Prior Auth Required

90715 - intramuscular use (Adacel, Boostrix) $48.00 Hib), for intramuscular use (COMVAX) $45.00

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Serviceintramuscular use (Adacel, Boostrix) $48.00 Hib), for intramuscular use (COMVAX) $45.00
Procedure / Service Description

Tetanus, diphtheria toxoids and acellular pertussis vaccine - 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- 90715 intramuscular use (Adacel, Boostrix) $48.00 90748 Hib), for intramuscular use (COMVAX) $45.00 Varicella virus vaccine (VAR), live, for subcutaneous use 90716 (Varivax) $122.02 90750 Shingrix. Adult dose 0.5 mL $169.99

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.