What are the vaccine administration counseling codes and when can I use them?
In 2011 the American Medical Association CPT coding panel approved two CPT codes that include counseling prior to the administration of vaccines. These codes can be used if:
- The patient to whom the vaccine is administered is 18 years of age or younger
- Counseling is provided by a qualified healthcare professional as identified in the CPT manual.
Qualified healthcare professional is usually interpreted as a physician or an advanced practice nurse or physician assistant.
The vaccine administration counseling codes allow for billing the administration of each component of a vaccine for which counseling was provided.
| Primary code (first vaccine or toxoid component) | |
|---|---|
| 90460 | Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health-care professional. |
| Add-on code (each additional vaccine or toxoid component) | |
|---|---|
| +90461 | Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health-care professional |
| This code can only be reported in conjunction with the primary code, and replaces add-on codes 90466 and 90468. | |
Adolescent Immunization Example
A 14-year-old adolescent is immunized at a well-visit with Tdap, MCV4, and HPV vaccine.
Counseling is provided by the physician.
| Date | CPT code | Units | Diagnosis code |
|---|---|---|---|
| 1/11/16 | 99394 (well-visit) | 1 | V20.2 |
| 1/11/16 | 90715 (Tdap vaccine) | 1 | Z23 |
| 1/11/16 | 90460 (first component) | 1 | Z23 |
| 1/11/16 | 90461 (additional components) | 2 | Z23 |
| 1/11/16 | 90734 (MCV4 vaccine) | 1 | Z23 |
| 1/11/16 | 90460 (first component) | 1 | Z23 |
| 1/11/16 | 90649 (HPV vaccine) | 1 | Z23 |
| 1/11/16 | 90460 (first component) | 1 | Z23 |
In keeping with the administration guidelines, CPT code 90460 is used for reporting the first component of each vaccine administered during the well-visit. In the case of Adacel vaccine, a combination vaccine, CPT code 90461 is used to denote each of the 2 additional components.