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in Your Practice. GSK Vaccines
For more information, visit GSKVaccinesCodes.com and:
Use this handy summary of CPT and NDC codes for proper coding and reporting of GSK vaccines.
A vaccines coding and reporting resource for healthcare professionals.
þAccess the most current product codes for GSK pediatric, adolescent, and adult vaccinesþFind common diagnosis and administration codesþExplore the claims process as it relates to GSK vaccinesþGet information on special coding circumstancesþUnderstand the process for appealing denied claimsþFind additional resources for your practice
For specific questions related to any GSK vaccine products, please refer to the full Prescribing Information for the product.
GSKVaccinesCodes.com is not intended to serve as comprehensive training on medical billing and coding nor is it intended to direct the use of specific vaccine products for individual patients. Only a trained medical professional using professional judgment and clinical skills can make the informed decision on when to administer a specific vaccine to a particular patient.
BRAND CPT CODE DOSAGE DESCRIPTION NDCs*
90620 0.5 mL Syringe in Package of 1Syringe:
Outer Carton:
Syringe in Package of 10Syringe:
Outer Carton:
NDC 58160-976-02NDC 58160-976-06
NDC 58160-976-02NDC 58160-976-20
90715 0.5 mL Vial in Package of 10Vial:
Outer Carton:
Syringe in Package of 1Syringe:
Outer Carton:
Syringe in Package of 10Syringe:
Outer Carton:
NDC 58160-842-01NDC 58160-842-11
NDC 58160-842-05 NDC 58160-842-34
NDC 58160-842-43NDC 58160-842-52
90744 10 mcg/ 0.5 mL
Vial in Package of 10Vial:
Outer Carton:
Syringe in Package of 10Syringe:
Outer Carton:
NDC 58160-820-01NDC 58160-820-11
NDC 58160-820-43NDC 58160-820-52
90746
90747(Dialysis or immuno-
suppressedpatient)
20 mcg/mL Vial in Package of 10Vial:
Outer Carton:
Syringe in Package of 1Syringe:
Outer Carton:
Syringe in Package of 10Syringe:
Outer Carton:
NDC 58160-821-01NDC 58160-821-11
NDC 58160-821-05NDC 58160-821-34
NDC 58160-821-43NDC 58160-821-52
90686 0.5 mLSyringe in Package of 10
2019/2020 Syringe:2019/2020 Outer Carton:
NDC 58160-896-41 NDC 58160-896-52
90686 0.5 mLSyringe in Package of 10
2019/2020 Syringe:2019/2020 Outer Carton:
NDC 19515-906-41 NDC 19515-906-52
Codes are believed to be accurate as of the date of publication. Users should independently verify accuracy.CPT and NDC Codes for GSK Vaccines
*Note that some payers require an 11-digit NDC, which involves adding a “0” immediately after the first hyphen in each GSK NDC. For example, when reporting NDC 58160-820-11 to TRICARE, it becomes NDC 58160-0820-11.
Continued on next page.
