Minnesota Minnesota

Provider Manual

Provider Manual


Immunization and Vaccine Benefits Codes for Adults

Revised: December 19, 2023

The following tables list all vaccines and toxoids covered for eligible members age 19 and older that are administered by the provider. Minnesota Health Care Programs (MHCP) providers can bill MHCP for vaccines (excluding COVID-19 vaccines) listed in the tables and for vaccine administration. Note, MHCP only reimburses for the administration of the COVID-19 vaccines.

MnVFC does not cover any adult toxoids, vaccines, or vaccine administration. Refer to Billing for Adult Vaccines for more information.

Seasonal Respiratory Illness Vaccines

CPT Code

Description

Ages

90662

Fluzone High-Dose (IIV4-HD)

65 years and older

90672

FluMist (LAIV4)

19 - 49 years

90674

Flucelvax (ccIIV4)

19 years and older

90678

RSV VACC PREF BIVALENT IM

60 years and older

90679

RSV VACC PREF RECOMB ADJT IM

60 years and older

90682

Flublok (RIV4)

19 years and older

90686

Fluarix (IIV4); FluLaval (IIV4); Fluzone (IIV4)

19 years and older

90688

Fluzone (IIV4); Afluria (IIV4)

19 years and older

90694

Fluad (allV4)

65 years and older

90756

Flucelvax (ccIIV4)

19 years and older

Vaccines and Toxoids for Adults

CPT Code

Description

Ages

90581

Anthrax vaccine

19 years and older

90586

Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer

19 years and older

90611

Smallpox and Mpox VAC 0.5ML

18 years and older

90630

Influenza virus vaccine, quadrivalent (IIV4)

19 - 64 years

90632

Hepatitis A vaccine (HepA)

19 years and older

90636

Hepatitis A and hepatitis B vaccine (HepA-HepB)

19 years and older

90649

Human Papillomavirus vaccine, types 6, 11,16, 18, quadrivalent (4cHPV), 3 dose schedule

19 - 28 years

90650

Human Papillomavirus vaccine, types 16,18, bivalent (2vHPV), 3 dose schedule

19 - 28 years

90651

Human Papillomavirus vaccine types 6, 1, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule

19 - 45 years

90653

Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use

65 years and older

90654

Influenza virus vaccine, trivalent (IIV3)

19 - 64 years

90661

Influenza virus vaccine, trivalent (ccIIV3)

19 years and older

90670

Pneumococcal conjugate vaccine, 13 valent (PCV13)

19 years and older

90673

Influenza virus vaccine, trivalent (RIV3)

19 years and older

90675

Rabies vaccine, for intramuscular use

19 years and older

90676

Rabies vaccine, for intradermal use

19 years and older

90677

Pneumococcal conjugate vaccine, 20 valent (PCV20)

19 years and older

90690

Typhoid vaccine, live, oral

19 years and older

90691

Typhoid vaccine, Vi capsular polysaccharide (ViCPs)

19 years and older

90707

Measles, mumps and rubella virus vaccine (MMR), live

19 years and older

90713

Poliovirus vaccine, inactivated (IPV)

19 years and older

90715

Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older.

19 years and older

90716

Varicella virus vaccine (VAR), live

19 years and older

90717

Yellow fever vaccine, live

19 years and older

90732

Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older

19 years and older

90733

Meningococcal polysaccharide vaccine, serogroups A, C, Y, W-135, quadrivalent (MPSV4)

19 years and older

90734

Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent (MCV4 ir MenACWY)

19 years and older

90736

Zoster (shingles) vaccine (HZV)

50 years and older

90739

Hepatitis B vaccine (HepB), 2 dose schedule

19 years and older

90740

Hepatitis B vaccine (HepB), 2 dose schedule

19 years and older

90746

Hepatitis B vaccine, (HepB), 3 dose schedule

19 years and older

90747

Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 4 dose schedule

19 years and older

90748

Hepatitis B and Haemophilus influenza type b vaccine (Hib-HepB)

19 years and older

90749

Unlisted vaccine/toxoid

19 years and older

90750

Zoster (shingles) vaccine (HZV)

50 years and older

Q2034

Influenza - Agriflu

19 years and older

Q2036

Influenza - Flulaval

19 years and older

COVID-19 Vaccines

MHCP only reimburses for the administration of the COVID-19 vaccines listed in the following table.

CPT Code

Description

Ages

Effective Date

91304

SARS-CoV-2 VAC 5MCG/0.5ml IM Novavax
COVID-19 Vaccine

12 years and older

July 13, 2022

91320

SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE
Pfizer-BioNTech COVID-19 Vaccine

12 years and older

Sept. 11, 2023

91322

SARSCOV2 VACCINE 50 MCG/0.5 ML
Moderna COVID-19 Vaccine

12 years and older

Sept. 11, 2023

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