Vaccine CPT codes Billing Guidelines

There are four different types of administration of vaccine CPT codes found.

1. Pediatrics patients up to 18 years of age - CPT 90460 & 90461.
2. Adult age patients - CPT 90471 & 90472.
3. For Intranasal or oral route - CPT 90473 & 90474
4. For COVID-19 vaccines - CPT 001A, 0002A, 0011A, 0012A, 0021A, 0022A, 0031A, 0041A, 0042A

If the provider and or other qualified healthcare professional administers more than one vaccine, use the appropriate add-on codes.

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)

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 the intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

Examples

Diphtheria and Tetanus Toxoids Adsorbed vaccine 2 components administered to a pediatric patient and provided and counseling to the patient and parents by a physician.

• The appropriate administration is billed with one each CPT 90460 and 90461 instead of a single code.

Fluzone Quadrivalent vaccine, a single-component vaccine, is administered to a pediatric patient and counseling is provided by the physician.

• The appropriate administration code 90460 with only one unit.

Pentacel vaccine, a 5-component vaccine, is administered to a pediatric patient, and counseling is provided by the other qualified healthcare practitioner.

• The appropriate administration CPT code 90460 with one unit and 4 units for CPT 90461

Flublok and Quadrivalent and Adacel vaccines are administered to an adult patient.

• 90471and 90472 can be billed one unit for each code.

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