G2154 (HCPCS) Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G2154: td/tdap Vaccine Received Within Nine-Year Lookback

HCPCS Level II code G2154 documents that a patient received at least one tetanus-diphtheria (td) or tetanus-diphtheria-acellular pertussis (tdap) vaccine within a nine-year lookback window ending at the measurement period close. Nationally, accurate capture of immunization history is essential for preventive care metrics, quality reporting, and public health surveillance. This code supports tracking of immunization status across ambulatory settings and contributes to adherence measures used by payers and programs.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what G2154 represents, clinical context for its use in outpatient and primary care settings, and the typical documentation scenarios that trigger reporting of the code. The publication outlines the value of a multi-year lookback for tetanus-containing vaccines, operational considerations for capturing immunization history, and how G2154 fits into broader immunization measurement and reporting efforts. Data not available in the input will be noted where relevant.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG2154HCPCS Level IIimmunizationtdaptetanus-diphtheriapreventive carequality reportingambulatory care

Billing Code Overview

HCPCS Level II code G2154 indicates that a patient received at least one tetanus-diphtheria (td) vaccine or one tetanus-diphtheria-acellular pertussis (tdap) vaccine between nine years prior to the start of the measurement period and the end of the measurement period. This measure documents vaccination history over a multi-year lookback window.

Service type: Vaccination history documentation / immunization reporting
Typical site of service: Outpatient clinics, primary care offices, public health clinics, and other ambulatory settings where immunizations or immunization records are administered or reviewed.

Clinical & Coding Specifications

Clinical Context

A 34-year-old adult presents to a primary care clinic for an occupational health clearance and immunization review. The patient reports a tetanus-containing vaccine within the past decade but lacks documentation in the electronic medical record. The clinical workflow includes verification of immunization history, review of county immunization registry, counseling about tetanus and pertussis risks, and administration of a tetanus-diphtheria (Td) or tetanus-diphtheria-acellular pertussis (Tdap) vaccine if indicated. Vaccine administration is documented with the HCPCS Level II code G2154 when the patient received at least one Td or Tdap vaccine between nine years prior to the measurement period start and the end of the measurement period. Typical steps include patient intake and screening for contraindications, vaccine consent, administration by a licensed nurse or pharmacist, observation for adverse reaction, and entry of the vaccination into the medical record and immunization registry.

Coding Specifications

Modifier	Description	When to Use
`22`

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HCPCS-G0416-PROSTATE-NEEDLE-BIOPSY-PATHOLOGY-EXAM

HCPCS G0416: Prostate Needle Biopsy Surgical Pathology

HCPCS-G9913-HBV-STATUS-NOT-ASSESSED-BEFORE-ANTI-TNF-INITIATION

HCPCS G9913: HBV Status Not Assessed Before Anti-TNF Initiation

HCPCS-G9750-LIVING-DONOR-KIDNEY-TRANSPLANT-SCHEDULED

HCPCS Level II G9750: Living Donor Kidney Transplant Scheduled

HCPCS-G2193-PEDIATRIC-NEW-ONSET-HEADACHE-IMAGING

HCPCS G2193: Pediatric Head Imaging for New-Onset Headache

HCPCS-G9262-IN-HOSPITAL-DEATH-ENDOVASCULAR-AAA-REPAIR

HCPCS G9262: In-hospital Death After Endovascular AAA Repair

HCPCS-G9310-UNPLANNED-30-DAY-READMISSION

HCPCS G9310: Unplanned Hospital Readmission within 30 Days

HCPCS-G8938-BMI-OUTSIDE-NORMAL-NO-FOLLOW-UP-DOCUMENTED-NOT-ELIGIBLE

HCPCS G8938: BMI Outside Normal, No Follow-Up Plan Documented

HCPCS-G2129-PROCEDURE-RELATED-BP-NOT-TAKEN-OUTPATIENT-PROCEDURE

HCPCS G2129: Procedure-Related Blood Pressures Not Taken

HCPCS-G0067-DENTISTRY-MIPS-SPECIALTY-SET

HCPCS G0067: Dentistry MIPS Specialty Set

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary providers who commonly assess immunization status and administer `Td`/`Tdap`.
`208D00000X`	Emergency Medicine	Emergency departments may administer tetanus-containing vaccines after injury exposure.
`363L00000X`	Infectious Disease	Specialty consultation for complex immunization decisions or contraindications.
`363A00000X`	Public Health & General Preventive Medicine	Oversee immunization programs and registry reporting.
`103T00000X`	Registered Nurse	Nurses commonly perform vaccine screening, administration, and documentation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Primary diagnosis code used when administering routine vaccines including `Td` or `Tdap`.
`W21.01XA`	Struck by nonvenomous insect, initial encounter	Example injury exposure where tetanus prophylaxis assessment and vaccination may be indicated.
`S01.81XA`	Laceration without foreign body of other part of head, initial encounter	Wound-related encounters that commonly prompt tetanus vaccine review and administration.
`S91.311A`	Laceration without foreign body of right foot, initial encounter	Extremity injuries often reviewed for tetanus immunization status in urgent care or ED.
`Z71.89`	Other specified counseling	Use when counseling about immunizations, risks, and benefits is documented as part of the visit.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`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	Use when counseling and administration are performed for pediatric patients; documents counseling time when applicable.
`90461`	Immunization administration through 18 years of age; each additional vaccine/toxoid component	Use for additional vaccine components given during the same pediatric visit.
`90471`	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination)	Commonly used for adult vaccine administration encounters when billing at the CPT level.
`90472`	Each additional vaccine (single or combination) administered in the same visit	Use when more than one vaccine is given during the same adult visit.
`90636`	Tetanus and diphtheria toxoids (Td), preservative-free, for intramuscular use, 0.5 mL	Vaccine product code that may be used for documentation and inventory; relates to the vaccine administered that satisfies `G2154` criteria.
`90715`	Tetanus, diphtheria, and acellular pertussis vaccine (Tdap), intramuscular use	Vaccine product code for `Tdap`; administration of this vaccine qualifies under the `G2154` description.

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