CPT code 90460, 90460, cpt 90460, 90460 cpt code

(2022) CPT Code 90460 | Description, Guidelines, Reimbursement, Modifiers & Example

CPT code 90460 is a medical procedure code in the Immunization Administration for Vaccines/Toxoids category. In this treatment, attenuated vaccines can administer intravenously, intramuscularly, or parenterally to individuals under 18.

When a doctor is present in the room with the caregiver or parent and provides face-to-face counseling, CTP code 90460 is employed. 

CTP code 90471 refers to medical personnel who deliver medication to patients without direct supervision from doctors.

The 90460 CPT code would use by any patient who is 19 years of age or older, regardless of whether or not a doctor is present or face-to-face counseling will provide. You must be a patient under 18 to use this code.

The American Medical Association continues recognizing Immunization Administration for Vaccines/Toxoids (CPT code 90460) as a medical procedure code (AMA). The patient taking this medicine can get attenuated vaccinations parenterally, intramuscularly, or intravenously.

 When a doctor provides face-to-face therapy to a caregiver or parent when both are present in the same room, the 90460 CPT code can utilize. Any patient over 19 can use this code, whether a doctor is present or face-to-face counseling.

When a vaccine component adds, a new code, CPT 90461, will add to the existing CPT 90460. It is a “component” of a vaccination that protects against a specific organism’s disease(s). Combination vaccines consist of many shots (antigens). 

It involves coding for medical record documentation and statewide registration, as well as giving and monitoring immunizations; all of this will cover under immunization administration codes.

A doctor’s or other licensed health care practitioner’s work to educate patients about vaccine risks and benefits will consider part of their employment (e.g., syringe, needle, bandages).

When a doctor or other competent health care practitioner fails to provide vaccine counseling to the patient to those over 18, the codes CPT 90471 – CPT 90474 will use instead. The current regulations deem CPT 90471 – CPT 90474 to be suitable. 

Each vaccine/toxoid is issued a unique product code based on the following criteria: manufacturer/brand/chemical formulation/dosage/recommended age range/schedule, and administration route.

Therefore, every product is unique, and there may be subtle variations from one to the next. For example, eight codes for reporting the influenza vaccine (CPT 90655 – CPT 90663).

90460 CPT Code Description

CPT 90460 is officially described in CPT’s manual: “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.”

CTP codes 90460-90474 and the associated vaccine-toxoid code (90476-90756) for the organism targeted can give for immunization administration.

Patients under 18 will only get vaccine counseling from a doctor or other qualified health care professional (QHP) under the vaccination administration the 90460 CPT code and the 90461 CPT code.

As a result, if CPT code 90460 and CPT code 90461 can use for vaccine counseling, an E/M visit code is not required to be recorded separately.

However, an E/M service conducted by the same physician or other competent health care professional can only register if it is separate from vaccination counseling and immunization delivery.

The remaining immunization administration numbers (90471-90474), which do not contain vaccination recommendations from a doctor or QHP, can be utilized by all patients, regardless of age.

The only immunization administration codes available to patients above the age of 19 now exclude vaccination advice.

When a doctor provided vaccine counseling to a patient who was 19 or older at the time of immunization, an E/M visit number was required.

To demonstrate that the evaluation and management service was critical and separate from the doctor’s vaccine counseling/administration activity, modifier 25 can be appended to the service code.

Billing Guidelines For CPT Code 90460

CPT code 90460 can be used with CPT 90472 and CPT 90474 to indicate that the initial vaccine provided counsel but that the subsequent vaccines were not.

A claim should only contain one instance of each immunization administration code. 

  • The appropriate number of units will be listed if more than one vaccination product code will associate with the same vaccine administration code. 
  • The vaccination administration code will charge the costs outlined in the Department of Community Health Check Services Manual.

Remember that during flu season, the Governor frequently issues an executive order allowing pharmacies to immunize patients under the age of 19, even though pharmacies are not required to participate in the VFC program when limiting their vaccine administrations to beneficiaries 19 and older. 

Component-based administration codes can use if the patient is under these codes to bill for vaccines based on the number of doses provided. A component is a disease you can expect to be protected by vaccination.

