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The CPT® Code 90736 refers to the Zoster (shingles) vaccine, which is a live vaccine administered via subcutaneous injection. Vaccines, unlike immune globulins that offer short-term, passive immunity, provide active and long-lasting immunity. This is achieved by introducing altered versions of specific viruses or bacteria into the recipient's immune system, prompting it to produce its own antibodies against these pathogens. The immune system retains a memory of how to generate these antibodies, enabling a quicker and more effective response upon subsequent exposures to the same antigens. The Zoster vaccine specifically targets the zoster virus, which is the reactivated form of the varicella virus responsible for chickenpox. Individuals who have previously contracted chickenpox may experience shingles when the zoster virus reactivates, often triggered by factors such as stress or a decline in immune function. It is important to note that this code solely represents the vaccine product used for immunization against the zoster virus, without any additional services or procedures associated with its administration.
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The Zoster vaccine (CPT® Code 90736) is indicated for individuals who have a history of chickenpox, as it is designed to prevent the reactivation of the varicella virus, which can lead to shingles. The vaccine is particularly recommended for older adults and individuals with weakened immune systems, as they are at a higher risk for developing shingles due to decreased immunity. The administration of this vaccine is crucial in reducing the incidence of shingles and its associated complications, such as postherpetic neuralgia, which can cause significant pain and discomfort.
The administration of the Zoster vaccine involves several key procedural steps to ensure proper delivery and effectiveness of the vaccine. First, the healthcare provider must verify the patient's eligibility for the vaccine, confirming that the individual has a history of chickenpox and is within the recommended age group or has a weakened immune system. Next, the provider prepares the vaccine for subcutaneous injection, ensuring that the vaccine is stored and handled according to manufacturer guidelines to maintain its efficacy. The injection site is then selected, typically the upper arm, and the skin is cleaned with an antiseptic to reduce the risk of infection. Following this, the vaccine is administered subcutaneously, which involves inserting the needle into the fatty tissue just beneath the skin. After the injection, the provider may apply a bandage to the site and provide the patient with post-vaccination care instructions, including information on potential side effects and when to seek medical attention if necessary.
After the administration of the Zoster vaccine, patients are typically monitored for a short period to observe for any immediate adverse reactions. Common side effects may include redness, swelling, or pain at the injection site, as well as mild fever or rash. Patients should be informed about these potential reactions and advised to report any unusual or severe symptoms. It is also important to remind patients that while the vaccine significantly reduces the risk of developing shingles, it does not guarantee complete immunity. Therefore, they should remain vigilant for any signs of shingles and seek medical attention if symptoms arise. Additionally, patients may be advised to avoid certain medications or treatments that could interfere with the vaccine's effectiveness, particularly if they have a compromised immune system.
| Short Descr | HZV VACCINE LIVE SUBQ | Medium Descr | ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE | Long Descr | Zoster (shingles) vaccine (HZV), live, for subcutaneous injection | Status Code | Excluded from Physician Fee Schedule by Regulation | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Not Billable to the MAC | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 228 - Prophylactic vaccinations and inoculations |
| 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | SA | Nurse practitioner rendering service in collaboration with a physician | SL | State supplied vaccine | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2016-01-01 | Changed | First appearance of change in codebook. |
| 2015-07-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Short description changed. |
| 2006-01-01 | Added | First appearance in code book in 2006. |
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