Prior Auth Required

90756 - intramuscular use (PEDIARIX) $50.00 intramuscular use $25.00

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Serviceintramuscular use (PEDIARIX) $50.00 intramuscular use $25.00
Procedure / Service Description

Tetanus, diphtheria toxoids and acellular pertussis vaccine - Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis Influenza virus vaccine, quadrivalent (ccllV4), derived from B, and poliovirus vaccine, inactivated (DtaP-HepB-IPV), for cell cultures, subunit, antibiotic free, 0.5mL dosage, for 90723 intramuscular use (PEDIARIX) $50.00 90756 intramuscular use $25.00 Pneumococcal polysaccharide vaccine, 23-valent (PPV23), adult or immunosuppressed patient dosage, when administerd to

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.