CPT 90460, cpt code 90460, 90460 cpt code

How To Use CPT Code 90460

CPT 90460 refers to the immunization administration for patients up to 18 years of age, with counseling by a physician or qualified healthcare professional. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 90460.

1. What is CPT 90460?

CPT 90460 is a medical billing code used to describe the administration of immunizations to patients up to 18 years of age, with counseling provided by a physician or other qualified healthcare professional. This code is used to bill for the first or only component of each vaccine or toxoid administered during a patient’s visit.

2. 90460 CPT code description

The official description of CPT code 90460 is: “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.”

3. Procedure

  1. The patient is assessed for eligibility and the need for immunization.
  2. The provider reviews the patient’s medical history and any contraindications to the vaccine(s).
  3. The provider counsels the patient and/or their guardian on the benefits, risks, and potential side effects of the vaccine(s).
  4. The patient is prepped for the immunization, which may include cleaning the injection site and preparing the vaccine(s).
  5. The provider administers the vaccine(s) via the appropriate route (intramuscular, subcutaneous, oral, intranasal, or intravenous).
  6. Post-vaccination, the provider monitors the patient for any immediate adverse reactions and provides any necessary care.
  7. The provider documents the immunization(s) in the patient’s medical record, including the vaccine(s) administered, the date, and any counseling provided.

4. Qualifying circumstances

Patients eligible to receive CPT code 90460 services are those up to 18 years of age who require immunization(s) as part of their preventive care or in response to a specific health concern. The provider must be a physician or other qualified healthcare professional who is authorized to administer vaccines and provide counseling on their use. Additionally, the patient or their guardian must receive counseling from the provider regarding the vaccine(s) being administered.

5. When to use CPT code 90460

It is appropriate to bill CPT code 90460 when a physician or qualified healthcare professional administers the first or only component of each vaccine or toxoid to a patient up to 18 years of age, with counseling provided. This code should be used for each vaccine or toxoid component administered during a single patient visit. If additional components are administered, the appropriate add-on code (+90461) should be used.

6. Documentation requirements

To support a claim for CPT 90460, the following information should be documented in the patient’s medical record:

  • Patient’s age at the time of immunization
  • Indication for the vaccine(s) administered
  • Specific vaccine(s) or toxoid(s) given, including the manufacturer, lot number, and expiration date
  • Route of administration
  • Date of administration
  • Details of the counseling provided, including the benefits, risks, and potential side effects of the vaccine(s)
  • Provider’s signature or electronic authentication

7. Billing guidelines

When billing for CPT code 90460, it is important to follow the appropriate guidelines and rules. Some key points to consider include:

  • Use CPT 90460 for the first or only component of each vaccine or toxoid administered during a single patient visit.
  • If additional components are administered, use the add-on code +90461 for each additional vaccine or toxoid component.
  • Ensure that the patient’s age, counseling provided, and other required documentation are accurately recorded in the medical record.
  • Be aware of any payer-specific requirements or guidelines for billing immunization services.

8. Historical information

CPT 90460 was added to the Current Procedural Terminology system on January 1, 2011. The code was changed on January 1, 2012, with the previous descriptor being “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.”

9. Similar codes to CPT 90460

Five similar codes to CPT 90460 and how they differentiate are:

  1. CPT 90461: Used for each additional vaccine or toxoid component administered during the same visit as CPT 90460.
  2. CPT 90471: Immunization administration without counseling, for patients of any age.
  3. CPT 90472: Used for each additional vaccine or toxoid administered without counseling during the same visit as CPT 90471.
  4. CPT 90473: Immunization administration by intranasal or oral route, without counseling, for patients of any age.
  5. CPT 90474: Used for each additional vaccine or toxoid administered by intranasal or oral route without counseling during the same visit as CPT 90473.

10. Examples

Here are 10 detailed examples of CPT code 90460 procedures:

  1. A 2-month-old infant receives the first dose of the DTaP vaccine, with counseling provided by the pediatrician.
  2. A 12-year-old patient receives the first dose of the HPV vaccine, with counseling provided by the healthcare professional.
  3. A 4-year-old child receives the MMR vaccine prior to starting school, with counseling provided by the physician.
  4. A 6-month-old infant receives the first dose of the Hib vaccine, with counseling provided by the healthcare professional.
  5. A 15-year-old patient receives the meningococcal vaccine before attending a summer camp, with counseling provided by the physician.
  6. An 18-year-old patient receives the first dose of the hepatitis A vaccine, with counseling provided by the healthcare professional.
  7. A 9-year-old child receives the annual influenza vaccine, with counseling provided by the physician.
  8. A 16-year-old patient receives the Tdap booster vaccine, with counseling provided by the healthcare professional.
  9. A 1-year-old child receives the first dose of the varicella vaccine, with counseling provided by the physician.
  10. A 14-year-old patient receives the first dose of the pneumococcal vaccine due to a specific health concern, with counseling provided by the healthcare professional.

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