Prior Auth Required

90740 - USP [For Pediatric Use]) $20.00 (Recombivax dialysis) $70.00

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceUSP [For Pediatric Use]) $20.00 (Recombivax dialysis) $70.00
Procedure / Service Description

Diphtheria, tetanus toxoids, and acellular pertussis vaccine - administered to individuals younger than 7 years, for Hepatitis B vaccine (HepB), dialysis or immunosuppressed intramuscular use (Diptheria and Tetanus Toxoids Adsorbed patient dosage (3 dose schedule), for intramuscular use 90702 USP [For Pediatric Use]) $20.00 90740 (Recombivax dialysis) $70.00 Measles, mumps and rubella virus vaccine (MMR), live, for Hepatitis B vaccine (HepB), adolescent 2 dose schedule, for 90707 subcutaneous use (M-M-R II) $75.00 90743 intramuscular use (Energix-B, Recombivax HB) $35.00

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.