G9415 HCPCS Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS G9415: Missed Meningococcal Vaccine Dose, Ages 10–13

HCPCS Level II code G9415 documents a missed dose of meningococcal vaccine for patients who did not receive one dose of serogroups A, C, W, Y (or A, C, W, Y, B) between their 10th and 13th birthdays. Nationally, accurate coding of missed adolescent immunizations supports public health surveillance, school-entry requirements, and targeted outreach to improve vaccination coverage. Clear documentation also affects preventive care workflows and quality reporting.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical context, typical sites of service, and what the code signifies for immunization status tracking. The publication outlines common reporting contexts, relevant quality and population health implications, and benchmarking considerations where available. When payer-specific coverage or billing guidance is not provided in the input, the report notes that data are not available.

This summary is intended for clinicians, billing professionals, and health system administrators seeking a national overview of HCPCS Level II code G9415, its role in documenting missed adolescent meningococcal vaccination, and the operational implications for outpatient and public health settings.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9415HCPCS Level IImeningococcal vaccineadolescent immunizationpreventive carevaccine documentationschool-entry immunizationpublic healthimmunization status

Billing Code Overview

HCPCS Level II code G9415 indicates that a patient did not receive one dose of meningococcal vaccine (serogroups A, C, W, Y or A, C, W, Y, B) on or between the patient's 10th and 13th birthdays. This code documents a missed recommended adolescent vaccine dose during the target age window.

Service Type: Immunization assessment / vaccine administration status review

Typical Site of Service: Outpatient clinics, primary care offices, school-based health centers, and public health clinics

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 12-year-old adolescent presents to a primary care pediatric clinic for a routine well-child visit and immunization review. During the visit the clinician reviews the immunization record and identifies that the patient did not receive a dose of meningococcal conjugate vaccine covering serogroups A, C, W, Y (MenACWY) between the 10th and 13th birthdays as recommended. The clinician documents vaccine history, discusses vaccine benefits and risks with the parent/legal guardian, obtains informed consent, and administers the indicated meningococcal vaccine per the immunization schedule. The immunization is recorded in the electronic health record and state immunization registry, and billing staff assign the preventive visit and vaccine administration codes. If the patient declines or a medical contraindication is identified, the visit is documented accordingly and an appropriate preventive or counseling code may be billed without the vaccine. Typical sites of service include outpatient primary care clinics, pediatric offices, school-located health centers, community health centers, and public health clinics.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or resources for vaccine counseling or complex consent exceed typical vaccine administration time and documentation supports increased work.

HCPCS G9958: Missed Combination Prophylactic Antiemetic Therapy

HCPCS-LEVEL-II-G9810-ASTHMA-CONTROLLER-MEDICATION-ADHERENCE-PDC-75

HCPCS Level II G9810: Asthma Controller Medication Adherence (PDC ≥75%)

HCPCS-G8725-FASTING-LIPID-PROFILE-TRIGLYCERIDES-LDL-HDL-TOTAL-CHOLESTEROL

HCPCS G8725: Fasting Lipid Profile (Triglycerides, LDL-C, HDL-C, Total Cholesterol)

HCPCS-G9639-NO-MAJOR-AMPUTATION-OR-BYPASS-WITHIN-48-HOURS

HCPCS G9639: No Major Amputation or Bypass Within 48 Hours

HCPCS-G8887-BP-NOT-UNDER-CONTROL-MEDICAL-REASON-DOCUMENTATION

HCPCS G8887: Documentation of Medical Reason for BP Not Under Control

HCPCS-G0490-HOME-HEALTH-NURSING-VISIT-RHC-FQHC-SHORTAGE-AREA

HCPCS G0490: Face-to-Face Home Health Nursing Visit

HCPCS-G9836-REASON-TRASTUZUMAB-NOT-ADMINISTERED

HCPCS G9836: Reason for Not Administering Trastuzumab

HCPCS-G9964-WELL-CHILD-VISIT-PRIMARY-CARE

HCPCS G9964: Well-Child Visit with Primary Care Provider

HCPCS-G0918-CATARACT-SATISFACTION-NOT-ACHIEVED-90-DAYS

HCPCS G0918: Satisfaction with Care Not Achieved Within 90 Days Following Cataract Surgery

HCPCS-G9648-90-DAY-MRS-GREATER-THAN-2-OUTCOME-ASSESSMENT

HCPCS G9648: 90-Day mRS Greater Than 2 Outcome Assessment

Showing 1–10 of 1996

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Taxonomy Code	Specialty	Notes
`207RP0101X`	Pediatrics	Primary specialty administering routine adolescent immunizations.
`207Q00000X`	Family Medicine	Frequently provides adolescent vaccinations in office-based settings.
`208000000X`	Internal Medicine	May provide adolescent vaccines in transitional care settings.
`363LP0200X`	Public Health	Community and school-based immunization clinics and public health departments.
`363A00000X`	School Health Services	School-located health centers administering catch-up vaccines.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z28.8`	Immunization not carried out for other reasons	Used when an immunization, such as the adolescent meningococcal dose, was not administered for documented nonmedical reasons.
`Z23`	Encounter for immunization	Commonly used when a patient presents specifically for vaccination or catch-up immunization.
`Z00.129`	Encounter for routine child health examination without abnormal findings	Used for well-child visits where catch-up meningococcal immunization is provided.
`Z91.12`	Patient’s refusal of recommended care and treatment	Applied when patient or guardian refuses the recommended meningococcal vaccine.
`D82.9`	Immunodeficiency, unspecified	Example of medical condition that may alter timing or contraindicate certain vaccines; relevant when tailoring meningococcal vaccine decisions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90460`	Immunization administration through 18 years of age, first or only component of each vaccine or toxoid given (includes percutaneous, intradermal, subcutaneous, intramuscular); with counseling by physician or other qualified health care professional; first vaccine/toxoid component reported	Used when provider counsels and administers the first vaccine component during the visit for the adolescent meningococcal vaccine.
`90461`	Immunization administration through 18 years of age, each additional vaccine/toxoid component (includes percutaneous, intradermal, subcutaneous, intramuscular); with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component	Used when additional vaccine components are administered and billed separately during the same visit.
`90471`	Immunization administration (intramuscular, subcutaneous); single vaccine/toxoid; without counseling by physician or other qualified health care professional	Applies if vaccine is administered without documented vaccine-specific counseling.
`90472`	Immunization administration (intramuscular, subcutaneous); each additional vaccine/toxoid (single or combination vaccine)	Used for additional vaccines given in the same encounter without counseling.
`90620`	Meningococcal polysaccharide vaccine, A, C, W, Y; 1 dose, for intramuscular use	Relevant vaccine product code for certain MenACWY formulations that may be administered as the dose the patient missed.
`90620`	Meningococcal conjugate vaccine (MenACWY) or `90621`	(If alternative conjugate product used) These vaccine product CPT codes are reported to identify the vaccine given as the missed adolescent dose and link clinical administration codes to vaccine product.

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