Preventive Services

Preventive Services Guide


Hepatitis B Virus Vaccine and Administration

Hepatitis B is a virus that can damage the liver; it is spread through contact with infected blood or body fluids and can be transmitted through sex with an infected person or by sharing injection drug equipment.

Coverage Criteria

Medicare beneficiaries at high risk for contracting hepatitis B are covered, scheduled dosages are required.

High-Risk Factors

  • ESRD patients
  • Hemophiliacs who receive Factor VIII or IX concentrates
  • Clients of institutions for the individuals with intellectual disabilities
  • Persons who live in the same household as a hepatitis B virus carrier
  • Homosexual men
  • Illicit injectable drug abusers
  • Persons diagnosed with diabetes mellitus

Intermediate-Risk Factors

  • Staff in institutions for the mentally retarded
  • Workers in health care professions who have frequent contact with blood or blood-derived body fluids during routine work

Exception: Persons in both of the above-listed groups would not be considered at high/intermediate-risk of contracting hepatitis B, however, if there were laboratory evidence positive for antibodies to hepatitis B. (ESRD patients are routinely tested for hepatitis B antibodies as part of their continuing monitoring and therapy.)

HCPCS/CPT Coding

  • 90739: Hepatitis B vaccine (HepB), adult dosage, two-dose schedule, for intramuscular use
  • 90740: Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, three-dose schedule, for intramuscular use
  • 90743: Hepatitis B vaccine (HepB), adolescent, two-dose schedule, for intramuscular use
  • 90744: Hepatitis B vaccine (HepB), pediatric/adolescent dosage, three-dose schedule, for intramuscular use
  • 90746: Hepatitis B vaccine (HepB), adult dosage, three-dose schedule, for intramuscular use
  • 90747: Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, four-dose schedule, for intramuscular use
  • 90759: Hepatitis B vaccine (HepB), 3-antigen (S, Pre-S1, Pre-S2), 10 mcg dosage, 3 dose schedule, for intramuscular use (effective for claims with dates of services on/after 1/11/2022).
     
  • G0010: Administration code

Frequency

  • Two, three or four doses depending on vaccine or condition

ICD-10 Diagnosis Coding

  • Z23
  • Additional ICD-10 codes may apply. Find individual change requests and specific ICD-10-CM service codes we cover on the CMS ICD-10 web page.

Note: Additional ICD-10 codes may apply. See the CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service, and contact your Medicare Administrative Contractor (MAC) for guidance.

Cost Sharing

  • Copayment/coinsurance waived
  • Deductible waived

Nonparticipating Providers

  • Nonparticipating reduction applies
  • Limiting charge provision applies

Common Claim Denial Reasons

  • Benefit maximum for this time period or occurrence has been reached

Related Content

Revised 9/27/2024