G2155 HCPCS: Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS G2155: Documentation of Contraindication to Tdap/Td Vaccination

HCPCS Level II code G2155 documents a patient history of major contraindications to tetanus-containing vaccines, including anaphylaxis to Tdap or Td or vaccination-associated encephalopathy. Nationally, a standardized code for documenting these contraindications supports accurate immunization records, patient safety, and appropriate exclusion from vaccine administration when clinically indicated. This coding can affect quality measurement, vaccination coverage reporting, and clinical workflow for providers assessing vaccine suitability.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare and Medicare. Readers will find a concise explanation of the code's clinical context, typical settings where it is used, and the implications for billing and documentation. The publication outlines benchmarks and reporting considerations, recent policy updates relevant to vaccine safety documentation, and operational factors for clinicians and billing staff managing immunization contraindications. Data not available in the input is explicitly noted where applicable, and the focus remains on national applicability rather than state-specific rules.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicareG2155HCPCS Level IIvaccine contraindicationimmunization documentationTdapTdencephalopathyanaphylaxisoutpatient care

Billing Code Overview

HCPCS Level II code G2155 indicates that a patient has a documented history of at least one specified contraindication to tetanus-containing vaccination. The listed contraindications include anaphylaxis due to Tdap vaccine, anaphylaxis due to Td vaccine or its components, and encephalopathy associated with Tdap or Td vaccination (for example, post-tetanus, post-diphtheria, or post-pertussis vaccination encephalitis).

Service Type: Contraindication documentation / immunization exclusion note

Typical Site of Service: Outpatient clinical settings such as primary care offices, specialty clinics, and immunization clinics where vaccination history and contraindications are assessed and documented.

Clinical & Coding Specifications

Clinical Context

A patient with a documented history of a serious adverse reaction to tetanus-containing vaccines presents for routine preventive care or wound management. During intake, the clinician reviews immunization history and finds prior anaphylaxis to Tdap or Td or a history of post-vaccination encephalopathy attributed to tetanus/diphtheria/pertussis components. The clinical workflow includes verification of the contraindication in the medical record, counseling the patient that tetanus-containing vaccines are contraindicated, documenting the specific reaction and source of information (patient report, historical medical record, or allergy/immunization registry), and recording the contraindication using billing code G2155 for quality measures and reporting. Typical sites of service include primary care clinics, urgent care centers, emergency departments when presenting with wounds, and public health clinics where immunizations are otherwise administered. The typical patient scenario: an adult with a laceration from a farm injury who reports prior anaphylaxis to Tdap as a teenager; the clinician evaluates wound risk, documents the contraindication G2155, considers alternative management strategies (e.g., tetanus immunoglobulin if indicated), and records the encounter in the allergy list and immunization registry.

Coding Specifications

Modifier	Description	When to Use

HCPCS G9406: Clinician-Documented Reason 7-Day Post-Discharge Follow-Up Not Completed

HCPCS-G9456-HCC-SCREENING-NOT-PERFORMED-DOCUMENTATION

HCPCS G9456: Documentation of Reason for Not Performing HCC Screening

HCPCS-G9670-MULTIPLE-CHRONIC-CONDITIONS-QUALITY-ACTIONS-COMPLETE

HCPCS G9670: All Quality Actions Completed for Multiple Chronic Conditions

HCPCS-G9215-CD4-NOT-DOCUMENTED

HCPCS G9215: CD4+ Count Not Documented

HCPCS-G9173-VOICE-FUNCTIONAL-LIMITATION-DISCHARGE-STATUS

HCPCS G9173: Voice Functional Limitation, Discharge Status

HCPCS-G8629-PROPHYLACTIC-PARENTERAL-ANTIBIOTIC-ORDER-TIMING

HCPCS G8629: Prophylactic Parenteral Antibiotic Order, Preoperative Timing

HCPCS-G8666-SHOULDER-RESIDUAL-SCORE-NOT-MEASURED

HCPCS G8666: Shoulder Residual Score Not Measured

HCPCS-G8703-PROPHYLACTIC-ANTIBIOTIC-TIMING-NOT-DOCUMENTED

HCPCS G8703: Documentation of Missing Perioperative Prophylactic Antibiotics

HCPCS-G8682-LVF-TESTING-DOCUMENTED-PRIOR-TO-DISCHARGE

HCPCS G8682: LVF Testing Documented Prior to Discharge

HCPCS-G2080-ADDITIONAL-30-MINUTE-COUNSELING-MAT-WEEK

HCPCS G2080: Additional 30-Minute Counseling for Medication Assisted Treatment

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary site for vaccine counseling and documentation of contraindications.
`207R00000X`	Internal Medicine	Adult primary care clinicians who manage immunization contraindications and wound risk.
`363L00000X`	Emergency Medicine	Frequent site for wound care where tetanus vaccine decisions and contraindication documentation occur.
`207P00000X`	Pediatric Medicine	Childhood/adolescent history of vaccine reactions may be recorded and followed into adulthood.
`3336C0003X`	Public Health Agency	Immunization clinics and public health programs document contraindications for registry reporting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T78.01XA`	Anaphylactic reaction due to penicillin, initial encounter	Data not applicable for tetanus vaccine — Data not available in the input.
`T88.1XXA`	Other complications following immunization, initial encounter	Often used to indicate a prior adverse event following vaccination when documenting history of vaccine-related complications.
`Z88.0`	Allergy status to penicillin	Not specific to tetanus-containing vaccines — Data not available in the input.
`G04.8`	Other encephalitis, myelitis and encephalomyelitis	Represents encephalopathic processes; post-vaccination encephalopathy may be documented under more specific vaccine adverse effect codes.
`Y59.9`	Vaccine or biological substance as the cause of adverse effect, unspecified	Used to designate adverse effects attributed to vaccines in coding of historical events.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common E/M code for visits where vaccine contraindication is reviewed and documented.
`99283`	Emergency department visit for the evaluation and management of a patient, low to moderate severity	Used in ED encounters for wound evaluation when `G2155` is documented and vaccine is withheld.
`90471`	Immunization administration (includes counseling when performed) by intramuscular, single vaccine	Listed here for workflow context — documentation that vaccine was not administered due to contraindication would accompany this code when applicable or result in omission.
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance)	Used when an alternative injectable therapy (e.g., tetanus immune globulin) is administered because vaccine is contraindicated.
`99401`	Preventive medicine counseling, individual, low complexity (15 minutes)	Used when extended counseling about vaccine contraindication and alternatives is billed in preventive care settings.

`22`	Increased procedural service	Use when additional documentation supports substantially greater work related to counseling or complex decision-making because of the contraindication.
`23`	Unusual anesthesia	Use if unexpected anesthesia is required for a procedure during the same encounter unrelated to vaccination status.
`52`	Reduced services	Use when components of a planned service are partially reduced because vaccination was omitted due to contraindication.
`53`	Discontinued procedure	Use if a planned vaccination procedure is started but discontinued due to an acute reaction or new information about the contraindication.
`54`	Surgical care only	Use when only the surgical portion of care is billed and immunization-related counseling is not included.
`55`	Postoperative management only	Use when only post-procedure management is billed and the contraindication affected follow-up care.
`56`	Preoperative management only	Use when only preoperative evaluation is billed and immunization contraindication influenced pre-op planning.
`62`	Two surgeons	Use rarely when two surgeons are required for wound management in a patient with vaccination contraindication complicating care.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice clinician serves as assistant during a procedure in the encounter.
`CO`	Routine screening service (Medicare modifier for behavioral health) — note: often payer-specific	Use when applicable per payer guidance for encounters focused on prevention where vaccination is deferred.

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