Prior Auth Required

90713 - intramuscular use (IPOL) $30.00 REQUIRED $70.00

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Serviceintramuscular use (IPOL) $30.00 REQUIRED $70.00
Procedure / Service Description

Diphtheria, tetanus toxoids, and acellular pertussis vaccine - Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, Poliovirus vaccine, inactivated (IPV), for subcutaneous or for intramuscular use (Energix-B, Recombivax HB)-AUTH 90713 intramuscular use (IPOL) $30.00 90746 REQUIRED $70.00 Tetanus and diphtheria toxoids (Td) adsorbed, preservative free, when administered to individuals 7 years or older, for Hepatitis B vaccine (HepB), dialysis or immunosuppressed

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.