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Coverage & Coding

SHINGRIX has broad insurance coverage for patients

Nationally, 97% of patient lives with Commercial medical benefit insurance are now covered for SHINGRIX*

Nationally, 100% of patient lives with Medicare Part D are now covered for SHINGRIX*

Commercial medical benefit enrollees

  • Primarily people <65 years
  • Out-of-pocket costs are likely to be limited if vaccine is administered in-network for members of plans implemented after passage of the Affordable Care Act (ACA)
    • Individual costs may vary

Medicare Part D enrollees

  • Primarily people ≥65 years
  • Per Medicare policy, shingles vaccines are only covered in Part D plans, not in Part B
    • Part D covered vaccinations are typically administered at a retail site of care (pharmacy)
  • Out-of-pocket costs vary due to different plan benefit designs, special beneficiary status and individual drug utilization

Patients means covered lives for all Commercial and employer payer types (excluding Managed Medicaid), and covered lives enrolled in Medicare payer types as calculated by MMIT as of June 2020. Covered means any potential for reimbursement from a health plan and may include step edits, prior authorizations, and other restrictions. Commercial calculations do not include Indian Health Service or Department of Veterans Affairs lives.

  •   *SOURCE: Managed Markets Insight & Technology, LLC, database as of June 2020.  

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
 

You may also be interested in:

See product coding details for SHINGRIX, including CPT, MVX, and CVX codes.

See how you and your staff can reconstitute SHINGRIX in four steps. Vaccinate confidently.

Talk to your patients about what to expect, including common adverse reactions.

Coding

Use the following codes when billing for 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 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 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.

You may also be interested in:

See how you and your staff can reconstitute SHINGRIX in four steps. Vaccinate confidently.

Learn how to store SHINGRIX and about the importance of proper dosing.

Talk to your patients about what to expect, including common adverse reactions.

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