G9416 Tdap Immunization HCPCS: Reimbursement | OpenPayer

Summary & Overview

HCPCS G9416: Tdap Vaccine Given Between Ages 10 and 13

HCPCS Level II code G9416 documents administration of a single tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) given on or between a patient’s 10th and 13th birthdays. This preventive immunization code matters nationally as part of adolescent vaccine coverage and school-entry immunization tracking; proper coding supports public health surveillance and payer policy alignment.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise code definition and clinical context for adolescent Tdap vaccination, an overview of where the service is typically provided, and note of common ancillary billing elements when available. The publication outlines what to expect in payer coverage patterns and documentation priorities, plus where to find related coding guidance.

This national summary targets clinical coders, billing teams, and policy analysts seeking a clear reference for G9416, situating the code within preventive care delivery for adolescents and highlighting the code’s role in immunization reporting and reimbursement workflows.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9416HCPCS Level IITdapadolescent immunizationvaccine administrationpreventive careambulatory careschool-based health

Billing Code Overview

HCPCS Level II code G9416 indicates that a patient received one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient's 10th and 13th birthdays. This service represents administration of a routine adolescent immunization.

Service type: Vaccine administration for adolescent Tdap booster
Typical site of service: Outpatient clinic, pediatrician or family medicine office, school-based health center, or other ambulatory care settings

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 12-year-old adolescent presents to a pediatric clinic for routine immunizations as part of school entry requirements and adolescent preventive care. The patient’s immunization record is reviewed, and documentation confirms no prior tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) between ages 10 and 13. The clinician verifies immunization history, obtains informed consent from the parent/guardian, screens for contraindications (e.g., severe allergic reaction to a prior dose or vaccine component, acute moderate or severe illness), and administers a single Tdap intramuscular injection in the deltoid. Post-vaccination observation for 15 minutes is performed for syncope risk. Vaccine lot number, manufacturer, administration site, and clinician information are documented in the medical record and the state immunization registry. The service is billed using HCPCS Level II code G9416 to report that one Tdap vaccine was given on or between the patient’s 10th and 13th birthdays. Typical sites of service include pediatrician offices, family medicine clinics, school-based health centers, and community health clinics. Typical modifiers that may accompany billing for this service include those indicating unusual procedural circumstances, anesthesia, or third-party payment arrangements when applicable.

Coding Specifications

Modifier	Description	When to Use

HCPCS G9900: Mammography Results Not Documented and Reviewed

HCPCS-G8877-BREAST-CANCER-NO-PREOP-MINIMALLY-INVASIVE-BIOPSY-ATTEMPT

HCPCS G8877: No Preoperative Minimally Invasive Breast Biopsy Attempt

HCPCS-G9766-INTERFACILITY-TRANSFER-ENDOVASCULAR-STROKE

HCPCS G9766: Transfer for Endovascular Stroke (CVA)

HCPCS-G9434-ASTHMA-NOT-WELL-CONTROLLED-ASSESSMENT

HCPCS G9434: Asthma Not Well-Controlled Assessment

HCPCS-G9421-NSCLC-HISTOLOGIC-CLASSIFICATION-REPORTING

HCPCS G9421: NSCLC Biopsy/Cytology Report Lacking Specific Histologic Classification

HCPCS-G9746-MITRAL-STENOSIS-PROSTHETIC-VALVE-TRANSIENT-AF

HCPCS G9746: AF with Mitral Stenosis, Prosthetic Valve, or Reversible Cause

HCPCS-G9728-PATIENT-REFUSED-TO-PARTICIPATE

HCPCS Level II G9728: Patient Refused to Participate

HCPCS-G9100-GASTRIC-CANCER-POST-R0-RESECTION-NO-EVIDENCE-DISEASE

HCPCS G9100: Gastric Cancer Disease-Status Post R0 Resection

HCPCS-G9380-END-OF-LIFE-ASSISTANCE-OR-PLAN-REVIEW

HCPCS G9380: End-of-Life Assistance or Plan Review

HCPCS-G4026-PHYSICAL-OCCUPATIONAL-THERAPY-MIPS-SPECIALTY-SET

HCPCS G4026: Physical Therapy/Occupational Therapy MIPS Specialty Set

Showing 1–10 of 1996

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Taxonomy Code	Specialty	Notes
`208000000X`	Pediatrics	Pediatricians commonly administer adolescent immunizations including `Tdap`.
`208000000S`	Family Medicine	Family physicians provide routine adolescent vaccines in office settings.
`165000000X`	Emergency Medicine	May administer vaccines in emergency or urgent care settings when appropriate.
`363LP0800X`	Public Health Clinic	Clinic-based immunizers and public health nurses deliver school-entry and community vaccines.
`367A00000X`	School-Based Health Center	Providers in school health centers vaccinate adolescents per school or public health programs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Most common primary diagnosis for documenting a visit where `Tdap` immunization is administered; justifies preventive vaccine administration.
`Z28.0`	Immunization not carried out because of contraindication	Use when `Tdap` is indicated but withheld due to documented contraindication (e.g., severe allergic reaction).
`Z28.2`	Underimmunization status	Documents that the patient is not fully immunized and requires `Tdap` to update status.
`Z00.129`	Encounter for routine child health examination without abnormal findings	Preventive visit where adolescent immunizations, including `Tdap`, are commonly given.
`Z71.89`	Other specified counseling	Use when vaccine counseling or education is billed or documented as part of the visit (payer-dependent).

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90460`	Immunization administration through 18 years of age, percutaneous, intradermal, subcutaneous or intramuscular; first vaccine/toxoid component	Billed when separately reporting administration of the first vaccine component for patients under 18, often used with multi-component billing rules for `Tdap`.
`90461`	Immunization administration through 18 years of age; each additional vaccine/toxoid component (List separately in addition to code for primary procedure)	Billed for each additional vaccine component administered at the same visit when applicable.
`90471`	Immunization administration (intramuscular, single vaccine)	Used to report the administration of a single intramuscular vaccine if payer prefers CPT administration codes instead of HCPCS Level II.
`90472`	Immunization administration (intramuscular), each additional vaccine	Used when multiple vaccines are administered during the same visit in addition to `90471`.
`90715`	Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 through 10 years of age, for intramuscular use	Related vaccine CPT code; historical or age-specific variants may be used per payer rules.
`90714`	Tetanus and diphtheria toxoids (Td), preservative-free, when administered to individuals 7 years or older, for intramuscular use	May be used when `Td` rather than `Tdap` is administered, which is a related clinical alternative in some scenarios.

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