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| | New Immunization Administration Codes
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Major billing change with new codes 90460 and 90461
Please review filing guidelines for new immunization administration CPT®* codes 90460 and 90461, codes which became effective January 1, 2011, and are used to report each vaccine by component.
| Codes |
Immunization Administration Definition |
| 90460 |
Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/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; each additional vaccine/toxoid component (List separately in addition to code for primary procedure) |
Billing Requirements for Codes
The new codes require each component of a vaccine to be reported separately. CPT defines a component as all antigens in a vaccine that prevents disease(s) caused by one organism. Combination vaccines are those vaccines that contain multiple vaccine components.
Example
An 18-year-old patient is counseled on each of the following vaccine components.
| Vaccine Code |
Descriptor |
# of
Components |
Administration Codes |
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90670
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Pneumococcal Conjugate Vaccine
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1
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90460 x 1
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90723
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Diphtheria, Tetanus Toxoids, Acellular Pertussis, Hepatitis B, Poliovirus Vaccine (DtaP-HepB-IPV)
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5
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90460 x 1
90461 x 4
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90680
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Rotavirus Vaccine
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1
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90460 x 1
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To receive proper reimbursement in this case, the patient’s claim should list 90460 and 90461 once, with multiple units of service for each code:
- 90460 x 3 units
- 3 units represent the only component of pneumococcal and rotavirus vaccine, and first component of DtaP-HepB-IPV
- 90461 x 4 units
- 4 units represent each additional component of DtaP-HepB-IPV; no other vaccine has more than one component to report
If 90460 or 90461 is listed on a claim more than once, the repeated administration code(s) will deny as duplicate services.
Please contact your software vendor for an update if your software cannot accommodate these coding requirements.
*CPT® is a trademark of the American Medical Association. Current Procedural Terminology© 2011 American Medical Association. All Rights Reserved.
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