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2011 Pediatric Immunization Administration Codes


The American Academy of Pediatrics (AAP) developed new Current Procedural Terminology (CPT ®) codes for reporting immunization administration in the pediatric patient population. The new codes become effective on January 1, 2011, and will replace codes 90465–90468.

In an effort to ensure that you are prepared for the new codes, we have developed a number of educational resources.

Frequently Asked Questions for the 2011 Pediatric Immunization Administration Codes

Q. I heard that the pediatric immunization administration codes (90465-90468) have been deleted for 2011. Is that true?

A. Yes, that is true. Starting January 1, 2011, codes 90465, 90466, 90467, and 90468 have been deleted from the Current Procedural Terminology (CPT®) nomenclature.

Q. Have codes 90471-90474 been deleted, as well?

A. No, codes 90471–90474 have not been deleted or revised in any way.

Q. Have codes 90465–90468 been replaced? If so, what are the new code numbers and descriptors?

A. Yes, codes 90465–90468 have been replaced with 2 new codes, 90460 and 90461.

The new CPT codes are as follows:

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.)

Code 90460 is reported once for the first component of each vaccine or toxoid administered by any route. The reporting of code 90460 includes counseling for the first vaccine component. Code 90461 is additionally reported for the counseling associated with each additional component of any combination vaccine or toxoid.

The + next to code 90461 indicates that it is an add-on code, just like 90466 was an add-on code to 90465 and 90468 was an add-on code to 90467. An add-on code (ie, 90461) can only be reported in conjunction with the primary code (in this case, 90460).

Q. How does CPT define a vaccine component?

A. A component refers to all antigens in a vaccine that prevent disease(s) caused by one organism. Combination vaccines are those vaccines that contain multiple vaccine components.

Q. How many components are in the common pediatric vaccines and which pediatric IA codes would I report with each?

A. Please see the following chart:

VaccineNo. of Vaccine ComponentsImmunization Administration Code(s) ReportedICD-9-CM Code Reported When Vaccine Administered During a Non-preventive Medicine Visita 
HPV190460 V04.89 
Influenza190460 V04.81 
Meningococcal 190460 V03.89 
Pneumococcal190460 V03.82 
Td290460, 90461 V06.5 
DTaP or Tdap390460, 90461, 90461 V06.1 
MMR390460, 90461, 90461 V06.4 
DTaP-Hib-IPV (Pentacel)590460, 90461, 90461, 90461, 90461 V06.8 
DTaP-HepB-IPV (Pediarix)590460, 90461, 90461, 90461, 90461 V06.8 
DTaP-IPV (Kinrix)490460, 90461, 90461, 90461 V06.3 
MMRV (ProQuad)490460, 90461, 90461, 90461 V06.8 
DTaP-Hib (TriHIBit)490460, 90461, 90461, 90461 V06.8 
HepB-Hib (Comvax)290460, 90461 V06.8 
Rotavirus190460 V04.89 
IPV190460 V04.0 
Hib190460 V03.81 

ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; HPV, human papillomavirus; Td, tetanus and diphtheria; DTaP, diphtheria, tetanus, and acellular pertussis; Tdap, tetanus, diphtheria, and acellular pertussis; MMR, measles, mumps, and rubella; Hib, Haemophilus influenzae type b; IPV, inactivated poliovirus; HepB, hepatitis B; MMRV, measles, mumps, rubella, and varicella.

aICD-9-CM guidelines indicate that immunizations administered as part of a routine well-baby or well-child check should be reported with code V20.2. The codes listed in this chart can be reported in addition to V20.2 if specific payers request them. Immunizations administered in encounters other than those for a routine well-baby or well-child check should be reported only with the codes listed in this chart.


Q. Code 90460 includes reference to "first vaccine/toxoid component." Some payers are interpreting the slash between the terms vaccine and toxoid to try to justify their rationale for limiting a claim to only one "first vaccine" code per date of service. Is this correct?

A. No, this is not correct. The intent of the slash is to indicate that the component belongs to a vaccine or toxoid, as in first vaccine component/first toxoid component. Because the "first" refers to the order of the components within a product, more than one 90460 (and 90461) may be reported on the same date of service.

Q. If a vaccine provides protection against multiple diseases but is not available in the United States as single-component individual products, can I still report codes 90460–90461?

A. Yes, the CPT definition of component is not dependent on the availability of the product as single components. The commercial availability of vaccine products is a dynamic process that may vary throughout the year, making this a difficult indicator to use.

