How does CPT define a vaccine component? A component refers to all antigens in a vaccine that prevents disease(s) caused by one organism. Multivalent antigens or multiple serotypes of antigens against a single organism are considered a single component of vaccines. Combination vaccines are those vaccines that contain multiple vaccine components. Conjugates or adjuvants contained in vaccines are not considered to be component parts of the vaccine as defined above.
Vaccine administration coding
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.
For immunization administration of any vaccine that is not accompanied by face-to-face counseling of
the patient/family or for the administration of vaccines for patients over 18 years of age, report codes
90471-90474.
Code 90460 is reported once for the first component of each vaccine or toxoid administered by any
route. The reporting of code 90460 includes counseling for the first vaccine component. Code 90461 is
additionally reported for the counseling associated with each additional component of any combination
vaccine or toxoid.
CPT Coding
• 90460 Through 18 years via any route with counseling by physician or other qualified health
care professional; first vaccine/toxoid component.
• 90461 Through 18 years via any route, with counseling by a physician or other qualified health
care professional; each additional vaccine/toxoid component.
• 90471 (including percutaneous, intradermal, subcutaneous, or intramuscular injections); one
vaccine (single or combination vaccines/toxoid).
• 90472 (including percutaneous, subcutaneous, intradermal, or intramuscular injections); each
additional vaccine (single or combination vaccine/toxoid).
ICD-10-CM code for any vaccine given including influenza is Z23 encounter for immunizations.
Document requirements:
Federal requirements mandate that you document five things when you administer a vaccine:
- The name of the vaccine and the manufacturer;
- The lot number and expiration date of the vaccine;
- The date of administration;
- The name, address, title, and signature (electronic is acceptable) of the person administering the vaccine
- The edition date of the Vaccine Information Statement (VIS) and the date the patient or parent receives the VIS.
NCCI Edits
• The NCCI edits are code edits published by both Medicaid and Medicare to support correct
coding and claims adjudication
• The version effective 1/1/2013 included edits on all E/M services that disallow patient visits with
immunization administration codes without the proper modifier
• With proper modifier placement, the edit can be overridden
TIPS
• Append modifier 25 to the preventive medicine service code (99381-99395) when it is reported in
conjunction with any immunization administration service (90460-90461; 90471-90474). Modifier 25
should also be appended to other non-preventive medicine E/M services (e.g., 99201-99215) when
reported in conjunction with immunization administration -- but only when the E/M service is
significant and separately identifiable. So…anytime a vaccine is administered, whether it is a WCC
or acute visit a -25 modifier needs to be added to the E/M code.
• If a WCC and acute visit is done at the same visit, and shots are administered a -25 modifier needs to
be attached to both the WCC and the acute visit code.
• No modifier needed if shots only.
• Add modifier -25 to the sick visit code if both a well and a sick visit are coded and no immunizations
are given.
• If you have G8431/G8510 (depression screen) with a vaccine admin, add the -25 modifier to
G8431/G8510.
• Use both modifiers if you have CPT 99173, G8431/G8510, and a vaccine admin.
• NCCI prohibits the use of procedure code 99211 (office or other outpatient visits for the evaluation
and management of an established patient, which may not require the presence of a physician) with
vaccine/immunization administration procedure codes 90460-90474. No NCCI bypass modifiers are
recognized with these procedure code pairs.
is a CDC-approved description of the vaccine, its benefits, and adverse effects, and it includes information about the disease the vaccine protects against. This is written at a level most patients can understand.
Immunization Resources:
Advisory Committee on Immunization Practices | |
American Academy of Family Physicians | |
American Academy of Pediatrics' Red Book Online | |
Centers for Disease Control and Prevention | |
Group on Immunization Education of the Society of Teachers of Family Medicine | |
Immunization Action Coalition | |
National Immunization Program's vaccine information statements | |
National Immunization Program's vaccination schedule | |
Vaccine Adverse Event Reporting System | |
Vaccines for Children |