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

Certain patients with Medicare Part B who are at intermediate or high risk for contracting hepatitis B, and (effective 1/1/2025) patients who haven’t previously gotten a completed hepatitis B shot series or whose shot is unknown.

Roster Billing

Streamlined process for submitting vaccination claims for large groups of individuals
- All patients have the same service
- Not used for single patient billing
Patient roster form includes the following with a single modified CMS-1500 claim form as roster cover document for each facility where the services are rendered:
- Patients name, address, Medicare number, date of birth and gender
- Date of service
- Beneficiary signature or stamped "Signature on File"
- Providers name and identification number
- Control number for contractor
Immunization Roster Billing

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