Prior Auth Required

90747 - adult) $25.00 (Energix-B, RECOMBIVAX dialysis)-AUTH REQUIRED $70.00

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Serviceadult) $25.00 (Energix-B, RECOMBIVAX dialysis)-AUTH REQUIRED $70.00
Procedure / Service Description

Diphtheria, tetanus toxoids, and acellular pertussis vaccine - free, when administered to individuals 7 years or older, for Hepatitis B vaccine (HepB), dialysis or immunosuppressed intramuscular use (DECAVAC/TENIVAC, Tetanus-diphtheria patient dosage 4 dose schedule, for intramuscular use 90714 adult) $25.00 90747 (Energix-B, RECOMBIVAX dialysis)-AUTH REQUIRED $70.00 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for Hepatitis B and Hemophilus influenza b vaccine (HepB-

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.