Prior Auth Required

90750 - (Varivax) $122.02 Shingrix. Adult dose 0.5 mL $169.99

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Service(Varivax) $122.02 Shingrix. Adult dose 0.5 mL $169.99
Procedure / Service Description

Tetanus, diphtheria toxoids and acellular pertussis vaccine - 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 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

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.