Effective with date of service Oct. 1, 2023, NC Medicaid Direct and NC Medicaid Managed Care cover typhoid vi polysaccharide vaccine (Typhim Vi) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code 90691 - Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use.
Strength/Package Sizes:
- Single-dose syringe, without needle, 0.5 mL.
- Multi-dose vial, 20 doses.
Typhoid vi polysaccharide vaccine is indicated for active immunization for the prevention of typhoid fever caused by S typhi and is approved for use in persons two years of age or older. Immunization with Typhim Vi vaccine should occur at least two weeks prior to expected exposure to S typhi.
Typhim Vi vaccine is not indicated for routine immunization of individuals in the United States (US).
Selective immunization against typhoid fever is recommended under the following circumstances:
- travelers to areas where a recognized risk of exposure to typhoid exists, particularly ones who will have prolonged exposure to potentially contaminated food and water,
- persons with intimate exposure (i.e., continued household contact) to a documented typhoid carrier, and
- workers in microbiology laboratories who frequently work with S typhi.
Recommended Dose: The immunizing dose for adults and children is a single injection of 0.5 mL. A reimmunizing dose is 0.5 mL. Reimmunization consisting of a single dose for US travelers every two years under conditions of repeated or continued exposure to the S typhi organism is recommended at this time.
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: 90691 - Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use
- One Medicaid unit of coverage is: 0.5 mL
- 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:
Syringe: 49281-0790-51, 49281-0790-88
Vial: 49281-0790-20, 49281-0790-38 - 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