Insurance and Payment Information

For all travel consultations and vaccines we require payment in full on the day of the visit.

The following form is intended for use when calling your insurance company to establish if you have coverage for vaccines.

Use the member service number on the back of your card. You must be specific that the vaccines are intended for travel purposes

For each vaccine give the name and the CPT code (the number beginning with 90 directly following the name.

Place a check in the space corresponding to that particular vaccine. The insurance company should be able to give you a direct yes/no answer. Ask for written confirmation to be sent to you. Print the form for your records We will gladly supply the appropriate documentation to send to your insurance company for reimbursement.

(CPT Code/ICD-9 Code)
Hepatitis A Vaccine, Inactivated 90632/VO5.3
Hepaittus B Vaccine, (Recombinant) 90747/VO5.3
Hepaittus A and Hepaittus B Vaccine 90538/VO5.3
Influenza Virus Vaccine 90658/Vo4.31
Japanese Encephalitis Virus Vaccine, Inactivated 90735/VO5.1
Measels, Mumps, and Rubetis Virus Vaccine Live 90707/VO5.4
Meningococcal Polysaccharide Vaccine Groups - A, C, Y and W-135 Combined 90734/VO3.89
Pneumococcal Vaccine Polyvalent 90733/VO3.89
Poliovirus Vaccine Inactivated 90732/VO3.82
Rabies Vaccine 90713/VO4.0
Tetanus and Diphtheria Toxolds Adsorbed for Adult Use 90675/VO4.5
Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussls Vaccine Absorbed 90714/VO6.5
Typhoid VI Polysaccharide Vaccine 90715/VO6.1
Typhoid Vaccine, Oral Live 90691/VO3.1
Varicella Virus Vaccine Live (Oka/Merck) 90690/VO3.1
Yellow Fever Vaccine 90716/VO5.4
Vaccine Administrailon 1st Injection 90471
Vaccine Administrailon Each Additional 90472
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