• Contraindications for ROTARIX include a history of any of the following: hypersensitivity to the vaccine or any component of the vaccine, intussusception, uncorrected congenital malformation of the gastrointestinal tract that would predispose the infant to intussusception, or Severe Combined Immunodeficiency Disease (SCID)
    See full Important Safety Information below
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Diagnosis Codes

ICD-10-CM codes are used to report diseases and conditions. These will be needed on the CMS-1500 form.

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Printable Summary Sheet

This PDF provides a summary of CPT codes for GSK vaccines.

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Coding for ROTARIX
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This section provides the vaccine product codes as well as some common administration codes associated with immunization using ROTARIX. 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.


ROTARIX is a vaccine indicated for the prevention of rotavirus gastroenteritis caused by G1 and non-G1 types (G3, G4, and G9) when administered as a 2-dose series. ROTARIX is approved for use in infants 6 weeks to 24 weeks of age.

Description [29] NDCs* ICD-10-CM
Code [8]**
1 mL
90681 ROTARIX is available in single-dose vials of lyophilized vaccine, accompanied by a prefilled oral applicator of liquid diluent (1 mL) with a plunger stopper, and a transfer adapter for reconstitution.   Z23
The tip caps of the prefilled oral applicators contain natural rubber latex; the vial stoppers are not made with natural rubber latex.  
Supplied as an outer package of 10 doses (NDC 58160-854-52) containing:
Vial of lyophilized vaccine (NDC 58160-851-01) in package of 10 (NDC 58160-851-10); oral applicators of diluent (NDC 58160-853-02) and transfer adapters.
Saleable Unit:
Package of 10:
Outer Carton:
NDC 58160-851-01 NDC 58160-851-10 NDC 58160-853-02 NDC 58160-854-52
* Note that some payers require an 11-digit NDC, which involves adding a "0" immediately after the first hyphen in each GSK NDC. For example, when reporting NDC 58160-820-11 to TRICARE, it becomes NDC 58160-0820-11. [14]
** With the implementation of ICD-10-CM, all vaccine-related encounters are reported as code Z23 for all vaccines given.
TIP To promote accuracy, always consult the most current Prescribing Information or product packaging when documenting NDCs.
Immunization Administration Codes (CPT) [6]
CPT Immunization administration through 18 years of age with counseling by physician or other qualified healthcare professional
90460 Immunization administration via any route, first vaccine/toxoid component
CPT 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
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), one vaccine (single or combination vaccine/toxoid)
+90472 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)
90473 Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)
+90474 Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
Adapted from the American Medical Association, CPT 2017 Professional Edition,
Current Procedural Terminology (CPT), 2016.
TIP 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. [6]


ROTARIX is a registered trademark of the GSK group of companies.

816235R0 February 2017

Please note that this website is provided for informational purposes only and is not intended to serve as comprehensive training on medical billing and coding. Additional training on medical coding may be required. The information on this website is believed to be accurate as of the date of publication. Users should independently verify accuracy.

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.

You are encouraged to report vaccine adverse events to the US Department of Health and Human Services.
Visit to file a report, or call 1-800-822-7967.

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