Effective with date of service Oct. 1, 2023, NC Medicaid Direct and NC Medicaid Managed Care cover typhoid vaccine live oral Ty21a (Vivotif) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code 90690 - Typhoid vaccine, live, oral.
Strength/Package Size: Single foil blister containing 4 doses of vaccine in a single package
Typhoid vaccine live oral Ty21a is indicated for immunization of adults and children greater than six years of age against disease caused by Salmonella typhi. Routine typhoid vaccination is not recommended in the United States.
Selective immunization against typhoid fever is recommended for the following groups:
- travelers to areas in which there is a recognized risk of exposure to S. typhi,
- persons with intimate exposure (e.g. household contact) to a S. typhi carrier, and
- microbiology laboratorians who work frequently with S. typhi.
There is no evidence to support the use of typhoid vaccine to control common source outbreaks, disease following natural disasters or in persons attending rural summer camps.
Recommended Dose: One capsule is to be swallowed approximately 1 hour before a meal with a cold or luke-warm drink on alternate days, e.g., days 1, 3, 5 and 7. Immunization should be completed at least 1 week prior to potential exposure to S. typhi.
It is recommended that a re-immunization dose consisting of 4 vaccine capsules taken on alternate days be given every five years under conditions of repeated or continued exposure to typhoid fever.
See full prescribing information for further detail.
For Medicaid Billing
- The ICD-10-CM diagnosis codes required for billing are:
- Z22.0 - Carrier of typhoid;
- Z23 - Encounter for immunization
- Providers must bill with HCPCS code: 90690 - Typhoid vaccine, live, oral
- One Medicaid unit of coverage is: 4 capsules
- The maximum reimbursement rate per unit is: NDC specific SMAC rate. See fee schedule for current rate.
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are: 69401-0000-01, 69401-0000-02
- The NDC units should be reported as "UN1"
- For additional information, refer to the January 2012, Special Bulletin, National Drug Code Implementation Update.
- For additional information regarding NDC claim requirements related to the PADP, refer to the PADP Clinical Coverage Policy 1B, Attachment A, H.7 on NC Medicaid's website.
- Providers shall bill their usual and customary charge for non-340B drugs.
- PADP reimburses for drugs billed for Medicaid beneficiaries by 340B participating providers who have registered with the Office of Pharmacy Affairs (OPA). Providers billing for 340B drugs shall bill the cost that is their actual acquisition cost. Providers shall indicate that a drug was purchased under a 340B purchasing agreement by appending the "UD" modifier on the drug detail.
- The fee schedule for the PADP is available on the NC Medicaid Fee Schedule & Covered Code portal.
ICD-10-CM Manual. American Medical Association, 2023 manual.
*Information current as of Sept. 26, 2023, and is not a substitute for professional judgment. For full prescribing information, please refer to current package insert or other appropriate sources prior to making clinical judgments.
Contact
NCTracks Call Center: 800-688-6696