This site requires JavaScript to be enabled to work properly. Please modify your settings or use a different browser to continue

       

Leaving GSK Pro

You are leaving GSK Pro to visit a separate website not associated with GSK Pro, a portal for US Healthcare Professionals.There are website links to third-party sites on GSK Pro. GSK is not responsible for content on third-party websites.

Continue

Cancel

Popup

ROTARIX Logo

Prescribing Information

Coding for ROTARIX

Here you’ll find vaccine product codes and some common administration codes associated with immunization using ROTARIX. Select another vaccine here.

Vaccine administration codes are dependent on the services provided. Please refer to the latest edition of Current Procedural Terminology (CPT) for appropriate administration codes, and the latest edition of International Classification of Diseases (ICD) manual for appropriate diagnosis codes.

ROTARIX is supplied as either:

  • Vial and oral dosing applicator presentation: The vial contains the lyophilized vaccine component and the oral dosing applicator contains the diluent. The contents of teh vial must be reconstituted with the diluent to form ROTARIX prior to adminstration.1
  • Oral dosing applicator only presentation: The oral dosing applicator contains ROTARIX and does NOT require reconstitution or dilution before use.1

The tip caps of the prefilled oral dosing applicators contain natural rubber latex which may cause allergic reactions.1

Dosage:

  • Vial and oral dosing applicator presentation: a single dose is 1 mL1
  • Oral dosing applicator only presentation: a single dose is 1.5 mL1

Coding for ROTARIX

CPT Code

90681

ICD-10-CM Code2*

Z23

MVX Code3

SKB

CVX Code4

119

NDCs† (vial and oral dosing applicator presentation)

Outer Carton

 

NDC 58160-854-52

 
  • Package of 10 Vials

NDC 58160-851-10

Vial of Lyophilized Vaccine

 

NDC 58160-851-01

 
  • Oral Applicator of Diluent (10 applicators)

NDC 58160-853-02

NDCs† (oral dosing applicator only presentation)

Outer Carton

 

NDC 58160-740-21

 
  • 1 prefilled oral dosing applicator with a plunger stopper

NDC 58160-740-02
Tip

Tip

To promote accuracy, always consult the most current Prescribing Information or product packaging when documenting NDCs.

ROTARIX CPT Code – Immunization Administration Codes5‡

Immunization administration through 18 years of age with counseling by physician or other qualified healthcare professional.

90460:

Immunization administration via any route, first vaccine/toxoid component 

Immunization administration of any vaccine for a patient through 18 years of age that is not accompanied by counseling.

90473:

Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)

+90474:

Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid)
(List separately in addition to code for primary procedure)

Tip

Tip

If reporting multiple vaccine administrations given to a patient through age 18 on the same date along with counseling by a qualified healthcare professional, report one administration code (90460) for each vaccine administered.6

Diagnosis Codes

Z23 is the ICD-10-CM code used when reporting an encounter for immunization for all vaccines given within the encounter. In some instances, additional ICD-10-CM coding may be needed. 

See all code types

GSK Codes Summary Sheet

Get a PDF of the most current CPT, CVX, MVX, and NDC codes for GSK vaccines.

Download

Questions?

Find answers to frequently asked questions, along with additional resources, to guide you to the information you need.

Get help

  •   *ICD-10-CM code Z23, Encounter for Immunization, is reported for all vaccines given within an encounter; additional ICD-10-CM coding may be needed.2
  •   †Note that some payers require an 11-digit NDC, which involves adding a "0" immediately after the first hyphen in each GSK NDC.7 For example, when reporting NDC 58160-820-11 to TRICARE, it becomes NDC 58160-0820-11.
  •    ‡Adapted from the American Medical Association, CPT 2023 Professional Edition, Current Procedural Terminology (CPT), 2023.

