CPT Shingrix 90750 - What's the reimbursement?

Understanding Shingrix Zoster Vaccine CPT Code 90750

Key points to remember in properly billing and coding for Shingrix:

​Keypoints to remember!

1. ICD-10 Code is obviously indicated for Z23 - Encounter for Immunization (most payers want to see this ICD-10 Diagnosis code)
2. CPT Code (Product is SHINGRIX), use CPT Code 90750 - Zoster (shingles) vaccine, (HZV), recombinant, sub-unit, adjuvanted, for intramuscular injection.
3. CPT Vaccine Administration
   1. Use CPT Code 90471  1 vaccine administered
      1. Use CPT Code 90472  Each additional vaccine administered during same encounter
4. 0.5ml is equal to 1 billable unit
5. Per Medicare policy, shingles vaccines are only covered in Part D plans, not in Part B Part D covered vaccinations are typically administered at a retail site of care (pharmacy)

CPT Code Shingrix 90750 What's the reimbursement?

CPT Code Shingrix 90750 - What's the reimbursement?

I called the manufacturing company of Shingrix at GSK or Global Smith Klein and contacted their Provider Reimbursement support at Phone: 1-855-636-8291. Unfortunately they told me they don't have a national average rate on how much you can get reimbursed per unit for the Shingrix shot. Understandably because it is based on Payer's reimbursement policy.

​I did some research some more research and found this:
From Medicaid North Carolina:
ICD-10-CM diagnosis code required for billing is Z23 - Encounter for immunization.
Providers must bill with CPT code: 90750 - Zoster (shingles) vaccine, (HZV), recombinant, sub-unit, adjuvanted, for intramuscular injection.
One Medicaid unit of coverage is 0.5 mL.
The maximum reimbursement rate per unit is $144.20.
Providers must bill 11-digit National Drug Codes (NDCs) and appropriate NDC units. The NDCs are 58160-0823-11 and 58160-0819-12.
The NDC units should be reported as “UN1.”

You can read the complete post here - https://medicaid.ncdhhs.gov/blog/2018/02/07/billing-guidelines-zoster-vaccine-recombinant-adjuvanted-suspension-intramuscular

Conclusion: It is always best that your verify your patient's benefits and eligibility for the Shingrix - Zoster Vaccine. As with Medicare, they should be under the beneficiary's Part D benefits. 

I hope this post helps.