Vaccine administration

Also see:

Flu shots

Preventive vaccine codes

Medicare preventive services


Vaccine administration documentation

Vaccine administration criteria that must be included in your documentation:

  • Drug administered
  • Dosage administered
  • Location of vaccination

When billing for multiple vaccine administrations, you can either report administration add-on codes per line or report as multiple units on one line.

Initial administration coding

Only one initial administration code can be reported per day, regardless of vaccine administration method.

Initial administration CPT codes 90460 (18 years and younger), 90471 and 90473 cannot be billed together on the same date of service.

When one of these initial administration codes is billed, report all additional vaccine/toxoid components administered with the appropriate add-on code (i.e. 90461, 90472 or 90474). Reference your CPT book for coding guidelines if you have additional questions.

Reporting 90460 and 90461

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.

Immunization administration of vaccine that is not accompanied by face-to-face counseling or patient over the age of 18, assign a code from range:  90471-90474

Assign one code for each vaccine's initial component

A component refers to all antigens in a vaccine that prevent disease(s) caused by one organism.

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/toxoid component (List separately in addition to code for primary procedure.)

Examples:

A pediatrician counsels on vaccine risks and benefits prior to giving the patient DTaP (3 components) and MMR (3 components).

Vaccine codes reported:

  • 90700: Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use 
  • 90707: Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use

The initial vs. add-on vaccine administration on these components is:

  • Diphtheria (intial component), tetanus toxoids (additional component), acellular pertussis vaccine (additional component) 
  • Measles (initial component), mumps (additional component) and rubella virus (additional component) 

Report vaccine administration codes as:

  • 90460 x 2
  • 90461 x 4

A pediatrician counsels on vaccine risks and benefits prior to giving the patient Pediarix, which has five components: DTaP-HepB-IPV.

The diphtheria, tetanus toxoids, acellular pertussis each count as one component, plus Hepatitis B and inactivated polio virus each count as one.

Vaccine code reported:

  • 90723 Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DTaP-HepB-IPV), for intramuscular use

The initial vs. add-on vaccine administration on these components is:

  • Diphtheria (initial component), tetanus toxoids (additional component), acellular pertussis vaccine (additional component), hepatitis B (additional component), and inactivated poliovirus vaccine (additional component)

Report vaccines administration codes as:

  • 90460
  • 90461 x 4