Vaccine administration
Also see:
Vaccine administration documentation
Vaccine administration criteria that must be included in your documentation:
- Drug administered
- Dosage administered
- Location of vaccination
When billing for multiple vaccine administrations, you can either report administration add-on codes per line or report as multiple units on one line.
Initial administration coding
Only one initial administration code can be reported per day, regardless of vaccine administration method.
Initial administration CPT codes 90460 (18 years and younger), 90471 and 90473 cannot be billed together on the same date of service.
When one of these initial administration codes is billed, report all additional vaccine/toxoid components administered with the appropriate add-on code (i.e. 90461, 90472 or 90474). Reference your CPT book for coding guidelines if you have additional questions.
When submitting an National Drug Code (NDC), confirm it's valid and matches the vaccine(s) administered.
Reporting 90460 and 90461
Report codes 90460 and 90461 only when the physician or qualified health care professional provides face-to-face counseling of the patient/family during the administration of the vaccine.
Immunization administration of vaccine that is not accompanied by face-to-face counseling or patient over the age of 18, assign a code from range: 90471-90474
Assign one code for each vaccine's initial component
A component refers to all antigens in a vaccine that prevent disease(s) caused by one organism.
90460: Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered
90461: Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component (List separately in addition to code for primary procedure.)
Examples:
A pediatrician counsels on vaccine risks and benefits prior to giving the patient DTaP (3 components) and MMR (3 components).
Vaccine codes reported:
- 90700: Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use
- 90707: Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use
The initial vs. add-on vaccine administration on these components is:
- Diphtheria (intial component), tetanus toxoids (additional component), acellular pertussis vaccine (additional component)
- Measles (initial component), mumps (additional component) and rubella virus (additional component)
Report vaccine administration codes as:
- 90460 x 2
- 90461 x 4
A pediatrician counsels on vaccine risks and benefits prior to giving the patient Pediarix, which has five components: DTaP-HepB-IPV.
The diphtheria, tetanus toxoids, acellular pertussis each count as one component, plus Hepatitis B and inactivated polio virus each count as one.
Vaccine code reported:
- 90723 Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DTaP-HepB-IPV), for intramuscular use
The initial vs. add-on vaccine administration on these components is:
- Diphtheria (initial component), tetanus toxoids (additional component), acellular pertussis vaccine (additional component), hepatitis B (additional component), and inactivated poliovirus vaccine (additional component)
Report vaccines administration codes as:
- 90460
- 90461 x 4
Reporting diagnoses Z28.0-Z28.29 and Z28.8-Z28.9
Immunization and administration codes reported with the following diagnosis codes will not be reimbursed.
- Z28.0- Z28.29 - immunization not carried out because of contraindication
- Z28.8- Z28.9 - immunization not carried out for unspecified reason
Clinical edit: Vaccines and administration
Claims will deny immunization administration (90460-90461, 90471-90474, 90480) when billed without a vaccine/toxoid code (90476-90750, 90756, 90758, 90759, 91318-91322, J3530, Q2034-Q2039) by any provider on the same date of service. AMA CPT Manual and the HCPCS Level II Manual, immunization administration for vaccines and toxoids (90460-90461, 90471-90474, 90480) must be reported in addition to the vaccine and toxoid codes (90476-90750, 90756, 90758, 90759, 91318-91322, J3530, Q2034-Q2039).
For Priority Health Medicaid, vaccines should be reported with a zero allowed amount for vaccines supplied though the State as part of the Vaccine for Children (VFC) program. See page 20 of Michigan VFC Provider Manual for additional detail.