Appendix
II
Codes for Commonly Administered Pediatric Vaccines/Toxoids
and Immune Globulins
Immune
Globulin
Separately report the administration
with code 96372 Manufacturer Brand
ICD-9-CMa/
ICD-10-CMa
90375 Rabies immune globulin (RIG), human, for intra-
muscular and/or subcutaneous use
Novartis HyperRA S/D bV04.5/
Z20.3b
90376 Rabies immune globulin, heat treated (RIG-HT),
human, for intramuscular and/or subcutaneous
use
Sanofi Pasteur IMOGAM Rabies-HT V04.5/
b
Z20.3b
90378 Respiratory syncytial virus immune globulin (RSV-
IGIM), for intramuscular use, 50 mg, each
MedImmune Synagis V04.82
c
Vaccine
Separately report the administration with
codes 90460–90461 or 90471–90474
[Please see table below] Manufacturer Brand
ICD-9-CMa/
ICD-10-CMa
Number
of Vaccine
Components
90630 Influenza virus vaccine, quadrivalent (IIV4), split
virus, preservative free, for intradermal use

V04.81/Z23 1
90633 Hepatitis A vaccine (HepA), pediatric/adolescent
dosage, 2 doses, for intramuscular use
GlaxoSmithKline
Merck
HAVRIX
VAQTA
V05.3/Z23 1
90644 Meningococcal conjugate vaccine, serogroups
C & Y and Haemophilus influenzae type b vaccine,
tetanus toxoid conjugate (Hib-MenCY-TT),
4-dose schedule, when administered to children
2-15 months of age, for intramuscular use
GlaxoSmithKline MenHibrix V06.8/Z23 2
90647 Haemophilus influenzae type b vaccine (Hib),
PRP-OMP conjugate, 3 doses, for intramuscular
use
Merck PedvaxHIB V03.81/Z23 1
90648 Haemophilus influenzae type b vaccine (Hib), PRP-T
conjugate, 4 doses, for intramuscular use
Sanofi Pasteur
GlaxoSmithKline
ActHIB V03.81/Z23 1
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