Some important changes in vaccine administration coding have been implemented for services provided in 2011 and thereafter. These changes specifically address the increased physician work of counseling pediatric patients and caregivers regarding the risks and benefits of combination vaccines.
New codes 90460-90461 replace codes 90465-90468 for all dates of service on or after 01/01/2011. These codes are reported for either single or combination vaccine administration when the physician or other qualified health care professional (e.g., physician assistant or nurse practitioner) provides counseling at the time of the administration.
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Administration Coding Changes 2011
Reporting Administration per Component
The new pediatric immunization administration codes are:
90460 - Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component
+90461 each additional vaccine/toxoid component (List separately in addition to code for primary procedure)
These codes are reported per vaccine/toxoid component. CPT defines a component for these purposes as each antigen in a vaccine that prevents disease(s) caused by one organism. Combination vaccines are those vaccines that contain multiple vaccine components.
You may report multiple units of code 90460 for each first vaccine/toxoid component administered. No modifier should be required when reporting multiple first components. Note also that code 90460 does not apply only to combination vaccines, but also to single component vaccines (such as influenza, human papilloma virus or pneumococcal conjugate vaccines). This base code is reported for each vaccine administration to patients 18 years of age and under who receive counseling about the vaccine from a physician or qualified health care professional at the time of administration. Code 90461 is an add-on code reported for each additional vaccine component administered.
90460 - Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component
+90461 each additional vaccine/toxoid component (List separately in addition to code for primary procedure)
These codes are reported per vaccine/toxoid component. CPT defines a component for these purposes as each antigen in a vaccine that prevents disease(s) caused by one organism. Combination vaccines are those vaccines that contain multiple vaccine components.
You may report multiple units of code 90460 for each first vaccine/toxoid component administered. No modifier should be required when reporting multiple first components. Note also that code 90460 does not apply only to combination vaccines, but also to single component vaccines (such as influenza, human papilloma virus or pneumococcal conjugate vaccines). This base code is reported for each vaccine administration to patients 18 years of age and under who receive counseling about the vaccine from a physician or qualified health care professional at the time of administration. Code 90461 is an add-on code reported for each additional vaccine component administered.
Items of Note About 90460 and 90461
To correctly report vaccine counseling and administration with these codes, it is important to recognize what the codes do and do not include.
- These codes are limited to immunization administration, meaning purchased vaccine products must be separately reported.
- A face-to-face service where a physician or other qualified health care professional (qualified per state licensure) provides counseling to the patient and/or caregivers is required to report 90460-90461. In the absence of counseling, the administrations must be reported with codes 90471-90474.
- 90460-90461 are reported for administration to patients 18 years of age and under.
- Code 90460 is reported for each separate administration of single component vaccines and/or first component of a combination vaccine.
- When reporting administration of combination vaccines, code 90460 is reported for the first component and add-on code 90461 is reported for each additional component (no modifier -51 required).
- Note that route of administration (whether injection, oral or intranasal) does not matter, since the codes include “via any route of administration.”
Administration coding example
An 11-year old girl presents for a preventive visit (99393). In addition, the child and her mother are counseled by the physician on risks and benefits of HPV (90649), Tdap (90715) and seasonal influenza (90660) vaccines. The mother signs consent to administration of these vaccines. A nurse prepares and administers each vaccine, completes chart documentation and vaccine registry entries, and verifies there is no immediate adverse reaction.
CPT Codes reported are:
99393 - Preventive Service
90649 - HPV vaccine
90460 - Administration first component (1 unit)
90715 - Tdap vaccine
90460 - Administration first component (1 unit)
90461 - 2 additional components (2 units)
90660 - Influenza vaccine, live, for intranasal use
90460 - Administration first component (1 unit)
99393 - Preventive Service
90649 - HPV vaccine
90460 - Administration first component (1 unit)
90715 - Tdap vaccine
90460 - Administration first component (1 unit)
90461 - 2 additional components (2 units)
90660 - Influenza vaccine, live, for intranasal use
90460 - Administration first component (1 unit)
Coding for Vaccines and Administration
