Prior Auth Required

90647 - dose schedule), for intramuscular use (Pedvax HIB) $50.00 mL dosage, for intramuscular use. (FLucelvax) $24.05

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Servicedose schedule), for intramuscular use (Pedvax HIB) $50.00 mL dosage, for intramuscular use. (FLucelvax) $24.05
Procedure / Service Description

Influenza virus vaccine, split virus, preservative free, - Influenza virus vaccine, quadrivalent (ccIIV4), derived from Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate (3 cell cultures, subunit preservative and antibiotic free, 0.5 90647 dose schedule), for intramuscular use (Pedvax HIB) $50.00 90674 mL dosage, for intramuscular use. (FLucelvax) $24.05 Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, 90648 schedule), for intramuscular use (ActHIB, Hiberix) $45.00 90680 live, for oral use (RotaTeq) $92.00

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.