All antigens in a vaccine that prevent disease 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.
For administration of a vaccine six CPT can be designated. These codes are depend on counseling provided in same visit or not.
Administration with Counseling
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 physician or other qualified health care professional; each additional vaccine/toxoid component.
Administration without Counseling
90471 : Immunization administration (including percutaneous, subcutaneous, intramuscular, or jet injections); one vaccine (single or combination vaccine/toxoid)
90472 : each additional vaccine (single or combination vaccine/toxoid)
(Use code 90472 in conjunction with 90471.)
90473 : Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid)
90474 : each additional vaccine (single or combination vaccine/toxoid)
Tips to code vaccine
Vaccine administration codes are categorised on the basis of patient age and divided in two category:-
- 18 year or younger
- Older than 18 year
Face – to – Face counseling with Patient and family
Some vaccines needed counseling specially for paediatric vaccine. Parents have so many query regarding particular vaccine. Physician provides information like indications, risk factors, possible side effect and benefits. 9047- 90471 codes are not include counseling whereas 90461- 90462 codes are include vaccine
Number of Vaccine and Toxoid component
For administration of one component of a vaccine we can use 90460 and more than one component use 90461 (seperately for each component).
Whereas 90471 – 90474 use per vaccine rather than per vaccine componant.
- Human Pappiliomavirus vaccine includes single component : (90460)
- DTaP- Hemophillus influenza type b (90460, +90461*3 ) vaccine includes four components.
Route of Administration
Route of administration is also a important factor for proper coding of an admin code.
- 90471-90472 for percutaneous, intradermal, subcutaneous or intramuscular injection.
- 90473- 90474 use for oral or intranasal route.
Example: Physician has given 2 intramuscular, 1 oral and 1 intranasal injection to a 40 years old patient. Condition should be coded as:
Tips for Supplies and diagnosis
Don’t be confuse with supplies code. It is necessary to apply a supplies in addition to administration code.
Example: to report Vericella virus vaccine SQ, MMR vaccine sc and DTaP vaccine –
- 90716: Vericella vaccine
- 90707: MMR vaccine
- 90700: DTaP vaccine im
- 90471 for one vaccine
- 90472* 2 for other two vaccine
Diagnosis : All vaccine and immunisation support diagnosis Z23.
Z23 : Encounter for Immunization
Evaluation and Management Services with Immunizations
Payers may require modifier 25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to be appended to the E/M code to distinguish it from the administration of the vaccine.