Summary & Overview
HCPCS G9414: Meningococcal Vaccine Dose Given Ages 10–13
HCPCS Level II code G9414 documents administration of a single dose of meningococcal vaccine (serogroups A, C, W, Y or A, C, W, Y, B) given between a patient’s 10th and 13th birthdays. The code signals an age-specific preventive immunization event important for population-level protection against invasive meningococcal disease and for tracking adolescent vaccine coverage.
Key payers included in coverage discussions are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will learn how this code is used to capture adolescent meningococcal vaccination encounters across typical outpatient settings, the clinical context for age-based dosing, and which payers commonly process claims for this service.
The publication provides national-level benchmarks and coding guidance context (where available), summarizes common payer approaches to processing adolescent vaccine claims, and flags policy-relevant points such as age-based eligibility and documentation expectations. Data not available in the input is noted where specific payer policies, associated taxonomies, ICD-10 mappings, related codes, and service-line billing details are not provided.
Billing Code Overview
HCPCS Level II code G9414 indicates that a patient received one dose of meningococcal vaccine covering serogroups A, C, W, Y or A, C, W, Y, B on or between the patient's 10th and 13th birthdays. This describes a single-dose immunization event tied to the adolescent vaccination schedule.
Service Type: Vaccination / Immunization administration
Typical Site of Service: Clinic, physician office, public health clinic, or school-based vaccination program
Clinical & Coding Specifications
Clinical Context
A healthy adolescent presents to a primary care clinic for routine immunizations. The patient is age 11 and due for the routine meningococcal conjugate vaccine targeting serogroups A, C, W, Y (or the quadrivalent formulation that includes B when indicated). The clinic encounter includes vaccine consent confirmation, allergy and contraindication screening, vaccine administration, documentation of lot number and site, and observation for immediate adverse reaction. The typical workflow: check immunization registry and chart, verify birthdate to confirm the dose falls between the 10th and 13th birthdays, obtain verbal consent from parent/guardian, administer the single dose intramuscularly (usually deltoid), document vaccine details in the medical record and immunization information system, provide vaccine information statement (VIS) to the parent/guardian, and schedule any subsequent adolescent immunizations. Usual payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for qualifying beneficiaries. Typical site of service is an outpatient primary care clinic or pediatric office; school-based health centers and public health clinics also commonly administer this vaccine.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Rarely used; apply when vaccine administration requires substantially greater resources than typical (e.g., extensive counseling due to complex medical condition) |
23 | Unusual anesthesia | Not typically applicable to routine IM vaccination; used only if general anesthesia is required for concomitant procedures |
52 | Reduced services | Use when vaccine administration is partially reduced or abbreviated |
53 | Discontinued procedure | Use if administration was started but stopped due to acute reaction before completing |
54 | Surgical care only | Not applicable for vaccination; included for completeness when surgical component separated |
55 | Postoperative management only | Not applicable for vaccination |
56 | Preoperative management only | Not applicable for vaccination |
62 | Two surgeons | Not applicable for vaccination |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Not applicable for vaccination |
CO | Worker’s compensation | Use when the vaccine administration is billed to a worker’s compensation payor |
CQ | Service furnished by a registered nurse practitioner in the home health or hospice setting | Use when APP provides the vaccine under home health/hospice benefit (per payor rules) |
FX | Procedure performed by non-physician without required modifier | Use where documentation indicates non-physician performed but payer requires FX |
FY | Service furnished by a physician assistant under physician billing | Use when payer requires FY to indicate supervising physician arrangement |
QK | Medical direction of two, three, or four eligible professionals | Use when physician directs multiple personnel and payor requires this modifier |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207Q00000X | Family Medicine | Primary care clinicians who routinely administer adolescent vaccines |
208000000X | Pediatrics | Pediatricians commonly provide adolescent immunizations |
363LF0000X | Public Health | Public health nurses and clinics administer routine vaccine programs |
364S00000X | Preventive Medicine | Preventive medicine specialists involved in immunization policy and clinics |
367500000X | Physician Assistant | PAs frequently administer vaccines in outpatient settings |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z23 | Encounter for immunization | Primary diagnosis code used to indicate vaccine administration |
Z28.0 | Immunization not carried out because of contraindication to vaccine | Used if vaccine was withheld due to contraindication |
Z28.1 | Immunization not carried out because of patient refusal | Used when patient/guardian declines vaccination |
Z71.89 | Other specified counseling | Used when counseling regarding immunizations is documented |
R68.82 | Postvaccination fever | Used if patient develops fever following vaccination and is evaluated |
T78.2 | Anaphylactic shock, unspecified | Used if severe allergic reaction occurs during or after administration |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
90460 | Immunization administration through 18 years of age via any route of administration with counseling by physician or other qualified health care professional; first or only component of each vaccine/toxoid administered | Used when counseling is provided and billing for administration of the first vaccine dose at same encounter |
90461 | Immunization administration through 18 years of age via any route of administration with counseling; each additional vaccine/toxoid (List separately in addition to code for primary vaccine) | Used when more than one vaccine is administered and additional vaccine administration is billed |
90471 | Immunization administration (single vaccine/toxoid) intramuscular or subcutaneous | Used to report administration when counseling is not separately reported; common for single-dose IM meningococcal vaccine |
96372 | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular | Sometimes used by non-physician providers to bill for vaccine administration depending on payer |
99401 | Preventive counseling and/or risk factor reduction intervention(s) provided to an individual; approximately 15 minutes | Used when additional preventive counseling (vaccine education) is provided during the visit and billed separately per payer rules |
90734 | Meningococcal conjugate vaccine (groups A, C, W, Y), 1 dose, for intramuscular use (historical vaccine-specific code) | Related vaccine-specific code historically used for documentation; administration codes above are used alongside the vaccine product code |