Coding description of CPT code 90460 & 90461

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

The physician or other qualified health care professional instructs the patient or family on the benefits and risks related to the vaccine or toxoid. The physician counsels the patient or family regarding signs and symptoms of adverse effects and when to seek medical attention for any adverse effects. A physician, nurse, or medical assistant administers an immunization by any route to the patient.

It may be a single vaccine or a combination vaccine/toxoid in one immunization administration (e.g., diphtheria, pertussis, and tetanus toxoids are in a single DPT immunization). Report CPT code 90460 for the first or only vaccine/toxoid component. Report CPT code 90461 for each additional component. These codes report immunization administration to patients 18 years of age or younger.

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 or toxoid component administered (List separately in addition to code for primary procedure)

Use 90460 for each vaccine administered. For vaccines with multiple components [combination vaccines], report CPT code 90460 in conjunction with 90461 for each additional component in a given vaccine.

ICD-10 requires only one code (Z23) per vaccination, regardless if single or combination. Report Z23 for all vaccination diagnoses.

You may report multiple units of code 90460 for each first vaccine/toxoid component administered. No modifier should be required when reporting multiple first components. Note also that code 90460 does not apply only to combination vaccines, but also to single component vaccines (such as influenza, human papilloma virus, or pneumococcal conjugate vaccines).

This base code is reported for each vaccine administration to patients 18 years of age and under who receive counseling about the vaccine from a physician or qualified health care professional at the time of administration. Code 90461 is an add-on code reported for each additional vaccine component administered.

For immunization administration of any vaccine that is not accompanied by face-to-face counseling of the patient/family or for administration of vaccines for patients over 18 years of age, report codes 90471-90474

Other considerations to keep in mind when reporting codes 90471-90474:

 If you administer an injection of the influenza vaccine only, report 90471.

 If you administer the intranasal influenza vaccine only, report 90473. If you administer an influenza vaccine in addition to other vaccines, report the influenza injection with 90472 or the intranasal with 90474.

 Note that code 90471 or 90473 cannot be reported in conjunction with 90460. Therefore, if during a single encounter, a patient receives multiple vaccines and there is counseling on all but the influenza vaccine, report 90472 or 90474 in addition to 90460 and 90461 as appropriate.

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Coding example for CPT code 90460 and 90461

A 12-year-old is seen for her well-child check and vaccines. She receives tetanus, diphtheria and acellular pertussis (Tdap), human papillomavirus (HPV) and meningococcal vaccines in addition to the intranasal influenza vaccine. The physician counsels on all of the vaccines. Report the following IA codes:

90460 x4 (tetanus component; meningococcal; influenza; HPV)

90461 x2 (diphtheria and pertussis component)

To code for the same scenario as above except that the physician does not document counseling for the intranasal influenza or Tdap vaccine but does document counseling for meningococcal and HPV vaccines,

report: 90460 x2 (meningococcal; HPV)

90472 x 1 (Tdap)

90474 x 1 (influenza)

To report CPT code 90460 & 90461, provider documentation must substantiate three elements:

1. Patient age.These codes apply only to those patients age 18 years or younger. For patients older than 18 years old, you must turn to the second category of administration codes, detailed below.
2. Face-to-face counseling with the patient and/or family.Parents with children often have questions about vaccines, and the provider may spend significant time on education and counseling. Documentation of the encounter should detail the vaccines given and summarize patient risk factors or concerns, and information shared with the patient/family (e.g., possible side effects and benefits of the vaccine). If the provider does not document face-to-face counseling, he must turn to the second category of administration codes, detailed below.
3. The number of vaccine or toxoid components — NOT the number of individual vaccines — administered. Report 90460 for the first component administered, and one unit of 90461 for each additional component administered. For example:

• HPV vaccine includes a single component (90460)
• Td vaccine includes two components (90460, 90461)
• DTaP and Tdap vaccines include three components (90460, 90461 x 2)
• DTaP-Hib vaccine includes four components (90460, 90461 x 3)
• DTaP-Hib-IPV vaccine includes five components (90460, 90461 x 4)

The route of administration (subcutaneous, intranasal, etc.) is not relevant when reporting 90460 and 90461.

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General information about CPT code 90460

                                                                                 Global
Work RVU/Base Units:                                       0.24
Non Facility Practice Expense RVU:                0.41
Facility Practice Expense RVU:                         NA
Professional Liability Insurance RVU:             0.02
Non Facility Total RVU:                                      0.67
Facility Total RVU:                                               NA
Medicare Non Facility National Payment:      $22.70
Medicare Facility National Payment:                NA
Medicare Status*:                                                  A
Medicare Policy Indicators*:                              A+

General information about CPT code 90461

                                                                                       Global
Work RVU/Base Units:                                            0.18
Non Facility Practice Expense RVU:                     0.11
Facility Practice Expense RVU:                              NA
Professional Liability Insurance RVU:                  0.01
Non Facility Total RVU:                                           0.30
Facility Total RVU:                                                    NA
Medicare Non Facility National Payment:           $10.17
Medicare Facility National Payment:                     NA
Medicare Status*:                                                       A
Medicare Policy Indicators*:                                   A+