Coverage & Coding

SHINGRIX has broad insurance coverage for your patients 50 years and older. For billing, use the codes listed below the coverage section.

RECOMMEND WITH CONFIDENCE — SHINGRIX IS COVERED for patients 50 years and older.

For patients with commercial plans:

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More than 9 out of 10 are covered, with average copays of just $4 or less—making SHINGRIX cost less than a movie ticket.1,2,*

 

For your Medicare Part D patients:

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100% of Medicare Part D patients are covered. In some cases, out-of-pocket costs may apply, as with most medicines covered by Part D. If out-of-pocket costs do apply, for most patients, the cost is less than $50 per dose.1,2,*

*SOURCE: Managed Markets Insight & Technology, LLC, Database as of February 2022. Coverage represents access to reimbursement from a health plan with restrictions appropriate to the Advisory Committee on Immunization Practices (ACIP) recommendation(s) and/or prescribing information, which means no accompanying step edits. Veterans Affairs (VA) and Indian Health Service (IHS) lives have been omitted when calculating the percentage of lives.

Coding

Use the following codes when billing SHINGRIX:

 

CPT Code (Product):

90750

 

CPT Code (Administration)
 

1 vaccine administered:
 

Each additional vaccine administered during same encounter:

   
 

90471
 

90472

 

ICD-10-CM Code (Encounter for Immunization):

Z23

 

Administration Modifier for Medicare:

GY

 

MVX Code:

SKB

 

CVX Code:

187

The CDC also created CVX code 188 for "zoster vaccine, unspecified formulation" to facilitate transmission of administration data when the exact formulation of the vaccine is not known (such as when recording data from a vaccination card).

CDC=Centers for Disease Control and Prevention; CPT=Current Procedural Terminology; ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification; MVX=Manufacturers of Vaccines; CVX=vaccine administered.

How SHINGRIX is supplied

SHINGRIX Outer Package of 1 Dose

SHINGRIX is supplied as an outer package of 1 dose (NDC 58160-819-12) containing:

  • Adjuvant Suspension Component (Vial 1 of 2) NDC 58160-829-01
  • Lyophilized gE Antigen Component (Vial 2 of 2) NDC 58160-828-01
SHINGRIX Outer Package of 10 Doses

SHINGRIX is supplied as an outer package of 10 doses (NDC 58160-823-11) containing:

  • Adjuvant Suspension Component (10 vials) NDC 58160-829-03
  • Lyophilized gE Antigen Component (10 vials) NDC 58160-828-03

gE=glycoprotein E.

The GSK Vaccines Reimbursement Support Center is a resource for physicians, physician office staff, and pharmacists to help address questions about billing, coding, and reimbursement for GSK vaccines.

GSK Vaccines Reimbursement Support Center contact information:

Phone: 1-855-636-8291

Fax: 1-877-683-1329

Monday – Friday 8:00 am-8:00 pm ET

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