Pediatric Immunization Administration codes 90460 and 90461

Component-Based Billing (90460-90461)

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 which contain multiple vaccine components.

• 90460- Immunization Administration through 18 years of age via any route of administration, with counseling by physician or other qualified healthcare professional; first or only component of each vaccine or toxoid administered
• +90461 (add-on) each additional vaccine or toxoid component administered (list separately in addition to code for primary procedure)
• Use 90460 for each administered. For vaccines with multiple components [combined vaccines], report 90460 in conjunction with 90461 for each additional component of a given vaccine and physician counseling given at time of injection and documented

Items of Note About Codes 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)
• VFC: Code as required per the state guidelines and instruction

*Check your payer policies to verify the correct coding claim billing structure, due to two common billing scenarios.

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:
• Code the vaccine substance and required administration code(s) right after as noted below.
  • 99393 – Preventive service 90649 – HPV vaccine
  • 90460 – Administration first component (1 unit)
  • 90715 – Tdap vaccine
  • 90460 – Administration first component (1 unit)
  • 90461 – Two (2) additional components (2 units)
  • 90660 – Influenza vaccine, live, for intranasal use
  • 90460 – Administration first component (1 unit)
• Code the vaccine substance and group the administration codes and bill by Units.
  • An 18-year old patient is counseled on risks and benefits of Pneumococcal Vaccine, Diphtheria- Tetanus- Pertussis-Hepatitis B, Poliovirus Vaccine and seasonal influenza. The healthcare provider administers each vaccine, completes chart documentation and vaccine registry entries, and verifies there is no immediate adverse reaction.
  • CPT Codes reported are:
    • 90670 – Pneumococcal conjugate
    • 90723 – DTaP-HepB-IPV
    • 90658 – Influenza virus vaccine, split virus
    • 90460 Administration first component (3 unit)
    • 90461 Four(4) additional components (4 units)

Vaccine Component Table: CDC 2016 Pediatric Chart

Referenced Documents:

• http://www.aafp.org/practice-management/payment/coding/admin.html
• http://www.bcbsnc.com/content/providers/news-and-information/news/aug19-2011.htm
• http://cchap.org/wp-content/uploads/2016/02/AAP_Vaccine-Coding-Table_2016.pdf