ICD-9-CM Codes
This page provides a listing of some ICD-9-CM codes you may want to consider when submitting claims to private health plans for certain vaccines. The information provided here is not intended to be conclusive or exhaustive, nor is it intended to replace the guidance of a qualified professional advisor. The final determination of diagnosis and appropriate ICD-9-CM code must be made by the physician.
Payers may utilize and/or mandate use of the International Classification of Diseases, Clinical Modification (ICD-9-CM) codes to describe the viral disease for which the prophylactic vaccination is being administered. Accuracy in coding and billing for vaccines is a necessary step in obtaining appropriate reimbursement from the payer.
As a provider, you are solely responsible for billing third-party payers correctly and therefore need to be familiar with any payer-specific requirements. For Medicaid (or other government program) specific billing requirements, you should contact your state Medicaid or other government program representative.
The following table lists various generic and non-generic vaccination codes that may be associated with certain vaccines and related services. When billing for a vaccine, you will also need to provide the appropriate CPT code for that vaccine, as most payers reference the CPT code when processing reimbursement claims. It is possible that you may also need to include additional diagnosis codes based on the patient’s medical condition, as indicated by the physician.
The use of this coding reference is not intended in any way to replace reference to the ICD-9-CM manual. Please refer to the current ICD-9-CM manual to check the appropriateness of using a particular code and for information on additional codes.
| ICD-9-CM code | Description | Vaccine category |
|---|---|---|
| V04.89 | Need for prophylactic vaccination and inoculation against certain viral diseases; other viral disease | HPV |
| V05.8 | Need for prophylactic vaccination and inoculation against a single disease; other specified disease | HPV |
| V06.8 | Need for prophylactic vaccination and inoculation against combinations of diseases, specified type | Measles, Mumps, Rubella, Varicella |
| V06.9 | Need for prophylactic vaccination and inoculation against combination of diseases | Measles, Mumps, Rubella, Varicella |
| Combination of codes | Need for other prophylactic vaccination and inoculation against single disease, varicella; Need for prophylactic vaccination and inoculation against combination of diseases, measles-mumps-rubella | Measles, Mumps, Rubella, Varicella |
| V04.89 | Need for prophylactic vaccination and inoculation against certain viral diseases; other viral disease | Rotavirus |
| V05.8 | Need for prophylactic vaccination and inoculation against a single disease; other specified disease | Rotavirus |
| V04.89 | Need for prophylactic vaccination and inoculation against certain viral diseases; other viral disease | Zoster |
| V05.8 | Need for prophylactic vaccination and inoculation against a single disease; other specified disease | Zoster |
Regarding Medicare Part D claims, an ICD-9-CM code may not be utilized by the Medicare Part D Plan in connection with reimbursement for the vaccine product, as a current method for obtaining product reimbursement commonly used is for the patient to submit his/her claim directly to the patient’s Medicare Part D Plan.
This information is current as of November, 2006. Confirm all coding and billing information with individual third-party payers, as policies may differ or change. The codes provided on this page serve only as a guide, and their use does not guarantee reimbursement. It is the responsibility of each provider to ensure that the billing and coding for all services and products are appropriate and correct.