Prior Auth Required

90734 - (Menactra, Menveo) $125.00 REQUIRED $45.00

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Service(Menactra, Menveo) $125.00 REQUIRED $45.00
Procedure / Service Description

Meningococcal conjugate vaccine, serogroups A, C, Y and W- - Meningococcal conjugate vaccine, serogroups A, C, Y and W- 135, quadrivalent (MPSV4 or MenACWY) for intramuscular use Injection, ceftriaxone sodium, per 750 mg-AUTH 90734 (Menactra, Menveo) $125.00 J0696 REQUIRED $45.00 All vaccinations must follow the guidelines of the AAP and AFP. This Fee Schedule pertains only to those immunizations and injections that the IPA is responsible for reimbursing. For certain HMOs, some immunizations will be reimbursed directly by the Health Plan and will be paid at the Health Plan rate. All other medically necessary immunizations and

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.