Summary & Overview
CPT 90747: Hepatitis B Vaccine for Immunosuppressed or Dialysis Patients
CPT code 90747 denotes an intramuscular hepatitis B vaccine formulation administered in a four-dose schedule for patients who are immunosuppressed or receiving dialysis. This vaccine is clinically important because immunosuppressed and dialysis populations have higher risk of inadequate vaccine response and greater morbidity from hepatitis B infection, making appropriate vaccine selection and scheduling a public health priority.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a compact overview of the clinical context for CPT code 90747, payer coverage considerations, common billing modifiers, and where this vaccine is typically administered. The publication also summarizes benchmarking topics relevant to billing and reimbursement for this vaccine formulation and flags areas where policy updates or payer-specific rules commonly affect claims processing.
The report is intended for clinical administrators, billing professionals, and payers seeking a national perspective on the clinical use and billing context of CPT code 90747. It provides practical reference material on service type and site of service, and identifies gaps where detailed payer policy or diagnosis linkage varies across plans. Data not available in the input is identified where applicable.
Billing Code Overview
CPT code 90747 represents an intramuscular hepatitis B vaccine formulation intended for patients who are immunosuppressed or undergoing dialysis. The vaccine is administered as part of a four-dose schedule designed to provide protection against hepatitis B virus–related liver disease.
Service Type: Vaccine administration / preventive immunization
Typical Site of Service: Outpatient clinic, dialysis center, or other ambulatory care setting
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with end-stage renal disease on maintenance hemodialysis presents to the outpatient dialysis clinic for routine intramuscular immunization with the hepatitis B vaccine, dose-scheduled as a four-dose series for dialysis patients. The vaccine is administered by a licensed nurse in the dialysis unit after review of prior vaccination records and hepatitis B surface antibody titers. Documentation includes vaccine product, lot number, expiration date, injection site, route (intramuscular), informed consent, and any immediate adverse reactions. The encounter is billed using 90747 for the immunosuppressed/dialysis four-dose hepatitis B vaccine formulation. Typical site of service is an outpatient dialysis center or physician office; the service type is vaccine administration during a medically directed dialysis or chronic care encounter. Time-based or bundled services (for example, dialysis session or evaluation and management services) are documented separately and modifiers may be appended when applicable to indicate distinct or reduced services.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Standard reporting when no other modifier applies |
11 |