90740` for dialysis patients within the dialysis unit.
`363L00000X`	Infectious Disease	Consults on vaccine management for complex immunosuppressed patients.
`363A00000X`	Allergy & Immunology	Manages vaccine decisions in patients with allergy or immunodeficiency.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Primary diagnosis for administration of vaccines including `90740`.
`Z92.89`	Personal history of other specified conditions influencing health status and contact with health services	Used when documenting history that affects vaccination decisions (e.g., prior vaccine reactions).
`Z79.899`	Other long term (current) drug therapy	Indicates chronic immunosuppressive therapy that may necessitate the specialized Hepatitis B vaccine schedule.
`N18.6`	End stage renal disease	Relevant for dialysis patients who require the higher-dose Hepatitis B vaccine formulation.
`D80.9`	Immunodeficiency, unspecified	Indicates immunocompromised status influencing vaccine choice and schedule.
`R51`	Headache	Example of intercurrent minor illness; vaccinations may be deferred based on clinical judgment.
`T88.1XXA`	Other complication following immunization, initial encounter	Used if an adverse reaction occurs after `90740` administration.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90471`	Immunization administration (percutaneous, intradermal, subcutaneous, or intramuscular) when performed alone	Billed for vaccine administration when payer requires separate administration code instead of vaccine code-only billing for `90740`.
`90472`	Immunization administration, each additional vaccine (same date)	Use when `90740` is administered with another vaccine during the same encounter.
`96372`	Therapeutic, prophylactic, or diagnostic injection (subcutaneous or intramuscular)	Occasionally used for injection services when payer requires this code for administration instead of vaccine-specific administration codes.
`36415`	Collection of venous blood by venipuncture	Performed when pre-vaccination serology (HBsAg, anti-HBs) is collected.
`99213`	Office or other outpatient visit, established patient, low to moderate complexity	Used for evaluation and management when a clinician provides counseling or pre-vaccination assessment in the same visit.

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