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Coding for PEDIARIX
This section provides the vaccine product codes as well as some common administration codes associated with immunization using PEDIARIX. Administration codes will vary based on the service provided. Please refer to your most up-to-date Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) manuals for appropriate coding.
PEDIARIX is a vaccine indicated for active immunization against diphtheria, tetanus, pertussis, infection caused by all known subtypes of hepatitis B virus, and poliomyelitis. PEDIARIX is approved for use as a three-dose series in infants born of hepatitis B surface antigen (HBsAg)-negative mothers. PEDIARIX may be given as early as 6 weeks of age through 6 years of age (prior to the 7th birthday).
||PEDIARIX is available in 0.5-mL single-dose disposable prefilled Tip-Lok® syringes (packaged without needles).
|Syringe in Package of 10
|NDC 58160-811-43 NDC 58160-811-52
To promote accuracy, always consult the most current Prescribing Information or product packaging when documenting NDCs.
|Immunization Administration Codes (CPT) 
||Immunization administration through 18 years of age with counseling by physician or other qualified healthcare professional
||Immunization administration via any route, first vaccine/toxoid component
||Immunization administration via any route, each additional vaccine/toxoid component (List separately in addition to code for primary procedure)
||Immunization administration of any vaccine for a patient through 18 years of age that is not accompanied by counseling, or for administration of vaccines to patients over 18 years of age
||Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), one vaccine (single or combination vaccine/toxoid)
||Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
||Adapted from American Medical Association, CPT 2016 Professional Edition
Current Procedural Terminology (CPT), copyright 2015.
If reporting multiple vaccine administrations given to a patient through age 18 years on the same date along with counseling by a qualified healthcare professional, report one administration code (90460) for each vaccine administered.
If a vaccine has multiple components, then 90460 should be reported once in conjunction with 90461 for each additional vaccine/toxoid component contained within that vaccine. 
IMPORTANT SAFETY INFORMATION
- Contraindications for PEDIARIX are: severe allergic reaction (eg, anaphylaxis) after a previous dose of any diphtheria toxoid-, tetanus toxoid-, pertussis-, hepatitis B-, or poliovirus-containing vaccine, or to any component of PEDIARIX; encephalopathy within 7 days of administration of a previous pertussis-containing vaccine; progressive neurologic disorders
- In clinical trials, PEDIARIX was associated with higher rates of fever relative to separately administered vaccines
- The decision to give PEDIARIX should be based on potential benefits and risks if Guillain-Barré syndrome has occurred within 6 weeks of receipt of a prior vaccine containing tetanus toxoid, or if adverse events (ie, temperature ≥105°F, collapse or shock-like state, persistent, inconsolable crying lasting ≥3 hours, occurring within 48 hours after vaccination; seizures within 3 days after vaccination) have occurred after receipt of a pertussis-containing vaccine
- The tip caps of the prefilled syringes contain natural rubber latex, which may cause allergic reactions
- Syncope (fainting) can occur in association with administration of injectable vaccines. Procedures should be in place to avoid falling injury and to restore cerebral perfusion following syncope
- For children at higher risk for seizures, an antipyretic may be administered at the time of vaccination with PEDIARIX
- Apnea following intramuscular vaccination has been observed in some infants born prematurely. Vaccination with PEDIARIX should be based on consideration of the individual infant's medical status and the potential benefits and possible risks of vaccination
- In clinical trials, common adverse reactions in infants receiving PEDIARIX included injection-site reactions (pain, redness, and swelling), fever, drowsiness, irritability/fussiness, and loss of appetite
- Vaccination with PEDIARIX may not result in protection in all vaccine recipients
PEDIARIX and Tip-Lok are registered trademarks of the GSK group of companies.
815344R0 December 2016
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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.