Coding changes for new administration codes: Vaccines
The new codes, 90460-90461 are specific to members birth to 18 years old receiving counseling
for each vaccine component.*
Please note that the coding guidelines associated with newly deleted CPT codes 90465-90468
are different from those associated with the new CPT codes 90460-90461. Before you code for
your services, make sure to verify if the immunizations provided has single or multiple vaccine
components (example – DTaP contains three components – Diphtheria, Tetanus Toxoids, and
Acellular Pertussis; Rotavirus has one component).
Administration coding examples:
- Rotavirus vaccine given. Administration would be coded with 90460 (only one
component to this vaccine so only one administration service is reported)
- And -
- DTaP vaccine given. Administration would be coded with 90460 (first vaccine
administered Diphtheria), 90461 (second component - Tetanus Toxoids) and 90461
(third component – Acellular Pertussis)
Provider would bill a total of two 90460 and two 90461.
Remember, codes 90460-90461 should be reported only when a physician (or other qualified
health professional) provides counseling for each vaccine component and it is documented
within the medical record. Documentation without this specific requirement may generate a
claim denial.
If counseling related to the vaccine(s) does not occur, continue to utilize CPT codes 90471-
90474. Coding guidelines associated with these services has not changed.
*According to the AMA, component refers to each antigen in a vaccine that prevents disease(s) caused by one organism.
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