CPT 90750: Adjuvanted Varicella Zoster Vaccine, Intramuscular Injection - OpenPayer

Summary & Overview

CPT 90750: Adjuvanted Varicella Zoster Vaccine, Intramuscular Injection

CPT code 90750 represents intramuscular administration of an adjuvanted varicella zoster vaccine, a preventive immunization to reduce the risk of shingles and related complications. Nationally, vaccine administration codes like 90750 are important for capturing preventive services, ensuring appropriate payment for vaccine delivery, and monitoring immunization uptake among eligible populations.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for adjuvanted varicella zoster vaccination, typical settings where the service is delivered, and the billing considerations relevant to payers nationwide. The publication outlines benchmarks for utilization and reimbursement trends where available, summarizes recent policy updates affecting vaccine administration billing, and highlights documentation and coding points that influence claim acceptance.

This resource is intended for billing professionals, practice managers, and policy analysts seeking a concise reference on how CPT code 90750 is used in clinical practice and across major payers, along with the operational and policy factors that commonly affect vaccine administration claims.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare90750CPTvaccine-administrationvaricella-zosterimmunizationadjuvanted-vaccineoutpatientpreventive-care

Billing Code Overview

CPT code 90750 describes the injection of an adjuvanted vaccine administered intramuscularly to protect against varicella zoster infection. The service involves a licensed provider delivering an intramuscular vaccination using an adjuvanted formulation intended to enhance immune response to varicella zoster.

Service Type: Vaccine administration (intramuscular), adjuvanted varicella zoster vaccine

Typical Site of Service: Outpatient clinic, physician office, or other outpatient vaccination setting

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult seeking vaccination against varicella zoster (herpes zoster/shingles) in an outpatient primary care clinic or pharmacy clinic. The patient presents for routine prevention or following clinician recommendation due to age (commonly ≥50 years) or immunocompetent status. The clinical workflow includes patient check-in, review of immunization history and contraindications (e.g., allergy to vaccine components, pregnancy status, immunosuppression), informed consent and counseling about benefits and potential side effects, preparation of the adjuvanted zoster vaccine, intramuscular injection (typically into the deltoid muscle), documentation of vaccine lot number and manufacturer, billing using 90750, and observation for a short period for adverse reactions before discharge.

Common sites of service are outpatient clinic, physician office, and retail pharmacy immunization clinic. The service type is an intramuscular vaccine administration procedure for prevention of varicella zoster infection. Typical patient scenario: a 62-year-old adult with no contraindications receives the adjuvanted zoster vaccine in the deltoid after counseling; vaccine lot and manufacturer are recorded; the patient is observed for 15 minutes and leaves without immediate adverse event.

Coding Specifications

For the adjuvanted zoster vaccine injection billed as 90750, the following modifiers are most clinically relevant and commonly applied in outpatient immunization settings.

