90471 CPT Code (2023) | Description, Guidelines, Reimbursement & Example
90471 CPT code is used to bill the Immunization Administration for Vaccines/Toxoids. The doctor injects a live attenuated vaccination into the patient intramuscularly or intradermally.
Summary
When a doctor is present to provide one-on-one counseling to a caregiver or parent, the 90460 code will utilize. This code is only for patients under the age of 18. When a medical assistant or nurse gives a drug, and the patient does not see the physician, the 90471 CPT code will use.
Vaccine and Toxoid Product CodesVaccines and toxoid commodities will code 90476–90749, respectively. When vaccines give to people over 18, codes 90471–90474 are used instead of 90460–90461. By current criteria, codes 90471–90474 are reportable.
It is always important to submit the 90460–90461 and 90471–90474 codes separately for immunization administration. Each vaccine may report meeting the requirements of immunization registries, vaccine distribution programs, and reporting systems.
When administering a combination vaccine, a specific vaccine code may provide. Unless both the components and the combination vaccination may give out simultaneously, the details of a combination vaccine will specify individually.
When a combination vaccine is unavailable or a clinical cause exists to deliver each component separately, the physician is likelier to report the use of component vaccines rather than the combination vaccine.
A physician or other competent health care practitioner must meet with the patient and family during immunization delivery and provide face-to-face counseling to use report codes 90460-90461. Codes 90471-90474 may use to report a client over t
The numeric codes 90476-90748 are restricted solely for usage with vaccines. The vaccination product code must be used in conjunction with the administration code 90460-90474 to report the administration of a vaccine or toxoid.
A VFC-member clinician must vaccinate patients under the age of 19. Pharmacists are not required to participate in the VFC program if they only offer vaccines to people over 19. However, during flu season, the Governor usually issues an executive order allowing pharmacies to immunize anyone under 19.
Modifier 51 should not be specified for vaccines or toxoids when using these administrative procedures.
The VFC group receives an additional $17.85 in reimbursements for vaccine administration. These pharmacies must participate in the VFC program to serve this demographic.
Description Of The 90471 CPT Code
Each vaccination or toxoid component is assigned a unique identification. Each antigen in a vaccine that protects against a specific disease produced by a single organism is considered one component by CPT.
However, combination vaccines contain numerous components for various regions of the body.
The official description of CPT 90471 is: “Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid).”
This code 90460 reports multiple doses of a vaccine or toxoid. If numerous first components provide, a modifier should not be needed. Code 90460 applies not only to multi-component vaccines but also to single-component vaccines (such as influenza, human papillomavirus, or pneumococcal conjugate vaccines).
This number may rack each time a vaccination may give to a patient under t 90461 is a separate code for each vaccine component supplied.
Any vaccination delivery not accompanied by a doctor or other health care professional present to counsel the patient and their family, as well as patients above 18, should be reported.
Understanding what these codes cover and do not cover is critical for accurately reporting vaccination counseling and administration.
Vaccine material may obtain separately because these codes are only for immunization administration. When a physician or another competent health care professional (licensed by the state) counsels the patient and carers, the service must report 90460-90461.
- If no counseling offers, 90471 CPT code through 90474 will utilize.
- Patients under the age of 18 are permitted to consume 90460-90461.
- The first component of a combination vaccine may code 90460, and each next part may code 90461.
Billing Guidelines
If more than one VFC vaccine dose gives on the same day, the code 90460 may provide for each one (up to age 18). Those under 19 are eligible for free immunizations through the VFC program.
Medicaid will only pay for vaccines for children under 19 under the VFC program. For economic considerations, a combination vaccine will continue to provide a single dose.
VFC accreditation may require clinicians who want to administer vaccinations to patients under the age of 19. Remember that during flu season, the Governor frequently issues an executive order authorizing pharmacists to immunize anyone under 19.
Pharmacists who exclusively deliver vaccines to adults are not obligated to participate in VFC. However, these pharmacies must engage in the VFC program to serve this demographic. The VFC group earns an additional $17.85 in vaccine administration reimbursement.
A clinical staff member who delivers vaccines with or without counseling under the supervision of a physician must use 90471 CPT code and 90474 to document their service. Each immunization administration code 90471-90474 should have its line item for the vaccine product.
An immunization claim must include the administration and the vaccination product’s billing numbers to be reimbursed. If the provider’s sole offering is a vaccine, E&M services cannot pay.
Adult vaccine reimbursement may calculate using either the Medicaid price plan or the invoiced expenses, whichever is lower.
Counseling services for children aged 0 to 18 will not pay using CPT codes 90471-90474. Members over 19 or under 18 who have not undergone therapy may use CPT codes 90471-90474. For more details, see “Using Pediatric Immunization Codes 90460 and 90461” in this manual.
Patients and parents may not inform about two vaccines with numerous components. We inject them both. In this situation, the patient is a 5-year-old kid. These are two of the most regularly used phone numbers in the United States.
A 5-year-old boy is a patient:
- Even though the patient is of legal drinking age, no counseling may provide.
- A nurse suggests giving the patient or parent two vaccines with many components.
- They’ve both had the medicine put into them.
To code the immunization, utilize CPT codes 90460, 90471, and 90473, the diagnosis code, and the EP modifier.
CPT 90460 will demonstrate that face-to-face counseling provides immunization.
Combining the vaccine product code with the correct diagnosis code and the EP modifier yields the vaccine product code.
Add the required number of units, the diagnosis code, and the EP modifier to the applicable add-on vaccination administration code (CPT 90472 or 90474).
The first vaccine may advise, but subsequent doses were not, as long as the CPT 90472 and 90474 add-on vaccine administration codes will supply.
Each claim should only have one immunization administration code. If vaccination administration codes match multiple vaccine product codes, they are only listed once with the appropriate number of units. For example, the illustration of a vaccination administration claim below is incorrect:
First, the CPT 90460 vaccine administration code is missing from the claim.
The immunization administration code CPT 90460 results in a $0.00 fee. To bill the appropriate amount, use the vaccination administration code.
CPT 90744 and 90700 vaccination product codes will not charge. However, the vaccine administration code should include a vaccination administration price.
Reimbursement
The VFC program provides free immunizations to people under the age of 19. Medicaid does not cover vaccines for children under 19 if they are accessible under the VFC program.
The administration of the components of a combination vaccine will continue to treat as a single immunization for financial reasons.
Immunizations for Children providers must join to deliver vaccines to patients under the age of 19. (VFC). Pharmacists are not required to participate in the VFC program if they only offer vaccines to people over the age of 19, but keep in mind that during flu season, the Governor usually issues an executive order allowing pharmacies to immunize anyone under the age of 19.
The VFC group receives an additional $17.85 in reimbursements for vaccine administration. These pharmacies cannot serve this group if they do not engage in the VFC program.
Billing Example
From 19 and up (Immunization Administration) is an example of this. Providers can submit two claim lines for the patient if they utilize Procedure Codes 90656 (Influenza Virus Vaccine) and 90471 CPT code.
CPT code 90471 will use for the first vaccine given to anyone aged 19 and up, and code 90472 will use for any subsequent immunizations given on the same day. The additional immunizations will bill as 90472 on the billing line.