Q. How are the new pediatric IA codes (90460–90461) different from the former pediatric IA codes (90465–90468)?

A. Please see the following chart:

 New CodesDeleted Codes
 90460–9046190465–90468
Reported perComponentImmunization (single or combination)
Age restriction18 years and youngerYounger than 8 years
CounselingRequired by physician or other qualified health care professionala 
 
Required by physician
Routes of administrationUse for all routes of administration.Codes differ based on route of administration (eg, injectable versus intranasal).

aNote that Current Procedural Terminology does not define the term other qualified health care professional. Please refer to your state scope of practice laws to determine qualification.


Q. Will there ever be an occasion, given the new guidelines for reporting pediatric IA codes (90460–90461), for which we would need to report 90471–90474?

A. Yes, if you see older patients (ie, those 19 years and older), there is no counseling performed on the patient, or the health care professional counseling does not meet state requirements for an other qualified health care professional.

I was surprised at the 2011 Medicare Resource-Based Relative Value Scale (RBRVS) practice expense values for code 90461, which is reported for each additional vaccine component and, therefore, does not represent much incremental practice expense beyond the first vaccine component.

The Centers for Medicare and Medicaid Services (CMS) did not accept the American Medical Association (AMA)/Specialty Society Relative Value Scale Update Committee (RUC)-recommended values for the new codes and instead assigned what it felt to be a crosswalk to the former pediatric IA codes.

Q. How will we report a patient encounter in which 2 injectable, single-component vaccines are administered, yet counseling is only provided on 1 of the 2 vaccines? Will we report 90460 for the first (ie, counseled) vaccine and 90472 for the second (ie, non-counseled) vaccine?

A. Yes. If counseling is performed for one single-component vaccine but not another, code 90472 (or 90474 if the second, non-counseled vaccine is administered orally or intranasally) is reported for the non-counseled additional vaccine.

Q. What constitutes sufficient documentation for vaccine counseling with these new codes? Do we have to document counseling for each separate vaccine component?

A.CPT guidelines indicate that you must provide documentation to support the reporting of a given service. As an example, documentation should list all vaccine components along with a notation such as "counseling for all components completed." The documentation format (eg, check box, handwritten, electronic template, etc) for this service should be the same as it is for other services. Physicians and other qualified health care professionals can choose whatever format meets their needs as long as it is reflective of the service provided and is documented by the reporting clinician. Documentation should support the service provided and is not meant to be onerous. At the same time, payers may have their own rules on use of "auto-populated" or "pre-populated" templates that may not reflect actual services provided.

Q. Some vaccines are given in a series—an initial dose and then one or more booster doses over a period of time. Is it a correct assumption that counseling codes 90460 and 90461 are only appropriate prior to the initial dose, and that further counseling sessions prior to the booster doses would not be required, only a vaccine administration code? If additional counseling is reportable for subsequent booster doses, why?

A. The decision for counseling will depend on patient and parent questions and concerns and not on the initial versus booster dose. For certain vaccines in a series, such as the human papillomavirus vaccine given to adolescents, the adolescent may return for subsequent doses to be administered by clinical staff, in which case counseling is unlikely to be provided and IA code 90471 would be reported instead of 90460.

However, if the patient or parent has new questions or concerns at the return visit and the physician or other qualified health care professional is asked to address these concerns, it would be appropriate to report IA code 90460. For infants who are receiving 3 doses of diphtheria, tetanus, and acellular pertussis (DTaP) in the first year of life, it is common for parents to be anxious and have questions and concerns at each visit. Parents hear stories from friends or read new information on the Internet and want to make sure that vaccines are safe even though the child may have already had a dose.

Q. Based on an example from the Centers for Disease Control and Prevention Web site, it appears that 90460 might be used up to 9 times on a single date of service, with up to 5 instances of 90461 being reported on the same date. Are there any circumstances in which a higher frequency of the use of either code might appropriately be reported?

A. When counseling is provided and the patient is 18 years or younger, the national routine childhood immunization schedule will drive the number of components needed and hence the number of IA codes reported.

For example, on the routine schedule, the maximum number of diseases covered (components) via immunization is at the 4-year-old visit during influenza season. At this age, with the recently added Prevnar 13 vaccine, the following disease protection is recommended: diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, varicella, influenza, and pneumococcus. If all 10 of these components were given separately (unlikely), code 90460 would be reported 10 times and code 90461 would not be reported at all. If some of the components were provided in a combination vaccine, code 90460 would be reported for the first component of that individual combination vaccine and code 90461 for each additional component within that individual combination vaccine.

