Correct Coding for Vaccine Administration

September 28, 2016

CPT designates six codes to report vaccine administration. Here's how to make sure you are reporting the correct service and conditions.

CPT® designates six codes to report vaccine administration, which are divided into two main categories:

Category 1: Administration with Counseling

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 or toxoid component administered (List separately in addition to code for primary procedure)

To report these codes, provider documentation must substantiate three elements:

1. Patient age. These codes apply only to those patients age 18 years or younger. For patients older than 18 years old, you must turn to the second category of administration codes, detailed below.

2. Face-to-face counseling with the patient and/or family. Parents with children often have questions about vaccines, and the provider may spend significant time on education and counseling. Documentation of the encounter should detail the vaccines given and summarize patient risk factors or concerns, and information shared with the patient/family (e.g., possible side effects and benefits of the vaccine). If the provider does not document face-to-face counseling, he must turn to the second category of administration codes, detailed below.

3. The number of vaccine or toxoid components - NOT the number of individual vaccines - administered. Report 90460 for the first component administered, and one unit of 90461 for each additional component administered. For example:

• HPV vaccine includes a single component (90460)

• Td vaccine includes two components (90460, 90461)

• DTaP and Tdap vaccines include three components (90460, 90461 x 2)

• DTaP-Hib vaccine includes four components (90460, 90461 x 3)

• DTaP-Hib-IPV vaccine includes five components (90460, 90461 x 4)

The route of administration (subcutaneous, intranasal, etc.) is not relevant when reporting 90460 and 90461.

Category 2: Administration without Counseling

90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 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)

Several factors distinguish these vaccine administration services 90460 and 90461, all of which are significant for code selection and provider documentation:

• 90471-90474 do not include counseling. These are the correct codes to report when the provider does not document counseling with the patient and/or family regarding the vaccine administration.

• 90471-90474 do not specify patient age. You may report these codes for patients of any age.

• 90471-90474 specify the route of administration. Report 90471-90472 for percutaneous, intradermal, subcutaneous, or intramuscular injections. Report 90473-90474 for administration by intranasal or oral route.

• 90471-90474 are reported per vaccine, rather than per vaccine component.

Report 90471 and 90473 are for the initial or first vaccine administered, depending on the route of administration. You may use only one initial administration code per patient encounter. When both an injected and an oral/intranasal vaccine are administered during the same visit, report 90471 as the initial administration code. If the provider administers multiple vaccines, report each additional vaccine administration using either 90472 and/or 90474, as appropriate to the route of administration. For example:

• To report a single intramuscular vaccination, report 90471.

• To report three intramuscular injections, report 90471 for the initial intramuscular vaccination administration and 90472 x 2 for the additional intramuscular administrations.

• To report two intramuscular injections, one oral administration, and one nasal administration, report 90471 (initial intramuscular vaccination administration), 90472 (additional intramuscular administration), and 90474 x 2 (one unit for each oral/nasal administration).

Mix and match codes when counseling for some (but not all) administrations

You can mix and match 90460-90461 and 90471-90474 if the provider counsels the patient on some, but not all, of the vaccines or vaccine/toxoid components administered. For example, if counseling is performed for HPV vaccine but not for an influenza vaccine provided at the same visit, report 90460 for the HPV administration with counseling, and either 90472 (injected) or 90474 (oral/intranasal) for administration of the influenza vaccine without counseling.

Don't forget the vaccine supply and diagnosis

In addition to vaccine administration, you typically may report the vaccine supply using a separate CPT® or HCPCS supply code. For example, to report the administration and supply of DTaP; measles, mumps, and rubella (MMR); and, Varicella vaccines, select:

90700 (DTaP Vaccine, IM)

90707 (MMR Vaccine, SQ or Jet Injection)

(90716) Varicella Virus Vaccine, SQ

(90471) Administration of DTaP, IM

(90472 x 2) Administration of MMR and Varicella Virus Vaccine

Note: The Vaccines for Children (VFC) program provides free vaccines for children under the age of 18 who meet certain criteria. If the provider participates in VFC, he or she may not separately charge for the vaccine supplies provided as part of the program; however, providers may charge for the vaccine administration(s). Check with your state VFC program and local carriers for specific coding rules.

Finally, note that all vaccines and immunizations are reported using ICD-10-CM code Z23 Encounter for immunization.