Syringe in Package of 10 2020/2021 Syringe:
2020/2021 Outer Carton:NDC 58160-885-41 NDC 58160-885-52
Syringe in Package of 10 2020/2021 Syringe:
2020/2021 Outer Carton:NDC 19515-816-41 NDC 19515-816-52
BRAND CPT CODE DOSAGE DESCRIPTION NDCs*
90633 720 EL.U./ 0.5 mL
Vial in Package of 10Vial:
Outer Carton:
Syringe in Package of 10Syringe:
Outer Carton:
NDC 58160-825-01NDC 58160-825-11
NDC 58160-825-43NDC 58160-825-52
90632 1440 EL.U./mL
Vial in Package of 10Vial:
Outer Carton:
Syringe in Package of 1Syringe:
Outer Carton:
Syringe in Package of 10Syringe:
Outer Carton:
NDC 58160-826-01NDC 58160-826-11
NDC 58160-826-05NDC 58160-826-34
NDC 58160-826-43NDC 58160-826-52
90648 0.5 mL Supplied as package of 10 doses:
Vial of lyophilized vaccine in Package of 10
Saleable Unit:Outer Carton:
Vial of saline diluent in Package of 10
Saleable Unit:Outer Carton:
NDC 58160-818-11
NDC 58160-816-01NDC 58160-816-05
NDC 58160-817-01NDC 58160-817-05
90700 0.5 mL Vial in Package of 10Vial:
Outer Carton:
Syringe in Package of 10 Syringe:
Outer Carton:
NDC 58160-810-01NDC 58160-810-11
NDC 58160-810-43NDC 58160-810-52
90696 0.5 mL Vial in Package of 10Vial:
Outer Carton:
Syringe in Package of 10 Syringe:
Outer Carton:
NDC 58160-812-01NDC 58160-812-11
NDC 58160-812-43NDC 58160-812-52
90734 0.5 mL Vial in Package of 105 vials containing MenA lyophilized
conjugate component:5 vials containing
MenCYW-135 liquidconjugate component:
Outer Carton:
NDC 58160-958-01
NDC 58160-959-01NDC 58160-955-09
*Note that some payers require an 11-digit NDC, which involves adding a “0” immediately after the first hyphen in each GSK NDC. For example, when reporting NDC 58160-820-11 to TRICARE, it becomes NDC 58160-0820-11.
Continued on next page.
©2020 GSK or licensor.MLVWCNT190031 January 2020Produced in USA.
BRAND CPT CODE DOSAGE DESCRIPTION NDCs*
90723 0.5 mL Syringe in Package of 10 Syringe:
Outer Carton:NDC 58160-811-43NDC 58160-811-52
90675 1.0 mL RABAVERT is supplied as a 1.0 mL Single dose kit:
Package contents:1 vial of freeze-dried
vaccine containing a single dose:
1 disposable prefilled syringe of sterile diluent for
reconstitution (1 mL):
NDC 58160-964-12
NDC 58160-966-01
NDC 58160-967-02
90681 1 mL Vial and applicator in Package of 10
Saleable Unit:Applicator:
Outer Carton:
NDC 58160-851-01NDC 58160-853-02NDC 58160-854-52
90750 0.5 mL Outer package of 1 dose:1 vial of adjuvant suspension:
1 vial of lyophilized gE antigen:
Outer package of 10 doses:10 vials of adjuvant suspension:
10 vials of lyophilized gE antigen:
NDC 58160-819-12NDC 58160-829-01NDC 58160-828-01
NDC 58160-823-11NDC 58160-829-03NDC 58160-828-03
90636 1 mL Vial in Package of 10Vial:
Outer Carton:
Syringe in Package of 1Syringe:
Outer Carton:
Syringe in Package of 10 Syringe:
Outer Carton:
NDC 58160-815-01NDC 58160-815-11
NDC 58160-815-05NDC 58160-815-34
NDC 58160-815-43NDC 58160-815-52
For more information about the claims process and codes for GSK vaccines, visit GSKVaccinesCodes.com.
*Note that some payers require an 11-digit NDC, which involves adding a “0” immediately after the first hyphen in each GSK NDC. For example, when reporting NDC 58160-820-11 to TRICARE, it becomes NDC 58160-0820-11.
References:American Medical Association. CPT® Category I New and Revised Vaccine Codes (Including Incorporation of ACIP Abbreviations Listing) Long Descriptors. Updated January 8, 2018. https://www.ama-assn.org/sites/default/files/media-browser/public/physicians/cpt/vaccine-long-descriptors.pdf. Accessed January 16, 2018.
American Medical Association. Current Procedural Terminology 2018: Standard Edition. Chicago, IL: AMA Press; 2017.
Medicare Claims Processing Manual Chapter 26 - Completing and Processing Form CMS-1500 Data Set. Rev. 3881, October 2017. CMS.gov website managed by the Centers for Medicare & Medicaid Services. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c26.pdf. Accessed January 9, 2018.
Office injectable guidelines; National drug code (NDC) pricing and filing tips. Humana Military website. https://www.humanamilitary.com/provider/claims/office-injectables. Accessed January 9, 2018.
For additional questions, please contact the GSK Vaccines Reimbursement Support Center at 855-636-8291.
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