In the best-case scenario using currently available combination vaccines, one would report code 90460 5 times and 90461 5 times using DTaP; measles, mumps, rubella, and varicella (MMRV); poliovirus; Prevnar; and influenza vaccines.

It is possible that a child will be behind on vaccines and more vaccines may be given than are typically found for a certain age on the routine schedule. Pediatricians have seen as many as 7 injections given on one date and some of these were combination vaccines. However, if one were to add these up in total over the child’s lifetime, the number of components would not exceed the recommended number even though a larger quantity may be given on a single date. These catch-up visits would be the circumstance with which a higher frequency of IA codes may be used. Again, this represents a situation in which charges are lumped in one visit instead of spread out over many, but the total remains the same.

Q. Can the new IA codes (90460–90461) be reported in the neonatal intensive care unit setting where the independent physician is providing face-to-face counseling and dissemination of information about the vaccine components but the hospital-employed nursing staff is providing the supplies and administering the vaccine?

A. No. Because this situation essentially splits the actual administration (as performed by facility-employed nurses) from the vaccine counseling (as performed by the physician), codes 90460–90461 cannot be reported.

The new pediatric IA codes (90460–90461) are no different from their predecessor pediatric IA codes (90465–90468) in this regard. Because the Medicare Resource-Based Relative Value Scale values for the IA codes include the work (counseling), practice expense (clinical staff time, medical supplies, and medical equipment), and professional liability insurance expense, all 3 of these components must originate from one source for the codes to be able to be reported. In this situation, the facility is incurring practice expense while the physician is doing the work of vaccine counseling. Therefore, the codes cannot be reported. Again, this restriction is no different from the restriction in place with the previous pediatric IA codes (90465–90468).

Q. The new codes specify that the counseling must be performed by a physician or "other qualified health care professional." What determines who qualifies as another qualified health care professional?

A. Each state’s scope of practice laws determine what types of individuals are qualified health care professionals.

When CPT guidelines reference a qualified health care professional, they are referring to "those providers whose scope of practice as defined by regulation permits them to perform the service represented by the specific code…[with acknowledgment that]…licensure and credentialing vary on a state-by-state and institutional basis…[and that]…relevant state and institutional authorities should be consulted regarding the appropriate reporting of these services by qualified health care professionals" (American Medical Association,Principles of CPT Coding, 6th Edition, page 468).

Scope of practice is terminology that is used by state licensing boards for various professions to define the procedures, actions, and processes that are permitted for a licensed individual. It defines the level of medical responsibility or health services (boundaries within which a health care professional may practice) or range of activities that a practitioner is legally authorized to perform independently or with supervision based on specific education and experience.

To report CPT codes 90460–90461, the physician or the qualified health care professional who is reporting the service must perform face-to-face counseling (and so document that the counseling was personally performed). To determine if someone other than a physician meets the criteria of a qualified health care professional, each practice should refer to its particular state scope of practice laws.

Q. Do codes 90460-90461 require that the physician or the qualified health care professional perform the actual administration of the vaccine? In other words, do they have to be the ones to physically inject the patient with the vaccine in order to report the codes?

A. No, the physician or the qualified health care professional does not have to perform the actual administration of the vaccine in order to report codes 90460-90461. The administration (whether it is an injection or an oral/intranasal administration) can be performed by the clinical staff per the physician’s or the qualified health care professional’s orders.

Q. Can codes 90460–90461 be reported for vaccines administered in the continuity clinic setting even when only the resident-in-training (education-limited license) does the vaccine counseling?

A. The IA service is unique. As such, the Physicians at Teaching Hospitals (PATH) guidelines do not specifically address this issue, and each academic center will need to determine the appropriate approach within its institution.

However, we can encourage each academic center to be compliant by

  • Being aware of new IA codes 90460–90461

  • Being aware of the lack of defined guidance for IA per se in the PATH guidelines

  • Reaching out to local or regional public and private payers for specific guidance, as might be done with other services not addressed by the Centers for Medicare & Medicaid Services

Q. Can codes 90460–90461 be reported even when the vaccine counseling occurs on a different date of service from the actual administration?

