CPT codes 90471 to 90474 are non-age specific immunization administration codes that are reported per immunization, whether it is a single or combination vaccination. These codes do not have any age restrictions or counseling requirements. The routes of administration codes differ based on the method used – for example, injectable vaccinations are represented by codes 90471 and 90472, while intranasal or oral vaccinations are represented by codes 90473 and 90474.
When billing for immunization administration services, it is crucial for healthcare providers to accurately select the appropriate CPT code based on the specific route of administration used. This ensures proper reimbursem*nt and compliance with coding guidelines. By distinguishing between injectable and intranasal/oral routes of immunization, healthcare professionals can accurately reflect the services provided and ensure clear communication with payers and other stakeholders.
90471 CPT Code and 90472 CPT Code (Injectable Vaccinations)
90471 CPT Code pertains to the administration of a single vaccine, covering the injection process for vaccines including percutaneous, intradermal, subcutaneous, or intramuscular injections. This code represents the initial vaccine service rendered to a patient.
Conversely, 90472 CPT Code is used for each additional vaccine administered following the primary procedure, with the requirement to list each additional vaccine separately on the claim in addition to the code for the primary immunization administration.
In other words, we can describe 90471 CPT Code is used to report immunization administration services for the first vaccine administered during a patient encounter. This code includes the actual administration of the vaccine via various routes such as percutaneous, intradermal, subcutaneous, or intramuscular injections. It applies to both single vaccines and combination vaccines/toxoids.
90472 CPT Code, on the other hand, is utilized to document each additional vaccine administered beyond the first one. This code should be listed separately in the billing or coding process in addition to the primary procedure code to indicate that multiple vaccines were given during the same encounter.
Examples for 90471 CPT Code and 90472 CPT Code (Injected Vaccines)
Scenario 1: During a well-child visit, the child is due for multiple vaccinations, including the MMR and Varicella vaccines.
– **Billing**: Use CPT Code 90471 for the first vaccine administered (MMR) and CPT Code 90472 for each additional vaccine (Varicella) administered.
Scenario 2: A patient receives a tetanus booster and Hepatitis A vaccine concurrently.
– **Billing**: Use CPT Code 90471 for the tetanus booster and CPT Code 90472 for the Hepatitis A vaccine.
90473 CPT Code and 90474 CPT Code (intranasal or oral route)
90473 CPT code is utilized to report the primary procedure of administering the vaccine through intranasal or oral means. It is important to ensure accurate coding for this service to reflect the specific route of administration, whether it be intranasal or oral.
On the other hand, 90474 CPT Code is assigned for each additional vaccine (single or combination vaccine/toxoid) that is administered in conjunction with the primary procedure. This code should be listed separately in addition to the code for the primary immunization administration. It is crucial to differentiate the primary vaccine from any additional vaccines administered during the same encounter to ensure appropriate reimbursem*nt and documentation of the services provided
When reporting vaccination administration codes, it is important to note that 90471 and 90473 are used for the initial or first vaccine administered, depending on the route of administration. It is important to note that 90473 CPT Code should not be reported in conjunction with 90471 CPT Code, as they cover different administration methods.
It is crucial to use only one initial administration code per patient encounter. In cases where both an injected and an oral or intranasal vaccine are given during the same visit, 90471 CPT Code should be utilized as the initial administration code.
Understanding the nuances of CPT codes 90471 to 90474 is essential for healthcare providers to effectively document and bill for immunization administration services.
Examples for 90473 CPT Code and 90474 CPT Code: Oral/Intranasal Vaccines
Scenario 1: A child receives the flu vaccine (intranasal spray) during a pediatric visit.
– **Billing**: Use CPT Code 90473 for the intranasal flu vaccine.
Scenario 2: A patient receives both the oral rotavirus vaccine and the intranasal flu vaccine in a single visit.
– **Billing**: Use CPT Code 90473 for the rotavirus vaccine and CPT Code 90474 for the flu vaccine.
When a patient encounter involves the administration of two injectable, single-component vaccines, but counseling is provided only for one of the vaccines?
When a patient encounter involves the administration of two injectable, single-component vaccines with counseling provided only for one of them, proper coding is essential for accurate billing and documentation. For the vaccine that received counseling, report CPT code 90460. For the vaccine that did not receive counseling, use 90472 CPT Code if it was administered through injection. If the second vaccine was administered orally or intranasally, then 90474 CPT Code should be used instead of 90472.
Difference between Immunization Administration Codes (CPT Codes 90471 to 90474) and (CPT Codes 90461-90462)?
When comparing the Immunization Administration Codes, it is important to note that CPT Codes 90471-90474 are non-age specific codes that are reported per immunization, regardless of the age of the patient. These codes do not have any age restrictions and do not require counseling. The routes of administration codes differ based on the route used, such as injectable (90471 & 90472) versus intranasal/oral (90473 & 90474).
On the other hand, CPT Codes 90461-90462 are pediatric-specific immunization administration codes that are reported per component for patients aged 18 years and younger. Counseling is required for these codes, provided by a physician or other qualified healthcare professional. These codes are applicable for all routes of administration.
In summary, while both sets of codes relate to immunization administration, the main differences lie in their age restrictions, counseling requirements, and the specific routes of administration covered.
Will there ever be an occasion, given the guidelines for reporting pediatric Immunization administration codes (90460–90461), for which we would need to report 90471–90474?
For pediatric immunization administration, the standard guidelines recommend reporting codes 90460–90461. If no counseling is provided for a child less than 18 years of age or does not meet the criteria for another qualified health care professional, such as clinical staff, using pediatric IA codes may not be appropriate. In such situations, it becomes necessary to report codes 90471–90474 to accurately reflect the services rendered.
