SCENARIO: Billing for Vaccine Counseling

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 repoted 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.