References:

  1. Prescribing Information for ROTARIX.
  2. Centers for Medicare and Medicaid Services. 2021 ICD-10-CM official guidelines for coding and reporting. Updated January 1, 2021. Accessed January 5, 2023. https://www.cms.gov/files/document/2021-coding-guidelines-updated-12162020.pdf
  3. Centers for Disease Control and Prevention. Immunization information systems (IIS): HL7 standard code set, MVX – manufacturers of vaccines. Accessed January 5, 2023. https://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=mvx
  4. Centers for Disease Control and Prevention. Immunization information systems (IIS): Current HL7 standard code set, CVX – vaccines administered. Accessed January 5, 2023. https://www2a.cdc.gov/vaccines/IIS/IISStandards/downloads/cvx_list.pdf
  5. American Medical Association. CPT category I new vaccine codes (including incorporation of ACIP abbreviations listing) long descriptors. Updated December 29, 2022. Accessed January 5, 2023. https://www.ama-assn.org/system/files/vaccine-long-descriptors.pdf
  6. American Academy of Pediatrics. Bright futures coding for pediatric preventive care 2022. Accessed January 5, 2023. https://downloads.aap.org/AAP/PDF/Coding%20Preventive%20Care.pdf
  7. Humana Military. Office injectable guidelines, national drug code (NDC) pricing and filing tips. Accessed January 5, 2023. https://www.humanamilitary.com/provider/education-and-resources/claims/office-injectable

Please note that this website is provided for informational purposes only and is not intended to serve as comprehensive training on medical billing and coding. Additional training on medical coding may be required. The information on this website is believed to be accurate as of the date of publication. Users should independently verify accuracy.

Healthcare providers are responsible for making the ultimate decision on when to use a specific product based on clinical recommendations and how to bill for products and related services rendered. Consult third-party insurers' guidelines for specific information regarding the billing and reporting of services rendered.

Indications for ROTARIX

ROTARIX is a vaccine indicated for the prevention of rotavirus gastroenteritis caused by G1 and non-G1 types (G3, G4, and G9) when administered as a 2-dose series. ROTARIX is approved for use in infants 6 weeks and up to 24 weeks of age.

Important Safety Information for ROTARIX

  • Contraindications for ROTARIX include a history of any of the following: hypersensitivity to the vaccine or any component of the vaccine; uncorrected congenital malformation of the gastrointestinal tract (such as Meckel’s diverticulum) that would predispose the infant to intussusception; intussusception (in postmarketing experience, intussusception resulting in death following a second dose has been reported following a history of intussusception after the first dose); or Severe Combined Immunodeficiency Disease (SCID) 
  • The tip caps of the prefilled oral dosing applicators contain natural rubber latex which may cause allergic reactions
  • Administration in infants suffering from acute diarrhea or vomiting should be delayed. Safety and effectiveness in infants with chronic gastrointestinal disorders have not been evaluated 
  • Safety and effectiveness in infants with known primary or secondary immunodeficiencies, including infants with human immunodeficiency virus (HIV), infants on immunosuppressive therapy, or infants with malignant neoplasms affecting the bone marrow or lymphatic system have not been established
  • Rotavirus shedding in stool occurs after vaccination with peak excretion occurring around Day 7 after Dose 1. One clinical trial demonstrated that vaccinees transmit vaccine virus to healthy seronegative contacts. Caution is advised when considering whether to administer ROTARIX to individuals with immunodeficient close contacts
  • A study conducted after approval of ROTARIX showed an increased risk of intussusception in the 31 days after the first dose of ROTARIX, especially in the first 7 days. In other reports, an increased risk of intussusception has been observed within 7 days after dose 2
  • Safety and effectiveness of ROTARIX when administered after exposure to rotavirus have not been evaluated
  • In clinical studies, common (≥5%) solicited adverse reactions among recipients of ROTARIX included fussiness/irritability, cough/runny nose, fever, loss of appetite, and vomiting
  • Safety and effectiveness of ROTARIX in infants younger than 6 weeks or older than 24 weeks of age have not been evaluated
  • The effectiveness of ROTARIX in pre-term infants has not been established
  • Vaccination with ROTARIX may not result in protection in all vaccine recipients

    • Please see full Prescribing Information for ROTARIX.