Vignette A

A physician or other qualified health care professional counsels a patient or parent on all vaccines needed during the annual preventive medicine service visit. Because the parent refuses multiple vaccines on the same day, the patient is on an alternative vaccine schedule and some of the vaccines are given over a series of visits. These subsequent visits are for vaccines only and the physician or other qualified health care professional does not see the patient or parent. Can codes 90460–90461 be reported on each day that vaccine(s) is administered?

Vignette B

A physician or other qualified health care professional counsels a patient or parent on vaccines during an office visit. However, because the patient is ill, vaccine administration is deferred at the parent’s request until the patient’s illness has resolved. Therefore, the vaccines are administered on a different day than the vaccine counseling. Can codes 90460–90461 be reported?

A. No. CPT 2011 currently states that codes 90460–90461 are reported when the physician or qualified health care professional provides face-to-face counseling of the patient and family during the administration of a vaccine. Because the situations in these vignettes essentially split the actual administration from the vaccine counseling into separate dates of service, codes 90460–90461 cannot be reported. In these situations, continue to report IA using codes 90471–90474 because they do not have explicit counseling requirements as part of their descriptors.

Q. Do the new IA codes require that we submit vaccine registry data electronically?

A. No. While the vignette for all IA codes says, ". . .the immunization tracking number is entered into a computerized statewide registry," vignettes simply describe the typical patient and do not set requirements to report a code. Because the immunization registry reference is not included as part of the CPT code descriptor, use of an immunization registry is not required to appropriately report the IA codes.

Q. We administer Prevnar 13 to our patients. Do we report this vaccine to have 13 components?

A. No, because the antigens contained in the Prevnar 13 vaccine only prevent disease caused by one organism (ie, pneumococcus).

Q. In a single encounter, can I report code 90460 more than once?

A. Yes, it is possible and allowable. Keep in mind that each vaccine administered is its own entity. Therefore, for each individual vaccine administered, you will report code 90460 because every vaccine will have at minimum one vaccine component. Because 90460 represents the first vaccine component of each vaccine, if you report 90460 in multiple units, you lose the ability to separately designate each vaccine administered during the course of a single patient encounter.

Then, depending on the specific vaccine, code 90461 may be additionally reported if the vaccine is a multiple component vaccine.

For example, if you administer a measles, mumps, and rubella (MMR) vaccine and a varicella vaccine at the same encounter, you will report codes 90460, 90461, and 90461 for the MMR vaccine and 90460 for the varicella vaccine.

Q. What International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes should we report with the new pediatric IA codes when vaccines are administered during a routine well-baby/infant/child check?

A. Per ICD-9-CM guidelines, code V20.2 encompasses all age-appropriate vaccines administered during a routine health check to patients through 17 years of age and therefore should be the only diagnosis code reported for any vaccine administered during a routine well-baby/infant/child check. For patients 18 years and older, report V70.0 instead of V20.2.

Q. When administering certain multiple component vaccines, such as Pentacel (DTaP-inactivated poliovirus [IPV]-Haemophilus influenzae type b [Hib]), Pediarix (DTaP-hepatitis B [HepB]-IPV), ProQuad (MMRV), or Comvax (HepB-Hib), during a time other than a routine well-baby/infant/child check, what ICD-9-CM codes(s) should be reported? I am asking because under the former pediatric IA codes, we were required to report 2 distinct ICD-9-CM codes, and that could complicate things under the new pediatric IA codes, which are component-based.

A. Under the new pediatric IA codes, those vaccines that contain multiple components that now require 2 distinct ICD-9-CM codes (eg, Pentacel is reported with V06.3 and V03.81) will be reported with one ICD-9-CM code—V06.8.

This guideline was revised because of the significant administrative burden it would have caused for the physician or other qualified health care professional to have to know which vaccine components are linked to which ICD-9-CM code. While ICD-9-CM guidelines do require coding to the greatest specificity, in this case it is too burdensome. Please refer to the AAP Vaccine Coding Table below for more information.

Q. Most infant well-visit examinations generate more than one claim per visit; because paper claims have limits on the number of billable items, I am wondering if we are going to see a lot of rejected claims and, if so, how do we deal with that?

Also, must the 90460s be reported "pair-wise" on claims (ie, one line for each supported vaccine), or can they be rolled up to the total unit count for the encounter? In other words, for the following vignette, would you report 4 lines of 90460 with 1 unit each, or could you create a single line of 90460 with 4 units?