Four CPT 90461 units and one 90460 CPT code unit must purchase. If the patient is a young adult 18 years 18 or younger, and no counseling should provide, use the code determined by the number of injections administered during that appointment (CPT 90471 – CPT 90472).

Only the 90471 CPT code and the 90472 CPT code are applicable due to the injectable form of all Sanofi Pasteur vaccines. CPT 90473 – CPT 90474 for intranasal and oral preparations.

How To Use Modifier 25 For CPT Code 90460

Modifier 25 should enter with the preventive medicine E/M service to account for the administration service and the critical and individually identifiable E/M service performed on the administration service; modifier The Preventive Medicine E/M code for counseling delivered in conjunction with vaccine administration should not include in this report.

Regarding the E/M code for the appointment, which carries the modifier -25, office visits differ from immunizations. A -25 adjustment may be required when a vaccine must provide during an office visit. Many variables consider when CMS developed its coding policy, including the American Medical Association’s CPT Manual, coding recommendations developed by national societies, an analysis of typical medical and surgical operations, and a review of current coding practices.

 The National Correct Coding Initiative (NCCI) combines service codes for immunization administration (IA) with evaluation and management (E/M) (e.g., CPT 90460 – CPT 90474).

Therefore, providers risk denying their claims if an E/M visit and an IA visit occur on the same day. 

To overcome these denials, provide detailed documentation and add modifier 25 to the relevant E/M service code for significant, separately identifiable evaluation and management services performed on the same day as procedures or other services performed by the same doctor or other qualified health care professional.

A substantial and differentiated E/M service One must be aware of this to understand the NCCI’s “edit” that bans separate payment for E/M and IA services at the same visit.

NCCI can override the edit by appending modifier 25 to the E/M service code. Modifier 25 verifies to the payor that the E/M service met the CPT criterion and was “substantial” and “separately identifiable,” as defined by the modifier.

E/M services unrelated to other procedures or services performed on the same day can frequently be reported separately (in this case, the IA). If the E/M service requires a change in the patient’s condition or a worsening of an existing situation, it could report separately.

 If the patient arrives for an IA without a current complaint or has exacerbated symptoms indicating the need for a new E/M service, a new history, exam, and medical decision-making (MDM) procedure may be required (which could include additional testing or therapy).

It is critical to document the interaction to distinguish the E/M service from any other procedures or services (such as vaccination administration) undertaken on the same day.

If the physician writes the patient’s history, exam, and MDM in the chart and the procedure note on a separate sheet connected to the graph or in a different area inside the electronic health record, it will be easy to identify a significant independently billable E/M service.

Reimbursement

The VFC population will reimburse at a higher rate of $17.85 for CPT 90460. These pharmacies cannot service this demographic if they do not participate in the VFC program.

Clinical workers who administer a vaccine while under the supervision of a physician and record the therapy using the provider’s CPT 90471 and CPT 90474 require to report the treatment.

To be reimbursed for CPT code 90460, the vaccine product number and the immunization administration code should submit. Depending on the patient’s age and whether or not they got counseling, one of two code sets must utilize.

 The VFC program provides free vaccines to people under the age of 19. When vaccines are made available under the VFC program, Medicaid will not reimburse doctors for immunizations given to kids under the age of 19.

For payment purposes, a combination of vaccine components will still recognize as a single immunization. Healthcare practitioners must participate in VFC to deliver vaccines to patients under 19. 

To be compensated for their services under the current Immunization Schedule, physicians must submit the CPT code for each immunization delivered and the relevant administration CPT code (s). In addition, the vaccine must note on the claim form for federal reporting requirements.

To be returned for giving all of the recommended vaccines as indicated by the Advisory Committee on Immunization Practices (ACIP), clinicians must submit the appropriate CPT code for each vaccination they deliver as part of the current Immunization Schedule (s).

In addition, the vaccine must include on the claim form for federal reporting purposes. CPT codes for vaccines given to children from birth to age 18 will reimburse zero dollars ($0) due to the Vaccines for Children Program’s reimbursement policy.

There will be no reimbursement for CPT codes that include immunizations for children aged newborn to 18 because the Vaccines for Children Program provides the vaccines free of charge to clinicians. 

Example

All flu vaccines contain a single-component vaccine for young patients aged 18 years, which is why they bill as a unit of the 90460 CPT code.

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