Prior Auth Required

90733 - A/C/Y/W-135) $100.00 REQUIRED $30.00

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceA/C/Y/W-135) $100.00 REQUIRED $30.00
Procedure / Service Description

Meningococcal polysaccharide vaccine serogroups A, C, Y, W- - Meningococcal polysaccharide vaccine serogroups A, C, Y, W- 135, quadrivalent (MPSV4), for subcutaneous use (Menomune- Injection, ceftriaxone sodium, per 500 mg-AUTH 90733 A/C/Y/W-135) $100.00 J0696 REQUIRED $30.00 Meningococcal conjugate vaccine, serogroups A, C, Y and W- 135, quadrivalent (MPSV4 or MenACWY) for intramuscular use Injection, ceftriaxone sodium, per 750 mg-AUTH

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.