HCPCS M1174: Herpes Zoster Recombinant Vaccine Series Completion - OpenPayer

Summary & Overview

HCPCS M1174: Herpes Zoster Recombinant Vaccine Series Completion

HCPCS Level II code M1174 represents confirmation that a patient completed the two-dose herpes zoster recombinant vaccine series, with doses at least 28 days apart and an initial dose recorded on October 20, 2017, through the end of the measurement period. This code is important for tracking adult immunization quality measures, public health monitoring, and payer reporting for vaccination status at the national level. It supports clinical quality measurement, prevention initiatives for herpes zoster, and vaccination coverage assessment across ambulatory care settings. Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical intent of the code, typical service lines and sites of care where the vaccine is administered, and the contexts in which the code is used for quality measurement and reporting. The publication also outlines common administrative considerations and identifies where input data are not provided. Data not available in the input: associated taxonomies, ICD-10 diagnoses, related codes, and service line details beyond the vaccination context.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1174HCPCS Level IIherpes zoster vaccinerecombinant zoster vaccinevaccine administrationimmunization quality measureadult vaccinationambulatory carepreventive care

Billing Code Overview

HCPCS Level II code M1174 documents that a patient received at least two doses of the herpes zoster recombinant vaccine, administered at least 28 days apart, with the first recorded dose on October 20, 2017, through the end of the measurement period. This code captures completion of the two-dose recombinant zoster vaccine series.

Service type: Vaccine administration for herpes zoster (recombinant zoster vaccine series completion)
Typical site of service: Outpatient clinics, physician offices, pharmacies, and other ambulatory care settings where routine adult immunizations are provided.

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient presents for routine immunization in a primary care clinic. The patient previously received the first dose of the recombinant zoster vaccine (Shingrix) and returns at least 28 days later to receive the second dose on October 20, 2017, completing the two-dose series within the measurement period. Typical workflow: verification of identity and vaccine history, review of contraindications and current medications, informed consent, administration of the intramuscular vaccine in the deltoid, documentation of lot number, expiration date, site, and manufacturer in the medical record and immunization registry, counseling on expected local and systemic reactions, and scheduling or confirming follow-up if needed. Billing is captured using HCPCS Level II code M1174 for patients who have received at least two doses of the herpes zoster recombinant vaccine at least 28 days apart during the reporting period.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased Procedural Services	Use when administration required substantially greater resources (rare for routine vaccine administration).

HCPCS Level II M1300: Influenza Immunization Not Administered

HCPCS-M1452-PATIENT-HISTORY-DEMENTIA

HCPCS M1452: Patient Ever Had a Diagnosis of Dementia

HCPCS-M1317-COUNSELING-CSP-CONNECTION-OPT-OUT

HCPCS M1317: Counseling on Community Service Provider Connection, Patient Opt-Out

HCPCS-M1147-ONGOING-CARE-DISCONTINUED-DUE-TO-HOSPITALIZATION-OR-SURGERY

HCPCS M1147: Ongoing Care Discontinued Due to Hospitalization or Surgery

HCPCS-M1256-PRIOR-HISTORY-KNOWN-CVD

HCPCS M1256: Prior History of Known Cardiovascular Disease

HCPCS-M1184-DOCUMENTATION-MEDICAL-REASON-NO-CORTICOSTEROID-OR-IMMUNOSUPPRESSANT

HCPCS M1184: Documentation of Medical Reason for Not Prescribing Corticosteroid/Immunosuppressant

HCPCS-M1216-NO-SPIROMETRY-RESULTS-DOCUMENTATION

HCPCS M1216: No Spirometry Results Documented for Airflow Obstruction

HCPCS-M1479-ASSESSMENT-IMPACT-FUNCTIONAL-CAPACITY-MOTIVATION

HCPCS M1479: Assessment Impacted by Functional Capacity or Motivation

HCPCS-M1167-HOSPICE-ENROLLMENT-OR-HOSPICE-SERVICE-USE

HCPCS M1167: In Hospice or Using Hospice Services During Measurement Period

HCPCS-M1340-WHODAS-SDS-INDEX-ASSESSMENT

HCPCS M1340: 12-item WHODAS 2.0 or SDS Index Assessment

Showing 1–10 of 356

23

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Most common primary care specialty administering adult vaccines.
`207R00000X`	Internal Medicine	Common provider type for adult immunizations.
`363A00000X`	Nurse Practitioner	Frequently administers vaccines in outpatient settings.
`367A00000X`	Physician Assistant	Common vaccinator in clinics and pharmacies.
`251B00000X`	Public Health Nurse	Administers vaccines in community and public health programs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Standard diagnosis code documenting administration of immunizations including zoster vaccine.
`B02.9`	Zoster without complications	Indicates history or presence of herpes zoster; may be used if vaccinating a patient with prior zoster, though vaccination is typically for prevention.
`Z00.00`	Encounter for general adult medical examination without abnormal findings	May be used when vaccine is administered during a routine preventive visit.
`Z00.01`	Encounter for adult health check with abnormal findings	Used if vaccination occurs during an evaluation that finds abnormal findings.
`Z79.899`	Other long term (current) drug therapy	May be relevant if documenting concurrent long-term medications that could affect vaccine decisions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90471`	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular); one vaccine (single or combination vaccine/toxoid)	Used when billing the administration of a single intramuscular vaccine dose such as a dose of recombinant zoster vaccine.
`90472`	Immunization administration, each additional vaccine (single or combination vaccine/toxoid), when performed at the same visit	Used if another vaccine is administered during the same visit as the zoster vaccine.
`90460`	Immunization administration through 18 years of age via any route of administration; with counseling by physician or other qualified health care professional	Not typically applicable to adult zoster immunization but relevant if counseling is separately reported for younger patients.
`90750`	Zoster vaccination, recombinant, 2 dose schedule, for intramuscular use (Shingrix) — (Note: This is an immunization vaccine product code used in some billing systems)	Relates directly to the product given; used in systems that capture the specific vaccine product in addition to or instead of HCPCS Level II coding.
`99070`	Supplies and materials (eg, bandages, glucose test materials), provided by the physician over and above those usually included with the office visit	May be used to bill for ancillary supplies used during vaccine administration if payer allows.

OpenPayer