Modifier	Description	When to Use

CPT 90644: Infant Meningococcal and Hib Combination Vaccine, IM

cpt-90681-rotavirus-live-oral-two-dose-vaccine

CPT 90681: Live Oral Rotavirus Vaccine, Two-Dose Schedule

cpt-90655-preservative-free-trivalent-influenza-vaccine-025ml-im-immunization

CPT 90655: Preservative-Free Trivalent Influenza Vaccine, 0.25 mL IM

cpt-90673-recombinant-trivalent-influenza-vaccine-im-injection

CPT 90673: Recombinant Trivalent Influenza Vaccine, Intramuscular

cpt-90694-quadrivalent-influenza-adjuvanted-0-5ml-im

CPT 90694: Quadrivalent Inactivated Adjuvanted Influenza Vaccine, 0.5 mL

cpt-90657-trivalent-influenza-vaccine-split-virus-025ml-im-im

CPT 90657: Trivalent Influenza Vaccine, Split Virus, 0.25 mL IM

cpt-90740-hepatitis-b-vaccine-immunosuppressed-dialysis

CPT 90740: Hepatitis B Vaccine for Immunosuppressed and Dialysis Patients

cpt-90621-meningococcal-recombinant-lipoprotein-vaccine-im

CPT 90621: Meningococcal Recombinant Lipoprotein Vaccine, IM

cpt-90664-live-intranasal-pandemic-influenza-vaccine

CPT 90664: Live Intranasal Pandemic Influenza Vaccine

cpt-90647-hib-vaccine-prp-omp-three-dose

CPT 90647: Haemophilus influenzae type b (Hib) PRP–OMP Vaccine, IM

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`00`	Standard procedure code (no modifier)	Use when no special circumstances require a modifier and payer accepts unmodified billing.
`25`	Significant, separately identifiable evaluation and management service by the same provider on the same day	Use when a distinct E/M visit is performed the same day as vaccine administration and must be reported in addition to `90750`.
`59`	Distinct procedural service	Use when another procedure on the same day is unrelated and must be distinguished from vaccine administration.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use when patient counseling/consent for vaccination was delivered via synchronous telemedicine and payer requires this modifier with the in-person vaccine claim.
`GA`	Waiver of liability statement on file (payer-specific coverage)	Use when an advance beneficiary notice or waiver is on file for a patient and required by payer rules.
`GZ`	Item or service expected to be denied as not reasonable and necessary (no ABN/waiver)	Use when billing indicates the provider expects denial for medical necessity reasons and no waiver is on file.
`JW`	Drug discarded/not administered	Use when a portion of a multi-dose vaccine vial is discarded and payer requires reporting of discarded biologic; attach appropriate documentation if required.
`QW`	CLIA waived test	Included in modifier lists for clinic services that also perform point-of-care tests; only use if a CLIA-waived test accompanies the visit and payer requires this modifier.
`RT`	Right side	Use when laterality is required by payer or documentation specifies the right deltoid.
`LT`	Left side	Use when laterality is required by payer or documentation specifies the left deltoid.
`52`	Reduced services	Use when the vaccine administration was partially performed or reduced for clinical reasons and documentation supports reduction.
`53`	Discontinued procedure	Use when vaccine administration was started but discontinued prior to completion for documented clinical reasons.
`59`	Distinct procedural service	Use to indicate the vaccine administration is separate from other services provided the same day when needed by payer.
`MC`	Data not available in the input	Data not available in the input.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Family physicians commonly administer adult immunizations including zoster vaccine.
`207R00000X`	Internal Medicine	Internists provide vaccination for adult prevention and chronic disease management.
`3336C0002X`	Pharmacy	Pharmacists in many jurisdictions administer zoster vaccines in retail or clinic settings.
`207L00000X`	Pediatric Medicine	Pediatricians may administer zoster vaccine for eligible younger adults in some practices (less common).
`391200000X`	Public Health Clinic	Public health nurses and clinics provide immunization services including zoster vaccination.

Related Diagnoses

Common diagnosis codes associated with administration of zoster vaccine for prevention are listed below.

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Primary billing diagnosis for routine administration of zoster vaccine.
`Z00.129`	Encounter for routine child health examination without abnormal findings	Occasionally used for well visits where age-eligible vaccination is given (pediatric context).
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Used when vaccination occurs during a routine adult preventive visit.
`Z79.899`	Other long term (current) drug therapy	May appear in history when assessing vaccine interactions or immunosuppressive therapy that affects vaccine timing.
`D84.9`	Immunodeficiency, unspecified	Relevant when assessing contraindications or precautions to live vs. adjuvanted vaccine use (clinical evaluation).

Related CPT Codes

Commonly performed codes alongside zoster vaccine administration include vaccine product codes, administration codes when reported separately, and routine E/M or counseling codes.

CPT Code	Description	Relationship to This Procedure
`90750`	(Primary code) Injection, adjuvanted zoster vaccine, intramuscular	Primary vaccination procedure for prevention of varicella zoster; includes intramuscular administration of the adjuvanted zoster vaccine.
`90460`	Immunization administration through 18 years of age via any route, with counseling by physician or other qualified health care professional; first vaccine/toxoid component	Used when counseling and administration for pediatric patients require reporting of vaccine counseling alongside administration (note age-limited).
`90461`	Each additional vaccine/toxoid component (List separately in addition to code for primary)	Used when multiple vaccine components are administered during the same encounter and separate reporting is appropriate.
`90471`	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular); one vaccine (single or combination vaccine/toxoid)	Alternate administration code used by some payers for single adult vaccine administration when product code reporting differs.
`90472`	Each additional vaccine (single or combination vaccine/toxoid)	Used when more than one vaccine is administered in same visit and payer requires separate per-vaccine administration reporting.
`99212`	Office or other outpatient visit for the evaluation and management of an established patient, typically 10 minutes	Represents an E/M visit often billed same day when a significant, separately identifiable service is performed in addition to vaccination (paired with modifier `25` when appropriate).

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