The shingles vaccine CPT code for Shingrix is 90750. However, a correct claim needs more than one code. You also need the right administration code, the right diagnosis, and, above all, the right payer. For example, Medicare covers Shingrix under Part D, not Part B, which surprises many practices.
In this guide, we explain which codes to use, how to bill each dose, and how coverage differs across Medicare, Medicaid, and commercial plans. We also list the mistakes that cause most vaccine denials.
What Is the Shingles Vaccine CPT Code?
Today, CPT 90750 reports Shingrix, the recombinant zoster vaccine. It is the only shingles vaccine available in the United States. In contrast, CPT 90736 reported Zostavax, the live vaccine. The manufacturer discontinued Zostavax in the U.S. in November 2020, so practices should no longer use 90736 for new doses.
| CPT code | Vaccine | Type | Status |
|---|---|---|---|
| 90750 | Shingrix | Recombinant, adjuvanted | Current; two-dose series |
| 90736 | Zostavax | Live, attenuated | Discontinued in the U.S. (2020) |
According to the CDC, Shingrix is recommended for adults 50 and older and for adults 19 and older with weakened immune systems. You can review the full guidance on the CDC shingles vaccine recommendations page.
Administration Codes to Pair With the Shingles Vaccine CPT Code
Every vaccine claim needs two lines: the vaccine product and the administration service. Since Shingrix is an injection given to adults, the usual pairing is simple.
| CPT code | When to use it |
|---|---|
| 90471 | First (or only) injected vaccine at the visit |
| 90472 | Each additional injected vaccine at the same visit |
| 90460 / 90461 | Patients under 19 when the physician or QHP counsels; rarely used for Shingrix |
| 90473 / 90474 | Oral or intranasal vaccines; not used for Shingrix |
For instance, an adult who receives only Shingrix gets 90750 plus 90471. If the same patient also receives a flu shot, add the flu vaccine code and 90472 for the second administration.
How to Bill the Two-Dose Shingrix Series
Shingrix is a two-dose series. Generally, the second dose follows 2 to 6 months after the first. For immunocompromised adults, the CDC allows the second dose 1 to 2 months later. Also, if more than 6 months pass, give the second dose as soon as possible without restarting the series.
Quick visual guide
Billing each Shingrix dose
Dose 1
Report 90750 + 90471 (or 90472) with Z23 on the claim.
2 to 6 months later
Track the due date and remind the patient before the window closes.
Dose 2
Report 90750 + the administration code again on a separate claim for that date.
Bill each dose on its own date of service. Never bill both doses at once.
Shingles Vaccine Coverage by Payer
Medicare: Part D, not Part B
Medicare covers Shingrix under Part D prescription drug plans. As a result, a physician office cannot bill it to the Medicare Administrative Contractor under Part B. Instead, offices can bill the patient’s Part D plan through an electronic vaccine billing service, or patients can get the vaccine at a pharmacy. Since 2023, Part D plans cover ACIP-recommended adult vaccines with no cost sharing.
Medicaid
State Medicaid programs must also cover ACIP-recommended adult vaccines without cost sharing. Still, billing rules differ by state, so check your state’s fee schedule and any managed care plan rules.
Commercial plans
Most commercial plans cover Shingrix as a preventive service for eligible adults. However, some plans route it through the pharmacy benefit instead of the medical benefit. Therefore, verify benefits before the visit. Our insurance eligibility verification services can confirm the right benefit before the patient arrives.
Diagnosis Code and Documentation
Use ICD-10-CM Z23, encounter for immunization, on vaccine claims. In addition, the record should include the following:
- Vaccine name, manufacturer, lot number, and expiration date
- Dose number in the series and the date given
- Route and injection site
- Name and title of the person who gave the vaccine
- The Vaccine Information Statement given to the patient
Common Shingles Vaccine CPT Code Errors
- Billing Medicare Part B: Shingrix belongs on a Part D claim.
- Using 90736: Zostavax is no longer available in the U.S.
- Missing the admin code: every vaccine product line needs an administration line.
- Wrong admin code: using 90460 or 90473 for an adult intramuscular dose.
- Combining doses: each dose needs its own date of service.
Fortunately, a short pre-billing checklist prevents most of these errors. Our article on why insurance companies deny claims covers more common issues.
Get Help With Vaccine Billing
To sum up, the shingles vaccine CPT code is 90750, paired with 90471 or 90472 and diagnosis Z23. Yet the payer decides where the claim goes, so verify Part D or medical benefits first.
Dr Biller RCM helps primary care groups bill vaccines and preventive services correctly. Explore our family practice billing services and geriatrics billing services, or request a free RCM audit to find missed vaccine revenue.
FAQs
What CPT code is used for the Shingrix vaccine?
Use CPT 90750 for each Shingrix dose, plus an administration code such as 90471 or 90472.
Is CPT 90736 still used?
No. CPT 90736 reported Zostavax, which was discontinued in the United States in November 2020.
Can I bill Shingrix to Medicare Part B?
No. Medicare covers Shingrix under Part D, so bill the patient’s Part D plan or refer the patient to a pharmacy.
What ICD-10 code goes with the shingles vaccine?
Use Z23, encounter for immunization.
