Summary & Overview
HCPCS Level II M1064: Shingrix vaccine administered or previously received
HCPCS Level II code M1064 documents administration of the Shingrix recombinant zoster vaccine or acknowledgement of a previously received dose. Nationally, accurate capture of vaccine administration and prior-dose documentation is important for immunization tracking, quality reporting, and claims adjudication, particularly for adult shingles prevention.
Key payers covered in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical context, typical service settings, and common modifiers used with immunization services. The publication outlines billing and documentation considerations relevant to payers, summarizes benchmarks where available, and highlights policy and coverage elements that affect claim processing for adult immunizations.
This piece is intended for a national audience of clinicians, billers, and policy analysts who need a clear summary of what M1064 represents, where it is used, and which major payers are relevant to reimbursement and coverage discussions.
Billing Code Overview
HCPCS Level II code M1064 documents that the Shingrix vaccine was administered or previously received. This code represents reporting of patient immunization status for the recombinant zoster vaccine (Shingrix) and is used to indicate that the vaccine has been given or that a prior dose was received.
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Service type: Vaccine administration / Immunization documentation
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Typical site of service: Outpatient clinics, physician offices, pharmacies, and other ambulatory care settings where adult immunizations are provided.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient presents to a primary care clinic during a scheduled immunization visit for herpes zoster prevention. The clinician documents that the patient received the recombinant zoster vaccine (Shingrix) on site during the encounter and records vaccine lot number, manufacturer, route (intramuscular), dose (0.5 mL), and injection site. The patient has Medicare Part B coverage for vaccine administration when appropriate, and payer adjudication requires documentation that the vaccine was administered or previously received. The clinical workflow includes verification of vaccination history, informed consent discussion, screening for contraindications (allergy to vaccine components), administration of the dose, observation for immediate adverse reaction for 15 minutes, and documentation in the electronic medical record and immunization registry. If the patient is receiving the second dose of the series, the clinician confirms prior-dose date and documents that the vaccine was previously received if administration occurred outside the current encounter.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When unusually high work, time, or complexity is required during the encounter (rare for routine vaccine administration). |
23 |