Forum - Questions & Answers

May 23rd, 2011 - dmcjelly

Vaccine Administration

I just recently went to a seminar on advanced coding and when billing for vaccine administration each additional would be billed if it was a combination vaccine. Examples TDAP
90460
90461x2

MMR
90471
90472x2

I received my first EOB after making this change and insurance did not pay accordingly. Was I informed incorrectly?

May 25th, 2011 -

re: Vaccine Administration

Are they kidding??? It's per shot not per ingredient. People come up with the stragest ways to commit fraud!!!

May 25th, 2011 - nmaguire   2,606 

re: Vaccine Administration

New codes 90460-90461 replace codes 90465-90468 for all dates of service on or after 01/01/2011. These codes are reported for either single or combination vaccine administration when the physician or other qualified health care professional (e.g., physician assistant or nurse practitioner) provides counseling at the time of the administration.

These codes are reported per vaccine/toxoid component. CPT® defines a component for these purposes as each antigen in a vaccine that prevents disease(s) caused by one organism. Combination vaccines are those vaccines that contain multiple vaccine components.

You may report multiple units of code 90460 for each first vaccine/toxoid component administered. No modifier should be required when reporting multiple first components. Note also that code 90460 does not apply only to combination vaccines, but also to single component vaccines (such as influenza, human papilloma virus or pneumococcal conjugate vaccines). This base code is reported for each vaccine administration to patients 18 years of age and under who receive counseling about the vaccine from a physician or qualified health care professional at the time of administration. Code 90461 is an add-on code reported for each additional vaccine component administered. •A face-to-face service where a physician or other qualified health care professional (qualified per state licensure) provides counseling to the patient and/or caregivers is required to report 90460-90461. In the absence of counseling, the administrations must be reported with codes 90471-90474• When reporting administration of combination vaccines, code 90460 is reported for the first component and add-on code 90461 is reported for each additional component (no modifier -51 required)..
Example:
An 11-year old girl presents for a preventive visit (99393). In addition, the child and her mother are counseled by the physician on risks and benefits of HPV (90649), Tdap (90715) and seasonal influenza (90660) vaccines. The mother signs consent to administration of these vaccines. A nurse prepares and administers each vaccine, completes chart documentation and vaccine registry entries, and verifies there is no immediate adverse reaction.
CPT® Codes reported are:
99393 - Preventive Service
90649 - HPV vaccine
90460 - Administration first component (1 unit)
90715 - Tdap vaccine
90460 - Administration first component (1 unit)
90461 - 2 additional components (2 units)
90660 - Influenza vaccine, live, for intranasal use
90460 - Administration first component (1 unit)

•When reporting administration of combination vaccines, code 90460 is reported for the first component and add-on code 90461 is reported for each additional component (no modifier -51 required).

May 25th, 2011 - nmaguire   2,606 

re: Vaccine Administration

They may have been referencing these codes

May 25th, 2011 - nmaguire   2,606 

re: Vaccine Administration

90460 - immunization admin thru age 18 via any route with counseling first vaccine
+90461 - immunization admin thru age 18 via any route with counseling each additional
The admins are applied to each component (antigen) of the vaccine. For example, the admin for an influenza vaccine would be 90460 even though different strains are involved. The admin for MMR would be 90460, 90461, 90461
DTaP-HepB-IPV (Pediarix®) 5 codes 90460, 90461, 90461 90461, & 90461 V06.8
DTaP-Hib-IPV (Pentacel®) 5 codes 90460, 90461, 90461 90461, & 90461 V06.8
if you administer an 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

May 26th, 2011 -

re: Vaccine Administration

I also went to a billing expo that highlighted the 90460-90461 and stated that it is billed for each component for the vaccine and not per injection.

May 26th, 2011 - nmaguire   2,606 

re: Vaccine Administration

And they are correct.

May 26th, 2011 - nmaguire   2,606 

re: Vaccine Administration

90471 and 90472 are different services and do not include physician counseling

May 26th, 2011 -

re: Vaccine Administration

Sorry-- I guess as an internist I don't deserve to get paid to counsel patients on vaccines as my pediatric colleagues.

Jun 14th, 2011 - oub0275 2 

re: Vaccine Administration

We did impliment the changes for these codes with DOS 1/1/11.
I have read 1 article that talked about chnges in the way we bill 90460 and 90461 that would be effective 7/1/11, but have seen any additional information. Do you have any additional information on changes effective 7/1?

Jun 22nd, 2011 - cgarza 1 

re: Vaccine Administration

I am having some conflicting information from my insurance companies. Some are saying to bill 90460 with each corresponding vaccine, some are saying to bill my 90460's and 90461's together, with total number of units.

EX: 90698, 90670, 90680, 90460- 3 units, 90461- 4 units. I am currently billing my 90460's with each corresponding vaccines, but am getting denials from some of my insurances, mostly Medicaid, denying as previously processed.

What is the correct way to bill these codes, and do I need a modifier on my 90460's and 90461's, since they are multiple units?

Jun 14th, 2011 - Aileen

re: Vaccine Administration

With the new vaccine administration codes 90460 and 90461 it is coded per antigen. for an MMR you would have three admin codes. 90460 for the first and 90461 X2

Jun 14th, 2011 - Aileen

re: Vaccine Administration

You were informed correctly. You may have to appeal the claim with the insurance company. You do, however need to be sure the couseling for the immunization was done by the doctor or physician extender.

Aug 13th, 2014 - TSAWYER29 3 

re: Vaccine Administration

how come insurance does not pay physical exam 99391 or etc if billed with 90460 and 90461? they indicated that need to use modifier. therefore what modifier should i use to bill it



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