Similarly, with code 90461, would your first vignette be 4 lines of code 90461 with 1 unit each, or a single line of code 90461 with 4 units? If the latter approach is acceptable, what would happen if a single claim contained more than one multiple-component vaccine? Can code 90461 cross state lines or must it be used pair-wise with each vaccine?

A. Given that IA codes have always been written to report multiple codes based on the number of injections, this is not a novel issue with the advent of codes 90460–90461. Continue to follow CPT guidelines and instructions provided by payers for reporting the service in units.

The following is an example of how a payer may require reporting during a patient’s first year of well-baby visits, including all of the age-appropriate corresponding vaccines:

A patient presents for her 2-month well-child check and is given the DTaP-Hib-IPV (Pentacel), pneumococcal, and rotavirus vaccines.

 CPT Descriptor CPT code Units
Line 1Preventive medicine service <1 year99391 1
Line 2DTaP-Hib-IPV (Pentacel) vaccine90698 1
Line 3First (Pentacel) vaccine component90460 1
Line 4Each additional (Pentacel) component90461 4
Line 5Pneumococcal vaccine90670 1
Line 6First (pneumococcal) vaccine component90460 1
Line 7Rotavirus vaccine90680 1
Line 8First (rotavirus) component90460 1


The same patient presents for her 4-month well-child check and is given the DTaP-Hib-IPV (Pentacel), pneumococcal, and rotavirus vaccines.

 CPT Descriptor CPT code Units
Line 1Preventive medicine service <1 year99391 1
Line 2DTaP-Hib-IPV (Pentacel) vaccine90698 1
Line 3First (Pentacel) vaccine component90460 1
Line 4Each additional (Pentacel) component90461 4
Line 5Pneumococcal vaccine90670 1
Line 6First (pneumococcal) vaccine component90460 1
Line 7Rotavirus vaccine90680 1
Line 8First (rotavirus) component90460 1


The same patient presents for her 6-month well-child check and is given the DTaP, pneumococcal, and HepB-Hib (Comvax) vaccines.

 CPT Descriptor CPT code Units
Line 1Preventive medicine service <1 year99391 1
Line 2DTaP vaccine90700 1
Line 3First (DTaP) vaccine component90460 1
Line 4Each additional (DTaP) component90461 2
Line 5Pneumococcal vaccine90670 1
Line 6First (pneumococcal) vaccine component90460 1


Additional claim form

 CPT Descriptor CPT code Units
Line 1HepB-Hib (Comvax) vaccine90748 1
Line 2First (Comvax) vaccine component90460 1
Line 3Each additional (Comvax) vaccine component90461 1


The same patient presents for her 12-month well-child check and is given the MMRV (ProQuad), IPV, and Hib vaccines.

 CPT Descriptor CPT code Units
Line 1Preventive medicine service 1–4 years99392 1
Line 2MMRV vaccine90710 1
Line 3First (MMRV) vaccine component90460 1
Line 4Each additional (MMRV) component90461 3
Line 5IPV vaccine90713 1
Line 6First (IPV) vaccine component90460 1
Line 7Hib vaccine90648 1
Line 8First (Hib) vaccine component90460 1


Be sure to lump all codes related to a single vaccine onto a single claim form. If you encounter a case where a claim must extend onto a second claim form, it will be important that the vaccine code and appropriate IA codes appear on that second claim form together.

NOTE: The limitations imposed by some claims processing systems may reject the aforementioned reporting guidelines due to classification of multiple 90460 codes or multiple 90461 codes appearing on the same claim form as “duplicate claims.” The following is what some payers have indicated will work with their systems:

A patient presents for her 2-month-old well-child check and given the DTaP-Hib-IPV (Pentacel®) vaccine, pneumococcal vaccine, and rotavirus vaccine:

First Claim Form:

 CPT Descriptor CPT code Units
Line 1DTaP-Hib-IPV (Pentacel®) vaccine 
 
90698 1
Line 2Pneumococcal vaccine90670 1
Line 3Rotavirus vaccine90680 1
Line 4First component administration for each vaccine90460 3
Line 5Each additional component administration for each vaccine90461 4


Second Claim Form:

 CPT Descriptor CPT code Units
Line 1Preventive medicine service <1 year99391 1

Attachment A: Vaccine Coding Table

Attachment B: IA RVU Analysis

Attachment C: Immunization Product Table (Exiting site)

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.





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