Summary & Overview

HCPCS G9417: Missing Tdap Vaccine Between Ages 10 and 13

HCPCS Level II code G9417 denotes that a patient did not receive one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between their 10th and 13th birthdays. The code captures a gap in adolescent preventive immunization during a defined age window and is used in outpatient and primary care settings to document incomplete Tdap vaccination for surveillance, quality reporting, and care coordination. Nationally, standardized documentation of adolescent vaccine gaps supports population health initiatives, school-entry requirements tracking, and preventive care measures.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical meaning of the code, typical settings where the code is applied, and the implications for immunization tracking and preventive care workflows. The publication summarizes benchmarking considerations, common billing modifiers (provided separately), and where to look for related policy updates affecting adolescent immunization documentation. Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9417HCPCS Level IITdapAdolescent ImmunizationPreventive CareImmunization StatusOutpatientPrimary Care

Billing Code Overview

HCPCS Level II code G9417 indicates that the patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient's 10th and 13th birthdays. This code represents a preventive care observation related to incomplete adolescent immunization status during the specified age window.

Service Type: Immunization status evaluation / preventive care assessment
Typical Site of Service: Primary care clinic, pediatrician's office, school-based health center, or other outpatient settings where adolescent preventive care is provided

Data not available in the input for payers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.

Clinical & Coding Specifications

Clinical Context

A 12-year-old adolescent presents to a primary care clinic for a routine well visit. The patient’s immunization record is reviewed and it is documented that the patient did not receive one Tetanus, Diphtheria toxoids and Acellular Pertussis vaccine (Tdap) on or between the patient’s 10th and 13th birthdays, meeting the criteria described by billing code G9417. Clinic staff confirm age eligibility, review contraindications (severe allergic reaction to prior vaccine components, acute severe illness), and offer catch-up immunization according to the immunization schedule. If the patient or guardian declines vaccination, the reason and counseling are documented. The clinical workflow includes verification of identity and birthdate, review of immunization registry, counseling, obtaining informed assent/consent, administration of Tdap if accepted, documentation of vaccine lot number and site, and billing using G9417 to indicate the absence of the required Tdap dose during the specified age window. Typical sites of service are outpatient primary care clinics, school-based health centers, and community immunization clinics.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documentation supports substantially greater work than usual for vaccine counseling or management related to complex immunization refusal or medical evaluation.
`23`	Unusual anesthesia	Rarely applicable; use only if unexpected general anesthesia was required for vaccine administration (uncommon for `Tdap`).
`52`	Reduced services	Use when the intended immunization service was partially performed or abbreviated.
`53`	Discontinued procedure	Use when vaccination attempt was started but discontinued due to adverse reaction or other immediate contraindication.
`54`	Surgical care only	Not typically applicable; retained for completeness when post-operative vaccine-related care is billed separately.
`55`	Postoperative management only	Not applicable for routine vaccination; use only in atypical care splits.
`56`	Preoperative management only	Not applicable for routine vaccination; use only in atypical care splits.
`62`	Two surgeons	Not applicable for vaccine administration; use when two providers are required for a procedure.
`AS`	Ambulatory surgical center facility charge	Use when a facility charge at an ambulatory surgical center is billed in relation to a vaccine service provided there.
`CO`	Patient’s condition due to military service	Use when the vaccination or its coding is related to a service-connected condition as defined by payors.
`CQ`	Service furnished under a qualified provider agreement	Use when a registered nurse or other delegated provider administers the vaccine under such an agreement.
`FX`	CAH method II exception	Use for Critical Access Hospital billing exceptions when applicable.
`FY`	CAH method II billing	Use for facility billing in Critical Access Hospital scenarios.
`QK`	Medical direction of two, three, or four assistants	Not typical for vaccination; use when documented medical direction for assistants is present.
`QX`	Service performed by certified registered nurse anesthetist (CRNA)	Not applicable for routine `Tdap`; included only if CRNA documents vaccine administration in unusual settings.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary providers who commonly review immunizations and administer `Tdap`.
`208000000X`	Pediatrics	Pediatricians routinely assess adolescent immunization status and provide `Tdap`.
`163W00000X`	Preventive Medicine	Providers focusing on preventive services and immunization program oversight.
`364A00000X`	Public Health	Clinic or community immunization program providers administering catch-up vaccines.
`363L00000X`	Nurse Practitioner	Advanced practice providers who frequently provide immunizations in outpatient settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

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 administered (includes counseling when performed)	Used when counseling and administration of `Tdap` to an adolescent are provided; captures vaccine administration with counseling for patients ≤18 years.
`90461`	Immunization administration through 18 years of age, each additional vaccine component (list separately in addition to code for primary vaccine)	Used if multiple vaccine components or additional vaccines are administered at the same visit alongside `Tdap`.
`90698`	Tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap), for use in individuals 7 years or older; equivalent might be used depending on product	Represents the actual vaccine product code billed by payors or reflected in inventory; links to administration codes.
`99381`	Initial comprehensive preventive medicine evaluation and management of an individual including a comprehensive history, exam and counseling for new patient; infant through 4 years	Example preventive visit CPT family—use analogous preventive visit codes for adolescent well visits when immunization reconciliation occurs (select appropriate age-based preventive E/M code in practice).
`99394`	Periodic comprehensive preventive medicine reevaluation and management of an individual including an age-appropriate history and exam; adolescent (12-17 years)	Commonly billed for adolescent well visits during which `Tdap` immunization status is assessed and the vaccine administered or discussed.
`90716`	Tetanus and diphtheria toxoids (Td) adult formulation booster; old code often used for Td vaccine	May be relevant if `Td` (not `Tdap`) is administered instead based on clinical decision; documents related vaccine options.