Prior Auth Required

90744 - subcutaneous use (ProQuad) $202.40 Recombivax HB) $35.00

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Servicesubcutaneous use (ProQuad) $202.40 Recombivax HB) $35.00
Procedure / Service Description

Diphtheria, tetanus toxoids, and acellular pertussis vaccine - Hepatitis B vaccine (HepB), pediatric/adolescent dosage 3 Measles, mumps, rubella, and varicella vaccine (MMRV), live, for dose schedule, for intramuscular use (Energix-B, 90710 subcutaneous use (ProQuad) $202.40 90744 Recombivax HB) $35.00 Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, Poliovirus vaccine, inactivated (IPV), for subcutaneous or for intramuscular use (Energix-B, Recombivax HB)-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.