PEDIARIX CPT Vaccine Code: 90723

Vaccine & Product Overview

HCPCS Descriptor Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DTaP-HepB-IPV), for intramuscular use

Manufacturer Glaxo Smithkline Pharmaceuticals

Route of Administration Intramuscular

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection, Suspension

About PEDIARIX

Pediarix is a medication aligned to the HCPCS CPT Drug Code: 90723 for billing, pricing, and reimbursement purposes in the United States. It is a Vaccine drug administered via the intramuscular route and manufactured by Glaxo Smithkline Pharmaceuticals.

Manufacturers, reach out to us to add more information.

NDC Code Information

1 NDC package is crosswalked to 90723. Package detail is available to logged-in subscribers.

NDC Code	Drug	Manufacturer	Billing Units / Pkg	Package Size
•••••-••••-•• Log in to view	PEDIARIX

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PEDIARIX Pricing & Reimbursement

90723 Private Payer Reimbursement

$119.04 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

Create an account on PayerPrice for more information →

PEDIARIX Vaccine Administration Codes

CPT Code	Description
90471	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), one vaccine (single or combination vaccine/toxoid)
90472	Immunization administration (each additional vaccine or toxoid), when performed in conjunction with primary procedure.

PEDIARIX Medically Unlikely Edits (MUE)

The most billing units of 90723 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 dose.

Practitioner Office & Hospital Outpatient

0 units / day

Not payable in this setting

MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →

PEDIARIX Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.

Diphtheria Tetanus Pertussis Hepatitis B Poliomyelitis

Drug Class

Actively Acquired Immunity [PE]Diphtheria Toxoid [CS]Inactivated Bordetella Pertussis Vaccine [EPC]Inactivated Clostridium Tetani Vaccine [EPC]Inactivated Corynebacterium Diphtheriae Vaccine [EPC]Inactivated Poliovirus Vaccine [EPC]Pertussis Vaccine [CS]Poliovirus Vaccines [CS]Tetanus Toxoid [CS]VaccinesInactivated [CS]

Frequently Asked Questions

Is there an available Pediarix billing and coding guide?

Billing and coding information for PEDIARIX can be found through GSK. Visit Here →

Are there any available Pediarix patient assistance programs?

PEDIARIX patient assistance information can be found through GSK. Visit Here →

Where can I find Pediarix prescribing information?

PEDIARIX prescribing information can be found at the link below: Visit Here →

Where can I find Pediarix side effect information?

Our team has not yet identified a source of side effects information for PEDIARIX. Please check back in a few weeks.

Does billing PEDIARIX require JZ/JW wastage modifiers?

CMS does not include PEDIARIX (90723) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing 90723. For more information, visit the link below.

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